Osteochondral Allograft Transplantation of the Patellofemoral Joint Shows High Short- to Midterm Survivorship but Variable Long-Term Outcomes: A Systematic Review.

PURPOSE: To evaluate clinical outcomes, complication and failure rates, and graft survivorship after patellofemoral osteochondral allograft (OCA) transplantation with a minimum follow-up of 2 years. METHODS: A systematic review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, and Cochrane databases were queried in June 2025 for English-language human studies on OCA transplantation of the patellofemoral joint with ≥2-year follow-up. Data including patient demographics, lesion characteristics, surgical techniques, prior surgery, outcomes, complications, and failures were extracted. Descriptive statistics were calculated, including mean delta values for reported scores. Study quality was assessed using the modified Coleman Methodology Score and risk of bias with Methodological Index for Non-Randomized Studies criteria in the included studies. RESULTS: A total of 7 studies published between 1990 and 2024 met inclusion criteria, encompassing anywhere from 8 to 40 patients with an age range of 12 to 64 years and follow-up of 24 to 238.8 months. OCA was most frequently performed as a revision procedure, with 57.8% to 100% of patients having undergone at least 1 prior surgery. All studies reported statistically significant improvements (P < .05) in functional outcomes, including International Knee Documentation Committee, Knee Outcome Survey Activities of Daily Living, and modified d'Aubigné-Postel scores. Reported failure rates ranged from 0% to 25%, with most studies citing conversion to arthroplasty as the primary endpoint for failure. CONCLUSIONS: OCA transplantation of the patellofemoral joint showed meaningful improvements in patient-reported outcomes and satisfaction, with high short- to midterm graft survivorship. Long-term graft survivorship was variable because of graft reoperation and conversion arthroplasty. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.