September 30, 2025
1 min read
Key takeaways:
- Osteochondral allograft transplantation with the multiplug technique had comparable outcomes vs. the single-plug technique for osteochondral defects.
- Defect size is just one parameter to dictate treatment.
A matched cohort analysis showed multiplug snowman osteochondral allograft transplantation had comparable clinical outcomes and graft survivorship vs. single-plug circular osteochondral allograft transplantation for similar sized defects.
“Both groups did well whether we used single plugs or multiple plugs, and it may not necessarily be the size of the defect but rather the shape of the defect that dictates treatment techniques,” Brian J. Cole, MD, MBA, professor and acting chair in the department of orthopedics at Midwest Orthopaedics at Rush in Chicago, told Healio.
Data were derived from Mufti YN, et al. Am J Sports Med. 2025;doi:10.1177/03635465251352172.
Cole and colleagues propensity score matched patients with osteochondral defects of the knee who underwent snowman osteochondral allograft transplantation (n = 26) with those who underwent single-plug osteochondral allograft transplantation (n = 52) based on age, sex, BMI, defect location and defect size. Researchers assessed IKDC subjective score, Lysholm score, KOOS score and SF-12 Health Survey, and determined rates of achieving the minimal clinically important difference (MCID) or patient acceptable symptom state (PASS) for patient-reported outcome measures.
Brian J. Cole
According to the results, patients in the snowman group and single-plug group had no differences in the rate of achieving the MCID or PASS. Cole and colleagues found 19.2% of patients in the snowman group experienced graft failure at a mean of 1.7 years and 19.2% of patients in the single-plug group met criteria for failure at a mean 6.6 years.
Although treatments for osteochondral lesions have historically been based on defect size, Cole said “size is just one parameter.”
“There are a number of other parameters that are important when determining how to treat a defect and it is the shape of the defect, as well, which determines one treatment method vs. another,” Cole said.
For more information:
Brian J. Cole, MD, MBA, can be reached at brian.cole@rushortho.com.
Perspective
This article by Brian J. Cole, MD, MBA, and colleagues at Rush University Medical Center in Chicago reported on 26 patients with a snowman osteochondral allograft compared with a matched group of 52 patients with a single-plug osteochondral allograft. Overall, they found no significant differences in the minimal clinically important difference or patient-acceptable symptom state, and both groups demonstrated significant improvements in postoperative IKDC, Lysholm, KOOS and SF-12 physical component summary scores. Overall, the failure rates for both groups were 19.2%.
Historically, it was felt that single-plug osteochondral allografts would have improved outcomes and incorporation, with concerns that the snowman technique may have a higher failure rate due to potential graft instability with early rehabilitation and activities. This may be one of the reasons why, in this study, the snowman group had a faster time to failure, at an average of 1.7 years, compared with 6.6 years for the control group.
We recognize that this group has outstanding surgical techniques and patient selection; however, as noted by the authors, others have reported higher failure rates for the snowman technique. Therefore, when choosing between techniques, one should do what is best in their own hands and be cautious in the early postoperative period to progress impact activity slowly, especially for the snowman technique.
Robert F. LaPrade, MD, PhD
Luke Tollefson, BS
Disclosures: LaPrade and Tollefson report no relevant financial disclosures.
Sources/Disclosures
Source:
Mufti YN, et al. Am J Sports Med. 2025;doi:10.1177/03635465251352172.
Disclosures:
Cole reports receiving research support from Arthrex and MediPost; royalties from Arthrex and Elsevier; financial or material support from JRF Ortho; and stock or stock options in Ossio. Please see the study for all other authors’ relevant financial disclosures.
