Editorial Commentary: Are We Really Ready to Talk About Sports After Osteochondral Allograft Transplantation?

When it comes to return to high-level sports participation, articular cartilage surgical treatment outcomes were historically abysmal, whereas osteochondral allografts have allowed return to sport at rates as high as 88%. However, although osteochondral allograft transplantation effectively reconstructs the damaged articular surface in affected knees, the grafts themselves do nothing to re-establish normal joint homeostasis, resulting in high reoperation rates. Return to sport should require recovery of nearly normal motion and strength, as well as magnetic resonance imaging showing intact cartilage, bony incorporation, and no effusion. These milestones typically occur at 6 months. Persistent joint inflammation and reactivity remain a vexing issue, and long-term durability is of significant concern. In the future, a goal could be to develop biological therapies that could modulate the joint inflammation and catabolism associated with articular cartilage injury.