I'm Steve DeFrota from the University of Missouri. It's an honor to present our team's research. It's kind of a mouthful, but we're looking at the pre- and post-operative patient management and how it varies using an integrated team approach to reduce post-operative failure rates after osteochondrial allograft and meniscal allograft transplantation in the knee. Disclosures can be found on the AOS and ORS websites. So as we all know, complex knee issues are very common. We see them very frequently in our practice, and we have these patients that are very difficult to manage. This can be a life-changing problem, and it can be really hard to navigate for patient and family, especially depending on socioeconomic support, patient expectations, and kind of knowledge of their condition. And the problem that we have, especially in treating these complex cartilage issues, is managing our expectations as a physician and the patient's expectation. For us, we want to get them back to a daily living, walking on the beach, playing with their kids, playing with their grandkids. But the patient, they want to get back to Division I athletics, water skiing, skiing Black Diamond ski runs. So how do we get those to kind of line up all while running a busy clinic in 15-minute, 30-minute increments? We don't call it compliance. We kind of call it adherence. And how do you line up the patient expectations to patient adherence to optimize patient outcomes? Our objective was to kind of assess this kind of integrative approach where we utilized a health behavior psychologist in the pre-operative assessment and post-operative assessment of our patients to kind of optimize their adherence to the rehab protocol following these cartilage transplant procedures. And we wanted to see how this would affect outcome and success or failure after osteochondroallograft and meniscal allograft transplantation. So this was kind of our study design. It was an IRB-approved study. We had two primary cohorts looking at patients who did and did not have this kind of health psychometric evaluation by our on-staff psychiatrist prior to surgical intervention. And they also looked at the post-operative adherence with the rehab protocol kind of throughout the various timeframes. And we wanted to make sure that we had at least one-year follow-up outcomes for the patients that were included. We looked at once again adherence, patient-reported outcomes, and then just treatment success or failure. Failure was indicated as a return to the operating room or a conversion to total knee arthroplasty. So did it work? It did work. Our overall patient cohort for all comers, the total non-adherence rate was about 23.5%. And there was a major difference between the patients who had the pre-operative psychological evaluation and who didn't. So the ones who didn't, 26% were non-adherent versus the ones who did have it, we were able to get under 10%. Obviously there were other risk factors for non-adherence, more pain pre-operatively, higher BMI, older patient age, tobacco usage. Overall, however, the patients who were adherent in and of themselves, 81.6% of these were successful, had successful outcomes, had not gone on to failure yet within the study period at a mean of approximately 46.7 months. And we found that the people who were adherent were three times more likely to succeed and have a successful outcome. Kind of reiterating what we already know, that you need to really go slow with these patients. And if you adhere to the guidelines, they're going to do better than if they don't. So kind of the take-home point that we took away from that is that the pre-operative education as well as post-operative support really from a socioeconomic and a psychological side is going to impact your patient outcomes significantly and kind of improve adherence and improve your outcomes following these complex osteochondral allograft and meniscal allograft transplantation. So this is something that's now standard of care for us where any patient who's indicated for this surgery has to meet with our psychiatrist and get evaluated prior to surgery. And then they kind of report back to us, the surgeon, to make their recommendation, whether this patient will really comply and can they handle the responsibility of this surgery or not. So bottom line, it works. Thank you very much. Here's our team.

pre-operative patient management

post-operative patient management

osteochondral and meniscal allograft transplantation

integrated team approach

health behavior psychologist