Can Fresh Osteochondral Allografts Restore Function in Juveniles with Osteochondritis Dissecans of the Knee?

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2012 Sep 14

PMID 22972653

Citations 23

Authors

Roger Lyon

Carl Nissen

Xue Cheng Liu

Brian Curtin

Affiliations

Soon will be listed here.

Abstract

Background: Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will restore function in most adults, it is unclear whether fresh osteochondral allograft transplantations similarly restore function in skeletally immature patients who failed conventional treatment.

Questions/purposes: Therefore, we determined function in (1) daily activity; (2) sports participation; and (3) healing (by imaging) in children with juvenile OCD who failed conventional therapy and underwent fresh osteochondral allograft transplantation.

Methods: We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). The average age of the children at the time of their allograft surgery was 15.2 years (range, 13-20 years). The clinical assessments included physical examination, radiography, MRI, and a modified Merle D'Aubigné-Postel score. The size of the allograft was an average of 5.11 cm(2). The minimum followup was 12 months (average, 24 months; range, 12-41 months).

Results: All patients had returned to activities of daily living without difficulties at 6 months and returned to full sports activities between 9 and 12 months after surgery. The modified Merle D'Aubigné-Postel score improved from an average of 12.7 preoperatively to 16.3 at 24 months postoperatively. Followup radiographs at 2 years showed full graft incorporation and no demarcation between the host and graft bone.

Conclusions: Our observations suggested fresh osteochondral allografts restored short-term function in patients with juvenile OCD who failed standard treatments.

Level Of Evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Citing Articles

Comparison of Outcomes After Primary Versus Salvage Osteochondral Allograft Transplantation for Femoral Condyle Osteochondritis Dissecans Lesions.

Nuelle C, Rucinski K, Stannard J, Ma R, Kfuri M, Cook J Orthop J Sports Med. 2024; 12(3):23259671241232431.

PMID: 38465259 PMC: 10921854. DOI: 10.1177/23259671241232431.

Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020.

Wang X, Ren Z, Liu Y, Ma Y, Huang L, Song W Orthop J Sports Med. 2023; 11(9):23259671231199418.

PMID: 37745815 PMC: 10515554. DOI: 10.1177/23259671231199418.

An update on osteochondritis dissecans of the knee.

Tudisco C, Bernardi G, Manisera M, De Maio F, Gorgolini G, Farsetti P Orthop Rev (Pavia). 2022; 14(5):38829.

PMID: 36540072 PMC: 9760694. DOI: 10.52965/001c.38829.

Osteochondral Allograft for Unsalvageable Osteochondritis Dissecans in the Skeletally Immature Knee.

Tisano B, Ellis H, Wyatt C, Wilson P Orthop J Sports Med. 2022; 10(2):23259671211072515.

PMID: 35178463 PMC: 8844736. DOI: 10.1177/23259671211072515.

Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results.

Turhan A, Acil S, Gul O, Oner K, Okutan A, Ayas M World J Orthop. 2021; 12(11):867-876.

PMID: 34888147 PMC: 8613687. DOI: 10.5312/wjo.v12.i11.867.

References

Czitrom A, Keating S, Gross A . The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg Am. 1990; 72(4):574-81. View

Moriya T, Wada Y, Watanabe A, Sasho T, Nakagawa K, Mainil-Varlet P . Evaluation of reparative cartilage after autologous chondrocyte implantation for osteochondritis dissecans: histology, biochemistry, and MR imaging. J Orthop Sci. 2007; 12(3):265-73. DOI: 10.1007/s00776-007-1111-8. View

Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A . Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000; (374):212-34. DOI: 10.1097/00003086-200005000-00020. View

OConnor M, Palaniappan M, Khan N, Bruce C . Osteochondritis dissecans of the knee in children. A comparison of MRI and arthroscopic findings. J Bone Joint Surg Br. 2002; 84(2):258-62. DOI: 10.1302/0301-620x.84b2.11823. View

Edmonds E, Albright J, Bastrom T, Chambers H . Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop. 2010; 30(8):870-8. DOI: 10.1097/BPO.0b013e3181f5a216. View

Kocher M, Czarnecki J, Andersen J, Micheli L . Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med. 2007; 35(5):712-8. DOI: 10.1177/0363546506296608. View

Pill S, Ganley T, Milam R, Lou J, Meyer J, Flynn J . Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children. J Pediatr Orthop. 2002; 23(1):102-8. View

Peterson L, Minas T, Brittberg M, Lindahl A . Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003; 85-A Suppl 2:17-24. DOI: 10.2106/00004623-200300002-00003. View

Gudas R, Simonaityte R, cekanauskas E, Tamosiunas R . A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop. 2010; 29(7):741-8. DOI: 10.1097/BPO.0b013e3181b8f6c7. View

10.

Garrett J . Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res. 1994; (303):33-7. View

11.

Emmerson B, Gortz S, Jamali A, Chung C, Amiel D, Bugbee W . Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med. 2007; 35(6):907-14. DOI: 10.1177/0363546507299932. View

12.

Miniaci A, Tytherleigh-Strong G . Fixation of unstable osteochondritis dissecans lesions of the knee using arthroscopic autogenous osteochondral grafting (mosaicplasty). Arthroscopy. 2007; 23(8):845-51. DOI: 10.1016/j.arthro.2007.02.017. View

13.

Kocher M, Tucker R, Ganley T, Flynn J . Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006; 34(7):1181-91. DOI: 10.1177/0363546506290127. View

14.

Ghazavi M, Pritzker K, Davis A, Gross A . Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. 1997; 79(6):1008-13. DOI: 10.1302/0301-620x.79b6.7534. View

15.

Aglietti P, Buzzi R, Bassi P, Fioriti M . Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy. 1994; 10(3):286-91. DOI: 10.1016/s0749-8063(05)80113-6. View

16.

Smillie I . OSTEOCHONDRITIS DISSECANS OF THE KNEE. Am J Orthop. 1964; 6:236-41. View

17.

Wall E, Von Stein D . Juvenile osteochondritis dissecans. Orthop Clin North Am. 2003; 34(3):341-53. DOI: 10.1016/s0030-5898(03)00038-5. View

18.

Berlet G, Mascia A, Miniaci A . Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy. 1999; 15(3):312-6. DOI: 10.1016/s0749-8063(99)70041-1. View

19.

Langer F, Percy E . Osteochondritis dissecans and anomalous centres of ossification: a review of 80 lesions in 61 patients. Can J Surg. 1971; 14(3):208-15. View

20.

DAUBIGNE R, Postel M . Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954; 36-A(3):451-75. View