Skip to main content
SpringerLink
Log in

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

  • Symposium: Osteochondritis Dissecans
  • Published:
Clinical Orthopaedics and Related Research®

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 cm2. 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C
Fig. 2A–B
Fig. 3A–B

Similar content being viewed by others

References

  1. Aglietti P, Buzzi R, Bassi PB, Fioriti M. Arthroscopic drilling in juvenile osteochoindritis dissecans of the medial femoral condyle. Arthroscopy. 1994;10:286–291.

    Article  PubMed  CAS  Google Scholar 

  2. Anderson AF, Anderson CN. Management of osteochoindritis dissecans of the knee. Techniques in Knee Surgery. 2005;4:23–35.

    Article  Google Scholar 

  3. Anderson AF, Pagnani MJ. Osteochondritis dissecans of the femoral condyles long-term; results of excision of the fragment. Am J Sports Med. 1997;25:830–834.

    Article  PubMed  CAS  Google Scholar 

  4. Berlet GC, Mascia A, Miniaci A. Treatment of unstable osteochoindritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy. 1999:15;312–316.

    Article  PubMed  CAS  Google Scholar 

  5. Bradley J, Dandy DJ. Results of drilling osteochoindritis dissecans before skeletal maturity. J Bone Joint Surg Br.1989;71:642–644.

    Google Scholar 

  6. Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg. 1995;3:237–247.

    PubMed  Google Scholar 

  7. Cahill BR. Current concepts review. Osteochondritis dissecans. J Bone Joint Surg Am. 1997;79:471–472.

    PubMed  CAS  Google Scholar 

  8. Czitrom AA, Keating S, Gross AE. The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg Am. 1990;72:574–581.

    PubMed  CAS  Google Scholar 

  9. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.

    PubMed  Google Scholar 

  10. De Smet AA, Ilahi OA, Graf BK. Untreated osteochoindritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings. Skeletal Radiol. 1997;26:463–467.

    Article  PubMed  Google Scholar 

  11. Edmonds EW, Albright J, Bastrom T, Chambers HG. Outcomes of extra-articular, intra-epiphyseal drilling for OCD of the knee. J Pediatr Orthop. 2010;30:870–878.

    Article  PubMed  Google Scholar 

  12. Emmerson BC, Gortz S, Jamali AA, Chung C, Amiel D, Bugbee WD. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med. 2007;35:907–914.

    Article  PubMed  Google Scholar 

  13. Garrett JC. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res. 1994;303:33–37.

    PubMed  Google Scholar 

  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;79:1008–1013.

    Article  PubMed  CAS  Google Scholar 

  15. Gortz S, Deyoung A, Bugbee W. Fresh osteochondral allografting for steroid-associated osteonecrosis of the femoral condyles. Clin Orthop Relat Res. 2010;468:1269–1278.

    Article  PubMed  Google Scholar 

  16. Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas 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. 2009;29:741–748.

    Article  PubMed  Google Scholar 

  17. Hughston JC, Hergenroeder PT,Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1984;66:1340–1348.

    PubMed  CAS  Google Scholar 

  18. Kocher MS, Czarnecki JJ, Anderson JS, Micheli LJ. Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med. 2007;35:712–718.

    Article  PubMed  Google Scholar 

  19. Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA. Functional and radiographic outcome of juvenile osteochoindritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med. 2001;29:562–566.

    PubMed  CAS  Google Scholar 

  20. Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006;34:1181–1191.

    Article  PubMed  Google Scholar 

  21. Krishnan SP, Skinner JA, Bartlett W, Carrington RWJ, Flanagan AM, Briggs TWR, Bentley G. Who is the ideal candidate for autologous chondrocyte implantation? J Bone Joint Surg Br. 2006;88:61–64.

    Article  PubMed  CAS  Google Scholar 

  22. Langer F, Percy EC. Osteochoindritis dissecans and anomalous centres of ossification: a review of 80 lesions in 61 patients. Can J Surg. 1971;14:208–215.

    PubMed  CAS  Google Scholar 

  23. Michael JW, Wurth A, Eysel P, Konig DP. Long-term results after operative treatment of OCD of the knee joint—30 year results. Int Orthop. 2008;32:217–221.

    Article  PubMed  CAS  Google Scholar 

  24. Miniaci A, Tytherleigh-Strong G. Fixation of unstable osteochoindritis dissecans lesions of the knee using arthroscopic autogenous osteochondral grafting (mosaicplasty). Arthroscopy. 2007;23:845–851.

    Article  PubMed  Google Scholar 

  25. Moriya T, Wada Y, Watanabe A, Sasho T, Nakagawa K, Mainil-Varlet P, Moriya H. Evaluation of reparative cartilage after autologous chondrocyte implantation for osteochondritis dissecans: histology, biochemistry, and MR imaging. J Orthop Sci. 2007;12:265–273.

    Article  PubMed  Google Scholar 

  26. O’Connor MA, Palaniappan M, Khan N, Bruce CE. Osteochoindritis dissecans of the knee in children: a comparison of MRI and arthroscopic findings. J Bone Joint Surg Br. 2002;84:258–262.

    Article  PubMed  Google Scholar 

  27. 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;85:17–24.

    Article  PubMed  Google Scholar 

  28. 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;374:212–234.

    Article  PubMed  Google Scholar 

  29. Pill S, Ganley T, Milam RA, Lou J, Meyer JS, Flynn J. Role of MRI and clinical criteria in predicting successful nonoperative treatment of osteochoindritis dissecans in children. J Pediatr Orthop. 2003;23:102–108.

    PubMed  Google Scholar 

  30. Rodegerdts U, Gleissner B. [Long-term experience with the operative treatment of osteochondrosis dissecans of the knee joint] [in German]. Orthop Praxis. 1979;8:612–622.

    Google Scholar 

  31. Smillie IS. Osteochondritis dissecans of the knee. Am J Orthop. 1964;6:236–241.

    PubMed  CAS  Google Scholar 

  32. Wall E, Von Stein D. Juvenile osteochondritis dissecans. Orthop Clin N Am. 2003;34:341–353.

    Article  Google Scholar 

  33. Williams JS Jr, Bush-Joseph CA, Bach BR Jr. Osteochoindritis dissecans of the knee. Am J Knee Surg. 1998;11:221–232.

    PubMed  Google Scholar 

  34. Wright RW, McLean M, Matava MJ, Shively RA. Osteochoindritis dissecans of the knee: long-term results of excision of the fragment. Clin Orthop Relat Res. 2004;424:239–243.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Mr Marquez-Barrientos and Mrs McKeon for assisting with data recording and photograph preparations.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Pediatric Orthopaedics, Suite C360, P.O. Box 1997, Milwaukee, WI, 53201, USA

    Roger Lyon MD & Xue Cheng Liu MD, PhD

  2. Elite Sports Medicine, Connecticut Children’s Medical Center, Farmington, CT, USA

    Carl Nissen MD

  3. Department of Orthopedics and Rehabilitation, Loyola University Medical Centre, 2160 S. 1st Ave., Maywood, IL, USA

    Brian Curtin MD

Authors
  1. Roger Lyon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl Nissen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xue Cheng Liu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian Curtin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roger Lyon MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA; and Elite Sports Medicine, Connecticut Children’s Farmington, CT, USA.

About this article

Cite this article

Lyon, R., Nissen, C., Liu, X.C. et al. Can Fresh Osteochondral Allografts Restore Function in Juveniles With Osteochondritis Dissecans of the Knee?. Clin Orthop Relat Res 471, 1166–1173 (2013). https://doi.org/10.1007/s11999-012-2523-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2523-0

Keywords

Search

Navigation