Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 6, pp 1726–1738 | Cite as

Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies—The advantages of allografts to address an osteochondral challenge

  • Giuseppe Filardo
  • Luca AndrioloEmail author
  • Francesc Soler
  • Massimo Berruto
  • Paolo Ferrua
  • Peter Verdonk
  • Frederic Rongieras
  • Dennis C. Crawford


Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults.

Level of evidence



Osteochondritis dissecans Young adult Surgical treatment Knee Osteochondral Cartilage Scaffold Allograft 



There is no funding source.

Compliance with ethical standards

Conflict of interest

GF is a consultant for Finceramica Faenza Spa, Fidia Farmaceutica, Cartiheal Ltd, EON medica; received institutional support from Finceramica Faenza Spa, Fidia Farmaceutica, IGEA Biomedical, Zimmer Biomet, Kensey Nash. PV is a consultant for DePuy Synthes, Smith and Nephew, Conmed, Active implants. LA, FS, MB, PF, FR and DCC have nothing to disclose.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.ATRC, IRCCS Istituto Ortopedico RizzoliBolognaItaly
  2. 2.Clinica Ortopedica e Traumatologica IIIRCCS Istituto Ortopedico RizzoliBolognaItaly
  3. 3.Traumadvance Orthopaedic GroupTerrassaSpain
  4. 4.Dept. of Knee SurgeryASST Pini-CTOMilanItaly
  5. 5.Department of Orthopaedic Surgery, Department of Orthopaedic SurgeryMonica Hospitals, Monica Research Foundation, University HospitalAntwerpBelgium
  6. 6.Service de chirurgie orthopédique et traumatologiqueHôpital d’instruction des armées Desgenettes, Univ Lyon, Université Claude Bernard Lyon 1LyonFrance
  7. 7.Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandUSA

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