Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee? Clin Orthop Relat Res 2013 Apr;471(4):1166-73
Date
09/14/2012Pubmed ID
22972653Pubmed Central ID
PMC3586015DOI
10.1007/s11999-012-2523-0Scopus ID
2-s2.0-84877929281 (requires institutional sign-in at Scopus site) 58 CitationsAbstract
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.
Author List
Lyon R, Nissen C, Liu XC, Curtin BAuthors
Xue-Cheng Liu PhD Professor in the Orthopaedic Surgery department at Medical College of WisconsinRoger M. Lyon MD Adjunct Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Activities of Daily LivingAdolescent
Bone Transplantation
Diagnostic Imaging
Female
Humans
Knee Joint
Male
Osteochondritis Dissecans
Pain Measurement
Physical Examination
Radiography
Range of Motion, Articular
Retrospective Studies
Transplantation, Homologous
Treatment Outcome
Young Adult
