Osteochondral Allograft Transplantation for Osteochondritis Dissecans of the Medial Femoral Condyle.

BACKGROUND

While the data are not as robust as in the adult population, osteochondral allograft transplantation has proven to be an effective treatment for osteochondritis dissecans (OCD) lesions of the knee in the pediatric and adolescent populations.

INDICATIONS

The primary indication for osteochondral allograft transplantation is a symptomatic, full-thickness, localized cartilage lesion. Acceptable underlying causes include trauma, avascular necrosis, and OCD lesions. As these are pediatric and adolescent patients, they are not candidates for joint arthroplasty. In this case, the patient is a 16-year-old girl with a 1.5 cm × 1.2 cm OCD lesion of the medial femoral condyle.

TECHNIQUE DESCRIPTION

The patient was positioned supine with a tourniquet on the thigh. The lesion was identified on the medial femoral condyle and exposed. A guidepin was placed in the center of the lesion and a 15 mm reamer was used to ream to a depth of 6 to 7 mm. The wound was copiously irrigated. A corresponding 15 mm plug was harvested from the donor graft and prepared to match the morphology of the condyle. The 12 o'clock position was marked with a fresh marking pen to maintain orientation. The graft was lavaged with a pulsavac and bathed in autologous conditioned plasma. The recipient bed was prepared with 0.0045 K wire, and then the donor graft was placed in proper position and impacted with a tamp, flush with the surrounding cartilage. The tourniquet was deflated and the surgical site was closed in a layered fashion.

RESULTS

Studies of adult patients have demonstrated survival rates of greater than 80% for osteochondral allograft transplantation, with pain improvement of 74% to 85%, and return to competitive athletics of 88%. While there is a paucity of studies looking at osteochondral allograft transplantation in pediatric and adolescent populations, outcomes appear to be similar to that of the adult population.

DISCUSSION/CONCLUSION: Osteochondral allograft transplantation is a viable treatment option for pediatric and adolescent patients with symptomatic cartilage lesions. It allows for joint preservation and provides significant improvement of pain with high rates of return to athletics.