Torres LeeAnne, Dennis Eric, Dogariu Lauren, Waterman Brian R
Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2021 Apr 6;1(2):26350254211001369. doi: 10.1177/26350254211001369. eCollection 2021 Mar-Apr.
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.
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.
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.
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.
虽然数据不如成人人群那样充分，但骨软骨异体移植已被证明是治疗儿童和青少年人群膝关节剥脱性骨软骨炎（OCD）损伤的有效方法。
骨软骨异体移植的主要适应症是有症状的、全层的、局限性软骨损伤。可接受的潜在病因包括创伤、缺血性坏死和OCD损伤。由于这些是儿童和青少年患者，他们不适合进行关节置换术。在本病例中，患者为一名16岁女孩，内侧股骨髁有一处1.5厘米×1.2厘米的OCD损伤。
患者仰卧位，大腿上扎止血带。在内侧股骨髁上识别并暴露损伤部位。在损伤中心置入一根导针，并用15毫米扩孔钻扩孔至6至7毫米深度。伤口用大量生理盐水冲洗。从供体移植物中获取相应的15毫米栓块，并进行处理以匹配髁的形态。用新鲜的标记笔标记12点位置以保持方向。移植物用脉冲冲洗器冲洗，并用自体条件血浆浸泡。用0.0045 K钢丝准备受区床，然后将供体移植物置于适当位置，并用压塞器压实，使其与周围软骨齐平。松开止血带，手术部位分层缝合。
对成年患者的研究表明，骨软骨异体移植的存活率大于80%，疼痛改善率为74%至85%，恢复竞技运动的比例为88%。虽然针对儿童和青少年人群骨软骨异体移植的研究较少，但结果似乎与成人人群相似。
讨论/结论：骨软骨异体移植是有症状软骨损伤的儿童和青少年患者的一种可行治疗选择。它能够保留关节，并能显著改善疼痛，恢复运动的比例很高。
