Osteochondral autograft transplantation for juvenile osteochondritis dissecans of the knee: a series of twelve cases

Abstract

Purpose The purpose of this study was to evaluate the clinical outcomes of osteochondral autograft transplantation (OAT) for juvenile osteochondritis dissecans (JOCD) lesions of the knee, especially time to return to sports. Methods Twelve knee JOCD lesions with OCD grade 3 and 4 categorised by magnetic resonance imaging (MRI) were treated with OAT. Nine male and two female skeletally immature patients averaging 13.7 years old were included. The OCD lesions were assessed arthroscopically and then fixed in situ using multiple osteochondral plugs harvested under fluoroscopy from the distal femoral condyle without damaging the physis. International Cartilage Repair Society (ICRS) score and Lysholm score were assessed pre-and postoperatively.Results After a mean follow-up of 26.2±15.1 months, the International Knee Documentation Committee (IKDC) subjective score significantly improved (p<0.01). According to the IKDC score, objective assessment showed that ten of 12 (83 %) had excellent results (score: A) after OAT and significantly improved (p<0.01). Based on ICRS criteria, results were satisfactory in all patients. No patients experienced complications at the graft harvest site. All patients returned to their previous level of athletic activity at an average of 5.7 months after the surgery. Conclusions OAT for JOCD of the knee provided satisfactory results in all patients at a mean follow-up of 26.2 months.

Sustained Results in Long-Term Follow-Up of Autologous Chondrocyte Implantation (ACI) for Distal Femur Juvenile Osteochondritis Dissecans (JOCD)

“…With poor long-term clinical outcomes [ 42 , 43 ] and evidence of early osteoarthritic changes on radiographs [ 44 ], JOCD fragment excision and debridement are less than desirable surgical techniques. Long-term results of osteochondral allografts [ 45 , 46 ] and autografts [ 47 , 48 ] indicated promise, but must be used with care in skeletally immature patients and near open physes of the distal femur. In short, surgeons who are planning to conduct future studies need to consider improving study methodologies and outcomes in order to determine the best treatment option for the individual patients, especially skeletally immature patients.…”

Articular Cartilage Repair of the Knee in Children and Adolescents

“…Eighty-nine percent of patients reported being extremely satisfied or satisfied. 49 Miura et al 45 and Sasaki et al 72 described comparable outcomes in their respective cohorts of patients with OD who were all treated by autogenous osteochondral plugs. Yet, these patients had fewer failures compared with the allograft patients who were analyzed by Murphy et al 49…”

Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review

“…The plugs provide bone graft as well as fixation of the lesion. Three studies 89–91 reported that biological fixation provided healing of the osteochondral fragment with promising results.…”