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Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle

Bryan C. Emmerson, MD^*, Simon Görtz, MD^*, Amir A. Jamali, MD, Christine Chung, MD, David Amiel, PhD^*, and William D. Bugbee, MD^*

From the ^* Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, Department of Orthopaedic Surgery, University of California Davis, Sacramento, California, and Department of Radiology, University of California San Diego, San Diego, California

Address correspondence to David Amiel, PhD, University of California San Diego, 9500 Gilman Drive, Mail Code 0630, La Jolla, CA 92093-0630 (e-mail: damiel{at}ucsd.edu).

Background: The treatment of osteochondritis dissecans in the adult knee can be challenging. As part of our comprehensive treatment program, fresh osteochondral allografts have been used in the surgical management of osteochondritis dissecans of the femoral condyle.

Hypothesis: Fresh osteochondral allograft transplantation will provide a successful surgical treatment for osteochondritis dissecans of the femoral condyle.

Study Design: Case series; Level of evidence, 4.

Methods: Sixty-six knees in 64 patients underwent fresh osteochondral allografting for the treatment of osteochondritis dissecans. Each patient was evaluated both preoperatively and postoperatively using an 18-point modified D’Aubigné and Postel scale. Subjective assessment was performed using a patient questionnaire. Radiographs were evaluated preoperatively and postoperatively.

Results: Mean follow-up was 7.7 years (range, 2–22 years). There were 45 men and 19 women with a mean age of 28.6 years (range, 15–54 years). All patients had undergone previous surgery. Forty-one lesions involved the medial femoral condyle, and 25 involved the lateral femoral condyle. All were osteochondritis dissecans type 3 or 4. The mean allograft size was 7.5 cm². One knee was lost to follow-up. Of the remaining 65 knees, 47 (72%) were rated good/excellent, 7 (11%) were rated fair, and 1 (2%) was rated poor. Ten patients (15%) underwent reoperation. The mean clinical score improved from 13.0 preoperatively to 16.4 postoperatively (P < .01). Fifty-nine of 64 patients completed questionnaires. Subjective knee function improved from a mean of 3.4 to 8.4 on a 10-point scale (P < .01).

Conclusion: With greater than 70% good or excellent results, fresh osteochondral allograft transplantation is a successful surgical treatment for osteochondritis dissecans of the femoral condyle.

Key Words: osteochondritis dissecans • osteochondral defect • fresh osteochondral allograft • osteochondral transplantation • knee • cartilage