Knee Osteochondritis, Dissecans Fixation, Osteochondral Allograft Transplant
Osteochondritis dissecans (OCD) is a significant source of pain and disability, and may lead to early osteoarthritis. The treatment of OCD aims to restore normal function of the knee and relieve pain, while also facilitating the healing of the affected bone and cartilage. Treatment strategies vary depending on the age of the patient, the stage of the condition, and the specific joint affected. They range from non-surgical methods, such as rest and physical therapy, to surgical interventions.
OCDs in children who are still growing can heal with nonoperative management in up to 75% of cases. However, osteochondritis dissecans (OCD) in those who have stopped growing (adults or older adolescents) have little healing potential. When conservative treatments fail or in cases where the bone fragments are loose or unstable, surgical intervention may be required.
One common surgical treatment for OCD is internal fixation. This procedure involves reattaching the fragment of bone and cartilage back to its normal position in the joint. A minimally invasive approach (arthroscopy) or an open surgical technique may be used to access the knee. The loose bone and cartilage fragment is reattached using fixation devices such as screws or pins. After surgery, a period of rest and non weight bearing on crutches to protect the repair is followed by physical therapy to restore strength and mobility to the knee. Most patients can expect to return to their normal daily activities within a few months, and a full return to sports, particularly high-impact sports, takes around 5-6 months.
It is a surgical procedure used to treat large osteochondritis dissecans (OCD) lesions where the original fragment of bone and cartilage may not be able to be reattached due to fragmentation, for example. The goal is to replace the damaged cartilage and bone fragment with a healthy plug of bone and cartilage to restore the normal function of the knee joint and alleviate symptoms.
The osteochondral allograft is a plug of both bone and cartilage that has been retrieved from a donor’s knee. It is sterilized and tested for to minimize risk of disease transmission. The donor tissue is size matched and with the recipient’s knee.
The surgery is typically performed through an open incision. The damaged area of the knee cartilage and bone is carefully prepared. The donor graft is shaped to fit the individual defect and press fit into the defect created by OCD, ensuring a precise fit. The donor graft may be also secured with screws and pins.
Recovery involves a brace and use of crutches to avoid weight bearing for 6 weeks. Pain medication will be provided. A special machine called a continuous passive motion machine may be recommended as knee motion helps the cartilage and bone plug to heal. Postoperative rehabilitation is crucial for successful outcomes. Physical therapy typically begins week 1 with gradual increases in physical activity and is continued for several months. The goal is to restore knee mobility, strength, and stability to allow participation in daily activities and sports.
Osteochondral allograft transplantation is an effective solution for patients with large and complex OCD defects. Studies report that allografts offer numerous advantages including restoration of native anatomy, long-term graft durability, and improved function.
The UCSF Women’s Sport Medicine Center supports female athletes of all ages and abilities from the recreational to the elite athlete with a team of sports medicine and orthopaedic specialists. We offer comprehensive care for conditions such as OCDs. Please contact us to schedule a consultation to learn more.
References
- Husen M, Van der Weiden GS, et al. Internal Fixation of Unstable Osteochondritis Dissecans of the Knee: Long-term Outcomes in Skeletally Immature and Mature Patients. Am J Sports Med. 2023 May;51(6):1403-1413. doi: 10.1177/03635465231164410. Epub 2023 Apr 7. PMID: 37026762.
- Leland DP, Bernard CD, et al. Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? A Systematic Review. Arthroscopy. 2019 Aug;35(8):2512-2522. doi: 10.1016/j.arthro.2019.03.020. PMID: 31395194.
- Matthews JR, Sonnier JH, et al. A systematic review of cartilage procedures for unstable osteochondritis dissecans. Phys Sportsmed. 2023 Dec;51(6):497-505. doi: 10.1080/00913847.2022.2082262. Epub 2022 May 31. PMID: 35611658.
- Allahabadi S, Quigley R, Frazier L, Joyce K, Cole BJ. Outcomes and Return to Sport After Knee Osteochondral Allograft Transplant in Professional Athletes. Orthop J Sports Med. 2024 Feb 26;12(2):23259671241226738. doi: 10.1177/23259671241226738. PMID: 38410170; PMCID: PMC10896054.
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