Clinician-to-Clinician Update Clinician-to-Clinician Update

Young Adult Regains Activity Level after Cartilage Transplant

March 2015 - Orthopaedics

Osteochondritis dissecans (OCD) is an idiopathic disorder primarily affecting subchondral bone that results in destabilization of the affected subchondral bone and its overlying articular cartilage. It is a common cause of knee pain and dysfunction among young adult patients. Here we describe the case of a young adult female patient with femoral condylar OCD whose condition was successfully managed with a cadaveric osteochondral allograft.

Poor-fill-osteochondritis-dissecans-lesion Consult-Ortho-Mar15-443x294
— Figure 1 Poor fill of the osteochondritis dissecans lesion with fibrocartilage; image taken after a previous excision surgery.
post-osteochondral-allograft-transplant-443x294
— Figure 2 Knee following osteochondral allograft transplantation.

Patient

A 28-year-old female presented with the acute onset of pain and swelling in the left knee following a hike through Central America as part of a scientific research team. An aspiration was completed locally in which 100+ cc of bloody fluid was removed. Upon return to her home, she was referred to the Orthopaedic Clinic. Radiographs and an MRI of the knee were obtained. An osteochondritis dissecans (OCD) lesion of her lateral femoral condyle was observed. The patient agreed to undergo surgery.

Management

The surgical plan was for an arthroscopic examination of the OCD fragment and a repair, if possible. If the fragment was found to be unrepairable, then excision would be performed. During the procedure, the OCD fragment was found to be unrepairable and was excised. Postsurgery, the patient remained symptomatic with pain and swelling over her lateral knee. Cartilage restoration surgery was pursued. The lesion, examined during this procedure, showed poor fill with fibrocartilage (Figure 1). A fresh osteochondral allograft was used to reconstruct her cartilage (Figure 2). The patient was found to have neutral knee alignment so an osteotomy was not performed.

Postoperatively the patient was restricted to 6 weeks of protected weight bearing. Rehabilitation then included progressive weight bearing as tolerated, continuous passive motion for 4 weeks, and a structured physical therapy program for strength and motion. She was allowed to return to her active research position at 3 months postsurgery. After 6 months, the patient returned from another research trip to Central America and endorsed normal knee function, with no complaints of pain or swelling.

Discussion

Radiography shows that patients with adult OCD develop knee osteoarthritis about 10 years earlier than primary osteoarthritic patients; therefore, aggressive treatment of OCD is warranted. Studies indicate a success rate of 70% to 94% in adult patients treated with osteochondral allografts for femoral condylar OCD.1, 2

References

1. Garrett JC. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res. 1994;(303):33-37.

2. Emmerson BC, et al. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med. 2007;35(6):907-914.

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