Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies—The advantages of allografts to address an osteochondral challenge

Giuseppe Filardo, Luca Andriolo, Francesc Soler, Massimo Berruto, Paolo Ferrua, Peter Verdonk, Frederic Rongieras, Dennis Crawford

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Abstract: Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. Level of evidence: V.

Original languageEnglish (US)
JournalKnee Surgery, Sports Traumatology, Arthroscopy
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Osteochondritis Dissecans
Allografts
Young Adult
Knee
Joints
Autografts
Therapeutics
Cell Transplantation
Osteoarthritis
Bone Marrow

Keywords

  • Allograft
  • Cartilage
  • Knee
  • Osteochondral
  • Osteochondritis dissecans
  • Scaffold
  • Surgical treatment
  • Young adult

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Treatment of unstable knee osteochondritis dissecans in the young adult : results and limitations of surgical strategies—The advantages of allografts to address an osteochondral challenge. / Filardo, Giuseppe; Andriolo, Luca; Soler, Francesc; Berruto, Massimo; Ferrua, Paolo; Verdonk, Peter; Rongieras, Frederic; Crawford, Dennis.

In: Knee Surgery, Sports Traumatology, Arthroscopy, 01.01.2018.

Research output: Contribution to journalArticle

@article{df29d456b7e342f28aae9cfc7ea7bd9c,
title = "Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies—The advantages of allografts to address an osteochondral challenge",
abstract = "Abstract: Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. Level of evidence: V.",
keywords = "Allograft, Cartilage, Knee, Osteochondral, Osteochondritis dissecans, Scaffold, Surgical treatment, Young adult",
author = "Giuseppe Filardo and Luca Andriolo and Francesc Soler and Massimo Berruto and Paolo Ferrua and Peter Verdonk and Frederic Rongieras and Dennis Crawford",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00167-018-5316-5",
language = "English (US)",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Treatment of unstable knee osteochondritis dissecans in the young adult

T2 - results and limitations of surgical strategies—The advantages of allografts to address an osteochondral challenge

AU - Filardo, Giuseppe

AU - Andriolo, Luca

AU - Soler, Francesc

AU - Berruto, Massimo

AU - Ferrua, Paolo

AU - Verdonk, Peter

AU - Rongieras, Frederic

AU - Crawford, Dennis

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Abstract: Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. Level of evidence: V.

AB - Abstract: Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. Level of evidence: V.

KW - Allograft

KW - Cartilage

KW - Knee

KW - Osteochondral

KW - Osteochondritis dissecans

KW - Scaffold

KW - Surgical treatment

KW - Young adult

UR - http://www.scopus.com/inward/record.url?scp=85058029301&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058029301&partnerID=8YFLogxK

U2 - 10.1007/s00167-018-5316-5

DO - 10.1007/s00167-018-5316-5

M3 - Article

C2 - 30523367

AN - SCOPUS:85058029301

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

ER -