Authors:

Grace E. Guerin, M.S.3., Luke V. Tollefson, B.S., Evan P. Shoemaker, B.A., Matthew T. Rasmussen, M.D., Dustin R. Lee, M.D., and Robert F. LaPrade, M.D., Ph.D.

Abstract:

Osteochondritis dissecans (OCD) is a subchondral bone and articular cartilage abnormality that can lead to detachment of a bone fragment and eventually osteoarthritis. Juvenile OCD typically presents in male patients, with the most common presenting symptom being pain with weight-bearing. When conservative measures are not effective, OCDs are treated surgically with subchondral drilling, fixation, or autologous chondrocyte implantation, depending on the severity of the lesion and whether it has detached. Fragment fixation of the bone fragment may be attempted for high-grade OCD with subchondral bone to try and restore the native cartilage. When fixation of an unstable OCD lesion is unsuccessful, osteochondral allograft transplantation and an offloading osteotomy may be considered. This Technical Note describes a lateral opening-wedge distal femoral osteotomy and osteochondral allograft transplantation for a failed OCD fixation of the lateral femoral condyle.

Technique Video Credit: Grace E. Guerin, M.S.3., Luke V. Tollefson, B.S., Evan P. Shoemaker, B.A.,Matthew T. Rasmussen, M.D., Dustin R. Lee, M.D., and Robert F. LaPrade, M.D., Ph.D.

Osteochondritis dissecans (OCD) of the knee is characterized by a subchondral bone abnormality that may detach from the surrounding bone, leading to pain, instability, and eventually osteoarthritis.1,2 The incidence ranges from 9.5 to 29 per 100,000, with most patients aged 10 to 19 years old and male patients being 4 times more likely to be affected.3,4 The exact etiology of OCD is unknown, but it is likely multifactorial with genetic risk factors, repetitive microtrauma, and/or undistributed axial loading with coronal malalignment, which can disrupt blood flow to the subchondral bone, playing a role in the pathogenesis.1,4 Conservative treatment may be indicated for stable lesions or nonsurgical candidates with concomitant degenerative joint disease.5 When lesions become unstable, generating pain, mechanical locking, and swelling, surgical treatment is indicated. Initial surgical intervention may include fragment refixation and bone grafting, chondroplasty/debridement, microfracture, or autologous chondrocyte implantation.3, 4, 5 Procedural success is variable depending on the location, with lateral femoral condyle lesions being an independent risk factor for failure because of their generally larger size than medial femoral condyle OCD lesions, especially in patients with valgus malalignment. If failure of the initial surgical treatment occurs, osteochondral transplantation either with osteochondral allograft transplantation (OCA) or osteochondral autograft transfer may be indicated, but a complete workup and concomitant management of coronal malalignment should be considered to optimize the long-term healing potential.2,5,6 In this Technical Note, we describe a failed treatment of an OCD fixation in a patient with valgus alignment that was treated with a lateral femoral condyle OCA and a concomitant lateral opening-wedge distal femoral osteotomy (DFO).

You can download the study here: Lateral Femoral Condyle Osteochondral Allograft and Concomitant Lateral Opening-Wedge Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation