Osteochondral Allografting for Knee Lesions in the Pediatric and Adolescent Population

OBJECTIVES: Osteochondral allografting is a useful reconstructive procedure for large ostechondral lesions of the knee. The purpose of this study was to evaluate the clinical outcome of osteochondral allografting in pediatric and adolescent patients. METHODS: This IRB-approved study evaluated 39 patients (43 knees) less than 18 years of age who underwent osteochondral allografting between 1983 and 2010. The mean age was 16.4 years (range, 11.1 to 17.9) and 61% were male. The etiology of the lesions were osteochondritis dissecans in 26 knees (60.5%), avascular necrosis in 7 (16.3%), traumatic chondral injury in 6 (14%), degenerative chondral lesion in 2 (4.7%), and fracture in 2 (4.7%). Thirty-four patients (79%) underwent an average of 1.5 previous surgeries on the operative knee. Surgery was preformed using either a dowel or shell technique with fresh allograft tissue. The mean graft area was 8.4 cm(2) (range, 2.2 to 20.8). The majority of grafts (76.7%) were located on the femoral condyle. Function and pain were assessed preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score, the Knee Society function (KS-F) score, and the modified Merle d’Aubigné-Postel (18-point) scale. Postoperative assessment included patient satisfaction, reoperations, and allograft survivorship. Failure was defined as any further procedure that resulted in removal of the allograft. RESULTS: The mean follow-up was 8.4 years (range, 1.7-27.1). The IKDC score improved from 42 to 75 and the KS-F score improved from 69.3 to 89.4 (both p<0.05). Using the modified Merle d’Aubigné-Postel (18-point) scale, 87.5% of patients had a “good” or “excellent” score postoperatively, compared to 17% preoperatively. Patient satisfaction was 88.6%. Sixteen of 43 knees (37.2%) had reoperations following the allograft surgery. Kaplan-Meier survivorship was 92.9% at 5 years and 89.8% at 10 years. Five failures (11.6%) occurred, which were all salvaged with revision allografting. CONCLUSION: Osteochondral allografting was successfully employed to treat complex knee chondral and osteochondral pathology in patients less than 18 years of age. This procedure yielded improved function, decreased pain, and high satisfaction at an average follow-up of 8 years. Failure rates were relatively low, and when they did occur, were successfully revised with a second allograft procedure.