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

Autor: Francesc Soler, Massimo Berruto, Giuseppe Filardo, Luca Andriolo, Frédéric Rongieras, Peter Verdonk, Paolo Ferrua, Dennis C. Crawford
Přispěvatelé: ATRC, IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Traumadvance Orthopaedic Group, Terrassa, Department of Knee Surgery, ASST Pini-CTO, Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Monica Hospitals, Monica Research Foundation, University Hospital, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Department of Orthopaedics and Rehabilitation, Oregon Health and Science University [Portland] (OHSU)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Joint Instability
Allograft transplantation
medicine.medical_specialty
Knee Joint
Economics
Arthroplasty
Subchondral
OSTEOCHONDRITIS DISSECANS
ALLOGRAFT
OSTEOCHONDRAL
Lesion
03 medical and health sciences
BIOMECANIQUE
[SPI]Engineering Sciences [physics]
Chondrocytes
0302 clinical medicine
Sociology
Bone Marrow
CARTILAGE
medicine
SURGICAL TREATMENT
Humans
Regeneration
Orthopedics and Sports Medicine
GENOU
Young adult
Unstable knee
030222 orthopedics
Bone Transplantation
Tissue Scaffolds
business.industry
Cartilage
SCAFFOLD
[SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph]
YOUNG ADULT
030229 sport sciences
Articular surface
Allografts
medicine.disease
Osteochondritis dissecans
Orthopedic Fixation Devices
Surgery
medicine.anatomical_structure
Orthopedic surgery
KNEE
Human medicine
medicine.symptom
business
Zdroj: Knee surgery, sports traumatology, arthroscopy
Knee Surgery, Sports Traumatology, Arthroscopy
Knee Surgery, Sports Traumatology, Arthroscopy, Springer Verlag, 2019, 27 (6), pp. 1726-1738. ⟨10.1007/s00167-018-5316-5⟩
ISSN: 0942-2056
1433-7347
DOI: 10.1007/s00167-018-5316-5⟩
Popis: 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.
Databáze: OpenAIRE
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