Case report: Fresh-stored osteochondral allograft for treatment of osteochondritis dissecans the femoral head

Abstract

Osteochondral defects of the femoral head are exceedingly rare, with limited treatment options. Restoration procedures for similar defects involving the knee and ankle have been well described. In this report, we present a young patient who had a symptomatic osteochondral defect of the femoral head develop secondary to trauma and underwent subsequent treatment using a fresh-stored osteochondral allograft via a trochanteric osteotomy. At the 1-year followup, the patient was symptom free with near-complete incorporation of the graft radiographically. Our observations in this case suggest osteoarticular implantation may be an appropriate alternative to consider when treating osteochondral defects of the femoral head.

Fig. 1A–B

(A) Anteroposterior and (B) lateral radiographs reveal an osteochondral defect of the femoral head.

Fig. 2A–B

(A) Coronal and (B) sagittal T2-weighted MRI scans of the femoral head defect show the areas of high signal intensity are not contiguous and do not undermine the lesion, suggesting the fragment is stable without evidence of collapse.

Fig. 3A–B

(A) Coronal and (B) sagittal CT scans show fragmentation of the lesion.

Fig. 4

An intraoperative photograph shows the lesion involving the anterior superomedial aspect of the femoral head.

Fig. 5

An intraoperative photograph shows the osteochondral plug after harvesting.

Fig. 6A–B

Intraoperative photographs illustrate (A) the host defect after preparation and (B) the osteochondral allograft after implantation.

Fig. 7A–B

Postoperative (A) anteroposterior and (B) lateral radiographs at 1-year followup show graft incorporation.