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. 2025 Jan 20;13(1):23259671241302125.
doi: 10.1177/23259671241302125. eCollection 2025 Jan.

Functional Recovery and Clinical Outcome After Internal Fixation Using Osteochondral Autologous Transplantation for Osteochondritis Dissecans of the Knee

Kenta Amai  1 , Ryo Kanto  1 , Shintaro Onishi  2 , Hiroshi Nakayama  1 , Shinichi Yoshiya  2 , Toshiya Tachibana  1 , Tomoya Iseki  1
Affiliations

Functional Recovery and Clinical Outcome After Internal Fixation Using Osteochondral Autologous Transplantation for Osteochondritis Dissecans of the Knee

Kenta Amai et al. Orthop J Sports Med. .

Abstract

Background: Functional recovery and return to sports after fixation of osteochondritis dissecans (OCD) lesions of the knee with osteochondral autologous transplantation (OAT) have not been well investigated.

Purpose: To retrospectively evaluate the functional recovery and clinical outcomes after internal fixation with OAT for knee OCD.

Study design: Case series; Level of evidence, 4.

Methods: A consecutive series of patients who underwent OAT for OCD lesions between 2010 and 2020 were initially enrolled in the study. Patients with adult-onset OCD and those who underwent fragment removal and/or mosaicplasty were excluded. Lysholm score, Tegner activity scale, return-to-sports rate (at the practice/training and preinjury levels), and time to return were evaluated. Clinical factors influencing postoperative functional recovery were analyzed.

Results: Included were 24 patients (26 knees); there were 23 male and 1 female patients, with a mean age of 14.7 years. The mean follow-up period was 27.6 months. A total of 17 lesions were located in the medial femoral condyle and 9 in the lateral femoral condyle. The mean Tegner score was 7.0 preoperatively and 6.5 postoperatively, with no significant difference. The return-to-sports rate was 96.2% at the practice/training level and 84.6% at the preinjury level, with an average return time of 5.1 months and 9.6 months, respectively. In a subgroup analysis of knees that returned to preinjury level (n = 22) by lesion location, there was a significant difference between knees with lesions in the lateral femoral condyle (12.9 months) versus the medial femoral condyle (8.1 months) (P = .02). The rate of return to preinjury level after primary surgery was significantly higher than after revision surgery after failed drilling (P = .02).

Conclusion: Return-to-sports rates and clinical outcomes were favorable after fixation with OAT in patients with knee OCD. A shorter time to return to sports was observed in knees with medial lesions compared with lateral lesions. Furthermore, the rate of return to sports at the preinjury level was significantly higher after primary surgery than after revision surgery after drilling.

Keywords: OAT; OCD; clinical score; osteochondral autologous transplantation; osteochondritis dissecans of the knee; return to sports.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Hyogo Medical University (reference No. 3760).

Figures

Figure 1.
Figure 1.
Serial images of a 16-year-old boy with OCD in the medial femoral condyle who underwent internal fixation using OAT. (A) Anteroposterior radiograph reveals a demarcated lesion in the MFC. (B) Sagittal T2-weighted MRI scan of the knee before surgery showing a bone fragment in situ completely surrounded by high-signal intensity line (Hefti classification stage 4). (C) Postoperative radiograph at 4 months, demonstrating progression of bony healing with apparently smooth joint congruity. (D) Intraoperative image showing partial cartilage fissuring at periphery of the OCD lesion in the MFC. (E) In situ fixation performed by biological fixation using 2 8-mm-diameter autogenous osteochondral plugs under arthrotomy. MFC, medial femoral condyle; MRI, magnetic resonance imaging; OAT, osteochondral autologous transplantation; OCD, osteochondritis dissecans.
See this image and copyright information in PMC

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