title: Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee?
abstract: BACKGROUND
  Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will restore function in most adults, it is unclear whether fresh osteochondral allograft transplantations similarly restore function in skeletally immature patients who failed conventional treatment.
  
  
  OBJECTIVE
  Therefore, we determined function in (1) daily activity; (2) sports participation; and (3) healing (by imaging) in children with juvenile OCD who failed conventional therapy and underwent fresh osteochondral allograft transplantation.
  
  
  METHODS
  We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). The average age of the children at the time of their allograft surgery was 15.2 years (range, 13-20 years). The clinical assessments included physical examination, radiography, MRI, and a modified Merle D'Aubigné-Postel score. The size of the allograft was an average of 5.11 cm(2). The minimum followup was 12 months (average, 24 months; range, 12-41 months).
  
  
  RESULTS
  All patients had returned to activities of daily living without difficulties at 6 months and returned to full sports activities between 9 and 12 months after surgery. The modified Merle D'Aubigné-Postel score improved from an average of 12.7 preoperatively to 16.3 at 24 months postoperatively. Followup radiographs at 2 years showed full graft incorporation and no demarcation between the host and graft bone.
  
  
  CONCLUSIONS
  Our observations suggested fresh osteochondral allografts restored short-term function in patients with juvenile OCD who failed standard treatments.
  
  
  METHODS
  Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Pediatric Orthopaedics, Suite C360, P.O. Box 1997, Milwaukee, WI 53201, USA. rmlyon@mcw.edu
authors.forename: Roger
authors.initials: R
authors.lastname: Lyon
authors.forename: Carl
authors.initials: C
authors.lastname: Nissen
authors.forename: Xue Cheng
authors.initials: XC
authors.lastname: Liu
authors.forename: Brian
authors.initials: B
authors.lastname: Curtin
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010147:Pain Measurement; D010808:Physical Examination; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult