title: Osteochondral grafting for failed knee osteochondritis dissecans repairs.
abstract: BACKGROUND
  Revision of failed surgical treatments of osteochondritis dissecans (OCD) lesions remains a challenge without an obvious solution. The aim of this study was to evaluate seven consecutive patients undergoing osteochondral grafting of a failed OCD repair.
  
  
  METHODS
  The mean time from surgery to the latest evaluation was 7.0 years. IKDC, WOMAC, Tegner, and MRI studies were collected both preoperatively and during follow-up. Evaluation of the graft was assessed using the magnetic resonance observation of cartilage repair tissue (MOCART) grading system.
  
  
  RESULTS
  Over the course of the study period, five patients required additional surgery with a study median of one additional surgery (range, zero to 3). At most recent follow-up, there was significant improvement from preoperative values in median IKDC (p=0.004), WOMAC (p=0.030), and Tegner (p=0.012). Complete cartilage fill and adjacent tissue integration of the paste graft were observed by MRI evaluation in five of the seven (71.4%) patients. Definitive correlation between clinical outcomes and MRI scores was not observed.
  
  
  CONCLUSIONS
  This study shows promising results of osteochondral grafting as a viable option for the revision of failed OCD lesion repairs; however, more patients are needed to fully support its efficacy in these challenging failed revision cases.
authors.affiliation: The Stone Clinic, San Francisco, CA, USA; Stone Research Foundation, San Francisco, CA, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Stone
authors.affiliation: Stone Research Foundation, San Francisco, CA, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Pelsis
authors.affiliation: Radnet, Los Angeles, CA, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Crues
authors.affiliation: The Stone Clinic, San Francisco, CA, USA; Stone Research Foundation, San Francisco, CA, USA.
authors.forename: Ann W
authors.initials: AW
authors.lastname: Walgenbach
authors.affiliation: Stone Research Foundation, San Francisco, CA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Turek
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D002356:Cartilage / Q000637:transplantation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D008297:Male; D010008:Osteochondritis Dissecans / Q000473:pathology* / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D055815:Young Adult
keywords: Arthroscopy; Failed repair; Osteoarthritis; Osteochondral paste grafting; Osteochondritis dissecans