Autologous Chondrocyte Implantation for Osteochondritis Dissecans in the Knee

Full-thickness cartilage defects, whether the result of a traumatic event or caused by osteochondritis dissecans (OCD), can result in a painful, debilitating problem for patients and a quandary for orthopedic surgeons. Marrow stimulation techniques can produce short- to mid-term symptomatic relief; however, the fibrocartilaginous repair tissue that is produced with these measures lacks the mechanical and viscoelastic properties of hyaline cartilage. Autologous chondrocyte implantation (ACI) for OCD lesions has shown durability of the articular repair with excellent mid- to long-term clinical outcomes. Proper patient selection as well as correcting concomitant pathology (femoral-tibial malalignment, patella maltracking, ligamentous instability, and meniscal insufficiency) is paramount to the success of ACI. Subchondral bone deficiency such as encountered with deep OCD lesions may require an additional bone-grafting procedure, which can be performed in a concurrent or staged fashion. Postoperative compliance with weight-bearing and rehabilitation protocols is necessary to protect the integrity of the repair tissue. Results of ACI for OCD lesions are encouraging and should be considered when the native osteochondral fragment cannot be salvaged.