Osteochondral grafting for failed knee osteochondritis dissecans repairs

•We evaluate seven patients undergoing osteochondral grafting of a failed OCD repair.•MRI showed restored surface tissue with abnormal subchondral signal.•Patient median pain, activity, and function levels showed significant improvement.•MOCART score did not correlate with subjective outcome measures.•Osteochondral grafting shows promise as a viable option for the revision failed OCD repairs.

BackgroundRevision 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.MethodsThe 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.ResultsOver 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.ConclusionsThis 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.