Use of fresh osteochondral allograft in repair of distal femur after trauma.

Preserving the ability to maintain an active lifestyle is a major concern in the reconstruction of the knee in young patients. For the healthy individual who desires to maintain a relatively active lifestyle, fresh osteochondral allografts may serve as an alternative to total joint reconstruction. The use of fresh allografts is primarily indicated in the patient suffering from a traumatic loss of articular segments, who is too young or active for arthroplasty. In addition, fresh osteochondral allografts have a number of advantages over arthroplasty such as providing surgeons with a source of large grafts that can be fitted to replace osteochondral defects and cover the majority or entirety of articular surfaces without any donor site morbidity. In this case, a young, active patient lost a 7 x 8 cm portion of their distal femur, including a large portion of the articulating surface. Using a fresh osteochondral allograft, harvested within 24 hours of donor death, a segment was fitted to match bony apposition, articular congruity, and congruity with the femoral notch and affixed with four partially threaded cancellous screws. Joint function was restored with the allograft in place, allowing the patient to delay the need for a total joint replacement.