BACKGROUND Osteochondritis dissecans (OCD) of the knee can progress to large osteochondral defects when fragment fixation fails, representing a reconstructive challenge in young active patients. Fresh osteochondral allograft transplantation (OCA) restores both the viable hyaline cartilage and subchondral bone and has emerged as a joint-preserving treatment for these lesions. However, reports describing OCA as a salvage procedure after failed OCD fixation remain limited. CASE REPORT A 19-year-old female patient who participated in competitive sports presented with recurrent pain and mechanical locking of the left knee after previous fixation of an OCD lesion of the lateral femoral condyle. Imaging demonstrated fixation failure, retained hardware, loose bodies, and an osteochondral defect measuring 25×12 mm. Open removal of the failed fixation and loose bodies was followed by fresh size-matched OCA using a press-fit technique. At the 24-month follow-up, the patient had returned to high-level athletic activity without mechanical symptoms. Clinical examination demonstrated functional range of motion and adequate quadriceps strength. The International Knee Documentation Committee subjective score was 93/100, and the Tegner Activity Scale score was 7, compared with a preinjury score of 8. Magnetic resonance imaging confirmed satisfactory graft incorporation without graft-related complications. CONCLUSIONS Fresh OCA may be considered as a joint-preserving salvage option after failed OCD fixation in carefully selected young patients. In this case, satisfactory graft incorporation, functional recovery, and return to preinjury recreational sports activities were observed at 24-month follow-up.
