18 Acute Osteochondral Defects in the Knee JOHN G. COSTOUROS, MARC R. SAFRAN, AND GREGORY B. MALETIS Despite surgical and technologic advancements, the treatment of osteochondral defects continues to challenge orthopaedic surgeons. The severity of your injury will determine what treatment you will receive. Intra‐articular osteochondral fracture has a certain ability for self‐repair. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. This prevents the need from harvesting bone and cartilage from another part of the body (ex. Active infection (local or systemic) 2. This is because the healthy graft tissue can only be taken from a limited area of the same joint. Purpose: Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. We have dealt with the actual ligament injury and its repair, treatment of peroneal tendon injuries and also conservative care of ankle injuries. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. It can be done with an arthroscope. Clinicians have used variety of terms to describe these injuries, including osteochondritis dissecans, osteochondral defect or osteochondral fracture. The ideal lesion for this treatment is the focal chondral or osteochondral defect on the femoral condyle or talus in a young patient. Treatment is split up into three grades, depending on how severe the injury is: Grade 1: This treatment doesn’t require any invasive procedures. An osteochondral defect, also known as a Talar dome lesion, is a spot where the cartilage has been damaged or worn through. Osteochondral lesions most often result from an injury, such as a sprain. Large osteochondral defects involving the femoral condyles of the knee have frustrated orthopaedic surgeons for generations. Osteochondral defects generally linger or get worse unless they’re treated. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. Treatment options to restore joint congruity vary widely from nonoperative closed treatment to arthroscopic drilling, with or without fixation, to tissue transplantation or reconstructive procedures. However, the major disadvantage of the microfracture technique is that the durability of fibrocartilage tissue is inferior to normal hyaline cartilage . It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). II. If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. 3-B) views; the defect cannot be detected on the lateral view (Fig. Indication for microfracture is recommended as a first-line treatment, especially in osteochondral defects of the talus measuring less than 1.5 cm 2 [57, 80]. options like osteochondral autograft transfer system (OATS) or autologous chondrocyte implantation (ACI), arthroscopic debridement and bone marrow stimulation remains the best treatment that is currently available for defects up to 15 mm in diameter.14,15 In larger (cystic) defects this treatment is less successful, hence there is more debate.16,17 The defect area of the cartilage surface is in excess of 4 to 16 mm 2, which is usually not the result of self‐repair 6. If there are no loose pieces of bone or cartilage, your Pensacola orthopedic specialist might prescribe you one or more of the non-surgical treatment options below. In the past year, we broadened the scope of the project and focussed on 1) the treatment of joint capsule changes associated with osteochondral defects, 2) medical treatment of chondral defects, and 3) the development of the sheep model for the application of bulk ostechondral defect ("Next-generation orthobiologics for joint repair"). OCD usually causes pain during and after sports. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI 11) cause damage of the superficial layer of the cartilage, and with time deep cracks and degeneration of the cartilage.Subsequently, joint fluid pumps into the subchondral bone and creates … Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. 16 Allograft transplantation can be used to repair larger defects. Treatment is variable depending upon the size of the bone fragment, age of the patient and activity level of the patient. 3-C). Fresh stored allografts for the treatment of osteochondral defects of the knee. Non-Surgical Treatment for Osteochondral Defect. Cartilage defects and osteoarthritis are acknowledged as a disease of the entire osteocartilaginous unit, rather than a disorder limited to the surface cartilage alone. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Chondral defects of the knee are important to thoroughly evaluate to determine the best treatment regimen. knee). Treatment . doi: 10.2106/JBJS.F.00625 10. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. Osteochondral autograft is used for smaller cartilage defects. Both operative and nonoperative treatments may be indicated. In addition, assessment of alignment may indicate if an unloader brace may help alleviate a patient’s symptoms and review of newer biologic or corticosteroid or viscosupplementation injections may be indicated. One kind of surgical treatment is microfracture surgery, where the surgeon creates small holes in the cartilage defect to help stimulate cartilage growth. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. Terminology. This is done using arthroscopic techniques. Symptomatic osteochondral ankle defects often require surgical treatment. 3. of . An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. Criteria for Exclusion: A. Autologous chondrocyte implantation, osteochondral autograft, or osteochondral allograft of the knee or talus are considered not medically necessary if any of the following are present; 1. 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