osteochondral defect treatment


The severity of your injury will determine what treatment you will receive. Osteochondral defects generally linger or get worse unless they’re treated. When filling osteochondral defects in the knee, surgeons have a list of treatment options to choose from and more options are in the works. Both operative and nonoperative treatments may be indicated. J Bone Joint Surg Am. The past several “Treatment Dilemmas” columns have dealt with the treatment of chronic ankle pain subsequent to an ankle sprain (see page 92, July issue and page 88, September issue). 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. 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. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. 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. Osteochondral autograft is used for smaller cartilage defects. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. 3. of . 1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. We have dealt with the actual ligament injury and its repair, treatment of peroneal tendon injuries and also conservative care of ankle injuries. Treatment of Osteochondral Defects. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. 3-C). It is known from long-term followup studies, such as those conducted by Linden, 7 that osteochondritis dissecans diagnosed in adulthood is likely to lead to the development of early onset osteoarthritis. 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. The ideal lesion for this treatment is the focal chondral or osteochondral defect on the femoral condyle or talus in a young patient. doi: 10.2106/JBJS.F.00625 10. Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. Normal surrounding hyaline cartilage reduces boundary shear and improves outcome. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Terminology. If a cartilage defect is too large for an autograft, an allograft may be considered. 16 Allograft transplantation can be used to repair larger defects. Treatment is split up into three grades, depending on how severe the injury is: Grade 1: This treatment doesn’t require any invasive procedures. 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. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. 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 … An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. When osteochondral lesions of the talus are associated with subchondral bone defects or cysts with intact overlying cartilage, retrograde drilling is a more effective reparative treatment option than microfracture as it is able to treat the pathology without disturbing the overlying, healthy cartilage. The broad term “osteochondral lesion of the talus” describes an injury or abnormality of the talar articular cartilage and adjacent bone. 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. Non-Surgical Treatment for Osteochondral Defect. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 10. 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]. Immobilization. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. This prevents the need from harvesting bone and cartilage from another part of the body (ex. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. 2007; 89(4):718–726. Chondral defects of the knee are important to thoroughly evaluate to determine the best treatment regimen. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. OCD usually causes pain during and after sports. One kind of surgical treatment is microfracture surgery, where the surgeon creates small holes in the cartilage defect to help stimulate cartilage growth. If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. knee). Symptomatic osteochondral ankle defects often require surgical treatment. 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