Treatment of osteochondral injuries and osteochondritis dissecans (OCD) is quite controversial and has received recent attention in the literature. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. The purpose of this article is to give an overview of the treatment options available for osteochondral defects in the knee and to propose a treatment algorithm based on the senior author's (WGC) experience. You may need to wear a cast or walking boot to restrict certain movements, but most of this treatment focuses on limiting sports and heavy activity. This cartilage would withstand years of use and prevent the development of arthritis. Should the cartilage be disrupted, then microdrilling or micropicking of … Trauma, osteochondritis dissecans, osteonecrosis, osteochondroses, and hereditary epiphyseal abnormalities can cause osteochondral lesions in the knee joint.25, 61, 62, 72 When an osteochondral defect persists in a weightbearing portion of the knee joint, degenerative arthritis of that compartment can result. In conclusion, treatment of early knee osteoarthritis and chondral lesions is still a challenging problem. Treatment of osteochondral injuries and osteochondritis dissecans (OCD) is quite controversial and has received recent attention in the literature. We use cookies to help provide and enhance our service and tailor content and ads. Damage to the surface of the knee joint is commonly caused by osteochondral lesions. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. Address reprint requests to E. Lyle Cain, MD, 1313 13th Street South, Birmingham, AL 35205, References5, 8, 12, 14, 19, 24, 34, 37, 40, 45, 59, 60, 65, 72, 74, 77 and82. Treatment depends upon the size of the osteochondral defect and the condition of the overlying cartilage. Kon E. et al. By continuing you agree to the use of cookies. For those patients who have a surface defect of the cartilage, with a flap or crack in it, a cleaning out or shaving of a defect, called a chondroplasty, can be performed. Knee Surg Sports Traumatol Arthrosc 5(4):262–267 Significant articular cartilage incongruity often causes mechanical joint dysfunction and eventual cartilage deterioration, resulting in osteoarthritis. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. 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. restored with osteochondral transplantation and whether the donor defect may lead to an increased activity is unclear. Address reprint requests to E. Lyle Cain, MD, 1313 13th Street South, Birmingham, AL 35205, References5, 8, 12, 14, 19, 24, 34, 37, 40, 45, 59, 60, 65, 72, 74, 77 and82. Copyright © 2001 W. B. Saunders Company. Chondral and osteochondral defects in the PF compartment are often encountered in clinical practice on advanced imaging studies and/or during arthroscopy. The type of surgery that is most effective depends on the size, location and severity of the lesion. Cartilage can be focally damaged, producing a “pot hole” in the joint surface, when the knee ligaments are injured. The purpose of this article is to give an overview of the treatment options available for osteochondral defects in the knee and to propose a treatment algorithm based on the senior author's (WGC) experience. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) … Copyright © 2020 Elsevier B.V. or its licensors or contributors. For large osteochondral defects (> 9.6 cm2) of weightbearing areas of the knee, techniques established for smaller sized lesions such as drilling, microfracturing, and transplantation of osteochondral plugs (OATS, Mega-OATS) provide only insufficient clinical outcomes (12, 13). Those on the tibia and kneecap (patella) are harder to treat and the results are not as reliable. * https://doi.org/10.1016/S0278-5919(05)70309-4. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. 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. 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. Who is a perfect candidate for MaioRegen Prof. Matej Drobnic MaioRegen Clinical Evidence Giulia Scarpato, Finceramica Surgical technique: Tips and tricks Mr Andrew Edwards Tips … Contraindications included patients with inflammatory arthritis, age below 35 or above … Berruto M. et al. Large osteochondral defects involving the femoral condyles of the knee have frustrated orthopaedic surgeons for generations. Treatment of osteochondral defects of the knee.pdf. einstein. Protection – protect the affected area from further injury by using a support, such as a knee brace ; Rest – rest the affected joint as much as possible during the first 2 or 3 days (crutches may help if you've injured your knee or ankle), then try gradually returning to light activity over the next few days and weeks For adults, such a condition usually requires surgery. Osteochondral autograft transplantation is used to address small to medium defects (1–4 cm 2), often with associated bone loss. We use cookies to help provide and enhance our service and tailor content and ads. The fixed sutures on the femoral surface did not have much effect on the joints, and the patients did not feel any discomfort. 2009;7(2 Pt 1):245-7. Large, focal articular cartilage defects of the knee (> 4 cm) can be a source of significant morbidity and often require surgical intervention. Published by Elsevier Inc. All rights reserved. A preliminary report. The purpose of this article is to give an overview of the treatment options available for osteochondral defects in the knee and to propose a treatment algorithm based on the senior author's (WGC) experience. 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. Terminology. The treatment of chondral defects of the knee can depend upon the location and size of the defect. Background: Mosaicplasty and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage-bone dowels into chondral lesions of the knee. Published by Elsevier Inc. All rights reserved. The transplantation of autologous hyaline cartilage plugs results in a hyaline cartilage base with fibrocartilage “grout.”40 Mosaicplasty is designed for the treatment of focal chondral and osteochondral defects of the knee in patients under 45 years of age. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. Osteochondral defect is a broad term that describes the morphological change of a localised gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the paediatric population. TREATMENT ALGORITHM FOR OSTEOCHONDRAL INJURIES OF THE KNEE. James L. Chen, MD, (San Francisco, CA) provides a case presentation of a patient with an osteochondral lesion of the lateral femoral condyle. Of these, 37.5% were in the patella alone . This allows us to treat the bone defect without affecting the cartilage. 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