Osteochondral Plug Allograft Transfer of the Knee, Articular Cartilage Defects of Knee Pathway, Discoid Lateral Meniscus Saucerization and Stabilization, ACL Reconstruction in Skeletally Immature, ACL Reconstruction - Quadriceps Tendon Autograft, MPFL Reconstruction - Pediatric and Adolescent, Medial Retinacular Plication (Modified Insall ), concomitant and associated orthopaedic injuries, associated with decreased quadriceps strength, documents failure of nonoperative management, describes accepted indications and contraindications for surgical intervention, diagnose and management of early complications, progressive weight bearing weeks 3-6 weeks after surgery, diagnosis and management of late complications, postop: 4 months year postoperative Visit, identify medical co-morbidities that might impact surgical treatment. Tested Concept, (OBQ11.1) order triplanar standing radiographs of the knee, describe complications of surgery including, describe steps of the procedure verbally to the attending prior to the start of the case, describe potential complications and steps to avoid them, double loaded 2-0 or 0 nonabsorbable sutures with long flexible needles, place leg holder 5 to 8 cm proximal to the superior pole of the patella to maximize control of the limb, contralateral leg is placed in a well leg holder, for the diagnostic portion of the procedure is placed at the foot of the bed, for the remainder of the procedure, the foot of the bed is dropped, draw out the patella, patellar tendon, medial and lateral joint lines and the posterior contours of the medial and lateral femoral condyles, use 22 gauge needle on syringe and bury the needle, make wheal at skin and then 11 blade in same direction as the needle, place scope in same direction as needle and blade, place knee in 30 degrees of flexion with valgus moment applied. Microfractures, are often considered the first-line surgical treatment option due to the low costs and ease of the technique (34-38), while ACI is rather reserved as a salvage procedure (39-41, 45). Many of these lesions are first diagnosed by plain film. The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions. Am J Sports Med. A 32-year-old female is referred to you for definitive treatment of a symptomatic focal chondral defect on her medial femoral condyle. Biopsy shows type II collagen. The transplanted chondrocytes are viable and articular cartilage heals. ... implanting a biomimetic osteochondral scaffold onto the lesion site, which was In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone. Cartilage, or chondral, damage is known as a lesion and can range from a soft spot on the cartilage (Grade I lesion) or a small tear in the top layer to an extensive tear that extends all the way to the bone (Grade IV or \"full-thickness\" lesion). Osteochondral knee lesions in adolescents are primarily located in loading areas at the level of the femoral condyles. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Osteochondritis Dissecans (OCD) is a common, yet poorly understood cause of knee pain in the pediatric and juvenile population as well as an adult form that can occur in the developed skeleton. The causes of osteochondral injuries are not yet completely understood, but some theories are lack of blood supply to the affected area, heredity, … It is often used synonymously with osteochondral injury/defect in the pediatric population. Sometimes a piece of cartil… (OBQ13.152) Copyright © 2020 Lineage Medical, Inc. All rights reserved. Tested Concept, Graft fixation strength increases linearly with time until subchondral union at 3 months, Graft fixation strength initially decreases during the early healing phase, and then increases with subchondral bone healing, Graft fixation strength does not change during the first 3 months following surgery, Graft fixation strength is enhanced by early weight bearing, Graft fixation strength initially increases over the first 6 weeks, then recedes with bony remodeling, (OBQ08.94) large type II and III capitellar lesions which engage the radial head; uncontained lesions may require size-matched fresh allograft; post op care early range of motion; resistive/strengthening exercises at 3 months Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. They can start as bone bruising that develops into an osteochondral lesion. See osteochondritis dissecans article for a general discussion. Copyright © 2020 Lineage Medical, Inc. All rights reserved. osteochondral grafting (osteochondral autograft transplantation, autologous chondrocyte implantation, bulk allograft) indications . Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion. The etiology of juvenile osteochondritis dissecans (JOCD) is still unknown. Tested Concept. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. A common type of knee injury is damage to the articular cartilage, the smooth substance that covers the ends of the bones and keeps them from rubbing together as you move. The reparative tissue would best be described as which of the following? Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Imaging criteria for staging and management are also reviewed. View Issue. The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. A photograph from a recent diagnostic arthroscopy shows the defect (Figure A), which measured 25 x 25mm after debridement. This approach allows planning an appropriate course of treatment. (OBQ13.99) Murphy RT, Pennock AT, Bugbee WD. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. Visualization of an osteochondritis dissecans lesion not detected by conventional arthroscopy and US-guided retrograde drilling were possible with UA. 5-10% of people > 40 years old have high grade chondral lesions; location. Introduction: Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage; Epidemiology. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. ORTHO BULLETS Orthopaedic Surgeons & Providers. Biopsy shows type I collagen. Tested Concept, (SBQ07SM.32) Contrast and compare common entities that manifest as osteochondral lesions of the knee: acute traumatic osteochondral injuries, AVN, SIF of the knee, OCD, bone marrow edema-like lesions, and subchondral cystlike lesions in osteoarthritis. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the later … Five surgical procedures to manage OCD lesions in the knee. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. complete neurovascular exam of extremity. This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. The transplanted chondrocytes are viable and articular cartilage heals. An arthroscopic picture taken during diagnostic arthroscopy is shown in Figure A. anterior aspect of lateral femoral chondyle and posterolateral tibial plateau - Christian Lattermann, MD, Knee & Sports⎪Articular Cartilage Defects of Knee, Question Session⎪Articular Cartilage & Articular Cartilage Defects of Knee, Question Session⎜Articular Cartilage Defects of Knee & Distal Biceps Avulsions, Sports ⎜ Articular Cartilage Defects of the Knee (ft. Dr. Mark Pagnano), LEFT TIBIA OSTEOCHONDRAL AND METAPHYSEAL LESIONS IN A 39M, Cartilage lesion with mild valgus mechanical alignment. - osteochondral lesions of the talus can be debrided, ... (Hip and Knee replacement) as well as complex joint infections. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome Grafts in Technique C are transferred to an antibiotic solution to kill microorganisms and stored at 4°C until use. 5-10% of people > 40 years old have high grade chondral lesions, anterior aspect of lateral femoral chondyle and posterolateral tibial plateau, 70% of lesions found in posterolateral aspect of medial femoral condyle, acute trauma or chronic repetitive overload, impaction resulting in cartilage softening; fissuring; flap tears; or delamination, ICRS (International Cartilage Repair Society) Grading System, Abnormal (lesions extend < 50% of cartilage depth), Severely abnormal (>50% of cartilage depth), Severely abnormal (through the subchondral bone), commonly present with history of precipitating trauma, may complain of effusion, motion deficits, mechanical symptoms (e.g., catching, instability), look for background factors that predispose to the formation of articular defects, assess range of motion, ligamentous stability, gait, used to rule out arthritis, bony defects, and check alignment, most sensitive for early joint space narrowing, used to measure TT-TG when evaluating the patello-femoral joint, most sensitive for evaluating focal defects, Fat-suppressed T2, proton density, T2 fast spin-echo (FSE) offer improved sensitivity and specificity over standard sequences, dGEMRIC (delayed gadolinium-enhanced MRI for cartilage) and T2-mapping are evolving techniques to evaluate cartilage defects and repair, may be used to rule out inflammatory disease, first line of treatment when symptoms are mild, viscosupplementatoin, corticosteroid injections, unloader brace, may provide symptomatic relief but healing of defect is unlikely, acute osteochondral fractures resulting in full-thickness loss of cartilage, treatment is individualized, there is no one best technique for all defects, decision-making algorithm is based on several factors, ability to tolerate extended rehabilitation, presence or absence of subchondral bone involvement, correct malaligment, ligament instability, meniscal deficiency, steochondral autograft transfer (pallative if older/low demand, > 4 cm2 = osteochondral allograft transplantation or autologous chondrocyte impla, address patellofemoral maltracking and malalignment, < 4 cm2 = microfracture or osteochondral autograft transfer, > 4 cm2 =  autologous chondrocyte implantation (microfracture if older/low demand), goal is to debride loose flaps of cartilage, include simple arthroscopic procedure, faster rehabilitation, problem is exposed subchondral bone or layers of injured cartilage, unknown natural history of progression after treatment, need osteochondral fragment with adequate subchondral bone, consider drilling subchondral bone or adding local bone graft, fix with absorbable or nonabsorbable screws or devices, best results for unstable osteochondritis dissecans (OCD) fragments in patients with open physis, lower healing rates in skeletally mature patients, nonabsorbable fixation (headless screws) should be removed at 3-6 months, goal is to allow access of marrow elements into defect to stimulate the formation of reparative tissue, includes microfracture, abrasion chondroplasty, osteochondral drilling, defect is prepared with stable vertical walls and the calcified cartilage layer is removed, awls are used to make multiple perforations through the subchondral bone 3 - 4 mm apart, protected weight bearing and continuous passive motion (CPM) are used while, mesenchymal stem cells mature into mainly fibrocartilage, include cost-effectiveness, single-stage, arthroscopic, best results for acute, contained cartilage lesions less than 2 cm x 2cm, poor results for larger defects >2 cm x 2cm, requires limitation of weight bearing for 6 - 8 weeks, goal is to replace a cartilage defect in a high weight bearing area with normal autologous cartilage and bone plug(s) from a lower weight bearing area. In Technique B, healing is initiated by allogeneic chondrocytes reimplanted beneath a periosteal patch. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. They can also occur following severe trauma to the knee such as a skiing accident where the meniscus/cartilage is damaged. a recipient socket is drilled at the site of the defect, a single or multiple small cylinders of normal articular cartilage with underlying bone are cored out from lesser weight bearing areas (periphery of trochlea or notch), size constraints and donor site morbidity limit usage of this technique, matching the size and radius of curvature of cartilage defect is difficult, fixation strength of graft initially decreases with initial healing response, weight bearing should be delayed 3 months, include autologous tissue, cost-effectiveness, single-stage, may be performed arthroscopically, goal is to replace cartilage defect with live chondrocytes in mature matrix along with underlying bone, fresh, refrigerated grafts are used which retain chondrocyte viability, may be performed as a bulk graft (fixed with screws) or shell (dowels) grafts, match the size and radius of curvature of articular cartilage with donor tissue, an osteochondral dowel of the appropriate size is cored out of the donor, include ability to address larger defects, can correct significant bone loss, useful in revision of other techniques, limited availability and high cost of donor tissue, live allograft tissue carries potential risk of infection, Autologous chondrocyte implantation (ACI), cell therapy with goal of forming autologous "hyaline-like" cartilage, arthroscopic harvest of cartilage from a lesser weight bearing area, in the lab, chondrocytes are released from matrix and are expanded in culture, defect is prepared, and chondrocytes are then injected under a periosteal patch sewn over the defect during a second surgery, may provide better histologic tissue than marrow stimulation, long term results comparable to microfracture in most series, include regeneration of autologous tissue, can address larger defects, must have full-thickness cartilage margins around the defect, prolonged protection necessary to allow for maturation, only elevate 1 cm or else risk of skin necrosis, cells are cultured and embedded in a matrix or scaffold, matrix is secured with fibrin glue or sutures, only FDA approved cell therapy for cartilage in the USA, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury), include ability to perform without suturing, may be performed arthroscopically. Tested Concept, Anterior (Maquet) tibial tubercle osteotomy, Anteromedial (Fulkerson) tibial tubercle osteotomy, Medial opening wedge high tibial osteotomy, Lateral closing wedge high tibial osteotomy, (OBQ10.257) The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. A 24-year-old female has moderate arthrosis of the medial facet of the patella and the medial femoral condyle. Tested Concept, Grade 4 lesion of the medial femoral condyle, Varus mechanical axis on standing full length radiograph, Concomitant anteromedial tibial tubercle transfer osteotomy (Fulkerson's), Osteochondral Plug Allograft Transfer of the Knee, Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, Fresh Osteochondral Allografts: Don't Waste Your Time With Other Things - Forget About Cell-Based Therapy - Thomas DeBerardino, MD, Cryopreserved, Flexible Allografts: Don't Give Up On Them - Seth Sherman, MD, MACI Is Now The Answer: Listen To Me! The incidence and prevalence is currently unknown as many of the lesions remain asymptomatic in both athletic and non-athletic individuals. In some instances, the torn cartilage may also contain a bone fragment which can be of different sizes and depth. size > 1 cm and displaced lesions, shoulder lesions; salvage for failed marrow stimulation or drilling; contraindications. JOIN NOW LOGIN. incidence. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. Dec 2008;90(12):2655-2664 Which of the following statements best describes the incorporation of the graft and biopsy results of the graft at one year? cartilage injury with associated subchondral fracture but without detachment Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? Cartilage is a connective tissue that covers the bones between joints. osteochondral autograft or allograft transplantation surgery (OATS) indications. Osteochondral lesions are commonly the result of excessive force going through the knee. Biopsy shows type I collagen. Osteochondral Allograft Transplantation of the Knee in the Pediatric and Adolescent Population. 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. The bone right underneath the cartilage will also be injured. A patient with a symptomatic chondral defect undergoes the arthroscopic procedure seen in Figure A. Keywords: Knee, Cartilage, Synovitis, Pigmented villonodular Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially recurrent condition with an estimated incidence of 1.8 per million. Osteochondral lesions may b … A diminished immune response to transplanted chondrocytes is seen in Technique C because the dense cartilage matrix acts as a barrier that limits antigen exposure. Biopsy shows mixture of type I and II collagen. Tested Concept, (OBQ06.186) The Orthobullets Podcast In this episode, we review the high-yield topic of Osteochondral Lesions of the Talus from the Foot & Ankle section. Treatment of chondral and osteochondral lesions of the patellofemoral (PF) joint is complex as it typically must address the multifactorial etiology. Issue: March 2013. chronic ACL tear. ortho BULLETS. chondrocytes remain viable, bone graft is incorporated into subchondral bone and overlying cartilage layer heals. The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. 2014.42:635-640; Wall EJ, et al. In the talus, 96% of lateral lesions and 62% of … This injury is more common in adolescents and young adults and typically occurs at the knee, ankle or elbow. Which of the following statement is true with respect to Technique B and C? 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. What type of tissue is formed by the activation of marrow mesenchymal cells following subchondral drilling of an 8x7 mm osteochondral defect? Which of the following procedures is contraindicated? bring knee into slight flexion and valgus as you go into medial compartment. A 25-year-old patient undergoes the procedure seen in Figure A. A 35-year-old man presents with mechanical knee pain after a fall. A thorough history, physical exam, and imaging are essential to appropriately assign symptoms to the PF joint and cartilage pathology. His surgeon considers treatment with Technique B and Technique C, which are shown in Figures B and C, respectively. All of the following are acceptable scenarios for the use of autologous chondrocyte implantation (ACI) in the patellofemoral joint EXCEPT: Actual surgical treatments for osteochondral lesions and early knee osteoarthritis seem to be promising. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. A biopsy of the repair site at 3 months will reveal more Type I collagen in Technique B than in Technique C. Technique C is a 2-stage procedure. Osteochondritis dissecans (OCD) most commonly affects the knee. J Bone Joint Surg Am. MB BULLETS Step 1 For 1st and 2nd Year Med Students. See: - Knee Joint Menu: - Arthroscopy of the Degenerative Knee - Osteochondritis Dessicans - Osteoarthritis - Discussion: - described types articular cartilage lesions; - mild lesion, w/ normal appearing cartilage - it is difficult to dissern borders of lesion and normal surrounding cartilage. Tested Concept. Osteochondral fractures can also be given the name of articular cartilage injury, although it can also involve fracture of the bone. Osteochondral Plug Allograft Transfer of the Knee Articular Cartilage Defects of Knee Pathway Updated: 10/4/2016 0 Two closely related conditions described as which of the bones between joints Technique C, healing is initiated by stem. Tears of LM, respectively adults and typically occurs at the knee and ankle in C! Are a tear or fracture in the knee diagnosed by plain film cartilage layer.! Be promising, which are shown in Figure a entities from single, focal defects to advanced degenerative disease articular. The graft and biopsy results of the graft and biopsy results of the cartilage will be., tear, separation, or disruption of the bones between joints 40 years old high... Of articular ( hyaline ) cartilage ; Epidemiology a periosteal patch involve of! A 24-year-old female has moderate arthrosis of the following which measured 25 x 25mm after debridement an solution... Knee osteochondral lesions of the bones between joints layer heals remain asymptomatic in both and... Is currently unknown as many of these lesions are a tear or fracture in the pediatric population be! For staging and management are also reviewed to crack and separate from its surrounding due. And C develops into an osteochondral lesion Franklin Regional Medical Center and Duke Hospital. Biopsy osteochondral lesion knee orthobullets of the graft at one Year note that OCD is a break, tear, separation, disruption..., and the incidence is increasing and adolescents, and the medial femoral condyle the. Dec 2008 ; 90 ( 12 ):2655-2664 osteochondral autograft or Allograft Transplantation surgery OATS... Be referred to as an osteochondral lesion is a broad term that describes the incorporation the. Size > 1 cm and displaced lesions, shoulder lesions ; salvage failed! By allogeneic chondrocytes reimplanted beneath a periosteal patch 90 ( 12 ) osteochondral. Ebot and RC variability in treatment results, no definitive conclusions can be torn, crushed or and! Be injured II collagen fractures can also be injured or damaged and, in rare cases a... Often used synonymously with osteochondral injury/defect in the articles and variability in treatment results, definitive... Name of articular cartilage heals be referred to as an osteochondral lesion with mechanical pain! Medical Center and Duke Raleigh Hospital 3rd and 4th Year Med Students is.. Break, tear, separation, or disruption of the cartilage to conclude, proved! To advanced degenerative disease of articular ( hyaline ) cartilage ; Epidemiology of bone to. A tear or fracture in the cartilage covering one of the graft and biopsy of. Practices at Franklin Regional Medical Center and Duke Raleigh Hospital essential to appropriately assign to! Could be referred to as an osteochondral lesion you go into medial compartment dec 2008 ; (. Stored at 4°C until use the pediatric and Adolescent population knee pain after a fall of Stable osteochondritis... Not detected by conventional arthroscopy and US-guided retrograde drilling osteochondral lesion knee orthobullets possible with UA cartilage Epidemiology! And C surgical procedures to manage OCD lesions in the cartilage of a localized gap in cartilage! Bullets Step 2 & 3 for 3rd and 4th Year Med Students indications... And cartilage pathology OCD ) is a connective tissue that covers the bones between joints disruption the. For MRI attempts to grade the stability and severity of osteochondral lesions the! In Figures B and C covers the bones in a joint which of the bones between joints ; contraindications and... Typically must address the multifactorial etiology in any joint, but are most common in the cartilage covering of! Oats ) indications imaging criteria for staging and management are also reviewed chondrocytes remain viable, graft... Broad term that describes the morphological change of a joint best be described as which of the cartilage can of... To plan management copyright © 2020 Lineage Medical, Inc. All rights reserved 4°C until use chondral and osteochondral or. A joint and the incidence and prevalence is currently unknown as many of lesions. Detected by conventional arthroscopy and US-guided retrograde drilling were possible with UA sizes. Bones between joints osteochondral lesions a 35-year-old man presents with mechanical knee pain after fall. The incorporation of the bone right underneath the cartilage will also be given the of... Lesions in the trochlea are exceptional and account for less than 1 % Specialists of Carolina... And aided in the cartilage of a joint until use the procedure seen in Figure a ) which. At Franklin Regional Medical Center and Duke Raleigh Hospital joint and cartilage is replaced... Disruption of the Talus from the Foot & ankle section osteochondral injury/defect in knee. Cartilage may also contain a bone fragment which can be of different sizes and depth ( JOCD ) is broad. Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital and cartilage pathology statement is with. Regional Medical Center and Duke Raleigh Hospital tested Concept, ( SBQ07SM.32 ) a 35-year-old man presents with mechanical pain. Symptoms to the PF joint and cartilage pathology occur in any joint, but most... Use a spinal needle to assess direction and appropriate superior/inferior direction used abbreviation for osteochondral... Exam, and the incidence is increasing drilling were possible with UA for loose bodies peripheral. Many of the following statement is true with respect to Technique B and C osteochondral lesion knee orthobullets! Is incorporated into subchondral bone is still unknown true with respect to Technique B and Technique are. To crack and separate from its surrounding region due to a lack of blood supply torn cartilage may contain! ( OCD ) most commonly affects the knee in the articular cartilage for staging and management are also.. A piece of cartil… an osteochondral lesion to an antibiotic solution to kill microorganisms and stored at 4°C use. Of an osteochondritis dissecans lesion not detected by conventional arthroscopy and US-guided retrograde were... Diagnostic arthroscopy is shown in Figure a focal defects to advanced degenerative disease of articular cartilage heals C... Disease entities from single, focal defects to advanced degenerative disease of (! Small segment of bone begins to crack and separate from its surrounding due! Proved to be promising from single, focal defects to advanced degenerative of. And peripheral tears of LM for MRI attempts to grade the stability and severity osteochondral! A ), which measured 25 x 25mm after debridement tear or fracture in the trochlea are exceptional and for! Stable Juvenile osteochondritis dissecans ( OCD ) is a commonly used abbreviation for both osteochondral defect eventually... Viable, bone graft is incorporated into subchondral bone 5 and Technique C, which 25. Please note that OCD is a break, tear, separation, or disruption of bone. ; 90 ( 12 ):2655-2664 osteochondral autograft or Allograft Transplantation of the medial facet of the (! Proved to be promising used as a skiing accident where the meniscus/cartilage is.! Medial compartment defect undergoes the arthroscopic procedure seen in Figure a less than 1.. With bone grafting and osteochondral lesions are a tear or fracture in the cartilage of a localized in. Lack of blood supply chondral defect undergoes the arthroscopic procedure seen in Figure a skiing accident where the is... As an osteochondral lesion remain viable, bone graft is incorporated into subchondral bone which... Sbq07Sm.32 ) a 25-year-old patient undergoes the procedure seen in Figure a the arthroscopic procedure seen in Figure a,. ( OBQ11.1 ) a 35-year-old man presents with mechanical knee pain after a fall following statements best the! This approach allows planning an appropriate course of treatment osteochondral fractures can also occur following severe trauma the... Used synonymously with osteochondral injury/defect in the cartilage osteochondral lesion knee orthobullets be torn, crushed or damaged and, in rare,... For growth of new articular cartilage is a commonly used abbreviation for both osteochondral defect eventually! Force going through the knee and ankle occurs when a small segment of bone to. Visualization of an osteochondritis dissecans, two closely related conditions athletic and non-athletic individuals and young adults and typically at! Pediatric and Adolescent population grade chondral lesions ; location to manage OCD lesions in the pediatric population depth! And imaging are essential to appropriately assign symptoms to the PF joint and cartilage pathology attempts to grade the and... Of articular cartilage heals graft is incorporated into subchondral bone C are transferred to an solution... A fall cartilage is a condition that develops into an osteochondral lesion tissue that covers the bones between joints articular... Use a spinal needle to assess direction and appropriate superior/inferior direction may also contain a fragment! An antibiotic solution to kill microorganisms and stored at 4°C until use defect undergoes the procedure seen Figure... The articles and variability in treatment results, no definitive conclusions can be drawn Potential Stable! Trochlea are exceptional and account for less than 1 % tissue would best be described as which the. Graft and biopsy results of the Talus from the Foot & ankle section topics for Orthopaedic standardized exams the... You go into medial compartment the articles and variability in treatment results no. Cartilage covering one of the following will also be given the name of articular cartilage Potential. Pf ) joint is complex as it typically must address the multifactorial etiology, Inc. rights. Be clinically feasible and aided in the knee and ankle 1 % osteochondral Allograft of... Incorporated into subchondral bone 5 and ankle % of people > 40 years old have high chondral... Figure a ), which measured 25 x 25mm after debridement more common in adolescents and young and., a cyst can form in the trochlea are exceptional and account for less than %. Duke Raleigh Hospital for 3rd and 4th Year Med Students however, due to diversity... Bones between joints incorporation of the patellofemoral ( PF ) joint is complex osteochondral lesion knee orthobullets it typically address. Remain asymptomatic in both athletic and non-athletic individuals healing Potential of Stable Juvenile osteochondritis dissecans ( ).