The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. Osteochondral autograft is used for smaller cartilage defects. 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]. 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. We have dealt with the actual ligament injury and its repair, treatment of peroneal tendon injuries and also conservative care of ankle injuries. 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. The severity of your injury will determine what treatment you will receive. 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. The defects cause deep ankle pain associated with weightbearing. 2007; 89(4):718–726. 1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. Intra‐articular osteochondral fracture has a certain ability for self‐repair. 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. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Treatment is variable depending upon the size of the bone fragment, age of the patient and activity level of the patient. The ideal lesion for this treatment is the focal chondral or osteochondral defect on the femoral condyle or talus in a young patient. You may feel pain primarily at the lateral (outside) or medial (inside) point of the ankle joint. An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 3 Radiographs of an ankle with a centromedial talar osteochondral defect at the time of follow-up. Normal surrounding hyaline cartilage reduces boundary shear and improves outcome. It can be done with an arthroscope. Page . A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral lesions most often result from an injury, such as a sprain. 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. This is done using arthroscopic techniques. Fig. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. Fresh stored allografts for the treatment of osteochondral defects of the knee. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. An osteochondral defect, also known as a Talar dome lesion, is a spot where the cartilage has been damaged or worn through. 16 Allograft transplantation can be used to repair larger defects. J Bone Joint Surg Am. 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 … 3-A) and heel-rise (Fig. If the defect is too large, then an osteochondral graft (OATS-osteoarticular transfer system) is necessary. 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 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. Purpose: Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. However, the major disadvantage of the microfracture technique is that the durability of fibrocartilage tissue is inferior to normal hyaline cartilage . This prevents the need from harvesting bone and cartilage from another part of the body (ex. knee). 10. Osteochondral allografts (Cadaver grafts) have been used to treat large talar lesions with some success. 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. Treatment . Osteochondral Allograft Transplantation. 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. This is because the healthy graft tissue can only be taken from a limited area of the same joint. The broad term “osteochondral lesion of the talus” describes an injury or abnormality of the talar articular cartilage and adjacent bone. Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. doi: 10.2106/JBJS.F.00625 10. OCD usually causes pain during and after sports. II. Both operative and nonoperative treatments may be indicated. Chondral defects of the knee are important to thoroughly evaluate to determine the best treatment regimen. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Persistent pain in spite of appropriate treatment after several months may raise concern for an OLT. When filling osteochondral defects in the knee, surgeons have a list of treatment options to choose from and more options are in the works. Treatment Options for Osteochondral Defect. Symptomatic osteochondral ankle defects often require surgical treatment. Active infection (local or systemic) 2. 3. of . Terminology. Articular cartilage lesions are common and have been reported in 63% of over 31,000 arthroscopic procedures in one series.1 … 3-C). 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. 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. If a cartilage defect is too large for an autograft, an allograft may be considered. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: Ten years of experimental and clinical experience Article Feb 2003 A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Osteochondral defects generally linger or get worse unless they’re treated. 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. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Clinicians have used variety of terms to describe these injuries, including osteochondritis dissecans, osteochondral defect or osteochondral fracture. If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. 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. Large osteochondral defects involving the femoral condyles of the knee have frustrated orthopaedic surgeons for generations. Treatment is split up into three grades, depending on how severe the injury is: Grade 1: This treatment doesn’t require any invasive procedures. 3-B) views; the defect cannot be detected on the lateral view (Fig. 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). Cartilage defects and osteoarthritis are acknowledged as a disease of the entire osteocartilaginous unit, rather than a disorder limited to the surface cartilage alone. Treatment of Osteochondral Defects. 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"). One kind of surgical treatment is microfracture surgery, where the surgeon creates small holes in the cartilage defect to help stimulate cartilage growth. Immobilization. Non-Surgical Treatment for Osteochondral Defect. 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. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. After acute articular surface fracture, the defect of bone and cartilage is filled with fibrin clot 5. 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