2011 Dec;97(8 Suppl):S140-53. Surgical intervention (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. An osteochondral defect can occur acutely or develop as a result of several chronic conditions including (a) separation of the osteochondral fragment caused by an acute traumatic injury or as the end result of an unstable fragment in osteochondritis dissecans (OCD), (b) acute osteochondral … In fact, … Treatment of knee cartilage defect in 2010. Based on multiple studies demonstrating similar functional outcomes after both conservative and operative procedures for treatment of APD, Conservative treatment has been traditionally the preferred option for APD without an osteochondral … For nondisplaced lesions, conservative treatment is attempted initially; however, a low threshold is set for surgical intervention. He ambulated with an antalgic gait, using a cane and wearing a knee sleeve. Débridement, drilling, microfracture, and abrasion chondroplasty have been shown to result in fibrocartilage with inferior mechanical properties when compared with hyaline cartilage. Optimal surgical intervention should treat the OCD as well as prevent early onset, or the progression of already present, osteoarthritis (Versier & Dubrana, 2011). Here is presented two cases of symptomatic OCDs of the knee with associated imaging. For failed fixation attempts or lesions not amenable to fixation, each treating surgeon must be proficient and comfortable with an articular surface reconstruction technique. There was no ligamentous laxity. The Cochrane Database of Systematic Reviews, 9, CD010675. Management of osteochondritis dissecans of the knee: Current concepts review. No evident fracture, dislocation, or other osseous abnormality to explain patient's symptoms. Nonsurgical treatment. The second case was that of a 58-year-old man who presented with about a month of worsening left anterior knee pain. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. He noted tenderness about the patella and a positive patellar grind. 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. For larger defects — including those greater than 3 cm to 4 cm in diameter — Scuderi recommends osteochondral allograft transplantation. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. USA.gov. This may be useful to all… “The literature on conservative treatments for knee Osteochondritis dissecans is scarce. Upon presentation, he was as an alert, oriented, affect-appropriate male in no apparent distress. Surgical treatments of cartilage defects of the knee: Systematic review of randomized controlled trials. He described an aching and throbbing pain of the knee. Most nondisplaced lesions in the patient with open physes will heal with conservative treatment. NLM 2019 Mar 25;16(4):308-311. doi: 10.1016/j.jor.2019.02.030. COVID-19 transmission: Is this virus airborne, or not? Medicine and Science in Sports and Exercise, 42(10), 1795-1801. The choice of treatment will depend on the size of the defect, its location, and the patient’s goals. Ellipse about osteochondral defect with underlying bony edema. Clinics in Sports Medicine, 20(2), 321-342. Treatment algorithm for osteochondral injuries of the knee. Guidance for PPE use in the COVID-19 pandemic. Sizing the defect appropriately and matching this defect with that of the cadaver knee can sometimes be a time-consuming and expensive process. 2019 Mar 22;16(4):284-287. doi: 10.1016/j.jor.2019.03.001. Epub 2018 Jun 26. Am J Sports Med 2012; 40(11):2499-508. The lesion is treated as a pure chondral lesion with … Epub 2015 Oct 12. [Treatment of Osteochondral Lesions in the Ankle: A Guideline from the Group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU)]. Gradual strengthening of the injured joint, … © 2020 Wolters Kluwer Health, Inc. and/or its subsidiaries. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee …  |  For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. doi: 10.1016/j.otsr.2011.09.007. These include medications, physical therapy, possibly injections, and other options. Gudas R, Kalesinskas RJ, Kimtys V et al. Orthopedic & Traumatology, Surgery & Research, 97(8), 140-153. In-Vitro Detection of Small Isolated Cartilage Defects: Intravascular Ultrasound Vs. Optical Coherence Tomography. Since 1922 when this syndrome was first described by Kappis [], numerous terms have been used to describe chondral lesion of the dome of the talus including osteochondral fracture, … Neglected Pediatric Osteochondral Fracture Dislocation of the Patella. Large, focal articular cartilage defects of the knee (> 4 cm) can be a source of significant … Those on the tibia and kneecap (patella) are harder to treat and the results are not as reliable. When patients are properly selected, results of non-operative treatment for JOCD of the knee are very successful. Prevention of Osteochondral Defect. ... Outerbridge AR, Outerbridge RE. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondral defects (OCDs), often used interchangeably with osteochondritis dissecans in the juvenile population, are focal areas of articular cartilage wear/damage resulting in a loss of cartilage and inflammation of the adjacent subchondral bone (Juneau et al., 2016; Modarresi & Jude, 2015; Wheeless, 2012). Current review of literature indicates there is no single intervention that can be generally recommended as superior for the treatment of symptomatic OCDs of the knee (Devitt, Bell, Webster, Feller, & Whitehead, 2017; Gracitelli et al., 2016; Millington et al., 2010). The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects … Although the results of many reconstructive procedures are quite encouraging with early follow up, the ultimate goal is to prevent long-term degenerative arthritis. Sagittal T2- and T1-weighted images as well as axial T2-weighted images (respectively). UpToDate. He displayed positive bounce home, patellar grind, patellar tilt, and Clarke's tests. Anteroposterior and lateral views of the right knee. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Conservative treatment … Prior surgical … eCollection 2019. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. A period of immobilization might be necessary after surgery. Further research, optimally with randomized control trials of these various surgical interventions, is needed to define the best potential surgical intervention for the treatment of isolated OCDs (Devitt et al., 2017; Gracitelli et al., 2016; Millington et al., 2010). Autologous bone graft can be necessary to stimulate healing and properly reconstruct the subchondral bony contour. the treatment of osteochondral defects in the knee joint of athletes. She displayed positive bounce home, McMurray's, Thessaly's, and Apley's compression tests. Autologous chondrocyte transplantation (ACT), osteochondral autografts and allografts have been reported as a treatment for articular disorders other than the knee, including the ankle (talus), elbow, … Sagittal and coronal T1- and T2-weighted images (respectively). Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. With this finding, it was recommended the patient to undergo MRI to confirm the presence of an OCD (see Figure 4), which was evident on that study. There was no gross deformity, discoloration, or abnormal warmth about the knee. Treatment options include: non-operative conservative therapy (including but not limited to modification of activity, injections, casting, or boots), various surgeries like “microfracturing” the affected bone which … [Context Link], Gracitelli G. C., Moraes V. Y., Franciozi C. E., Luzo M. V., Belloti J. C. (2016). The MRI was significant for an OCD of the lateral femoral condyle (see Figure 2). COVID-19 is an emerging, rapidly evolving situation. Clipboard, Search History, and several other advanced features are temporarily unavailable. What Are the Treatment Options for a Patient With a Cartilage Defect? Management of Large Focal Chondral and Osteochondral Defects in the Knee. Acute patellar dislocation (APD) is associated with a spectrum of soft tissue and osteochondral injuries. 2018 Nov;46(11):1745-1755. doi: 10.1007/s10439-018-2073-z. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. In discussing options for surgical intervention, the advanced practice provider should understand there are multiple options for intervention based on the location and size of the OCD, as well as patient-specific factors such as age, activity level, body mass index, and presence of osteoarthritis (Cain & Clancy, 2001; Juneau et al., 2016). Range of motion was smooth and symmetrical, with noted lateral discomfort at end ranges. Chondral defects are difficult to treat and can sometimes require surgical repair if all conservative measures have failed. However, there is no current literature providing definitive timing for operative treatment. In these … Richter DL, Schenck RC Jr, Wascher DC, Treme G. Sports Health. Current concepts in the treatment of patellofemoral osteochondritis dissecans. [Context Link], Millington K. L., Shah J. P., Dahm D. L., Levy B. (2010). Options for surgical intervention include debridement, drilling, microfracture, abrasion chondroplasty, mosaicplasty, and allograft or autograft transplantation (Cain & Clancy, 2001; Gracitelli, Moraes, Franciozi, Luzo, & Belloti, 2016; Juneau et al., 2016; Millington, Shah, Dahm, Levy, & Stuart, 2010). Stable ligamentous testing and equal strength were noted. 2019 Oct 21;2019:2904782. doi: 10.1155/2019/2904782. Clin Sports Med. Many new procedures and techniques have been developed recently to address osteochondral lesions, indicating that no single procedure is accepted universally. Cain E. L., Clancy W. G. (2001). Chondral and osteochondral injuries. Figure 4. The exact incidence and prevalence within the general population are unknown but have been reported as high as 62% in those patients requiring arthroscopic intervention for knee pain (Flanigan, Harris, Trinh, Siston, & Brophy, 2010). Purpose of review: Osteochondritis dissecans (OCD) of the knee is a well-described condition that can cause significant morbidity in children and adolescents; timely diagnosis is key to preventing … Treatment is split up into three grades, depending on how severe the injury is: Grade 1: This treatment doesn’t require any invasive procedures. Osteochondral defects (OCDs), often used interchangeably with osteochondritis dissecans in the juvenile population, are focal areas of articular cartilage wear/damage resulting in a loss of cartilage and inflammation of the adjacent subchondral bone (Juneau et al., 2016; Modarresi & Jude, 2015; Wheeless, 2012). On sunrise, note the lucency of posterior patella (ellipse), which is concerning for an osteochondral defect. May/June 2017, Volume :36 Number 3 , page 237 - 239 [Free], Join NursingCenter to get uninterrupted access to this Article. In Wheeless' textbook of orthopaedics. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. He noted a history of osteoarthritis, intermittent "flares" related to this, but had never previously experienced symptoms of this severity. Epub 2011 Oct 28. The knee was sore and aching at the time, but she figured it was simply related to her previous inactivity. 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 … eCollection 2018 Sep. Horeman T, Buiter EC, Pouran B, Stijntjes M, Dankelman J, Tuijthof GJM. 2018 Sep 19;6(9):2325967118798355. doi: 10.1177/2325967118798355. Orthop Traumatol Surg Res. Diagnosis and management. The goal of conservative nonoperative treatment is to promote healing of lesions in situ and prevent lesion displacement. He also noted a throbbing pain when seated with knees flexed as with riding in the car. All rights reserved. Ellipse and arrows highlighting osteochondral defect with underlying bony edema. In the knee… [Context Link], Devitt B. M., Bell S. W., Webster K. E., Feller J. Treatments. Upon presentation, she was an alert, oriented, affect-appropriate female in no apparent distress. Flexed as with riding in the cartilage can be torn, crushed or and! 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