Currently, most surgeons have abandoned the older methods in favor of microfracture, which is usually performed in an all-arthroscopic fashion. Neither Dr. Mangan nor any immediate family member has received anything of value from or has stock or stock options held in a commercial… The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. If you've injured your joint and your symptoms are not too severe – for example, you're still able to put weight on and move the joint – you can often look after yourself using PRICE therapy. Restorative cartilage repair techniques such as autologous chondrocyte implantation (ACI) introduce chondrogenic cells into the defect area, resulting in the formation of a repair tissue that more closely resembles the collagen type-II rich hyaline cartilage. The original technique of ACI was developed in the 1980s, Cartilage replacement techniques include osteochondral autograft and allograft transfers, such as the osteochondral autograft transfer system (OATS; Arthrex, Naples, FL), mosaicplasty (Smith & Nephew, Andover, MA), and mega-OATS techniques. Five surgical procedures to manage OCD lesions in the knee. The treatment of chondral defects with fresh osteochondral allografts has garnered significant attention because of its potential to restore and resurface even extensive areas of damaged cartilage and bone. This was achieved by substitution of periosteum with a collagen membrane, frequently consisting of a porcine type-I/III collagen bilayer membrane. Treatment Options Articular cartilage has no blood supply and its ability to repair itself is poor. What are the options for treating a chondral defect of the knee caused by sports trauma? Osteochondral allograft transplantation is used predominantly in the treatment of large and deep osteochondral lesions resulting from OCD, osteonecrosis, and traumatic osteochondral fractures, but it can also be used to treat peripherally uncontained cartilage and bone defects. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions. ACI is indicated for the treatment of medium to large chondral defects with no or shallow associated osseous deficits. Much of this bone is covered with cartilage. Issue: ... have been described as suitable treatment options. CONCLUSION: Osteochondral allograft transplantation is a useful salvage treatment option for reciprocal bipolar cartilage lesions of the knee. Transchondral drilling for osteochondritis dissecans of the medial condyle of the knee, Osteochondral autograft transplantation for juvenile osteochondritis dissecans of the knee: a series of twelve cases, Juvenile Osteochondritis Dissecans of the Knee: Predictors of Lesion Stability, Extraarticular Drilling for Stable Osteochondritis Dissecans in the Skeletally Immature Knee. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. This chapter provides an overview of the existing techniques and supporting data in an attempt to guide surgeons in their indications for the treatment of cartilage defects of the knee. How to Treat an Osteochondral Lesion: Brace Even though wearing a cast or a brace might help to alleviate some of the pain caused from the lesion, they are often not enough to correct the problem on a permanent basis, except for children who tend to respond good a to non-surgical approach. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or … ACI in its current form is a two-stage procedure with an initial arthroscopic cartilage biopsy, followed by a staged reimplantation through an arthrotomy. Treatment may include activity modification, drilling, fixation, or osteochondral replacement of osteochondritis dissecans lesions in the knee. Unlike hyaline cartilage, this fibrocartilage largely consists of type I collagen and is mechanically less stable and less durable.5 The pluripotential marrow-derived cells may also form bone, another mode of MST-related failure that is increasingly becoming recognized.6 Although closely related, MSTs vary by the degree of trauma to the subchondral bone, which has been recognized as a factor in the failure of these techniques. It serves as al low friction high wear resistance surface to ideal provide mobility and strength. The talus is the bottom bone of the ankle joint. Simple arthroscopic lavage and debridement of lesions has been used since the 1940s in an effort to reduce symptoms resulting from loose bodies and cartilage flaps, and it is a common first-line treatment, especially for coincidental defects. Patients are approximately evenly split in reporting a traumatic versus an insidious onset of symptoms; athletic activities are the most common inciting event associated with the diagnosis of a chondral lesions.1 Traumatic events and developmental causative agents such as osteochondritis dissecans (OCD) predominate in younger age groups. An allograft is usually used when cartilage defect being treated is too large for an autograft (≥2cm). Furthermore, osteochondral allografting presents a viable salvage option after failure of other cartilage resurfacing procedures. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Before the development of modern bioengineering techniques, orthopedists were restricted to procedures that aimed to palliate the effects of chondral lesions or attempted to stimulate a healing response initiated from the subchondral bone resulting in the formation of fibrocartilage to fill the defect. Marrow stimulation techniques (MST), such as abrasion arthroplasty, drilling, and microfracture, attempt to induce a reparative response by perforation of the subchondral bone after radical debridement of damaged cartilage and removal of the tide mark “calcified” zone to enhance the integration of repair tissue. Osteochondral allograft transplantation is used predominantly in the treatment of large and deep osteochondral lesions resulting from OCD, osteonecrosis, and traumatic osteochondral fractures, but it can also be used to treat peripherally uncontained cartilage and bone defects. Within the ankle, these lesions often occur on the talus, which is the bone that joins the foot and the leg together. What Are the Best Diagnostic Criteria for Lateral Epicondylitis? It serves as al low friction high wear resistance surface to ideal provide mobility and strength. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. A large knee osteochondral lesion treated using a combination of osteochondral autograft transfer and second-generation autologous chondrocyte implantation: A case report Regen Ther . 2013;41(3):528-34. Large osteochondral defects involving the femoral condyles of the knee have frustrated orthopaedic surgeons for generations. Long implicated in the subsequent development of osteoarthritis, focal chondral defects result from various causative factors. The causes of osteochondral injuries are not yet completely understood, but some theories are lack of blood supply to the affected area, heredity, direct compressive trauma or repetitive strain. The widely published treatment strategies of symptomatic osteochondral lesions include the non-surgical treatment with rest or cast immobilization, and surgical excision of the lesion, excision and curettage, excision combined with Author information: (1)Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran. The original technique of ACI was developed in the 1980s7 and has been used in the United States to treat more than 10,000 patients since its approval by the U.S. Food and Drug Administration (FDA) in 1997. Furthermore, osteochondral allografting presents a viable salvage option after failure of other cartilage resurfacing procedures. Marrow stimulation techniques (MST), such as abrasion arthroplasty, drilling, and microfracture, attempt to induce a reparative response by perforation of the subchondral bone after radical debridement of damaged cartilage and removal of the tide mark “calcified” zone to enhance the integration of repair tissue. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. What Is the Best Treatment for Posterior Tibial Tendonitis? Before the development of modern bioengineering techniques, orthopedists were restricted to procedures that aimed to palliate the effects of chondral lesions or attempted to stimulate a healing response initiated from the subchondral bone resulting in the formation of fibrocartilage to fill the defect. Simple arthroscopic lavage and debridement of lesions has been used since the 1940s in an effort to reduce symptoms resulting from loose bodies and cartilage flaps, and it is a common first-line treatment, especially for coincidental defects. Osteochondral autograft transplantation is used to address small to medium defects (1–4 cm 2), often with associated bone loss. Studies have shown that these lesions tend to progress in size and severity, affecting the rest of the articular cartilage and predisposing you to suffer from an early onset of arthritis, Once an osteochondral defect occurs, it must be identified and treated accordingly. Recent MR scanning techniques such as MR arthrography, magnetization transfer imaging, and fast spin echo sequences have improved the visualization of chondral defects. Currently, to our knowledge, there are no data regarding which MRI features may predict improved outcomes in these patients. However, there are limited data regarding the management of large lesions in an athletic population, notably with regard to … BACKGROUND: Autologous osteochondral transplantation (AOT) has been shown to be a viable treatment option for large osteochondral lesions of the talus. Although wearing a brace or cast may ease the discomfort of an osteochondral lesion, they are usually not enough to remedy the problem permanently, except in children, who can respond well to … Shorter duration of symptoms before cartilage repair results in better outcomes. ACI, autologous chondrocyte implantation; ACI-c collagen-covered autologous chondrocyte implantation; BMI, body mass index; MACI, membrane-associated autologous chondrocyte implantation. You are currently offline. Cartilage can be focally damaged, producing a “pot hole” in the joint surface, when the knee ligaments are injured. 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