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 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. In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone. In the talus, 96% of lateral lesions and 62% of … This approach allows planning an appropriate course of treatment. The causes of osteochondral injuries are not yet completely understood, but some theories are lack of blood supply to the affected area, heredity, … It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. chronic ACL tear. Issue: March 2013. The Orthobullets Podcast In this episode, we review the high-yield topic of Osteochondral Lesions of the Talus from the Foot & Ankle section. Biopsy shows type I collagen. 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. 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. anterior aspect of lateral femoral chondyle and posterolateral tibial plateau (OBQ13.203) An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. J Bone Joint Surg Am. Cartilage is a connective tissue that covers the bones between joints. - osteochondral lesions of the talus can be debrided, ... (Hip and Knee replacement) as well as complex joint infections. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondral lesions may b … Treatment of chondral and osteochondral lesions of the patellofemoral (PF) joint is complex as it typically must address the multifactorial etiology. Introduction: Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage; Epidemiology. osteochondral autograft or allograft transplantation surgery (OATS) indications. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. An arthroscopic picture taken during diagnostic arthroscopy is shown in Figure A. incidence. This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Which of the following statements best describes the incorporation of the graft and biopsy results of the graft at one year? Lesions located in the trochlea are exceptional and account for less than 1%. 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). They can start as bone bruising that develops into an osteochondral lesion. Imaging criteria for staging and management are also reviewed. bring knee into slight flexion and valgus as you go into medial compartment. Tested Concept, (SBQ07SM.32) Technique B is a single-stage procedure. What type of tissue is formed by the activation of marrow mesenchymal cells following subchondral drilling of an 8x7 mm osteochondral defect? ... implanting a biomimetic osteochondral scaffold onto the lesion site, which was The transplanted chondrocytes are viable and articular cartilage heals. The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion. size > 1 cm and displaced lesions, shoulder lesions; salvage for failed marrow stimulation or drilling; contraindications. The bone right underneath the cartilage will also be injured. In some instances, the torn cartilage may also contain a bone fragment which can be of different sizes and depth. This injury is more common in adolescents and young adults and typically occurs at the knee, ankle or elbow. use a spinal needle to assess direction and appropriate superior/inferior direction. To conclude, UA proved to be clinically feasible and aided in the diagnosis when assessing knee osteochondral lesions. Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? Osteochondral fractures can also be given the name of articular cartilage injury, although it can also involve fracture of the bone. (OBQ13.152) 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. His surgeon considers treatment with Technique B and Technique C, which are shown in Figures B and C, respectively. Which of the following procedures is contraindicated? The incidence and prevalence is currently unknown as many of the lesions remain asymptomatic in both athletic and non-athletic individuals. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. Visualization of an osteochondritis dissecans lesion not detected by conventional arthroscopy and US-guided retrograde drilling were possible with UA. Sometimes a piece of cartil… Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Tested Concept. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Am J Sports Med. 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. 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