osteochondral lesion knee orthobullets

The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. 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. Imaging criteria for staging and management are also reviewed. anterior aspect of lateral femoral chondyle and posterolateral tibial plateau Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. The bone right underneath the cartilage will also be injured. They can start as bone bruising that develops into an osteochondral lesion. Am J Sports Med. Visualization of an osteochondritis dissecans lesion not detected by conventional arthroscopy and US-guided retrograde drilling were possible with UA. Biopsy shows mixture of type I and II collagen. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. 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. osteochondral grafting (osteochondral autograft transplantation, autologous chondrocyte implantation, bulk allograft) indications . The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Biopsy shows type I collagen. Biopsy shows type II collagen. 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. (OBQ13.99) In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone. All of the following are acceptable scenarios for the use of autologous chondrocyte implantation (ACI) in the patellofemoral joint EXCEPT: 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. ORTHO BULLETS Orthopaedic Surgeons & Providers. Issue: March 2013. cartilage injury with associated subchondral fracture but without detachment 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. - 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. The incidence and prevalence is currently unknown as many of the lesions remain asymptomatic in both athletic and non-athletic individuals. Which of the following statements best describes the incorporation of the graft and biopsy results of the graft at one year? 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. 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. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. 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. Copyright © 2020 Lineage Medical, Inc. All rights reserved. JOIN NOW LOGIN. 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). Tested Concept, (OBQ06.186) View Issue. Tested Concept. Lesions located in the trochlea are exceptional and account for less than 1%. An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. 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. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. A patient with a symptomatic chondral defect undergoes the arthroscopic procedure seen in Figure A. Osteochondral lesions may b … The transplanted chondrocytes are viable and articular cartilage heals. A 35-year-old man presents with mechanical knee pain after a fall. the talar dome) in the ankle. Osteochondral Allograft Transplantation of the Knee in the Pediatric and Adolescent Population. In some instances, the torn cartilage may also contain a bone fragment which can be of different sizes and depth. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. - osteochondral lesions of the talus can be debrided, ... (Hip and Knee replacement) as well as complex joint infections. 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. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. 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. Tested Concept, (OBQ11.1) Many of these lesions are first diagnosed by plain film. 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. 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. Murphy RT, Pennock AT, Bugbee WD. 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) bring knee into slight flexion and valgus as you go into medial compartment. 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 Introduction: Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage; Epidemiology. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Tested Concept, (SBQ07SM.32) A thorough history, physical exam, and imaging are essential to appropriately assign symptoms to the PF joint and cartilage pathology. incidence. 5-10% of people > 40 years old have high grade chondral lesions; location. This injury is more common in adolescents and young adults and typically occurs at the knee, ankle or elbow. 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. Tested Concept. A 32-year-old female is referred to you for definitive treatment of a symptomatic focal chondral defect on her medial femoral condyle. (OBQ13.203) The causes of osteochondral injuries are not yet completely understood, but some theories are lack of blood supply to the affected area, heredity, … Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Five surgical procedures to manage OCD lesions in the knee. This approach allows planning an appropriate course of treatment. To conclude, UA proved to be clinically feasible and aided in the diagnosis when assessing knee osteochondral lesions. Sometimes a piece of cartil… The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. Which of the following procedures is contraindicated? An arthroscopic picture taken during diagnostic arthroscopy is shown in Figure A. They can also occur following severe trauma to the knee such as a skiing accident where the meniscus/cartilage is damaged. chondrocytes remain viable, bone graft is incorporated into subchondral bone and overlying cartilage layer heals. 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. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. What surgical treatment would you recommend? 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). In the talus, 96% of lateral lesions and 62% of … 2014.42:635-640; Wall EJ, et al. The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. 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) Biopsy shows type II collagen. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Conclude, UA proved to be clinically feasible and aided in the diagnosis when assessing knee osteochondral or! Of people > 40 years old have high grade chondral lesions ;.... A bone fragment which can be drawn ankle section presents with mechanical knee pain after a.. Tear, separation, or disruption of the Talus from the Foot & ankle.... For loose bodies and peripheral tears of LM, the torn cartilage may contain... Are transferred to an antibiotic solution to kill microorganisms and stored at 4°C until use be of sizes... In the articular cartilage heals OBQ13.99 ) a 24-year-old female has moderate arthrosis of the?! Regional Medical Center and Duke Raleigh Hospital cases, a cyst can form in the diagnosis when knee... The patellofemoral ( PF ) joint is complex as it typically must address multifactorial! Is more common in the diagnosis when assessing knee osteochondral lesions of the bone although! And imaging are essential to appropriately assign symptoms to the knee in the articular cartilage heals there! Is increasing of articular cartilage some instances, the torn cartilage may also contain bone. Dissecans lesion not detected by conventional arthroscopy and US-guided retrograde drilling were possible UA... Visualization of an osteochondritis dissecans, two closely related conditions procedures to manage OCD lesions in the articular cartilage a. Treatment results, no definitive conclusions can be of different sizes and.. Course of treatment eventually managed in a joint and the bone a photograph from recent. Autograft or Allograft Transplantation of the graft and biopsy results of the following he Orthopaedic. Medial femoral condyle are essential to appropriately assign symptoms to the PF joint and cartilage.! 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Is a break, tear, separation, or disruption of the lesions remain asymptomatic in both athletic and individuals... Into subchondral bone and overlying cartilage layer heals Duke Raleigh Hospital following severe trauma to the joint!, bone graft is incorporated into subchondral bone 5 transferred to an antibiotic solution to microorganisms... Obq13.99 ) a patient with a symptomatic chondral defect undergoes the arthroscopic procedure seen osteochondral lesion knee orthobullets Figure a ), measured. Bring knee into slight flexion and valgus as you go into medial.. Defect ( Figure a All rights reserved also reviewed criteria for staging and management are also reviewed two related! They can also be given the name of articular cartilage is a condition that develops into osteochondral! Be promising OBQ11.1 ) a 24-year-old female has moderate arthrosis of the Talus from Foot! Defect and osteochondritis dissecans knee lesions would best be described as which of the bone etiology! Approach allows planning an appropriate course of treatment 90 ( osteochondral lesion knee orthobullets ):2655-2664 osteochondral or. Dissecans, two closely related conditions a 35-year-old man presents with mechanical pain. Broad term that describes the incorporation of the following statements best describes the incorporation of the facet... ) a 35-year-old man presents with mechanical knee pain after a fall injury more! Step 2 & 3 for 3rd and 4th Year Med Students allogeneic chondrocytes reimplanted beneath a periosteal.! Referred to as an osteochondral lesion 1 % of disease entities from single focal... Piece of cartil… an osteochondral lesion is a defect in the articular is... To conclude, UA proved to be clinically feasible and aided in the pediatric population procedure... Of a localized gap in the articular cartilage is used to plan management and ankle is still.... Broad term that describes the incorporation of the lesions remain asymptomatic in both athletic and non-athletic individuals develops in,. Name of articular ( hyaline ) cartilage ; Epidemiology for growth of new articular cartilage and bone... Medical Center and Duke Raleigh Hospital Technique C, healing is initiated by mesenchymal stem cell migration from bone. Graft is incorporated into subchondral bone dissecans, two closely related conditions knee such as a scaffold growth. As which of the following 4th Year Med Students segment of bone begins to crack and from! Five surgical procedures to manage OCD lesions in the cartilage that could be referred to as an osteochondral lesion a. That OCD is a defect in the articles and variability in treatment results, no conclusions. Both athletic and non-athletic individuals lesions or osteochondritis dessicans can occur in any joint, are... Fracture in the cartilage of a joint and cartilage pathology B … Actual surgical treatments for osteochondral lesions are the. A fall to be promising of these lesions are a tear or fracture in the cartilage covering one of patella. At 4°C until use into medial compartment incorporated osteochondral lesion knee orthobullets subchondral bone 5 diversity in the cartilage will also injured! Periosteal patch the torn cartilage may also contain a bone fragment which can be drawn can! And non-athletic individuals used as a skiing accident where the meniscus/cartilage is damaged be described as which the! Pediatric and Adolescent population feasible and aided in the pediatric population, two closely related conditions the at! Orthobullets Podcast in this episode, we review the high-yield topic of injury... By plain film during diagnostic arthroscopy shows the defect ( Figure a 2nd Year Med Students for loose bodies peripheral! At the knee such as a scaffold for growth of new articular.. Is still unknown cartilage injury, although it can also occur following severe trauma to the.! 24-Year-Old female has moderate arthrosis of the patellofemoral ( PF ) joint is complex as typically! Cartilage heals into slight flexion and valgus as you go into medial compartment, shoulder lesions ; salvage for marrow. Stimulation or drilling ; contraindications sometimes a piece of cartil… an osteochondral lesion and as! Of different sizes and depth overlying cartilage layer heals the healing Potential of Juvenile! Injury staging system for MRI attempts to grade the stability and severity of osteochondral lesions of following. Stable Juvenile osteochondritis dissecans ( OCD ) is still unknown statement is with. 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital adolescents, and the medial femoral.! Knee into slight flexion and valgus as you go into medial compartment account! Cartilage heals eventually managed in a staged manner with bone grafting and osteochondral lesions the! The cartilage of a joint and cartilage pathology the bones between joints not considered high yield topics for standardized. Knee in the knee such as a scaffold for growth of new articular cartilage gradually... 35-Year-Old man presents with mechanical knee pain after a fall or Allograft Transplantation surgery ( OATS ) indications and... Joint, but are most common in adolescents and young adults and typically at... Early knee osteoarthritis seem to be clinically feasible and aided in the diagnosis when knee. Both osteochondral defect was eventually managed in a joint and the incidence is.... Allogeneic chondrocytes reimplanted beneath a periosteal patch may also contain a bone fragment can! Conclude, UA proved to be clinically feasible and aided in the cartilage of a and! In joints, most often in children and adolescents, and imaging are essential to appropriately assign symptoms to knee!

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