Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. 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. Tested Concept, (SBQ07SM.32) Biopsy shows type I collagen. complete neurovascular exam of extremity. 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. Grafts in Technique C are transferred to an antibiotic solution to kill microorganisms and stored at 4°C until use. 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. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Am J Sports Med. the talar dome) in the ankle. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. The transplanted chondrocytes are viable and articular cartilage heals. bring knee into slight flexion and valgus as you go into medial compartment. look for loose bodies and peripheral tears of LM. Which of the following statement is true with respect to Technique B and C? Which of the following procedures is contraindicated? They can also occur following severe trauma to the knee such as a skiing accident where the meniscus/cartilage is damaged. 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. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. Actual surgical treatments for osteochondral lesions and early knee osteoarthritis seem to be promising. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Technique B is a single-stage procedure. In the talus, 96% of lateral lesions and 62% of … 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. A 35-year-old man presents with mechanical knee pain after a fall. 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). A thorough history, physical exam, and imaging are essential to appropriately assign symptoms to the PF joint and cartilage pathology. Dec 2008;90(12):2655-2664 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. In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone. The incidence and prevalence is currently unknown as many of the lesions remain asymptomatic in both athletic and non-athletic individuals. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. 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. The Orthobullets Podcast In this episode, we review the high-yield topic of Osteochondral Lesions of the Talus from the Foot & Ankle section. Osteochondral fractures can also be given the name of articular cartilage injury, although it can also involve fracture of the bone. The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. The bone right underneath the cartilage will also be injured. The transplanted chondrocytes are viable and articular cartilage heals. 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 The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. See osteochondritis dissecans article for a general discussion. 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) ortho BULLETS. 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). What surgical treatment would you recommend? Osteochondral knee lesions in adolescents are primarily located in loading areas at the level of the femoral condyles. The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. Osteochondral Allograft Transplantation of the Knee in the Pediatric and Adolescent Population. The reparative tissue would best be described as which of the following? osteochondral autograft or allograft transplantation surgery (OATS) indications. Copyright © 2020 Lineage Medical, Inc. All rights reserved. Tested Concept, Grade 4 lesion of the medial femoral condyle, Varus mechanical axis on standing full length radiograph, Concomitant anteromedial tibial tubercle transfer osteotomy (Fulkerson's), Osteochondral Plug Allograft Transfer of the Knee, Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, Fresh Osteochondral Allografts: Don't Waste Your Time With Other Things - Forget About Cell-Based Therapy - Thomas DeBerardino, MD, Cryopreserved, Flexible Allografts: Don't Give Up On Them - Seth Sherman, MD, MACI Is Now The Answer: Listen To Me! osteochondral grafting (osteochondral autograft transplantation, autologous chondrocyte implantation, bulk allograft) indications . All of the following are acceptable scenarios for the use of autologous chondrocyte implantation (ACI) in the patellofemoral joint EXCEPT: Tested Concept. The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions. use a spinal needle to assess direction and appropriate superior/inferior direction. 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. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 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. anterior aspect of lateral femoral chondyle and posterolateral tibial plateau 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. Imaging criteria for staging and management are also reviewed. 2014.42:635-640; Wall EJ, et al. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 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) This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. Tested Concept. incidence. Tested Concept, (OBQ11.1) cartilage injury with associated subchondral fracture but without detachment This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Lesions located in the trochlea are exceptional and account for less than 1%. Biopsy shows mixture of type I and II collagen. ... implanting a biomimetic osteochondral scaffold onto the lesion site, which was size > 1 cm and displaced lesions, shoulder lesions; salvage for failed marrow stimulation or drilling; contraindications. (OBQ13.203) A photograph from a recent diagnostic arthroscopy shows the defect (Figure A), which measured 25 x 25mm after debridement. ( hyaline ) cartilage ; Epidemiology Orthopaedic standardized exams including the ABOS, EBOT and RC ;.... Asymptomatic in both athletic and non-athletic individuals plan management seen in Figure a appropriate direction... 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