When you have total knee replacement (TKR) surgery, recovery and rehabilitation is a crucial stage. Pool therapy and bicycling are usually started within 2 weeks. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. Allograft: A tissue graft is obtained from a donor knee and made to fit the patient knee. The General Hospital Corporation. The long-term effects on the harvested area are still unknown, as is the long-term performance of the transplanted cartilage. Autograft: A cartilage and bone from another site in the knee in the patient’s own body. Osteochondral lesions of the talus: aspects of current management. There are a number of treatment options. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). This is the standard operative treatment and leads to good or excellent results in 75-80% of patients with typical talar OCLs (less than 15mm²), Osteochondral Autologous Autograft Transfer (OATs Procedure) An OATs-type procedure is reserved for patients who have been treated with arthroscopic cleaning out (debridement) and microfracture and are still not doing well, or patients that have a very large (>20mm²) talar OLT. The lesions size went from 2 cm2 to 6 cm2. The most commonly affected joint is the knee, with the majority of lesions located in the femoral condyle and/or patellofemoral articulation (Wheeless, 2012). This injury is more common in adolescents and young adults and typically occurs at the knee, ankle or elbow. It is a block of cartilage and bone that can be shaped to fit the exact contour of the defect and then pressed into place. OLTs on the top outside part of the talus (Antero-lateral lesions) usually have a history of a traumatic injury with a twisting component, such as an ankle sprain. THE SITE MAY OFFER HEALTH, FITNESS, NUTRITIONAL AND OTHER SUCH INFORMATION, BUT SUCH INFORMATION IS DESIGNED FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY. When an unexpected chondral or osteochondral lesion is found during surgery or when simple debridement of damaged tissue does not suffice, a limited number of procedures appear to be available. Tweet on Twitter. Click here to learn more! The amount of weight put on the area of microfracture must be limited.2 This allows the cells to grow in develop in the area that underwent the microfracture treatment. Should you play sports with an OCD lesion in your knee? We offer diagnostic and treatment options for common and complex medical conditions. The surgery is quick (typically lasting between 30–90 minutes), minimally invasive, and can have a significantly shorter recovery time than an arthroplasty (knee replacement). Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Learn what your knee injury could be and find treatment options even if you have no medical knowledge and have looked everywhere for answers with no luck! (5) This course teaches you what to expect and how to prepare for surgery to have the best outcome. Osteochondral fractures involve are an articular surface injury involving the articular cartilage and the subchondral bone plate.. Radiographic features. These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. A potentially fixable loose osteochondral body in the setting of a first-time PF dislocation or idiopathic OCD is an indication for early surgery . Also read: OLTs can be an incidental finding on an MRI ordered to assess another problem. The lesions years) with knee osteochondral lesions were treated with scaffold implantation from January 2007 to July 2007. Please remember, while I appreciate your questions, I cannot and will not offer specific medical advice by email, on my website, on my podcast, or in social media. Pool therapy and bicycling are usually started within 2 weeks. Surgical treatment is indicated for displaced talar OLTs or lesions that have not improved with appropriate non-operative management. Osteochondral allografts are composed of fresh donor tissue and are procured from tissue banks that follow strict safety guidelines. In general, crutches are required for about 6 weeks after surgical treatment, followed by a 2- to 4-month course of physical therapy to regain strength and motion in the affected joint. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. A typical recovery following cartilage transfer surgery takes approximately 6-9 months. Return to sports is often delayed for 6 to 9 months after surgery. Take steps to recover from knee surgery quickly and safely! When the microfracture is on the top of the shin bone (tibia) or the end of the thigh bone (femur), weight is limited by having a patient use crutches. In some rare cases, osteochondral lesions … Microfracture surgery is an articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone.This causes new cartilage to develop from a so-called super-clot. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. Osteochondral Lesion Picture 2 – Osteochondral fracture of the femur. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The use of a machine to bend the knee (called a continuous passive motion or CPM machine) is recommended for 6-8 hours per day for 6 weeks after surgery. General anesthesia wears off in about an hour and spinal anesthesia may take about two hours to wear off. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Osteochondral Lesion. Decide if you should see one, find one suited for you and get the most from your visit. should i go for a surgery ? In skeletally immature patients, internal fixation of chondral only fragments may be attempted with sutures or suture anchors with reasonable success rates ( … Arthroscopic microfracture is considered the primary treatment strategy for osteochondral lesions of the talus and has been shown to provide successful outcomes. They may also complain of mechanical symptoms, such as clicking and popping sounds caused by a loose fragment of cartilage and/or bone associated with the OLT. o This can be done by ‘microfracture’, or stimulation of the bone, to make new scar tissue that acts like cartilage. Shelbourne KD, Jari S, Gray T. BACKGROUND: Articular cartilage damage has been reported in 23% of knees with an acute anterior cruciate ligament (ACL) injury and 54% of those with chronic ACL laxity. Microfracture knee surgery or Arthroscopic microfracture drilling: If you have cartilage breakdown behind the kneecap or in the knee joint itself, this procedure may be recommended to stimulate healing by drilling into the bones of the knee underneath the cartilage. X If you experience episodes of minor swelling or pain while exercising, have your physician examine your ankle. The main disadvantage of this procedure is the prolonged recovery time and increased complication rate, compared to arthroscopic debridement; Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. Get in touch. The patient is permitted to weight bear during this time and bend the knee to sit and for some specific exercises. Causes and Basic Symptoms. The long-term effects on the harvested area are still unknown, as is the long-term performance of the transplanted cartilage. For osteochondritis dissecans (OCD) of the knee, avascular necrosis of subchondral bone can lead to fragmentation of bone and overlying cartilage [Figure 1]; osteochondral loose body formation may occur, leading to pain and further articular damage. An osteochondral cyst can also be present following surgery. Microfracture surgery is an articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone.This causes new cartilage to develop from a so-called super-clot. Osteochondritis dissecans, particularly affecting the joints such as ankles, elbows, and knees tend to become more severe. Copyright © 2007-2020. Surgical treatment of talar OLTs includes: Any other significant pathology that exists may also need to be addressed at the time of surgery. In this Ask Dr. Geier video, I discuss this injury and surgery for an OCD lesion of the knee. 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