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. According to Kevin Black, M.D., Penn State Hershey Bone and Joint Institute, “The number one goal in treating all patients with OCD is to preserve the articular surface. In skeletally immature children, OCD tends to heal on its own with three to six months of rest and limited activity. In skeletally mature patients, the lesions don’t heal and predictably require surgery.” Continue reading
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When a younger (e.g., less than 50 years old), active patient presents with a symptomatic focal cartilage defect, orthopaedists are posed with a difficult treatment dilemma. When defect-associated pain significantly limits a formerly active lifestyle, secondary medical and psychological problems may occur. Joint replacement may not be a viable option due to the patient’s age and or preference for a high-demand lifestyle. For these cases, many may consider from a host of potential cartilage restoration options, ranging from microfracture to osteochondral allograft. The success of these procedures varies significantly depending on a multitude of factors.
Cartilage defects are often caused by biomechanical problems like joint instability, meniscal insufficiency, and or malalignment. According to Robert A. Gallo, M.D., assistant professor at Penn State Hershey Bone and Joint Institute, “In any patient with a cartilage defect, it’s advisable to first obtain long-length standing X-rays, to examine the weight bearing axis and conduct a thorough exam of ligamentous stability. If one addresses biomechanical problems prior to cartilage restoration procedures, the likelihood of significant benefit is greatly increased.” Often, osteotomies and ligamentous reconstructions are performed concomitantly with cartilage restoration procedures to improve the biomechanical milieu of the affected joint. Continue reading