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Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus

Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. Michael Aynardi, MD, orthopaedic surgeon and assistant professor of orthopaedics, Penn State Bone and Joint Institute, says, “Patients with these types of lesions usually experience significant functional limitations and, due to lesion size, are not good candidates for microfracture and require a more invasive reconstructive approach.” Options include autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), matrix-induced autologous chondrocyte implantation (MACI) and allograft cartilage grafting combined with the autologous mesenchymal stem cells (MSCs). Procedures such as OATS require a formal osteotomy to expose the lesion and gain access into the ankle joint to deliver the graft. Newer techniques such as MACI and allograft cartilage grafting can be performed without using an osteotomy and use a technique called distal tibial plafondplasty to access the joint.1 Continue reading

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