OSTEOCHONDRAL LESION

03 Oct OSTEOCHONDRAL LESION

JUVENILE

• called osteochondritis dissecans(OCD)
• subchondral delamination due to micro trauma or AVN
• Better prognosis
• Open distal femoral physics is the best predictor of successful non-operative management
• Location
  • posterolateral aspect of lateral femoral condyle(poor prognosis)
  • posterolateral aspect of medial femoral condyle(most common)
• Pathophysiolologic sequence
  • initial soft articular cartilage
  • separation of zone of articular cartilage
  • formation of loose bodies due to complete separation.

CLASSIFICATION

1. Depressed lesionI
2. Partial detachment
3. Detached non-displaced
4. Displaced fragment

• Imaging- X-ray and MRI

TREATMENT

• Stable
  • undisplayed with intact overlying articular cartilage
  • restricted weight bearing and bracing
  • subchondral drilling with k wire or drill
  • less than 12 years have good prognosis
• Unstable
  • fixation needs adequate bony fragment more than 2 cm
  • subchondral drilling

ADULT

• Outerbridge arthroscopic grading of articular defect
  • 0- normal
  • 1 – softening
  • 2 – partial thickeness fissure or fibrillation
  • 3 – full thickness fissure to subchondral bone
  • 4 – exposed subchondral bone

MANAGEMENT

• Correct mal-alingment, ligament instability and meniscal deficiency before any bony procedure
• debridement chonfroplasty for small defect
• fixation
• Micro fracture
• Mosaicplasty
• Autologous chondrocyte implantation