What is Osteochondral Defect Repair?
Osteochondral defect repair, also known as osteochondral fracture repair, is a surgical method to treat defects due to damaged articular cartilage and underlying bone.
What is an Osteochondral defect?
An osteochondral defect is a damage or injury to an area of smooth articular cartilage with the underlying bone. It usually involves the knee joint and can occur due to trauma, repeated microtrauma, or bone disorders that have caused the collapse of articular cartilage. The defect may vary from a small rupture of the cartilage and a small crack in the bone to a piece of the bone-breaking off from the joint. Osteochondral defects are usually associated with inflammation of the underlying bone, causing pain and difficulty walking.
Preparation for Osteochondral Defect Repair
Prior to the procedure:
- Your doctor will perform a detailed physical examination as well as imaging studies such as an X-ray or MRI scan to clearly visualize the defect. A bone scan may also be performed.
- Inform your doctor if you have any health conditions or are taking any regular medications.
- Inform your doctor if you are allergic to anesthesia or any medications.
Treatment for Osteochondral Defect Repair
There are various treatment methods your doctor can recommend based on the size and location of the defect, your activity level, and other factors.
Conservative Approach
Your doctor may recommend conservative methods to control your symptoms and improve function. These include resting the joint, avoiding weight-bearing, using ice and anti-inflammatory medications, intraarticular injections, bracing, or physical therapy.
Surgical Method
Surgery is recommended for repair of the osteochondral defect where conservative measures have not been successful or appropriate. It may be performed by open or arthroscopic techniques and includes the following:
- Microfracture: The microfracture technique is used for small defects in young individuals. In this technique, small holes are formed in the bone underlying the defect using an instrument. This provides a passage for blood into the damaged area where it forms a clot. The blood clot later forms a tissue called fibrocartilage that covers the defect.
- Autologous chondrocyte implantation (ACI): In this procedure, healthy cartilage is harvested from a non-weight-bearing joint and cartilage tissue is cultured in the laboratory. The cultured cartilage tissue is then implanted into the defect to stimulate the growth of new cartilage.
- Bone drilling: In this technique, multiple small holes are drilled into the bone to allow the growth of new blood vessels in the damaged area. This promotes blood flow to the defective area, enhancing the healing process, and helping to form new cartilage cells.
- Osteochondral allografting: This procedure involves the transfer of cartilage tissue from a healthy area of the joint to the damaged part. This helps the new transplant of bone and cartilage to grow in the defected area. Grafts may be taken from a donor (allograft) or from your own body (autograft).
Post-operative Instructions and Recovery for Osteochondral Defect Repair
After the surgery, your doctor will advise you on weight-bearing limitations and bracing. Physical therapy is recommended to prevent stiffness, stimulate repair and get you back to a normal range of motion. You will gradually be allowed to return to your regular activities. Return to competitive sports usually takes more than 6 months, depending on the type of procedure done.
