Osteochondral Lesion or defect/ Articular cartilage repair

The causes of Osteochondral lesions/ defects are:

• Repetitive microtrauma to the joint. This means no major trauma, which the patient can remember, but continuous loading of the joint. Usually involved in activities such as sports, patients are involved in heavy work, which puts joints under stress continuously and repeatedly.
• In a few cases, genetics has also been a cause
• In the acute setting, trauma or a blow to the joint

The types of osteochondral lesions/defects of joints are:

• Type 1- is very mild only softening of cartilage is present
• Type 2- in this partial damage to cartilage and bone present. Continuity is maintained
• Type 3- complete tear of cartilage and bone but are in normal position inside the joint. These types can move from their natural position.
• Type 4- complete tear of cartilage and bone and removed from a natural position inside the knee joint
• Type 5- loose body the broken piece is lying inside the joint. It can be anywhere inside the joint.

The symptoms of osteochondral lesions/defects are:

• Pain
• Swelling of the joint
• Locking of the joint
• In cases of trauma, severe swelling of a joint due to the collection of blood in the joint
• Stiffness
• Inability to bend or straighten the joint

The main investigation to diagnose osteochondral lesions/defects is x-rays, ct scans and MRI, magnetic resonance arthrogram

It depends on various factors, which include

• Age of patient/ activity of the patient
• Type of osteochondral lesion/ defect
• Size of lesion
• Location of lesion
• Stability of lesion

Yes, most osteochondral lesions/ defect cases can be treated without surgery. Consult your surgeon to know about further treatment of osteochondral lesions/defects.

These include:

• Protected weight bearing using crutches or walker for a few weeks
• Knee braces
• Activity modification in old ages
• Physiotherapy to regain full movement of joints and strength
• In a few cases, injection to the knee joint

A final decision has to be taken in consultation with the surgeon.

There are injections available to treat osteochondral lesions/defects. It include:

• Pla-te-let-rich pl-as-ma with Growth Factors is commonly involved in injection into the joint. They produce better clinical and functional outcomes. But studies must provide concrete evidence to support whether they generate cartilage.
• St-em Cell Injections are newer injections that use st-em cells from the patient's own body and are injected in joints. As such better clinical and functional results are present but further studies are required to provide evidence to support their role in cartilage generation.

Microfracture is used in cases where the defect size is small and in young patients. This is one of the most commonly performed procedures. A defect is created artificially to enhance the healing of the lesion.

The osteochondral autograft procedure is a novel technique used in defects larger than 1 cm to treat osteochondral lesions/defects. This involves taking osteochondral grafts from the patient's body and placing them in the same position in the defect to maintain natural joint structure.

The key feature of this procedure is that the body's tissue is used, and the natural shape of the joint is maintained.

If type 5 cases and the size of the fragment present inside the joint is large. If the fragment is large and can be returned to its natural position, it is fixed back to its original position.

The fixation devices are mostly bioabsorbable, so no metal remains inside the joint after surgery. Bioabsorbable implants are dissolved inside the body only, leaving no hardware after healing.

This is usually done in larger osteochondral defects >5 cm

This is a 2-stage technique that involves:

• Stage 1- harvesting of cartilage cells from the patient's own body, and they are sent to a lab to grow them so that a large number of cells are available for implantation.
• Stage 2- Place cells grown in the lab into the defect so that new cartilage grows over them.

This is the only technique that ensures cartilage regrowth.

It depends on various factors, and an informed decision must be made in consultation with your surgeon.

A person returning to work depends on the condition a patient has faced. It include:

• Microfracture
  The patient is usually kept in a brace and protected weight bearing for 6 weeks, after which rigorous physiotherapy is done. After which, the patient can join sports after 4-5 months after consultation with the surgeon.
  
  Patients can join back desk jobs after 4-6 weeks and in cases of heavy work jobs after 3-4 months
• Osteochondral Autograft Procedure (OATS)
  The patient is usually kept in a brace and protected weight bearing for 6 weeks, after which rigorous physiotherapy is done. After which, the patient can join sports after 4-5 months after consultation with the surgeon.
  
  The patient can join the back desk job after 4-6 weeks and, in cases of heavy work, after 3-4 months.
• Fixation of Osteochondral Defect/ Lesion
  In these cases, the patient requires protected weight bearing for 6 weeks with a brace and, after that, full weight bearing and regular physiotherapy. Patients can usually return to sports after 3-4 months.
• Autologous Chondrocyte Implantation
  This procedure has one of the longest rehabilitation protocols, and the patient has to consult a surgeon depending on the patient's recovery. Usually, the patient will be able to return to sports after 12 months of therapy.

Chances are

• Early degenerative arthritis of the joint will occur
• The defect may increase in size
• Symptoms will gradually worsen with time, and the patient may undergo total knee replacement afterward.

It depends on the hospital category chosen by patients and the type of implant discussed. At Simpainortho.com, we have tried to reduce the cost of surgery and hospital expenses and included complete after-surgery services, which patients require after surgery because we know treatment doesn’t end at patient discharge. To ensure the quick recovery of patients in simpainortho.com, we believe that a patient requires expert care within the most comfortable surroundings until he/she can join routine activities. So, we have made different packages for different patients according to need, and that too at the most affordable prices.

Yes, most insurances have included osteochondral lesion/ defect surgery.