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Advances in Cartilage Repair.

Mohammad T Azam1, James J Butler1, Matthew L Duenes1

  • 1Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, USA.

The Orthopedic Clinics of North America
|March 9, 2023
PubMed
Summary

Osteochondral ankle lesions often result from trauma and are difficult to treat conservatively due to poor cartilage healing. Treatment depends on lesion size, with smaller ones managed invasively and larger ones requiring autologous osteochondral transplantation.

Keywords:
Ankle osteochondral lesionAutologous osteochondral transplantationBiologicsMicrofracture

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Regenerative Medicine

Background:

  • Osteochondral lesions of the ankle joint are frequently caused by trauma, leading to pain and swelling.
  • Articular cartilage has limited healing capacity, making conservative management of these lesions often ineffective.
  • Treatment strategies for ankle osteochondral lesions vary based on lesion characteristics.

Purpose of the Study:

  • To outline current management strategies for osteochondral lesions of the ankle.
  • To differentiate treatment indications based on lesion size and characteristics.
  • To highlight the role of surgical interventions for refractory cases.

Main Methods:

  • Review of current literature on ankle osteochondral lesion treatment.
  • Categorization of lesions by size (<100 mm² vs. >100 mm²) and type (cystic, uncontained).
  • Description of minimally invasive procedures (debridement, drilling, scaffold therapies) and autologous osteochondral transplantation.

Main Results:

  • Smaller osteochondral lesions (<100 mm²) can be addressed with arthroscopic debridement, anterograde drilling, or biological augmentation.
  • Larger lesions (>100 mm²), cystic lesions, uncontained lesions, or those failing prior bone marrow stimulation necessitate autologous osteochondral transplantation.
  • Treatment choice is dictated by lesion size, morphology, and prior treatment outcomes.

Conclusions:

  • Effective management of ankle osteochondral lesions requires tailored approaches based on lesion specifics.
  • Minimally invasive techniques are suitable for smaller lesions, while larger or complex lesions benefit from osteochondral transplantation.
  • Autologous osteochondral transplantation remains a key treatment for significant ankle osteochondral defects.