Treatment of osteochondral defects of the talus.

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Abstract

[Indexed for MEDLINE] 4. J Knee Surg. 2020 Dec;33(12):1187-1200. doi: 10.1055/s-0040-1721053. Epub 2020 Dec 1. Management of Large Focal Chondral and Osteochondral Defects in the Knee. Calcei JG(1), Ray T(2), Sherman SL(2), Farr J(3). Author information: (1)Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio. (2)Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California. (3)Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana. Large, focal articular cartilage defects of the knee (> 4 cm2) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions. Thieme. All rights reserved. DOI: 10.1055/s-0040-1721053