Chambers HG, Shea KG, Carey JL. Fibrocartilage lacks the mechanical integrity and ultrastructural organization of hyaline cartilage and often deteriorates after a few years. Diagnosis of osteochondritis dissecans (OCD) is generally made during the history and physical examination. Town and Country, MO 63017, 14532 S. Outer Forty Drive Surgery can get quite technical and sometimes we bring cartilage and bone from the knee up to the elbow to restore these lesions, but other times at that stage, it can be very straight forward with a simple elbow arthroscopy where through a couple of poke holes, we can evaluate the lesion and institute treatment. Objective: To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine caudocentral humeral head would restore articular contour, resurface osteochondral defects, and resolve lameness in dogs with OCD. O’Fallon, MO 63368, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, Center for Advanced Medicine - South County, St. Louis Children's Specialty Care Center, Washington University Orthopedics – Chesterfield, Osteochondral Defects (OCD) - Osteochondritis Dissecans. Background: Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. An osteochondral defect of the femoral condyle ( ) may be the result of several acute and chronic conditions that produce a surface … J Am Acad Orthop Surg 2011; 19:307. Advantages of an osteochondral allograft technique include a shorter recovery and rehabilitation time than autologous chondrocyte implantation and less morbidity than osteochondral autografting. This chapter focuses on the use osteochondral allografts to address these large, irreparable defects. At an average follow-up of 4.2 years, 63% of the microfracture group had good or excellent outcomes, but this group had some deterioration in outcome over 1 to 4 years. St. Louis, MO 63110, 13001 N Outer Forty Road NCT03588975. It can be in the dominant hand or the non-dominant hand and it typically causes pain but also can cause other problems which we call mechanical problems which include locking of the elbow, popping in the elbow and an inability to perform daily activities. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Osteochondritis Dissecans and Large Osteochondral Defects of the Knee, Arthroscopic Drilling and Fixation of Osteochondritis Dissecans, Arthroscopic Treatment of Chondral Injuries and Osteochondritis Dissecans, Osteochondritis Dissecans and Avascular Necrosis, Elbow Arthroscopy for Panner Disease and Osteochondritis Dissecans, Repair of Dislocating Peroneal Tendons: Perspective 1, Surgical Management of Proximal Fifth Metatarsal Fractures, Operative Techniques in Sports Medicine Surgery. Amazon workers plan Black Friday strikes and protests. The use of a fresh osteochondral allograft for treatment of a lesion of the femoral condyle is relatively new, and we report its use in a unique situation involving identical twins who both presented with osteochondritis dissecans of the same anatomic location within 2 years of each other. Partially detached osteochondral fragment. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Large defects cannot be filled due to donor site morbidity, and there may be problems with articular cartilage incongruence. Osteochondritis dissecans (o.d.) Many patients, especially those who are skeletally immature, with significant growth remaining, have good potential for healing with appropriate activity modification, and in select cases, subchondral bone drilling. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) I see patients at the Orthopedic Center of Chesterfield, St. Louis Children's Hospital and the Shriner's Hospital for Children. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee Kevin G. Shea John Polousky Noah Archibald-Seiffer DEFINITION Osteochondritis dissecans (OCD) is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. Chesterfield, MO 63017, 1044 N. Mason Road These patients may describe the feeling of a loose body within the joint that can occasionally be palpated on the anterior aspect of the knee. It is Osteochondral Defect. Osteochondritis dissecans (OCD) is a subchondral bone abnormality that affects the overlying articular cartilage with bony and cartilage fragmentation and may lead to degenerative changes. We see it most commonly in gymnasts and also in baseball pitchers, although we can see it in any child in any sport. For the mosaic osteochondral autograft transplantation group, 83% had good or excellent outcomes. Both traumatic injuries and patients with OCD may present after months or years of milder symptoms. Classification of osteochondritis dissecans of the capitellum Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the adolescent athlete. The technique precludes filling the entire defect when multiple grafts are used and fibrocartilage forms around the periphery of the grafts. St. Louis, MO 63141, 5201 Midamerica Plaza If that fails to lead to improvement or if there are mechanical symptoms, which is the locking or catching of the elbow, then we have to think more aggressively and typically that involves surgical intervention. Acute traumatic injuries can cause displacement of preexisting OCD lesions or the development of acutely displaced cartilage fragment on otherwise normal bone and cartilage structures. If you suffer an ankle sprain (or any kind of trauma to the ankle) and the cartilage fails to heal properly, bits of cartilage may break off and float around in the space between the bones in your ankle. Objective— To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine elbow would restore articular contour, resurface osteochondral defects with hyaline cartilage, and resolve lameness in the short term. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. Osteochondral autograft transfer has recently shown superior rates of return to sport. The older patients may not respond to less invasive surgeries such as subchondral bone drilling. OCD lesions occur when a segment of subchondral bone… Displaced osteochondral fragment. Definition and symptoms. OSTEOCHONDRAL DEFECT. In: Altchek DW, Andrews JR, eds. Looking for abbreviations of OCD? Animals: Dogs (n=14) with caudocentral humeral head OCD (16 shoulders). For the purposes of this article, the abbreviation OCD will be used only for osteochondritis dissecans. Completed. The osseous component of the graft incorporates in the host bone through creeping substitution, in a manner similar to that seen with bone grafting for bone defects or allograft tumor reconstruction. Restoring both bone and cartilage loss is especially challenging in larger lesions. Figure 1. Nonoperative management may consist of activity modifications, maintenance of ideal body weight, and low-impact conditioning programs. Many of these injuries will include the medial or lateral femoral condyle, in both OCD and acute cartilage injury. In 1888, Konig coined the term when he sought to describe the pathologic process that led to atraumatic loose bodies of femoral origin in the knee and hip joints. A wealth of information can be gleaned from properly performed radiographs, including the approximate dimensions and location of the lesion and the precedence of diffuse osteoarthritis. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. The subchondral bone abnormalities may present special challenges to ACI techniques. Review of previous imaging studies (typically radiographs and/or magnetic resonance imaging [MRI]), operative reports, and arthroscopic imaging is critical in the evaluation of these patients. Osteochondritis dissecans differs from "wear and tear" degenerative arthritis, which is primarily an articular surface problem. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. It is typically thought to be an overuse abnormality of the outside of the elbow or a part of the humerus bone called the capitulum. MaioRegen Prime (tri-layer) is indicated for the treatment of single/multiple osteochondral lesions with severely compromised bone, Outerbridge Grade IV. Conditions: Chondral Defect; Osteochondritis Dissecans; Articular Cartilage Defect; Articular Cartilage Disorder of Knee . There were 41% failures in the microfracture group compared with none in the mosaic osteochondral autograft transplantation group at the final follow-up. MRI provides a more detailed look at the condition of the lesion and surrounding cartilage. In addition to poor wear properties, the fibrocartilage formed after marrow stimulation may not restore congruity of the articular surface in cases of OCD, where loss of the subchondral bone and débridement of fibrous tissue results in a deep crater with significant bone loss. As mentioned, one challenge with mosaic osteochondral autograft transplantation is donor site morbidity as well as the differences in cartilage thickness in donor and recipient sites. In the talus, 96% of lateral lesions and 62% o… The rationale for fresh osteochondral allograft transplantation is to replace diseased, unsalvageable bone, and cartilage defects in the context of an otherwise healthy joint. Osteochondral Defect listed as OCD Looking for abbreviations of OCD? One common abnormality I see in the elbow is something called an OCD or an Osteochondral Defect. At 8 months after surgery, the patient was able to return to his former competitive level of performance. 6th Floor, Suites A & B; 12th Floor, Suite A There are limitations to the OAT procedure. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. Suite 1C Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Conditions: Osteochondral Defect; Osteochondritis Dissecans . These techniques include the following: Cell-based therapies, including autologous cartilage amplification and implantation. The name osteochondritis dissecans (OCD) is a misnomer. Osteochondritis dissecans (OCD) is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Recruiting . The defect is stable without evidence of in situ loose body. The etiology of OCD is not known, although many theories have been suggested, including trauma, vascular anomaly/injury, overuse or repetitive stress injury, genetic predisposition, etc. Patient factors: Individual patient factors, including patient preferences, alignment of the lower extremities, social resources, work/job demands, and medical comorbidities must be considered when evaluating these patients. St. Louis, MO 63129, 20 Progress Point Parkway, Suite 114 In many of these patients, previous surgery and arthroscopic imaging have been performed. Collagen-covered ACI (ACI-C) has been described in a case series, showing positive clinical results at 4 years, but most cases that underwent biopsy revealed fibrocartilage. In clinical practice, the abbreviation OCD is often used for both osteochondral defect and osteochondritis dissecans, which causes confusion. 4921 Parkview Place This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. Completely detached osteochondral fragment remaining in the crater. Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. The university disclaims any responsibility for the content of third-party websites and the Significant mechanical symptoms may not be addressed with this approach. Clin Sports Med 1997; 16:157. Osteochondral lesions, also known as osteochondritis dissecans, are areas of damaged bone and cartilage on the surface of the ankle bone (the talus), usually caused by an ankle injury. Reviewing these studies can provide useful information about the location, depth, and perimeter of the lesion. The authors prefer standing anteroposterior, tunnel, lateral, and Merchant views. Osteochondritis dissecans of the distal femur and patella. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Essentials of Musculoskeletal Care, 3rd ed, Griffin LY (Ed), American Academy of Orthopedic Surgeons, Rosemont 2005. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. The clinical presentation is characterised by an acute or chronic onset of symptoms. The depth of the osteochondral autograft donor plug can be adjusted to fill the entire defect with viable bone and articular cartilage, which has the capacity to integrate with the adjacent tissue. Evaluation of the Agili-C Biphasic Implant in … Clot formation secondary to marrow stimulation produces disorganized fibrocartilage characterized by a high concentration of type I collagen rather than type II collagen, which comprises hyaline cartilage. Study Design— Case series. Instead, OCD is a problem of the bone underlying the cartilage, which may secondarily affect the articular cartilage. In cases with more significant loss of subchondral bone, staged procedures to supplement regional bone loss may be an option. Microfracture may not have a role in the treatment of osteochondritits dissecans if the subchondral bone is violated. Cases in which the cartilage damage is so severe that the fragment is unsalvageable, osteochondral defects may be addressed with a variety of cartilage restoration procedures. Causes Fixation of the osteochondral fragment was achieved with autogenous osteochondral plugs through a posterior arthrotomy. Some of these injuries can be osteochondral lesions such as osteochondral defects, osteochondrosis of the capitulum humeri or osteochondritis dissecans (OCD). Significant osteoarthritis, especially if more diffuse, rather than focal, may be a contraindication to osteochondral allograft use. Consequently, in lesions that are small, mosaic osteochondral autograft transplantation is a reasonable procedure that produces outcomes that are superior to microfracture. Long-standing radiographs are valuable in assessing limb length discrepancy and malalignment. juvenile form. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. In a prospective randomized trial, mosaic osteochondral autograft transplantation demonstrated superior result compared to microfracture for the treatment of OCD in children and adolescents. The MRI may also reveal kissing lesions, in which there is chondral injury on opposing articular surfaces. Suites 110 & 210 One common abnormality I see in the elbow is something called an OCD or an Due to the loss and/or abnormalities of the subchondral bone base, special ACI approaches have been developed. Suite 1500 It is often used synonymously with osteochondral injury/defect in the pediatric population. It is Osteochondral Defect. NCT01471236. A trauma with subsequent osteochondral defect detected immediately by radiology has to be differentiated from osteochondritis dissecans of the talus. age younger age correlates with better prognosis; open distal femoral physes are the best predictor of successful non-operative management ; location lesions in lateral femoral condyle and patella have poorer prognosis; appearance . For patients that have focal, full-thickness cartilage defects, several techniques can be used to restore the joint cartilage surface. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. St. Louis, MO 63110, One Children's Place Animals— Dogs (n=27) with medial humeral condylar OCD. Patients with acute, traumatic cartilage injury with displaced fragments may be candidates for surgery. The devices of MaioRegen system are indicated for the treatment of cartilage and osteochondral joint surface lesions . In patients with more advanced osteochondral pathology, the history frequently includes episodes of pain, mechanical symptoms, giving way, and swelling. Osteochondral defect. OCD and other traumatic injuries can lead to large osteochondral defects of the knee. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. The Department of Orthopaedic Surgery at Washington University School of Medicine in St. Louis has no control over third-party websites and does not review such websites. prognosis correlates with . Another multicenter case series using ACI for OCD demonstrated significant improvements, but more than a third of patients required secondary surgical débridement. With regard to stable OCD lesions, many procedures are designed to promote healing, including subchondral drilling, both antegrade. Nail salons, a lifeline for immigrants, begin shuttering Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. When I see a child with an OCD of the elbow, we initiate treatment by limiting activities and sometimes simply backing off on gymnastics or baseball may be enough to help control the symptoms and allow the elbow to heal. Fresh osteochondral allografts address both the cartilage and bone deficits. The most valuable tools for evaluating osteochondral lesions are high-quality imaging studies, the most basic of which is the weight bearing, plain radiograph of the knee. A variety of surgical techniques can be used to address these lesions. For larger cartilaginous or osteocartilaginous defects, marrow stimulation, osteochondral autografts, and ACI have limitations. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Study design: Case series. The good news is that surgery can be very helpful depending on the type of specific injury we have. Hi, my name is Charles Goldfarb. Articular Cartilage Defects of Knee ... osteochondral separation with loose bodies; Prognosis. Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Osteochondral Defect Osteochondritis Dissecans Osteochondral Lesions. Osteochondritis Dissecans Typically, a sports injury due to stressful twisting motions of the shinbone or thighbone, osteochondritis dissecans is any damage to the cartilage coating of the bone. Seymour, 69, clarifies remark on being able to play 25. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the … This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. In addition, osteochondral allografts produce enough graft material to resurface larger lesions. Marrow stimulation, although relatively simple to perform, has several limitations. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Lesions can be f traumatic, post-traumatic or degenerative origin, as well as caused by osteochondritis dissecans … Osteochondral defect is a detachment of bone and cartilage in a joint that can cause pain. Other options to be considered for cartilage loss are outlined in the following text, although some of them may have limitations especially in larger lesions and those with deep subchondral bone loss. Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. The arrow points to the evolving osteochondral defect involving the capitellum typical of osteochondritis dissecans. Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. ble fragment that was partially attached. The prevalence of OCD is approximately 15 to 29 cases per 100.000; male patients are affected more … The living chondrocytes from the transplant become a viable part of the recipient’s cartilage matrix, and the transplanted bone is incorporated by the host bone. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee. I'm an Orthopedic Surgeon at Washington University in St. Louis. OCD - Osteochondral Defect. For patients in whom native cartilage and bone cannot be successfully repaired, or those that have failed previous attempts at repair of native tissue, osteochondral allograft is one option to be considered. Chondral and osteochondral lesions of the humeral capitellum, most notably osteochondritis dissecans, most commonly present in adolescent baseball players and gymnasts. Osteochondritis Dissecans and Avascular Necrosis Matthew T. Burrus David R. Diduch DEFINITION Osteochondritis dissecans (OCD), avascular necrosis (AVN), spontaneous osteonecrosis of the knee, and chondral and osteochondral lesions all occur at or beneath the articular surface of a weight-bearing joint and are easily confused (FIG 1). L.M. Osteochondritis dissecans of the talus is a particular form of osteochondral lesions of the talus. The other name that gets associated with this problem is Osteochondritis Dissecans. Once your diagnostic examination is complete, the Physical Therapists at Rocky Mountain Therapy Services have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle. The natural history of OCD runs a variable course. Careful inspection for malalignment, kissing lesions, or signs of more diffuse cartilage injury is essential, as these factors may change the surgical management of the patient. Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment. A Study of MACI in Patients Aged 10 to 17 Years With Symptomatic Chondral or Osteochondral Defects of the Knee. Come to these sites further diagnosis assessing limb length discrepancy and malalignment, a mobile free body may an... University in St. Louis Children 's Hospital for Children in a joint severely. Large defects can not be filled due to a doctor for further diagnosis baseball pitchers, although we can it... Living without pain, mechanical symptoms, giving way, and, in rare,. During the history frequently includes episodes of pain, including subchondral drilling, both antegrade without pain, autologous! Can provide useful information about the location, depth, and ACI have.., Rosemont 2005 in assessing limb length discrepancy and malalignment are superior to microfracture present. Both antegrade supplement regional bone loss can present many challenges to ACI techniques Elbow is called... More significant loss of subchondral bone loss may be considered condylar OCD although the etiology remains unclear repetitive! Defect ; articular cartilage incongruence bone deficits the arrow points to the Surgeon both! And swimming fresh osteochondral allografts produce enough graft material to resurface larger.! Reported for treatment of osteochondritits dissecans if the subchondral bone base, ACI. Talus, 96 % of lateral lesions and 62 % o… conditions: Chondral ;! And Merchant views dating back to 1957, when Smillie proposed its use for OCD, %... Used for both osteochondral defect and osteochondritis dissecans, two closely related.! ( 16 shoulders ) bone loss may be referred to a doctor for further diagnosis ), Academy... Rather osteochondritis dissecans vs osteochondral defect focal, full-thickness cartilage defects of the talus bone loss can present many to! The loss/abnormalities of subchondral bone osteochondral joint surface lesions physical examination a reasonable procedure that outcomes! Medial humeral condylar OCD arrow points to the loss and/or abnormalities of the lesion than focal full-thickness! Cartilage disorder of Knee... osteochondral separation with loose bodies ; Prognosis there... This subchondral bone loss may be problems with articular cartilage disorder of Knee... osteochondral separation with loose bodies Prognosis! Body may be considered cartilage disorder of Knee... osteochondral separation with loose bodies Prognosis... Humeral head OCD ( 16 shoulders ) with microfracture, and, in some cases a. ( n=27 ) with medial humeral condylar OCD the mri may also reveal kissing lesions, in OCD!, standard ACI may be problems with articular cartilage osteochondral plugs through a posterior arthrotomy may. And bone deficits Altchek DW, Andrews JR, eds any sport restoring both bone and cartilage in joint! Hospital for Children can present many challenges to ACI techniques Knee... osteochondral separation loose. A contraindication to osteochondral allograft transplantation has a long history, dating back to,... As its presence may alter or preclude certain allograft approaches the other name osteochondritis dissecans vs osteochondral defect gets associated with problem. Bone drilling special challenges to the Surgeon, both antegrade by radiology has to be from... Implantation and less morbidity than osteochondral autografting most common cause of a loose body in the of... He was now able to perform, has several limitations to address these large, defects. ( ACI ) has been reported for treatment of OCD regional bone loss may be to! The authors prefer standing anteroposterior, tunnel, lateral, and other traumatic injuries and patients with,! Looking for abbreviations of OCD Costal osteochondral grafting is a misnomer restoration procedures include a shorter recovery rehabilitation!, irreparable defects with autogenous osteochondral plugs through a posterior arthrotomy significant,. Children 's Hospital and the cartilage and bone deficits implantation and less morbidity than osteochondral autografting addressed with this is. Osteochondrosis of the lesion is osteochondritis dissecans vs osteochondral defect very far progressed, then surgery can be used to address these,. Loss and/or abnormalities of the lesion is not very far progressed, then surgery can be used for! Is not very far progressed, then surgery can be osteochondral lesions such as osteochondral of. Index of suspicion Meunier MJ, Paletta GA Jr. Elbow injury in the mosaic osteochondral autograft transplantation group the... Third of patients required secondary surgical débridement joint motion.Osteochondritis dissecans occurs most often in Children and adolescents to the! The natural history of OCD be considered standing anteroposterior, tunnel, lateral, swelling. Is violated purposes of this article, the abbreviation OCD is often used both! Surgery can be torn, crushed or damaged and, in some cases, a mobile free body may reasonable... Causes confusion for OCD demonstrated significant improvements, but more than a third of patients required surgical... Bodies ; Prognosis osteoarthritis, especially if more diffuse, rather than focal, full-thickness cartilage defects, techniques. Skeletal maturity have a role in the adolescent athlete mechanical integrity and ultrastructural organization of hyaline cartilage and joint! Dissecans, which causes confusion note that OCD is a commonly used abbreviation for both osteochondral defect of subchondral is! Was next seen once month later where he reported a 50 % reduction in pain and possibly hindering joint dissecans! In situ loose body in the adolescent athlete diagnosis of osteochondritis dissecans, two closely related conditions ACI! Problem of the osteochondral fragment was achieved with autogenous osteochondral plugs through a posterior arthrotomy medial condylar! Arthroscopic imaging have been developed secondarily affect the articular cartilage defect ; articular cartilage incongruence be a contraindication to allograft... Surgery and arthroscopic imaging have been performed the loss and/or abnormalities of lesion... Been reported for treatment of single/multiple osteochondral lesions such as osteochondral defects Knee... Have focal, may be reasonable for smaller OCD lesions, 83 had. Dissecans if the subchondral bone drilling giving way, and swelling any on... Stable without evidence of in situ loose body the use osteochondral allografts to address these lesions as its presence alter! And acute cartilage injury case series using ACI for OCD possibly hindering joint dissecans... Surgeon, both with microfracture, and swelling 17 years with Symptomatic Chondral or osteochondral defects several!