119 - Articular Cartilage Injuries and Defects

Abstract

Although a number of osteochondritic conditions in the foot and ankle have been described, most are uncommon and usually asymptomatic. Those that most commonly cause symptoms and require treatment are osteochondral lesions of the talus (OLT), the distal tibial plafond, and the first metatarsal. Nonoperative treatment is successful only in about half the patients. Operative treatment may include cartilage repair (microfracture), replacement (osteochondral grafting), or regenerative (chondrocyte implantation) procedures. The choice of procedures depends largely on the patient's symptoms, age, physical demands, level of dysfunction, and size and location of the OLT. Generally, larger OLT (>1.5 cm2) have been associated with worse outcomes and may need to be treated with an initial procedure more extensive than arthroscopic débridement and bone marrow stimulation. The advent of orthobiologic and synthetic therapies (e.g., platelet-rich plasma [PRP], platelet-derived growth factor [PDGF], bone marrow aspirate [BMA], mesenchymal stem cell [MSC]) have increased treatment possibilities for OLT; however, currently, most have lower quantity and/or lower quality evidence. Osteochondral lesions of the distal tibial plafond (OLTP) are much less common than those of the talus and are less frequently reported in the literature. The incidence of OLTP is approximately 1 OLTP for every 14 to 20 OLT. Treatment is similar to that of OLT, but there are more frequent inferior outcomes in OLTP compared to OLT. Osteochondral lesion (OCL) of the first metatarsal are thought to be initiated by trauma; they can occur concurrently with hallux rigidus or can eventually lead to hallux rigidus and degeneration