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OSTEOCHONDRAL LESION
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What Is It?

An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. Cartilage is a connective tissue that covers the bones between joints. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion. The bone right underneath the cartilage will also be injured. The knee joint, ankle joint, and elbow joint are common places where this defect occurs.

 

Symptoms/Risks

Patients who have osteochodral lesions typically will have pain in the involved joint. The pain is usually worsened by activity. Swelling of the joint can also be a symptom. Instability, locking, or catching can be other symptoms. A history of trauma to the joint or prior joint surgery may be clues leading to an osteochondral lesion diagnosis. This problem happens more frequently in the younger athletic population.

 

Sports Medicine Evaluation & Treatment

A sports medicine physician will review symptoms and history of the problem. They will evaluate the affected joint by pressing for tender areas and moving the joint to see if any motions cause pain. Usually, an x-ray will be ordered first. However, an x-ray cannot always identify problems in the cartilage since connective tissue does not show up well on x-ray. If the x-ray does not show any problems, a further imaging test might be ordered to take a closer look. In most cases, a MRI (preferred method) or CT will be done which shows soft tissues like cartilage in more detail.

 

Treatment options will vary depending on the patient. Age, athletic goals, location and size of defect will all be analyzed to decide which treatment is best. Treatment options include: non-operative conservative therapy (including but not limited to modification of activity, injections, casting, or boots), various surgeries like “microfracturing” the affected bone which brings new cells to the area in hopes building new cartilage, or transplantation of cartilage/bone from a donor or different body part.

 

Injury Prevention

It is not known for sure what will prevent an osteochondral lesion and it is hard to prevent acute traumatic injuries that sometimes lead to an osteochondral lesion. However, keeping your muscles strong and flexible helps support the joints. So participating in strength and flexibility exercises may prevent an osteochondral lesion. Maintaining bone health by getting adequate levels of calcium and vitamin D in your diet might also be beneficial. Following proper training guidelines will also help so the body does not get overwhelmed with too much stress or overload on the joints.

 

Return to Play

This depends on how the injury was managed. If conservative treatment is used, an athlete will have to wait to return to play until pain resolves, which could be 4-12 weeks. If the treatment included an operation, the return to play timeline will likely be similar. A rehabilitation program might also be needed before returning to full play.

AMSSM Member Authors
Angelene Elliott, DO & Warren A. Bodine, DO

References
Schachter AK, Chen AL, Reddy PD, Tejwani NC. Osteochondral lesions of the talus. J Am Acad Orthop Surg 2005; 13:152.
Laffenętre O. Osteochondral lesions of the talus: Current concept. Orthop Traumatol Surg Res 2010; 96:554.
Beltran J, Shankman S. MR imaging of bone lesions of the ankle and foot. Magn Reson Imaging Clin N Am 2001; 9:553.

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