Osteochondral (OC) defects of the knee are identified in more than 60% of patients undergoing knee arthroscopy. Of these about 5-10% are full thickness lesions. Some are symptomatic causing pain and dysfunction. Osteochondral defects involve damage to both cartilage and bone. Large and deep symptomatic lesions are challenging to treat.
Cartilage restoration procedures have been proven to provide good results in restoring small defects, even in high demand patients. However, they do not treat bone defects and are unsuitable to treat large defects. OCA is the preferred technique to treat medium to large and deep symptomatic osteochondral defects in the young and active patient. OCA has demonstrated excellent long-term outcomes and a reliable return to the high levels of activity in about 80% of patients.
The goal of surgery is to improve pain and function and reduce the risk of knee osteoarthritis and knee replacement in young and active patients, who have high functional demands and are eager to return to the normal activities of daily life.
The benefits of OCA are:
- It replaces damaged hyaline cartilage with fresh hyaline cartilage.
- It can treat both cartilage and bone damage.
- It is a single stage procedure that can be performed arthroscopically.
- It can treat large and deep osteochondral defects with size-matched allografts.
- It is the preferred technique for revision surgery.
- Other bone, ligament and meniscus issues can be addressed during OCA.
- No donor site recovery as with an autograft.
Large full – thickness cartilage and cartilage/bone defects on the femur (the thigh bone) are the usual indications for fresh OCAs. Patients with small cartilage lesions and no bone disease are better served with autologous chondrocyte implantation (ACI). OCAs are also appropriate for traumatic OC defects and osteonecrosis, and for revision of a prior failed cartilage repair.
Patients who smoke, are obese, have rheumatoid arthritis, and those with advanced osteoarthritis are not good candidates for this surgery.
Dr. Petrigliano will review your medical history and symptoms and findings from a physical exam. He will evaluate arthroscopic, x-ray and MRI findings to gauge the size, depth and location of the defect and the condition of the bones, as well as the status of other soft tissues in the knee such as ligaments and the meniscus. The graft is procured from a size-matched donor. All grafts undergo extensive screening and testing.
The procedure may be performed as open surgery or minimally invasive arthroscopic surgery. The damaged cartilage and bone are removed, and a replacement graft is crafted from donor tissue to fit the void. The graft is tapped into place to fit snugly, so no screws or devices are necessary.
After surgery your will receive pain medication and wear a brace for the first two weeks. You will use crutches for the first 4-6 weeks after surgery. Rehabilitation is critical to recovery. Physical therapy with limited weight bearing exercise can begin immediately after surgery. Physical therapy will continue for three to six months to gradually restore range of motion and function. Patients may return to sports about six to nine months after surgery.
OCA provides consistently successful outcomes in a high percentage of select patients. Most can expect to regain or improve full range of motion at one year after surgery.
Why choose Dr. Petrigliano?
Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Kings hockey team and associate team physician for USC Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in El Segundo California, and serves greater Los Angeles, Beverly Hills, the South Bay, and the Santa Clarita Valley. Contact Dr. Petrigliano to schedule a consultation today.
At a Glance
Dr. Frank Petrigliano
- Associate Professor of Orthopaedic Surgery at USC
- Chief of the Epstein Family Center for Sports Medicine
- Team physician for the LA Kings and USC Athletics
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