Management of Unstable Osteochondral Fragments

The approach to cartilage injury is a patient-specific, and recommendations are based on the extent and location of injury, age and skeletal maturity, activity level, and alignment

Fixation of Unstable Osteochondral Fragments

Magnetic resonance imaging (MRI) is necessary to fully characterize the size, shape, and location of the osteochondral injury and to delineate suitability for fixation.

Non-operative care includes rest, NSAIDs, physical therapy, and injections are the first line of treatment for mild symptoms. An unloader brace may be recommended for focal compartment joint space narrowing/cartilage injury. If conservative treatment does not reduce symptoms or the size/type of the cartilage injury is more significant, surgery may be considered. 

Osteochondral fracture fixation is traditionally performed using metal or bioabsorbable pins or compression screws through the fragment. If metal screws are utilized, a second staged surgery is performed to remove the screw following sufficient healing. Bioabsorbable devices do not need to be removed. Late presentation of osteochondral injuries may not have a viable fragment suitable for fixation and may necessitate fragment excision and/or a cartilage transplantation procedure.

Fixation of unstable osteochondral fragments may be performed via an arthroscopic technique or through a mini-open incision depending on the size and location of the fragment.

Recovery is closely guided, and physical therapy begins in the days following surgery. A period of non weight bearing is important to allow healing of the fragment following fixation. Physical therapy begins immediately to assist with edema control, to reduce quadriceps atrophy and promote range of motion.