Osteochondral Lesions

what is an osteochondral lesion (ocl)?

The bones of most joints are covered with smooth articular cartilage that prevents the bones grinding on each other on movement and provides cushioning between the joints.

An Osteochondral lesion is an injury to the articular cartilage and the bone beneath it. It usually occurs in the knee, ankle or elbow. Injuries can range from a fine crack of the joint surface all the way though to a piece of the bone breaking away.

Osteochondral injuries are most common in adolescents and young adults.

what are the causes?

In many cases the cause of an Osteochondral lesion is unknown. It is thought that an injury to articular cartilage and bone may result in a lack of blood supply to the the injured area leading to a Osteochondral lesion. This can occur following an injury such as a dislocation of the knee cap.
Another important factor is a family history of an osteochondral lesion.

what are the symptoms?

The symptoms associated with an osteochondral lesion include:

  • Pain on weight bearing
  • Swelling
  • Instability of the joint
  • Catching of the joint
  • Localized tenderness
  • Decreased movement

how is it diagnosed?

Your surgeon will usually ask about your symptoms and activity levels as well as any injuries, either recent or in the past, that will put you at risk of having an osteochondral lesion.

After an examination of the effected region, an x-ray will be ordered to assess for any OCL’s or associated signs of trauma such as joint swelling.

A MRI scan will usually be ordered to further assess the OCL. A MRI scan is very useful for helping your surgeon determine if the lesion is stable or not and this will dictate management.

how is it treated?

The treatment of an osteochondral lesion is based on the stability of the lesion. Lesions can be stable or unstable.

A Stable lesion means that the cartilage overlying the bone is not damaged and the lesion is not likely to be lose. For stable lesions, non-operative management is usually the first step including:

  • Activity modification – avoiding twisting and heavy contact activities
  • Rest
  • Ice
  • Pain relief

Surgery may be needed in stable osteochondral lesion’s that have a failed to improve despite a prolonged period of non-operative management. If the lesion is considered stable but large, surgery may also be indicated.

An Unstable lesion means the cartilage and bone are both broken and, in some instances, the lesion can break away from the original donor site and become a loose fragment moving freely within the joint. Surgery is nearly always be recommended if the OCL has broken free and is loose inside the joint.