Tim Bryant, BSN

Treating symptomatic osteochondral defects is challenging, especially in young adults with deep (>8-mm to 10-mm deep), empty defects after osteochondritis dissecans or collapsed condyles secondary to avascular necrosis. For this population, osteoarthritis is inevitable if articular congruence is not restored. Fragment removal of an osteochondritis dissecans lesion produces an incongruous joint surface, which uniformly leads to OA. Once a femoral condyle with avascular necrosis collapses (Ficat stage 3), OA ensues. Moreover, once defects deepen to more than 8-mm to 15-mm deep and have associated subchondral cystic and sclerotic bone changes, restoration of the osteochondral unit requires bone and cartilage restoration.