Osteochondral defects and treatments What are the treatments available for an osteochondral defect?
Non operative treatment
A defect with minimal cartilage and bone changes ,if detected early, may settle with treatment using a plaster cast or by restiction of activities. This may need to be worn for one to four months. The chance of success is in the region of 40 to 50 %. Arthroscopic debridement/subchondral drilling What is it?
Keyhole surgery on the ankle joint aimed at the defect (see ankle arthroscopy). Very occasionally the fragment of bone and cartilage can be fixed back into place or if it sits stably in its 'bed' can be encouraged to heal by drilling into it with a fine wire. More commonly this is not technically possible and the loose fragments are best removed and the underlying bone drilled with fine wires, again using the keyhole technique . How does this type of treatment work?
Drilling into the bone releases growth factors which cause new bone to be formed, filling the bony part of the defect. Additionally very adaptable cells are released which form a layer of cartilage in the joint. This is not the normal joint lining cartilage(known as Hyaline) but a form known as fibrocartilage ,less suited to lining joints and probably less long lasting . In whom?
This is the 'first line' of operative treatment for most defects. | 
