Osteochondral Lesions: Current Knowledge and Future Perspectives

Dear Colleagues,

Osteochondral lesions (OCLs) have been recognized in both pediatric and adult patients as a challenging entity, presenting either as acute (e.g., traumatic injuries), subacute or even chronic conditions. OCLs are clinically associated with significant morbidity and may impair the quality of life. Scientific investigations have focused on OCLs as the cause of symptomatic joint dysfunction and premature articular degeneration for more than a century, but the exact etiology and ideal management remain unknown.

A broad range of clinical, cadaveric, animal, advanced imaging, biomechanical and genetic studies have been initiated in order to elucidate the etiology of these manifold lesions. With variable involvement of the subchondral bone and cartilaginous layers, osteochondral lesions may affect the articular architecture of any joint of the human body. In clinical and surgical practice, the knee, elbow and ankle are most prevalent, but enarthroses (e.g., shoulder or hip) may also be involved.

The complex osteochondral unit may be harmed by multifactorial effects, including sports-related injuries, chronic overload, local ischemia/osteonecrosis, as well as aberrant endochondral ossification or osteoarthritis. The highest incidence is observed in active adolescents and young adults, and increased risk is observed for multisport athletes. The regenerative potential is limited and proposed to be associated with skeletal maturity, vascular supply, genetic variations, and biomechanical factors.

For unstable symptomatic lesions, a variety of interventions have been applied, including techniques to stimulate subchondral revascularization, promote parent–progeny healing, and restore anatomic joint congruity. Surgical strategies after failed nonoperative treatment involve unstable fragment fixation, bone marrow stimulation, autologous and allograft transplantation, biomaterials, scaffolds, cells, and adjuvant therapies. In the light of a high number of secondary procedures, the diagnostic and therapeutic management of osteochondral lesions warrants current scientific evaluation.

The purpose of this Special Issue is to investigate current epidemiology, established and innovative strategies and future perspectives for the management of osteochondral lesions.

Dr. Christian David Weber
Dr. Filippo Migliorini
Guest Editors

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