How do you decide when it's time to have surgery for a problem? I have a free-floating bone fragment in my elbow joint. For the most part, I'm okay but sometimes the elbow locks up until I can get that piece to move around. There's always pain but I can live with that. The loss of motion bothers me the most.

Osteochondral lesions refer to damage or defect to the joint cartilage (chondral) that extend all the way down to the first layers of bone (osteo). Holes in the osteochondral layer and/or loose fragments of bone and cartilage in the joint can cause pain, locking of the joint, and eventually osteoarthritis.

There are many ways to treat this problem starting with conservative (nonoperative) care. Have you tried any antiinflammatories, steroid injections, or physical therapy? These would be the first treatment ideas to discuss with your physician.

If you have tried at least six months of conservative care without change or improvement, then surgical treatment is considered. Surgery is often the only option when motion is very restricted and/or the joint if unstable.

The surgeon may remove the fragments and smooth the area over with a special surgical shaver. This procedure is called debridement. Other surgical options include reattachment of the fragments, microfracture (drilling tiny holes to stimulate healing), or osteotomy (removing a wedge of bone to close up the hole).

Another surgical option for more severe osteochondral lesions or defects is a procedure called Osteochondral Autograft Transfer or OAT. Osteochondral autograft transfer (OAT) involves removing a plug of cartilage and bone from a healthy area (e.g., from a non-weight bearing area of the knee) and transferring it into the osteochondral lesion (i.e., hole in the surface of the same patient's lesion). The word "autograft" refers to the fact that the patient donates his or her own tissue for the procedure.

Studies show good coverage of the defects with full incorporation of the graft using the OAT procedure. Even for patients who have already had one surgical procedure, there may be other ways to address the continued problem. A second surgical procedure may be needed. The osteochondral autograft transplantation is an option for patients who have tried other surgical treatments that failed to bring satisfying results.

It doesn't sound like you have had any surgery yet, so this may not apply to you now but perhaps may be useful information down the road. The next step for you may be to see an orthopedic surgeon to discuss treatment options. A physical examination and perhaps some imaging tests will help you and the surgeon formulate a plan of care that best suits you at this time.