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Der Orthopäde

, Volume 37, Issue 3, pp 204–211 | Cite as

Diagnostik und Therapie osteochondraler Läsionen des Talus

  • M. Merian
  • M. EasleyEmail author
Leitthema

Zusammenfassung

Die osteochondralen Läsionen des Talus werden meistens erst im chronischen Stadium erkannt. Die operative Behandlung der osteochondralen Läsionen basiert somit in erster Linie auf der Defektdeckung, sei es durch Bildung eines Ersatzknorpels nach Exzision und Mikrofrakturierung oder durch hyaline Knorpelreparaturverfahren wie die autologe Knorpel-Knochen-Transplantation oder die autologe Chondrozytentransplantation. Basierend auf der heutigen Literatur erläutert dieser Beitrag die präoperative Diagnostik und die Indikationsstellung zur operativen Therapie osteochondraler Defekte des Talus. Es wird besonders auf die sprunggelenkspezifischen Operationstechniken zur Behandlung von Knorpelschäden eingegangen.

Schlüsselwörter

Sprunggelenk OSG Knorpelrekonstruktion Osteochondrale Läsion Arthroskopie 

Diagnosis and treatment of osteochondral lesions of the talus

Abstract

Delayed diagnosis of osteochondral lesions of the talus is common; acute osteochondral injuries to the talar dome frequently go unrecognized. While acute lesions may be repaired, typically the focus of operative treatment for osteochondral lesions is on: (a) débridement and drilling/microfracture (leading to filling of the defect with fibrocartilage) or (b) salvage procedures, including osteochondral autograft transfer system and autologous chondrocyte implantation (potentially leading to resurfacing of the defect with hyaline cartilage). In this article, we review current trends in preoperative assessment, defining indications and surgical management of osteochondral lesions of the talus.

Keywords

Ankle OSG Cartilage reconstruction Osteochondral lesion Arthroscopy 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Al-Shaikh RA, Chou LB, Mann JA et al. (2002) Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int 23: 381–389PubMedGoogle Scholar
  2. 2.
    Baltzer AW, Arnold JP (2005) Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy 21: 159–166PubMedCrossRefGoogle Scholar
  3. 3.
    Barnes CJ, Ferkel RD (2003) Arthroscopic debridement and drilling of osteochondral lesions of the talus. Foot Ankle Clin 8: 243–257PubMedCrossRefGoogle Scholar
  4. 4.
    Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26: 583–589PubMedGoogle Scholar
  5. 5.
    Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41: 988–1020PubMedGoogle Scholar
  6. 6.
    Brittberg M, Peterson L, Sjogren-Jansson E et al. (2003) Articular cartilage engineering with autologous chondrocyte transplantation. A review of recent developments. J Bone Joint Surg Am 85(Suppl 3): 109–115PubMedGoogle Scholar
  7. 7.
    Ferkel R (1993–1994) Arthroscopic treatment of osteochondral lesions of the talus. Orthop Trans 17: 1011Google Scholar
  8. 8.
    Giannini S, Buda R, Grigolo B et al. (2001) Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int 22: 513–517PubMedGoogle Scholar
  9. 9.
    Giannini S, Buda R, Grigolo B et al. (2005) The detached osteochondral fragment as a source of cells for autologous chondrocyte implantation (ACI) in the ankle joint. Osteoarthritis Cartilage 13: 601–607PubMedCrossRefGoogle Scholar
  10. 10.
    Gobbi A, Francisco RA, Lubowitz JH et al. (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22: 1085–1092PubMedCrossRefGoogle Scholar
  11. 11.
    Hangody L, Kish G, Modis L et al. (2001) Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int 22: 552–558PubMedGoogle Scholar
  12. 12.
    Hepple S, Winson IG, Glew D (1999) Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 20: 789–793PubMedGoogle Scholar
  13. 13.
    Huntley JS, Bush PG, McBirnie JM et al. (2005) Chondrocyte death associated with human femoral osteochondral harvest as performed for mosaicplasty. J Bone Joint Surg Am 87: 351–360PubMedCrossRefGoogle Scholar
  14. 14.
    Insall JN (1967) Intra-articular surgery for degenerative arthritis of the knee. A report of the work of the late K. H. Pridie. J Bone Joint Surg Br 49: 211–228PubMedGoogle Scholar
  15. 15.
    Kelberine F, Frank A (1999) Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. Arthroscopy 15: 77–84PubMedCrossRefGoogle Scholar
  16. 16.
    Koh JL, Kowalski A, Lautenschlager E (2006) The effect of angled osteochondral grafting on contact pressure: a biomechanical study. Am J Sports Med 34: 116–119PubMedCrossRefGoogle Scholar
  17. 17.
    Koh JL, Wirsing K, Lautenschlager E et al. (2004) The effect of graft height mismatch on contact pressure following osteochondral grafting: a biomechanical study. Am J Sports Med 32: 317–320PubMedCrossRefGoogle Scholar
  18. 18.
    Kono M, Takao M, Naito K et al. (2006) Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med 34: 1450–1456PubMedCrossRefGoogle Scholar
  19. 19.
    Kumai T, Takakura Y, Higashiyama I et al. (1999) Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 81: 1229–1235PubMedGoogle Scholar
  20. 20.
    Loomer R, Fisher C, Lloyd-Smith R et al. (1993) Osteochondral lesions of the talus. Am J Sports Med 21: 13–19PubMedCrossRefGoogle Scholar
  21. 21.
    Mandelbaum BR, Gerhardt MB, Peterson L (2003) Autologous chondrocyte implantation of the talus. Arthroscopy 19(Suppl 1): 129–137PubMedCrossRefGoogle Scholar
  22. 22.
    Muir D, Saltzman CL, Tochigi Y et al. (2006) Talar dome access for osteochondral lesions. Am J Sports Med 34: 1457–1463PubMedCrossRefGoogle Scholar
  23. 23.
    Raikin SM (2004) Stage VI: massive osteochondral defects of the talus. Foot Ankle Clin 9: 737–744PubMedCrossRefGoogle Scholar
  24. 24.
    Robinson DE, Winson IG, Harries WJ et al. (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85: 989–993PubMedCrossRefGoogle Scholar
  25. 25.
    Sammarco GJ, Makwana NK (2002) Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int 23: 693–698PubMedGoogle Scholar
  26. 26.
    Savva N, Jabur M, Davies M et al. (2007) Osteochondral lesions of the talus: results of repeat arthroscopic debridement. Foot Ankle Int 28: 669–673PubMedCrossRefGoogle Scholar
  27. 27.
    Schuman L, Struijs PA, Dijk CN van (2002) Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br 84: 364–368PubMedCrossRefGoogle Scholar
  28. 28.
    Scranton PE Jr, Frey CC, Feder KS (2006) Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br 88: 614–619PubMedCrossRefGoogle Scholar
  29. 29.
    Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop 391: S362–S369PubMedCrossRefGoogle Scholar
  30. 30.
    Taranow WS, Bisignani GA, Towers JD et al. (1999) Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int 20: 474–480PubMedGoogle Scholar
  31. 31.
    Tochigi Y, Amendola A, Muir D et al. (2002) Surgical approach for centrolateral talar osteochondral lesions with an anterolateral osteotomy. Foot Ankle Int 23: 1038–1039PubMedGoogle Scholar
  32. 32.
    Tol JL, Struijs PA, Bossuyt PM et al. (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21: 119–126PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Duke Health CenterDurhamUSA

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