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Osteochondrale autologe Knorpel-Knochen-Transplantation (OATS) in der Behandlung der Talus-Osteonekrose

  • Osteonekrose
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die autologe osteochondrale Transplantation stellt heute eine der wichtigsten Möglichkeiten zur Therapie von Osteonekrosen und osteochondralen Defekten am Talus dar. Bei dieser technisch aufwändigen Technik werden Knorpel-Knochen-Zylinder aus dem ipsilateralen proximalen lateralen Femurkondylus zur Transplantation in die zuvor ausgestanzten Zylinder im Bereich der talaren Defekte verwendet. Der Vorteil dieser Operationsmethode gegenüber den knochenmarkstimulierenden Verfahren ist die Wiederherstellung der Gelenkfläche mit biologisch und biomechanisch vollwertigem hyalinem Knorpel. Die Transplantation ist bei Defekten bis zu einer Größe von 3 cm2 und bei Patienten unter 60 Jahren anwendbar. Die Nachteile, wie die Notwendigkeit der Kniegelenkarthrotomie und die häufig erforderliche Malleolarosteotomie sind, zumindest nach unseren mittelfristigen Daten, den guten klinischen Ergebnissen deutlich unterlegen. Bei richtiger und frühzeitiger Indikation bietet die autologe osteochondrale Transplantation am Talus heute die beste Alternative für sportlich aktive Patienten zur Behandlung osteochondraler Defekte am oberen Sprunggelenk.

Abstract

Autologous osteochondral transplantation represents today one of the most important possibilities for the treatment of talar osteonecrosis and osteochondral defects. Using this technique, cartilage-bone plugs harvested from the ipsilateral proximal femoral condyle are used for autologous transplantation into talar defects. The advantage of this method in comparison to bone marrow stimulating procedures is the restoration of the articular surface with hyaline cartilage of superior biological and biomechanical quality. The transplantation is applicable in defects up to 3 cm2 and in patients up to 60 years old. The disadvantages such as the necessity of knee joint arthrotomy and of the malleolar osteotomy are, according to our mid-term data, inferior to the good clinical results. In case of a correct and early indication, autologous osteochondral transplantation today offers the alternative for active patients in the treatment of osteochondral defects of the ankle.

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Authors and Affiliations

  1. Abteilung für Sportorthopädie, Technische Universität München

    V. Martinek, P. Ansah & A. B. Imhoff

  2. Abteilung für Sportorthopädie, TU München, Connolly-Straße 32, 80809 , München

    V. Martinek

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  1. V. Martinek
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  2. P. Ansah
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  3. A. B. Imhoff
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Correspondence to V. Martinek.

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Martinek, V., Ansah, P. & Imhoff, A.B. Osteochondrale autologe Knorpel-Knochen-Transplantation (OATS) in der Behandlung der Talus-Osteonekrose. Arthroskopie 16, 29–33 (2003). https://doi.org/10.1007/s00142-003-0208-0

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