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Osteochondrosis dissecans des Talus im Überblick

Overview of osteochondritis dissecans of the talus

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Trauma und Berufskrankheit

Zusammenfassung

Die Osteochondrosis dissecans wird mit transchondralen und osteochondralen Frakturen unter dem Oberbegriff der osteochondralen Läsionen des Talus zusammengefasst. Die genaue Ursache zur Entstehung der aseptischen Knochennekrose ist unbekannt. Bei unspezifischen klinischen Beschwerden erfordert die Osteochondrosis dissecans eine weiterführende radiologische Diagnostik aus konventionellem Röntgenbild in 2 Ebenen und nachfolgenden Schnittbildverfahren. Die Einteilung nach Berndt und Harty mit den angepassten Graduierungen für die Computertomographie und Magnetresonanztomographie hat sich präoperativ bewährt. Asymptomatische Läsionen sowie Läsionen im Stadium I und II werden primär konservativ behandelt. Stadium-III-Läsionen oder Beschwerdepersistenz nach 6 Monaten konservativer Therapie erfordern ein operatives Vorgehen in Form von knochenmarkstimulierenden Verfahren oder Knorpelzelltransplantationen. Kleine Defekte ohne subchondrale Beteiligung sind ideal für die Mikrofrakturierung, während subchondrale Zysten und mittelgroße Defekte mit osteochondralen autologen Transplantationen versorgt werden. Autologe Knorpelzelltransplantationen kommen bei großen Defekten mit intakten subchondralen Knochen zum Einsatz. Zur Therapie der Osteochondrosis dissecans existieren aktuell keine validen Evidenzempfehlungen.

Abstract

Osteochondritis dissecans, transchondral and osteochondral fractures are collectively known under the generic term osteochondral lesions of the talus. The etiology of the aseptic bone necrosis still remains unclear. Osteochondritis dissecans often requires additional radiological diagnostics by conventional X‑ray imaging in two planes and subsequent cross-sectional imaging in cases of unspecific clinical symptoms. The classification of Berndt and Harty with modifications for computed tomography and magnetic resonance imaging has been preoperatively proven. Asymptomatic lesions and stage I and II lesions are treated conservatively. Stage III lesions or persistance of symptoms after 6 months of conservative treatment require a surgical procedure in the form of bone marrow stimulation techniques or chondrocyte transplantation. Small defects without subchondral involvement are ideal for microfracturing, whereas subchondral cysts and medium sized defects are treated by osteochondral autograft transplantation. Autologous chondrocyte transplantations are used for large defects with intact subchondral bone. Currently, there are no valid evidential recommendations for the treatment of osteochondritis dissecans.

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Abbreviations

A.p.:

Anterior-posterior

ACT:

Autologe Chondrozytentransplantation

AMIC:

Autologe Matrix-induzierte Chondrogenese

BMI:

Body-Mass-Index

CT:

Computertomographie

ICRS:

International Cartilage Repair Society

MACT:

Matrix-assoziierte Chondrozytentransplantation

MF:

Mikrofrakturierung

MRT:

Magnetresonanztomographie

OCLT:

Osteochondrale Läsionen des Talus

OD:

Osteochondrosis dissecans

Literatur

  1. Aichroth P (1971) Osteochondritis dissecans of the knee. a clinical survey. J Bone Joint Surg Br 53(3):440–447

    CAS  PubMed  Google Scholar 

  2. Alexander AH, Lichtman DM (1980) Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). long-term follow-up. J Bone Joint Surg Am 62(4):646–652

    CAS  PubMed  Google Scholar 

  3. Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D (1989) Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am 71(8):1143–1152

    CAS  PubMed  Google Scholar 

  4. Badekas T, Takvorian M, Souras N (2013) Treatment principles for osteochondral lesions in foot and ankle. Int Orthop 37(9):1697–1706

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baker CL, Andrews JR, Ryan JB (1986) Arthroscopic treatment of transchondral talar dome fractures. Arthroscopy 2(2):82–87

    Article  PubMed  Google Scholar 

  6. Barnes CJ, Ferkel RD (2003) Arthroscopic debridement and drilling of osteochondral lesions of the talus. Foot Ankle Clin 8(2):243–257

    Article  PubMed  Google Scholar 

  7. Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87(5):640–645

    Article  CAS  PubMed  Google Scholar 

  8. Bauer M, Jonsson K, Lindén B (1987) Osteochondritis dissecans of the ankle. a 20-year follow-up study. J Bone Joint Surg Br 69(1):93–96

    CAS  PubMed  Google Scholar 

  9. Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM (2006) Autologous chondrocyte transplantation for treating cartilage defects of the talus. J Bone Joint Surg Am 88(2):303–308

    Article  CAS  PubMed  Google Scholar 

  10. Baums MH, Schultz W, Kostuj T, Klinger HM (2014) Cartilage repair techniques of the talus: an update. World J Orthop 5(3):171–179

    Article  PubMed  PubMed Central  Google Scholar 

  11. Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H (2010) Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc 18(5):656–663

    Article  PubMed  Google Scholar 

  12. Behrens P (2005) Matrixgekoppelte Mikrofrakturierung – Ein neues Konzept zur Knorpeldefektbehandlung. Arthroskopie 18:193–197

    Article  Google Scholar 

  13. Behrens P, Ehlers EM, Köchermann KU, Rohwedel J, Russlies M, Plötz W (1999) New therapy procedure for localized cartilage defects. Encouraging results with autologous chondrocyte implantation. MMW Fortschr Med 141(45):49–51

    CAS  PubMed  Google Scholar 

  14. Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41-A:988–1020

    CAS  PubMed  Google Scholar 

  15. Bohndorf K, Imhof H, Schibany N (2001) Diagnostic imaging of acute and chronic osteochondral lesions of the talus. Orthopade 30(1):12–19

    Article  CAS  PubMed  Google Scholar 

  16. Braun S, Vogt S, Imhoff AB (2007) Stage oriented surgical cartilage therapy. current situation. Orthopade 36(6):589–599; quiz 600

    Article  CAS  PubMed  Google Scholar 

  17. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331(14):889–895

    Article  CAS  PubMed  Google Scholar 

  18. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69

    PubMed  Google Scholar 

  19. Bruns J (1997) Osteochondrosis dissecans. Orthopade 26(6):573–584

    Article  CAS  PubMed  Google Scholar 

  20. Bruns J, Rosenbach B (1992) Osteochondrosis dissecans of the talus. Comparison of results of surgical treatment in adolescents and adults. Arch Orthop Trauma Surg 112(1):23–27

    Article  CAS  PubMed  Google Scholar 

  21. Buckwalter JA, Mow VC, Ratcliffe A (1994) Restoration of injured or degenerated articular cartilage. J Am Acad Orthop Surg 2(4):192–201

    Article  PubMed  Google Scholar 

  22. Campbell CJ (1969) The healing of cartilage defects. Clin Orthop Relat Res 64:45–63

    CAS  PubMed  Google Scholar 

  23. Canale ST, Belding RH (1980) Osteochondral lesions of the talus. J Bone Joint Surg Am 62(1):97–102

    CAS  PubMed  Google Scholar 

  24. Choi WJ, Kim BS, Lee JW (2012) Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Am J Sports Med 40(2):419–424

    Article  PubMed  Google Scholar 

  25. Choi WJ, Park KK, Kim BS, Lee JW (2009) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med 37(10):1974–1980

    Article  PubMed  Google Scholar 

  26. Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24(1):106–112

    Article  PubMed  Google Scholar 

  27. Conti S, Taranow W (1996) Transtalar retrograde drilling of medial osteochondral lesions of the talar dome. Oper Tech Orthop 6:226–230

    Article  Google Scholar 

  28. Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7(1):101–104

    Article  CAS  PubMed  Google Scholar 

  29. Dunfee WR, Dalinka MK, Kneeland JB (2002) Imaging of athletic injuries to the ankle and foot. Radiol Clin North Am 40(2):289–312

    Article  PubMed  Google Scholar 

  30. Easley ME, Scranton PE (2003) Osteochondral autologous transfer system. Foot Ankle Clin 8(2):275–290

    Article  PubMed  Google Scholar 

  31. Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM (2007) Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28(2):154–161

    Article  PubMed  Google Scholar 

  32. Ferkel R, Sgaglione N, Del Pizzo W (1990) Arthroscopic treatment of osteochondral lesions of the talus: long-term results. Orthop Trans 14:172–173

    Google Scholar 

  33. Flick AB, Gould N (1985) Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 5(4):165–185

    Article  CAS  PubMed  Google Scholar 

  34. Giannini S, Buda R, Grigolo B, Vannini F (2001) Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int 22(6):513–517

    CAS  PubMed  Google Scholar 

  35. Hangody L, Kish G, Kárpáti Z, Szerb I, Eberhardt R (1997) Treatment of osteochondritis dissecans of the talus: use of the mosaicplasty technique–a preliminary report. Foot Ankle Int 18(10):628–634

    Article  CAS  PubMed  Google Scholar 

  36. Hankemeier S, Müller EJ, Kaminski A, Muhr G (2003) 10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus. Unfallchirurg 106(6):461–466

    Article  CAS  PubMed  Google Scholar 

  37. Hembree WC, Wittstein JR, Vinson EN, Queen RM, Larose CR, Singh K, Easley ME (2012) Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int 33(7):591–597

    Article  PubMed  Google Scholar 

  38. Hepple S, Winson IG, Glew D (1999) Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 20(12):789–793

    Article  CAS  PubMed  Google Scholar 

  39. Johnson LL (1986) Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status. Arthroscopy 2(1):54–69

    Article  CAS  PubMed  Google Scholar 

  40. Kadakia AR, Espinosa N (2013) Why allograft reconstruction for osteochondral lesion of the talus? The osteochondral autograft transfer system seemed to work quite well. Foot Ankle Clin 18(1):89–112

    Article  PubMed  Google Scholar 

  41. Kappis M (1922) Weitere Beiträge zur traumatisch-mechanischen Entstehung der „spontanten“ Knorpelablösungen (sogen. Osteochondritis dissecans). Dtsch Z Chir 171:13–29

    Article  Google Scholar 

  42. Kessler JI, Weiss JM, Nikizad H, Gyurdzhyan S, Jacobs JC, Bebchuk JD, Shea KG (2014) Osteochondritis dissecans of the ankle in children and adolescents: demographics and epidemiology. Am J Sports Med 42(9):2165–2171

    Article  PubMed  Google Scholar 

  43. Kramer DE, Glotzbecker MP, Shore BJ, Zurakowski D, Yen YM, Kocher MS, Micheli LJ (2015) Results of surgical management of Osteochondritis Dissecans of the ankle in the pediatric and adolescent population. J Pediatr Orthop 35(7):725–733

    Article  PubMed  Google Scholar 

  44. König F (1888) Über freie Körper in den Gelenken. Dtsch Z Chir 27:90–109

    Article  Google Scholar 

  45. Laffenêtre O (2010) Osteochondral lesions of the talus: current concept. Orthop Traumatol Surg Res 96(5):554–566

    Article  PubMed  Google Scholar 

  46. Letts M, Davidson D, Ahmer A (2003) Osteochondritis dissecans of the talus in children. J Pediatr Orthop 23(5):617–625

    Article  PubMed  Google Scholar 

  47. Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T (1993) Osteochondral lesions of the talus. Am J Sports Med 21(1):13–19

    Article  CAS  PubMed  Google Scholar 

  48. Ly PN, Fallat LM (1993) Trans-chondral fractures of the talus: a review of 64 surgical cases. J Foot Ankle Surg 32(4):352–374

    CAS  PubMed  Google Scholar 

  49. Mankin HJ (1982) The response of articular cartilage to mechanical injury. J Bone Joint Surg Am 64(3):460–466

    CAS  PubMed  Google Scholar 

  50. Martinek V, Ottl G, Imhoff AB (1998) Chondral and osteochondral lesions of the upper ankle joint. clinical aspects, diagnosis and therapy. Unfallchirurg 101(6):468–475

    Article  CAS  PubMed  Google Scholar 

  51. McCullough CJ, Venugopal V (1979) Osteochondritis dissecans of the talus: the natural history. Clin Orthop Relat Res 144:264–268

    PubMed  Google Scholar 

  52. McGahan PJ, Pinney SJ (2010) Current concept review: osteochondral lesions of the talus. Foot Ankle Int 31(1):90–101

    Article  PubMed  Google Scholar 

  53. Mesgarzadeh M, Sapega AA, Bonakdarpour A, Revesz G, Moyer RA, Maurer AH, Alburger (1987) Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging. Radiology 165(3):775–780

    Article  CAS  PubMed  Google Scholar 

  54. Metsäranta M, Kujala UM, Pelliniemi L, Osterman H, Aho H, Vuorio E (1996) Evidence for insufficient chondrocytic differentiation during repair of full-thickness defects of articular cartilage. Matrix Biol 15(1):39–47

    Article  PubMed  Google Scholar 

  55. Minas T, Peterson L (1997) Chondrocyte transplantation. Oper Tech Orthop 7:323–333

    Article  Google Scholar 

  56. Mitchell ME, Giza E, Sullivan MR (2009) Cartilage transplantation techniques for talar cartilage lesions. J Am Acad Orthop Surg 17(7):407–414

    Article  PubMed  Google Scholar 

  57. Muir D, Saltzman CL, Tochigi Y, Amendola N (2006) Talar dome access for osteochondral lesions. Am J Sports Med 34(9):1457–1463

    Article  PubMed  Google Scholar 

  58. Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 95(11):1045–1054

    Article  PubMed  Google Scholar 

  59. Naumetz VA, Schweigel JF (1980) Osteocartilagenous lesions of the talar dome. J Trauma 20(11):924–927

    Article  CAS  PubMed  Google Scholar 

  60. O’Driscoll SW (1998) The healing and regeneration of articular cartilage. J Bone Joint Surg Am 80(12):1795–1812

    PubMed  Google Scholar 

  61. O’Loughlin PF, Heyworth BE, Kennedy JG (2010) Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 38(2):392–404

    Article  PubMed  Google Scholar 

  62. Orr JD, Dawson LK, Garcia EJ, Kirk KL (2011) Incidence of osteochondral lesions of the talus in the United States military. Foot Ankle Int 32(10):948–954

    Article  PubMed  Google Scholar 

  63. Orr JD, Dutton JR, Fowler JT (2012) Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus. Foot Ankle Int 33(12):1051–1057

    Article  PubMed  Google Scholar 

  64. Paul J, Sagstetter A, Kriner M, Imhoff AB, Spang J, Hinterwimmer S (2009) Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus. J Bone Joint Surg Am 91(7):1683–1688

    Article  CAS  PubMed  Google Scholar 

  65. Pridie K (1959) A method of resurfacing osteoarthritic knee joints. J Bone Jt Surg 41:618–619

    Google Scholar 

  66. Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E (2007) The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med 35(1):80–85

    Article  PubMed  Google Scholar 

  67. Sanders RK, Crim JR (2001) Osteochondral injuries. Semin Ultrasound CT MR 22(4):352–370

    Article  CAS  PubMed  Google Scholar 

  68. Schuman L, Struijs PA, van Dijk CN (2001) Traumatic osteochondral lesions of the talar dome. Orthopade 30(1):66–72

    Article  CAS  PubMed  Google Scholar 

  69. Scranton PE, 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(5):614–619

    Article  PubMed  Google Scholar 

  70. Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75(4):532–553

    CAS  PubMed  Google Scholar 

  71. Steadman J, Rodkey W, Singleton S, Briggs K (1997) Microfracture technique for full-thickness chondral defects: Technique and clinical results. Oper Tech Orthop 7(4):300–304

    Article  Google Scholar 

  72. Steinhagen J, Niggemeyer O, Bruns J (2001) Etiology and pathogenesis of osteochondrosis dissecans tali. Orthopade 30(1):20–27

    Article  CAS  PubMed  Google Scholar 

  73. Thermann H, Driessen A, Becher C (2008) Autologous chondrocyte transplantation in the treatment of articular cartilage lesions of the talus. Orthopade 37(3):232–239

    Article  CAS  PubMed  Google Scholar 

  74. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21(2):119–126

    CAS  PubMed  Google Scholar 

  75. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18(5):570–580

    Article  PubMed  PubMed Central  Google Scholar 

  76. Verghese N, Morgan A, Perera A (2013) Osteochondral lesions of the talus: defining the surgical approach. Foot Ankle Clin 18(1):49–65

    Article  PubMed  Google Scholar 

  77. Verhagen RA, Maas M, Dijkgraaf MG, Tol JL, Krips R, van Dijk CN (2005) Prospective study on diagnostic strategies in osteochondral lesions of the talus. Is MRI superior to helical CT? J Bone Joint Surg Br 87(1):41–46

    CAS  PubMed  Google Scholar 

  78. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8(2):233–242

    Article  PubMed  Google Scholar 

  79. Zanon G, Vico DIG, Marullo M (2014) Osteochondritis dissecans of the talus. Joints 2(3):115–123

    PubMed  PubMed Central  Google Scholar 

  80. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246

    Article  PubMed  PubMed Central  Google Scholar 

  81. Zollinger H, Dexel M (1981) Etiology of the osteochondrosis dissecans of the talus (author’s transl). Orthopade 10(1):92–94

    CAS  PubMed  Google Scholar 

  82. Zwingmann J, Südkamp NP, Schmal H, Niemeyer P (2012) Surgical treatment of osteochondritis dissecans of the talus: a systematic review. Arch Orthop Trauma Surg 132(9):1241–1250

    Article  PubMed  Google Scholar 

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  1. Chirurgische Universitäts- und Poliklinik, BG Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    Christopher Ull, Marcel Dudda, Thomas Armin Schildhauer, Dominik Seybold & Jan Geßmann

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Ull, C., Dudda, M., Schildhauer, T.A. et al. Osteochondrosis dissecans des Talus im Überblick. Trauma Berufskrankh 18, 48–55 (2016). https://doi.org/10.1007/s10039-016-0144-7

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