Arthroskopische Behandlung von Knorpelverletzungen am Sprunggelenk

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• 作者：Dr. M. Thomas ; M. Jordan ; E. Hamborg-Petersen
• 关键词：Osteochondrale Läsion ; Mikrofrakturierung ; Anbohrung ; Sprunggelenkdistorsion ; Talus ; Osteochondral lesion ; Microfracture ; Ankle sprain ; Talus ; Drilling
• 刊名：Der Unfallchirurg
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：119
• 期：2
• 页码：100-108
• 全文大小：1,037 KB
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• 作者单位：Dr. M. Thomas (1)
  M. Jordan (1)
  E. Hamborg-Petersen (2)
  
  1. Abteilung für Fuß- und Sprunggelenkschirurgie, Hessingpark-Clinic, Hessingstrasse 17, 86199, Augsburg, Deutschland
  2. Department of Orthopaedic Surgery, Odense University Hospital, Odense, Dänemark
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Traumatic Surgery
  Medicine/Public Health, general
  Sports Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-044X

文摘

Ankle sprains are the most relevant injuries of the lower extremities and can lead to damage to ligaments and osteochondral lesions. Up to 50 % of patients with a sprained ankle later develop a lesion of the cartilage in the ankle joint or an osteochondral lesion of the talus. This can lead to osteoarthritis of the injured ankle joint. Spontaneous healing is possible in all age groups in cases of a bone bruise in the subchondral bone but in isolated chondral injuries is only useful in pediatric patients. In many cases chondral and osteochondral injuries lead to increasing demarcation of the affected area and can result in progressive degeneration of the joint if not recognized in time. There also exist a certain number of osteochondral changes of the articular surface of the talus without any history of relevant trauma, which are collectively grouped under the term osteochondrosis dissecans. Perfusion disorders are discussed as one of many possible causes of these alterations. Nowadays, chondral and osteochondral defects can be treated earlier due to detection using very sensitive magnetic resonance imaging (MRI) and computed tomography (CT) techniques. The use of conservative treatment only has a chance of healing in pediatric patients. Conservative measures for adults should only be considered as adjuvant treatment to surgery. Based on a comprehensive analysis of the current literature, this article gives an overview and critical analysis of the current concepts for treatment of chondral and osteochondral injuries and lesions of the talus. With arthroscopic therapy curettage and microfracture of talar lesions are the predominant approaches or retrograde drilling of the defect is another option when the chondral coating is retained. Implantation of autologous chondral cells or homologous juvenile cartilage tissue is also possible with arthroscopic techniques. Osteochondral fractures (flake fracture) are usually performed as a mini-open procedure supported by arthroscopy. The use of the osteochondral autograft transfer system (OATS), implantation of membranes with or without autologous bone marrow transfer and possibly with growth factors or implantation of stem cells are carried out in combination with arthroscopic mini-open procedures. The results from the literature are discussed and compared with own results after arthroscopic treatment of chondral lesions of the talus. Keywords Osteochondral lesion Microfracture Ankle sprain Talus Drilling