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Osteochondrale Läsionen des Talus

Therapieoptionen

Osteochondral lesions of the talus

Treatment options

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die osteochondrale Läsion (OCL) des Talus scheint multifaktorieller Genese zu sein. Sowohl akute Traumata als auch repetitive Mikroverletzungen zeigen einen ätiologischen Bezug. Des Weiteren werden Malalignment, Durchblutungspathologien und idiopathische Ursachen diskutiert. Die symptomatische OCL führt bei den häufig jungen Patienten zu einer deutlichen Einschränkung der Lebensqualität. Die konservativen Therapieoptionen sind begrenzt und enden bei anhaltender Beschwerdesymptomatik oft in einer chirurgischen Versorgung. Die operativen Maßnahmen lassen sich in chondrale, ossäre oder kombinierte (chondrale und ossäre) Verfahren unterteilen. Ein Goldstandard bei der Behandlung der OCL konnte bisher nicht definiert werden. Das Ziel der vorliegenden Arbeit ist die Darstellung der aktuellen Therapieoptionen mit Übersicht über den aktuellen Stand der Literatur. Dabei zeigt sich ein tendenzieller klinischer Vorteil der kombinierten chondralen und ossären Therapieoptionen, insbesondere die Induktion von Regeneratgewebe scheint einen klinischen Vorteil zu erbringen. Zu den neueren Operationstechniken, wie die autologe matrixinduzierte Chondrogenese, liegen nur Daten mit kurz- bis mittelfristigen Nachuntersuchungen vor, die jedoch gute bis sehr gute Ergebnisse aufzeigen. Die Behandlung von Begleitpathologien bei Vorliegen einer symptomatischen OCL ist in der Literatur bisher nicht ausreichend untersucht worden. In den wenigen vorliegenden Arbeiten konnte jedoch ein Vorteil dargestellt werden. Größere Studienkollektive sind hier nötig, um das therapeutische Vorgehen unter Berücksichtigung der Größe, Lage, Ätiologie und Begleitpathologien der OCL zu definieren.

Abstract

Osteochondral lesions (OCL) of the talus seem to be of multifactorial genesis. Both acute trauma and repetitive microtrauma have an etiological relevance. Furthermore, malalignment, circulatory pathologies and idiopathic causes are discussed. Additional pathologies may be more clinically symptomatic and need a specific diagnosis. Asymptomatic OCLs do not require direct surgical treatment. Symptomatic OCLs often lead to a significant reduction in quality of life in the frequently affected young patients. Conservative treatment options for OCLs are limited. Operative strategies differ in terms of addressing chondral, osseous or combined (chondrale and osseous) tissue. A gold standard could not be defined so far. The aim of the present article is the presentation of the current treatment options with an overview of the current literature. There might be a clinical advantage of the combined chondral and osseous treatment options, particularly in the induction of tissue regeneration. Only few reports are available on newer surgical techniques, such as autologous matrix-induced chondrogenesis which showed good to very good results. Addressing concomitant pathologies in the presence of symptomatic OCL has not yet been clearly established; however, the few clinical data show an advantage. Larger study groups are needed to define treatment strategies depending on the size, location, etiology and comorbidities of OCLs.

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Authors and Affiliations

  1. Klinik für Fuß- und Sprunggelenkchirurgie, Hessing Stiftung, Hessingstraße 17, 86199, Augsburg, Deutschland

    H. Waizy & C. Weber

  2. Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover, Anna-von-Borries Str. 1–7, 30625, Hannover, Deutschland

    H. Waizy

  3. Department für orthopädische Sportmedizin, TU München, Ismaninger Straße 12, 81675, München, Deutschland

    D. Berthold & S. Vogt

  4. Klinik für Sportorthopädie und Arthroskopische Chirurgie, Hessing Stiftung, Hessingstraße 17, 86199, Augsburg, Deutschland

    S. Vogt

  5. Orthopädische Klinik, Mitglied der Fakultät Gesundheit Universität Witten/Herdecke, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland

    D. Arbab

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  1. H. Waizy
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Correspondence to H. Waizy.

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Interessenkonflikt

H. Waizy, C. Weber, D. Berthold, S. Vogt und D. Arbab geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Waizy, H., Weber, C., Berthold, D. et al. Osteochondrale Läsionen des Talus. Arthroskopie 31, 104–110 (2018). https://doi.org/10.1007/s00142-018-0195-9

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  • DOI: https://doi.org/10.1007/s00142-018-0195-9

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