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PubMed1956

Talus exhalations.

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Fractures, Bone↗
PubMed1992

Osteochondrosis dissecans of the talus. Comparison of results of surgical treatment in adolescents and adults.

Clinical results in two groups of patients treated for osteochondrosis dissecans tali were examined in a follow-up examination: adolescents up to age 16 years versus adults. Thirteen patients were reexamined in each group. Clinical comparison revealed distinct differences between the groups. In adolescents there were eight excellent and three good results, only one fair, and one poor result. In contrast, adults demonstrated excellent results in only two and good results in five patients; five patients showed fair results and one a poor outcome. No signs of osteoarthrosis were detected in adolescents whereas in four adult patients slight radiological signs of osteoarthritis were visible. In both groups clinical and radiological results were better when the cartilage layer at the talar dome was found to be intact at the time of surgical intervention. Detectable cartilage damage at the time of operation was accompanied by a worse result at the time of follow-up examination. In conclusion, adolescents without any signs of joint locking or loose body formation should first be treated conservatively. The older the patient the shorter the period of nonsurgical treatment should be. In cases of increasing stages, joint locking, or formation of loose bodies surgical intervention is recommended.

Adolescent↗
PubMed2003

[10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus].

The optimal operative therapy for the treatment of osteochondritis dissecans tali is still controversial. Beside bone marrow-stimulating techniques like abrasion arthroplasty, drilling and microfracturing, new techniques like autologous osteochondral transplantation and autologous chondrocyte transplantation are increasingly used. This study reviewed the clinical, radiological and subjective long-term outcome of bone marrow-stimulating therapy for 45 ankles with an osteochondritis dissecans tali stage 3 or 4 according to the classification by Berndt and Harty. All ankles were treated by the removal of the dissecate and abrasion of the subchondral bone. In 67%, an additional antegrade drilling of the defect was performed. The average maximum size of the lesion was 1.1 cm. At follow-up examination, 10.4 years (7.1-13.5 years) postoperatively, the average AOFAS-score was 91 points (66-100 points). Using the score of Mazur, the outcome of 28 ankles (62%) was rated excellent, 12 ankles (27%) were rated good and five ankles (11%) fair or poor. Progressive osteoarthritic changes, according to the classification of van Dijk, were seen in seven ankles (16%). Reoperations were necessary in eight cases (18%). Obesity, age older than 40 years and preoperative osteoarthritic changes had a significant negative impact on the clinical outcome. Bone marrow stimulating therapy is an inexpensive, low invasive therapy and a good therapeutic option at least for small Berndt/Harty stage 3 and 4 ODT lesions. Autologous chondrocyte transplantation and osteochondral autografts yield encouraging 2- and 4-year results, but still have to prove their superiority in long-term follow-up studies.

Adolescent↗