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PubMed2004

Osteochondritis dissecans of the talus treated by the transplantation of tissue-engineered cartilage.

Management of osteochondral lesions of the joint has been difficult, because articular cartilage has a poor healing capacity as a result of its lack of vessels, nerve supply, and its isolation of systemic regulation. Although a lot of basic research and surgical treatments for cartilage repair have focused on osteochondral lesions in the knee joint, orthopedic surgeons have recently diverted their attention to osteochondral lesions in the ankle joint, partly because of the widespread introduction of arthroscopy in ankle surgery. There have been many attempts to treat articular cartilage defects in the ankle joint as well as in the knee joint. However, no treatment has achieved efficient healing with hyaline cartilage. Recently, tissue engineering technique for cartilage repair has been gaining much attention in the orthopedic field. In this study, we reported on a patient with osteochondritis dissecans of the talar dome, successfully treated by transplantation of tissue-engineered cartilage made ex vivo using atelocollagen gel and low tibial osteotomy.

Adult↗
PubMedDate not supplied

[Postoperative evaluation of osteochondrosis dissecans of the talus with special reference to medial malleolar osteotomy].

58 out of 69 patients after open operation for osteochondritis dissecans (OD) of the upper ankle joint were reexamined retrospectively. In 44 cases the medial talar edge was concerned, in 15 the lateral one. Pain in activity resisting conservative treatment led to the operations. 31 excisions, 16 drillings, 10 autogenous bone graftings (2 external) and 2 diagnostic arthrotomies had been carried out. Medial malleolar osteotomy had to be performed in 22 cases, mainly concerning excisions and graftings to maintain sufficient survey of the lesion. Follow-up examination took place an average 67 months postoperatively. The results were obtained through a new scoring system with special regard to subjective and clinical criteria. 13 excellent, 29 good, 10 fair and 7 bad results were obtained. Results depended mainly on operative approach, location of the lesion and in lateral OD time of operation. Medial malleolar osteotomy frequently led to local osteoarthritis and less favourable clinical findings. No significant difference could be realized for size of the lesion and the applied operative technique. Stage and age at time of operation did not clearly influence the outcome. The indication for operation must be made dependant on individual complaints. Even in the era of arthroscopy medial malleolar osteotomy sometimes is necessary, but goes along with higher morbidity and worse prognosis. Operations have to be carried out according to stage and followed by proper rehabilitation to render proper assessment. Lateral lesions result from sprains and should be operated early.

Adolescent↗