Savage-Elliott Ian, Ross Keir A, Smyth Niall A, Murawski Christopher D, Kennedy John G
Foot and Ankle Service, Hospital for Special Surgery, New York, New York.
Foot and Ankle Service, Hospital for Special Surgery, New York, New York
Foot Ankle Spec. 2014 Oct;7(5):414-22. doi: 10.1177/1938640014543362. Epub 2014 Aug 5.
Osteochondral lesions of the talar dome are increasingly diagnosed and are a difficult pathology to treat. Conservative treatment yields best results in pediatric patients, often leaving surgical options for adult populations. There is a paucity of long-term data and comparisons of treatment options. Arthroscopic bone marrow stimulation is a common first-line treatment for smaller lesions. Despite promising short to medium term clinical results, bone marrow stimulation results in fibrocartilagenous tissue that incurs differing mechanical and biological properties compared with normal cartilage. Autologous osteochondral transplantation has demonstrated promising clinical results in the short to medium term for larger, cystic lesions and can restore the contact pressure of the joint. However, concerns remain over postoperative cyst formation and donor site morbidity. Recent developments have emphasized the usefulness of biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate, as well as particulate juvenile cartilage, in augmenting reparative and replacement strategies in osteochondral lesion treatment. The purpose of this article is to review diagnosis and treatment of talar osteochondral lesions so that current practice guidelines can be more efficiently used given the available treatment strategies. A treatment paradigm based on current evidence is described.
Therapeutic, Level V, Expert Opinion.
距骨穹窿部骨软骨损伤的诊断率日益提高，且是一种难以治疗的病理状况。保守治疗在儿科患者中效果最佳，通常会为成年人群保留手术选择。长期数据以及治疗方案的比较较为匮乏。关节镜下骨髓刺激是较小损伤的常见一线治疗方法。尽管短期至中期临床结果令人满意，但骨髓刺激会产生纤维软骨组织，与正常软骨相比，其机械和生物学特性有所不同。自体骨软骨移植在短期至中期对较大的囊性损伤已显示出令人满意的临床效果，并且可以恢复关节的接触压力。然而，术后囊肿形成和供区并发症仍然令人担忧。最近的进展强调了生物辅助手段的有用性，如富血小板血浆、浓缩骨髓抽吸物以及颗粒状青少年软骨，在增强骨软骨损伤治疗中的修复和替代策略方面的作用。本文的目的是回顾距骨骨软骨损伤的诊断和治疗，以便在现有治疗策略的基础上更有效地应用当前的实践指南。描述了基于当前证据的治疗模式。
治疗性，V级，专家意见。
