Etiology, Classification, Diagnostics, and Conservative Management of Osteochondral Lesions of the Talus. 2023 Recommendations of the Working Group “Clinical Tissue Regeneration” of the German Society of Orthopedics and Traumatology

Walther, Markus ; Gottschalk, Oliver ; Madry, Henning ; Müller, Peter E. ; Steinwachs, Matthias ; Niemeyer, Philipp ; Niethammer, Thomas R. ; Tischer, Thomas ; Petersen, Jan ; Feil, Roman ; Fickert, Stefan ; Schewe, Bernhard ; Hörterer, Hubert ; Ruhnau, Klaus ; Becher, Christoph ; Klos, Kajetan ; Plaass, Christian ; Rolauffs, Bernd ; Behrens, Peter ; Spahn, Gunter ; Welsch, Götz ; Angele, Peter ; Ahrend, Marc-Daniel ; Kasten, Philip ; Erggelet, Christoph ; Ettinger, Sarah ; Günther, Daniel ; Körner, Daniel ; Aurich, Matthias

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Alternative Links zum Volltext:DOIVerlag

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Details

Dokumentenart:	Artikel
Titel eines Journals oder einer Zeitschrift:	CARTILAGE
Verlag:	SAGE PUBLICATIONS INC
Ort der Veröffentlichung:	THOUSAND OAKS
Band:	14
Nummer des Zeitschriftenheftes oder des Kapitels:	3
Seitenbereich:	S. 292-304
Datum:	2023
Institutionen:	Medizin > Lehrstuhl für Unfallchirurgie
Identifikationsnummer:	Wert Typ 10.1177/19476035231161806 DOI
Stichwörter / Keywords:	ARTHROSCOPIC TREATMENT; TREATMENT STRATEGIES; CARTILAGE REPAIR; TALAR DOME; ANKLE; DISSECANS; DEFECTS; DEBRIDEMENT; LIGAMENT; regulatory issues; general; articular cartilage; tissue; ankle; joint involved; other; non-surgical therapy; guidelines
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Ja
Dokumenten-ID:	76102

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Zusammenfassung

The working group, "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology (DGOU) issues this paper to update their guidelines. Methods Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available ...

Zusammenfassung

The working group, "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology (DGOU) issues this paper to update their guidelines. Methods Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. Conclusion In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.

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