The management of talar osteochondral lesions - Current concepts

Q4 Medicine
Tian Lan , Helen S. McCarthy , Charlotte H. Hulme , Karina T. Wright , Nilesh Makwana
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引用次数: 13

Abstract

Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the “gold standard” for lesions <150 mm2, there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes.

Abstract Image

Abstract Image

距骨软骨病变的处理-当前概念。
距骨软骨损伤(OLTs)是创伤后常见的并发症,涉及关节软骨和下方软骨下骨,病因各异,通常表现为非特异性症状。OLT的诊断需要临床评估和成像相结合,尽管有许多不同的治疗方案,但对于哪种方案最有效,还没有达成普遍共识。如果不治疗,OLT有发展为骨关节炎的风险。急性非移位OLT可以非手术治疗。然而,非手术治疗三到六个月的OLT可能适合手术治疗。在这些情况下,保守治疗往往不成功,尤其是对于较大和更严重的缺陷,因此大多数需要手术干预。尽管骨髓刺激技术仍然是病变2的“金标准”,但与其他治疗方案相比,仍需要更好的长期临床数据和成本效益分析。然而,再生或替换关节软骨的生物学尝试正在证明一些有希望的结果,但每种方法都有各自的优缺点。在这篇综述中,我们总结了OLT的临床管理,并介绍了不同治疗方案的当前概念。
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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
自引率
0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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