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