Mehmet AŞIK, Cengiz ŞEN, F. Erkal BİLEN, Önder İ. KILIÇOĞLU, Ömer F. TAŞER

Talus osteokondral lezyonlarında artroskopik tedavi

Amaç: Talus osteokondral lezyonu olan hastaların tedavisinde artroskopik cerrahi ve orta dönem sonuçlar değerlendirildi. Çalışma planı: Talus osteokondral lezyonu tanısıyla artroskopik cerrahi tedavi uygulanan 28 hasta (17 erkek, 11 kadın; yaş ort. 30.3; dağılım 22-55) çalışmaya alındı.Şikayetlerin başlangıcı ile ameliyat arasında geçen süre ortalama 8.3 ay (dağılım 3-17 ay) idi. Yirmi iki hastada (%79) travma anamnezi görüldü. Lezyon 11 hastada (%40) lateralde, 17 hastada (%60) ise medialde idi. Lezyonlar, Berndt ve Harty radyolojik sınıflamasına göre 12 hastada evre II, altı hastada evre III ve 10 hastada evre IV olarak değerlendirildi. Evre II lezyonu olan hastalara anterograd drilleme, evre III lezyonu olanlara fragman ekstirpasyonu, debridman ve drilleme ve evre IV lezyonu olanlara fragman ekstirpasyonu ile lezyon yatağının debridman ve küretaj işlemi yapıldı. Ortalama takip süresi 51.1 ay (11-108 ay) idi. Sonuçlar: Ameliyat öncesi AOFAS skorlarının ortalaması 71.6 iken ameliyat sonras›nda 86.5’e yükseldi. Martin değerlendirme şemasına göre de 14 hastada mükemmel, 10 hastada iyi ve dört hastada orta sonuç elde edildi. Radyolojik olarak, evre II lezyonu olan hastalarda subkondral remodelasyon izlendi; evre III ve IV lezyonlu hastalarda ise subkondral değişiklikler bulunduğu, ancak artroz olmadığı gözlendi. Çıkarımlar: Açık yöntemlere göre daha az morbiditesi, daha hızlı rehabilitasyon süreci ve daha erken günlük ya- şama dönme olanağı vermesi nedeniyle talus osteokondral lezyonlarında artroskopik tedavinin daha başlarılı ve etkin bir yöntem oldu¤u sonucuna varıldı.

Anahtar Kelimeler:

Kırık tespiti, Ayak bileği eklemi, Artroskopi, Osteokondrit

Arthroscopic treatment of osteochondral lesions of the talus

Objectives: We evaluated mid-term results of patients who underwent arthroscopic treatment for osteochondral lesions of the talus. Methods: The study included 28 patients (17 males, 11 females; mean age 30.3 years; range 22-55 years) who had osteochondral lesions of the talus and were treated by arthroscopic surgery. Mean duration between the occurrence of symptoms and surgery was 8.3 months (range 3 to 17 months). Twenty-two patients (79%) had a history of trauma. Lesions were located laterally in 11 (40%) and medially in 17 (60%) patients. According to the radiologic classification (Berndt and Harty), 12 patients had stage II, six had stage III and 10 had stage IV lesions. Arthroscopic treatment consisted of antegrade drilling in stage II, removal of the loose body combined with debridement and drilling in stage III, and removal of the loose body combined with debridement and curettage in stage IV lesions. The mean follow-up was 51.1 months (range 11 to 108 months). Results: The mean preoperative and postoperative AOFAS scores were 71.6 and 86.5, respectively. According to the Martin scoring, the results were excellent in 14 patients, good in 10, and fair in four patients. Radiologic evaluation showed subchondral remodelation in stage II lesions; subchondral changes were observed in stage III and IV lesions, but these did not suggest arthritic changes. Conclusion: We concluded that arthroscopic treatment of osteochondral lesions of the talus is a successful and effective method due to less morbidity, a shorter rehabilitation period, and opportunity to return more rapidly to daily activities.

Keywords:

Fracture Fixation, Ankle Joint, Arthroscopy, Osteochondritis,

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1.Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg [Am] 1959; 41:988-1020.
2. Ferkel RD. Osteochondral lesions of the talus. In: Whipple TL, editor. Arthroscopic surgery: the foot and ankle. 1st ed. Philadelphia: Lippincott-Raven; 1996. p. 145-70.
3. Alexander AH, Lichtman DM. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up. J Bone Joint Surg [Am] 1980;62:646-52.
4. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 1985;5:165-85.
5. Parisien JS. Arthroscopic treatment of osteochondral lesions of the talus. Am J Sports Med 1986;14:211-7.
6. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg [Am] 1986;68:862-5.
7. Guhl JF. Osteochondritis dissecans. In: Guhl JF, editor. Ankle arthroscopy: pathology and surgical techniques. Therefore, NJ: Slack Inc.; 1988. p. 95-106.
8. Martin DF, Baker CL, Curl WW, Andrews JR, Robie DB, Haas AF. Operative ankle arthroscopy. Long-term followup. Am J Sports Med 1989;17:16-23.
9. Roden S, Tillegard P, Unander-Scherm L. Osteochondritis dissecans and similar lesions of the talus. Report of 55 cases. Acta Orthop Scand 1953;23:51-66.
10. Dore JL, Rosset PH. Lesions osteochondrales du dome astragalien. Etude multicentrique de 169 cas. Ann Orthop de l’quest 1955;27:146-91.
11. Vrahas M, Fu F, Veenis B. Intraarticular contact stresses with simulated ankle malunions. J Orthop Trauma 1994;8:159-66.
12. Guhl JF. Portals and techniques. In: Guhl JF, editor. Ankle arthroscopy: pathology and surgical techniques. Therefore, NJ: Slack Inc.; 1988. p. 49-62.
13. Ferkel RD, Fischer SP. Progress in ankle arthroscopy. Clin Orthop 1989;(240):210-20.
14. Morgan CD. Gross and arthroscopic anatomy of the ankle. In: McGinty JB, editor. Operative arthroscopy. New York: Raven Press; 1991. p. 677-94.
15. Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg [Am] 1999;81:1229-35.
16. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15:349-53.
17. Kim SH, Ha KI, Ahn JH. Tram track lesion of the talar dome. Arthroscopy 1999;15:203-6.
18. Kılıçoğlu Ö, Alturfan AK, Demirhan M. Talus osteokondral lezyonlarında artroskopik yaklaşım. Acta Orthop Traumatol Turc 1996;30:515-22.
19. Lee CK, Mercurio C. Operative treatment of osteochondritis dissecans in situ by retrograde drilling and cancellous bone graft: a preliminary report. Clin Orthop 1981;(158):129-36.
20. Ogilvie-Harris DJ, Sarrosa EA. Arthroscopic treatment of osteochondritis dissecans of the talus. Arthroscopy 1999; 15:805-8.
21. Ogilvie-Harris DJ, Sarrosa EA. Arthroscopic treatment after previous failed open surgery for osteochondritis dissecans of the talus. Arthroscopy 1999;15:809-12.
22. Lahm A, Erggelet C, Steinwachs M, Reichelt A. Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthroscopy 2000; 16:299-304.
23. Higuera J, Laguna R, Peral M, Aranda E, Soleto J. Osteochondritis dissecans of the talus during childhood and adolescence. J Pediatr Orthop 1998;18:328-32.
24. Kelberine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. Arthroscopy 1999;15:77-84.
25. Schenck RC Jr, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg [Am] 1996;78:439-56.
26. Bryant DD 3d, Siegel MG. Osteochondritis dissecans of the talus: a new technique for arthroscopic drilling. Arthroscopy 1993;9:238-41.
27. Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg [Am] 1980;62:97-102.
28. Baker CL Jr, Morales RW. Arthroscopic treatment of transchondral talar dome fractures: a long-term follow-up study. Arthroscopy 1999;15:197-202.