운동선수의 족관절 골연골 손상에서의 치료 (Treatment of Osteochondral Lesions of the Talus in Athletes)

서지정보

· 발행기관 : 대한스포츠의학회
· 수록지 정보 : 대한스포츠의학회지 / 35권 / 2호 / 77 ~ 85페이지
· 저자명 : 유정우, 여의동, 이영구

초록

The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and thesubchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although manyclassification schemes for OLT have been proposed, Berndt and Harty’s 4-staging classification is most commonlyused. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. Thetreatment approach for athletes should be more elaborate due to the need for an early return to play. Severaldifferent types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondralautograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system showsgood clinical outcome and has the advantages that could be applied to large defect and recurred lesions, however,it has some disadvantages in terms of the complications related with the donor site and the difficult approach tothe medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTswith successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage andcomplicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effectiveprocedure associated with a low complication rate and low postoperative pain has faster return to play and isrecommended the first-line treatment for the OLTs of athletes.

영어초록

The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and thesubchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although manyclassification schemes for OLT have been proposed, Berndt and Harty’s 4-staging classification is most commonlyused. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. Thetreatment approach for athletes should be more elaborate due to the need for an early return to play. Severaldifferent types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondralautograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system showsgood clinical outcome and has the advantages that could be applied to large defect and recurred lesions, however,it has some disadvantages in terms of the complications related with the donor site and the difficult approach tothe medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTswith successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage andcomplicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effectiveprocedure associated with a low complication rate and low postoperative pain has faster return to play and isrecommended the first-line treatment for the OLTs of athletes.

참고자료

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