Das steife Sprunggelenk

Stiffness of the ankle joint can lead to severe loss of quality of life and impairment of gait. In most cases the loss of motion results from secondary intraarticular and extraarticular pathologies which are differentiated into soft tissue and bony pathologies. This article describes the etiology and treatment of ankle stiffness with the main focus on arthroscopic procedures.     

Ventrales Impingementsyndrom am oberen Sprunggelenk

Impingement of the ankle joint and instability are the most commonly described pathological symptoms of the ankle. Approximately 80% occur in the ventral compartment and 20% in the dorsal compartment of the ankle joint. The most common causes in order of frequency are torn (anterolateral) ligaments and soft tissue elements disrupted bony structures with the resulting fixed and/or free joint bodies laterally and medially, synovial hypertrophy in chronic instability or based on systemic disease processes and finally injuries of the syndesmosis as well as scar fibres after large capsule ruptures. The so-called bony impingement laterally or medially must be differentiated from the above due to the narrowing of the joint space with increased cartilage stress. An osteophytic lesion at the front of the tibia or talus edge causing arthritis or as a sign of a rotational instability can cause pain particularly in dorsiflexion and a reduction in range of motion. Arthroscopic resection of the impingement cause leads to a significant reduction of the symptoms.     

Tendoskopie am Sprunggelenk und Fuß

Ankle arthroscopy is increasingly used as a technique for dealing with a wide range of ankle pathologies. In contrast, extra-articular problems of the ankle still most often demand open surgery. In the recent years, endoscopic procedures for treating various tendon pathologies have been developed. Like arthroscopic surgery, tendoscopy offers the advantages related to any minimally invasive procedure such as fewer wound infections, less blood loss, smaller wounds and less morbidity. This article defines the major indications in which tendoscopy is appropriate and presents current techniques for treatment.     

Behandlung osteochondraler Läsionen am Sprunggelenk

Osteochondral lesions involve articular cartilage as well as subchondral bone. Chronic osteochondral lesions of the ankle are often misdiagnosed, which often results in delayed treatment. The principles of a comprehensive therapeutic clarification as well as the resulting decision-making between conservative and operative procedures are elucidated in this article. In particular, different surgical procedures are presented and critically discussed. The indications and limitations as well as the results of each technique will be presented in an overview based on the current literature.     

Arthroskopische Anatomie und Technik am oberen Sprunggelenk

Over the years arthroscopy of the ankle joint has developed into a standard technique in arthroscopic clinics as well as in outpatient units. A profound knowledge of the arthroscopic anatomy in combination with the safe creation of a portal makes low-risk surgical operations possible. Most pathological forms can be found in the ventral aspect and a dorsal portal is rarely needed.     

Knorpelknochentransplantation mit dem OATS-Instrumentarium am oberen Sprunggelenk bei osteochondralen Defekten des Talus

Zusammenfassung Die Arthroskopie des oberen Sprunggelenks hat sich bei der Therapie der Osteochondrosis dissecans (OD) am Talus etabliert. Arthroskopisch finden sich häufig eine mehr oder weniger tamponierende Synoviitis der vorderen Gelenkkammer sowie chondrale Läsionen bzw. osteochondrale Läsionen am Talus mit begleitenden Knorpelschäden an der tibialen Gelenkfläche. So wurde an der Klinik für Unfallchirurgie des Klinikums Nürnberg-Süd in der Zeit vom 01.01.1998-31.12.2000 an insgesamt 9 Patienten aufgrund einer Osteochondrosis dissecans des Talus eine autologe Knorpelknochentransplantation mittels des OATS-Instrumentariums vorgenommen. Sechs Patienten waren voroperiert. Die Indikation zur OATS-Transplantation wurde gestellt, wenn ein Stadium 4 oder 5 nach Loomer vorlag und ein anderes Behandlungsverfahren erfolglos gewesen war. Die Nachuntersuchungen sahen neben den radiologischen Untersuchungen eine klinische und funktionelle Untersuchung vor. Grundlage der Nachuntersuchung bildete der Score nach Pförringer und Stolz. Es fanden sich 3-mal ein sehr gutes und 3-mal ein gutes und 2 mal ein befriedigendes Behandlungsresultat. Zwei Patienten klagten über erhebliche Belastungsschmerzen, eine Bewegungsverbesserung konnte nur bei 3 der 8 nachuntersuchten Patienten erreicht werden. Aus unserer Sicht kann das Verfahren bei lokalisierten Herden in fortgeschrittenen Stadien der Osteochondrosis dissecans bei Jugendlichen und Erwachsenen sowohl primär, aber auch sekundär nach Versagen einer antero- oder retrograden Anbohrung eingesetzt und mit vorsichtigem Optimismus unserer Kurzzeitergebnisse empfohlen werden. Abstract The arthroscopy of the upper ankle joint is established in the therapy of theosteochondrosis dissecans of the talus. Often during the arthroscopy you can see a more or less tamponating synoviitis of the ventral joint region as well as chondral or osteochondral lesion of the talus with accompaning chondral lesion of the tibial joint region. In the department of traumatologic surgery in the hospital Nürnberg Süd between 01.01.98 and 31.12.00 there were 9 patients who had an autologic osteochondral transplantation with the OATS-instrumentary because of an osteochondrosis dissecans of the talus. 6 patients had an earlyer operation of the upper ankle joint. If the osteochondral lesion fullfilled the assumption of stadium 4 or 5 of the Loomer-classification and other treatments were without success, we saw the indication for autologic osteochondral transplantation using the OATS-instrumentary. The follow-up examination includes a x-ray documentation as well as a clinical and functional examination. The follow-up examinations were based on the score of Pförringer and Stolz. In 3 cases we saw an excellent, in 3 cases a good, and in 2 cases a satisfied result. Two patients had considerable pain at work-load. A better range of movement was only seen in 3 out of 8 cases. From our point of view this treatment of OATS is promising by local lesion in higher stadiums of osteochondrosis dissecans by juvenile and adult onset as primery treatment, but also as secondary treatment after ineffectiv anterograde or retrograde boring with careful optimism based on our short term results.