Tuesday, May 24, 2011

Osteochondritis dissecans - Treatment

Patient age is critical in determining surgery in a patient with osteochondritis the knee and the time of surgery. Surgical interventions are secured in a child with knee damage if symptoms persist for 6-12 months, radiographic signs predicting healing abnormal if the conservative measures, if skeletal maturity is final in six months or if present corpus are lost. Early surgical interventions are considered an adult with knee damage. The decision to operate an adult is based on sitoricul trauma.Surgery is indicated in all patients with ankle injury with osteochondritis Talara side and completely detached fragment but remain in the crater of the lesion. Symptomatic patients with stage III medial Talara require surgery. Stage IV on the lateral and medial faces require surgery.
Surgical indications are controversial elbow damage. Progressive joint contracture, soup unresolved symptoms conservative treatment and fixed contracture at over 10 degrees of elbow pain are common indications for surgery.All patients with symptomatic lesions that fail conservative treatment may require surgery. Radiography should be correlated with other clinical features. Asymptomatic lesions require surgery weight supporting joints due to degenerative risk.
Conservative therapy:Conservative treatment in these patients includes limiting activity and joint protection to prevent future dislocations. Affected joints are fixed to limit the stress in the lesion. The activity is allowed once the patient does not report pain, shows a normal physical examination and radiographic healing. After 3 months, patients who are still symptomatic or whose radiographs show no improvement require surgery.Conservative treatment for impaired ankle is guided by two considerations: the location of the lesion and radiographic evidence. Patients with damage to the medial or lateral radiograph and normal or only partial detachment can be treated conservatively. Conservative treatment in these patients include limb immobilization for 6-12 weeks.
Surgical therapy:Surgical options have traditionally included the drilling of the defect, nlaturarea bodies, fragmented, their attachment to the place of separation and placement of osteochondral grafts.Current interventional methods include determining the lesion, drilling into the lesion and autologous osteochondral mosaicplasty autologous chondrocyte transplantation.
Autologous osteochondral mosaicplasty:Cilindroce osteochondral grafts from the periphery of bone are removed and transplanted into defects prepared arthroscopic affected areas. Fibrocartilajului growth stimulated by abrasion or abortion based on the new surface defect fill.
Autologous chondrocyte transplantation:Arthroscopic chondrocytes are taken and grown in the laboratory for three weeks. during chondrocyte transplantation is critical to avoid bleeding defect. Cultivae cells are injected into the defective part covered with perisoteala. This technique is necessary for large defects when other treatments have failed.
Sandwich technique (radical excision of sclerotic bone in the defect with bone grafting and autologous chondrocyte transplantation)The defect is excised until normal cartilage and sclerotic bone is excavated until the bone that singereaza. Bone defect is filled with healthy bone from the subchondral plate and apply perisoteala part to secure the graft. Chondrocyte transplantation is performed.
Prognosis:Natural evolution and prognosis of the different treatments vary according to age, patient I, the affected joint and lesion stage.Impaired knee heal with conservative therapy if there body loses.The results are 94% favorable in patients treated with ortoza for four months. Adult form of the disease rarely respond to conservative treatment. Patients with impaired ankle juveniles respond to conservative therapy better than the adults. Adult form of damage to the elbow responds well to surgery.Mosaicplasty autologous chondrocyte implantation and procedures are still relatively new. Their initial results are promising, however further data are needed before recommending strongly procedures. Studies are needed to differentiate the answers to these therapies for adult and juvenile form of the disease.

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