Ätiopathogenetische Aspekte der medialen Osteochondrosis dissecans tali

Zusammenfassung:

Es wird über eine experimentelle Untersuchung in einem biostatischen Modell berichtet, in dem der Gelenkflächendruck des oberen Sprunggelenks in Abhängigkeit von verschiedenen Gelenkstellungen und lateralen Bandläsionen unter axialer Belastung gemessen wurde. Die Ergebnisse zeigen, daß Druckmaxima unter Varus- und Supinationsposition am medialen Talusrand liegen, dort wo die Osteochondrosis dissecans tali besonders häufig auftritt. Im Zusammenhang damit wird die Ätiologie und Pathogenese der Osteochondrosis dissecans tali diskutiert und der hohe Stellenwert des Supinationstraumas hervorgehoben.

Abstract

In a cadaveric biostatic model the pressure distribution at the weightbearing ankle has been investigated under different joint positions and stages of artificial lateral ligament dissection mimicking a supination trauma. The location of the transduced contact area, the size of these areas and amount of pressure were evaluated after application of axial load. The results showed that the location, size of contact area and the maximum transduced pressure were depending on the joint Position and stage of ligament dissection. Interestingly the peak pressure was located at the medial talar rim even without lateral ligament dissection. The transduced pressure areas were located at that locations were osteochondral lesions are mostly observed. In regard to these results the etiology and pathogenesis of osteochondritis dissecans tali is discussed. It is thought that supination traumas as well as other biomechanical factors such as overweight and lax ankle ligaments have an important influence on the development of osteochondritis dissecans at least at the medial rim of the talus.