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유정우 ( Jungwoo Yoo ),여의동 ( Eui Dong Yeo ),이영구 ( Young Koo Lee ) 대한스포츠의학회 2017 대한스포츠의학회지 Vol.35 No.2
The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and the subchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although many classification schemes for OLT have been proposed, Berndt and Harty`s 4-staging classification is most commonly used. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. The treatment approach for athletes should be more elaborate due to the need for an early return to play. Several different types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondral autograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system shows good 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 to the medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTs with successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage and complicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effective procedure associated with a low complication rate and low postoperative pain has faster return to play and is recommended the first-line treatment for the OLTs of athletes.
발목의 외측 측부인대 불안정성에 대한 관절경적 변형 브로스트롬 술식
이영구(Young Koo Lee),여의동(Eui Dong Yeo),유정우(JungWoo Yoo) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.2
발목의 외측 측부 인대 손상은 발목손상 중 가장 많이 발생하는 손상으로서 보존적 치료에도 불구하고 외측 불안정성 증상과 징후가 확인될 경우 수술적 치료를 고려하는데, 가장 흔하게 사용하는 방법은 관혈적 변형 브로스트롬 술식(modified Broström operation, MBO)이다. 최근 견관절과 슬관절의 경우처럼 발목관절에서도 관절경적 술기가 발전하면서 발목인대의 봉합도 관절경만을 이용한 방법으로 시도되고 있다. 특히 사체를 대상으로 한 외측인대 봉합 후의 생역학적 강도 측정 연구와 전향적 무작위 대조군 임상 연구에서 관절경적 MBO는 관혈적 MBO와 동등 이상의 결과가 보고된 바, 관절경적 MBO는 발목관절의 외측 불안정성에 대한 효과적인 치료 방법이며 나아가 관혈적 MBO를 대체할 수도 있는 수술법이라고 생각된다. 또한 이러한 관절경적 수술법을 바탕으로 최근에는 발목의 원위경비이개 및 삼각인대에 대한 관절경적 치료가 소개되고 발전되면서 향후 발목에 대한 관절경적 수술법은 더욱 발전할 것으로 기대된다. Lateral ankle sprain is the most common ankle injuries. Patients who fail conservative treatments are candidates for modified Broström operation (MBO). Traditionally, the primary surgical treatment performed is the open MBO. Recently, there has been an evolution in the arthroscopic treatment of lateral ankle injury. Several reports reveal biomechanically equivalent results of arthroscopic vs . open MBO when using matched cadaver pairs. Also there was no difference in the clinical or radiologic outcomes between the arthroscopic and open MBO in randomized controlled trial. Therefore, arthroscopic MBO is reasonable and good alternative treatment for lateral ankle injury. Actually new techniques of arthroscopic treatment for ankle injury is introduced about arthroscopic syndesmotic repair and arthroscopic deltoid repair. Arthroscopic techniques for ankle injuries seem to develop further in the future.