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<Provider Id="sundheddkcms"> <Item Id="{2B9F6335-1679-4DD8-8AAA-5D1B96BDB3E8}" Name="ankel-bruskskader" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{AEB4ECE5-3040-426F-9E18-375AFD4D8112}" SortOrder="0" PublishDate="2009-02-22T12:35:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Sygehistorien giver mistanken</li> <li>Billeddiagnostik <ul> <li>Første valg er røntgen (der vil ofte være et lille knoglefragment, som er fraktureret af samtidigt med bruskskaden)</li> <li>Ved negative røntgen og fortsat klinisk mistanke kan laves MR-scanning</li> </ul> </li> </ul> <h3>Sygehistorie</h3> <ul> <li>Smerter som vedvarer eller recidiverer nogen tid efter den oprindelige ankelskade </li> <li>Hyppigste symptomer er smerter, stivhed og aflåsning af leddet (frit knoglefragment) </li> </ul> <h3>Kliniske fund</h3> <ul> <li>Ofte begrænsede kliniske fund</li> <li>Evt. palpationsømhed over laterale eller mediale hjørne af talusdomen</li> <li>Evt. aflåsning ved passive bevægelser</li> <li>Evt. øget ømhed ved bevægelse til yderstilling (dorsal-ekstension; plantar-fleksion)</li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen relevante ud over klinisk undersøgelse</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Røntgen undersøgelse er første valg.</li> <li>MR bekræfter diagnosen og skelner mellem forskellige grader af skade</li> <li>CT kan anvendes til at se knoglesammenfald</li> <li>Artroskopi, som led i behandling</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li><a href="~/link.aspx?_id=53C1E0B08BAA4D6B95AD8ECE611B5560&_z=z">Kronisk instabilitet i ankelleddet</a></li> <li><a href="~/link.aspx?_id=887CB398F4E44C928EF418CC1180F32E&_z=z">Anterolateral synovial impingement i anklen</a></li> <li><a href="~/link.aspx?_id=56651BF70B6B4F88A1C926D998EE73EF&_z=z">Posterior impingement i anklen</a></li> <li><a href="~/link.aspx?_id=1716D5DB342E4377B98CC762B238016C&_z=z">Ankelartrose</a></li> </ul> <h2>Behandling<a title="Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ, Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 2017;8(1): 19-30" href="EditorPage.aspx?da=core&id=%7B2B9F6335-1679-4DD8-8AAA-5D1B96BDB3E8%7D&ed=FIELD9067192573&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067193157&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ, Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 2017;8(1): 19-30" data-value-piped="Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ|Evaluation and Management of Osteochondral Lesions of the Talus|Cartilage|2017|8(1)|19-30" data-url="reference-link"><sup>1</sup></a><sup>,</sup><a title="Murawski CD, Kennedy JG, Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 2013;95(11): 1045-54" href="EditorPage.aspx?da=core&id=%7B2B9F6335-1679-4DD8-8AAA-5D1B96BDB3E8%7D&ed=FIELD9067192573&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067193157&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Murawski CD, Kennedy JG, Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 2013;95(11): 1045-54" data-value-piped="Murawski CD, Kennedy JG|Operative treatment of osteochondral lesions of the talus|J Bone Joint Surg Am|2013|95(11)|1045-54" data-url="reference-link"><sup>2</sup></a><sup>,</sup><a title="Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG, Osteochondral lesions of the talus: aspects of current management.. Bone Joint J 2014;96-B: 164-71" href="EditorPage.aspx?da=core&id=%7B2B9F6335-1679-4DD8-8AAA-5D1B96BDB3E8%7D&ed=FIELD9067192573&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067193157&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG, Osteochondral lesions of the talus: aspects of current management.. Bone Joint J 2014;96-B: 164-71" data-value-piped="Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG|Osteochondral lesions of the talus: aspects of current management.|Bone Joint J|2014|96-B|164-71|24493179" data-url="reference-link" data-pubmedid="24493179"><sup>3</sup></a></h2> <h3>Behandlingsmål</h3> <ul> <li>Symptomfrihed og normal funktion hvis muligt</li> <li>Alternativt aflastning af gener</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Frakturer uden løsrevet knoglefragment <ul> <li>Immobiliseres i ankelgips i 6-8 uger uden belastning</li> </ul> </li> <li>Operation kan være nødvendig <ul> </ul> </li> <li>Rehabilitering <ul> <li>Gradvis optræning før genoptagelse af belastende aktiviteter, f.eks. idræt</li> </ul> </li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Hvis der er klinisk mistanke eventuelt suppleret af røntgenfund henvises til ortopædkirurg</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Undgå kraftig belastning indtil diagnosen er afklaret</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Ingen relevante ud over analgetika</li> </ul> <h3>Kirurgi</h3> <ul> <li>Frakturer med løsrevet knoglefragment kræver ofte operativ behandling</li> <li>Ved artroskopisk operation foretages: <ul> <li> Fjernelse af små osteokondrale legemer</li> <li>Fiksation af større osteokondrale legemer</li> <li>Debridement/curettage og opboring af bruskdefekten</li> <li>Brusktransplantation er forsøgt, men metoden anvendes ikke som standardbehandling ved bruskskader i ankel</li> </ul> </li> </ul> <p>Ortose/gængesål</p> <ul> <li>Er der gener, som ikke kan kuperes medicinsk eller kirurgisk kan der evt. være effekt af ankelstabiliserende ortose, som modvirker at leddet kommer i yderstillinger. Endvidere kan gængesål måske aflaste smerter ved gangafvikling. </li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Undgå ankeldistorsioner ved brug af forebyggende tiltag under sport</li> </ul> <h2>Henvisning</h2> <ul> <li>Henvises til ortopædkirurg <ul> <li>Ved længerevarende ankelsmerter uden sikker årsag</li> <li>Ved mistanke om bruskskade og knogleavulsion</li> </ul> </li> </ul> <h2>Opfølgning</h2> <ul> <li>Normalt i specialafdeling, når det drejer sig om brusklæsion og ikke en simpel distorsion</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Symptomerne aftager ofte på konservativ behandling for at blusse op igen ved kraftig belastning eller nye traumer</li> </ul> <h3>Komplikationer</h3> <ul> <li>Artroseudvikling over en årrække på grund af bruskskaderne</li> </ul> <h3>Prognose</h3> <ul> <li>Yngre patienter og mindre skader har bedst prognose</li> <li>Langtidsprognosen ved debridement og opboring er usikker på grund af risiko for sekundær artrose</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Osteokondrale skader </li> <li>Osteokondrale frakturer og kondrale skader er almindelige i forbindelse med ankeldistorsioner</li> <li>Inddeling af kondrale frakturer: <ul> <li>Grad I - subkondrale frakturer </li> <li>Grad II - kondrale frakturer uden løshed </li> <li>Grad III - kondrale frakturer med løshed men uden dislokation </li> <li>Grad IV - kondrale frakturer med løshed og med dislokation </li> </ul> </li> </ul> <h3>Forekomst</h3> <ul> <li>Forholdsvis hyppig komplikation til ankelskader hos idrætsudøvere </li> </ul> <h3>Ætiologi og patogenese<a title="Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ, Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 2017;8(1): 19-30" href=" " data-type="journal-reference" data-value="Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ, Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 2017;8(1): 19-30" data-value-piped="Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ|Evaluation and Management of Osteochondral Lesions of the Talus|Cartilage|2017|8(1)|19-30" data-url="reference-link"><sup>1</sup></a></h3> <ul> <li>Tidligere eller recidiverende ankeldistorsion </li> <li>Inversionstraume er det hyppigste <ul> <li>Talus er her tiltet i fodgaflen, og kompressionsskade kan opstå på mediale eller laterale hjørne af trochlea tali </li> <li>Brusk- og knogleskader kan også opstå på tibia og fibulas ledflader mod talus</li> </ul> </li> <li>Alvorlighedsgraden <ul> <li>Kan variere fra kompression af knogle til løsning af et mindre knoglefragment, så der foreligger et frit legeme i ankelleddet som mus articuli, se også (<a href="~/link.aspx?_id=7ABAD738D35E4753AD6FFAF512DA3AFD&_z=z">osteokondritis dissecans</a>)</li> </ul> </li> </ul> <h4>Opheling af bruskskade</h4> <ul> <li>Ledbrusk kan ikke regeneres. Der dannes i stedet for fibrøs brusk og arvæv.</li> <li>Der forskes i reparation af brusk, enten i form af osteokondral autotransplantation eller autolog bruskcelletransplantation, men behandling er stadig på forsøgsstadiet</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Idræt</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Hvad findes der af skriftlig patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=A503A272EC6E455E845FC9552CAED2AB&_z=z">Bruskskader i ankelleddet</a></li> </ul> <h3>Træningsfilm for underben og fod</h3> <ul> <li><a href="~/link.aspx?_id=1F6D4E5CBD3F4692BA93BE7541182DB7&_z=z">Øvelsesprogram, 3 øvelser</a><br> <br> <a href="~/link.aspx?_id=66FD9B729628437E98D9A0A38C191DB8&_z=z"><img alt="" src="E5F85279BD074A85A25EAE999BECACD2-135-84" style="height: 84px; width: 135px;" height="84" width="135"></a></li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og pakkeforløb [ICPC]</li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h4>Diagnose</h4> <ul> <li>Opstår på baggrund af ankeltraume</li> <li>Typiske symptomer er smerte, stivhed og aflåsning</li> <li>Røntgenundersøgelse kan af og til vise læsionen, men ofte kræves der MR for at stille diagnosen</li> <li>Artroskopi anvendes både til yderligere diagnostik og behandling</li> </ul> <h4>Behandling</h4> <ul> <li>Aflastning i lettere tilfælde</li> <li>Fjernelse af løse fragmenter eller refiksation</li> <li>Oprensning af læsionerne </li> </ul> <h4>Henvisning</h4> <ul> <li>Ved mere vedvarende symptomer og mistanke om, at det ikke er en simpel distorsion</li> <li>Hvis røntgenundersøgelse giver mistanke om osteochondral fraktur</li> </ul> <h3>Seneste væsentlige ændringer</h3> <ul> <li>Evt. brug af ortose/gængesål ved persisterende gener, som ikke kan kuperes medicinsk eller kirurgisk</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField 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]]></Media> 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