[Clinical relevance of unloading in cartilage therapy of the knee--shoe insoles, knee braces or additional operative procedure?].
Restoration of a neutral biomechanical environment and reduction of overload is an important factor contributing to the success of any cartilage repair procedure. Reduction of overload can by achieved by so called unloading procedures in order to reduce intraarticular pressure from the repair zone. Unloading can be achieved via loss of weight, wedged shoe insoles, knee braces or via operations such as osteotomies around the knee joint. The cartilage therapy and the concomitant unloading procedure should be adapted to the individual pathology and realistic aims of the patient. Wedged insoles and braces are the least invasive treatment methods. In comparison, however, beneficial effects of braces outline those of laterally wedged heels. Nevertheless long-term compliance with insoles and braces is poor. Concerning braces either because the positive effects of the braces are too small or because the adverse effects are too large. Unloading in the long run may only be achieved through operative procedures. When an osteotomy seems to be too invasive the arthroscopic release of the posterior oblique ligament might be an option. Patients with an intact contralateral chondral status, medium to slight malalignment who want to remain at high activity levels, remain good candidates for unloading osteotomies.
BG Unfallklinik, Eberhard-Karls-Universität Tübingen.
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Kraus
Abteilung für Sportorthopädie, Klinikum rechts der Isar der TU München.
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Imhoff
BG Unfallklinik, Eberhard-Karls-Universität Tübingen.
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Ateschrang
BG Unfallklinik, Eberhard-Karls-Universität Tübingen.
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Stöckle
BG Unfallklinik, Eberhard-Karls-Universität Tübingen.
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Schröter
D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods*; D001915:Braces; D003131:Combined Modality Therapy / Q000379:methods; D061826:Foot Orthoses; D050724:Fractures, Cartilage / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000628:therapy*; D018579:Patient Selection; D016896:Treatment Outcome