INTRODUCTION: The following article deals with the problem of peroneal clicking. This means a clicking of the two peroneal tendons against each other. It has to be differentiated from peroneal tendon dislocation or subluxation. METHOD: In three patients, a peroneal click was found without symptoms of dislocation of the tendons over the fibula. In these cases the indication for resection of the peroneal brevis tendon was seen. RESULTS: Postoperatively no pain, swelling, and peroneal click were present. The partial loss of function of the peroneal brevis tendon seems to be negligible. CONCLUSION: In case of pain and swelling over the peroneal tendons, peroneal clicking should be included in a differential diagnosis. Resection of the peroneal brevis tendon is an effective treatment in these cases.

Adult↗

PubMedDate not supplied

[Surgical shortening of the Achilles tendon for correction of elongation following healed conservatively treated Achilles tendon rupture].

INTRODUCTION: Is operative shortening of the achilles tendon an adequate therapy in cases of elongation following conservative treatment of achilles tendon rupture? METHODS: From 11/89 to 12/97, 12 patients underwent achilles tendon shortening (9 male, 3 female, average age 43 years). All patients had an elongated tendon following conservative treatment of achilles tendon rupture. We were able to examine 8 patients (67%) after the operation. The average follow-up period was 35 (7-103) months with an average span between the primary trauma and surgery of 22 (8-45) months. RESULTS: Prior to surgery, all patients complained of weakness, gait disturbance and limitation of activity. At follow-up a subjective weakness of the plantar flexion remained in five and an objective weakness in all patients. We found a decrease of the isometric plantar flexion strength to 52% of the non-operated lower extremity while the maximum calf circumference was only 5% decreased. Only two patients reported of a gait disturbance and activity limitation whereas three patients were free of complaints. Using a modified Trillat score (1,967), 7 patients rated good or very good (1 poor). CONCLUSIONS: Achilles tendon shortening in case of elongation following conservative treatment of achilles tendon rupture helps to decrease gait disturbance and limitation of activity whereas a lack of the isometric plantar flexion strength persists. In our opinion an early decision for achilles tendon shortening might prevent this deficit.

Achilles Tendon↗

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[Characteristics of the learning curve in total hip endoprosthesis exemplified by the BiContact prosthesis].

AIM: Total hip arthroplasty is a common operation but there are few data describing the learning curve of this operation. The aim of the presented study is to prove and describe the learning curve in total hip arthroplasty. METHOD: Between 1991 and 1993, 168 patients were included in this prospective study, operated by three surgeons having different experiences in operating total hip arthroplasty. Perioperative complications and postoperative X-rays were analysed. Patients were re-examined clinically and radiologically and by a questionnaire 5 years after operation. RESULTS: Radiological complications of the first 84 operated patients were statistically significantly higher than those of the following 84 patients, except for minimal bone fractures and leg lengthening. The learning curve of all surgeons was finished after 20 operations independent of their experience. Clinical results were not influenced by the learning curve at follow-up. CONCLUSIONS: Regardless of the experience of the surgeon, the learning curve in total hip arthroplasty is finished after about 20 operations for each surgeon. Intensive preoperative planning and exchange of experience inside and outside every clinic will shorten the length of the learning curve.

Adult↗

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[Valgus tibial head reconstruction, monocondylar sled prosthesis or bicondylar gliding surface replacement in therapy of medial gonarthrosis--a cost analysis].

AIM: Three to a certain extent competing methods for the treatment of unicompartmental osteoarthritis of the knee are compared regarding the costs they cause. These methods comprise the high tibial valgus osteotomy (HTO), the unicompartmental knee arthroplasty (UKA), and the total knee arthroplasty (TKA). METHODS: We compared the in-patient costs and out-patient costs of 20 patients (drawn by lot) in each group who received one of the above-named operative methods at our hospital between 1988 and 1993. The results were extrapolated according to the expected survival rate of the applied method. RESULTS: The average total costs of patients who received a HTO were 9.487,-; for the unicompartmental arthroplasty the average cost were 11.687,-; the implantation of a TKA resulted in average costs of 16.940,-. All operative procedures exceeded a particular global amount, the socalled "Fallpauschale". CONCLUSION: Regarding the total costs that arise for the operative treatment of the degenerative arthritis of the knee, the HTO (with or without hardware removal) proves to be the cheapest of the applied methods. Projecting the results on the survival rate of each treatment method, no statistically significant differences could be recognized between the three operative procedures.

Adult↗

PubMedDate not supplied

[Transposition operation in paralysis of extensor muscles of the hand--intermediate-term results].

AIM: The surgical reconstruction of the dorsiflexion of the wrist and the abduction of the thumb in paralyzed radial nerve for the improvement of the useability of the hand is described. Likewise, the early functional subsequent treatment is described. Indications and contraindications are represented in detail. METHOD: Between October 1997 and May 2000 we treated 10 patients by the following method: The musculus flexor carpi ulnaris tendon is cut near the pisiform bone, transferred subcutaneously and fixed on the tendons of the extensor communis digitorum communis muscle. The tendon of the palmaris longus muscle is fixed on the tendon of the extensor pollicis longus muscle. After the swelling in the hand has subsided, the patients are supplied with a dynamic splint in order to avoid adhesions. RESULTS: According to the score suggested by Haas, 9 patients achieved a very good result (median: 30 degrees dorsiflexion), one patient had a good result (0 degree dorsiflexion). CONCLUSION: Adhesions could be avoided and the time of rehabilitation could be shortened by the operation method described. The operations result in an improvement of hand function and as well as patient satisfaction.

Adolescent↗

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[Corrective bone operations for treatment of deformities caused by obstetrical brachial plexus palsy].

In an adult, a marked deformity of the upper arm and forearm with loss of function of the limb due to obstetrical brachial plexus palsy has been corrected. An external rotational osteotomy of the humerus and radioulnar arthrodesis resulted in an improved function.

Adult↗

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[The influence of age on the outcome of anterior cruciate ligament reconstruction].

AIM: There is an increasing demand for a high loading capacity of the knee during exercise in the elderly patient with knee instability following rupture of the anterior cruciate ligament (ACL). The question is, if the results of an ACL reconstruction in patients over 40 years of age are as good as those in younger patients. METHOD: From 1989 to 1994 we replaced the ACL with a mid-third BPTB autograft in 397 patients following ACL rupture. A total of 309 patients (78%, 110 female, 199 male, the average age was 27 years) were followed for an average of 43 months. The results were compared relating to four groups of age (group 1: < 20 years, n = 41; group 2: 20 - 29 years, n = 175; group 3: 30 - 40 years, n = 77; group 4: > 40 years, n = 16). RESULTS: We did not find any significant differences between the groups in the different score ratings, the subjective and objective knee function and stability, the pain and the level of activity. The average Cincinnati score of the whole group was 91 points (HSS score: 78/16 % excellent/good, Lysholm score: 90 points, IKDC score: 22/31 % A/B). CONCLUSION: ACL replacement is a sufficient therapy for patients over 40 years of age with symptomatic knee instability following ACL rupture. The subjective and objective clinical outcome is comparable to the good results of ACL replacement in younger patients without any significant differences.

Adolescent↗

PubMedDate not supplied

[Changes of biomechanical parameters in dysplasia of the hip by total hip replacement].

AIM: Dysplastic hips or dislocated hips lead to loss of muscle strength claudication, and finally to coxarthrosis. This study analytically compares the hip joint forces in normal, dysplastic hips and hips after implantation of a hip prosthesis for several positions. METHOD: The results of 173 total hip replacements in 153 cases of either severe congenital dysplasia or dislocation were analyzed. A 2 dimensional mathematical model of the hip was developed to evaluate the effects of surgically achievable mechanical alterations such as acetabular placement, femoral shaft-prosthetic neck angle, and neck length of the femoral prosthesis. RESULTS: 63 % of the hip prosthesis were implanted on the right, 72 % on the left. Before implantation, the femoral shaft-prosthetic neck angle in mean was 146 degrees +/- 10 degrees, after implantation it was 135 degrees. The hip centre was displaced on in average 10 mm distally. Postoperatively hip joint force was increased 21 %. CONCLUSION: Minimum joint contact forces occurred when the femoral shaft prosthetic neck angles were small. The loads on the hip were lowered significantly by placing the centre of the acetabulum as far inferiorly and medially as possible. Another important finding is that displacement of the hip centre distally has a great effect on muscle performance and hip joint force.

Adult↗

PubMedDate not supplied

[Shoulder arthrodesis with plate fixation. Special features in cases of resection and defects].

AIM: Shoulder arthrodesis following prosthesis explantation or resection of the acromion has not often been described in the literature. The presented article analyses the special features and problems of these preoperative circumstances in 4 cases and discusses them within the entire group. PATIENTS AND METHOD: Between 06/1987 and 02/2001, a total of 30 shoulder arthrodeses using plate fixation were performed in our clinic and then analysed after an average of 2.7 (0.5 - 8.7) years. Surgery was carried out on 5 (17 %) females and 25 (83 %) males with a mean age of 37 (17 - 82) years. Two patients underwent shoulder arthrodesis as a salvage operation following unsatisfactory arthroplasty, or after trapezius transfer with corresponding reduced bony conditions, respectively. RESULTS: The active extent of movement following arthrodesis was 56 degrees (20 degrees - 90 degrees ) abduction, and 60 degrees (20 degrees - 105 degrees ) anteversion. The most frequent complications following arthrodesis included pseudarthroses (3/10 %), infections (4/13 %), and fractures of the humerus (4/13 %). The rate of complications was especially high in the cases after explantation of a shoulder prosthesis and resection of the acromion. In two of the four patients, three or five revision operations, respectively, were necessary. Two of the three pseudarthroses of the entire group occurred in these two cases. CONCLUSION: Complications of shoulder arthrodesis after resection of the acromion or the proximal humerus are especially frequent. To avoid pseudarthrosis in such cases, primary spongioplasty is advantageous. A fixation with plates is superior to a simple screw arthrodesis. For postoperative immobilization a plaster cast instead of an orthotic device should be taken into consideration.

Adolescent↗

PubMedDate not supplied

[On the German Orthopedics Congress 2003. Geriatric orthopaedics].

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

[Meniscus replacement with quadriceps tendon--a long-term analysis].

AIM: Early osteoarthritis of the knee is a common consequence ofA'complete meniscectomy. In order to prevent degenerative changes, meniscus replacement by autogenous quadriceps tendon was performed from 1986 until 1999 in 45 patients. In 29 patients, a reconstruction of the anterior cruciate ligament was done simultaneously. This study was intended to detect whether this meniscus replacement led to better subjective, clinical and radiological results in comparison to meniscectomised knees or meniscal allografts reported in the literature. METHODS: A standardised examination of the patients (4-17 years postoperatively, average 9 years) was carried out using the KOOS questionnaire, the IKDC examination form and a weight-bearing radiograph of the knee. RESULTS: 34 patients took part in the study. KOOS subgroups showed fair results for symptoms (25-96 points, average 65), butA'bad results for sports and quality of life (0-100, average 52; QoL 6-94, average 54). Clinical and radiological examination demonstrated on average stable knee joints without effusion (IKDC group A), but X-rays showed in most cases a clear or severe osteoarthritis of the knee (IKDC group C). Clinical and radiological findings demonstrated similar results in comparison with studies investigating results after meniscectomy without meniscus replacement. Concerning subjective results, meniscus replacement with quadriceps tendon was inferior to cryopreserved meniscal allografts. However, patients after meniscal allograft transplantation also show increasing degenerative changes of the respective joint in radiological follow-up studies. CONCLUSION: In the patient group studied here with pre-existing chondromalacia of the respective knee joint compartment and preoperative anterior instability, no advantage of meniscus replacement using quadriceps tendon over the normal course after meniscectomy could be proven. Therefore, this procedure cannot be generally recommended.

Adolescent↗

PubMedDate not supplied

[Effects of harvesting the central third of the patella tendon on the kinetics of the knee joint and the retropatellar pressure].

AIM: This biomechanical study was performed to evaluate the consequences of removing the central part of the patellar tendon on the kinematics and kinetics of the femoro-patellar joint. The tendonectomy was performed in the same manner as is frequently done during anterior cruciate ligament reconstructions. Of particular interest in this study was to identify potential factors of the patellar tendon resection which could result in anterior knee pain. METHOD: A simulated isokinetic knee extension from 120 degrees of flexion to full extension was performed on nine human knee cadaver specimens. Joint kinematics was evaluated with ultrasound sensors, and retropatellar contact pressure was measured using a thin-film resistive ink pressure measuring system. Data were taken before and after resection of the central third of the patellar tendon. RESULTS: Harvesting of the central third of the patellar tendon resulted in an elongation of the remaining patellar tendon by less then 0.5 mm. Furthermore, increases in patellar flexion lower than 1 degree were observed. Small changes in retropatellar pressure were also observed. CONCLUSION: The shortening of the patellar tendon due to tendon removal, as already suggested in several previous studies, is not attributed to the removal of the central portion of the tendon itself, but more likely due to secondary scarring contraction of the tissue. The changes of the patellarkinematics and the retropatellar pressure observed in this study are probably not of any clinical significance.

Adult↗

PubMedDate not supplied

[Influence of the postoperative activity level on tibial bone tunnel enlargement and functional treatment results following anterior cruciate ligament reconstruction using a patellar tendon autograft].

AIM: This study was performed to evaluate the influence of the postoperative activity level on tibial bone tunnel enlargement following anterior cruciate ligament reconstruction using a mid-third patellar tendon autograft. METHODS: A clinical and radiological assessment was performed on 50 patients (21 male, 29 female, mean age 32 years, range 18 to 57 years) following ACL reconstruction using a patellar tendon autograft. The average follow-up examination was performed 18 (12 to 30) months after the operation. RESULTS: 33 patients (66 %) developed a tibial bone tunnel enlargement > 1 mm. We found a positive correlation (+ 0.59) of the grade of activity and the muscle status (+ 0.56) to the tibial bone tunnel enlargement. Patients with a major tibial bone tunnel enlargement performed at a higher (p < 0.05) postoperative activity grade (5.2 versus 4.1 in the Tegner grading), rated higher in the Lysholm (88 versus 77 points) and IKDC scores (p < 0.05) and reported a better subjective functional outcome (p < 0.05). There was no significant correlation of the results of the knee stability tests and the age of the patients to the grade of tibial bone tunnel enlargement. CONCLUSIONS: In ACL reconstruction using a patellar tendon autograft we recommend early rehabilitation as the concomitant tibial bone tunnel enlargement does not significantly influence the clinical outcome or knee stability.

Adolescent↗

PubMedDate not supplied

[Comparison of clinical examination with NMR spectroscopy in the diagnosis of meniscal lesions in daily practice].

INTRODUCTION: We investigated the value of Magnetic Resonance Imaging compared to the clinical examination for meniscal lesions. MATERIAL AND METHODS: From 1991 to 1995 we did arthroscopic evaluation at 824 patients with the diagnose "meniscal lesion". 73 of them had an MRI-examination elsewhere before surgery. RESULTS: During arthroscopy we found 473 lesions of the medial meniscus and 160 of the lateral meniscus. The MRI-examination had an accuracy of 70% for the medial meniscus (sensitivity 79%, specificity 63%, positive predictive value 64%, negative predictive value 78%) and 78% for the lateral meniscus (sensitivity 50%, specificity 86%, positive predictive value 50%, negative predictive value 86%). The clinical examination had an accuracy of 73% for the medial meniscus (sensitivity 98%, specificity 39%, positive predictive value 69%, negative predictive value 88%) and 87% for the lateral meniscus (sensitivity 67%, specificity 92%, positive predictive value 65%, negative predictive value 93%). CONCLUSIONS: We conclude, that by an experienced examiner a meniscal lesion can be diagnosed adequately by clinical examination alone. The different radiologists who did the MRI examination in our study belong to different outward departments and used different apparatus with sometimes insufficient quality of the pictures. Therefore the sensitivity and specificity of the MRI for meniscal lesions is markedly lower than in other studies of departments where a close cooperation between the radiologist and the orthopedic surgeon is performed.

Arthroscopy↗