Biomedical subjects

C J Wirth

Publications and source records attributed to C J Wirth.

At least 91 records · Page 5Linked to original sources

PubMed1992

Medial meniscus replacement by a tendon autograft. Experiments in sheep.

In 20 skeletally mature female merino sheep, divided into four groups, we performed total medial meniscectomy, removal of the middle third of the patellar tendon, and tenotomy of the calcaneal tendon of the right hind leg. Group I (control) had no additional procedures. In the other three groups the medial meniscus was replaced by the middle third of the patellar tendon from the ipsilateral knee. The animals were killed at three (group II), six (group III), or 12 months (group IV) and the tendon-meniscus examined macroscopically, by light and scanning electron microscopy, and biomechanically. Remodelling of the tissue had taken place by 12 months but the failure stress and tensile modulus for the tendon-meniscus were lower than for the normal meniscus. Our evidence suggests that, in sheep, replacement of a meniscus by a tendon autograft may decrease the severity of the degenerative changes that occur after meniscectomy.

Animals↗

PubMed1992

Biterminal tenotomy for the treatment of congenital muscular torticollis. Long-term results.

Fifty-five patients who, in a twenty-eight-year period, had been managed with a biterminal open release because of congenital muscular torticollis, were re-examined at an average of fifteen years and a minimum of five years after the operation. Forty-eight patients reported no functional or cosmetic impairment. Palpable soft-tissue strands remained in twenty-nine patients, but bending toward the untreated side was limited more than 10 degrees in only one patient. The rate of recurrence was 2 per cent. Facial asymmetry improved or resolved in more than one-half of the patients. We recommend that biterminal release be performed at the age of three to five years in all patients who do not respond to non-operative treatment.

Adolescent↗

PubMed1992

[Post-traumatic recurrent hip joint dislocation].

Recurrent post-traumatic dislocation of the hip joint without an accompanying fracture is very rare. Delayed reduction and a too short immobilization periods seems to favor redislocation. One case is presented together with a discussion of the operative therapy and the intraoperative pathological-anatomical findings with respect to the literature.

Adult↗

PubMed1991

The function of the Thomas splint. An experimental study.

A Thomas splint of traditional design was fitted with measuring devices and examined for its hip-relieving effect during varying activities. It was shown that there is no complete weight relief of the hip joint with this orthosis. In the most favourable case, 50% of the weight can be conducted via the ischial tuberosity and therefore transferred to the ground surface bypassing the hip joint. In regard to the hip joint, the Thomas splint is a device that reduces weight but does not entirely remove it. The results proved to be practically independent of the fitting of the orthosis and of the kind of activity.

Biomechanical Phenomena↗

PubMed1991

[The significance of the activity score in evaluating knee ligament reconstructions].

In a follow-up study of 156 patients after knee ligament reconstruction for chronic instability, the results of subjective Lysholm score grading and of Tegner activity grading were compared. The postoperative Lysholm score averaged 85 +/- 13.2 points, the activity scores 6.9 +/- 0.9 points prior to instability, 1.7 +/- 0.9 points preoperatively and 5.9 +/- 1.2 points postoperatively. 89 patients reached their preinjury activity level, the average improvement through surgery was 4.2 +/- 1.6 points. Non-active patients regularly returned to their original activity-level, competitive athletes were less likely to regain their previous activity. The subjective results of athletes and non-athletes showed no significant differences. The postoperative activity level clearly correlated to subjective grading by the patient. For scoring results after knee ligament surgery, we use the subjective Lysholm score and an activity score based on average German sports activities.

Activities of Daily Living↗

PubMed1991

Shoulder surgery for rotator cuff tears. Ultrasonographic 3-year follow-up of 97 cases.

We reexamined 97 of 116 shoulders operated on for rotator cuff lesions after an average follow-up time of 37 months. Seventy percent had a good or excellent clinical result, and 14 percent were graded as poor. Upon ultrasonographic examination of the 97 shoulders, 37 had a normal rotator cuff, 31 had thinning and/or hyperdensity, and 29 had a complete rupture of the cuff. Patients with concomitant anterior acromioplasties did better than those without. There was a poor correlation between clinical and ultrasonographic results. We recommend that rotator cuff tears should be closed only if this can be achieved without undue tension. If extensive tissue mobilization or coverage with alloplastic material or with regional muscle flaps is required, the lesion should be debrided and left open, and only an anterior acromioplasty should be performed.

Adult↗

PubMed1991

[A new mechanism of injury of the anterior cruciate ligament].

In alpine skiing various mechanisms of injury to the anterior cruciate ligament have been described. External rotation-flexion-valgus stress and hyper-extension are considered the classic mechanisms. Rupture of the anterior cruciate ligament without falling has rarely been reported. In ski racers competing in the World Cup downhill races an accumulation of isolated anterior cruciate ruptures following landing after a jump in a more or less backward position without falling has become evident in recent years. We recorded this mechanism for the first time in 1986. A ski racer landing in a bent position on flat ground after a jump documented on video tape felt a sharp pain and immediate instability, though he did not fall. Clinically hemarthrosis and a positive Lachman sign were found, and intraoperatively an isolated rupture of the anterior cruciate ligament was confirmed. Analysis of the video tape and biomechanical considerations showed that even a minimal shift of the center of body mass dorsal to the axis of the lower leg leads to an acceleration of the thigh and body oriented centrifugally, vertically and in a plantar direction against the rotational axis of the knee and to a forward rotational acceleration of the tibia by the dorsal shaft of the ski boot. This acceleration produces a massive compensatory quadriceps contraction to prevent a backward fall, followed by an "anteroposterior shift" of the femur on the tibia in the sense of an anterior drawer, which in association with other factors leads to an ACL rupture. This "anteroposterior shift mechanism" is only possible in excellent skiers with the muscular control and coordination to prevent a backward fall.

Anterior Cruciate Ligament↗

PubMed1990

Madura foot. A report of two cases.

Two cases of Madura foot which originated in the Middle East are described. This so-called maduramycosis is a chronic progressive infection caused by thread fungi or actinomycetes. The diagnosis is confirmed when the grains of mycetoplaits are demonstrated in the discharge from a sinus. Clinical findings and treatment are discussed. Medical treatment may be needed for several months, but operation is indicated for infections caused by the true fungi (eumycetoma).

Adult↗

PubMed1990

[Meniscus replacement using Hoffa's infrapatellar fat bodies--initial clinical results].

Between December 1986 and July 1988 a replacement of the absent medial meniscus was taken by means of the infrapatellar adipose body in seven patients. A replacement of the anterior cruciate ligament by means of the middle one third of the patellofemoral ligament was taken too. This operation was done for reconstruction of the synergism between the anterior cruciate ligament and the posterior horn of the medial meniscus. All patients are controlled in our special knee outpatient service. There were no complication postoperatively and on all seven patients a control arthroscopy was performed twelve months postoperatively. The subjective results are very satisfying because of the restoration of knee stability. The arthroscopic controls of the meniscal replacements, however, showed a reduction in size of the transplants after one year, the tissue was weak and not identical to that of a normal meniscus. Autologous strong tissue, e.g. quadriceps tendon, may have better presuppositions for meniscal replacement.

Adipose Tissue↗

PubMed1990

[Meniscus transplantation and anterior cruciate ligament replacement--results 2-4 years postoperative].

23 transplantations of meniscus combined with replacement of the anterior cruciate ligament were performed from May 1984 to December 1986 at the Department of Orthopaedics of the University of Munich ('Klinikum Grosshadern'). Clinical follow-ups were coupled with arthroscopic follow-ups on the average 10 months postoperatively in 19 patients with transplantation of the medial meniscus of the knee joint. In 17 cases a lyophilised meniscus was transplanted and in 6 cases a deep-freeze allogenous meniscus. There were no operation-specific complications in either group. Both the lyophilised meniscus transplants and the deep-frozen ones underwent a reduction in size during the observation period. Whereas good to excellent results were generally obtained with the deep-frozen transplants, the results seen in the lyophilised transplants were less satisfactory due to reduction in size partly down to regenerate size. The treatment results were of course positively influenced due to the contributory effect of the regained stability; in the patients with meniscus transplants the preoperative Lysholm score was 72 +/- 14 points, on the average 36 weeks postoperatively 82 +/- 15 points. However, clinical and arthroscopic findings showed that no clinically, immunologically and morphologically satisfactory meniscus replacement has become available to date.

Adult↗

PubMed1990

[Scintigraphic control and x-ray findings following the cement-free implantation of the PM shaft in connection with hip joint allo-arthroplasty].

147 bone scans with 99mTc-MDP following 60 cementless hip arthroplasties were analysed at 3 to 160 weeks after operation. Results are compared to clinical evaluation according to Merle d'Aubigné. X-ray changes in a number of patients are included. In uncomplicated cases, bone scan activity decreased quickly within 26 weeks postoperatively. Decrease of scintigraphic activity was markedly delayed in patients with low Merle d'Aubigné values or persisting pain. In 4 cases, bone scan activity increased again. In these cases, reoperation revealed rotational instability of the shaft endoprostheses. Unusual x-ray phenomena such as development of a bony cup at the tip of the prosthesis or seams were found mainly in patients with less satisfying results. We consider nuclear imaging an important additional examination to evaluate bony integration of PM shaft endoprostheses after hip replacement, especially as interpretation of x-ray features alone is still doubtful.

Adult↗

PubMed1990

[Value of diagnostic measures in soft tissue diseases and soft tissue lesions of the shoulder joint].

Calcifying tendinitis, acute tendinitis, frozen shoulder, rotator cuff rupture, subluxation of the gleno-humeral joint and injury of the biceps tendon are commonly classed under the blanket term "peri-arthropathy of the shoulder". It is now possible to make a precise diagnosis of these shoulder disorders by means of a clinical examination supported by X-ray examination, ultrasonography, arthrography, computed tomography (CT), magnetic resonance imaging (MRI) and arthroscopy. Calcifying tendinitis is diagnosed by consideration of the patient's history, followed by clinical examination and X-ray examination. Acute tendinitis is a clinical diagnosis, as is frozen shoulder. Ruptures of the rotator cuff can be detected by ultrasonography, which is a screening method; such ruptures can also be detected by arthrography. The localization and extent of the defect are best estimated by arthroscopy. Shoulder instability is another clinical diagnosis. Bony defects of the humeral head (Hill-Sachs lesion) or the glenoid rim are revealed by computed tomography (CT). CT arthrography reveals the presence of any Broca-Hartman lesion in the anterior inferior part of the anterior capsular mechanism. Rupture, subluxation or luxation of the biceps tendon are diagnosed either by clinical examination or by arthroscopy. Knowledge of the sensitivity, specificity and accuracy of the diagnostic procedures makes it possible to carry them out in a standardized, logical sequence. Arthroscopy allows a decidedly more accurate diagnosis than any of the other methods, but as it is an invasive procedure it should be kept until last when diagnosis of disorders of the gleno-humeral joint is required.

Arthroscopy↗

PubMed1989

[Malignant primary bone tumors. Diagnosis, therapy and results of treatment].

Differences in the biological behavior of primary bone tumors have led to the development of differentiated treatment regimes. In recent years, a considerable improvement in the results of treatment has been accomplished, in particular by the introduction of adjuvant chemotherapy. The various therapeutic concepts for the three most common malignant bone tumors, osteosarcoma, chondrosarcoma and Ewing's sarcoma are described and, on the basis of the author's own results, discussed.

Bone Neoplasms↗

PubMed1989

Homologous meniscus transplantation. Experimental and clinical results.

The increase in severe ligament injuries of the knee has led to consideration of the need for meniscal transplantation in reconstructive operations for chronic rotational instability. Transplantation of the medial meniscus was carried out in two groups of 15 sheep. In one group lyophilised, gamma-sterilised allogenic menisci were transplanted and these underwent a complete remodelling in 48 weeks. In the other group, deep frozen allogenic menisci were used and these remained fully functional without remodelling. We then carried out meniscal transplantation in 22 patients who were followed-up for a mean of 14 months. Arthroscopy was possible in two-thirds of the cases at an average of 8 months after operation. Both types of transplanted menisci, lyophilised and deep frozen, decreased in size, as small as a regenerated meniscus in some cases. In general the deep frozen menisci showed better results.

Adult↗

PubMed1989

Limb-preserving operations in the treatment of malignant bone tumors.

Limb-preserving resections require very careful indications; in particular, the criteria of oncologic radicality must be strictly considered. The functional results can be improved compared with those of ablative surgery, while the rate of relapse-free survival is the same. Surgical therapy for metastases of bone tumors should be performed by simple and safe procedures which allow for quick rehabilitation. The most important limb-preserving methods of operation in the treatment of primary and secondary malignant bone tumors are discussed and a few examples are presented.

Adolescent↗

PubMed1989

[Basic principles of after care following autoplastic reconstruction of the cruciate ligament].

Since 1984 we avoided immobilization after reconstruction of the anterior and/or posterior cruciate ligament. Principles of kinematics were taken in consideration during aftertreatment. Results were very satisfactory in anterior cruciate ligament reconstruction. Subjective assessment of knee function (Lysholm score), objective measurement of anterior-posterior knee stability (KT-1000 arthrometer) and clinical follow-up results were good without immobilization.--This cannot be said for the posterior cruciate ligament, because the number of patients was too small. Our current concept of rehabilitation after reconstruction of the posterior cruciate ligament may yet serve as a reasonable but still unproven approach to the problem.

Athletic Injuries↗

PubMed1989

[Complete rotator cuff lesions in athletes].

The causal etiologies of complete rotator cuff lesions are described. Handball, volleyball, rugby, throwing and putting disciplins, but also tennis, swimming, golf and artistic gymnastics are regarded as sports especially straining the periarticular structures of the shoulder joints. In the period from November 1980 to April 1986, 72 shoulder joints with complete rotator cuff lesions were treated surgically (bilaterally in three cases). The 69 patients comprised 16 recreational and 11 competitive sportsmen. An average of 2.4 years after the operation, 66 shoulder joints (91.6%) could followed up clinically and sonographically with simultaneous use of a 100-point-score. Good and very good results were shown in 70% of the cases.

Adult↗

PubMed1989

[Cruciate ligament injuries of the knee joint].

There is no general agreement on conservative or operative treatment for ruptures of the cruciate ligament. The degree of resulting instability and the athletic ambitions of the patient in particular usually determine the individual therapeutic approach. In our experience, conservative treatment, emphasizing muscle training, can only achieve good medium-term results in unidirectional instabilities in the transverse plane, as expected after isolated rupture of the anterior or posterior cruciate ligament. Continuous long-term deterioration, however, must be anticipated, so that primary operative treatment is justified in patients under 40 who are active in sports. Multidirectional instability, which occurs in multilocular lesions of the ligaments and capsule, call for operative stabilization in order to restore the ability to participate in athletics.

Athletic Injuries↗