[Cruciate ligament lesions--primary and secondary management strategies].
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Adult↗
Biomedical subjects
C J Wirth
Publications and source records attributed to C J Wirth.
The results of reconstruction of the lateral ligaments of the ankle.
Eighty-one reconstructions of the lateral ligaments of the ankle were carried out at our clinics between 1967 and 1983. Three methods were used and 53 patients were followed up. The only two poor results followed infection after dural reconstruction. Peroneus brevis reconstruction, dural reconstruction and ligament advancement all had good results in over 80% of the patients. There was restriction of supination and an increase of osteoarthritis after the peroneus brevis reconstruction operations. Statistical analysis did not show that any one of these procedures was better than any other.
Adolescent↗
[Knee arthroplasty in osseous ankylosis. A case report].
We report on the successfully performed arthroplasty of a knee joint in a 19-year-old female patient in whom a bony ankylosis in malalignment had occurred following an infection. The deciding factor for performing the arthroplasty was not only the patients wish to regain mobility in the knee joint, but also the existing possibility of postoperative mobilization of the joint on a CPM-machine in combination with analgesia by means of a peridural catheter.
Adolescent↗
[Palliative surgical interventions in primary and secondary bone tumors].
The treatment of patients with skeletal metastases is becoming increasingly important because of longer survival times of patients with metastatic carcinoma. The most common surgical procedures and their indications in the treatment of metastatic carcinoma involving spine and extremities are described. Some typical clinical examples illustrate the operative techniques.
Bone Neoplasms↗
[Fixation of the cervical spine with a new halo fixation system].
The stable fixation of the cervical spine by means of a halo external fixator is superior in terms of stability compared with alternative methods. A new Halo external fixator system is being introduced which enables uncomplicated handling with which optimal possibilities for positional correction are achieved by means of lockable ball joints. By using carbon enhanced connection rods radiolucency is given.
Cervical Vertebrae↗
[Bilateral intra-ligamentous traumatic rupture of both patellar tendons--a case report].
The authors report on a rare case of a bilateral intra-ligamentous rupture of the patellar ligaments and describe their technique of reconstruction. Special emphasis is given to the correct adjustment of the length of the patellar ligament.
Adult↗
[Secondary ligament instabilities in the area of the elbow joint].
Secondary capsular or ligamentous injuries around the elbow joint, which are generally a rare finding, can give rise to medial, lateral, anterior, and posterior instability. Medial instability is especially bothersome during sporting activities, such as javelin throwing and baseball, and requires tightening or replacement of the ulnar collateral ligament. On the lateral side it is particularly the subluxation of the head of the radius that makes surgical tightening of the annular ligament essential. Anterior instability, which would cause the joint to dislocate anteriorly, is extremely rare and does not lead to secondary problems. Posterolateral, chronically recurrent, dislocation of the elbow joint, however, is intolerable for the patient, and many operative stabilizing procedures have been performed, mostly in isolated patients, in attempts at correction. The current method of choice consists in tightening of the dorsoradial capsular pouch in combination with osseous refixation of the slack radial ligament.
Chronic Disease↗
[Transplantation of the meniscus. Experimental study].
An experimental study has been made of the possibility of meniscus grafting. This was carried out in 30 merino sheep, 15 of which received lyophilised homologous menisci and 15 others deep-frozen homologous menisci. Three sheep had to be excluded because of wound breakdown and sepsis. The other animals were examined and the transplants assessed clinically, microscopically, micro-angiographically and by scanning electron microscopy over a period of 48 weeks; finally they were submitted to biomechanical tests. Both techniques are suitable for transplantation but, over the period of observation, the lyophilised grafts remodelled completely. At the end, the mechanical resistance of the meniscus was identical in the two groups.
Animals↗
[Operability of primary inoperable pelvic tumors by preoperative regional hyperthermia in combination with systemic chemotherapy exemplified by Ewing's sarcoma].
Failure of local tumor control is of critical importance in the clinical management of large pelvic tumors. For bulky sarcomas of the pelvis a new treatment strategy could be of importance in the future using preoperative regional hyperthermia combined with systemic chemotherapy. In our case history of a patient with unresectable Ewing sarcoma of the pelvis no tumor response could be observed during multi-drug chemotherapy alone. However, after treatment with regional hyperthermia combined with systemic chemotherapy, the tumor mass became resectable and was separated from the adjacent tissue by a fibrotic pseudocapsule. Histological evaluation of the tumor tissue showed a complete change of the pattern.
Adolescent↗
Distal femoral fixation of the iliotibial tract.
The anatomy of the distal femoral fixation of the iliotibial tract was studied in 100 knee joints. A fiber bundle system with three main parts was isolated: (a) the supracondylar bundle oriented from proximal-lateral to distal-medial and fixed to the supracondylar area of the femur; (b) the fibers near to the septum with transverse course between superficial tract and dorsolateral femur; (c) the retrograde tracts which connect Gerdy's tubercle with the dorsolateral femur and form an arc bridging the knee joint. Distance measurements over the range of motion of the knee joint revealed isometric conditions only for the insertion point on the dorsolateral femur. The retrograde fibers are believed to be static stabilizers of the lateral side of the knee, and their insertion point on the dorsolateral femur is the correct site for refixation or reefing of the distal iliotibial tract.
Femur↗
What is the efficacy of "soft" and "mid" lasers in therapy of tendinopathies? A double-blind study.
The efficacy of "athermic" lasers (HeNe lambda = 632.8 nm and IR diode lambda = 904 nm) in the treatment of tendinopathies was investigated in a randomized double-blind study. On 10 consecutive days, 64 patients (32 therapy, 32 placebo) were treated for 15 minutes each with a switched-on or switched-off laser under otherwise identical conditions. The extent of movement in involved joints (neutral 0 method) and rating on a pain scale for resting pain, movement pain, and pressure pain before treatment, after treatment, and 2 weeks after conclusion of therapy, as well as infrared thermography, served to check therapy. After the end of therapy, a significant reduction (P = less than 0.001) of 50% was shown for resting pain as well as reductions of 30% for movement and 30% for pressure pain. This result was identical in the therapy group and in the placebo group. There was also no indication of a different result of therapy between the therapy and placebo groups with regard to the thermographic control and the extent of movement. The breakdown of the data in terms of age, sex, and duration of disease did not provide any indications of different results for placebo or therapy. It was striking that the patients who reported sensations during or after the treatment (irrespective of whether pleasant or unpleasant) had a greater reduction of pain than the patients without sensations. This laser therapy thus did not show any effect above and beyond that in the untreated group in our double-blind clinical study.
Adolescent↗
[Meniscus refixation and transplantation].
The knowledge we have about the biomechanical importance of the menisci of the knee joint makes it imperative, where possible, to treat their injuries by means of meniscus-conserving measures. Hence today meniscal suturing is performed successfully not only in fresh injuries but also in old baseline longitudinal tears, whether by means of the arthroscope or arthrotomy. Even after having removed the medial meniscus at a previous operation this can be replaced through homologous lyophilized or deep-frozen meniscal transplants, as would be applicable in cruciate ligament insufficiency of the knee joint. As such it may act as a mechanical protection, during the postoperative period, for an anterior cruciate ligament transplant.
Animals↗
[Clinical results of sonographic functional studies of lesions of the capsule and ligaments of the knee and ankle joint].
The authors conducted a clinical study to examine whether sonographic examinations of function would be a reliable alternative to x-ray films of the forced extreme joint position in lesions of capsule and ligament of the knee and ankle joints. Sonographic standard planes of section are defined and the results of the described examination methods in 200 patients are demonstrated. Ruptures of the external ligaments of the ankle joint as well as cruciate and collateral ligament instabilities at the knee joint are simple and safe to assess and document via sonography.
Ankle Injuries↗
[Principles of surgical therapy of bone tumors with special reference to localization in the pelvis and lower extremity].
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Bone Neoplasms↗
When is surgery indicated in anterior knee instability? Considerations on operative and functional treatment.
Rupture of the ACL may result in chronic anterior knee instability. However, in the majority of patients the secondary stabilizers of the joint such as collateral ligaments, menisci, and the capsule will compensate for this instability. We recommend surgical reconstruction of the acute rupture of the ACL only in the young, active athlete. Concomitant ruptures of capsuloligamentuous structures do not indicate surgical treatment: they may be treated by a plaster cast or a splint with good results. Chronic symptomatic anterior knee instability should first be treated by a vigorous muscle-training program. Surgery is performed only for those patients who cannot compensate for their instability after this rehabilitation program.
Acute Disease↗
The ingrowth quota of autologous spongiosa from different points of removal--experimental study in sheep. A preliminary report.
The importance of the point of removal for the ingrowth quota of autologous spongiosa was examined in seven sheep. In six sheep spongiosa was taken from five different regions (proximal radius, olecranon, pelvic crest, trochanter major, and proximal tibia) and was transplanted autologously. Defined corticalis defects of the tibia were the chosen sites for the heterotopic implantations. The ingrowth quota were tested by X-ray as well as scintigraphically, histologically, and fluorescent-microscopically; one animal was taken for control. A judgement was made by quantifying scintigraphy and fluorescent-microscopic histometry. Better ingrowth quota were found for spongiosa from the pelvic crest, proximal tibia, and trochanter major as compared to qualitatively clearly worse transplants from radius base and olecranon. The results from the animal experiments prove the clinical experience.
Animals↗
[Autologous and homologous cruciate ligament transplants--ultrastructural integration, clinical results].
A successful integration of cruciate ligament grafts is dependent upon the structure of connective tissue transplants, the conservation in case of homologous grafts, the functional load, the fixation of the graft, and the bed for the transplant. As shown by our own experimentations on animals, the integration of connective tissue transplants depends above all on the connective tissue type (native, conserved), the functional stimulus, and the bed for the transplant. Nevertheless, the communications in literature indicate identical clinical results for different types of autologous transplants, which gives occasion to mention the specific cruciate ligament stability tests, i.e. the Lachman test and the Pivot-Shift sign. The authors discuss their own results achieved by using one third of a patellar tendon or pes anserinus tendons as cruciate ligament substitutes.
Animals↗
[Hemarthrosis and the isolated anterior cruciate ligament lesion. Value of clinical diagnosis].
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Adolescent↗