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Biomedical subjects

J Bruns

Publications and source records attributed to J Bruns.

88 records · Page 5Linked to original sources
PubMedDate not supplied

[Indications and implementation of recommendations of the working group "Tissue Regeneration and Tissue Substitutes" for autologous chondrocyte transplantation (ACT)].

For the treatment of full-thickness articular cartilage lesions of the knee joint, as a result of trauma or osteochondritis dissecans, a variety of biological reconstruction techniques have been developed. Different studies, some of which were performed as randomised, prospective clinical studies, showed that the autologous chondrocyte transplantation (ACT) provides the most satisfying and reliable method of cartilage reconstruction in the adult when applied to defects exceeding 4 cm (2). Based on these results, ACT seems to be of economic benefit, as the risk of developing osteoarthritis correlates significantly with the size of the cartilage defect, when not treated properly and in time. Surveying the studies on basic scientific aspects of ACT, cartilage defect animal models and clinical studies, it can be concluded that clinical results of ACT depend on a variety of factors. In this review, published by the joined advisory board of the German Societies of Traumatology (DGU) and Orthopaedic Surgery (DGOOC), we summarize the current knowledge available and the state of the art concerning ACT. Especially we discuss the advantages of different procedures, methods for treating knee cartilage defects and factors that influence the outcome of the different treatment regimens, with the aim to develop guidelines for the correct indication and application of the ACT.

Adult↗
PubMedDate not supplied

[Osteochondritis dissecans of the knee joint].

Osteochondritis dissecans is a disorder with a prevalence of 0.01 to 0.06 %. Men between 16 and 36 years of age are most commonly affected by it. In the western hemisphere, the knee is affected by this progressive disorder in 75 % of the cases, specifically the medial femoral condyle (70 - 80 %). The etiology is uncertain, although genetic defects, micro-trauma, ossification disorders and ischemia have been implicated. Pathogenetically, Osteochondritis dissecans is classified in four stages, whereas in stage one, there is merely a subchondrial edema. Without therapy this could lead to stage 4, with a free osteochondral joint fragment. Treatment is analogous with the stage of the disorder. Whereas conservative treatment may yield full recovery during stage 1, starting in stage 2, invasive treatment should be considered. When the cartilage surface remains intact retrograde procedures are indicated. If the cartilage is injured anterograde therapies, like the chondral or osteochondral transplantation, should be used.

Cartilage, Articular↗
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[Patellar osteochondrosis dissecans--results of surgical therapy].

Osteochondritis dissecans of the patella is a rare condition. 15 patients who had been treated by surgery were evaluated retrospectively by clinical examination, standard radiographs of the patellofemoral joint and using the Lysholm-Score. The results of treatment were classified as good, sometimes excellent. The worst results were found in centrally located lesions or in chondromalacia changes occurred at the time of surgery.

Adolescent↗
PubMedDate not supplied

[Paraplegia in manual therapy. A case report].

A case of complete paraplegia due to a giant cell tumor of the dorsal spine following manual therapy without previous x-ray examination is reported. In a malpractice trial the question whether manual therapy is indicated or not had strictly to be denied. The question whether paraplegia due to a giant cell tumor could have been avoided when the tumor would have been detected radiologically was impossible to answer retrospectively. But, it is likely that with immediate surgical therapy after radiological detection of this lesions complete paraplegia should have been avoidable.

Female↗
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[The principle of autogeneic rib perichondrial transplantation in the treatment of deep articular cartilage defects].

The purpose of this study was to examine the fate of autologous perichondrial grafts after transplantation into cartilage lesions in weight-bearing joints. Results were evaluated depending on the age of the animals and on the weight-bearing conditions. Osteochondral lesions were drilled in the articular surface of knee joints in 36 adolescent sheep. The defects were filled with autologous rib perichondrial grafts which were secured by either collagen sponges (n = 12) or fibrin glue (n = 12). Twelve animals served as controls. Following one week of immobilisation the animals were allowed to move freely. Animals were sacrificed after 4, 8, 12, and 16 weeks. The same procedure was performed in three adult animals in order to achieve hints regarding the age-dependent ingrowth of the transplants. In two of them the transplantation was done using fibrin glue for fixation; one animal served as control. Grafts were removed corresponding to the time intervals and investigated histologically. In adolescent animals grafts from weight-bearing areas and control defects did not show a regular cartilagenous differentiation. In contrast to that, hyaline-like cartilage formation could be noted in non-weight-bearing areas even after 4 weeks. In principle, the same results were found in adult sheep but a delay of cartilagenous differentiation of four weeks was observed. Depending on these results we use the procedure of perichondrial transplantation clinically for treatment of circumscript deep lesions of articular cartilage provided no osteoarthritis or any other overlying general diseases are evident. By means of the Lysholm- and Ranawat-score all six patients demonstrated postoperative improvement. Furthermore, in two patients arthroscopic controls exhibited sufficient filling of the defects and ingrowth to the surrounding cartilage. Thus, autogeneic perichondrial transplantation can be recommended for treatment of circumscript deep cartilagenous lesions of articular cartilage.

Aging↗
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[Synovial giant cell tumor or nodular circumscribed form of pigmented villonodular synovitis?].

In two case reports we demonstrate symptoms, clinical findings and treatment of patients with a benign synovial giant cell tumor of the knee and ankle joint. This tumor impresses like a localized pigmented villonodular synovitis but compared to this benign synovial giant cell tumors are rare in synovial joints and more often localized at the synovial tendon sheaths of fingers. Symptoms and clinical findings often mimic meniscal lesions. One of the most important finding is a hemorrhagic joint effusion without previous trauma. There are no typical findings in diagnostic imaging procedures and it seems that the most important fact is that the clinician is aware of this type of synovial tumor. Early resection of the tumor within wide margins is the treatment of choice. Postoperative radiotherapy is not to recommend.

Adult↗
PubMedDate not supplied

[ligament kinematics of the ankle joint. An experimental study].

In an experimental study using osteo-ligamentous preparations of ankle joints we studied the ligamentous kinematics of isolated ligament fibers of different lateral and medial ankle ligaments. Results demonstrate a different kinematic pattern of the ligaments depending on the joint position. The anterior fibula-talar ligament shows an anisometric characteristic of different fibers and demonstrates a maximal ligament strain of the most anterior fiber in maximal plantarflexion; fibers located more dorsally have their maximal strain in plantarflexion of less degrees. In contrast to that the fibula-calcaneus ligament demonstrates a more isometric characteristic. At the medial side the different parts of the deltoid ligament also demonstrate a different kinematic characteristic. In contrast to the pars tibio-calcanearis which has a more isometric ligament kinematic of isolated fibers, ligament fibers of the pars tibiotalaris posterior demonstrate an anisometric ligament kinematic. For clinical aspects an anatomically correct reconstruction of ruptured ligaments and fractures as well as an anatomic reconstruction in chronic unstable ankle joints is recommended.

Ankle Joint↗
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[Osteochondritis dissecans of the knee joint. Results of follow-up].

In a long-term follow-up examination (5-15 years postoperatively) clinical and radiological results after surgical treatment of osteochondritis dissecans of the knee of 97 patients with 109 osteochondritic lesions were controlled. The treatment consisted of retrograde removal of the subchondral osteonecrosis and -sclerosis with following autologous bone grafting in cases with intact hyaline cartilage. In cases of partial or total loosening of the osteochondritic lesion this procedure was done anterograde. For refixation different techniques such as fibrin glue or acylate glue were used. Using the classification of Arcq in 59.6% of the knee joints excellent and in 18.3% good results were obtained. Regarding the development of osteoarthritis in 56% no signs of osteoarthritis were visible. Worst results were obtained in knee joints in which non-resorbable acrylate glue was used for refixation of dissecates. In contrast to that patients in which loose dissecates were refixated with fibrin glue reached a significant better postoperative long-term result. In addition postoperative results were influenced by the age in which first symptoms were complained, by the stage of cartilaginous lesion, the kind of intraoperative technique and by additional morphological disturbances at the knee such as varus- or valgus mallaignment. In general for the treatment of osteochondritis dissecans of the knee an early operation before occurrence of cartilaginous lesions is recommended to avoid osteoarthritic changes. In cases of partial or complete loosening fibrin glue is recommended as the fixation technique of first choice.

Adolescent↗
PubMedDate not supplied

[Trigger hallux--a rare cause of pain at the inner malleolus].

Characteristic for a trigger-hallux is a thickening of the m. flexor hallucis longus tendon combined with partial rupture of the central fibers proximal to the tarsal tunnel. Division of the retinaculum flexorum leads to free tendon movement and prevents further tendon degeneration. The course of an 11-years old girl is reported. An effective treatment is established by a simple surgical procedure.

Ankle↗
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[Fungus-induced spondylitis].

Candida caused osteomyelitis of the spine is a rare entity. In the literature are only 15 cases reported. An own case of Candida-osteomyelitis of the spine is demonstrated and a overview of the literature is given.

Bone Transplantation↗
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[Osteonecrosis of the femur head. Comparative studies on methods for early diagnosis].

Compared to the computerized tomography and bone scintigraphy with additional single photon emission tomography the Magnetic-Resonance-Tomography shows early pre-radiological stages in cases of femoral head necrosis which cannot be seen neither by computerized tomography nor by usual x-ray. Compared to this the bone scintigraphy shows early stages similarly, but the topographic coordination and specific diagnosis is impossible.

Femur Head↗
PubMedDate not supplied

[Muscular stabilization of the upper ankle joint in lateral instability. An experimental study].

The mechanical stabilizing effect of artificially applied muscular strength to the peroneal tendons was examined in an experimental study using cadaveric lower legs with unstable ankle joints. Therefore the anterior fibulo-talar and the fibulo-calcanear ligament was dissected and the resulting instability with examination of the anterior drawer sign and the talar tilt was measured under standardized conditions. After initial measurement under standardized conditions a muscular strength of 75 N and 150 N was applied and the resulting stability was measured again. In a second experiment an additional orthotic device was applied and the stability was measured again under applied muscular strength. The results demonstrated that stable conditions at the lateral unstable ankle joint are only achievable when a muscular strength of 75 N (ant. drawer sign) or 150 N (talar tilt) is combined with the application of an orthotic device. For clinical treatment this means that functional treatment for ankle sprains with application of an orthotic device needs additional training for improvement of the muscular strength of the peroneal muscles.

Ankle Injuries↗
PubMedDate not supplied

[Joint loose bodies in both upper ankle joints in neural muscular atrophy of the Charcot-Marie-Tooth-Hoffmann type (hereditary motor sensory neuropathy I)].

A case is reported in which a patient with Charcot-Marie-Tooth-Hoffmann disease (HMSN I) complained about bilateral ankle pain, stiffness and swelling. Radiologically multiple loose bodies in both ankle joints were detectable. The etiology of loose bodies or secondary chondromatosis is still unclear. Different reasons are discussed. Regarding the case reported on here we discuss possible etiological connections and pathophysiological pathways that may explain influence of Charcot-Marie-Tooth-Hoffmann disease (hereditary motor sensory neuropathy I) on the development of loose bodies at both ankle joints.

Adult↗