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J D Agneskirchner

Publications and source records attributed to J D Agneskirchner.

10 recordsLinked to original sources
PubMed2004

Simplified MRI sequences for postoperative control of hamstring anterior cruciate ligament reconstruction.

INTRODUCTION: Usually, standard radiographs are used for postoperative quality follow-up after ACL reconstruction. However, with the use of hamstring grafts and bioabsorbable implants, accurate assessment of the tunnel and implant position is impossible. The graft and its relation to anatomical landmarks cannot be evaluated directly. MRI is an alternative to radiography, permitting direct graft visualization and 3-dimensional assessment of the tunnel position, but it is expensive and time consuming for routine use. The aim of this study was to develop a simplified MRI protocol and to evaluate it for routine postoperative quality follow-up after ACL reconstruction. MATERIALS AND METHODS: Various scanning protocols were tested in a series of 105 patients and evaluated for image sharpness, clarity of the structures, susceptibility to artefacts, applicability regarding precise analysis of graft and tunnel position, and time consumption. One simplified specific scan protocol was then defined and applied in a series of 60 consecutive patients after hamstring ACL replacement. The position of the femoral and tibial tunnels was measured in the sagittal, coronal and axial sections and classified according to Harner (femoral) and Stäubli (tibial). Impingement of the graft in the intercondylar roof was analysed according to Howell. The position of the bioabsorbable interference screws was assessed. RESULTS: Scan protocol: T2-weighted gradient-echo sequences (GRE) with TR 246 ms, TE 11 ms, flip angle 25 degrees, 2 mm sections and a 256 x 256 matrix yielded the best image quality of tendon grafts and bone tunnels with tolerable time consumption (average scanning time per patient 1 min 40 s). Altogether 8-16 sections were obtained for every patient. Tunnel placement: 46/60 (77%) of the femoral tunnels were in zone 4, 13/60 (21%) at the border of zones 3 to 4, 1/60 (2%) in zone 3 in the sagittal plane (Harner). The femoral tunnels in the axial plane were at 10:30 o'clock in 32/60 (53%), at 11:00 o'clock at 24/60 (40%) and at 10:00 o'clock in 4/60 (4%) patients. The mean distance of the anterior border of the tibial tunnel from the anterior cortex was 39% (+/- 4.9%) related to the total sagittal diameter of the tibia. There was no graft impingement. The position of the interference screws was anterior to the grafts in all cases. CONCLUSION: Simplified MRI sequences can be used for postoperative quality follow-up after ACL replacement and are an alternative to standard radiographs giving more specific and precise information regarding tunnel position and screw placement. Analyzing the bone tunnels in a series of 60 patients demonstrated that correct assessment of tunnel placement after arthroscopic ACL reconstruction is feasible using this simplified MRI technique.

Absorbable Implants↗
PubMed2004

[Outpatient arthroscopic surgery].

Arthroscopic surgery is being used more and more frequently worldwide for a growing number of indications and for almost all joints. In Germany, there is, however, no consensus on correct methods of arthroscopic surgery on an outpatient basis. Structural, personnel, and anesthesiologic factors and appropriate follow-up care play important roles in this type of operation. This study examines some basic requirements and presents an overview of the individual indications for such operations performed in an outpatient setting.

Ambulatory Surgical Procedures↗
PubMed2004

[Endoprostheses of the knee joint].

Due to the advances in prosthesis design and standardisation of implant techniques, the maintenance of implants in arthroplasty of the knee joint has enormously increased during the past few years. Various arthroplastic designs enable an adjustment towards the patient's individual indiction and anatomy. For one-compartmental arthrosis, monocondylous prosthesis can be implanted using microinvasive operation techniques. Prerequisite for mere joint resurfacing is an intact lateral ligament apparatus, whereas the the symmetrical ligament balancing is essential for long-term analgesia, joint stability and good flexion. Aseptic loosening, discreet infections, instabilities and patellar problems are common reasons for painful knee arthroplastics.

Arthroplasty, Replacement, Knee↗
PubMed2002

[Mega-OATS. Technique and outcome].

Big osteochondral defects in the weight-bearing zone of the medial respectively the lateral femoral condyle are still an unsolved problem especially in younger patients. The transfer of the posterior aspect of the femoral condyle was described as a salvage procedure. Mega-OATS is a technical improvement of the transfer of the posterior condyle-procedure. Essential advantages of the conventional OATS-technique are integrated in the Mega-OATS procedure, so that iatrogenic lesions of the transferred cartilage by press-fit-fixation and secondary hardware removal can be avoided. However, the Mega-OATS procedure itself remains a salvage procedure and should only be reserved for younger patients. The results of the first series of 17 patients (average follow-up 12 (5-19) months) showed an improvement of quality of life and a significant (p = 0.003) increase in the Lysholm-score.

Adult↗
PubMed2002

[Axis deviation, cartilage damage and cruciate ligament rupture--concomitant interventions in replacement of the anterior cruciate ligament].

BACKGROUND: Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability and varus malalignment. We present the indications, operative technique, and results for the combined operation of high tibial osteotomy and cruciate ligament reconstruction. MATERIALS AND METHODS: From April 1996 until December 2000, 58 patients (average age: 33 years) underwent simultaneous osteotomy (57 correcting valgus, 1 valgus malalignment) and cruciate ligament reconstruction (49 ACL, 7 PCL, 2 ACL & PCL) which was routinely performed with an arthroscopic technique after completion of the osteotomy (closed wedge technique). Average correction angle of the osteotomy was 7 degrees (4-10 degrees) with a mean malalignment of 5 degrees (0-10 degrees). Thirteen patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), and two patients were implanted with a collagen meniscus (CMI) at the same time. RESULTS: Preoperatively the Lysholm score was 66 (35-81) points and increased to 81 (74-95), 87 (79-99), and 93 (88-99) points 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in four patients. CONCLUSIONS: Unstable knees with varus malalignment can be sufficiently treated by osteotomy and cruciate ligament reconstruction at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost-effective therapy delaying the progression of osteoarthritis and minimizing clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and the return of these patients to the activities of daily living and sports.

Adult↗
PubMed2001

[Operative therapy of osteochondral lesions of the talus with autologous cartilage-bone transplantation].

Since 1996 we have gained experience in the development and clinical application of the OATS technique in 167 cases. Operative management, technical demands and early results of osteochondral cylindrical autograft plugs at the talus are presented. Between April 1996 and November 2000 we treated 39 patients (21 male, 18 female) with an average age of 28.4 years (range: 16-57 years) for osteochondral defects with an average size of 8 x 15 mm-20 x 15 mm at the medial (n = 31) and lateral (n = 6) talar dome as well as at the distal tibia (n = 2) with an OATS technique. Indications were osteochondral defects after trauma in 12 patients (med., n = 5; lat., n = 5; dist. tibia n = 2) and osteochondrosis dissecans (grades III and IV) in 27 patients (med., n = 26; lat., n = 1). The donor site was the proximal lateral femoral condyle in all patients. An additional osteotomy of the malleolus was necessary in 30 patients. All patients were scored pre- and postoperatively by a Lysholm Bruns score and monitored by postoperative MRI. The follow-up extended for an average of 19.6 months (6-42). The Lysholm score for all patients rose from 62 points (range: 20-77) up to 92 points (range: 63-100). There was no correlation between patients with and without an osteotomy of the malleolus. The postoperative MRI showed a complete incorporation and vitality of the transplanted cylinders as well as a congruence of the joint surface. Complications were pain in three cases in the region of the osteotomy, which decreased after removal of the screws, and synovialitis in one case. One patient reported femoropatellar pain for about 4 weeks. The OATS technique achieves encouraging results in limited osteochondral defects in the talar dome even in preoperated osteochondral defects. Because of the mostly posterior localization of the defect zone, osteotomy of the malleolus is necessary in most cases. Harvesting the donor cylinders from the ipsilateral knee joint by mini-arthrotomy shows a low mortality. The OATS technique is a suitable, causal and cost-effective therapy, which can possibly prevent and at least delay the development of an arthrosis.

Adolescent↗
PubMed2001

Acromion reconstruction after total arthroscopic acromionectomy: Salvage procedure using a bone graft.

We report 2 cases of acromion reconstruction with a bone graft as a salvage procedure after total arthroscopic acromionectomy. Complete removal of the acromion had produced severe shoulder abnormality with pain and joint stiffness. We present the operative technique of acromion reconstruction using a corticocancellous bone graft from the iliac crest. Recreation of the acromion as a fulcrum of the shoulder joint as well as an important physiological insertion area for the deltoid muscle markedly improved pain and range of motion in these patients. In conclusion, based on these cases, we believe that total acromionectomy is an inadequate procedure for treatment of shoulder impingement syndrome. Acromion reconstruction with a bone graft is an alternative that may lead to improvement of clinical symptoms.

Acromion↗
PubMed2000

[Superior labrum pathology in the athlete].

Since their first description several years ago, superior glenoid labral lesions have increasingly been blamed for shoulder problems associated with sports. Originally merely describing arthroscopically visible upper labral/biceps abnormalities, the current understanding is that often clinical problems such as impingement pain or even rotator cuff disease can be secondary to these lesions, especially in overhead athletes. Impingement in these cases is caused by superior shoulder instability originating from an unstable biceps insertion that is present for example in SLAP (superior labrum from anterior to posterior) lesions. Additional problems such as internal or posterosuperior impingement that are often found simultaneously in these patients are pathomorphologically located in the same anatomical region and therefore make exact diagnosis and thus treatment more complex. Magnetic resonance imaging with intra-articular contrast enhancement and particularly arthroscopy are the primary tools for exact diagnosis and classification of superior labral/biceps pathology. Therapeutically, lesions with unstable biceps origin (SLAP types 2 and 4) require operative refixation, as we have seen in our 50 cases in the last 4 years, in order to reestablish the stabilising effect of the biceps tendon for the shoulder joint. The arthroscopic technique for repair of these lesions using different devices of implantable suture anchors is presented. Long-term pain-free shoulder function in competitive athletes, throwers in particular, thus requires anatomical reconstruction of the originally unstable biceps, which is the causal therapy for these lesions.

Arthroscopy↗