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M Dienst

Publications and source records attributed to M Dienst.

At least 19 recordsLinked to original sources
PubMed2006

[Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination].

The differential diagnosis of hip and groin pain with respect to the high frequency of referred pain from the lumbar spine, lower abdomen, and pelvis is demanding. A systematic approach to the hip and groin area is important to identify the origin of pain. Both the history and quality of symptoms and the physical exam are the basics of the diagnostic algorithm. Roentgenograms and possibly an injection with a local anesthetic to the suspected origin of pain often complete the diagnostic work-up.The following report summarizes the typical symptoms of hip and groin disorders. A detailed description of the physical exam including functional tests for impingement, apprehension, adductor-, psoas-, and inguinal-related pain is included.

Arthralgia↗
PubMed2006

[Radiological examination of the hip. Analysis of standard projections].

Plain radiography of the hip joint is the imaging modality of first choice. The standard projections are an anteroposterior view of the whole pelvis and a lateral view of the involved hip. Depending on the suspected pathology, different lateral projections are used such as the Lauenstein view, a false profile view, or a lateral cross-table view. Additional projections may be helpful in special indications. For correct analysis and interpretation, the radiographs need to be checked for adequate orientation and exposure. The orthopedic surgeon has to be familiar with the imaging technique of each radiograph and its normal appearance in order to assess the orientation of the pelvis during exposure and to detect even subtle pathology or changes in orientation of the acetabulum or proximal femur.

Arthrography↗
PubMed2006

[Magnetic resonance tomography and arthrography of the hip joint].

Plain film radiographs represent the imaging of choice for the initial evaluation of pathologies of the hip. However, many lesions of the joint itself and surrounding soft tissues are often not visualized by conventional radiographs. Magnetic resonance imaging (MRI) demonstrates most of these pathologies with high sensitivity and specificity. For further assessment of intra-articular lesions such as labral tears, hyaline cartilage lesions, rupture of the ligamentum teres, and loose bodies, direct MR arthrography after intra-articular administration of contrast medium may be indicated. This article summarizes the technical aspects and the most important indications for MRI and MR arthrography of the hip in correlation with typical imaging findings of the most frequent pathologies.

Arthrography↗
PubMed2006

[Hip arthroscopy. Technique for positioning and distraction].

Arthroscopy of the hip joint can be performed in the supine or lateral position. The decision whether to use the supine or lateral position appears to be more a matter of individual training or habit. Both positions have specific pros and cons. The operative experience with arthroscopy of the central and peripheral compartment shows that a combined procedure with and without traction is beneficial. Whereas arthroscopy of the central compartment in normal joints of adults is feasible only with traction, the peripheral compartment can be better scoped without traction. The combination of both techniques however is technically demanding. Particularly for arthroscopy of the central compartment with traction, the success of the operative procedure is strongly correlated with a correct technique of positioning and distraction. Precise positioning and thick padding of the counterpost, secure fixation and thick padding of the foot, and the limitation of magnitude and duration of traction are important features in order to avoid soft tissue and nerve damage. Good relaxation, joint position, and distension of the joint to break the joint vacuum significantly improve distraction of the femoral head from the socket. In combination with fluoroscopy, scope trauma to the acetabular labrum and hyaline cartilage can be minimized. For arthroscopy of the peripheral compartment without traction, the counterpost is removed and the foot taken out of the traction module for free range of motion of the leg and hip joint. This allows dynamic testing of the hip and access to different parts of the peripheral labrum, proximal femur, and soft tissues.

Arthroscopes↗
PubMed2006

[Synovial disorders and loose bodies in the hip joint. Arthroscopic diagnostics and treatment].

Synovial disorders and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for loose bodies, synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage in comparison to radiologic imaging is the ability to inspect, biopsy, and treat within one procedure. In contrast to an arthrotomy, hip arthroscopy avoids the potential risks of extensive surgical exposure and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with loose bodies, synovial plicae, initial septic arthritis and, to a certain extent, PVNS curative therapy and "restitutio ad integrum" can be achieved. In contrast, in patients with synovial chondromatosis and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis and to provide symptomatic relief and maintain or improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.

Arthroscopy↗
PubMed2006

[Hip arthroscopy for femoroacetabular impingement].

Femoroacetabular impingement (FAI) is likely one of the main causes for osteoarthritis in young adults. Surgical treatment has until now been performed via open dislocation of the hip joint. With respect to its invasive nature and long rehabilitation, arthroscopic techniques have become established in recent years. The following article presents the latest developments in hip arthroscopy for FAI with a detailed description of technical aspects, pitfalls, and limitations. Hip arthroscopy is performed in the standard fashion with and without traction for arthroscopy of the central and peripheral compartments. Under traction, the anterosuperior cartilage and adjacent base of the acetabular labrum have to be inspected for frequent lesions such as cartilage flap tears and delaminations of the cartilage from the subchondral bone. An ossified labrum can be trimmed back with a burr. Currently, techniques are being developed for temporary detachment of the labrum, trimming of the acetabular rim, and refixation of the labrum with suture anchors. Without traction, femoroacetabular impingement has to be confirmed arthroscopically under flexion, internal rotation, and adduction of the hip. With respect to the frequent loss of internal rotation, the zona orbicularis and the iliofemoral ligament are released and removed if needed. The anterolateral bump of the head-neck junction is trimmed back for restoration of a more physiological head-neck offset. Postoperatively, continuous passive motion is important to prevent adhesions between the bleeding bone of the head-neck junction and the articular capsule. Weight bearing as tolerated is allowed if no treatment of cartilage defects or refixation of the acetabular labrum was performed. The early results after hip arthroscopy for FAI are very promising. Arthroscopic techniques will upstage open exposures of the hip joint for the treatment of FAI.

Arthroscopy↗
PubMed2002

[Diagnosis of rupture of the anterior cruciate ligament].

Clinical examination has remained the key for diagnosis of meniscal and ligament lesions of the knee. Economical use of imaging techniques is based on adequate clinical examination. Standard radiographic examination is still a simple and valuable method. Magnetic resonance tomography has made great progress during the past few decades. For this reason, this article centers on this imaging modality.

Anterior Cruciate Ligament↗
PubMed2001

[Hip arthroscopy. Minimal invasive diagnosis and therapy of the diseased or injured hip joint].

Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip.

Arthroscopy↗
PubMed2001

[Approach to open treatment of osteochondral lesions of the talus].

Arthroscopic techniques still represent the treatment of choice in osteochondral lesions of the talus (OLT). Open techniques may be used as an alternative or may be complementary to arthroscopic treatments. They are especially indicated in cases of large osteochondral lesions, difficult localisations and in cases of recurrent interventions. In addition to the type of treatment for the lesion itself, the choice of an ideal surgical approach is of paramount importance. Indications, operative technique, possible complications and rehabilitation are described in detail for each approach. Anterolateral, anteromedial, posterolateral and posteromedial soft-tissue approaches as well as medial and lateral malleolar osteotomies are discussed. If a distraction is not desired with arthroscopy, posteromedial and posterolateral soft-tissue approaches offer a good alternative for the treatment of posterior OLT. Osteotomy of the (medial) malleolus offers good visualisation of the medial talar dome. With the introduction of new techniques of osteochondral transplantations, the use of this approach is becoming more popular. However, it is an invasive technique and the risk of secondary osteoarthritis after malleolar osteotomy still needs to be determined.

Ankle Injuries↗
PubMed2001

Fracture of the proximal tibia six months after Fulkerson osteotomy. A report of two cases.

The Fulkerson osteotomy has proved to be a reliable treatment for subluxation of the patella due to malalignment. Aggressive rehabilitation in the early postoperative period is unwise since the proximal tibia is weakened by the oblique osteotomy. Early weight-bearing and unrestricted activity have caused fractures in a few patients. Even late in the postoperative period the osteotomy may adversely influence the biomechanical properties of the proximal tibia. We describe two athletes who sustained a fracture of the proximal tibia, during recreational activities, six months after a Fulkerson osteotomy. Both had been bearing full weight for about ten weeks without complaint. Bony healing of the osteotomy had been demonstrated on plain radiographs at ten and at 12 weeks. After a Fulkerson osteotomy, jogging and activities which impose considerable impact force should be discouraged for at least nine to 12 months.

Adult↗
PubMed2000

[Osteonecrosis of the hip joint in adulthood. Significance of various corrective osteotomies].

The importance of osteotomies in treatment of osteonecrosis of the femoral head has decreased. However, with proper selection of the patient, osteotomies are still useful for small stage III or IV lesions in patients younger than 45 years, and with no ongoing causes for progressive osteonecrosis such as the use of high doses of corticosteroids, chemotherapy, and chronic alcoholism. For preservation of natural hip joint function, the necrotic segment is moved away from the load-transmitting area of the acetabulum, and weight-bearing forces are redistributed to articular cartilage that is supported by healthy bone. In addition to radiographic evaluation, MRI is most accurate for imaging of the stage, localization, and extent of osteonecrosis in planning and selecting osteotomy.

Adult↗
PubMed2000

Chondral lesions after arthroscopic meniscus repair using meniscus arrows.

Meniscus repair using bioabsorbable devices has become popular in the last few years. Good clinical results have been reported and few complications have been published. This report describes the case of a 37-year-old male patient with a lateral meniscus repair using 4 Meniscus Arrows (Bionx Implants, Blue Bell, PA). Postoperatively, repeated episodes of intra-articular effusions have occurred. A second-look arthroscopy 8 months after the reconstruction showed that the meniscus tear had not healed and revealed the presence of chondral damage corresponding to the location of the arrows in the posterior area of the lateral femoral condyle. Surgeons using the Meniscus Arrow should be aware of this possible postoperative complication.

Absorbable Implants↗
PubMed2000

Bone bruise of the calcaneus. A case report.

A bone bruise to both calcanei after axial overloading is reported. Because radiographs were normal and weightbearing was not possible, magnetic resonance imaging was performed and showed characteristic findings for a bone bruise of the calcaneus more extended on the left side than the right side. Resolution of pain was within the first 2 weeks after trauma on the right side, whereas partial weightbearing was necessary for 4 months on the left side. Six months after trauma, complete resolution of magnetic resonance signal changes was evident. Bone bruises should be considered when radiographs are normal. Because bone bruises pose a potential risk for chondrolysis and stress fracture, mobilization and weightbearing should be increased gradually.

Adult↗
PubMed1999

Unilateral osseous bridging between the arches of atlas and axis after trauma.

STUDY DESIGN: This is a case report. OBJECTIVE: To present a case of osseous bridging between C1 and C2 of posttraumatic origin and with an associated closed head injury and to discuss its pathogenesis and clinical outcome after surgical resection. SUMMARY OF BACKGROUND DATA: Heterotopic ossifications of posttraumatic origin in the spine are rare. To the authors' knowledge, no cases have been reported of spontaneous bony bridging between C1 and C2 with a posttraumatic origin. METHODS: Heterotopic ossifications were detected when pain and limited axial rotation (left/right 10 degrees/0 degree/20 degrees) were persistent, despite intensive physical therapy. Because heterotopic ossifications were ankylosing C1 and C2, the decision was to resect the osseous bridge in combination with a careful mobilization of the cervical spine. Functional computed tomography was performed for analysis of the postoperative results. RESULTS: Four months after surgery, clinical examination showed asymptomatic increased axial rotation. Functional computed tomography indicated that left C1-C2 axial rotation was reduced, possibly related to impingement caused by residual bony spurs. Pathologic changes in the surrounding soft tissue may be another important factor in the persistent limitation of rotation. CONCLUSIONS: Osseous bridging between C1 and C2 may be considered when persistent pain and limited axial rotation are observed after trauma. Operative resection, together with careful intraoperative and postoperative mobilization, may be the treatment of choice.

Abdominal Injuries↗
PubMed1999

[Arthroscopy for diagnosis and therapy of early osteoarthritis of the hip].

Failure to conservative treatment in patients with less advanced radiographic signs of osteoarthritis of the hip (Danielsson grade 2-5) confronts with the decision of further treatment. Since radiographic imaging has not been proved very useful in demonstrating intraarticular structures and results of hip arthroscopies have been promising, arthroscopies have been performed in 17 hips from November 1997 to September 1998. Arthroscopic findings were exceeding preoperative imaging. In addition to cartilage degeneration, concomitant loose bodies, impinging osteophytes, degeneration of the labrum and synovial disease were found. Removal of loose bodies and osteophytes, partial resection of labral tears and partial synovectomy were performed. 1 month after arthroscopy (n = 15), mean Harris-Hip-Score was increased by 13 points und pain reduced by 39 % on average. 6 months after arthroscopy (n = 9), mean Harris-Hip-Score was increased by 14 points and pain reduced by 32 % on average. In addition to its therapeutic benefit, arthroscopy offers direct visualisation of the hip providing important information for the decision of further treatment.

Arthroscopy↗
PubMed1999

Meniscal substitutes--animal experience.

Animal studies have shown that meniscus allografts and tendon autografts generally heal to the capsule, are revascularized and repopulated with host cells. In animals, neither meniscal allografts nor tendon or fat autografts gain the properties of a normal meniscus. Meniscus allografts and tendon autografts are promising as both seem to offer some protection to the cartilage of the tibial plateau. There is no evidence that meniscal transplantation can prevent cartilage degenerative changes, and the long-term effect of meniscal transplantation on articular cartilage remains unknown. Whether cellular repopulation of the meniscal allograft is sufficient to restore its biomechanical properties is unknown. Collagen scaffolds and tissue engineered grafts are still under investigation, showing promising results especially for the former. Viable meniscal allografts should be implanted within 1 to 2 weeks after harvesting, as the production of proteoglycans decreases after 2 weeks.

Animals↗