[Medium-term results after m. vastus medialis obliquus-plasty for lateral patellar dislocation]. / Mittelfristige Ergebnisse der Vastus-medialis-obliquus-Plastik bei lateraler Patellaluxation.

Progressive retropatellar arthrosis is often seen in dated rigid distal realignment (i.e. osteotomy of tuberositas) at long-term follow-ups. Therefore, operations for lateral dislocation of the patella are still discussed controversially. Dynamic, proximal realignments seem to have lower rates of arthrosis but higher rates of redislocation. Recently, in anatomic and biomechanic studies, the m. vastus medialis obliquus (vmo) was found to be one of the most important proximal restraints to lateral dislocation of the patella.A total of 28 patients (mean age 21.5 years) were treated between 1994 and 2003 with a plasty of the vmo for lateral patellar dislocation. The technique was performed for most etiologies of femoropatellar instability. For this proximal soft tissue technique, the muscle tendon is detached from its patellar insertion. Subsequently, the tendon is reinserted at the patella 10-15 mm more distally and fixed with Mitek anchors. Full weight bearing in extension is possible immediately after surgery. An active vastus medialis training is started after 6 weeks. Of the patients, 27 were evaluated clinically and radiologically in 2004 (a mean of 5 years postoperatively). A total of 83% of the patients estimated the result to be good or excellent, 10% were satisfied and 7% were discontent. The mean Lysholm-Knee-Score was 83.1 points. Two patients suffered a patella redislocation (7%). A statistically significant improvement of the congruence angle was noted in the radiographs, even in medium-term controls. In 89% of the cases no or only little retropatellar arthrosis was observed. These 5 year results are comparable to those of other techniques for distal or proximal realignments. The rate of redislocation was below average. Compared to the rate of retropatellar arthrosis in long-term results of rigid distal realignment, our patients demonstrated a relative low rate after 5 years. We attribute this to the minimal interference in physiological joint mechanics and to the restored anatomy. In terms of future long-term results, our findings are promising. The idea of a proximal dynamic stabilization and the causal operative approach at the origin of pathology using vmo-plasty was confirmed in recent anatomic and biomechanic studies. Over or under correction of soft tissues could be adapted. More rigid techniques of distal realignment do not allow an adaptation to this extent and can lead to prearthrotic hyperpression in the medial femoropatellar and femorotibial joints.

[Possibilities of shoulder prostheses in arthritis]. / Möglichkeiten der Schulterprothetik bei Arthritis.

The most dramatic progress in shoulder surgery in the last 50 years has been the introduction of replacement arthroplasty for the treatment of posttraumatic, inflammatory and degenerative arthropathies. In rheumatoid arthritis shoulder replacement arthroplasty provides good and excellent subjective and objective middle- and long-term results in more than 80% of the patients. Above, all pain relief is reliable. The state of the rotator cuff and deltoid muscle at the time of operation determine the gain in function. Despite the high incidence of radiolucent lines about the prosthetic components, clinical loosening is rare. Actually the survival rate of shoulder prostheses is comparable to that of total hip and total knee prostheses.

[Long-term results after neurolysis and palmar transposition of the ulnar nerve]. / Langzeitresultate nach Neurolyse und Palmarverlagerung des Nervus ulnaris.

We reviewed 41 patients with 43 proximal ulnar nerve compression syndromes. The usual procedure was neurolysis of the ulnar nerve und subcutaneous transposition. The average follow-up period was 5 1/2 years (15 1/4 years to 3 months). The M/F ratio is 2.4:1. Most of the patients are hard manual workers, the dominant arm is most often affected, and 60% have some form of an injury in their history. About half of the patients followed-up have extensive relief of pain, loss of sensibility and weakness of the hand. But only 8 patients feel to have a perfect result. A few do complain of some tenderness in the scar region, some sensibility loss and a Tinel sign along the anterior route of the transposed nerve. Regaining of strength last months or even years. There is a general tendency to better final results in younger patients.

Roentgenologic assessment of initial relapse in stage I-III Hodgkin's disease.

The role of conventional radiography and CT in the assessment of initial thoracic and abdominal relapse in stage I-III Hodgkin's disease has been analysed in 43 patients. Lymph node involvement was seen in all patients, extranodal involvement in fifteen. The presence of thoracic relapse had been detected essentially by chest X-ray, but CT proved to be useful for definition of the topographic-anatomic extent of tumour manifestation. In the abdomen the presence and extent of any relapsing disease had been demonstrated mainly by CT. Additional lymphangiography was necessary in only one patient.