[Injuries of the medial collateral ligament and spring ligament complexes]. / Verletzungen des medialen Kollateralband- und "Spring-ligament"-Komplexes.

The medial collateral ligament (MCL) complex is characterized by a complex anatomical arrangement of the individual ligamentous structures including three joints and the spring ligament complex. Biomechanically it serves as the main stabilizing structure in the ankle region against rotational and pronating forces. Lesions in the region of the MCL complex are more frequent than previously thought and like lesions of the spring ligament complex can lead to pain and instability. A thorough examination including the patient history with possible injury mechanisms often yields valuable information on the diagnosis of injuries to the MCL or spring ligament complex. In many cases these are primarily overlooked and concomitant lesions, such as fractures, syndesmotic and lateral ligament lesions frequently occur; however, the clinical assessment of stability is often primarily impossible in an acute setting. High-resolution magnetic resonance imaging (MRI) plays a key role in identifying the ligamentous components. In addition, MRI plays a supportive role in the preoperative planning before reconstruction of acute and especially chronic lesions. In most cases the surgical treatment of acute ruptures of the MCL is not indicated. Various options for treatment of acute and chronic lesions of the MCL and spring ligament complex are available including the use of free tendon grafts. Controversy exists regarding the operative treatment of MCL lesions in the case of ankle fractures. It is recommended for cases with impinging tissue in the medial gutter serving as a barrier to adequate reduction of the joint and in cases of unstable fractures after reduction.

[New oral anticoagulants from the perspective of trauma surgery]. / Neue orale Antikoagulanzien aus unfallchirurgischer Sicht.

Heparins and vitamin K antagonists have been the cornerstones of anticoagulation therapy for several decades. While these compounds have proven to be effective at inhibiting the coagulation process, they have inherent limitations. This has spurred efforts to develop therapies that will overcome these drawbacks while matching the efficacy of the conventional anticoagulants. Significant advances have been made in the development of more specific treatments targeting factor Xa or thrombin and providing more predictable anticoagulant responses. They also offer the convenience of oral administration with fixed dose regimens not requiring routine monitoring which may have an impact on compliance. The factor Xa inhibitor rivaroxaban and the thrombin inhibitor dabigatran etexilate have become available for prevention of venous thromboembolism after elective hip and knee replacement surgery and registration of the factor Xa inhibitor apixaban is expected to occur soon. Furthermore, first clinical evidence has become available for all of these compounds in patients requiring long-term anticoagulation. It is to be expected that these results will lead to improvements in prevention of stroke in patients with atrial fibrillation and in treatment of venous thromboembolism.

[Surgical therapy of distal biceps tendon ruptures]. / Operative Therapie distaler Bizepssehnenrupturen.

Ruptures of the distal biceps tendon are rare injuries which nearly exclusively occur in middle-aged men when eccentric load is applied to the flexed elbow. Operative treatment is supposed to be the most effective method to restore flexion and supination strength. However, there is a wide variety of potential surgical treatment methods. This article is aiming to present the anatomical, pathophysiological and epidemiological basics and to demonstrate the surgical techniques. Not only the approaches but also the differing fixation methods like bone tunnel fixation, endobutton- or suture anchor and interference screw are described in detail. Additionally, rehabilitation protocols and considerations concerning medical expertise are presented.

[Bilateral fixed dislocation of the long head of the biceps tendon]. / Beidseitige habituelle asymptomatische Bizepssehnenluxation--ein Fallbericht.

In general, dislocations of the long head of the biceps tendon are associated with partial or complete rotator cuff rupture on the side of the affected shoulder. We report about a patient with bilateral fixed and painless dislocation of the tendon of the long biceps head. By using functional ultrasound, correct diagnosis was facilitated and accelerated.

[A new minimally invasive arthroscopic technique for reconstruction of the acromioclavicular joint]. / Eine neue minimal-invasive arthroskopische Technik zur Akromioklavikulargelenkrekonstruktion.

BACKGROUND: Over 100 techniques for acromioclavicular joint (ACJ) reconstruction have been described. Most of these techniques are invasive and are associated with a high complication rate. We therefore developed a new minimally invasive arthroscopic technique for reconstruction of the ACJ. METHODS: The new operation technique is described in detail. We operated 13 patients with Rockwood IV or V dislocations of the ACJ using this new technique. Intra- and postoperative complications were recorded. Each patient was evaluated after 3, 6, and 9 months using the Constant score for shoulder function and radiographs (anteroposterior, axillary, and Zanca views) of the operated and nonoperated shoulder for radiologic evaluation. The objective of this study was to evaluate the first clinical results and complication rates using this technique. RESULTS: The mean follow-up was 9 months. Of the 13 patients, 12 could be included in the study and we had 1 dropout. The mean Constant score was 97; all patients were satisfied with the postoperative shoulder function and cosmetics. Radiologically we observed ten patients with anatomic reduction and two with a subluxation between 2 and 4 mm compared to the nonoperated side. In one patient we determined coracoclavicular ossifications which were asymptomatic. There were no complications intra- and postoperatively. CONCLUSIONS: These first results suggest that this is a good and safe technique for ACJ reconstruction. Further randomized studies with more patients have to follow to confirm the results.

New mapping technology for atrial tachycardias.

UNLABELLED: Prerequisite for succesful radiofrequency catheter ablation of tachycardias is the exact mapping during the electrophysiological study. The new mapping system CARTO allows a three-dimensional color-coded electroanatomic map of impulse propagation using electromagnetic technology. The aim of this study was to determine the feasibility and safety of the new electromagnetic mapping technology CARTO for atrial tachycardias. RESULTS: Electrophysiologic study and CARTO mapping was performed in 38 atrial tachycardias. The mapping procedure took 26 +/- 23 min. We created 33 maps within the right atrium and 5 maps within the left atrium with a mean of 74 +/- 38 different catheter positions. The mechanism was determined as reentrant in 9, junctional in 1 and focal in 28 tachycardias. In focal tachycardias the tachycardia cycle length (CL) and the total atrial activation time (AT) were clearly different (352 +/- 98 ms vs 99 +/- 25 ms). Reentrant tachycardias had a comparable CL and AT (236 +/- 44 ms vs 240 +/- 56 ms). In 83% of the focal tachycardias and in 67% of the reentrant tachycardias, ablation was performed successfully. No complications occured. CONCLUSION: The electroanatomic mapping system allows high resolution visualization of electrical activity and may therefore improve precision and simplify the determination of the arrhythmogenic substrate during tachycardias for successful catheter ablation.