[The Kiel efficiency test--a method for the objectivation of the trunk musculature in adults]. / Der Kieler Leistungstest--Methode zur Objektivierung der Leistungsfähigkeit der Rumpfmuskulatur bei Erwachsenen.

Trunk muscle insufficiency plays a central role in the etiology and pathogenesis of low-back pain. Intensity, duration and recurrence of the complaints depend very much on whether rehabilitative measures succeed in achieving lasting strengthening of the trunk muscles by a specific exercise programme. So far we had to rely on subjective criteria to identify insufficiencies of the trunk muscles. Now the Kiel Efficiency Test gives us a measure to objectify and describe this disorder. The test is simple and reproducible, can be performed in any consultation room and has proved to be reliable.

[2 new methods for determination of the height of patella]. / Zwei neue Methoden zur Bestimmung der Patellahöhe.

A short review of the literature on various methods of determining the height of the patella in the sagittal plane is given. These methods are critically appraised. Two new measuring techniques based on other well-known ones are presented which have a number of advantages over those currently used. The accuracy of the two methods is about the same. The new patellar height angle is recommended. Both methods use the distal end of the femur as a reference and depend on the degree of bending of the knee on lateral films. Since, for technical reasons, a standardized lateral view, e.g., with 30 degrees flexion, is not feasible, both methods require a conversion table which indicates the knee-bending angle to within 5 degrees. In order to differentiate better between a knee cap at normal height and a patellar dystopia an intermediate or transition zone is stipulated. Measuring of the height of the patella requires more knowledge and experience than is generally realized. There is still no really convincing and absolutely reliable measuring method.

[Treatment of varus gonarthrosis using Coventry's modified technic]. / Behandlung der Varusgonarthrose mit einer modifizierten Technik nach Coventry.

A high plane femoral head osteotomy technique after Coventry, modified by Blauth, is described; during the last 10 years it has been used in over 200 cases at Kiel University Orthopedic Clinic. In the present paper the mid-term findings in follow-ups of 100 osteotomies in 86 patients are analyzed. Of these interventions, 83% resulted in a significant reduction in complaints at rest and on loadbearing, a considerable improvement in walking ability, and clinically a strengthening of the ligamentous apparatus as well as a reduction in irritation. The 17% poor results were mainly patients with advanced panarthroses, knee-bending contractures and increased loosening of the ligaments. In almost all of these cases, the axial error was insufficiently corrected, while the good results were usually associated with over-correction. In cases of varus gonarthrosis we therefore aim for 5 degrees overcorrection. With the exception of a motoric paresis of the peroneal nerve and a deep infection which healed without sequelae, there were no serious complications. This method can thus be recommended as a reliable procedure.

[Determination of femoropatellar joint dysplasia (author's transl)]. / Zur Bestimmung der Dysplasie des Femoro-Patellargelenkes.

On the basis of more than 1400 tangential X-rays made with Knutsson's technique, the author qims to demonstrate, employing optical and measurement criteria, the limits between normal conditions and dysplasias. Since there are no fixed boundaries, these two areas can only be delimited from each other with sufficient accuracy by means of an inter-mediate zone. The patella is differentiated according to its shape in euplasia, medial hypoplasia and dysplasia, corresponding to the trochlea in Types I-V. In relation to the knee joint in question, there is a high degree of correlation between the development of the patella and the trochlea. All in all, a dysplasia can be determined more easily and more accurately at the trochlea than at the patella, since the patella is subject to greater projectural changes and the points of measurement are more difficult to establish. Ficat and Bizou's condylar depth index and the condylar-joint surface angle of Brattström are recommended as especially suitable methods of measurement. Since the shape of the trochlea changes as a function of the extent to which the knee is bent, the latter must be cited in comparative investigations.

[Repair of defects in the Achilles tendon with the peroneus brevis muscle (author's transl)]. / Zur Behandlung von Achillessehnendefekten mit der "Peronaeus-brevis-Plastik".

The authors report a dynamic plastic repair of the Achilles tendon in cases of neglected rupture: The peroneus brevis muscle is used to bridge the gap. The muscle remains intact at the proximal end, its tendon is dissected immediately above its insertion, then pulled through the calcaneus by a bore-hole and fastened to itself and to the ends of the Achilles tendon. If a plantaris tendon exists, it may be used to strengthen the defect by resecting it as far as possible proximally and then fanning it out to cover the gap. The distal end of the peroneus brevis tendon is sutured side-by-side to the peroneus longus tendon. This technique was first applied in 1968. During the last 5 years 8 patients underwent repair of the Achilles tendon by this method at the Department of Orthopaedic Surgery at the University of Kiel. In all cases the results obtained were good or excellent. The patients were very content and returned to a comparable level of preoperative activity. They were able to go as well on tip-toes as on the heels, though dorsal extension in several cases was slightly restricted. Calf atrophy up to 3 cm was found in several cases, which, however, was due partly to preoperational influences. In two cases wound healing complications occured without disturbing the functional results. The authors can recommend their technique, which seems to be superior to other methods especially in difficult cases with large gaps and unfavourably anatomic conditions.

[Arthrolysis in the treatment of post-traumatic extensor rigidity of the knee (author's transl)]. / Die Arthrolyse in der Behandlung posttraumatischer Kniestrecksteifen.

Extensor rigidity of the knee may be due to a wide variety of causes and is certainly quite often a sequela of an injury. Rigidity is caused by damage to tissue distant or proximal to the knee joint, in the joint itself, or simultaneously at several locations. In many cases considerable improvement can be achieved by arthrolysis. However, this requires detailed knowledge of the involved and expected pathologic changes. Besides detailed clinical and x-ray examination via arthrography it is particularly important to select and prepare the patients properly. Knee arthrolysis can never be based on only one surgical procedure. The authors differentiate between covered and open loosening of the stiffened joint besides intraarticular and extraarticular arthrolysis, and a combined intraarticular and extraarticular procedure. Postoperative followup treatment is at least just as important as the surgical procedure itself. Complications can be largely avoided via subtile technique and sufficient experience. The authors report on 16 followup examinations effected during the past four subsequent to arthrolyses of the knee. On the average there was an improvement in flexibility and stretch-ability by 70 degrees, or a relative flexibility increase by 80%. No serious complications were seen. Arthrolysis of the knee is recommended as a well-tried and highly successful surgical procedure.