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1.
Knee Surg Sports Traumatol Arthrosc ; 21(10): 2200-5, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23942882

ABSTRACT

PURPOSE: Patient-specific instrumentation (PSI) technology for the implantation of total knee arthroplasty (TKA) has a rising interest in the orthopaedic community. Data of PSI are controversially discussed. The hypothesis of this paper is that the radiological accuracy of CT-based PSI is similar to the one of navigated TKA published in the literature. METHODS: Since 2010, all 301 consecutively performed PSI TKAs (GMK MyKnee©) were included in this study. The radiological assessment consisted in a preoperative and postoperative standard X-ray and long-standing X-ray. Changes from the planned to the definitively implanted component size were documented. Postoperative analysis included limb alignment and position of femoral and tibial components (for varus/valgus and flexion or tibial slope). RESULTS: The postoperative average hip-knee-ankle angle was 180.1° ± 2.0°. In the frontal plane a total of 12.4 % of outliers >3°, for the tibial components 4.1 % of outliers >3° and for the femoral components 4.8 % of outliers >3° were measured. A total of 12.3 % of outliers for posterior tibial slope and 9 % of outliers >3° for the femoral flexion were noted. 10.8 % of the 602 planned size components were adapted intraoperatively. CONCLUSION: Although it is still unknown which limb axis is the correct one for the best clinical result, a technology providing the aimed axis in a most precise way should be chosen. Comparing the outcome of the current study with the data from the literature, there does not seem to be any difference compared to computer-assisted surgery. LEVEL OF EVIDENCE: IV.


Subject(s)
Arthroplasty, Replacement, Knee/methods , Bone Malalignment/prevention & control , Knee Joint/diagnostic imaging , Postoperative Complications/prevention & control , Preoperative Care/methods , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed , Arthroplasty, Replacement, Knee/instrumentation , Bone Malalignment/diagnostic imaging , Bone Malalignment/etiology , Follow-Up Studies , Humans , Imaging, Three-Dimensional , Knee Joint/surgery , Knee Prosthesis , Outcome Assessment, Health Care , Postoperative Complications/diagnostic imaging , Preoperative Care/instrumentation , Retrospective Studies , Surgery, Computer-Assisted/instrumentation
2.
Sportverletz Sportschaden ; 27(1): 21-7, 2013 Mar.
Article in German | MEDLINE | ID: mdl-23413019

ABSTRACT

BACKGROUND: The aim of this study is to provide a valid and reliable German version of the Tegner activity scale (Tegner-G). The Tegner activity scale assesses on 11 levels the activity in sports (competitive and recreational) and work of patients with anterior cruciate ligament injuries. The English original version was elaborated in Sweden and contains sports that are unknown in German-speaking countries. METHODS: The translation and adaptation was conducted in several steps according to the guidelines in the literature. The validity (discriminative validity and content validity) and (absolute and relative) reliability were determined in 46 patients after reconstruction of the anterior cruciate ligament and in 20 healthy subjects. The patients were divided into an acute group (< 3 months after operation; 11 men; 30.9 ± 8.3 years) and a chronic group (3 - 12 months after operation; 18 men; 31.3 ± 11.6 years). All subjects filled in the scale two times within 3 - 7 days. For the additional determination of the relation between activity and function, they also filled in the German version of the Lysholm score (Lysholm-G). RESULTS: The three groups differed significantly from each other (Kruskal-Wallis test: χ2 = 27.95, p < 0.001; post hoc Mann-Whitney U tests: acute-chronic p < 0.001; acute-control p < 0.001; chronic-control p = 0.003). There was a floor effect in the acute patient group. The intraclass correlation coefficients indicated a high relative reliability (ICC2,1 > 0.9). The minimal detectable change was 1.4 points. The relation between activity (Tegner-G) and function (Lysholm-G) was stronger in the acute than in the chronic patient group (ρ = 0.77 and ρ = 0.60, respectively). CONCLUSION: The psychometric properties of the Tegner-G are comparable to those of the English original version. The Tegner-G is thus valid and reliable for the German-speaking part of Switzerland. The application in other German-speaking countries probably requires adaptations for some of the sports included. The relation between activity and function changes depending on time since operation. This confirms that a comprehensive assessment of the outcome after an anterior cruciate ligament injury requires the separate assessment of both parameters.


Subject(s)
Activities of Daily Living , Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament/surgery , Knee Injuries/diagnosis , Knee Injuries/surgery , Outcome Assessment, Health Care/methods , Trauma Severity Indices , Adult , Germany , Humans , Male , Recovery of Function , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome
4.
Clin Orthop Relat Res ; 469(8): 2377-84, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21318628

ABSTRACT

BACKGROUND: The risk of noncontact ACL injury reportedly is increased in patients with a greater posterior tibial slope (PTS), but clinical data are inconsistent. It is unclear whether the medial and lateral PTSs have a different impact on this connection. It also is unknown whether the meniscal slope (MS) is associated with ACL injury. PATIENTS/METHODS: Using MRI, we compared the medial and lateral PTSs and MSs separately in 55 matched pairs of patients with isolated noncontact ACL injuries and a control group. RESULTS: Neither the PTS nor the relative difference between the medial and lateral PTSs differed between groups. In contrast, the lateral MS was greater with ACL injuries: 2.0° versus -2.7° in males with and without ACL injury and 1.7° versus -0.9 in females. Uninjured females had a greater PTS than males: 4.9° versus 3.0° in females and males medially, respectively; 5.7° versus 4.0° lateral. CONCLUSIONS: There is no obvious link between the medial or lateral PTSs and ACL injury, and there is no obvious link between the relative difference in the medial and lateral PTSs and noncontact ACL injury. However, a greater lateral MS may indicate a greater risk of injury. The PTS can differ between the genders but the average difference is small. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.


Subject(s)
Anterior Cruciate Ligament Injuries , Knee Injuries/physiopathology , Menisci, Tibial/physiopathology , Tibia/physiopathology , Female , Humans , Logistic Models , Magnetic Resonance Imaging , Male , Prognosis , Range of Motion, Articular/physiology
5.
Clin Orthop Relat Res ; 442: 143-8, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16394753

ABSTRACT

We compared the in vitro pullout strengths of a metallic screw-type suture anchor (5-mm Corkscrew) and a new ultrasonically implanted absorbable pin from cadaveric humeral heads with different bone densities. They were assessed quantitatively using microcomputed tomography. Pullout tests were done at four standardized sites and then correlated with the local bone density. The mean pullout strengths for the 5-mm Corkscrew and the 3.5-mm polylactic pin were similar in weak bone (76 +/- 24 N versus 104 +/- 46 N), intermediate quality bone (194 +/- 81 N versus 218 +/- 76 N), and strong bone (349 +/- 127 N versus 325 +/- 100 N). Pullout strength correlated with bone density for both implants (r = 0.76 and r = 0.86 for the Corkscrew and polylactic pin, respectively). The ultrasonically implanted absorbable 3.5-mm polylactic pin achieved equal pullout strength in weak bone as the larger 5-mm titanium Corkscrew. Bone density is highly variable in humeral heads and influenced the pullout strength of both implants.


Subject(s)
Bone Diseases, Metabolic/physiopathology , Humerus/surgery , Orthopedic Procedures/instrumentation , Ultrasonics , Absorbable Implants , Aged , Aged, 80 and over , Analysis of Variance , Bone Density/physiology , Bone Nails , Cadaver , Humans , Materials Testing , Middle Aged , Prosthesis Design , Prosthesis Failure , Stress, Mechanical , Suture Techniques , Sutures , Tomography, X-Ray Computed/methods
6.
J Shoulder Elbow Surg ; 9(4): 336-41, 2000.
Article in English | MEDLINE | ID: mdl-10979532

ABSTRACT

The anatomy of the region between the supraspinatus and subscapularis tendons, called the rotator interval, was studied in 22 shoulders of 12 cadavers. Its function was then examined by sequential cutting of tendon or rotator interval structures. The rotator interval was found to be composed of parts of the supraspinatus, subscapularis, coracohumeral ligament, superior glenohumeral ligament, and glenohumeral joint capsule. A medial part composed of 2 layers was defined and distinguished from a more lateral part composed of 4 layers. The most superior 3 layers of the lateral part formed a fibrous plate. The medial part was found to primarily limit inferior translation and, to a lesser extent, external rotation. The fibrous plate of the lateral part of the rotator interval mainly limited external rotation of the adducted arm. The coracohumeral ligament played a key role in external rotation as well as in inferior translation.


Subject(s)
Rotator Cuff/anatomy & histology , Shoulder Joint/anatomy & histology , Tendons/anatomy & histology , Adolescent , Adult , Biomechanical Phenomena , Cadaver , Female , Humans , Humerus/anatomy & histology , Male , Middle Aged , Range of Motion, Articular
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