[Treatment of focal articular cartilage lesions of the knee with autogenous osteochondral grafts]. / Osetrení místního defektu chrupavky kolenního kloubu autologním chondrograftem.

PURPOSE OF THE STUDY: A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. Many surgical techniques have been studied in an attempt to restore the damaged articular cartilage. Autogenous osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness, however, only a few series have been reported in the literature. MATERIAL: A retrospective study included 14 patients with 14 knees with focal full thickness articular cartilage defects hospitalised in our department between January 1997 and June 2000. The diagnoses included six knees with osteonecrosis, five knees with osteochondritis dissecans and three knees with traumatic cartilage defect. METHODS: All these patients underwent an osteochondral autografts of the knee with 2 years follow-up. The evaluations were based on functional assessments, which included pain, giving way, locking, recurrent effusion, knee scores, functional scores and Lysholm scores. The postoperative values of functional assessments among the three categories of diagnosis were compared statistically using Kruskal-Wallis test. Radiographs of the knees were examined for joint congruence, joint space narrowing and degenerative changes. RESULTS: The study showed good or excellent clinical results in over than 85%. The duration of pain of the knees relief ranged from six to 16 weeks after surgery. DISCUSSION: There was no correlation of the clinical results with the underlying diagnosis, including osteonecrosis, osteochondritis dissecans and traumatic cartilage defect. Improvement in symptoms appeared time-dependent, ranging from 6 to 16 weeks, suggesting that postoperative protection of the graft is warranted. There was no radiographic progression of degenerative changes of the knee on the medium-term follow-up. CONCLUSION: There was no correlation of the clinical results with the underlying diagnoses. It appears that an osteochondral graft has the potential to prevent or delay the development of degenerative changes of the knee in the medium-term follow-up. Autogenous osteochondral graft is considered as a good method in the treatment of knees with moderately sized articular cartilage defects.

Rupture of the extensor pollicis longus tendon after wrist trauma.

In the period of 1976 to 1997 our clinic treated 33 patients after Colles fracture with ruptured extensor pollicis longus tendon. The occurrence of functional loss was observed after the trauma in 3 to 9 weeks. In 30 cases the surgical treatment of extensor indicis proprius tendon, in 2 cases a direct suture of the ruptured tendon was performed as a primary repair and in one patient a palmaris longus interposition was utilised.

L-arginine treatment in ischemia/reperfusion injury.

We tested whether treatment with exogenous L-arginine, the precursor of nitric oxide (NO), could protect the skeletal muscle from ischemia/reperfusion (I/R) injury. A rabbit hindlimb I/R model (2.5 h ischemia/2 h reperfusion) was used. Morphological changes were elucidated by morphometry. Plasma concentrations of malondialdehyde (pMDA), as well as L-arginine and L-citrulline content in the plasma and skeletal muscle were measured. I/R injury in the skeletal muscle was manifested by development of prominent interstitial edema (fraction of interfiber area was 26.23% vs 15.09% in sham operated control, p < .005) and severe microvascular constriction (capillary area was 11.41 microns2 vs 16.92 in control, p <.005). These changes were accompanied by increased pMDA levels, indicating a process of lipid peroxidation in the cell membranes. L-arginine treatment (4 mg/kg/min intravenously, for 1 h, infusion initiated 30 min before reperfusion) caused an intracellular accumulation of this amino acid in the SM. Intracellular concentrations of L-citrulline increased (201.0 mumol/dm3 after reperfusion vs 176.0 before ischemia onset, p < .005), suggesting stimulated endogenous NO synthesis. L-arginine treatment protected capillary constriction (capillary area was 17.64 microns2 vs 11.41 in the untreated animals, p < .0005) and reduced interstitial edema after reperfusion (fraction of interfiber area was 17.80% vs 26.23 in untreated animals, p < 0.005). The protective effect of L-arginine treatment on I/R injury of SM may be related to its ability to prevent microvascular constriction and reduce permeability disorders by the stimulation of endogenous NO production.

[Late lesion of the brachial plexus after clavicular fracture]. / Spätläsion des Plexus brachialis nach Klavikulafraktur.

Neurological complications in clavicle fractures are rare. As a primary lesion, it is caused by the trauma itself. More often however, the neurological symptoms develop later by large callus formation that encroach on the costoclavicular space. A case report is presented of delayed injury to the brachial plexus due to clavicular fracture with non-union and callus formation.

[Peripheral neurological deficit after fracture of the distal radius.]. / Periphere neurologische Defizite bei distalen Radiusfrakturen.

The objective of this retrospective study is to compare the results of early and delayed surgery of the carpal tunnel syndrome following fracture of the distal radius. The authors evaluate the quality of their treatment in neurological deficit associated with this injury and recommend the correct procedure. In the submitted study 32 patients with carpal tunnel syndrome after fracture of the distal radius operated in 1976-1978 are evaluated. Damage of the median nerve in the area of the carpal tunnel may develop after injury acutely, subacutely or also chronically. The causes of an acute posttraumatic lesion include haemorrhage into the carpal tunnel area as well as volar dislocated bone fragments. Chronic lesions develop as a result of oedema, excessive callus formation in the carpal tunnel area, persisting dislocation and prolonged immobilization. From the pathophysiological aspect the post-traumatic lesion develops as a result of a chronically elevated pressure in the carpal tunnel which leads to a restricted blood supply in the area of the flexor tendons as well as in the area of the median nerve. The thus developing hypoxia damages the endothelium of the vasa nervorum. Proteins penetrate and oedema develops as a vicious circle. This cascade can be the late consequence of the wrist injury or the consequence of reposition and many weeks' immobilization without adequate physical therapy and in some patients it may act as a "trigger" of Sudeck's syndrome.

[Lesions of lateral ligaments of ankle joint in sports.]. / Aussenbandverletzungen des oberen Sprunggelenkes im Sport.

Lesions of the lateral ankle ligaments are most common injuries in sportsmen. Expecially games of ball and racket are of highest risk. Diagnosis consists of a comprehensive clinical examination including tests of stability as well as radiographs to exclude a fracture. Key words: lateral ankle ligaments, functional treatment, ortheses, operative treatment.

[Arthroscopic subacromial decompression.]. / Arthroskopische subakromiale Dekompression.

Patients suffering from impingement grade II and III by Neer have to be operated on, if conservative therapy has failed. The value of the arthroscopical subacromial decompression in these patients is not completely cleared. In our study 54 patients have been followed up (mean 12 months). Using the UCLA - Score there were 44% very good and 50% good results; only one patient had a bad result. The average improve in the UCLA scoring from pre- to postoperative status was 14 points. Another very important advantage compared to the open procedure is the very short rehabilitation time. Key words: arthroscopy, subacromial decompression, humeroscapular periarthritis, impingement.

[Enthesopathy of the patellar ligament in weight lifters: a new therapeutic procedure.]. / Die Ansatztendinopathie der Patellasehne bei Gewichthebern: Vorstellung eines neuen Therapieansatzes.

The insertion tendinitis of the proximal part of the patellar tendon frequently occurs in weight-lifters. In a prospective non-randomized study soft-laserlight (helium/neon-laser, wave length: 632.8 nm, power: 5 mW) was applicated on standardized acupuncture points on 21 knee joints of 15 performance athletes. Pain reduction during sports activity was obtained in 85.7% after the end of therapy and in 81 % in a three months follow-up. Local tenderness improved in 57.1 %. Key words: patellar tendinitis, jumper's knee, soft laser, laser acupuncture, weight-lifting.

[Augmentation technique in reconstruction of the anterior cruciate ligaments.]. / Technik der Augmentation bei Rekonstruktionen des vorderen Kreuzbandes.

The reconstruction of the anterior cruciate ligament is of great importance to normal knee joint kinematics. Only the isometric reconstruction of the ACL with autologous tissue is viable for longterm function. For early functional follow-up treatment of ACL reconstruction with suture repair, however, augmentation with synthetic ligaments is necessary in order to prevent secondary instability. Anatomic, specimen-experimental, and materials technique were performed to demonstrate the importance of augmentation for ACL reconstruction. The postoperative clinical follow-up examination with LAD augmented ACL reconstructions showed very good results with regard to stability, mobility and function in more than 90 percent of the cases. Key words: anterior cruciate ligament, reconstruction, instability, augmentation.