[Efficacy of stairclimber for muscle strengthening in a closed system after anterior cruciate ligament reconstruction]. / Wirksamkeit des Steppertrainings als Muskelaufbautraining im geschlossenen System nach operativ versorgter vorderer Kreuzbandruptur.

UNLABELLED: In a prospective study we investigated the value regarding muscle strength of two stairclimbers with either coupled or non-coupled pedals at either high or low stepping frequency. Following autologous patellar tendon graft surgery 14 patients for each group completed a strict exercising program. After 6 weeks of training a clear advantage was found for the group stepping at low speed with coupled pedals when measuring: At 60 degree/s the average maximum torque of extension increased from 37.7 to 61.7% as compared to a control group (30 to 47.2%). Analogous the percent ratio of flexion/extension (H/Q ratio) improved significantly. During the second training period the improvement of the extension strength as well as the H/Q ratio was found to be only marginal. No negative effects of this type of training on ligament stability could be detected. CONCLUSIONS: Regarding a faster recovery of muscle strength and the improvement of the intermuscular coordination, the stairclimber training, beginning with week 7 after surgery and lasting over a period of 6 weeks, is considered advantageous, especially when exercising is done at low speed and with coupled pedals.

[Evaluation of cartilage changes within the scope of second-look arthroscopy 12 months after surgical reconstruction of anterior cruciate ligament rupture]. / Beurteilung von Knorpelveränderungen im Rahmen der "Second-look"-Arthroskopie 12 Monate nach operativer Rekonstruktion einer vorderen Kreuzbandruptur.

The anterior cruciate ligament (ACL) rupture is among the most frequent injuries of the joints. Actually, there is no doubt regarding the necessity for surgical treatment. However, little is known about the progression of osteochondral damages and their distribution following reconstruction of the ACL. We treated 150 tears of the ACL either acute (median 7d) with augmented reinsertion (n = 41) and with autologous bone patella tendon graft (n = 24) or chronic (median 369d) with autologous bone patella tendon graft (n = 85). The study design was prospective. All osteochondral defects were documented in the six compartments. Second look arthroscopy and clinical examination were performed after twelve months in the course of removal of implants and possible changes of the osteochondral state were evaluated. Detoriation of osteochondral state was seen in 86 (57%) of 150 patients, while there was no statistical difference between the three groups. The time of operation had no influence on the osteochondral damage. There was a significant increase of chondral damages in the medial and retropatellar compartment after autologous bone patella tendon graft, while the changes after augmented reinsertion were diffuse. There were no significant differences in the clinical examination between the three groups regarding the Lysholm score and the functional and subjective outcome. However, postoperative instability was frequently observed (positive pivot-shift 25%, positive Lachmann test 57%). We suggest that postoperative instability should have led to the increased osteochondral damages.

[Arthroscopically-assisted reconstruction of the anterior cruciate ligament with autologous patellar tendon replacement-plasty. 5 years results]. / Die arthroskopisch gestützte Rekonstruktion des vorderen Kreuzbands mittels autologer Patellarsehnenersatzplastik. 5-Jahres-Ergebnisse.

This study presents the five-year follow-up-results (range 56 to 63 months) of 76 of 119 patients who had had arthroscopically assisted reconstruction of the anterior cruciate ligament with use of the central third patellar tendon for acute rupture (19 patients = group A) or chronic ACL insufficiency (57 patients = group B) between may 1991 and october 1993 in the Department of Trauma Surgery University Hospital Ulm. The average Lysholm knee score was 94.6 points (group A = 97.1, group B = 93.8 points). The IKDC-score rated 21.1% of all patients as A (group A = 31.6%, group B = 17.5%), 57.9% as B (group A = 52.6%, group B = 59.6%), 19.7% as C (group A = 15.8%, group B 21.7%) and one patient of group B as level D. 9 patients (= 11.8%, group A = 21.1%, group B = 8.8%) showed up to 10 degree extension loss (compared with contralateral knee), one patient of group A (1.3%) more than 10 degree. A flexion loss up to 15 degree was seen in 12 patients (= 15.8%, group A = 21.1%, group B = 14.0%), of more than 15 degree in 3 patients (= 3.9%, group A = 5.3%, group B = 3.5%). The average KT-1000-side-to-side difference was 2.5 mm with 90 N (group A 2.4 mm, group B = 2.5 mm), 2.8 mm with 133 N (group A = 2.7 mm, group B = 2.8 mm) and 3.2 mm (both groups) for manual maximum. There was no statistically significant difference in quadriceps and hamstring isokinetic strength (Cybex) of operated vs. unaffected limb for 60/s as well as 240/s. X-ray analysis showed arthrotic signs of minimum one compartment in 22.3% of all patients (group A = 26.3%, group B = 21.1%). In summary, we found better long-term results of IKDC-score in patients with autogenous patellar tendon graft for acute ACL-rupture vs. chronic ACL insufficiency. In Lysholm knee score and KT-1000 arthrometric measurement we just saw little but not statistically significant differences between the two groups. The isokinetic strength of quadriceps and hamstring were similar between operated vs. unaffected limb as well as between group A and B.

[Minimal invasive implant removal after retrograde intramedullary nailing of the distal femur]. / Minimal-invasive Implantatentfernung nach retrograder Marknagelung am distalen Femur.

Recently, the retrograde femoral nailing has become a procedure with increasing acceptance. Indications for the retrograde femur nail are distal femoral fractures including dia- and transcondylar fractures, supracondylar osteotomies and distal periprosthetic femur fractures after total knee joint replacement. Controversial discussion is carried on about the implant removal, which is potentially afflicted with further damage to the knee joint. To minimize the operative damage due to the implant removal, an arthroscopic assisted procedure has been selected. The arthroscopic assisted implant removal was possible in all of our patients. Intraoperatively, 2/3 of the patients showed normal age-related findings of the chondral and meniscal structures. The arthroscopic assisted implant removal is a gentle procedure, which allows minimal invasive extraction of retrograde femur nails and prevents secondary damage to the knee joint due to the otherwise difficult localisation of the implant. The advantages of this procedure concerning gentleness and diagnostic capabilities are as convincing, that we indicate implant removal of retrograde femur nails in all younger patients (< 60 years), except in periprosthetic fractures.

[Computerized tomography measurement of torsion angle of the lower extremities]. / Computertomographische Torsionswinkelbestimmung der unteren Extremitäten.

The precise evaluation of post-traumatic deformities is indispensable when planning a corrective osteotomy. Torsional angles of the lower extremities of 186 patients were measured using CT. The mean age of the studied population was 34 years (18-80). It consisted of 131 men and 55 women. All patients had sustained a fracture of at least one of the leg's bony segments. The normal femoral (n = 293) inward torsion measured 23.47 degrees +/- 17.16 degrees (mean +/- 2 SD). Normal tibia (n = 263) outward torsion was 34.03 degrees +/- 17.22 degrees. The intraindividual torsional differences were not normally distributed. Normal femoral (n = 103) intraindividual torsional difference measured 11 degrees (95% percentile) and 15 degrees (99% percentile), with a median of 4 degrees. The tibiae (n = 76) showed a normal intraindividual torsional difference of 12 degrees (95% percentile) and 15 degrees (99% percentile). Right tibiae showed a statistically significant greater outward rotation when compared to their left counterpart (P < 0.001). No correlation to sex could be established. Preoperative planning of a corrective osteotomy should include the geometric evaluation of all four bony segments of the leg. Intraindividual torsional differences must be considered. A corrective osteotomy appears to be unnecessary with a torsional difference smaller than 15 degrees in the femora and smaller than 15 degrees in the tibiae.