[Cartilage damage caused by a dislocated resorbable interference screw of poly(L-lactide) 46 months after anterior cruciate ligament reconstruction]. / Knorpelschaden, verursacht durch eine dislozierte resorbierbare Interferenzschraube aus Poly(L-Lactid), 46 Monate nach vorderer Kreuzbandplastik.

The case of a 44-year-old male patient is reported, who was operated 4 years after a cruciate ligament replacement. A nearly completely intact biodegradable screw was removed arthroscopically. The screw dislocated from the tibial canal into the joint and caused damage to the retropatellar cartilage which was treated by debridement and lateral release. A material analysis was done on the explanted screw which showed no material fault. A review of the literature reporting adverse events connected to biodegradable implants was carried out. Nine papers reporting about adverse event are cited. There seem to be three main problems: delayed degradation, foreign body reaction and the filling of graft tunnels with non-ossified tissue. Instructions for the use of biodegradable interference screws were requested from seven manufacturers to compare the given information about the degradation behaviour. The information given on the period of time until the screws would be completely resorbed were heterogeneous, ranging from no specific information about the time span at all up to 24 months. More research is needed to identify the degradation behaviour more precisely and clarify the potential risks connected to biodegradable implants. Their use should be reconsidered critically.

[Synovitis score: value of histopathological diagnostics in unclear arthritis. Case reports from rheumatological pathological practice]. / Synovialitis-Score: Wertigkeit histopathologischer Diagnostik bei unklaren Arthritiden. Fallberichte aus der rheumatologisch-pathologischen Praxis.

Histopathological assessment of synovial biopsies has an established value. The value for inflammatory joint diseases without standardized rating mechanisms was, however, unknown until recently. The exemplary use of the synovitis score in four cases all including recurrent bruises of the knee joint portrays its value for diagnosis and therapy. Usage of the score includes assessing the enlargement of the lining layer, cellular density of synovial stroma and leucocyte infiltration by giving each a score of 0-3 points and adding them. Presence of high-grade synovitis (>or=4 points) in all cases displayed the reason for the joint bruises within a primarily inflammatory, rheumatoid circle. In this report we show the broad variety of uses for the synovitis score dealing with cases of Lyme arthritis, rheumatoid arthritis, seronegative monarthritis and HLA-B27-positive peripheral arthritis.

[Load-stable osteosyntheses in pertrochanteric fractures of the femur (author's transl)]. / Belastungsstabile Osteosynthesen bei pertrochanteren Femurfrakturen.

The authors report on the treatment of unstable pertrochanteric femoral fractures by means of 130 degrees angular-plate osteosynthesis using an additional traction plate against the proximal lateral femur. Patients operated by this method were able to expose the operated leg to load from the second postoperative day onwards. Practically full burdening capacity was achieved (with the help of crutch sticks) after 5.4 days. All patients were subjected to follow-up examinations 6 weeks and 3 months postoperatively. Breaking of the osteosynthesis occurred in 1 patient. In all other cases, no delayed healing of osseous fractures or breakage of material were seen. Hence, the authors conclude on the basis of their clinical observations that stability to load can be achieved by this method even in unstable pertrochanteric fractures.