[Post-traumatic knee joint arthroscopy in children and adolescents]. / Posttraumatische Kniegelenksarthroskopien beim Kind und Jugendlichen.

In a retrospective study we analyzed the arthroscopic findings of 166 knee-arthroscopies performed in children and young people up to the age of 16 years. A sports related trauma was present in 54%, a traffic injury in 15% and in 11% an other casualty. In 4% the precise injury was not sure and 16% did not refer any injury. Among the sports injuries (n = 90) ski injuries were the most frequent with 30% of all, followed by gymnastic injuries in 28%, soccer in 25% and other indoor sport injuries in 12%. 57% of all arthroscopies presented a hemarthrosis. The main finding of all arthroscopies was an cartilage lesion. The anterior cruciate ligament was torn in 30% and a dislocated patella was established in 22% of the arthroscopy while a meniscus injury was found in 17%. The injury of the collateral ligaments or of the retinaculum was found in 22%. In all cases of hemarthrosis origin of bleeding was found and only in 6% (n = 10) of all arthroscopy no pathological finding was established.

[Anterior knee laxity in a healthy patient sample]. / Anteriore Knielaxität in einem gesunden Kollektiv.

A prospective study investigates anterior knee laxity in 100 healthy subjects (mean age 24.5 years). Testing was performed by two examiners either clinically by Lachman test or by means of KT-1000 arthrometer. Mean anterior tibial translation was 4 mm for the right and 4.3 mm for the left knee when tested clinically. With use of KT-1000 at 89 Newton results were 4.6 mm and 4.0 mm, respectively. Clinical measurements revealed an inter-examiner difference of 0 to 1 mm in 77% of right and 80% of left knees. In the remainder difference was more than 1 mm. On apparative testing the two examiners obtained similar results at 67 Newton. Measurements differed increasingly, however, at 89 Newton and 134 Newton. In conclusion, the use of KT-1000 arthrometer in routine assessment of anterior knee laxity offers no advantage over clinical testing alone.

[Cold-induced pathology at high altitude]. / Kältepathologie in der Höhe.

Cold injury is an objective danger in mountain climbing as well as in many outdoor and recreational sports such as skiing, fishing, etc. Symptoms are easily recognizable by the experienced, and prevention is mostly possible. Cold injury should be divided by pathological means in general hypothermia and local frostbite injuries. Life-threatening deep hypothermia with coma and insufficient circulation or cardiac arrest is reversible under the condition of sufficient core rewarming, for instance by CEC. Because of the big tolerance of hypothermic patients to hypoxia, clinical death is not like biological death and therefore reversible. Local frostbite is not life-threatening, but has often deleterious effects. Rapid rewarming in warm water of 37 to 42 degrees C is mandatory. After rewarming, the difference between superficial and deep frostbite can be established. Scintigraphy seems to be of great help in setting early prognosis. Daily sterile treatment of the injury, whirlpool bath and prevention of infections belong to standard treatment. There are little objective informations about the role of vasodilators, anticoagulants, antibiotics, sympathectomy and others. Early experience with Prostavasine seems to bee encouraging.

[Does partial anterior cruciate ligament rupture really exist?]. / Gibt es die partielle vordere Kreuzbandruptur wirklich?

From 1983 to 1989 129 partial tears of the anterior cruciate ligament were diagnosed by arthroscopy. To confirm the diagnosis of a partial rupture of the anterior cruciate ligament, we began to split the synovial sheath of the anterior cruciate ligament in 1986 in order to prove the continuity of the fibers. Applying this technique, we quite often found the anterior cruciate ligament completely torn. Hence the rate of partial tears of the anterior cruciate ligament decreased from about 10% of all anterior cruciate ligament ruptures 1983 to about 3% 1989. 42 patients whose diagnosis had been a partial rupture of the anterior cruciate ligament were reviewed clinically to determine whether the anterior cruciate ligament injury had finally proved to be an insignificant lesion or had caused a knee instability. The overall results were very good in 12% and good in 14%; 41% showed a fair, 26% a poor result. Because of this unfavourable outcome, we believe that most of the partial tears of the anterior cruciate ligament should be regarded as complete ruptures.

[Test for the determination of endurance fitness and training style in young ice hockey players]. / Test zur Bestimmung der Ausdauerleistungsfähigkeit und Trainingsgestaltung beim jugendlichen Eishockeyspieler.

A test similar to the Conconi test was developed by the authors, to be used specifically with ice hockey players. The aim was to measure the aerobic performance capacity of these athletes. The results give us on one hand informations on the actual performance potential of these sportsmen. On the other hand, they enable us to design an optimal training schedule. With such data in hand, it becomes possible to determine which intensity of endurance training is optimally adapted to an individual's progress of performance. It is thus easier to develop the sought after basic fitness in youth players. 120 ice hockey players of several leagues had to go through either a Conconi test, or our modified, more sports specific Probst test. 54 of these were junior players (age 15-16). Our purpose in this paper is to discuss the aim of such endurance tests for youth players.

[Mesenterial anemia as a cause of jogging anemia?]. / Mesenteriale Ischämie als Ursache der "Jogging-Anämie"?

Anemia in runners is common but its origin is unknown. The present study reports on frequency and origin of gastrointestinal blood loss in cross-country skiers and runners. 41 participants in the Engadin Ski Marathon were checked by questionnaire and occult blood test. 8 (19%) had diarrhea or abdominal pain during or immediately after skiing and 3 (7%) had hemoccult-positive stools. In addition, the blood flow of the superior mesenteric artery was measured by duplex scanning in two trained runners after standardized exercise. While the mesenteric blood flow in the asymptomatic runner changed only insignificantly there was an impressive decrease in the second runner, who had been treated for anemia, down to 20% and 40% (30 and 90 min respectively) after exercise. It is concluded that the occurrence of gastrointestinal blood loss in cross-country skiing, and the significant decrease in mesenteric blood flow in a symptomatic runner, indicate a close and possible causal relationship between mesenteric ischemia and "jogging anemia".

[Capillary damage following freezing of the extremities, evaluated by fluorescence videomicroscopy]. / Kapillarschäden nach Erfrierungen an den Akren, beurteilt durch die Fluoreszenz-Videomikroskopie.

Four patients with subacute cold injury of the fingers have been examined by dynamic fluorescence videomicroscopy after intravenous bolus injection of Na-fluorescein. Avascular skin areas with no perfused capillaries were detected, a finding best explained by destruction of the microvessels induced by cold injury. Microvascular spasms play an additional role. Transcapillary diffusion of the fluorescent tracer seems to be enhanced in some preserved capillary groups. Cold injury induces microangiopathy characterized by spasms of precapillary vessels, destruction of capillaries in large skin areas, and increased permeability of microvessels still perfused.

Arthroscopy in acute trauma of the knee joint.

Even in massive hemarthrosis, arthroscopy of the acutely injured knee joint can be performed. The procedure is indicated in all cases where clinical findings and radiography cannot establish a clear diagnosis or a clear indication for operation. Hemarthrosis of unknown origin should be investigated in every case. An additional indication for arthroscopy is planned arthroscopic operation. In a series of 1000 arthroscopies, the examination was performed in 76 patients in the acute stage after trauma. In most knee joints several injuries were found; the most frequent being tears of the menisci, cartilage lesions, ruptures of the anterior cruciate ligament and tears of the joint capsule. 24 cases were treated by arthroscopic operation: 13 partial meniscectomies were performed in acute blocking of the knee and in 8 cases a detached chondral or osteochondral fragment was removed. 29 cases required arthrotomy. Post-operative morbidity of arthroscopic operation is surprisingly low. Patients were not hospitalized for diagnostic or operative arthroscopy.

[New tissue preservation method for bone flaps following decompressive craniotomy]. / Neue Aufbewahrungsart von Schädelkalottenstücken nach dekompressiver Kraniotomie.

Decompressive craniotomies with removal of the bone flap are still frequently performed in brain injured patients. Usually these bone flaps are refrigerated until reimplantation. In approximately 60% of cranioplasties performed in our clinic by this method we have observed considerable osteolysis especially in the marginal regions. This resulted in a instability which disturbed many patients and required an additional cranioplasty. Other methods for cranioplasty are briefly described. - For the last 3 years we have implanted the removed bone flaps immediately after craniotomy subcutaneously in the abdominal wall instead of preserving them in the refrigerator. By these means we were able to reimplant vital bone during the cranioplasty procedure weeks to months after the initial craniotomy. Our experience with this method shows a significant decrease of resorption in autologous cranioplasties. Out of 43 cases with a follow-up control after one and two years only 2 patients showed signs of resorption. One other bone flap was lost due to infection.