Clinical and radiological outcome after anterior cruciate ligament reconstruction using the T-lock Osteotrans resorbable tendon anchor: early experience and midterm follow-up.

PURPOSE: Reconstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw. METHODS: This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using a semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device. RESULTS: The average follow-up duration was 2 years (range 1-4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received a 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0-5). The median Tegner score was 6 (range 4-10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91 points (range 77-100). The mean Lysholm score was 86 points (74-96). All mentioned scores were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients. CONCLUSION: ACLR with the aforementioned procedure leads to good clinical and radiological outcome.

Comparison of biochemical cartilage imaging techniques at 3 T MRI.

OBJECTIVE: To prospectively compare chemical-exchange saturation-transfer (CEST) with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping to assess the biochemical cartilage properties of the knee. METHOD: Sixty-nine subjects were prospectively included (median age, 42 years; male/female = 32/37) in three cohorts: 10 healthy volunteers, 40 patients with clinically suspected cartilage lesions, and 19 patients about 1 year after microfracture therapy. T2 mapping, dGEMRIC, and CEST were performed at a 3 T MRI unit using a 15-channel knee coil. Parameter maps were evaluated using region-of-interest analysis of healthy cartilage, areas of chondromalacia and repair tissue. Differentiation of damaged from healthy cartilage was assessed using receiver-operating characteristic (ROC) analysis. RESULTS: Chondromalacia grade 2-3 had significantly higher CEST values (P = 0.001), lower dGEMRIC (T1-) values (P < 0.001) and higher T2 values (P < 0.001) when compared to the normal appearing cartilage. dGEMRIC and T2 mapping correlated moderately negative (Spearman coefficient r = -0.56, P = 0.0018) and T2 mapping and CEST moderately positive (r = 0.5, P = 0.007), while dGEMRIC and CEST did not significantly correlate (r = -0.311, P = 0.07). The repair tissue revealed lower dGEMRIC values (P < 0.001) and higher CEST values (P < 0.001) with a significant negative correlation (r = -0.589, P = 0.01), whereas T2 values were not different (P = 0.54). In healthy volunteers' cartilage, CEST and dGEMRIC showed moderate positive correlation (r = 0.56), however not reaching significance (P = 0.09). ROC-analysis demonstrated non-significant differences of T2 mapping vs CEST (P = 0.14), CEST vs dGEMRIC (P = 0.89), and T2 mapping vs dGEMRIC (P = 0.12). CONCLUSION: CEST is able to detect normal and damaged cartilage and is non-inferior in distinguishing both when compared to dGEMRIC and T2 mapping.

Groin pain in athletes.

Groin pain in athletes is one of the most difficult to treat clinical entities in sports medicine. The reasons are the amount of differential diagnoses, complexity of pathophysiologic causes and the long time of limited participation in sport. In order to maximize efficient treatment, thorough diagnostics and a clear therapeutic regimen are crucial. To succeed with this issue, a close cooperation between physicians and radiologists is mandatory. MRI is gold standard in the diagnostic work-up of the principal differential diagnoses, such as muscle tears, avulsion injuries, stress fractures, tears of acetabular labrum, and osteitis pubis. The article gives a comprehensive overview of the special anatomy and biomechanics of the pubic region and of typical MRI findings in athletes with groin pain. The use of dedicated imaging protocols is also discussed.

[Anterior cruciate ligament reconstruction using quadriceps tendon autograft and press-fit fixation]. / Fremdmaterialfreie Rekonstruktion des vorderen Kreuzbandes mit autologer Quadrizepssehne.

BACKGROUND: Reconstruction of the anterior cruciate ligament (ACL) is a widely used procedure, but up to now no results have been published on an implant-free technique using a quadriceps tendon autograft and press-fit fixation. METHODS: A total of 112 patients with primary rupture of the anterior cruciate ligament were included in a prospective case control study and 106 patients could be evaluated postoperatively after a mean of 12.4 months (range 12-14 months). RESULTS: The patients showed good to excellent results according to the Lysholm score in 81% and the International Knee Documentation Committee (IKDC) score in 86% of cases. Furthermore the anterior-posterior translation was less than 3 mm in 83% of the patients by testing with the KT-1000 arthrometer. Neither tunnel widening nor an increase of radiological joint degeneration was recorded by radiological examination. CONCLUSION: Reconstruction of the ACL with an autologous quadriceps tendon and an implant-free technique yielded good results compared to established operative methods in the short-term and should be consistently followed-up for long-term confirmation.

[Outcome of arthroscopic resection of labral tears]. / Ergebnisse der arthroskopischen partiellen Resektion des Labrum acetabulare.

PURPOSE: Arthroscopic treatment of labral pathologies in the hip has evolved considerably in recent years. Even though it has become an accepted therapeutic method there are only a few prospective outcome studies in extended patient collectives. PATIENTS AND METHODS: Since 9/2002 all patients undergoing hip arthroscopy in our institution have been prospectively evaluated by clinical and radiographic aspects and the use of several questionnaires (modified Harris hip score [MHHS], Larson hip score [LHS], visual analogue pain scale VAS]). In the present investigation only patients with an arthroscopically proven torn labrum and the absent of cartilage defects >I degrees according to the Outerbridge classification) with a minimum follow-up of at least 2 years postoperatively were included. Furthermore, only individuals without radiological evidence of a femoro-acetabular impingement or hip dysplasia were assessed. RESULTS: According to the inclusion criteria 34 patients were initially enrolled in the investigation. Out of them 31 individuals (18 female, 13 male) with a mean of 29.9 years (range 14-49) could be followed up clinically and radiologically. At an average of 33.6 months (range 25.2-47.8) postoperatively we found a significant increase in the visual analogue pain scale (VAS: 6.0 vs. 2.7). Furthermore there was a significant improvement of the modified Harris hip score as well of the Larson hip score (MHHS: 63.1 P. vs. 85.9 P., LHS: 57.8 P. vs. 79.6 P.). CONCLUSION: Arthroscopy of the hip can provide a significant improvement of patient satisfaction and hip function in patients with labral tears without associated cartilage or bony pathologies (dysplasia, FAI).

Comparison of modern marker proteins in serum and synovial fluid in patients with advanced osteoarthrosis and rheumatoid arthritis.

Numerous studies have focused on the significance of modern marker proteins in the synovial fluid of the knee joint and in the serum both, for osteoarthritis (OA) and rheumatoid arthritis (RA). The relationship between the serum concentrations and the concentrations in the synovial fluid is still unclear. Synovial fluid and serum samples were obtained from 13 patients with advanced OA and from 8 patients with severe RA and concentrations of MMP-1, MMP-3, MMP-13, TIMP-1, COMP and MIA/CD-RAP were determined. All values were normalized against the total protein concentrations. Serum concentrations of MMP-13 in the RA-group were statistically higher than the synovial values (P<0.05). MMP-13 was the only marker protein that revealed distinct higher levels in the serum than in the synovial fluid. The study design allows only conclusions about advanced stages of RA and OA. Longitudinal investigations may provide further information about the value of MMP-13 as a potential marker to monitor the course of RA and OA.

Endothelial function in the forearm circulation of patients with the metabolic syndrome--effect of different lipid-lowering regimens.

We compared the effect of statin therapy (either alone or combined with ezetimibe) on the inhibition of cholesterol resorption and endothelial function by measuring forearm blood flow in male patients with the metabolic syndrome. Compared to 40 mg atorvastatin alone, combination therapy with 10 mg ezetimibe and 10 mg atorvastatin for 8 weeks resulted in significantly decreased total serum cholesterol and triglycerides levels (n = 14). Endothelium-dependent, acetylcholine-mediated vasodilation was significantly better with combination therapy (p < 0.05). In contrast, endothelium-independent forearm blood flow response to sodium nitroprusside was comparable in both groups. Our data suggest a more effective restoration of endothelial function with the statin/ezetimibe combination compared to statin monotherapy in patients with the metabolic syndrome.

[The role of endoprostheses in the scope of hand surgery. Endoprostheses vs. traditional surgical procedures]. / Stellenwert der Endoprothetik im Bereich der Handchirurgie Endoprothetik vs. traditionelle Operationsverfahren.

Alloarthroplasty has largely replaced traditional procedures in arthrosis of hip and knee joints. In contrast the role of alloarthroplasty in comparison to traditional procedures in hand surgery has been uncertain. To evaluate this question every registered hand surgery department (n=307) in Germany received a questionnaire requesting information on number and type of implanted prostheses and traditional procedures concerning the wrist joint, distal radioulnar joint (DRUJ), first carpometacarpal joint (CMC), metacarpal phalangeal joint (MP), interphalangeal joint (PIP), and preferred characteristics of the prostheses. Of the 307 hand surgery departments, 150 (57% of the hospitals and 42% of the visiting surgeons) participated in the inquiry. Per year, only 98 wrist prostheses were implanted (distributed among five different models) but 1534 traditional procedures were performed. The Sauve-Kapandji procedure was the most popular for the DRUJ and was performed 264 times per year. In comparison 24 hemiarthroplasties were implanted at the DRUJ. Trapezectomy remains the standard procedure for arthrosis of the first CMC joint (n=1399). The future importance of alloarthroplasty of the CMC joint is doubted by the majority of participating hand surgeons (90.3%). In contrast the majority (85.3/71.8%) is convinced that alloarthroplasty will be of importance for the MCP and PIP joints, respectively. Currently, the number of implanted prostheses is close to the number of traditional procedures performed at the MP joint. Irrespective of the joint involved, cementless anchorage is preferred as is the surface replacement anatomical design. The results confirm that alloarthroplasty in hand surgery is of minor importance. Thus, the role of alloarthroplasty differs depending on the joint involved. Traditional procedures except for the MP joint continue to be of major importance in hand surgery.

[Clinical results after Sauve-Kapandji procedure in relation to diagnosis]. / Klinische Ergebnisse nach Sauvé-Kapandji-Operation in Abhängigkeit der Erkrankung.

We present the results of a retrospective study on 56 patients who underwent the Sauve-Kapandji procedure for chronic disorders of the distal radioulnar joint (DRUJ). Outcome was assessed with special regard to the diagnosis. The average follow-up was 5.9 years (1-12 years). Patients were assessed for pain, range of motion of wrist and forearm, and radiological features. The DASH score and Mayo wrist score were used. The diagnosis had an influence on the outcome. Patients with primary arthrosis of the DRUJ demonstrated better results than patients with traumatic disorders. Patients with growth deficiency-related complaint of the DRUJ showed slightly inferior results after the Sauve-Kapandji procedure compared to all patients. Patients were free of pain or had pain only during heavy labor in 81% of cases; 95% of the patients rated the outcome as excellent or improved, but only 50% were free of symptoms on the operated side during heavy manual labor. Symptoms of ulnar impingement were found in 11%. Improvement in range of motion of wrist and forearm was significant. The postoperative DASH score was 24.2+/-22.5 and the Mayo wrist score was 76.1+/-17.6. Our results confirm the Sauve-Kapandji procedure to be a reliable salvage procedure resulting in high patient satisfaction and reliable improvement in range of motion. However, decreased grip strength on the affected side must be accepted to some extent. The diagnosis of a DRUJ disorder influences the outcome.

[The Sauvé-Kapandji operation. Indications and results]. / Die Sauvé-Kapandji-Operation. Indikationen und Ergebnisse.

The Sauvé-Kapandji procedure consists of an arthrodesis of the distal radioulnar joint (DRUJ) in combination with an intentional pseudarthrosis of the distal ulna. In addition to other methods, the Sauvé-Kapandji operation is a salvage procedure of for chronic disorders of DRUJ. Different studies have confirmed that this procedure results in a pain reduction of between 73 and 100% and that patient' satisfaction lies between 68 and 100%. A reliable improvement of rotation of the forearm of between 134 and 171 degrees can be expected. On the other hand, a decrease in grip strength on the affected side is usual. The potential problem of instability of the proximal ulna stump can be avoided by performing a short distal segment and a narrow pseudarthrosis gap. The Sauvé-Kapandji procedure is a reliable salvage procedure resulting in high patient satisfaction and a reliable improvement in range of motion.

[Proximal row carpectomy in carpal collapse]. / Resektion der proximalen Handwurzelreihe bei karpalem Kollaps.

Proximal row carpectomy (PRC) is a generally accepted procedure in the treatment of an advanced radiocarpal arthrosis. The aim of this retrospective study was the evaluation of individual, functional and radiological results after proximal row carpectomy. Seventeen patients (15 male, two female) who had undergone proximal row carpectomy between 1991 and 1999, were reviewed. The most common indication was degenerative arthrosis secondary to carpal collapse associated with chronic scaphoid nonunion (SNAC), scapholunate advanced collapse (SLAC) deformity, late Kienböck's disease or perilunate dislocations. Clinical and subjective results were assessed using different scores (DASH-, modified Mayo wrist-score) and evaluating the individual wrist range of motion. Anteroposterior and lateral X-rays were obtained for radiological analysis. At follow-up evaluation (mean 65.4 months), the majority of patients reported pain relief and a significant increased range of motion for the operated wrist. Radiographical analysis showed degenerative changes at the radiocapitate articulation in ten patients. The intermediate-term results of this review would suggest that proximal row carpectomy is an effective procedure providing pain relief and a satisfactory range of motion in a variety of pathologic wrist disorders. Because of eventual radiocapitate arthrosis, we suggest PRC only in patients without significant degenerative changes at the proximal pole of the capitate or the lunate fossa.

[Kapandji-Sauvé procedure for chronic disorders of the distal radioulnar joint with special regard to the long-term results]. / Die Kapandji-Sauvé-Operation bei der chronischen Dysfunktion des distalen Radioulnargelenks unter besonderer Berücksichtigung der Langzeitergebnisse1.

We present the preliminary results of a retrospective study on 56 patients who underwent the Kapandji-Sauvé procedure for chronic disorders of the distal radioulnar joint (DRUJ). Outcome was assessed with special regard to the long-term results. The average follow-up was 5.9 years (1 to 12 years). 15 of the 56 operations were performed before 1996. Most procedures were performed because of secondary arthrosis or chronic dislocation of the DRUJ after distal radius fracture. Patients were assessed for pain, range of motion of wrist and forearm and radiological features. The DASH score and Mayo wrist score were used. Pain was improved in 94 % of the patients, but only 53 % were free of symptoms during heavy manual labour concerning the operated site. In four cases symptoms of ulnar impingement were found. Improvement in range of motion of wrist and forearm was significant. The post-operative DASH score was 22.6 +/- 20.0 and the Mayo wrist score was 79.5 +/- 14.6. One non-union of the DRUJ with consecutive fracture of the fixation screw and an algodystrophy in another case were found as postoperative complications. The only long-term complication consisted of a beginning humeroradial arthrosis ten years after the operation. The results demonstrate high patient satisfaction and reliable improvement in range of motion. Our results confirm the Kapandji-Sauvé procedure to be a reliable salvage procedure for arthrosis or chronic dislocation of the DRUJ even after long-term follow up.

Ceftazidime in combination with glycopeptide antibiotic is an effective first-line therapy for patients undergoing high-dose therapy with autologous peripheral blood stem cell support.

It was the objective of this study to evaluate the efficacy and toxicity of an empirical antibiotic therapy consisting in ceftazidime and a glycopeptide antibiotic. All patients enrolled in the study had hematological malignancies and underwent high-dose therapy with peripheral blood stem cell (PBSC) support. In this retrospective study, 183 of 207 patients who had received a PBSC-supported high-dose therapy were evaluable. Any patients who had fever higher than 38.5 degrees C received ceftazidime in combination with vancomycin (105 patients) or teicoplanin (69 patients). In 80 of 174 patients with fever (45%) the fever resolved within 72 h as a result of the treatment with ceftazidime and the glycopeptide antibiotic. In nonresponding patients, the changes included the replacement of ceftazidime by imipenem/cilastin (94 patients) and the addition of erythromycin (12 patients) or metronidazole (3 patients). Amphotericin B was administered in 29 patients. Following hematological reconstitution, the fever and clinical signs, including radiographic findings, resolved in 20 primarily nonresponding patients. In blood cultures, a significantly higher incidence of gram-positive than of gram-negative bacteria was observed (26 vs 7). The toxicity of the first-line antibiotic therapy was limited to allergic skin reactions in 12 patients. Ceftazidime in combination with a glycopeptide antibiotic provides an effective and safe first-line therapy for patients with neutropenic fever following PBSC-supported high-dose therapy.