[Low level laser therapy : A narrative literature review on the efficacy in the treatment of rheumatic orthopaedic conditions]. / Low-Level-Lasertherapie : Eine narrative Literaturübersicht zur Wirksamkeit bei der Behandlung rheumatologisch-orthopädischer Krankheitsbilder.

BACKGROUND: In low level laser therapy (LLLT) low wattage lasers are used to irradiate the affected skin areas, joints, nerves, muscles and tendons without any sensation or thermal damage. Although the exact mechanism of its effect is still unknown, it seems beyond dispute that LLLT induces a variety of stimulating processes at the cellular level affecting cell repair mechanisms, the vascular system and lymphatic system. LLLT has been popular among orthopaedic practitioners for many years, whereas university medicine has remained rather sceptical about it. OBJECTIVES: Overview of studies on the efficacy of LLLT in the treatment of rheumatic orthopaedic conditions, i. e. muscle, tendon lesions and arthropathies. MATERIALS AND METHODS: Narrative literature review (PubMed, Web of Science). RESULTS: While earlier studies often failed to demonstrate the efficacy of LLLT, several recent studies of increasing quality proved the efficacy of LLLT in the treatment of multiple musculoskeletal pain syndromes like neck or lower back pain, tendinopathies (especially of the Achilles tendon) and epicondylolpathies, chronic inflammatory joint disorders like rheumatoid arthritis or chronic degenerative osteoarthritis of the large and small joints. In addition, there is recent evidence that LLLT can have a preventive capacity and can enhance muscle strength and accelerate muscle regeneration. CONCLUSION: LLLT shows potential as an effective, noninvasive, safe and cost-efficient means to treat and prevent a variety of acute and chronic musculoskeletal conditions. Further randomized controlled studies, however, are required to confirm this positive assessment.

Good short- to medium-term results after osteochondral autograft transplantation (OAT) in middle-aged patients with focal, non-traumatic osteochondral lesions of the knee.

BACKGROUND: Osteochondral autograft transplantation (OAT) offers the opportunity to repair cartilaginous defects by restoring hyaline cartilage anatomy. Encouraging results have been reported in patients suffering from acute knee trauma or osteochondritis dissecans. Patients with focal chronic, non-traumatic osteochondral (FCNO) lesions of the knee, however, have rarely been the subject of investigation. Some authors even consider higher age as contraindications to OAT. OBJECTIVES: To assess the short- to medium-term outcomes of OAT in middle-aged patients with FCNO lesions of the knee and to identify predictors of clinical outcome. HYPOTHESIS: Filling FCNO defects with autologous osteochondral grafts should restore the congruency of the middle-aged knee joint and thereby reduce pain and loss of function on the one hand, and increase quality of life on the other hand. METHODS: One hundred and twelve patients (48.01±1.12yrs) with FCNO of the knee were assessed before OAT and 26.2±0.24 months after surgery. Clinical outcome was measured by WOMAC Index and the Visual Analogue Scale (VAS) for pain. RESULTS: Pain (pre-OAT VAS vs. post-OAT VAS: 7.14±0.19 vs. 3.74±0.26, P<0.001) was reduced and quality of life (pre-OAT WOMAC vs. post-OAT WOMAC: 134.88±5.84 vs. 65.92±5.34, P<0.001) improved. Retropatellar defects were associated with poor outcome, while overall surface and number of cylinders were not. DISCUSSION: Middle-aged patients with FCNO of the knee also profit from OAT at a short follow-up. LEVEL OF EVIDENCE: IV. Mono-centric, prospective clinical series.

[Sonographic standard values for the patellar tendon in competitive athletes]. / Sonografische Dimensionen der Patellasehne von Hochleistungssportlern.

BACKGROUND: The sonographic validity of a thickened tendon as a morphological correlate of patellar tendinopathy is beyond dispute, regarding the proximal insertion at the very least. There is, however, a lack of mandatory standard values for competitive athletes and normal individuals. In addition, research findings concerning the clinical relevance of qualitative changes such as hypoechogenic regions are still inconclusive. PARTICIPANTS: 202 national squad athletes from the German track and field federation and 199 age-matched normal individuals were examined sonographically. METHOD: 404 patellar tendons of athletes were compared as to tendon diameter at the (i) proximal insertion, (ii) waist, and (iii) distal insertion with 398 patellar tendons of normal individuals using the portable ultrasound scanner "Just Vision". Furthermore, qualitative pathologies and clinical symptoms were assessed. RESULTS: Athletes reported more clinical symptoms and their tendons were thicker than normal tendons at all three positions (all p's < 0.01). In athletes, proximal diameters above 6.0 mm were very likely to go along with clinical symptoms. There was an association between tendon diameter and symptoms at all three positions among the athletes, whereas in controls, this was only true for the proximal insertion. Only few consistent qualitative differences were found between athletes and normal individuals. CONCLUSION: The pattern of results confirms the clinical relevance of the proximal tendon diameter for patellar tendinopathy and provides standard values which should be evaluated in future research with regard to their prognostic utility in competitive sports. The importance of qualitative pathologies such as hypoechogenic regions could not be firmly asserted.

Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis.

OBJECTIVE: Osteoarthritis (OA) is prevalent and difficult to treat. Autologous conditioned serum (ACS), marketed under the trade name Orthokine, is a novel, injectable antiarthritic derived from the patient's own blood. The present study is the first time ACS has undergone a controlled clinical trial. METHOD: We investigated 376 patients with knee OA in a prospective, randomized, patient- and observer-blinded, placebo-controlled trial using an intention-to-treat analysis (ITT). The clinical effects of ACS were compared to hyaluronan (HA) and saline (placebo) as assessed by patient-administered outcome instruments (Western Ontario and McMaster Universities osteoarthritis index, global patient assessment, visual analog scale, Short-Form 8) after 7, 13 and 26 weeks. After 104 weeks an observer-blinded follow-up was carried out. Frequency and severity of adverse events were used as safety parameters. RESULTS: In all treatment groups, intra-articular injections produced a reduction in symptoms as well as an improvement in quality of life. However, the effects of ACS were significantly superior to those of HA and saline for all outcome measures and time points, and improvements were clinically relevant; there were no differences between the effects of HA and saline. The frequency of adverse events was comparable in the ACS and saline groups, but higher in the HA group. CONCLUSION: The data demonstrate that ACS injection considerably improves clinical signs and symptoms of OA. It remains to be determined whether ACS is disease-modifying, chondroprotective, or chondroregenerative.

Regional gene therapy to enhance bone repair.

Gene therapy presents a novel approach to the treatment of challenging bone loss problems. Recombinant, osteogenic growth factors are now available to enhance bone repair, particularly in those applications related to the treatment of fracture nonunions and the enhancement of fusion of the spine. However, there is concern that a single dose of an exogenous protein will not induce an adequate osteogenic signal in many patients, particularly in those cases where there is compromise of host bone and the surrounding soft tissue. Transfer of genes encoding osteogenic proteins has the potential to overcome the delivery problems associated with the use of the proteins themselves. Bone healing is an attractive application for gene therapy, because long-term protein production is not necessary for many bone repair problems. Therefore, the development of gene therapy strategies to treat bone repair problems promises to be easier than the application of gene therapy to treat chronic diseases. The purpose of this review is to highlight the advantages, disadvantages and clinical potential of various gene therapy strategies to enhance bone repair.

Lumbar microdiscectomy. Technique and complications.

Lumbar Microdiscectomy requires special instruments and provides a good view with a narrow approach. The microscope is the best surgical aid. Alternatives are a retractorintigrated light or headlamp. A specific complication of lumbar microdiscectomy - the wrong level - can be minimized by an exact preoperative planning. Other complications like dural lesions and exessive bleeding are less frequent with the microscope because of the better view. The most severe complications that can occur with any lumbar disc operation, major vessel or visceral injury, can be avoided by lusing the new rongeur with a depth guard.