[Traumatic muscle and tendon ruptures of the lower extremities in sport: adductor muscles, M. rectus femoris and M. biceps femoris]. / Traumatische Muskel- und Sehnenrupturen der unteren Extremität beim Sport: Adduktoren, M. biceps femoris und M. rectus femoris.

Ruptures of the adductor muscles, the M. rectus femoris or the M. biceps femoris are sports injuries which need quick and reliable diagnostic management. Treatment of muscle injuries is mostly conservative; complete tendon ruptures or avulsion fractures of the tendons are treated operatively according to the dislocation and the functional loss.

[Prognostic factors to assess the value of arthroscopy in gonarthrosis]. / Prognostische Faktoren zur Beurteilung der Wertigkeit der ASK bei Gonarthrose.

AIM: The value of athroscopy in osteoarthritis(oa) of the knee remains uncertain. Many studies claim to prove efficacy of arthroscopy in oa of the knee, while other authors report that there is no such effect. The purpose of this study was to identify factors to predict the outcome of arthroscopy in oa of the knee. METHOD: The modified Lysholm score was used to assess the outcome of arthroscopy in 49 patients after a follow up of 2.5 yrs. This was a retrospective outcome study. RESULTS: No correlation between modified Lysholm score and patient age and gender could be detected. There were significantly better outcomes in the group of patient with no deviation of axis and in the group of patients which did not show a progression of oa of the knee in the radiographs during follow-up. Even if the patients had more severe osteoarthritis. CONCLUSION: Patient selection is an important factor for a good outcome after arthroscopy in older patients with oa of the knee. Deviation of the axis and the "activity" of the osteoarthritis at the time of surgery are predictors for outcome. There is the need to establish diagnostic tools to measure the "activity" of oa of the knee before surgery.

[Outcome of surgically treated lateral clavicle fractures]. / Ergebnisse operativ behandelter lateraler Klavikulafrakturen.

This retrospective study presents the results of 41 patients with a lateral clavicle fracture eight years after the treatment at the Staatliche Orthopädische Klinik of the LMU München in the time between 31.10.1979 and 31.10.1994. It could be shown that the lateral clavicle fractures, due to their variety, hold a special position among the clavicle fractures and thus need a differentiated therapeutic procedure. Among the operation methods the K-wire stabilisation with cerclage was the most often chosen operation technique i.e. in 24 cases. The K-wire without cerclage was used in two cases. Twelve fractures were treated with AO-plate-osteosynthesis. Three fractures had to be treated by resection, as they produced two pseudarthrosis and one serious AC-arthrosis during the conservative therapy. 92.7% of the subjective results of the 41 checked up patients were good and very good. The clinical follow-up of 36 and the radiological follow-up of 33 patients revealed in 97% a good and very good outcome in the Boenisch-Score.

[Clinical and radiological results after arthroscopic partial medial meniscectomy. Are there risk factors?]. / Klinische und radiologische Ergebnisse nach arthroskopischer partieller Innenmeniskusresektion. Gibt es prädisponierende Faktoren?

In a retrospective study 100 patients underwent a clinical and radiological follow-up 7 years and 7 months after an arthroscopic partial medial meniscectomy. None of these patients had associated intraarticular lesions apart a minor chondral damage of the medial compartment. The follow-up showed excellent clinical results in 96% of patients according to the modified Marshall Score. The radiological results demonstrated a deterioration or development of osteoarthritis of the operated knee joint in 33% of patients, with a statistical significance between radiological and clinical results (p < 0.05). The age of the patients at time of operation and any angular deformity of the knee joint had no statistical significant influence on the radiological results. Women had a statistically significant higher risk to deteriorate or develop gonarthrosis after partial medial meniscectomy than men (p < 0.05). The arthroscopic partial medial meniscectomy leads to excellent subjective and functional results, but it could not totally prevent the increase or development of degenerative changes in the medial knee compartment.

Late results after arthroscopic partial medial meniscectomy.

In a retrospective study, 100 patients underwent a clinical and radiological follow-up examination after a minimum of 7 years (range 7.0-9.3 years) following an arthroscopic partial medial meniscectomy. None of these patients had associated intra-articular lesions, apart from minor chondral damage (max. grade 2 Outerbridge classification; < 1 cm2) of the medial compartment at the time of the primary arthroscopy. According to the modified Marshall score, the follow-up evaluation showed excellent clinical results in 96%. Nevertheless, the radiological outcome, as measured by comparing preoperative and postoperative X-rays, demonstrated a development or progression of the osteoarthritis of the affected knee joint in 33%, with a statistically significant correlation between the radiological and clinical outcomes (P < 0.05). The age of the patients at the time of operation and any angular deformity of the knee joint did not influence the radiological results. Women had a statistically significantly higher risk of developing gonarthrosis after partial medial meniscectomy than men (P < 0.05). The arthroscopic partial medial meniscectomy led to excellent subjective and functional results but could not prevent the increase or development of late degenerative changes in the medial knee compartment.

[Mid-term outcome after surgically managed re-rupture of the anterior cruciate ligament]. / Mittelfristige Ergebnisse nach operativ versorgter Reruptur des vorderen Kreuzbands.

This retrospective study shows the results in 30 patients of revision surgery on their reruptured ACL. The follow-up time was 30 months on average (range 10-54 months). The follow-up examination included subjective (Lysholm score, Tegner activity level rating score), clinical and radiological criteria and also instrumental laxity testing with the KT-1000 arthrometer. The overall evaluation was done according to the IKDC score. The follow up showed subjective and objective results almost equal to those after primary surgery on ACL. The IKDC score revealed certain abnormal and highly abnormal results, which demonstrated that revision ACL surgery gives poorer results than primary surgery. Nevertheless, we recommend reconstruction of a torn ACL even in a revision case to restore the knee function and prevent further menisceal and chondral damage and degeneration.

[Reconstruction of acute anterior cruciate ligament rupture by suture and semitendinosus tendon augmentation.]. / Die Rekonstruktion frischer vorderer Kreuzbandrupturen durch Naht und Semitendinosusaugmentation.

GOAL OF SURGERY: Restoration of normal knee function. INDICATIONS: Acute avulsion of the anterior cruciate ligament (ACL) from its femoral origin. CONTRAINDICATIONS: Mid substance and remote tears. POSITIONING AND ANAESTHESIA: Supine. Knee flexed, hip bent to 30 degrees . General or regional anaesthesia. SURGICAL TECHNIQUE: Step 1: Arthroscopy to confirm site of rupture, meniscus repair if necessary. Step 2: Mobilisation of semitendinosus tendon, left attached distally. Step 3: Mini-arthrotomy, securing of ACL stump with atraumatic suture. Step 4: Transfer of ST-tendon through 5 mm drill holes through tibial head and lateral femoral condyle. Step 5: Fixation of tendon and ACL-sutures with staple at the exit of the femoral drill hole. POSTOPERATIVE MANAGEMENT: Knee orthosis for 6 weeks, CPM, physiotherapy. ROM day 0-2: 0-10-10 degrees ; day 3-11: 0-0-60 degrees , day 12-42: 0-0-90 degrees . Increase of weight bearing 10 kg/week from operation date. Bicycling and running permitted 3 months post-op. Full sport activity after muscle power has reached that of opposite side. LMW heparin until full weight bearing. POSSIBLE COMPLICATIONS: Thrombosis. Embolism. Infection. Failure of reconstruction. Osteoarthritis. RESULTS: During 1 year, 116 patients were operated. Follow-up after 42 to 57 months (average 52 months) included 95 patients (82%). Of these, 76 underwent full examination (average age 33 1/2 years, 20-49 years), 11 answered a questionnaire, 8 had suffered re-injury. Average Lysholm score was 92 points (+/-13). Tegner activity scale amounted to 7.2 points pre-injury, 7.1 points at follow-up. Anterior translation (KT 1000 arthrometer testing at 89 N) was identical to opposite side in 25 patients, less than 2 mm in 14, up to 4 mm in 19, up to 6 mm in 15, more that 6 mm in 3 patients. Pivot shift was negative or trace 73 times, and positive in 3 patients. ROM was full in 54 patients, 17 times the flexion was limited up to 10 degrees . Ten times extension lag was less than 5 degrees , and twice between 5 and 10 degrees .

Muscular imbalance and shoulder pain in volleyball attackers.

OBJECTIVE: In overhead sports such as volleyball, baseball, or tennis shoulder problems are very common. The aim of this study was to identify features which may correlate with shoulder problems in volleyball attackers. METHODS: 30 competitive volleyball attackers (mean age 25 years) were included in the study; 15 were suffering from shoulder pain and 15 had no history of shoulder pain. The results were compared with those of a control group of 15 recreational athletes without any overhead sports activities. RESULTS: Volleyball attackers have a different muscular and capsular pattern at the playing shoulder compared to the opposite shoulder. Their playing shoulder is depressed, the scapula lateralised, and the dorsal muscles and the posterior and inferior part of the shoulder capsule shortened. These differences were of more significance in volleyball attackers with shoulder pain than in volleyball players without shoulder pain. In contrast to recreational athletes without any overhead sports activity, there were no significant difference in the comparison of the two shoulders. The histories, clinical and sonographic findings did not reveal further typical features for volleyball attackers with shoulder pain. CONCLUSIONS: Muscular balance of the shoulder girdle is very important in this sport. It is therefore imperative to include adequate stretching and muscular training programme for the prevention, as well as for therapy, of shoulder pain in volleyball attackers.

[Intermediate-term treatment outcome after fractures of the proximal radius]. / Mittelfristige Behandlungsergebnisse nach Frakturen des proximalen Radius.

The treatment of fractures of the proximal radius is controversial. This retrospective elaborates on indications for operative or conservative treatment, dependent on fracture type. A new classification of fracture and a new evaluation score for follow-up examination are presented. The study shows very good results for conservative treatment of type A1-fractures without dislocation of fragments and good results for operative treatment of type A2-fractures. Type A3-fractures (multifragment fractures) demand reconstruction. If that is not possible, the primary resection of the radial head leads to better results than its secondary resection. The implantation of silastic prostheses of the radial head leads to worse results in primary (2 cases) and secondary resection (2 cases) than resection of radial head alone.

[Thermo-elastic stress analysis of human bones]. / Thermoelastische Spannungsmessung am menschlichen Knochen.

The Thermoelastic Stress Analysis (THESA) is a widely used procedure in motorcar- and airplane engineering. This study investigated the reliability of THESA for stress analysis of human bone. A human femur was cyclic stressed and the resulting stress pattern was scanned from the surface of the bone by means of the thermoelastic stress measuring instrument SPATE 9000. To proof whether the scan of SPATE 9000 is equivalent to the stress distribution of human femur surface, strain gauges are used to control the results at two different regions of the femur diaphysis under equal but static conditions. It could be shown, that both measuring methods lead to corresponding results of stress pattern on human femur surface.

[Results of cementless acetabular revision surgery]. / Ergebnisse zementfreier Hüftpfannenwechseloperationen.

The great number of hip revision arthroplasties and the cementless fixation of arthroplasties has led to more and cementless hip revision operations with bone transplantation. This retrospective study shows the results of a clinical and radiological follow-up of 34 patients with an average age of 71 years and 4 months at their hip revision arthroplasty. The subjective and clinical result in the Harris-Hip-Score 3 years and 9 months (1 year 4 months-6 years 3 months) after surgery shows 67% of the patients content with the result of the revision arthroplasty. The Harris-Hip-Score shows an average of 41.1 points preoperatively and 73.2 points at the follow-up examination. The loosening-rate was 11.8%, all arthroplasties which seemed loosened radiologically had also a bad result clinically. No correlation could be shown between the age of the patients and the clinical results as well as between an additional stem revision (15 patients) and the clinical result in the Harris-Hip-Score. All revision operations were done with bone transplantation and demonstrate, that the concept of cementless fixation of acetabular component gives satisfactory results.

[Concomitant injuries with anterior cruciate ligament rupture. A retrospective study]. / Begleitverletzungen frischer vorderer Kreuzbandrupturen. Eine retrospektive Studie.

We identified 107 consecutive patients with anterior cruciate ligament (ACL) rupture who underwent arthroscopy after trauma. The results of the preoperative clinical examination and the arthroscopic findings of associated injuries to the knee are shown. Some 55% of the acute ACL ruptures involved a tear of the lateral meniscus, 45% of the medial meniscus, and 34% had a lesion of the medial collateral ligament. The most frequent combination of injuries with ACL rupture was a tear in both menisci and a lesion of the medial collateral ligament with a tear in the lateral meniscus. The preoperative examination revealed the ACL rupture in 94% of uses but the lateral meniscal lesion in only 32%. At the time of operation 29% of all associated injuries had not been discovered. These results show that--independent of the time of reconstruction of the thorn ACL--acute rupture of the ACL is an indication for arthroscopy.

[Chronic shoulder pain in the volleyball attack player]. / Der chronische Schulterschmerz des Volleyballangriffsspielers.

30 competitive volleyball attackers of the German third league, 15 with shoulder pain (group I) and 15 without shoulder pain (group II) were examined clinically and sonographically. Anamnesis was also carried out. The results were compared with those of a control of 15 non-volleyball players not subject to stress caused by overhead use of their arms. On the visual analog scale the average pain was 5.1 (SD 1.4). The average history of pain was 2.7 (SD 2.7) years. Cause for the pain was "spiking without warming up" (n = 7) or "unknown" (n = 8). Spiking respectively serving caused new pain sensation in 14 (11) attackers. Players of group I stretched shorter than those of group II. Pain was located laterally to the greater tuberculum (n = 8), at the origin of the deltoid muscle (n = 3), at the bicipital groove (n = 2) or in the area of the ventral glenoid (n = 2). Pain was caused by active anteversion above 160 degrees (n = 3), active abduction above 140 degrees (n = 2) or both (n = 10). The playing shoulder was depressed in all 30 volleyball attackers. By measuring the distance from the epicondylus radii to the acromion of the other side by maximal forced horizontal adduction, the distance from the margo medialis scapula to the spine, the distance from the tip of middle finger to the lumbar spine by maximal internal rotation of the shoulder up the back showed significant differences between both sides and between the groups. The spiking arm scapula is significantly lateralised compared to the opposite side and compared to sportsmen.(ABSTRACT TRUNCATED AT 250 WORDS)

[Stress-related clinical and ultrasound changes in shoulder joints of handball players]. / Belastungsabhängige klinische und sonographische Veränderungen an den Schultergelenken von Handballspielern.

This prospective clinical and ultrasound study was performed to show specific overuse injuries or changes in the periarticular structures of shoulder joints. Therefore, 11 male handball players with an average age of 23 years and 6 months were evaluated via a standardised shoulder exam sheet and an ultrasound examination before, one hour after, 10-12 hours after, 16-20 hours after and 22-24 hours after specific handball training. Characteristic changes were found in respect of bursitis subacromialis and tendinitis of biceps tendon up to 16-20 hours after training, which were fully reversible 22-24 hours after the stress. The effusion was visible for more than 24 hours after the training but was reversible 60 hours after stress. This study shows characteristic pariarticular changes in the shoulder joint of handball players without any clinical finding in physical examination, so that the ultrasound changes seem to be a physiological reaction to the specific stress. These changes should therefore not be misinterpreted especially if there are no clinical symptoms.

[Results of surgical treatment of peroneal tendon dislocations]. / Ergebnisse der operativen Behandlung bei Peronealsehnenluxationen.

Dislocation of the peroneal tendons is a very uncommon injury and therefore the diagnosis will often be missed and the patient will not be treated sufficiently. This results in a chronic situation which handicaps the patients in their everyday life and in their sports activities. The diagnosis of the acute injury is often "sprain of the ankle" or "rupture of the fibular ligaments". The first one is often treated insufficiently by a tape for a short time, and the second one is treated surgically and the dislocation recognized only during the operation for the first time. Considering the results of the follow-up examination (clinically, X-ray and ultrasonic), surgical treatment of the dislocation of the peroneal tendons is mandatory. The risks during and after the operation are negligible. Surgical treatment enables the patients to return to their everyday life and sports activities without any complaints.

[Effect of the injury process on prognosis of surgically treated Achilles tendon rupture. A score for evaluating late results]. / Einfluss des Verletzungsmechanismus auf die Prognose der operativ versorgten Achillessehnenruptur. Ein Score zur Beurteilung der Spätergebnisse.

372 Achilles tendon ruptures are reported that were surgically treated at the Staatliche Orthopädische Klinik Munich from 1978 to 1988. 122 Patients were examined on average 5.9 years postoperative. Further 50 patients participated at a questionnaire interview. In this follow-up, special importance was attached to the connection between the mechanism of the trauma that lead to the rupture, the clinical result and the result subjectively assessed by the patient. The following results were obtained: 1. Specific trauma mechanisms like external force on the tendon, supination and pronation trauma and in general all traumas that are able to rupture even a healthy tendon, have a worse prognosis regarding the late results. 2. In case of these mechanisms leading to the trauma, the Achilles tendon rupture is on average diagnosed noticeably later. 3. An early diagnosis and hence quick treatment is of decisive importance for the further prognosis.

[Sports-induced epiphyseal injuries of the knee and ankle joint]. / Sportinduzierte Epiphysenverletzungen des Knie- und Sprunggelenkes.

We report on the clinical and radiological follow-up results of 37 patients with epiphyseal injuries of the knee and ankle joint who were treated in our hospital between 1985 and 1990. Most of the ankle joint injuries were sustained during track and field, soccer and basketball, and most of the knee injuries during alpine skiing. The different mechanisms of injuries of the knee and ankle joint are discussed on the basis of our own results. The therapy considers the age of patient as well as localisation and type of the epiphyseal injury. In spite of this, growth disturbances occurred in 12.5% of the ankle joint and in 9.5% of the knee joint injuries.

[Results following percutaneous intramedullary pin fixation in distal radius fractures]. / Ergebnisse nach percutaner intramedullärer Bohrdrahtspickung bei distalen Radiusfrakturen.

42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures.

[Long-term results of surgically treated Achilles tendon ruptures]. / Langzeitergebnisse operativ behandelter Achillessehnenrupturen.

The rupture of the Achilles tendon is a frequent sports injury. Between 1978 and 1988 we treated 358 men and 54 women, with an average age of 43 years, for this. In most cases the site of rupture was 3-5 cm proximal to the distal insertion of the tendon. The long-term subjective results of operative treatment of Achilles tendon ruptures (122 patients) were "good" or "very good" on follow-up examination in 85% of cases, and 97% of the patients treated surgically would choose the same therapy in the event of a new rupture. The isokinetic results demonstrated a (9.1%) loss of static and a 16.7% loss of dynamic strength in plantar flexion of the upper ankle joint compared with the healthy side. Ultrasound examination revealed thickening of the tendon itself and of the dorsal paratendon, with alterations in the tendon structure. In spite of the good results, the high rate of complications, 15.1%, shows that new and extensive studies on functional conservative therapy of Achilles tendon rupture are necessary to find whether conservative or operative therapy is better.

[Distal finger joint destruction after frostbite in childhood]. / Fingerendgelenkdestruktion nach Erfrierung im Kindesalter.

Destruction of the DIP-joint and of the growth plate of the distal phalanx after frostbite is shown in the case of a 13-year-old boy. Clinical symptoms, therapy, and result of treatment are presented and literature reviewed.