Results of humeral stump angulation osteotomy.

Between 1972 and 1989 angulation osteotomy was performed on 61 patients with long humeral stumps at the Orthopaedic Hospital of Heidelberg University. Marquardt's surgical technique was used to improve function in patients who had undergone above-elbow amputation and in children with a risk of terminal osseous overgrowth. Thirty-one patients with 43 angulation osteotomies were followed up. Of the 10 adults followed up, the osteotomy had not straightened, whereas with the 33 angulation osteotomies in children, one had straightened out within 6 months, seven within 12 months and a further 12 up to 24 months after surgery. The only recognizable reason for this difference was the patient's age depending on whether humeral growth was not yet completed. Marquardt's angulation osteotomy, however, is still the only surgical technique that improves humeral stump function, providing a rotation-stable humeral prosthesis and a free-moving shoulder joint.

Follow-up results 20 years after surgical treatment of habitual ventral shoulder luxation using the Eden-Lange technique.

After undergoing an operation according to the Eden-Lange technique, 56 patients with recurrent anterior shoulder luxation were re-examined clinically at an average follow-up period of 20 years. The mean age of the patients at the time of the operation was 24.9 years; the ratio of male to female patients was 2.3:1. The Ellman score (maximum of 27 points), stability tests, reluxation rate and X-ray examinations served as re-examination criteria. The mean score for the Ellmann test was 18.3 points; 29 patients had ventral instability. In the meantime 11 shoulders had redislocated. Fifty-one patients had arthrotic alterations in the operated shoulder. Because of the unsatisfactory functional and radiographical results, the Eden-Lange technique can no longer be accepted as the only treatment of choice for anterior shoulder dislocation.

The influence of subchondral vascularisation on chondromalacia patellae.

An experiment was carried out on 40 rabbits in which the blood supply to the patella was interrupted for periods from 2 weeks to 6 months. With prolonged ischaemia, there were clear changes in the articular cartilage which were comparable with those seen in chondromalacia patellae.

Hip joint congruence: experimental studies.

Three-dimensional imaging of hip joint preparations was carried out by means of computed tomography (CT). On the assumption that the head of the femur and acetabulum are incongruent, a special experimental design was used to quantify the extent and direction of the gliding movement of the head and socket. A series of CT images in the supine and prone positions was made from hip preparations, and the cartilage was visualized by injecting a contrast medium. In all the preparations dorsal movement was noted in the supine position, and ventral movement in the prone position. Cryomicrotome slices of the hip preparations were used to verify the results of our CT scans and the measurements correlated with the anatomical examinations. Thus, there is a certain amount of play in the hip joint-it is not an ideal ball-and-socket joint. This knowledge is important for the planing and success of hip adjustment surgery.

Five-year results of conservatively treated tears of the anterior cruciate ligament.

Follow-up examinations of 35 patients with an arthroscopically confirmed isolated fresh tear of the anterior cruciate ligament were conducted after an average period of 5 years. After arthroscopy and immobilization of the knee in a plaster cast for 2 weeks, all 35 patients had been conservatively treated with neurophysiological physical therapy. Twenty-four of the tears were complete; the remaining 11 were partial. The results of the follow-up examination are based on subjective scores (O'Donoghue score, Lysholm score), an objective score (objective O'Donoghue score) and clinical examination. With the partial tears, good to satisfactory results were achieved, and surgery was needed less often. In these patients, it was largely possible to maintain the original level of athletic performance. Those patients with complete, isolated tears generally had satisfactory to poor results on the objective scores. There was a high rate of revision surgery, especially in the case of meniscus tears, and they were largely unable to regain their original level of athletic performance.

Macromorphological comparison of frozen sections concerning the problem of congruency of the hip joint.

We report on a comparative anatomical investigation of hip joints from animals which can walk on two legs or use their distal legs for jumping. The investigation supports the results of Bläsius [1] that the hip is not congruent. The cartilage of the load induction area is thicker. This means that one can only see congruency on X-rays, because cartilage cannot be visualised.

Intra-articular treatment with hyaluronic acid in osteoarthritis of the knee joint: a controlled clinical trial versus mucopolysaccharide polysulfuric acid ester.

In a single-blind, randomized clinical trial, both the efficacy and safety of hyaluronic acid (HA) were compared with that of mucopolysaccharide polysulfuric acid ester (MPA) in patients with osteoarthritis of the knee joint. Both agents were administered intra-articularly over six weeks. Patients received either seven injections of HA or 13 injections of MPA. Joint function, range of motion, severity of pain, the general condition of the bony structure and soft tissue of the joint area, and the global clinical efficacy and safety of the medication were assessed. The mean improvement in the modified total Larson rating score was 22% (SD = 28) after HA treatment and 7% (SD = 17) after treatment with MPA (analysis of variance: p = 0.02). This change was mainly caused by a reduction of pain. The onset of pain relief was more rapid in the HA group. The therapeutic effect increased in both treatment groups during the follow-up period. During this interval, lasting six months after the start of treatment, a further reduction of pain and an improvement of knee joint function could be observed. At the end of the study, 25 out of 33 (76%) patients in the HA group and 11 out of 24 (46%) patients in the MPA group were symptom-free or markedly improved (Chi-square test: p = 0.02). Both agents were tolerated very well.

[Results of follow-up of conservatively treated isolated fresh anterior cruciate ligament rupture]. / Nachuntersuchungsergebnisse nach konservativ behandelter isolierter frischer vorderer Kreuzbandruptur.

35 patients with an arthroscopically confirmed isolated fresh anterior cruciate ligament rupture were subjected to follow-up examination after an average period of four years. In all the 35 patients a conservative treatment schedule had been followed post-arthroscopically, with a physiotherapy on a neurophysiological basis. Of the 35 isolated anterior cruciate ligament ruptures, 24 were complete and 11 partial ruptures. The follow-up examination results are based on subjective scores (O'Donoghue Score, Lysholm Score) and on one objective score (objective ODonaghue Score), as well as on the Lachman Test and the Pivot Shift Sign. In the partial anterior cruciate ligament ruptures we obtained mostly good to satisfactory results with the subjective and objective scores and a lower incidence of surgery; the original performance ratings at sports were largely maintained. On the other hand, the complete isolated anterior cruciate ligament ruptures yielded mainly satisfactory to poor results with the objective scores and a high rate of repeat surgery especially in the case of meniscus tears, and a major setback in the original sports performance ratings.

[Importance of the subchondral space for development of chondromalacia patellae--morphologic study of joint cartilage of the rabbit patella after experimental ischemia]. / Die Bedeutung des subchondralen Raumes für die Entstehung der Chondromalazia patellae--Morphologische Untersuchung am Gelenkknorpel der Kaninchenpatella nach experimenteller Ischämie.

The aetiology of chondromalacia patellae and especially the importance of the subchondral space have not been clarified to date. However, clinical findings yielded pointers to a connection between degenerative changes of the articular cartilage and an influence exercised by the subchondral space. In our experiments we performed an operative ischaemia of the patella with interruption of the vascular inflow and outflow on 40 adult rabbits for exactly defined times (2 weeks, 6 weeks, 3 months, 6 months). The examinations were carried out using the plastination method, histology, transmission electron microscopy, and scanning electron microscopy. Marked changes can be seen from the third month onwards: disappearance of the tidemark, degeneration of the cartilaginous cells (formation of clusters) and onset of trachomatous keratitis. These degenerative changes progress further in the animals of 6 months of age. The results indicate that metaplasia of the tidemark plays a significant part in the pathogenesis of degenerative changes of the cartilage. Hence, chondromalacia patellae can be caused by subchondral vascularisation disorders.--This is, therefore, a new concept for the aetiopathogenesis of chondromalacia patellae, a disease pattern that is of great importance in sports orthopaedics.

Subchondral vascularisation and osteoarthritis.

A prospective experiment was carried out in 40 rabbits in which the blood supply to the patella was interrupted for defined periods from 2 weeks to 6 months. With prolonged ischaemia, there were clear changes in the articular cartilage which were comparable with those seen in human osteoarthritis.

Subchondral vascularisation and osteoarthritis.

A prospective experiment was carried out in 40 rabbits in which the blood supply to the patella was interrupted for defined periods from 2 weeks to 6 months. With prolonged ischaemia, there were clear changes in the articular cartilage which were comparable with those seen in human osteoarthritis.

[Long-term results following subcutaneous Achilles tendon rupture]. / Langzeitergebnisse nach subkutaner Achillessehnenruptur.

From 1972 to 1982, 132 ruptures of the achilles tendon were treated at the Orthopedics Division, University of Heidelberg. Surgical treatment was carried out in 125 cases, and seven patients were treated conservatively. The average age of the patients was 42 years. 84% of the achilles tendon ruptures occurred during sport. After an average investigation period of 6.5 years, 33 patients could be followed up. The rate of complications and the final functional results are communicated. The blood supply to the achilles tendon is described separately. Twelve cadaver achilles tendons were investigated by means of the plastination method. It could be demonstrated that a reduced blood supply to the Achilles tendon is present about 3-5 cm above the calcaneal tuber. This finding corresponds to the most frequent site of rupture. It is unclear to what extent there is a connection between the blood supply and the rupture site of typical locations.

[Long-term roentgenologic studies in peak performance javelin throwers]. / Röntgenologische Langzeitbeobachtungen bei Speerwerfern der Spitzenklasse.

The example of the javelin thrower demonstrates that an unphysiological movement sequence at the elbow joint (valgus stress) leads to regular arthrotic alterations by summation of such strains: these are known as "javelin elbow". Since the new javelin introduced in 1986 requires a greater explosive force, a tendency to an increased incidence of these alterations must be reckoned with in the future. Further observations are necessary to clarify whether there will be an increase in degenerative alterations in the lumbar spine by abrupt hyperlordosis and trunk rotation in producing the bow tension of the javelin thrower; whether the above-average incidence of patients with spondylolysis amongst competitive javelin throwers is coincidental; whether the processes of remodelling in the interarticular portion of javelin throwers constitute zones of fatigue; and, finally, whether the unilateral trunk strain of the javelin thrower influences the scoliotic posture.

Duplication of the scapula.

Complete duplication of the scapula has not been described. We report two children both of whom had duplication of their right scapula associated with other malformations. In each case an operation was done to fuse the two abnormal scapulae together and the results were good.

[Duplication of the scapula]. / Duplikatur des Schulterblattes.

Complete duplication of the shoulder blade has not been described so far in the literature. Two case reports with a duplication of the right shoulder blade in multiple malformations of the locomotor and postural apparatus are presented. In both children, the shoulder blades were mobilized and fused. The late examination shows good functional and cosmetic results.

[Etiopathology of camptodactyly (case report and literature review)]. / Beitrag zur Atiopathologie der Kamptodaktylie. (Fallbeschreibung und Literaturübersicht).

First, a review on the literature about camptodactyly and its pathogenesis is given. A case report is presented on a 13-year-old girl with a camptodactyly of both little fingers. Intraoperatively it was observed that the superficial flexor tendon of the right little finger ended in the palmar aponeurosis and was then found to be without function. It is our understanding that this type of anomaly of the superficial flexor tendon of the little finger as an aetiology of camptodactyly has not been reported yet in the previous literature.