[Spontaneous reposition of a hip prosthesis after atraumatic dislocation]. / Spontanreposition einer Hüft-TEP nach atraumatischer Luxation.

Traumatic dislocations of a hip prosthesis are not uncommon, and spontaneous repositions are well documented as well. To the best of our knowledge, however, there has been no report of a spontaneous reposition of a dislocated hip prosthesis head on the stem taper. We present such a rare case.

[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.

HLA-A2 phenotype may be protective against Graves' disease but not against Hashimoto's thyroiditis in Caucasians.

Graves' disease (GD) and Hashimoto's thyroiditis (HT) are the most common autoimmune thyroid diseases (AITDs) affecting up to 5% of the general population. In Caucasians HT has a prevalence of up to 4.60% and GD a prevalence of 1-2%. The aim of this study was to investigate the association between HLA-A2 and the AITDs GD and HT among Caucasians. HLA alleles of 33 patients with GD and 75 patients with HT were determined by serological typing. The frequency of HLA A2 was significantly reduced in GD (p=0.033) but not in HT (p=n.s.) as compared to control samples. In individuals positive for HLA-A2 odds ratio for protection from GD was found to be 2.8. This study supports the hypothesis that genetic predisposition to GD is not restricted to MHC class II molecules. The significant negative association between HLA A2 and GD supports the hypothesis that MHC class I genes may be relevant for the protection from GD. In contrast the nonsignificant results for HT indicate that this association may not apply to AITDs in general.

DREEM on, dentists! Students' perceptions of the educational environment in a German dental school as measured by the Dundee Ready Education Environment Measure.

OBJECTIVES: The educational climate in which future doctors are trained is an important aspect of medical education. In contrast to human medicine, it has been rather neglected in dental educational research. The aim of the study was to supplement this lack by applying and validating the Dundee Ready Education Environment Measure (DREEM) for the first time in a German-speaking sample of dental students. METHODS: All dental students at the Medical Faculty of Heinrich-Heine-University Düsseldorf were asked to complete a German adaptation of the DREEM and the Düsseldorf Mission Statement Questionnaire (DMSQ) in a paper-pencil survey. Data from 205 participants were analysed. Psychometric validation included analysis of item homogeneity and discrimination, test reliability, criterion and construct validity (convergent, factorial). RESULTS: DREEM item parameters were satisfactory, reliability (α = 0.87) and convergent validity (r = 0.66 with DMSQ) were also high. Factor analyses, however, yielded dimensions which did not fully correspond to the original DREEM subscales. Overall perception of the educational environment was positive (DREEM total score = 122.95 ± 15.52). Students in the clinical part of course rated the atmosphere more negatively, but their academic self-perception more positively than preclinical students. CONCLUSIONS: Showing satisfactory psychometric properties, DREEM proved suitable for assessing educational environments among dental students. Given the right circumstances, e.g., small and early clinically oriented classes, traditional curricula can generate positive environments.

[Training adaptation of the Achilles tendon in competitive athletes--sonographic standard values for the Achilles tendon]. / Trainingsadaptation der Achillessehne beim Hochleistungssportler--sonografische Grenzwerte für Achillessehnen.

BACKGROUND: Current theories and empirical results regarding the sonographic dimensions of the Achilles tendon as well as an alleged training adaptation of the tendon in competitive athletes are tested for the first time in a large in vivo sample. The pathological validity of a thickened tendon in competitive athletes is under scrutiny. MATERIAL AND METHOD: In addition to 202 national squad athletes from the German track and field federation, 199 age-matched normal individuals were examined sonographically. The portable ultrasound scanner Just Vision was used to compare 404 Achilles tendons of athletes with 398 Achilles tendons of normal individuals as to tendon diameter. Furthermore, pathologies were assessed. RESULTS: Achilles tendon diameter at the calcanear insertion was 4.2 ± 0.72 mm on average. Athletes' tendons were thicker than normal tendons (p < 0.001) - athletes, however, also reported more clinical symptoms (p < 0.001). In athletes, increasing diameters were associated with more clinical problems as opposed to normal individuals. At the tendon waist, diameters above 6.0 mm were very likely to go along with pathologies. CONCLUSIONS: For the first time, valid data of Achilles tendon diameters in competitive athletes and normal individuals have been presented. The emerging pattern of results clearly contradicts the notion of a physiological training adaptation of the Achilles tendon.