The infiltration of the AC joint performed by one specialist: ultrasound versus palpation a prospective randomized pilot study.

INTRODUCTION: The acromio-clavicular (AC) joint is very susceptible to degenerative processes that result in pain and functional impairment. One common modality of treatment has been local infiltration of the joint space. Although this procedure has produced notable positive results, needle misplacement occurs frequently. The aim of this investigation is to evaluate the effects of an intra articular infiltration by comparing precise needle placement into the joint space using high-resolution-ultrasound with the conventional palpation technique. METHODS: This prospective and randomized pilot study analysed 20 patients who were assigned either to the "ultrasound" or the "palpation" group. Clinical examinations were performed before treatment and at 1h, 1 week and 3 weeks after a single infiltration of local anaesthetic and corticoid carried out by one specialist. RESULTS: In both groups significant improvement in pain and function was obtained up to one-week post injection. Function remained significantly improved until the last follow-up and did not differ between the two groups. The agent was administered in all patients into the joint space in the ultrasound group. CONCLUSION: Ultrasound guided infiltration of the AC joint is an easily achieved procedure without any complications. However, clinical follow-up did not differ between free-hand and ultrasound-guided AC joint space infiltration.

[Arthroscopic menisectomy in older patients: assessing health-related quality of life]. / Die arthroskopische Teilmenisektomie bei älteren Patienten: Erfassung der gesundheitsbezogenen Lebensqualität.

AIM: Little information is available on partial arthroscopic menisectomy in patients 60 years of age or older. Due to the co-morbidity of meniscal tears and osteoarthritis in this age group, the effectiveness of this procedure is controversial. The purpose of this study was to evaluate the outcome of this procedure in terms of function and mobility in patients 60 years of age or older. METHOD: Between 1990 and 1999, 1920 arthroscopies of the knee were performed in a single primary care institution, and 51 patients, 60 years of age or older, had a partial arthroscopic menisectomy done. Outcomes were rated using the SF-36 Health Survey and a specially designed questionnaire including items of published scores. RESULTS: The mean age at surgery was 67 years (range: 60.3 - 78.9) and the mean follow-up was 5 years (range: 2 - 12). Due to persistent pain, 4 patients underwent a second operation including knee replacement in 3 cases and a high tibial osteotomy in 1 case. 41 patients (87.1 %) stated the arthroscopy had improved their quality of life. In terms of pain and daily life activities, the majority of the subjects showed an improvement after surgery. The SF-36 showed no clinically relevant difference compared to the control in all but one subscale. CONCLUSION: Despite of the presence of osteoarthritis in this age group, arthroscopic partial menisectomy can improve pain, function and mobility in the mid-term course.

Effects of extracorporeal shock waves on human articular chondrocytes and ovine bone marrow stromal cells in vitro.

INTRODUCTION: We investigated the effects of extracorporeal shock waves on cytotoxicity and on the proliferation of human chondrocytes and ovine bone marrow stromal cells. MATERIALS AND METHODS: Isolated cells were cultured to confluence, and 500 shock waves were applied at energy flux densities of 0, 0.02, 0.06, and 0.17 mJ/mm(2 )for the cytotoxicity assay. The same energies at 100, 500, and 1000 impulses were used for the proliferation assay. RESULTS: Although bone marrow stromal cells revealed a dose- and impulse-dependent increase in the proliferation rate, no significant differences were found. Chondrocytes had less proliferative potential than untreated control groups. In the experimental set-up using 1000 impulses, proliferation was even higher in the control group. Both types of cells revealed a dose-dependent increase in cytotoxicity in the lactate dehydrogenase (LDH) assay. CONCLUSION: As femoral head necrosis, osteochondritis dissecans, and similar disorders are increasingly treated with shock waves, their effect on human cartilage and chondrocytes deserves attention. We recommend further in vitro experiments with bone marrow stromal cells, as the latter might play an important role in the presumed multifactorial osteogenetic mechanism of shock waves due to their pluripotent character.

[3D-navigated high energy shockwave therapy and axis correction after failed distraction treatment of congenital tibial pseudarthrosis]. / 3D-navigierte hochenergetische Stosswellentherapie und Achskorrektur nach fehlgeschlagener Distraktionsbehandlung bei kongenitaler Tibiapseudarthrose.

The treatment of congenital tibial pseudarthrosis using a distraction procedure as described by Ilizarov is a standard surgical intervention. Nevertheless, there are problems in achieving bony stability in about 10% of cases even after repeated surgery as reported by Lammens et al. (2000). Traub et al. (1999) found a rate of 50% amputations in 33 cases treated since 1927. To prevent an Ilizarov procedure from resulting in a delayed union or nonunion, Paley et al. (1992) recommended autografting immediately after distraction. Based on the good results in the stimulation of osteogenesis in adults, we started to treat delayed bone union following distraction treatment with high-energy shock wave therapy also in children. In patients suffering from congenital tibial pseudarthrosis with a deviation of the bony axis, we combine this surgery-substituting therapy with fixation of a Taylor spatial frame in order to correct the axis. Using this new method of treatment, we were able to achieve stability in four children who previously had had nonunion even after multiple surgical interventions.

Vascular reconstruction for limb salvage in sarcoma of the lower extremity.

OBJECTIVES: To examine the patency and limb-salvage characteristics of vascular reconstruction in patients with sarcomas of the lower extremity who had been treated with limb-preserving resection and to examine patient survival during a long follow-up period. DESIGN: Retrospective cohort study. SETTING: University hospital, tertiary referral center. PATIENTS: From 1984 to 1992, 14 patients underwent limb-preserving resection of sarcomas in the proximal lower extremity, with 20 vascular reconstructions performed. OUTCOME MEASURES: Color Doppler scans documented patency of the vascular reconstructions. Clinical evaluation included functional results in terms of limb movement and quality of life. Local tumor control and systemic recurrence were examined by repeated radiologic examination. Overall survival as well as time and cause of death were assessed. RESULTS: A total of 13 patients had patent vascular grafts, while the venous graft became occluded in 1 patient. Limb function was rated as excellent or good in 9 patients, as fair in 3, as poor in 1, and could not be clinically estimated in 1. Postoperative thrombosis of the venous graft was detected in 3 patients and was effectively managed by thrombectomy in 2. Three patients underwent reoperation because of hematoma or complications caused by local infection. The tumor endoprosthesis had to be replaced in 3 patients. During follow-up periods that ranged from 15 to 132 months (mean, 55 months), 4 patients died. In all of these patients the cause of death was systemic recurrence in the lung. Two additional patients developed pulmonary metastases, but at the time of this report, they were still alive as long as 132 months after operative resection or chemotherapy. No local recurrence was found. CONCLUSION: Limb-preserving resection of sarcoma of the lower extremity can be performed with satisfactory function of the limb maintained, even if it becomes necessary to resect the femoral vessels. Autologous venous graft for vascular reconstruction is the treatment of choice. In spite of the high incidence of metastases, considerable long-term survival is possible.