Search

The posterior tibial slope (PTS) has different biomechanical effects on the knee. Especially in revision ACL reconstruction, a precise analysis is essential. Therefore, we investigate the influence of the anterior tibial bowing angle on the posterior slope measurement. Our hypothesis of the present study is that the short tibial X-rays underestimate the PTS in cases with increased anterior bowing of the tibia.The PTS was measured on 162 true longitudinal radiographs of the complete tibia (lateral mechanic axis). The average age of the patients was 35.7 years (range 19-59 years) and the most common diagnosis was failed anterior cruciate ligament reconstruction. Using this X-ray, the slope on the short axis and the slope on the entire axis were measured. In addition, the angle of the anterior bowing was determined.The mean PTS for the lateral mechanic axis of the tibia was 10.6° (± 3.5) in contrast to 11.6° (± 3.5) for the short tibial axis. These two measurements differ significantly. (p 0.001). The mean anterior tibial bowing angle on the lateral X-rays of the whole tibia was 2.3° (± 2.0). There is a significant positive, relationship between tibial bowing angle and PTS as referenced by the lateral mechanic axis (Spearman's correlation, r = 0.273 and p 0.001).With increasing anterior tibial bowing, the posterior tibial slope on the short knee radiograph is underestimated compared to the slope measurement on the lateral mechanic axis.

The aim of the present study was to evaluate if the vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. The hypothesis was that local antibiotic prophylaxis by soaking ACL grafts in vancomycin results in significantly less infections than ACL reconstruction without local antibiosis. In group 1, 636 patients who were operated between 1.9.2014 and 31.8.2016 received no local antibiotic treatment with vancomycin. In group 2, 536 patients who were operated between 1.9.2016 and 31.8.2018 received local antibiotic treatment with vancomycin (1 mg/ml). In this group the graft was soaked in the vancomycin solution for 10 min prior to graft passage and fixation. In group 1 (ACL reconstruction without vancomycin application), a postoperative infection was detected in ten patients (infection rate: 1.6%). In group 2 (ACL reconstruction with 1 mg/ml vancomycin), no postoperative infection was detected (infection rate: 0%). The statistical analysis showed a clear significant difference between the two groups (p = 0.002). The re-rupture rate and the rate of arthrofibrosis differed not significantly between the two treatment groups (p = 0.526). The results of the present study show that graft soaking in vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. III.

Zusammenfassung Mobile Taschen-Ultraschallgerate ermoglichen eine Bildgebung an Orten, an denen das Mitfuhren groser Gerate erschwert ist. Aktuell liegt die Qualitat ihrer Bildgebung noch unter der von Hochleistungsultraschallgeraten. Es besteht aber wissenschaftliche Evidenz aus verschiedenen medizinischen Disziplinen, dass die Sensitivitat und Spezifitat dieser neuen Gerategeneration ausreichend ist, um relevante Erkrankungen und Verletzungen zu detektieren. Am Bewegungsapparat betrifft das, strukturelle Verletzungen von Muskeln, Sehnen und Bandern sowie Gelenkergusse und Hamatome. Damit kann das mobile Taschen-Ultraschallgerat dem betreuenden Sportarzt fur die Weichenstellung weiterfuhrender Diagnostik und Therapie wertvolle Informationen geben. Weitere wissenschaftliche Studien sind jedoch dringend notwendig, um die Sensitivitat und Spezifitat dieser neuen Ultraschallgerategeneration fur die verschiedenen muskuloskelettalen Verletzungen und Uberlastungsschaden zu evaluieren.

Background Remnant-preserving anterior cruciate ligament reconstruction (ACLR) should have advantages for postoperative remodeling and proprioception. However, it has been suggested that the larger diameter of the graft tends to lead to impingement phenomena with a higher rate of cyclops lesions. The aim of this work was to find out whether the remnant-preserving ACLR actually leads to an increased rate of range of motion restraints compared to the remnant-sacrificing technique. Methods Patients, who fulfilled the inclusion criteria, were followed up for one year after surgery. The primary endpoint was arthrolysis due to extension deficit or cyclops syndrome. Secondary outcome measures were pain (NRS), knee function (KOOS), patient satisfaction and return to sports rate. Results One hundred and sixty-four patients were included in the study, 60 of whom received the “remnant augmentation” procedure (group 1). In the remnant augmentation group, one cyclops resection was performed, whereas in the non-remnant augmentation group three cyclops lesion resections had to be performed (odds ratio 0.6). There was no difference between the groups in pain (NRS) and knee function (KOOS) and patient satisfaction. The return to sports rate after one year was higher in the remnant augmentation group. Conclusions Patients who have undergone the sparing “remnant augmentation” ACLR have no increased risk of cyclops lesion formation or extension deficit in the first year after surgery. An improvement of the proprioceptive abilities by remnant augmentation ACLR should be investigated in further studies. Level of evidence III (prospective cohort study).

Ziel der Operation ist es, das vordere Kreuzband (VKB) mit einem autologen Sehnentransplantat zu ersetzen (Semitendinosussehne). Der femorale Tunnel wird uber ein tiefes anteromediales Portal unter arthroskopischer Kontrolle gebohrt. Das Knie muss beim Bohren mehr als 110° gebeugt sein. Als Landmarken dienen die Linea intercondylaris und die Knorpel-Knochen-Grenze. Die Position des Tunnels sollte uber das mediale Portal kontrolliert werden (medialer Portalblick). An der Tibia dient das Ausenmeniskusvorderhorn als Landmarke. Zur Fixation des Transplantates wird femoral ein Kippanker und tibial eine Interferenzschraube ggf. mit zusatzlichem extrakortikalem Knopf verwendet. Die Nachbehandlung erfolgt in verschiedenen Phasen. Die Progression bis zur Wiederkehr zum Sport sollte kriterienbasiert erfolgen.

Die Neigung des Tibiaplateaus in der Sagittalebene („Slope“) beeinflusst die Stabilitat des Kniegelenks. Aufgrund der nach hinten abfallenden Gelenkflache gleitet die Tibia unter Last nach anterior. Ein erhohter „Slope“ kann daher zu vorderen Instabilitaten beitragen. Auch Deformitaten in der Frontalebene konnen eine Auswirkung auf die Stabilitat des Kniegelenks haben. Anterolaterale Begleitinstabilitaten konnen bei vorbestehender ossarer Varusdeformitat eine zusatzliche ligamentare Varuskomponente induzieren (Doppelvarussituation). Das radiologische Klaffen des lateralen Gelenkspalts wird als „Varus-thrust“-Phanomen bezeichnet. Aus diesen Grunden mussen Deformitaten in der Sagittal- und Frontalebene bei der Therapie ligamentarer Instabilitaten beachtet werden. Das betrifft insbesondere Falle, bei denen eine Bandplastik des vorderen Kreuzbands (VKB) bereits versagt hat (Revisionen). Zur Korrektur dieser Deformitaten eignen sich extendierende und valgisierende Tibiakopfosteotomien. Durch die Verwendung winkelstabiler Implantate zur Stabilisierung der Osteotomie ist meist eine fruhfunktionelle Nachbehandlung moglich. Diese Eingriffe konnen einzeitig oder zweizeitig mit Kreuzbandplastiken kombiniert werden. Die bisherigen klinischen Erfahrungen mit diesen Eingriffen sind zwar limitiert, aber erfolgversprechend.

Aims and Objectives: The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon. Materials and Methods: We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score. Results: The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups. Conclusion: Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.

The optimal timing of anterior cruciate ligament (ACL) reconstruction remains controversial. Several studies have shown that early surgery leads to an increased rate of arthrofibrosis and poorer postoperative function. Other studies found no correlation between time of surgery and arthrofibrosis. The influence of simultaneous meniscus treatment is also discussed. Aim of this study was to ascertain whether the timing of surgery and treatment of meniscus influences the occurrence rate of arthrofibrosis. Two hundred and six patients could be included. These were split into two groups. Group 1: surgery within 6 weeks after ACL rupture (n = 68), group 2: surgery after more than 6 weeks (n = 68). In addition, 2 matched groups were created (n = 138 ). Follow-up was 12 months after surgery. The primary endpoint was the rate of subsequent arthrofibrosis procedures (arthroscopic arthrolysis). Secondary endpoints were knee function (knee osteoarthritis outcome score: KOOS), knee pain (numeric rating scale: NRS) and patient satisfaction measured on a 5 point Likert scale. In 6 of the 68 patients in group 1 (8.8%) and 3 of the 138 patients in group 2 (2.2%) a subsequent arthroscopic arthrolysis was performed (OR 4.4). A simultaneous meniscal suture was performed in 58 patients (30 of them in group 1). Five of the six patients with subsequent arthrolysis in group 1 received meniscal repair (OR for arthrolysis 3.4). There was no difference between the groups in terms of knee function (KOOS), pain (NRS) and patient satisfaction. The rate of subsequent arthroscopic arthrolysis was higher in the acute surgery group. However, most of these subsequent procedures were associated with meniscal repair at index surgery with a more restrictive rehabilitation protocol than after ACL reconstruction without meniscus repair. This allows the assessment that the meniscal suturing poses an increased risk. Therefore, this allows the conclusion that if using an anatomical surgical technique and considering the signs of inflammation with effusion, pain and movement deficit less than 90° there is no increased risk of arthrofibrosis.

Background The effects of psychological factors on the short-term outcome after uncomplicated total knee arthroplasty (TKA) have been described in several studies. However, the effects of mental factors on the midterm (5-year) outcome have not been described in the literature. This study was performed to examine the influence of pain catastrophizing, anxiety, depression symptoms, and somatization dysfunction on the outcome of TKA during a 5-year follow-up. Methods One hundred fifty patients were enrolled in this prospective study. The following mental parameters were assessed in all patients: pain catastrophizing (Pain Catastrophizing Scale), anxiety (State-Trait Anxiety Inventory), depressive symptoms and somatization dysfunction (Patient Health Questionnaire). The primary outcome measure was postoperative pain on a numerical rating scale. The secondary outcome measures were the Knee Injury and Osteoarthritis Outcome Score and patient satisfaction. Intergroup differences were tested using an independent t-test. Odds ratios were calculated to determine the probability of an unsatisfactory outcome. Results At the 5-year follow-up, only depressive symptoms and somatization dysfunction had a significant effect on postoperative pain (numerical rating scale score). This significant effect was also observed for the different Knee Injury and Osteoarthritis Outcome Score subscales and patient satisfaction (P = .010-.020). Pain catastrophizing and anxiety had only a small effect on the clinical outcome at 5 years postoperatively. Conclusion The effects of psychopathological factors (depressive symptoms and somatization dysfunction) on the clinical outcome after uncomplicated TKA persist for up to 5 years. Preoperative screening for and subsequent treatment of these psychological disorders may improve patient-reported outcomes after TKA. Level of Evidence Level II, diagnostic study.