[Shockwave treatment of therapy refractory soft tissue pain]. / Stosswellenbehandlung bei therapieresistenten Weichteilschmerzen.

Extracorporal shock-wave application (ESWA) has been used in the treatment of stones located in the kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of ESWA in the treatment of soft-tissue disorders and tendinosis calcarea. To date, the exact mechanism is unknown. Local hyperemia following damage or afferent inhibition is discussed. The possibilities and indications of ESWA with respect to several syndromes are presented. The results show the benefit of ESWA in the treatment of chronic soft-tissue disorders without severe side effects. Some patients showed small subcutaneous hematomas and erosion of the skin when energies about 20 mJ were used. Forty-seven of 84 of the patients obtained complete relief; 24 patients showed a marked reduction in their complaints. In only 13 of 84 cases was the treatment unsuccessful.

[Changes in muscle torque in patients after total knee arthroplasty]. / Veränderungen der muskulären Leistungsfähigkeit bei Trägern von Kniegelenkstotalendoprothesen.

AIM: The purpose of this study was to compare muscle torque during isokinetic knee movements of patients after total knee arthroplasty (TKA) with a similar healthy group. METHOD: 43 patients were examined 3 years after primary total knee arthroplasty with an isokinetic dynamometer (Cybex 340). Torque measurements were evaluated for extension and flexion with 4 different velocities. The results were compared with a group of 43 people without knee disease. Bouth groups consist of 29 women and 14 men. The mean age was also comparable (66.4 vs. 65.8 years). RESULTS: A mean peak torque of 65.9 Nm was measured during extension with low velocity (60 degrees /s) in the group of patients with TKA -- 84.3 % of the control group (p = 0.079). At the highest velocity the patients produced 30.2 Nm. This was 72.8 % of the control group (difference statistically significant, p = 0.006). No differences were found in the Extension/Flexion ratio between the two groups. CONCLUSION: The deficites of knee strength in patients after TKA are more distinct in high velocities of motion.

[Soft tissue management in knees with varus deformity. Computer-assisted sequential medial ligament release]. / Weichteilmanagement bei der Varusgonarthrose. Der navigationsgestützte schrittweise mediale Bandrelease.

BACKGROUND: Knees with severe varus deformities and contractures of the medial and lateral collateral ligaments and the posterior capsule require special soft tissue management to gain a stable knee over the full range of movement. The introduction of navigation systems into knee surgery has now made precise measurement of the leg axis and gap size possible. METHODS: Ten knee joints received a computer-assisted total knee replacement (Ci navigation system DePuy) I-Orthopaedics, Munich). The change of the leg axis and the size of the mediolateral gaps were measured and documented when performing a standardized medial ligament release sequence. RESULTS: We found a significant effect after each release step regarding the change of the leg axis as well as the gap width (p<0.001). The highest effect was seen for the 6-cm capsule release in extension and the release of the medial collateral ligament in 90 degrees flexion. CONCLUSION: Implementation of computer-assisted navigation facilitates visualization and quantification of the effect of the sequential medial soft tissue release in total knee arthroplasty.

[High energy shock wave treatment of the painful heel spur]. / Hochenergetische Stosswellenbehandlung des schmerzhaften Fersensporns.

Extracorporal shock wave application (ESWA) has been used in the treatment of stones located in kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of the ESWA on the treatment of soft tissue disorders. The aim of this study was to explore the effect of high energy extracorporal shock waves in patients with painful calcaneus spurs. 83 patients who underwent medicophysical treatment without benefit were treated with 3000 impulses of 0.30 mj/mm2. Follow-ups after 12 weeks and 12 months showed that 51 of 83 patients became pain-free and 20 patients improved from the treatment. The results are showing the benefit of the high energy extracorporal shock wave application in the treatment of chronic plantar fasciitis.

[Surgical outcome of single segment ventral fusion with plate osteosynthesis in therapy refractory chronic cervico-brachialgia]. / Operative Ergebnisse der monosegmentalen ventralen Fusion mit Plattenosteosynthese bei der therapieresistenten chronischen Zervikobrachialgie.

INTRODUCTION: In anterior cervical stabilization, collapses of the grafted bone with resulting localized kyphosis and graft dislocation has been reported. It was the aim of this clinical trial to evaluate the benefit of additional plating while taking specific implant-related complications into account. METHODS: The results of single level anterior cervical spinal fusion were evaluated. In 44 patients suffering from chronic cervical radicular pain with degenerative changes, arthrodesis with iliac-crest bone and plate fixation was performed. Apart from clinical parameters, the pre- and postoperative segmental kyphosis and cervical lordosis were evaluated. RESULTS: The total cervical alignment increased from 15.4 degrees to 18.5 degrees while the alignment of the fused segment increased from 2.6 degrees to 7.7 degrees. Postoperative decrease of correction did not occur. Bony fusion was confirmed in 95% after 12 months and 100% aller 36 months. Our results show that patients had more relief from radicular pain (80%) than from unspecific neck pain (66%). DISCUSSION: In single level anterior cervical fusion, additional plating successfully prevents dislocation of the bone graft and postoperative kyphosis. The clinical results and pseudarthrosis rate do not differ from studies without plating. Long. term follow-up studies are necessary to show the benefit of the reduced postoperative kyphosis.

[Navigated implantation of total knee endoprostheses in secondary knee osteoarthritis of rheumatoid arthritis patients as compared to conventional technique]. / Der navigationsgestützte bicondyläre Oberflächenersatz bei der sekundären Gonarthrose des RA-Patienten im Vergleich zur konventionellen Implantationstechnik.

INTRODUCTION: The operative treatment of a secondary gonarthrosis due to RA claims high quality in soft tissue balancing and accurate alignment in total knee arthroplasty (TKA) which are essential for good long-term results. The efficiency of an imageless computer-assisted implantation in TKA was evaluated and compared with conventional technique. METHOD: The authors implanted each 40 TKA either using the imageless computer-assisted or classical surgeon-controlled technique. The quality of implantation was studied on postoperative long leg coronal and lateral x-rays. RESULTS: A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in 37 patients (92.5%) in the study group and 30 patients (75%) in the control group. Complications influencing the clinical outcome did not occur. CONCLUSION: The use of the imageless Vector-Vision navigation system provides the patient a good chance for longterm survival. Especially the ligament balancing tool appears to be useful. Cutting errors can be detected and intraoperatively corrected.

[Comparison of results of results of medium energy ESWT and Mittelmeier surgical therapy in therapy refractory epicondylitis humeri radialis]. / Vergleich der Ergebnisse der mittelenergetischen ESWT und der operativen Therapie in der Technik nach Mittelmeier bei der therapieresistenten Epicondylitis humeri radialis.

INTRODUCTION: During the last years the extracorporal shock wave therapy has shown its efficiency in the treatment of the conservative non curable epicondylitis humeri radialis. This study evaluates the outcome of the ESWT and the operative treatment. METHODS: Between 1996 and 1997 60 patients suffering from lateral epicondylitis were analyzed. 30 were treated operative by using the Mittelmeier-procedure (tangential partial bone resection of the epicondylus humeri radialis) and further 30 with extracorporal shock waves. These patients received 2000 impulses of 0.23 mJ/mm2 in two sessions. RESULTS: Follow-up of the group who underwent the Mittelmeier procedure showed good and excellent results in 73% after one year using the score of Roles and Maudsley (1972). The patients treated by the ESWT showed good and excellent results in 43%. DISCUSSION: Regarding to the duration of symptoms and large scale of the primary treatment and operative hazards the results are showing the benefit of the medium energetic extracorporal shock wave application in the treatment of patients with no response on regular therapy.