[Arthroscopic decompression of extra-articular subspinal hip impingement]. / Arthroskopische Dekompression des extraartikulären subspinalen Hüftimpingements.

OBJECTIVE: Complete arthroscopic decompression of the impinging subspinal soft tissues and resection of the hypertrophic bone formation between the anterior hip capsule and the anterior inferior iliac spine (AIIS) or decompression of a hypertrophic AIIS. INDICATIONS: Painful anterior hip impingement and decreased hip flexion following a hypertrophic osseous subspinal deformation. CONTRAINDICATIONS: No clinical symptoms or decreased anterior hip function despite radiological osseous subspinal hip impingement. SURGICAL TECHNIQUE: Hip arthroscopy in supine position on an extension table. Treatment of possible intraarticular hip pathologies in the central or peripheral compartment. Arthroscopic visualization of the hypertrophic impinging soft tissues below the AIIS and decompression using a shaver or radiofrequency device. Complete arthroscopic resection of the hypertrophic AIIS parts and the osseous subspinal deformation using a high speed burr under fluoroscopic control. POSTOPERATIVE MANAGEMENT: Early functional rehabilitation with full weight-bearing and unlimited hip motion; 3 weeks ossification prophylaxis and 8 weeks of limitation for jumping and running sports activities. RESULTS: There are no comparative studies or medium- and long-term study results in the literature for arthroscopic AIIS decompression. However, currently published case series show an improvement of the determined scores.

Use of Tekscan K-scan sensors for retropatellar pressure measurement avoiding errors during implantation and the effects of shear forces on the measurement precision.

Pressure-sensitive K-Scan 4000 sensors (Tekscan, USA) provide new possibilities for the dynamic measurement of force and pressure in biomechanical investigations. We examined the sensors to determine in particular whether they are also suitable for reliable measurements of retropatellar forces and pressures. Insertion approaches were also investigated and a lateral parapatellar arthrotomy supplemented by parapatellar sutures proved to be the most reliable method. The ten human cadaver knees were tested in a knee-simulating machine at a torque of 30 and 40 Nm. Each test cycle involved a dynamic extension from 120° flexion. All recorded parameters showed a decrease of 1-2% per measurement cycle. Although we supplemented the sensors with a Teflon film, the decrease, which was likely caused by shear force, was significant. We evaluated 12 cycles and observed a linear decrease in parameters up to 17.2% (coefficient of regression 0.69-0.99). In our opinion, the linear decrease can be considered a systematic error and can therefore be quantified and accounted for in subsequent experiments. That will ensure reliable retropatellar usage of Tekscan sensors and distinguish the effects of knee joint surgeries from sensor wear-related effects.

Transitions of gene expression induced by short-term blue light.

Blue light modulates many processes in plants and plant cells. It influences global and long-term responses, such as seedling development and phototropism, and induces short-term adaptations like stomatal opening and chloroplast movement. Three genes were identified as important for the latter process, namely PHOT1, PHOT2 and CHUP1. The former two phototropin blue light receptors act in perception of the blue light signal. The protein CHUP1 is localised to the outer envelope membrane of chloroplasts and is involved in chloroplast movement. To explore whether short-term reactions required for chloroplast movement are under transcriptional control, we analysed the transcriptome in wild-type Arabidopsis thaliana, phot1, phot2 and chup1 with different blue light treatments for 5 or 30 min. Blue light-induced changes in transcription depended on illumination time and intensity. Illumination with 100 µmol·m(-2) · s(-1) blue light induced down-regulation of several genes and might point to cascades that could be important for sensing low levels of blue light. Analysis of the transcriptome of the mutants in response to the different light regimes suggests that the transcriptional response to blue light in the wild-type can be attributed to phot1 rather than phot2, suggesting that blue light-induced alteration of expression is a function of phot1. In contrast, the blue light response at the transcriptional level of chup1 plants was unique, and confirmed the higher light sensitivity of this mutant.

The biomechanical effect of specific labral and capsular lesions on posterior shoulder instability.

PURPOSE: In contrast to anterior shoulder instability there seems to be no single key lesion in posterior shoulder instability. Therefore, the purpose of this study was to determine the biomechanical effect of specific posterior capsulolabral lesions. Our hypothesis was that a posterior capsule lesion will have a predominant effect compared to a labrum detachment (Bankart lesion). METHODS: Stability testing of 16 cadaveric human shoulders was performed. The specimens were distributed to two groups: the labrum lesion group and the capsular lesion group. In the labrum lesion group three different conditions were tested consecutively: posteroinferior Bankart lesion, additive pHAGL lesion, additive posterosuperior Bankart lesion. In the capsular lesion group two conditions were tested: posteroinferior capsule cut including a glenoidal transection of the pIGHL, additive rotator interval and superior capsule lesion (SGHL and CHL cut). All lesions were set arthroscopically. Biomechanical testing was performed in two positions: the sulcus-test position and the jerk-test position each with a passive humerus load of 50 N in the posterior, posteroinferior and inferior direction. RESULTS: A posteroinferior Bankart lesion resulted in a percentage increase of 86% posterior translation in the jerk position and an increase of 31% inferior translation in the sulcus position. An additional pHAGL lesion resulted in a significant increase of posterior and inferior translation given by 31 and 41% in the jerk position. Regarding the capsular lesions, a cut of the posteroinferior capsule and the pIGHL resulted in a significant increased inferior translation of 53% in the sulcus position but did not cause a significant increase of posterior translation in the jerk position. If an additional rotator interval lesion is set the inferior translation is again significantly increased. CONCLUSIONS: On the basis of our results traumatic posterior shoulder instability must be suspected to be bidirectional posteroinferior independently if a posterior capsule lesion or a posterior Bankart lesion is evident. CLINICAL RELEVANCE: Capsular and labral lesions both have a significant biomechanical effect but differ in the predominant direction of instability, which is posterior for the Bankart lesion and inferior for the capsular lesion. An additional pHAGL or rotator interval lesion aggravates the posteroinferior instability and must be respected in the surgical treatment strategy.

[Influence of the postoperative activity level on tibial bone tunnel enlargement and functional treatment results following anterior cruciate ligament reconstruction using a patellar tendon autograft]. / Der Einfluss des postoperativen Aktivitätsgrades auf die tibiale Bohrkanalerweiterung und das funktionelle Behandlungsergebnis nach vorderer Kreuzbandplastik mit Patellarsehnendrittel.

AIM: This study was performed to evaluate the influence of the postoperative activity level on tibial bone tunnel enlargement following anterior cruciate ligament reconstruction using a mid-third patellar tendon autograft. METHODS: A clinical and radiological assessment was performed on 50 patients (21 male, 29 female, mean age 32 years, range 18 to 57 years) following ACL reconstruction using a patellar tendon autograft. The average follow-up examination was performed 18 (12 to 30) months after the operation. RESULTS: 33 patients (66 %) developed a tibial bone tunnel enlargement > 1 mm. We found a positive correlation (+ 0.59) of the grade of activity and the muscle status (+ 0.56) to the tibial bone tunnel enlargement. Patients with a major tibial bone tunnel enlargement performed at a higher (p < 0.05) postoperative activity grade (5.2 versus 4.1 in the Tegner grading), rated higher in the Lysholm (88 versus 77 points) and IKDC scores (p < 0.05) and reported a better subjective functional outcome (p < 0.05). There was no significant correlation of the results of the knee stability tests and the age of the patients to the grade of tibial bone tunnel enlargement. CONCLUSIONS: In ACL reconstruction using a patellar tendon autograft we recommend early rehabilitation as the concomitant tibial bone tunnel enlargement does not significantly influence the clinical outcome or knee stability.

[Results of hip arthroscopy in sports related groin pain]. / Ergebnisse der Hüftarthroskopie bei sportabhängigen Leistenschmerzen.

INTRODUCTION: The study analyses the intraoperative findings and the clinical results of hip arthroscopy in sports related groin pain. METHODS: Between june 1998 and october 2002 we performed hip arthroscopy in 30 athletes (12 female, 18 male) with a history of sports related groin pain. Their average age was 36 (20 to 68) years. All patients had a clinical follow-up- examination at an average of 20 (12 to 48) months postoperative. The result was rated using the Larson-Score. RESULTS: We found a lesion of the acetabular labrum and performed a partial resection at 17 patients (57 %) (synovitis: n = 28 [93 %] loose bodies: n = 6 [20 %] torn ligamentum teres: n = 4 [13 %], others: n = 2 [6 %]). 11 patients (37 %) had a cartilage degeneration grade II in the Outerbridge classification (III degrees : n = 9 [30 %], I degrees : n = 4 [13 %], 0 degrees : n = 6 [20 %]). Preoperative 14 patients (47 %) complained severe groin pain (moderate: n = 14 [47 %], slight: n = 2 [6 %]) against only 3 patients (10 %) with severe groin pain at the follow-up examination (moderate: n = 11 [37 %], slight: n = 16 [53 %]). Following hip arthroscopy 28 patients (94 %) returned to full sports activity. The Larson-Score was increased significantly (p < 0.05) rating 43 (10 to 64) points preoperative to 59 (28 to 80) points at the follow-up. DISCUSSION: We found that persistent sports related groin pain was frequently caused by an intraarticular hip disorder. Following hip arthroscopy pain could be reduced in most patients as a return to full sports activity.

[Effects of harvesting the central third of the patella tendon on the kinetics of the knee joint and the retropatellar pressure]. / Auswirkungen der Entnahme des mittleren Patellarsehnendrittels auf die Kinematik des Kniegelenkes und den retropatellaren Druck.

AIM: This biomechanical study was performed to evaluate the consequences of removing the central part of the patellar tendon on the kinematics and kinetics of the femoro-patellar joint. The tendonectomy was performed in the same manner as is frequently done during anterior cruciate ligament reconstructions. Of particular interest in this study was to identify potential factors of the patellar tendon resection which could result in anterior knee pain. METHOD: A simulated isokinetic knee extension from 120 degrees of flexion to full extension was performed on nine human knee cadaver specimens. Joint kinematics was evaluated with ultrasound sensors, and retropatellar contact pressure was measured using a thin-film resistive ink pressure measuring system. Data were taken before and after resection of the central third of the patellar tendon. RESULTS: Harvesting of the central third of the patellar tendon resulted in an elongation of the remaining patellar tendon by less then 0.5 mm. Furthermore, increases in patellar flexion lower than 1 degree were observed. Small changes in retropatellar pressure were also observed. CONCLUSION: The shortening of the patellar tendon due to tendon removal, as already suggested in several previous studies, is not attributed to the removal of the central portion of the tendon itself, but more likely due to secondary scarring contraction of the tissue. The changes of the patellarkinematics and the retropatellar pressure observed in this study are probably not of any clinical significance.

[Lig. capitis femoris. Arthroscopic diagnosis and treatment of degenerative and traumatic disorders]. / Lig.capitis femoris. Arthroskopische Diagnostik und Behandlung degenerativer und traumatischer Veränderungen.

The LT arises from the transverse acetabular ligament and the posterior inferior portion of the acetabular fossa and attaches to the femoral head at the fovea capitis. Lesions of the LT are accompanied by dislocation or subluxation of the hip as well as acetabular fractures. However, rupture may occur simply from a twisting injury in the absence of major trauma. Atraumatic degeneration associated with osteoarthritis and dysplasia as well as after Perthes' disease and slipped epiphysis capitis can occur. The symptoms of pain, popping, locking, and catching are nonspecific for a variety of intra-articular lesions. Most of the patients complain of deep anterior groin pain, but sometimes simply pain upon activity or loss of motion are described. No examination finding would distinguish injury to the ligament. The diagnosis of rupture of the LT remains elusive to various imaging techniques. Magnetic resonance arthrography is much more sensitive than magnetic resonance imaging at detecting various lesions but has a low sensitivity for ruptures of the LT. Lesions of the LT can be diagnosed using arthroscopy and respond remarkably well to arthroscopic débridement. Long-term results and potential consequences of treatment remain to be defined.

[Treatment of incomplete meniscal lesions in athletes]. / Die Therapie des inkompletten Meniskusrisses beim Sportler.

PURPOSE: Arthroscopic treatment of complete meniscal lesions is well established. Nevertheless there is discussion, how to treat incomplete meniscal tears, especially in younger and active patients. This study was designed to evaluate our standard-therapy without refixation of the meniscus. METHOD: Between 7/89 and 3/01 in 47 patients (48 knees, Ø age 29 years) an incomplete meniscal lesion following sports injury was found. The lesions were revitalized by "needling" or shaving. We performed no refixation. All patients had a postoperative flexion limit in an orthosis for 6 weeks. The follow-up examination was performed 6.5 (2 - 14) years postoperative. RESULTS: The avarage Lysholm-Score increased significantly from 55 points preoperative to 92 points at the follow-up examination. The Tegner-Score increased from 3.3 points preoperative to 6.2 points at the follow-up examination. The overall result was rated "exellent" and "good" by 83 % of the patients, "fair" by 15 % of the patients and "poor" by 2 % of the patients. Return to sports activity was possible at an avarage of 7 (3 - 12) months postoperative. CONCLUSIONS: In summary we found, that shaving and "needling" of an incomplete meniscal lesion in combination with partial synovectomi and standardized postoperative treatment leads to a high healing rate. A limited flexion for 6 weeks postoperativ in an orthosis at full weight bearing is recommended. In case of complete healing of the lesion the chondroprotective and joint stabilizing function of the meniscus, especially in young and active patients is obtained.

[Patellofemoral pain syndrome]. / Patellofemorales Schmerzsyndrom.

The patellofemoral pain syndrome is of high socioeconomic relevance as it most frequently occurs in young working patients. As its etiology is often unknown there is no standard treatment protocol. Several studies analyzed the different causes of patellofemoral pain and their different therapies. Static problems (pes planovalgus, instabilities, leg length differences) or chronic overuse of the knee extensor mechanism have to be identified and treated. After exclusion of intra-articular pathologies, the treatment of patellofemoral pain syndrome begins with conservative management. Stretching of the flexor and extensor muscles and training of the quadriceps muscle are the main approaches. If conservative treatment fails and patellofemoral pain persists, there are several surgical procedures for realignment of the patella in the trochlear groove and reduction of the patellofemoral pressure. Overweight patients exhibit chronic mechanical overuse of the patellofemoral joint. This leads to a higher rate of cartilage degeneration and problems at the inserting tendons and stabilizing tissues.

[Injury patterns and typical stress situations in paragliding]. / Verletzungsmuster und sportartbedingte Belastungen beim Gleitschirmfliegen.

Paragliding is known as a high risk sport with a substantial rate of severe and fatal injuries. Analysis of typical injury mechanisms and statistics showed that the total rate of paragliding injuries has decreased in recent years for an increasing number of pilots. In 2003, the rate of severe and fatal injuries in paragliding was less than that of other air sports and motorcycling. Through the introduction of a spine protector system in Germany and Austria, the number of vertebral fractures decreased significantly between 2000 and 2003. Most other injuries, especially of the lower extremities, could be avoided by adequate and farsighted flight behavior. Qualified instruction with regular training, standardized development of safety equipment and consequent analysis of paragliding injuries will help to improve the safety status in paragliding.

Trapezius transfer in brachial plexus palsy. Correlation of the outcome with muscle power and operative technique.

Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

[Shoulder arthrodesis. Indications, techniques, results, complications]. / Schulterarthrodese. Indikation, Technik, Ergebnisse, Komplikationen.

Besides the paralysis of shoulder muscles, large rotator cuff tears beyond repair, persistent shoulder instability with repeat dislocations and resection cases are recent indications for shoulder arthrodesis. The fusion of the shoulder is particularly useful since, despite immobilization of the glenohumeral and acromiohumeral joints, no loss of function is experienced; on the contrary, in many cases an increase of active total mobility may occur. According to the functional outcome, the majority of reports vary between 30 degrees and 90 degrees of active abduction and forward flexion with a mean value of about 60 degrees The most generally accepted arthrodesis position is 20 degrees -40 degrees abduction, forward flexion and internal rotation in relation to the trunk. This position results in a maximum development of muscle power and ensures that the arm will rest comfortably at the side, and that the scapula will not protrude. This also allows the hand to reach the head and facial region. The literature is not confined to any uniform type of arthrodesis and it would appear that the techniques and configurations of material vary considerably. A general advantage of any one particular form of arthrodesis, and the use of plates, screws or external fixators, cannot be deduced. Pseudarthrosis appears to be less frequent in cases of plate arthrodesis compared to screw arthrodesis. However, the application of plates more often results in infections, postoperative fractures of the humerus and the necessary removal of material. Screw arthrodesis is more beneficial in that the exposed area to be operated is smaller than in plate arthrodesis. Postoperative immobilization is more time consuming and, therefore, constitutes one of the disadvantages of screw fixation.

[The brachial plexus lesion. Management, consequences of palsy and reconstructive operations]. / Der Armplexusschaden. Management, Lähmungsfolgen und funktionsverbessernde Operationen.

The treatment of traumatic brachial plexus lesions follows sequential steps. After acute therapy (phase I), neurological diagnostics (phase II), neurosurgery and postoperative treatment (phase III/IV), reconstructive operations (phase V) can be indicated and performed. In most cases an insufficient grade of muscle power remains. Within 6 months after injury, neurosurgery must be performed in patients with brachial plexus palsy. After malfunction of the muscles, taking into account the individual neuromuscular defects, passive joint function and bony deformities, different procedures such as muscle transposition, arthrodesis and corrective osteotomy can be performed to improve the function of the upper extremity. The treatment of patients suffering from brachial plexus lesion requires interdisciplinary teamwork.

[Open versus arthroscopic shoulder stabilization. An analysis of the treatment costs]. / Offene vs. arthroskopische anteriore Schulterstabilisierung. Eine Kostenvergleichsanalyse.

In this study the total costs of clinical open and arthroscopic anterior shoulder stabilization were evaluated, analyzed and compared. From 1988 to 1998 147 patients underwent open (Bankart) or arthroscopic (ASK) anterior shoulder stabilization. We randomized two groups of 30 patients for each method (Bankart: 25 male, 5 female, 29 years of age; ASK: 25 male, 5 female, 26 years of age) and evaluated the costs of their clinical treatment. The total cost was significantly ( p<0.05, Mann-Whitney U-Test) higher for the open (5639 euro) than for the arthroscopic (4601 euro) therapy. There was a significant difference between the groups for the average cost of surgery (Bankart: 2741 euro; ASK: 2315 euro, p<0.05) and the average postoperative treatment cost (Bankart: 2202 euro; ASK: 1630 euro, p<0.05) whereas the average preoperative treatment cost was not significantly different (Bankart: 669 euro, ASK: 657 euro). The staff costs for the surgical procedure (Bankart: 1800 euro (32%), ASK: 1319 euro (29%)) and the postoperative staff costs of the nurses (Bankart: 1271 euro (23%), ASK: 997 euro (22%)) represented the greatest parts of the total costs. The average duration of the clinical treatment was 15.8 days for the open- and 12,4 days for the arthroscopic group.

[Arthroscopic anterior shoulder stabilization combined with laser-assisted capsular shrinkage (LACS) compared to other procedures]. / Die arthroskopische anteriore Schulterstabilisierung durch Kombination von laserassistiertem Kapsel-Shrinkage und Nahttechnik im Vergleich mit anderen Operationsverfahren.

INTRODUCTION: Does additional laser assisted capsular shrinkage (LACS) help to reduce the recurrence rate in arthroscopic anterior shoulder stabilization? METHODS: In a prospective study from 7/97 to 4/99 at 22 nonselected patients a combined Caspari + LACS-technique was performed. We could follow-up 152 (80%) of a total 191 anterior shoulder stabilizations between 4/88 and 4/99 (124 male, 28 female, average age 33 years) (80(52%) Bankart, 30(20%) Du Toit/Roux, 20(13%) Caspari, 22(15%) Caspari + -LACS. RESULTS: The rate of dislocation was 7% (11/152) for all patients (Bankart 5% 4/80), Du Toit/Roux 4% (1/30), Caspari 25%(5/20), Caspari + LACS 5%(1/22)). Using the score of Rowe et al. [34] 113 patients (75%) rated excellent or good (Bankart 77%, Du Toit/Roux 83%, Caspari 60%, Caspari + LACS 86%). CONCLUSIONS: An additional laser capsular shrinkage helps to reduce the high rates of dislocation in arthroscopic anterior shoulder stabilization with results similar to standard open procedures.

[Arthroscopy of the hip]. / Hüftarthroskopie.

Arthroscopy of the hip has become a well-established procedure for minimally invasive therapy of hip disorders. The surgical technique is demanding. A fracture table for distraction of the joint is required, as well as an exact positioning technique is most important. Because of eh great distance between skin and joint only restrictive intrarticular maneuvers are possible. Arthroscopically the hip can be divided into a central and peripheral compartment. For arthroscopy of the central compartment distraction of the joint is necessary. This part comprises the loaded surface of the femoral head and the lunate cartilage. The peripheral compartment consists of the unloaded cartilage of the femoral head and the femoral neck until the capsular insertion. This compartment can be visualized without traction. Good results can be achieved in the therapy of labral lesions, loose bodies, moderate osteoarthritis, synovial diseases and pathology of the teres ligament. Performing hip arthroscopy in an adequate technique and under consideration of contraindications, complications are rare.

[Shoulder arthrodesis with plate fixation. Special features in cases of resection and defects]. / Plattenarthrodese der Schulter. Besonderheiten bei Defekt- und Resektionszuständen.

AIM: Shoulder arthrodesis following prosthesis explantation or resection of the acromion has not often been described in the literature. The presented article analyses the special features and problems of these preoperative circumstances in 4 cases and discusses them within the entire group. PATIENTS AND METHOD: Between 06/1987 and 02/2001, a total of 30 shoulder arthrodeses using plate fixation were performed in our clinic and then analysed after an average of 2.7 (0.5 - 8.7) years. Surgery was carried out on 5 (17 %) females and 25 (83 %) males with a mean age of 37 (17 - 82) years. Two patients underwent shoulder arthrodesis as a salvage operation following unsatisfactory arthroplasty, or after trapezius transfer with corresponding reduced bony conditions, respectively. RESULTS: The active extent of movement following arthrodesis was 56 degrees (20 degrees - 90 degrees ) abduction, and 60 degrees (20 degrees - 105 degrees ) anteversion. The most frequent complications following arthrodesis included pseudarthroses (3/10 %), infections (4/13 %), and fractures of the humerus (4/13 %). The rate of complications was especially high in the cases after explantation of a shoulder prosthesis and resection of the acromion. In two of the four patients, three or five revision operations, respectively, were necessary. Two of the three pseudarthroses of the entire group occurred in these two cases. CONCLUSION: Complications of shoulder arthrodesis after resection of the acromion or the proximal humerus are especially frequent. To avoid pseudarthrosis in such cases, primary spongioplasty is advantageous. A fixation with plates is superior to a simple screw arthrodesis. For postoperative immobilization a plaster cast instead of an orthotic device should be taken into consideration.

[The influence of age on the outcome of anterior cruciate ligament reconstruction]. / Der Einfluss des Lebensalters auf den Behandlungserfolg nach vorderer Kreuzbandplastik.

AIM: There is an increasing demand for a high loading capacity of the knee during exercise in the elderly patient with knee instability following rupture of the anterior cruciate ligament (ACL). The question is, if the results of an ACL reconstruction in patients over 40 years of age are as good as those in younger patients. METHOD: From 1989 to 1994 we replaced the ACL with a mid-third BPTB autograft in 397 patients following ACL rupture. A total of 309 patients (78%, 110 female, 199 male, the average age was 27 years) were followed for an average of 43 months. The results were compared relating to four groups of age (group 1: < 20 years, n = 41; group 2: 20 - 29 years, n = 175; group 3: 30 - 40 years, n = 77; group 4: > 40 years, n = 16). RESULTS: We did not find any significant differences between the groups in the different score ratings, the subjective and objective knee function and stability, the pain and the level of activity. The average Cincinnati score of the whole group was 91 points (HSS score: 78/16 % excellent/good, Lysholm score: 90 points, IKDC score: 22/31 % A/B). CONCLUSION: ACL replacement is a sufficient therapy for patients over 40 years of age with symptomatic knee instability following ACL rupture. The subjective and objective clinical outcome is comparable to the good results of ACL replacement in younger patients without any significant differences.

[Corrective bone operations for treatment of deformities caused by obstetrical brachial plexus palsy]. / Knöcherne Korrektureingriffe zur Behandlung von Deformitäten nach geburtstraumatischer Arm-Plexus-Lähmung.

In an adult, a marked deformity of the upper arm and forearm with loss of function of the limb due to obstetrical brachial plexus palsy has been corrected. An external rotational osteotomy of the humerus and radioulnar arthrodesis resulted in an improved function.