Initial stability of two different adhesives compared to suture repair for acute Achilles tendon rupture--a biomechanical evaluation.

PURPOSE: Treatment of acute subcutaneous Achilles tendon rupture remains challenging. Whereas the results of conservative and operative treatment are inconsistent, early mobilisation treatment seems to be beneficial. Besides suture repair, operative treatment using adhesives reveals promising results. Our hypothesis was that a gluing technique provides initial stability comparable to sutures. METHODS: In a biomechanical study, 18 fresh frozen sheep Achilles tendons were used to compare the biomechanical properties of suture repair using PDS® II and Bunnell's technique to tendon gluing using BioGlue® and Tissucol®. Load to failure testing was performed. RESULTS: Ultimate failure loads of sutures (146.2 ± 30.8 N) are significantly superior to the techniques using BioGlue® (38.4 ± 18.3 N; p <0.0001) or Tissucol® (4.7 ± 2.5 N; p <0.0001). Interestingly, no significant differences in stiffness were found between the application of BioGlue® and PDS® II. CONCLUSIONS: Suture repair provides significantly superior biomechanical properties compared to the use of both tested adhesives BioGlue® and Tissucol®. Based on the presented data we recommend the use of suture material for open Achilles tendon repair.

Fractures in German elite male soccer players.

BACKGROUND: Aim of this retrospective cohort study was to identify fracture epidemiology and off times after different types of fractures in German male elite soccer players from the first division Bundesliga based on information from the public media. METHODS: Exposure and fracture data over 7.5 consecutive seasons (2009/10 until the first half of 2016/17) were collected from two media-based register (transfermarkt.de® and kicker.de®). RESULTS: Overall, 357 fractures from 290 different players were recorded with an incidence of 0.19/1000 hours of exposure (95% CI: 0.14-0.24). Most fractures in German elite soccer players involved the lower extremities (35.3%), the head/face (30.3%) and the upper extremities (24.9%). The median off time after a fracture in German elite male professional soccer in 7.5 Season was 51.1 days (range 0-144). The number of fractures per 100 players per season decreased between 2009 and 2016. There was no significant difference in overall fracture incidence when comparing players at different position (P=0.11). Goalkeepers have a significantly (P<0.02) higher likelihood of suffering hand and finger fractures and they are significantly (P<0.03) less prone of suffering foot fractures, cranial and maxillofacial fractures (P<0.04). compared to outfield players. CONCLUSIONS: This study can confirm that male professional soccer teams experience 1-2 fractures per season in German elite soccer. The incidence of fractures in elite German soccer players decreased between 2009 and 2016. The most fractures occur in the lower extremities and there is no difference in overall fracture risk for players at different playing positions. The information from our study might be of a great importance to medical practitioners, soccer coaches and soccer manager.

Neutral or Natural? Functional Impact of the Coronal Alignment in Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is a very successful procedure. The alignment in TKA has been identified as being of importance to prevent early implant failure and patient dissatisfaction. Our hypothesis was that patients with a preoperative varus deformation remaining in a slight varus alignment as their natural alignment after TKA will have superior clinical results compared with patients who are restored in neutral alignment. A total of 115 patients were corrected from varus to neutral (varus-neutral) and in 33 patients a preoperative varus alignment was kept in varus (varus). Standardized preoperative and postoperative full-length hip-knee-ankle radiographs under full weight-bearing conditions were performed in all patients. The patients' knees were categorized preoperatively and postoperatively based on the angle between mechanical femoral axis and mechanical tibial axis. Knees with alignment between ± 3 degrees were categorized as neutrally aligned, whereas alignment within ≤ -3 degrees was categorized as varus. The Knee Injury Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score were determined retrospectively. The varus group scored significantly better in total KOOS (p < 0.05) compared with the varus-neutral group. Also, a trend was visible in the Oxford Knee Score but this was not significant (p > 0.05). This trend was even more evident in varus knees which were slightly undercorrected. The results support the assumption that leaving a residual varus alignment after TKA leads to better functional outcomes in TKA for patients with preoperative varus osteoarthritis.

Anterior cruciate ligament ruptures in German elite soccer players: Epidemiology, mechanisms, and return to play.

BACKGROUND: Anterior cruciate ligament ruptures (ACLRs) are severe sports-related injuries with significant consequences for affected players and teams. This study aims to identify the epidemiology and injury-related lay-off after ACLR in professional male soccer players from the first-division German Bundesliga. METHODS: Exposure times and incidence of anterior cruciate ligament ruptures were collected during 7.5 consecutive seasons using two media-based registers. RESULTS: A total of 72 total ACLRs were registered in 66 different players with an incidence of 0.040 per 1000h of exposure (95% CI 0.009-0.12). On average there were 9.6 ACLRs per season and 0.53 per team and season. The mean age of players affected was 24 (standard deviation±3.6) years. The number of ACLRs recorded per season fluctuated during the period observed. Goalkeepers are significantly (P<0.05) less prone to suffer an ACLR compared to outfield players. CONCLUSIONS: Understanding ACLR loading mechanisms, knowing risk factors for the injury and mean off time after ACLR are essential information for the coach, the medical staff, the elite soccer players, the insurance and team managers. Our results are in accordance with reports based on information from medical team staff. Therefore, our analysis of ACLR based on media sources may serve as an alternative for injury reports in elite soccer. The information of this study may be helpful for the medical staff taking care of professional soccer players and for orthopedic surgeons performing ACL reconstructions in this patient population.

Cone beam CT in assessment of tibial bone defect healing: an animal study.

RATIONALE AND OBJECTIVES: To evaluate cone beam computed tomography (CBCT) for monitoring of tibial bone defect healing in comparison to histopathological findings. MATERIALS AND METHODS: Circumscribed tibial bone defects were created in 16 mini-pigs and imaging of the tibia was performed on day 42 using a modern CBCT scanner with flat panel detector (PaX-Duo3D, Vatech, Korea). The extent of osseous consolidation including remaining calcium phosphate granules was measured quantitatively by a CBCT volumetry tool using commercially available software (Osirix Imaging software, Pixmeo, Geneva, Switzerland). Volumes of the entire defect (including all pixels), areas of osseous consolidation (density values >2350) and nonmineralized areas (density values <2350) of the defect were determined. The extent of bone regeneration was determined and correlated with the histomorphometrical reference standard. Independently, a visual semiquantitative CBCT-score was applied (4-point scale) to assess bone defect healing. RESULTS: The extent of osseous consolidation in CBCT volumetry ranged from 14% to 92% (mean, 63.4 ± 17.6%). There was a significant positive correlation between histologically visible newly formed bone and the extent of bone regeneration on CBCT volumetry (r = 0.74-0.79, P < .001). The visual score matched with the volumetric results in 75% of the cases. CONCLUSION: CBCT volumetry allows for reliable, noninvasive quantitative monitoring of bone defect healing and correlates significantly with histological findings. CBCT is a promising technique for imaging of peripheral bones suggesting further evaluation in clinical trials.

Extracorporeal immune therapy with immobilized agonistic anti-Fas antibodies leads to transient reduction of circulating neutrophil numbers and limits tissue damage after hemorrhagic shock/resuscitation in a porcine model.

BACKGROUND: Hemorrhagic shock/resuscitation is associated with aberrant neutrophil activation and organ failure. This experimental porcine study was done to evaluate the effects of Fas-directed extracorporeal immune therapy with a leukocyte inhibition module (LIM) on hemodynamics, neutrophil tissue infiltration, and tissue damage after hemorrhagic shock/resuscitation. METHODS: In a prospective controlled double-armed animal trial 24 Munich Mini Pigs (30.3 +/- 3.3 kg) were rapidly haemorrhaged to reach a mean arterial pressure (MAP) of 35 +/- 5 mmHg, maintained hypotensive for 45 minutes, and then were resuscitated with Ringer' solution to baseline MAP. With beginning of resuscitation 12 pigs underwent extracorporeal immune therapy for 3 hours (LIM group) and 12 pigs were resuscitated according to standard medical care (SMC). Haemodynamics, haematologic, metabolic, and organ specific damage parameters were monitored. Neutrophil infiltration was analyzed histologically after 48 and 72 hours. Lipid peroxidation and apoptosis were specifically determined in lung, bowel, and liver. RESULTS: In the LIM group, neutrophil counts were reduced versus SMC during extracorporeal immune therapy. After 72 hours, the haemodynamic parameters MAP and cardiac output (CO) were significantly better in the LIM group. Histological analyses showed reduction of shock-related neutrophil tissue infiltration in the LIM group, especially in the lungs. Lower amounts of apoptotic cells and lipid peroxidation were found in organs after LIM treatment. CONCLUSIONS: Transient Fas-directed extracorporeal immune therapy may protect from posthemorrhagic neutrophil tissue infiltration and tissue damage.