[Surgical treatment of tibialis anterior tendon rupture]. / Operative Therapie der Tibialis-anterior-Sehnenruptur.

INTRODUCTION: Tibialis anterior tendon rupture is rare, with only a few cases and small series having been reported in the literature. In this article, cases reported in the literature from 1997-2012 are reviewed and patients treated by the author are presented. MATERIALS: Cases published from 1997-2012 needing surgical treatment for tibialis anterior tendon rupture were retrospectively reviewed. In all, 32 articles with a total of 44 reported cases and 5 patients from our own practice were included. Patient-specific data (e.g., age, trauma, secondary diagnosis, and time to surgery), surgical technique, operative result, and documented complications were also evaluated. RESULTS: The mean age (MA) of the patients (30 men and 19 women) undergoing treatment was 58 years. A total of 17 patients presented as a result of adequate trauma (MA 52) and 32 patients without or minor trauma (MA 62). In 16 patients (33 %), a primary tendon suture was selected, while in 11 patients (22 %) osseous refixation techniques were performed. In 21 patients (43 %), plastic reconstruction was necessary. Total recovery was observed in 69 % of patients (n = 34); 26 % (n = 13) had moderate limitations. Complications were reported in 12 % of cases (n = 6), thereof one re-rupture. CONCLUSION: Good to excellent results were observed in tibialis anterior tendon ruptures reconstruction. No associations between surgical treatment and outcome were observed. The selection of the surgical technique depended on rupture mechanism, location, size, tendon constitution, rupture age, and surgeon's experience.

[Acute hip pseudoparalysis with calcific tendinitis at the insertion of the psoas muscle. Case report and first description of an atypical location]. / Akute Pseudoparalyse der Hüfte bei Tendinitis calcarea der Psoassehne. Falldarstellung und Erstbeschreibung einer ungewöhnlichen Lokalisation.

Calcific tendinitis is a common and widespread disease. It is most common in the rotator cuff especially in the supraspinatus tendon. In some cases it may also involve other locations such as the hips, particularly at the trochanter minor. In particular calcific tendinitis of the iliopsoas muscle tendon has not yet been described. Because of uncharacteristic symptoms and ambiguous diagnostic imaging the differentiation between traumatic, infectious and neoplastic genesis is often difficult. Because of artefacts the typical calcareous spots near the insertions are often underdiagnosed in conventional diagnostic x-ray images. In this case report the differentiation from an infection of the hip was only possible with positron emission tomography computed tomography (PET-CT) imaging and negative microbiological testing of an aspirate. There are various therapy options, such as systemic and local medication, extracorporeal shock wave therapy up to surgery. However, calcific tendinitis is a self-limiting tendinopathy that can be treated with conservative therapy to complete remission in most cases.

[The impact of capsular repair on the dislocation rate after primary total hip arthroplasty: a retrospective analysis of 1972 cases]. / Der Einfluss der Kapselrekonstruktion auf die Luxationsrate nach primärer Hüftendoprothetik: eine retrospektive Analyse von 1972 Fällen.

BACKGROUND: Dislocation is the second most frequently encountered complication in primary total hip arthroplasty (THA) and occurs more commonly in the early postoperative rehabilitation phase. Sir Charnley recommended the "avoidance of resection of the capsule" and emphasised its contribution to hip joint stability in THA. Several authors, however, doubted its significance and considered resection of the capsule to be essential. Since 2002, some surgeons increasingly adopted a modified, less invasive technique of THA via Bauer approach, including the preservation and repair of the hip joint capsule with focus on maintaining its acetabular origin. Another group of surgeons applied the traditional technique including the resection of the joint capsule via an anterolateral approach. In this case-control study we investigated whether the dislocation rate can be reduced through joint capsule reconstruction and whether any negative impact on patient satisfaction, functional results or revision rate is observed. MATERIAL AND METHODS: All cases of primary THA performed in our institution in a timeframe between 2002 and 2009 were included with the only exceptions of resurfacing arthroplasty, dual mobility and tumour hip replacements. Joint capsule repair cases were gathered in the study group (SG), capsule resection cases in the control group (CG). Additional patient-related data were taken from the anaesthesia records. The WOMAC score and a questionnaire focusing on detection of dislocations and revision surgeries was sent out for each case. Further targeted research was conducted that included requesting records and reports from external hospitals. In the case of non-responding patients, all available data (operating room documentation, electronic files, archive, X-rays) were reviewed for incidents of dislocation and revision surgery. Groupings and classifications were exclusively performed by senior surgeons. SG and CG were compared regarding epidemiologic, implant-associated and surgery-specific data. Statistical evaluations were performed using the Chi-squared test and the Mann-Whitney U test. RESULTS: 1972 cases of primary THA were included: 992 in the SG and 980 in the CG. The follow-up rates were 92.7 % in the SG and 76.4 % in the CG, the mean follow-up times 33.5 months and 73.4 months, respectively, with a follow-up of at least 12 months in all cases. In the SG, the dislocation rate was 0.3 % (n = 3) and thus significantly lower than the 2.55 % in the CG (n = 25, p < 0.001). Both the WOMAC score (SG: 1.46 ± 1.73; CG: 1.53 ± 1.80; p > 0.05) and the revision rate (SG: 5.24 %; CG: 6.84 %; p = 0.139) showed no significant differences. CONCLUSION: Preservation and repair of the hip joint capsule causes an 88-%-reduction of the dislocation rate in primary THA in this large series including 1972 cases, operated via the Bauer or the anterolateral approach. Several authors reported comparable results after THA using similar techniques of soft tissue and capsular repair through the posterior or posterolateral approach. Sparing and reconstructing the hip joint capsule therefore seems to reduce the dislocation rate after primary THA by one order of magnitude regardless of the surgical approach and, especially, if the acetabular origin is preserved. Capsule-related specific complications such as an increased revision rate, malfunction or pain were neither recorded in our study nor by others. Thus, careful preservation and reconstruction of the hip joint capsule may be expressly recommended in primary THA.

Quantitative monitoring of extracellular matrix production in bone implants by 13C and 31P solid-state nuclear magnetic resonance spectroscopy.

We used (31)P and (13)C solid-state nuclear magnetic resonance (NMR) spectroscopy to detect and analyze the major organic and inorganic components (collagen type I and bioapatite) in natural rabbit bone and beta-tricalcium phosphate implants loaded with osteogenically differentiated mesenchymal stem cells. High-resolution solid-state NMR spectra were obtained using the magic-angle spinning (MAS) technique. The (31)P NMR spectra of bone specimens showed a single line characteristic of bone calcium phosphate. (13)C cross-polarization (CP) MAS NMR spectra of bone exhibited the characteristic signatures of collagen type I with good resolution for all major amino acids in collagen. Quantitative measurements of (13)C-(1)H dipolar couplings indicated that the collagen segments are very rigid, undergoing only small amplitude fluctuations with correlation times in the nanosecond range. In contrast, directly polarized (13)C MAS NMR spectra of rabbit bone were dominated by signals of highly mobile triglycerides. These quantitative investigations of natural bone may provide the basis for a quality control of various osteoinductive bone substitutes. We studied the formation of extracellular bone matrix in artificial mesenchymal stem cell-loaded beta-tricalcium phosphate matrices that were implanted into the femoral condyle of rabbits. The NMR spectra of these bone grafts were acquired 3 months after implantation. In the (31)P NMR spectra, beta-tricalcium phosphate and bone calcium phosphate could be distinguished quantitatively, allowing recording of the formation of the natural bone matrix. Further, (13)C CPMAS allowed detection of collagen type I that had been produced in the implants. Comparison with the spectroscopic data from natural bone allowed assessment of the quality of the bone substitute material.

[Extragenital endometriosis leading to piriformis syndrome]. / Piriformissyndrom infolge einer extragenitalen Endometriose.

We report on a 44-year-old woman with a history of sciatica fluctuating with her menstrual cycle and going back over 10 years; ultimately it was present continuously and became disabling. Over the years the patient developed ipsilateral foot-drop, a sensory disorder in the lateral aspect of the lower limb and back of the foot, and atrophy of the gluteus muscle. MRI confirmed the suspicion of extragenital endometriosis, which had caused piriformis syndrome by compression with consequent damage to the sciatic and inferior gluteal nerves. After hormonal therapy had been tried without success, the endometrioma was excised to relieve the pressure on the nerves, and the diagnosis was confirmed histopathologically. The motor deficit remained up to the 15 months since surgery, but the patient is now free of pain.

[Musculoskeletal biopsies in an open 0.5-T-MR system]. / Muskuloskelettale Biopsien im offenen 0.5-T--Kernspintomographen.

INTRODUCTION: MR-guided interventions have been successful in different medical disciplines. The aim of this paper is to report our results with the application of MR-guided biopsies of musculoskeletal lesions using an open 0.5-T-MR scanner and further to discuss these results on the basis of the available literature. PATIENTS AND METHODS: Between 1998 and 2003 30 patients (average age 44.1 years) underwent a total of 31 biopsies. The interventions were performed in an open 0.5-T MRI system using an active optical localization system as well as a navigation system. For the motion tracking we used T (1)-weighted real-time sequences with 0.25 pictures per second. For the sampling MR-compatible instruments were used that were specially developed for this purpose. The data of this retrospective investigation are based on the evaluation of the patient documents and the radiological findings. On the basis of the histological findings the technical success rate and the histological overall accuracy were determined. RESULTS: In 81 % of the biopsies the histological diagnosis was correct. In cases of suspected inflammation the histological accuracy was smaller (70 %). No differences were observed between skeletal and soft-tissue lesions. The technical success rate amounted to 77.5 %. No procedural or anesthesiological complications occurred. The mean operating time amounted to 65 min including the time for motion tracking. DISCUSSION: In cases of suspected lesions of the musculoskeletal system, the MR-guided biopsy represents a promising and safe procedure to get a histological diagnosis. In cases of sufficient size of the lesion sampling of a representative probe is possible. On account of the outstanding performance in soft-part contrasting, the sensitive structures surrounding the lesion can be saved. Substantial disadvantages of the procedure are the high costs for personal and material and the long operating time.

[Hereditary multiple exostoses. Molecular genetic analysis of the EXT1 gene in an unusual family]. / Hereditäre multiple Exostosen. Molekulargenetische Analyse des EXT1-Gens in einer ungewöhnlichen Familie.

Hereditary multiple exostosis (HME), a disorder inherited in an autosomal dominant manner, is characterized by multiple projections of bone, mainly at the extremities. The risk of malignant transformation of the exostoses is estimated to be up to 2%. The most common underlying cause of the disease involves mutations in either the EXT1 or the EXT2 gene. We report on the clinical and molecular findings in a family affected with HME.A mother and her three children from different partnerships, all clinically diagnosed with HME, were referred for genetic counseling. Subsequently, molecular analysis of the EXT1 gene was performed according to standard procedures. We identified a mutation in the EXT1 gene in all four affected family members (delA in codon 133). This mutation has not been previously described and is suggested to cause the disease in this family. Identification of disease causing mutations in patients with HME and their relatives can help to improve the clinical management of tumor prevention, early tumor detection, and orthopedic therapy.

[Results of surgical arthrolysis in treatment of restricted knee joint movement]. / Ergebnisse der operativen Arthrolyse in der Behandlung von Bewegungseinschränkungen des Kniegelenkes.

PROBLEM: The study's task is to describe the results of the 58 arthrolysis of the knee joint, which were performed between 1967 and 1995. Additionally, we wanted to find out about the influencing factors on the long-term results after this operation. METHOD: The data used for this retrospective study is based on the complete charts, in which the findings of the postoperative follow-up examinations were documented (range of motion, local findings, gait). The average follow-up time was 3.2 +/- 3.6 years. In order to draw conclusions, we focused on the extent of motion and on the relative benefit of motion. Despite of the inhomogeneity of the collective of patients, we performed statistical tests for a better presentation. RESULTS: The mean knee joint moveability was increased from 0 degree/11 degrees/46 degrees to 0 degree/7 degrees/90 degrees at the last follow-up date. The relative benefit was 44.5% (Median 54%). Additionally, the extraarticular procedures had the best, the combined arthrolysis the worst outcome. Postinfectious stiffness of the knee did not show a worse prognosis in comparison to non-infectious causes for a decrease in motion. CONCLUSIONS: Depending on the preoperative findings, the range of moveability was considerably better, when the indication for the performance of an arthrolysis was recognized in time.

[Treatment of periprosthetic femoral fractures associated with total hip arthroplasty]. / Zur Behandlung periprothetischer Femurfrakturen bei Hüftendoprothesen.

AIM: Periprosthetic femoral fractures represent a heterogeneous type of injury with a variety of treatment options. By retrospectively analysing our data, the results of different therapeutic procedures are compared and, reviewing previously published cases, suggestions for the management have also been developed. METHOD: This study is based on the analysis of records and radiograph series of 43 patients (50 procedures) with periprosthetic fractures. 22 patients could be followed-up using the Harris Hip Score at an average of 4.8 years after injury. RESULTS: Factors predisposing to fractures were found in 41 patients, only 9 fractures were due to an adequate trauma. According to the classification of Johansson et al., 15 fractures of type I and type II each and 20 fractures of type III were treated. In 23 cases open reduction and internal fixation (ORIF) with a plate was used, 10 fractures were stabilised by minimal osteosynthesis, in 8 cases a modular prosthesis for bone replacement was used, 6 times a revison stem was implanted, and in 2 fractures osteosynthesis of the femur could only be accomplished after the complete removal of implants. The mean Harris Hip Score was 69.9 points at the follow-up examination. Local surgical complications were more often observed than general. CONCLUSIONS: Due to their different clinical presentations periprosthetic fractures need to be managed individually and in most cases operatively. Internal fixation with a plate proved to give the best functional results for stable stem implants. Loosening stems have to be replaced by revision implants with long stems for intramedullary fixation. Alternative osteosynthetic techniques and additive minimal osteosynthesis can be favoured in special cases. Modular prostheses for bone replacement are reserved for fractures with extensive bone loss.