[Medialization of the tibial tuberosity in habitual dislocation of the kneecap]. / Die Medialisierung der Tuberositas tibiae zur Behandlung habitueller Patellaluxationen.

Referring to relevant literature, various concepts are discussed in the treatment of habitual dislocation of the kneecap. Between 1987 and 1997, 88 patients have been treated surgically in our clinic by uni- or bilateral medial transfer of the tibial tuberositas. In 21 of the cases lateral release was also performed. In the follow-up, after an average of 4.9 years, 79 patients were examined clinically, radiologically and isokinetically (Kintrex-Dynamometer). Isokinetic measurement of the extension showed an average deficit of 19 nm compared to the contralateral side. Using the Juliusson and Markhede scores, 51 cases had a good, 18 a fair and 10 a poor clinical outcome. In 79 % of the cases, the postoperative sports activity level was the same as preoperatively. Isokinetic measurement with the Kintrex is a useful method of evaluating the development of muscle strength.

Lumbar microdiscectomy. Technique and complications.

Lumbar Microdiscectomy requires special instruments and provides a good view with a narrow approach. The microscope is the best surgical aid. Alternatives are a retractorintigrated light or headlamp. A specific complication of lumbar microdiscectomy - the wrong level - can be minimized by an exact preoperative planning. Other complications like dural lesions and exessive bleeding are less frequent with the microscope because of the better view. The most severe complications that can occur with any lumbar disc operation, major vessel or visceral injury, can be avoided by lusing the new rongeur with a depth guard.

[Injuries specific to ice skating--documentation of the injuries of competitive athletes during a pre-season training camp]. / Eiskunstlaufspezifische Verletzungen--Verletzungsdokumentation von Hochleistungsathleten während eines saisonvorbereitenden Trainingscamps.

A Prospective Study. Competitive figure skaters absolve a comprehensive training schedule. The musculoskeletal system of pair and single skaters have to tolerate enormous impacts, especially throughout landings after repetitive jumps. Intense training leads therefore to specific sports injuries and chromic overuse injuries of the ice skaters. Twenty-five skaters were studied. We concentrated on the different types and localisations of injuries and on the individual loss of training sessions resulting from these injuries. The results are based on questionnaires and a clinical examination of the athletes. Typical acute and chronic injuries in figure skating mainly manifest at the lower extremity. It is striking that the first symptoms often occur during the preseason and persist the complete season or even for several years. The significance of sport specific and not ice skating related influences with regard to injury susceptibility is explained. Methodical "off-ice-training" seems to be useful to prevent injuries resulting from physical dysbalances. Improvements of the skating boots might protect from typical high impact during the landings after repetitive jumps.

[Results of mobilization under anesthesia in adhesive capsulitis in relation to stage of the disease]. / Ergebnisse der Narkosemobilisation bei Adhäsiver Kapsulitis in Abhängigkeit vom Stadium der Erkrankung.

PROBLEM: Mobilisation under anaesthesia is a well approved method for the treatment of idiopathic adhesive capsulitis, the best time to perform the mobilisation, however, is difficult to define. MATERIAL AND METHODS: Thirty-nine patients who had been treated with mobilisation under anaesthesia for idiopathic adhesive capsulitis stage II or III were examined at an average follow-up time of 3.4 years. RESULTS: This therapy failed in 10.3% of the patients. There were no differences in the follow-up results between both groups of patients, limitations in the range of motion remained in 20% of all patients. At follow up the average CONSTANT Score of the stage II patients was 86.8, that of the stage III patients was 89.9 points. However, manipulation under anaesthesia showed a significantly better influence on the course of the disease in patients with stage III than in patients with stage II adhesive capsulitis. CONCLUSION: Mobilisation under anaesthesia is a successful therapy in adhesive capsulitis stage III, but should be performed in adhesive capsulitis stage II only in cases of decreasing pain in which the limitation in the range of motion is the main symptom.

[Microsurgical lumbar intervertebral disk operation. Technique and complications]. / Mikrochirurgische lumbale Bandscheibenoperation. Technik und Komplikationen.

Lumbar Microdiscetomy requires special instruments and provides a good view with a narrow approach. The microscope is the best surgical aid. Alternatives are a retractorintigrated light or headlamp. A specific complication of lumbar microdiscectomy--the wrong level--can be minimized by an exact preoperative planning. Other complications like dural lesions and exessive bleeding are less frequent with the microscope because of the better view. The most severe complications that can occur with any lumbar disc operation, major vessel or visceral injury, can be avoided by lusing the new rongeur with a depth guard.

[Implantation of a Harms titanium mesh cylinder for vertebral body replacement in spinal metastases]. / Der Einsatz des Harms-Titannetzzylinders zum Wirbelkörperersatz bei Wirbelsäulenmetastasen.

OBJECTIVE: Vertebral metastases are quiet common and may result in vertebral collapse, spinal instability, and progressive neurological compromise. An anterior approach is the accepted method for decompression and stabilization by vertebral replacement. There is still need for discussion regarding the material of the replacement device. Here, the authors report on Harms' titanium cage (DePuy-Motech) for vertebral replacement. METHODS: From 1992 until 1995 17 patients with spinal metastases were treated by anterior vertebral replacement at the Orthopaedic Department, University of Magdeburg. Indications for the procedure were single metastases and respectively, progressive neurological deficit with vertebral destruction seen radiologically. Implantation of the cage was performed solely or in combination with anterior or posterior instrumentation. Pre- and postoperative assessments were evaluated by clinical scores. RESULTS: Mean follow-up was 9.3 months. At the end of our study 11 patients had died (mean survival 6.7 months). Mean follow-up of the surviving 6 was 9.8 months. Patient's daily activity (Karnofsky) improved in 8 cases, became worse in 4 cases, and did not change in 5 cases. Neurologically (Frankel) there was improvement in 3 patients, deterioration in 4 patients, and no change in 10 patients. Walking ability showed improvement in 6 cases, deterioration in 3 cases and no change in 8 cases. Relief of pain (Moskowitz) was reported by 12 patients, no patient complained of increasing pain, 5 patients reported no change, and 10 patients were pain-free. CONCLUSION AND CLINICAL RELEVANCE: In most cases with spinal metastases, the quality of life may be improved by vertebral replacement with Harms' titanium cage. Amelioration of clinical symptoms such as neurological deficit, pain, and tack of walking ability occurred in most patients.

[Osteochondral shear fractures in children. A case report and critical review of the literature]. / Osteochondrale Abscherfrakturen bei Kindern. Eine Falldarstellung unter kritischer Wertung der Literatur.

Only few articles on osteochondral flake fractures in children have been published. Diagnostic tools have been improved over the past decades, but still, diagnosis of severe osteochondral defects may be delayed. The presented case report describes the different techniques currently being available for the diagnosis of osteochondral flake fractures. The different therapeutic options for the treatment of osteochondral flake fractures in children are discussed based on the current literature. This article demonstrates the necessity to consider severe injuries, even if impressive clinical symptoms are lacking.

[Comparison of functional outcome in implantation of Natural Knee knee prostheses with and without patellar resurfacing]. / Vergleich funktioneller Ergebnisse bei der Implantation von Natural-Knee Knieendoprothesen mit und ohne Patellarückflächenersatz.

PROBLEM: Despite the great progress in knee arthroplasty made within the previous decade the problem of patellar resurfacing is still unsolved. MATERIAL AND METHODS: In a retrospective matched-pairs study in 62 patients with Natural Knee endoprostheses including one group with and another without patella resurfacing were compared. Results were assessed according to the American Knee Society Score and the patients subjective assessments. RESULTS: At an average follow-up time 2 years there were no differences in the clinical findings and the patients subjective opinions between both patient groups. However, patients with rheumatoid arthritis and patella resurfacing showed significantly better results in both categories than those rheumatoid patients without patella resurfacing. CONCLUSION: Summing our results up we cannot give a general advise towards the use of patella resurfacing in knee replacements. In patients with severe arthrosis of the femoro-patellar joint and in patients with rheumatoid arthritis, however, the patella replacement is considered to be the therapy of choice at our department.

[Experiences after 150 cartilage-bone-transplantations of the knee: a prospective analysis of the results]. / Erfahrungen nach 150 Knorpel-Knochen-Transplantationen (KKT) am Kniegelenk: Eine prospektive Ergebnisanalyse.

INTRODUCTION: To evaluate the clinical outcome of cartilage-bone-transplantations of the knee in patients with different indications, we studied the clinical results of 45 patients with a follow-up of 24 months after operation. PATIENTS AND METHODS: 29 male and 16 female patients with a mean age of 37.7 yrs (16-58 yrs) were included. Indications for operation were osteochondritis dissecans (OD) (n=13), limited arthritis (n=20), traumatic lesions (n=5) and retropatellar lesions (n=7). The results were evaluated by clinical score (McDermott Score; preoperatively, and 3, 6, 12, 24 months postoperatively), magnetic resonance imaging, and re-arthroscopy for most patients. RESULTS: 42 of 45 patients judged the operation as successful. The mean score value of all patients raised from 66.3 pts (out of 100 pts) preoperatively to 92.7 pts 24 months postoperatively. The results of the patients with circumscript arthritic lesions (62.9 pts. preoperatively vs. 91.5 pts. postoperatively) were comparable to those of the other patients. CONCLUSION: We conclude that cartilage-bone-transplantation of the knee is a valuable procedure to improve joint function not only after OD or trauma, but also in joints with local arthritic lesions on condition that there is an adequate quality of the donor site.