[Evaluation of cartilage degeneration by near infrared spectroscopy (NIRS): methodical description and systematic literature review]. / Bestimmung des Degenerationsgrads am hyalinen Gelenkknorpel durch Nah-Infrarot-Spektroskopie (NIRS): Methodenbeschreibung und Literaturübersicht.

Damage to hyaline cartilage is the most important pathophysiological tool in the development of osteoarthritis. Cartilage lesions are the most frequent pathological findings during arthroscopic operations. Arthroscopies as well as magnetic resonance tomography are gold standards for detection of cartilage lesions. But the arthroscopic evaluation of cartilage lesions is descriptive and subjective only. The surgeon is able to differentiate between intact cartilage surface, softening, superficial or deep fissure or flake and finally a complete defect. In routine arthroscopy the grading mostly is made by use of different scores [e.g. ICRS (International Cartilage Repair Society), Outerbridge, Insall, Jäger-Wirth or others]. Because the arthroscopic evaluation is subjective the reliability of this method is poor. Spectroscopic methods are established for evaluation of different tissue diseases in different indications. NIRS (near infrared spectroscopy) has become an important method for medical diagnostics in the last years. NIR is very energy-rich and suitable for glass fibre transport without relevant reduction. Insofar this technology may be ideal for endoscopic procedures. Our systematic literature review reveals that NIRS is a sufficient method for an objective diagnosis of cartilage lesions. In the current work we demonstrate an NIRS-based device for intraoperative, real-time cartilage evaluation. Furthermore, we discuss the possible clinical consequences from such measurements.

[Cost analysis of implant-free replacement of anterior cruciate ligament]. / Kostenanalyse für den implantatfreien vorderen Kreuzbandersatz.

Replacement of the anterior cruciate ligament (ACL) is presently routinely carried out with autologous transplantation of the ligamentum patellae (LP), semintendinosus-gracilis (SGS) or quadriceps (QS) tendons. The anatomical positioning of the drilling canals, transplant fixation, complication rate, revision aspects as well as economic aspects are still under discussion. Fixation of the transplant can be carried out mechanically with various anchoring systems or using biological implant-free healing (free of cost). The compulsory and private health insurance companies as well as staff medical insurance associations guarantee a constant remuneration according to the EBM (uniform evaluation standard), GOA (scale of fees for physicians) or UV-GOA (accident insurance scale of fees for physicians). At present all health insurances accept the costs for implantations in outpatient areas (minus 25 Euro own contribution for compulsory health insurance). For inpatient treatment remuneration is according to the flat-rate scale (diagnosis-related groups). Costs for implants, which are increasing over the years, diminish the economic result in this case. The technique of implant-free replacement of ACLs is cheaper, with fewer complications and achieves functional results for fixation of the transplant which are comparable to techniques with implants. This also applies to the double bundle technique. Implant-free replacement of ACLs with the patellar tendon is a suitable, uncomplicated operation technique with comparably low costs and belongs to the state of the art according to Hertel, Petersen and other authors. This method already has a valuable place in surgery of the ACL.

[Implant-free anterior cruciate ligament reconstruction with diamond instruments. A biological and anatomic method for every ligament transplantation]. / Fremdmaterialfreier Kreuzbandersatz mit Diamanthohlschleifen. Eine biologische und anatomische Methode für alle Sehnentransplantate.

UNLABELLED: Hamstring and patella tendons are usually used for anterior cruciate ligament (ACL) reconstruction and fixed with foreign material, partially executed far from the original point of insertion. Besides the biomechanical questions bone defects are a severe problem in cases of revision. We developed a biological method with diamond cutting instruments for graft fixation with bone dowels near the native insertion. The graft is tensioned and fixed in 120 degrees knee flexion and is self-adapting in extension. The technique has been used in a large number of cases during a prospective study with a follow-up of 10 years for patella tendon and 4 years for hamstring tendon grafts. In this investigation 124 patients with bone-patellar tendon-bone (BPTB) grafts showed an International Knee Documentation Committee (IKDC) score A/B in 87% after a mean follow-up of 9.6 years, a Lachman test (maximum side-to-side difference) of 1.38+/-0.93 mm and a negative pivot shift test in 91% of the cases. Of the 147 patients with hamstring tendon grafts 89% had an IKDC score A/B after a mean follow-up of 4.3 years, a Lachman test of 1.14+/-0.76 mm and no pivot shift in 90% of the cases. The Tegner activity score decreased by -1.8 in both groups. CONCLUSION: This method allows a reliable biological press-fit fixation for every kind of graft near the original point of insertion, preventing bone defects, allowing early intensive rehabilitation and low costs.

Failure of metal-backed uncemented patellar components. Report on 3 cases.

We report 3 cases of metal-backed patellar component failure of the Microloc total condylar knee, which was implanted in 51 cases. The main reason for failure was the design of the patellar and femoral components in combination with flexion of more than 100 degrees.

[Are non-radical interventions in giant cell tumors justifiable?]. / Sind unradikale Eingriffe bei Riesenzelltumoren vertretbar?

Eleven patients treated for giant cell tumors between 1966 and 1988 were followed up. Excochleations, i.e., thorough curettage and filling with spongiosa, were performed as a primary procedure in nine cases. Of these, en-bloc excision with Juvara plasty and amputation of the distal portion of the lower leg were necessary in one case each a week after confirmation of malignant degenerations. The mean duration of follow-up was 10.5 years; two recurrences were found among seven excochleations and one among four excisions. Taking function disturbances and their avoidance into account, excochleation and spongiosa filling appear justifiable as a form of primary therapy.

[Partial femur replacement: implanted without cement]. / Femurteilersatz: zementfrei implantiert.

The following indications are well accepted for subtotal femur replacement: 1. Malignoma of the hip region. 2. Pertrochanteric fractures. 3. Loosening of hip prosthesis in case of large bony defects. The common devices are implanted by use of bone cement,--we report on three cases, treated by cementless subtotal femoral replacements with bony ingrowth surface. The surface design imitates the structure of spongious bone. The mean observation time of our three patients is more than two years, no complaints are to be observed. By intensive permeation of bone in the surface structure we achieve a more advantageous biomechanical situation.