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1.
J Mater Sci Mater Med ; 35(1): 40, 2024 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-39073605

RESUMEN

Bone infections are still a major problem in surgery. To avoid severe side effects of systemically administered antibiotics, local antibiotic therapy is increasingly being considered. Using a pressure-based method developed in our group, microporous ß-TCP ceramics, which had previously been characterized, were loaded with 2% w/v alginate containing 50 mg/mL clindamycin and 10 µg/mL rhBMP-2. Release experiments were then carried out over 28 days with changes of liquid at defined times (1, 2, 3, 6, 9, 14, 21 and 28d). The released concentrations of clindamycin were determined by HPLC and those of rhBMP-2 by ELISA. Continuous release (anomalous transport) of clindamycin and uniform release (Fick's diffusion) of BMP-2 were determined. The composites were biocompatible (live/dead, WST-I and LDH) and the released concentrations were all antimicrobially active against Staph. aureus. The results were very promising and clindamycin was detected in concentrations above the MIC as well as a constant rhBMP-2 release over the entire study period. Biocompatibility was also not impaired by either the antibiotic or the BMP-2. This promising approach can therefore be seen as an alternative to the common treatment with PMMA chains containing gentamycin, as the new composite is completely biodegradable and no second operation is necessary for removal or replacement.


Asunto(s)
Antibacterianos , Materiales Biocompatibles , Proteína Morfogenética Ósea 2 , Clindamicina , Staphylococcus aureus , Antibacterianos/farmacología , Antibacterianos/química , Antibacterianos/administración & dosificación , Proteína Morfogenética Ósea 2/química , Proteína Morfogenética Ósea 2/farmacocinética , Clindamicina/administración & dosificación , Clindamicina/química , Clindamicina/farmacocinética , Humanos , Materiales Biocompatibles/química , Staphylococcus aureus/efectos de los fármacos , Cinética , Fosfatos de Calcio/química , Animales , Ensayo de Materiales , Proteínas Recombinantes/química , Cerámica/química , Factor de Crecimiento Transformador beta , Alginatos/química , Implantes Absorbibles , Pruebas de Sensibilidad Microbiana
2.
Arch Orthop Trauma Surg ; 143(11): 6719-6729, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37592159

RESUMEN

PURPOSE: The ambition of the research group was to develop a sensor-based system that allowed the transfer of results with strain sensors applied to the knee joint. This system was to be validated in comparison to the current static mechanical measurement system. For this purpose, the internal rotation laxity of the knee joint was measured, as it is relevant for anterolateral knee laxity and anterior cruciate ligament (ACL) injury. METHODS: This is a noninvasive measurement method using strain sensors which are applied to the skin in the course of the anterolateral ligament. The subjects were placed in supine position. First the left and then the right leg were clinically examined sequentially and documented by means of an examination form. 11 subjects aged 21 to 45 years, 5 women and 6 men were examined. Internal rotation of the lower leg was performed with a torque of 2 Nm at a knee flexion angle of 30°. RESULTS: Comparison of correlation between length change and internal knee rotation angle showed a strong positive correlation (r = 1, p < 0.01). Whereas females showed a significant higher laxity vs. males (p = 0.003). CONCLUSIONS: The present study showed that the capacitive strain sensors can be used for reproducible measurement of anterolateral knee laxity. In contrast to the previous static systems, a dynamic measurement will be possible by this method in the future.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Masculino , Humanos , Femenino , Rango del Movimiento Articular , Cadáver , Inestabilidad de la Articulación/diagnóstico , Fenómenos Biomecánicos , Articulación de la Rodilla , Lesiones del Ligamento Cruzado Anterior/diagnóstico
3.
Arch Orthop Trauma Surg ; 142(10): 2839-2847, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34870728

RESUMEN

PURPOSE: The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL. STUDY DESIGN: Cross-sectional study, Level of evidence III. METHODS: In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05). RESULTS: 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78). CONCLUSION: Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Estudios Transversales , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Rango del Movimiento Articular , Rotura/cirugía
4.
J Arthroplasty ; 36(1): 379-386, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32826141

RESUMEN

BACKGROUND: Computed tomography (CT) scan is the standard for assessment of femoral torsion. This observational study was conducted to evaluate the comparability of the EOS radiation dose scanning system (EOS imaging, Paris, France) and the CT scan in patients with suspected torsional malalignment of the femur. METHODS: Patients with suspected torsional malalignment of the femur were included in a study for surgical planning. The primary endpoint was to compare the 3-dimensional radiological (EOS) imaging system with the CT scan to determine femoral anteversion (AV) angle. Three independent raters performed measurements. Comparability of CT scan and EOS values was assessed by Pearson correlation, t test, interobserver reliability, and intraobserver reliability (Cronbach alpha). RESULTS: About 34 femora were examined. Interobserver reliability/intraobserver reliability was 0.911 of 0.955 for EOS and 0.934 of 0.934 for CT scan. EOS system revealed an AV angle of 12.2° ± 10.0° (-15.0° to 32.0°). CT examinations showed an AV angle of 12.6° ± 9.2° (-3.2° to 35.6°). About 11 hips featured physiological AV, 14 hips showed decreased AV (<10°) or retroversion (<0°), and 9 hips showed increased AV (>20°). Overall, a strong Pearson correlation of τ = 0.855 and a highly significant correlation in the t test for both methods was seen. In patients with decreased AV, retroversion, or increased AV, Pearson correlation only resulted in a moderate/low correlation of τ = 0.495 and τ = 0.292. The t test showed no significant correlation at malrotation. CONCLUSION: In torsional malalignment, EOS does not have correlation with CT measurements. In contrast to CT scan, EOS allows femoral torsion measurement independent of legs' positioning.


Asunto(s)
Fémur , Tomografía Computarizada por Rayos X , Fémur/diagnóstico por imagen , Francia , Humanos , Examen Físico , Reproducibilidad de los Resultados
5.
Arthroscopy ; 36(2): 556-557, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32014184

RESUMEN

Double-bundle (DB) reconstruction of the anterior cruciate ligament was favored for several years. However, recent studies increasingly show that this technique does not provide a clear advantage over the less-invasive single-bundle technique. Unfortunately, the graft fails relatively often after ACL reconstruction. Postoperative communication of the bone tunnels through bone tunnel widening is possible. Since 2 drill channels are created in the DB technique, femoral as well as tibial, it is assumed that this technique may cause problems during revision. So, in part, revision may require a 2-step procedure with bone graft filling of the tunnels as the first step. It is important that surgeons with experience using DB publish their revision strategies and experiences.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Fémur/cirugía , Humanos , Tibia/cirugía
6.
BMC Musculoskelet Disord ; 20(1): 343, 2019 Jul 27.
Artículo en Inglés | MEDLINE | ID: mdl-31351457

RESUMEN

BACKGROUND: Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. METHODS: Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. RESULTS: Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). CONCLUSIONS: Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. TRIAL REGISTRATION: Institutional Review Board University of Munich (LMU), Trial Number 507-14.


Asunto(s)
Artroscopía , Articulación del Codo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Intraarticulares/cirugía , Fracturas del Radio/cirugía , Adulto , Tornillos Óseos , Articulación del Codo/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Humanos , Fracturas Intraarticulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Fracturas del Radio/diagnóstico por imagen , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven , Lesiones de Codo
7.
Arthroscopy ; 35(3): 1004-1005, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30827420

RESUMEN

Systematic reviews now play a key role in evidence-based medicine, summarizing empirical findings from evaluated studies on a specific problem and examining the variability of those. These reviews help scientists integrate and evaluate relevant information in their research and support practitioners in decision-making processes. Since the early years of the current century, there has been a debate as to whether double-bundle or single-bundle reconstruction of the anterior cruciate ligament will better protect the knee. An essential aspect in the general indication of ligament reconstruction of the knee joint is the aim to prevent or at least to slow down the development process of osteoarthritis. At present, most clinical measures show no difference in outcome between single-bundle and double-bundle anterior cruciate ligament reconstruction. Systematic review of the literature investigating development of knee osteoarthritis after single-bundle and double-bundle anterior cruciate ligament reconstruction also shows no difference in outcome for this very important measure.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Osteoartritis de la Rodilla , Ligamento Cruzado Anterior/cirugía , Humanos , Articulación de la Rodilla/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Arch Orthop Trauma Surg ; 139(3): 383-391, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30656476

RESUMEN

INTRODUCTION: Arthrofibrosis (AF) is the result of increased cell proliferation and synthesis of matrix proteins (collagen I, III, and VI). Especially after invasive knee surgery, e.g., ligament reconstruction or knee replacement, abnormal fibroblast proliferation with pathological periarticular fibrosis can be observed leading to severely limited joint motion. The pathogenesis of AF is currently not fully understood. The present work aims to determine pathogenic factors. MATERIALS AND METHODS: A descriptive, histological and immunohistochemical comparative study was performed on tissue samples of 14 consecutive patients undergoing arthrolysis for joint stiffness due to AF. Seven human autopsy specimens served as control. Samples were stained for expression of relevant markers such as CD68, α-smooth muscle actin (ASMA), beta-catenin, BMP-2 and examined for the histological grade of AF (cell-rich versus cell-poor) and compared to a control. Furthermore, a microscopic evaluation of the samples for cell differentiation and number was performed. RESULTS: Tissue sections of cell-rich fibrosis showed a significantly higher expression of CD68 compared to the control with less than 10% of CD68 positive cells (p = 0.002). In cell-poor fibrosis no statistically significant difference was obvious (p = 0.228). Expression of ASMA in synovia, vessels, cell-rich and cell-poor fibrosis showed median values of 2.00 in the AF group and 1.75 in the control. Both groups differed significantly (p = 0.003). AF tissue showed a significantly difference in expression of ß-catenin (p < 0.001) compared to the control. The overall difference between AF and control group in expression of BMP-2 was also statistically significant (p = 0.002). CONCLUSIONS: Expression of CD68, ASMA, beta-catenin and BMP-2 is significantly increased in AF tissue samples. Based on presented findings, histological evaluation and immunohistochemical assessment of CD68, ASMA, ß-catenin and BMP-2 expression may proof useful to diagnose AF and to analyze AF activity.


Asunto(s)
Fibrosis , Artropatías , Articulación de la Rodilla , Biomarcadores , Proteína Morfogenética Ósea 2 , Estudios de Cohortes , Fibrosis/diagnóstico , Fibrosis/metabolismo , Fibrosis/patología , Humanos , Inmunohistoquímica , Artropatías/diagnóstico , Artropatías/metabolismo , Artropatías/patología , Articulación de la Rodilla/química , Articulación de la Rodilla/metabolismo , Articulación de la Rodilla/patología , beta Catenina
9.
Arthroscopy ; 34(9): 2647-2653, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29937346

RESUMEN

PURPOSE: To compare anatomic single-bundle (SB) with double-bundle (DB) anterior cruciate ligament reconstruction (ACL-R) and to evaluate the respective clinical outcome results. METHODS: In a prospective randomized study, 64 patients were included and separated into 2 groups. Anatomic SB and DB ACL-Rs were performed with hamstring tendons. Five years after surgery, the follow-up (FU) examination comprised International Knee Documentation Committee (IKDC) 2000, Laxitester (ORTEMA Sport Protection, Markgroeningen, Germany) measurement, and radiograph evaluation. Power calculation was performed to achieve a 95% confidence interval and 80% power on the base of 7-point IKDC subjective difference between the groups. RESULTS: A total of 53 patients (83% FU) were examined at 63.2 ± 4.7 months after surgery: 28 patients in the DB group and 25 patients in the SB group. IKDC subjective (SB: 92.8 ± 6.2, DB: 91.6 ± 7.1; P = .55) and objective scores (grade A SB/DB 20%/25%, B SB/DB 72%/57%, C SB/DB 8%/18%, D SB/DB 4%/0%; P = .45) showed no differences comparing both groups. The Laxitester measurements showed no significant difference in regard to anterior-posterior translation in neutral, internal, and external rotation or to rotation angles (P = .79). No difference was seen between the groups regarding osteoarthritic changes and tunnel widening. CONCLUSIONS: At the 5-year FU, no advantage for either the DB or SB technique in ACL-R can be seen with regard to patient-related and objective outcome measures. LEVEL OF EVIDENCE: Level I, prospective randomized controlled clinical trial.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Tendones Isquiotibiales/trasplante , Adulto , Artrometría Articular , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiología , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Radiografía
10.
Arch Orthop Trauma Surg ; 138(11): 1583-1590, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30182141

RESUMEN

INTRODUCTION: The differentiation between stiff-knee and low-grade periprosthetic joint infection (PJI) is the current diagnostic challenge in total knee (TKA) revision arthroplasty. The aim of this study was to investigate the additional value of dry biopsies, compared to wet biopsies, in patients presenting with knee stiffness following primary TKA. MATERIALS AND METHODS: Single center, prospective observational study. Consecutive patients with joint stiffness of unknown origin following primary TKA were enrolled. Patient assessment followed the diagnostic standard algorithm. During diagnostic arthroscopy, synovial fluid (synovial WBC, PMN%) and five dry biopsies (dry) were collected. Then fluid was infused and another five microbiology (wet) and five histological biopsies gathered, all from identical locations. The primary outcome parameter was the difference between the pathogens in wet and dry biopsies. RESULTS: 71 patients (61% females, 67 ± 10 years) were eligible. Preoperative blood serology mean CRP (0.7 ± 1.5 mg/dl; p = 0.852), WBC (6.6 ± 1.7 G/l; p = 0.056), and synovial fluid mean WBC (1639 ± 2111; p = 0.602), PMN% (38 ± 28; p = 0.738) did not differ between patients with negative, positive wet or dry biopsies. The histology was in 11% positive (p = 0.058). In 32% at least one pathogen was detected, 48% from wet, 44% from dry biopsies. An inhomogeneous distribution was found. Cutibacterium acnes (100%) was solely found in wet, Micrococcus luteus (75%), Staphylococcus capitis (67%), and Micrococcus lylae (100%) were predominantly found in dry biopsies. Additional dry biopsies increased the pathogen detection rate by 49%. CONCLUSION: The addition of dry biopsies to the current standard diagnostic algorithm for PJI increased the pathogen detection rate by 49%.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroscopía/métodos , Biopsia/métodos , Articulación de la Rodilla/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Anciano , Algoritmos , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/microbiología , Líquido Sinovial/microbiología
11.
Arthroscopy ; 33(2): 408-414, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27789072

RESUMEN

PURPOSE: The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR). METHODS: All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit. International Knee Documentation Committee (IKDC) 2000 subjective and objective, Lysholm score, and x-ray evaluation were documented. Statistical analysis and power calculation were performed (P < .05). RESULTS: One hundred forty-one patients (follow-up, 71%) were examined at a mean of 18.7 ± 2.6 years after arthroscopic arthrolysis. Mean IKDC 2000 score was 79.49 ± 14.32. IKDC objective was normal in 0%, nearly normal in 6%, abnormal in 56%, and severely abnormal in 38%. One hundred percent of patients showed more than grade II osteoarthritis. ROM improvement after arthrolysis did not change significantly compared with midterm results (t = 4.5 years). Patients with persisting motion deficits (P = .02) and after medial meniscus resection (P < .001) at time of ACLR showed significantly greater progression of osteoarthritis in comparison with patients without these additional disorders. In case of arthrolysis later than 1 year after ACLR, a more severe osteoarthritis grade (4% vs 20% grade III; P = .038) and a lower jump distance (IKDC: 61% A, 25% B vs 39% A, 41% B; P = .028) were obvious compared with patients who underwent arthrolysis within the first year after ACLR. CONCLUSIONS: Long-term motion improvement can be achieved by arthrolysis. Persistent loss of motion resulted in a higher degree of osteoarthritis in the study population. Early intervention seems advisable as patients with arthrolysis later than 1 year after index surgery reached worse IKDC objective grading. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Artroscopía/métodos , Fibrosis/cirugía , Artropatías/cirugía , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fibrosis/etiología , Estudios de Seguimiento , Humanos , Artropatías/etiología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/clasificación , Osteoartritis de la Rodilla/etiología
12.
Knee Surg Sports Traumatol Arthrosc ; 25(2): 445-453, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27234381

RESUMEN

PURPOSE: To prospectively evaluate the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures and to test for possible relationships between associated meniscal lesions and patient demographics or injury characteristics. METHODS: A prospective multicenter study was conducted to arthroscopically assess the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures between 04/2014 and 10/2015. Patient demographics and injury characteristics were assessed preoperatively. The presence of a meniscal injury was evaluated arthroscopically and characterized according to tear type and location (Cooper classification). Patients with and without meniscal injuries were compared with regard to sex, age, height, weight, BMI, type of injury, mechanism of injury, time to surgery, Tanner stage, sexual maturity (prepubescent vs. pubescent), and modified Meyers and McKeever classification. RESULTS: A total of 54 consecutive patients (65 % males, mean age: 12.5 ± 3.2 years) were enrolled. Meniscal injury were found in 20 patients (37 %). The lateral meniscus was involved in 18 patients (90 % of all meniscus injuries) and the medial meniscus in 2 patients (10 % of all meniscus injuries). The most common tear pattern was a longitudinal tear of the posterior horn of the lateral meniscus (30 % of all meniscus injuries) and the second most common tear was a root detachment of the anterior horn of the lateral meniscus (20 % of all meniscus injuries). Higher age, advanced Tanner stage, and pubescence were significantly associated with an accompanying meniscal injury. CONCLUSION: Meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures must be expected in almost 40 %, with a higher prevalence with increasing age and sexual maturity. With regard to the clinical relevance, the results of the present study argue in favor for magnetic resonance imaging prior to surgery in every patient with a suspected tibial eminence fracture and for an arthroscopic approach to adequately diagnose and treat meniscal injuries. LEVEL OF EVIDENCE: II.


Asunto(s)
Fracturas de la Tibia/cirugía , Lesiones de Menisco Tibial/fisiopatología , Lesiones de Menisco Tibial/cirugía , Adolescente , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Artroscopía/métodos , Niño , Femenino , Alemania/epidemiología , Humanos , Imagen por Resonancia Magnética , Masculino , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos , Fracturas de la Tibia/epidemiología , Lesiones de Menisco Tibial/epidemiología
13.
BMC Biotechnol ; 16(1): 44, 2016 05 20.
Artículo en Inglés | MEDLINE | ID: mdl-27206764

RESUMEN

BACKGROUND: Tissue engineering and bone substitutes are subjects of intensive ongoing research. If the healing of bone fractures is delayed, osteoinductive materials that induce mesenchymal stem cells (MSCs) to form bone are necessary. The use of Bone Morphogenetic Protein - 2 is a common means to enhance effectiveness and accelerate the healing process. A delivery system that maintains and releases BMP biological activity in controlled fashion at the surgical site while preventing systemic diffusion (and thereby the risk of undesirable effects by controlling the amount of protein implanted) is essential. In this study, we aimed to test a cylindrical TCP-scaffold (porosity ~ 40 %, mean pore size 5 µm, high interconnectivity) in comparison to BMP-2. Recombinant human BMP-2 was dissolved in different hydrogels as a carrier, namely gelatin and alginate cross-linked with CaCl2-solution, or a solution of GDL and CaCO3. FITC-labeled Protein A was used as a model substance for rhBMP-2 in the pre-trials. For loading, the samples were put in a flow chamber and sealed with silicone rings. Using a directional vacuum, the samples were loaded with the alginate-BMP-2-mixture and the loading success monitored by observing changes in a fluorescent dye (FITC labeled Protein A) under a fluorescence microscope. A fluorescence reader and ELISA were employed to measure the release. Efficacy was determined in cell culture experiments (MG63 cells) via Live-Dead-Assay, FACS, WST-1-Assay, pNPP alkaline phosphatase assay and confocal microscopy. For statistical analysis, we calculated the mean and standard deviation and carried out an analysis of variance. RESULTS: Directional vacuum makes it possible to load nearly 100 % of the interconnected micropores with alginate mixed with rhBMP-2. Using alginate hardened with CaCl2 as a carrier, BMP-2's release can be decelerated significantly longer than with other hydrogels - eg, for over 28 days. The effects on osteoblast-like cells were an increase of the growth rate and expression of alkaline phosphatase while triggering no toxic effect. CONCLUSION: The rhBMP-2-loaded microporous TCP scaffolds possess proliferative and osteoinductive potential. Alginate helps to lower the local growth factor dose below the cytotoxic limit, and allows the release period to be lengthened by at least 28 days.


Asunto(s)
Proteína Morfogenética Ósea 2/administración & dosificación , Fosfatos de Calcio/química , Preparaciones de Acción Retardada/química , Hidrogeles/química , Osteoblastos/fisiología , Andamios del Tejido , Factor de Crecimiento Transformador beta/administración & dosificación , Proteína Morfogenética Ósea 2/química , Sustitutos de Huesos/síntesis química , Línea Celular , Preparaciones de Acción Retardada/administración & dosificación , Difusión , Diseño de Equipo , Humanos , Ensayo de Materiales , Osteoblastos/efectos de los fármacos , Osteogénesis/efectos de los fármacos , Porosidad , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/química , Factor de Crecimiento Transformador beta/química
14.
Arthroscopy ; 32(1): 34-42, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26321112

RESUMEN

PURPOSE: To compare anatomic single-bundle (SB) versus double-bundle (DB) anterior cruciate ligament (ACL) reconstruction and to determine possible differences in clinical outcomes. METHODS: In this prospective randomized study, 64 patients were divided into 2 equal groups. Anatomic SB and DB ACL reconstructions were performed using hamstring tendons. A follow-up examination 2 years after surgery comprised International Knee Documentation Committee (IKDC) 2000 assessment, Laxitester (ORTEMA Sport Protection, Markgröningen, Germany) measurement of anteroposterior translation regarding rotational stability, and radiographic evaluation. Statistical analysis and power calculation were performed (P < .05). RESULTS: We examined 62 patients at a mean of 26 months (range, 23.3 to 32.7 months) after surgery. IKDC subjective and objective scores showed no significant differences when both groups were compared. The Laxitester measurements showed no significant differences regarding anteroposterior translation in the neutral position, internal rotation, and external rotation. However, there was a significant improvement in rotational laxity in external rotation in the DB group (P = .02). No differences were seen between the groups regarding osteoarthritic changes and tunnel widening. CONCLUSIONS: There were no differences in IKDC subjective and objective scores between patients who underwent anatomic SB ACL reconstruction and those who underwent anatomic DB ACL reconstruction. LEVEL OF EVIDENCE: Level I, prospective, randomized controlled clinical trial.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Artroscopía , Tendones/trasplante , Adulto , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Masculino , Evaluación del Resultado de la Atención al Paciente , Estudios Prospectivos , Rotación
15.
Knee Surg Sports Traumatol Arthrosc ; 24(10): 3200-3211, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26685696

RESUMEN

PURPOSE: Revision of total knee arthroplasty (TKA) is growing rapidly all over the world. The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation. METHODS: Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model. RESULTS: Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up <60 months. When follow-up period extend to more than 60 months, the same likelihood was observed as 0.98, 0.96, 0.97 and 0.98, respectively. There was no significant difference in any of these comparisons of survival-related indices. CONCLUSION: There was no significant difference in failure for any reason, reoperation, aseptic loosening and infection between revision TKA with cemented or cementless stem fixation. Based on the available literature, no superiority of any type of stem fixation was found. If follow-up period was neglected, aseptic loosening would be the leading reason for pain and dysfunction of patient undertaken revision TKA. LEVEL OF EVIDENCE: Systematic review of Level IV, Therapeutic studies, Level IV.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Cementos para Huesos , Prótesis de la Rodilla , Humanos , Falla de Prótesis , Reoperación
16.
J Arthroplasty ; 30(1): 46-9, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25304937

RESUMEN

In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Deportes , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento
17.
Knee Surg Sports Traumatol Arthrosc ; 22(5): 1156-62, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-23807029

RESUMEN

PURPOSE: A controversial discussion is held on using stabilizing knee braces after anterior cruciate ligament (ACL) surgery. The current study investigated the influence of a stabilizing knee brace on results after ACL reconstruction using patellar tendon autografts. METHODS: A prospective randomized study was started including 64 patients divided into two equal groups and treated with or without a stabilizing knee brace for 6 weeks post-operatively. A follow-up examination 4 years after operation comprised IKDC 2000, KT1000 measurement, a visual analogue pain scale (VAS; scores 0-10) and radiographic evaluation. The t test for independent and paired samples and the Pearson's Chi-square test were used for statistical analysis (p < 0.05). The primary endpoint was the difference in IKDC classification. RESULTS: Eighty-one per cent of the patients were examined 4 years post-operatively. IKDC 2000 subjective (brace group 90.5 ± 8.9, braceless group 93.2 ± 6.1) and objective results (brace A 30%, B 56%, C 16%; braceless A 32%, B 48%, C 20%) and instrumental measurement of anteroposterior laxity with KT1000 (brace 0.6 ± 2.4 mm, braceless 1.8 ± 3.4 mm) showed no significant differences. VAS pain results were significantly better in the braceless group at 1.0 ± 1.2 versus 1.9 ± 1.4 under sports activity or heavy physical work (p = 0.015). There were no radiographic differences concerning osteoarthritic findings and tunnel widening between the groups. CONCLUSION: Post-operative treatment with a stabilizing knee brace after ACL replacement showed no advantage over treatment without a brace at 4-year follow-up. The use of a knee-stabilizing brace after isolated ACL reconstruction with autologous patellar tendon graft is not recommended. LEVEL OF EVIDENCE: II.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Tirantes , Traumatismos de la Rodilla/rehabilitación , Adulto , Anciano , Ligamento Cruzado Anterior/cirugía , Femenino , Humanos , Traumatismos de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/trasplante , Estudios Prospectivos , Trasplante Autólogo , Resultado del Tratamiento , Adulto Joven
18.
Int Orthop ; 38(7): 1379-86, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24604621

RESUMEN

PURPOSE: The aim of this study was to evaluate laxity in knees with pre-operative (preop) valgus alignment compared to knees with pre-operative varus alignment after total knee arthroplasty (TKA). METHODS: This was a retrospective study including 81 patients, with six years follow-up, for pre-operative valgus- or varus alignment of the leg. All patients had been supplied with the same cruciate retaining (CR) TKA with rotating platform. Clinical findings were assessed by KSS, OKS and IKDC 2000 score. Rotational knee laxity was evaluated by a validated instrument (Laxitester®) with 2 Nm torque in 30° flexion. Collateral ligament laxity was tested manually in 30° flexion with a bending moment of approximately 5 Nm. Biomechanical results were compared to the contralateral side. RESULTS: Thirty-one patients had a preop valgus alignment of 8.96° and 50 patients a varus leg axis of 4.99° in the mean. In the preop valgus knees rotational analysis showed an increased laxity of 10.7° compared to preop varus knees (p = 0.001). There was no significant difference in medial (valgus 2.6 mm, varus 2.5 mm) and lateral (valgus 2.8 mm, varus 2.7 mm) laxity. KSS and OKS showed no significant differences in the follow-up results. In the IKDC 2000 objective score 50 % of the preop varus knees and 25.8 % of the preop valgus knees were classified as nearly normal. The difference in the IKDC objective was highly significant (p < 0.001). CONCLUSION: Preop valgus knees show a significantly increased rotational laxity but no increased collateral ligament laxity compared to pre-operative varus knees six years after TKA with rotating platform. There is a significant difference in IKDC objective.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Inestabilidad de la Articulación/diagnóstico , Prótesis de la Rodilla/efectos adversos , Anciano , Desviación Ósea/cirugía , Ligamentos Colaterales/fisiopatología , Ligamentos Colaterales/cirugía , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Rotación
19.
Biomedicines ; 12(8)2024 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-39200264

RESUMEN

The aim of the study was to compare conventional sintering with additive manufacturing techniques for ß-TCP bioceramics, focusing on mechanical properties and biocompatibility. A "critical" bone defect requires surgical intervention beyond simple stabilization. Autologous bone grafting is the gold standard treatment for such defects, but it has its limitations. Alloplastic bone grafting with synthetic materials is becoming increasingly popular. The use of bone graft substitutes has increased significantly, and current research has focused on optimizing these substitutes, whereas this study compares two existing manufacturing techniques and the resulting ß-TCP implants. The 3D printed ß-TCP hybrid structure implant was fabricated from two components, a column structure and a freeze foam, which were sintered together. The conventionally fabricated ceramics were fabricated by casting. Both scaffolds were characterized for porosity, mechanical properties, and biocompatibility. The hybrid structure had an overall porosity of 74.4 ± 0.5%. The microporous ß-TCP implants had a porosity of 43.5 ± 2.4%, while the macroporous ß-TCP implants had a porosity of 61.81%. Mechanical testing revealed that the hybrid structure had a compressive strength of 10.4 ± 6 MPa, which was significantly lower than the microporous ß-TCP implants with 32.9 ± 8.7 MPa. Biocompatibility evaluations showed a steady increase in cell proliferation over time for all the ß-TCP implants, with minimal cytotoxicity. This study provides a valuable insight into the potential of additive manufacturing for ß-TCP bioceramics in the treatment of bone defects.

20.
Front Bioeng Biotechnol ; 12: 1364536, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38707504

RESUMEN

This study was designed to provide information on how the menisci change over the course of osteoarthritis, particularly with regard to their mechanical properties. The aim was to determine the difference between healthy menisci (fresh frozen meniscal transplants) and menisci harvested during total knee arthroplasty. The latter allows the grading of age-related and osteoarthritic changes in the menisci on macroscopic and microscopic levels. A total of 10 menisci from arthritic knee joints (medial) harvested during total knee arthroplasty were used and compared with 10 medial fresh frozen meniscal transplants. The mechanical measurements were carried out on a Mach-1 testing machine using indentation testing to determine the instantaneous modulus and the thickness of the menisci. The specimens were then embedded in paraffin, sectioned on a microtome, and stained with hematoxylin-eosin and safranin-O. All measurements were divided into the anterior horn, pars intermedia, and posterior horn. There was no significant difference in the instantaneous modulus for the posterior horn in the fresh frozen menisci with 0.27 ± 0.1 MPa compared to the arthritic menisci with 0.18 ± 0.03 MPa. No significant difference could be determined for the meniscus thicknesses. There was a significant difference in the safranin-O staining. There were also significant differences in the Pauli score: the arthrosis menisci showed a sum score that was, on average, four times higher than the sum score of the fresh frozen menisci. In the present study, it could be shown very well that there are significant differences in the mechanical properties as well as in the macroscopic and histopathological scores, such as the Pauli score, between the fresh frozen meniscus allografts considered healthy and osteoarthritic menisci resulting from total knee arthroplasty. With a degradation score of 3 (Pauli), the instantaneous modulus was reduced by more than 50% compared to healthy controls. More importantly, however, the fresh frozen menisci only show a grade 2 when converting the sum values into grades, where a grade 2 indicates slight degeneration. This is interesting because fresh frozen meniscus transplants were always considered healthy in previous publications and should, therefore, actually have a grade 1.

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