RESUMEN
INTRODUCTION: Rupture of the anterior cruciate ligament (ACL) has been surgically reconstructed mainly arthroscopically for many years. The long-propagated single bundle replacement was followed by recommendations for the anatomical double-bundle reconstruction. The aim of this study is the evaluation of clinical follow-up results in terms of function and stability after performing an ACL reconstruction with both the single bundle (SB) and the double bundle (DB) technique. METHODOLOGY: Eighty patients receiving ACL reconstruction were included (41 SB / 39 DB). The follow-up period was 17.4 months. To assess knee joint stability, anteroposterior translation and rotation translation were determined. In addition, arthrometric measurement and the implementation of standardized scores were performed. Data were statistically evaluated using the Pearson χ2 test and Fisher's exact test (pâ¯= 0.05). RESULTS: While the Lachman test in the SB group showed a significant (pâ¯= 0.032) greater stability of the knee joints, a higher stability of the knee joints in the DB group was documented by the anterior drawer test and the stability measurement with the rolimeter. In the DB group a significantly higher number of patients with local sensitivity deficits (pâ¯= 0.045) and paresthesia as well as a significantly higher active and passive flexion deficit were noted compared to the SB group (pâ¯= 0.09 / pâ¯= 0.038, respectively). CONCLUSION: Based on the results of this study it is currently not possible to give any recommendations regarding any operating procedure after a follow-up period of at least 12 months. However, there is evidence of a higher complication rate in the DB group. Clinically, these results should be considered in the evaluation of the indications.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Humanos , Articulación de la Rodilla , Rotación , Resultado del TratamientoRESUMEN
BACKGROUND: Complex procedures in knee surgery, such as anterior cruciate ligament (ACL) reconstruction with the double bundle technique are not specially recognized within the German diagnosis-related groups (G-DRG) system. Hence, the goal of the present study was to perform a cost unit calculation and evaluate how ACL reconstruction in single versus double bundle techniques is remunerated. PATIENTS AND METHODS: In 30 patients ACL reconstruction was performed with the single bundle technique (group A) and in 21 an anatomic double bundle reconstruction (group B) was performed. All costs including those for human resources, implants and materials, as well as general costs for administration and facilities were calculated. RESULTS: All cases entered one DRG category, the I30Z "complex procedures at the knee joint". Thus, the revenue in 2008 was 2,996.65 euro per case and in 2009 3,120.35 euro per case. Calculating all costs, the profit contributions in 2008 and 2009 were 592,42 euro and 716,12 euro, respectively for group A. However, in group B the profit contributions were 314,68 euro and 438,38 euro, respectively. CONCLUSION: Performing the double bundle technique for ACL reconstruction in a university hospital setting, significant cost reductions are needed to achieve the revenue generated by the single bundle technique. Additional changes of the relative weighting in the DRG are also necessary.
Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/economía , Ligamento Cruzado Anterior/cirugía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitales Universitarios/economía , Traumatismos de la Rodilla/economía , Traumatismos de la Rodilla/cirugía , Adolescente , Adulto , Reconstrucción del Ligamento Cruzado Anterior/estadística & datos numéricos , Niño , Femenino , Alemania/epidemiología , Hospitalización/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Traumatismos de la Rodilla/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Clinical examination of acute knee injury in childhood is often difficult and therefore magnetic resonance imaging (MRI) serves as an additional diagnostic tool. The aim of the present study was to evaluate on the one hand the indications for diagnostic arthroscopy and on the other hand the indications for MRI. METHODS: Of the children treated between 1990 and 1999, 87 (group 1) underwent arthroscopy after clinical examination. Between 2000 and 2006 (group 2) 83 patients were examined using MRI after clinical examination and 53 were subsequently submitted to arthroscopy. RESULTS: In group 1 the clinical diagnosis was verified by arthroscopy in 79%. In group 2 the clinical and arthroscopic diagnoses were consistent in 60% of the patients. The MRI diagnosis was correctly recognized for patella dislocation in all cases, for ligament injuries in 83% and for meniscus injuries in 56%. Due to the application of MRI before arthroscopy the fraction of diagnostic arthroscopies could be reduced from 22% to 13%. CONCLUSION: The number of diagnostic arthroscopies in childhood can be reduced by application of MRI.
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Artroscopía/métodos , Traumatismos de la Rodilla/diagnóstico , Imagen por Resonancia Magnética/métodos , Enfermedad Aguda , Adolescente , Niño , Preescolar , Femenino , Humanos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Lemierre's syndrome is a rare disease in young otherwise healthy people showing septic embolism in the lungs and peripheral vessels. We report the case of a 19-year-old male patient who presented initially with a phlegmon of the right palm and beginning septic shock. During the clinical course a subcutaneous abscess of the left shoulder, multiple lesions of the lungs and a pericardial abscess were identified and Lemierre's syndrome was diagnosed. In this case, positron emission tomography (PET) was revealed to be an appropriate instrument to determine the extent of the disease in a one step procedure.
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Absceso/diagnóstico , Articulación Acromioclavicular/patología , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/cirugía , Infecciones por Fusobacterium/diagnóstico , Infecciones por Fusobacterium/cirugía , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/cirugía , Procesamiento de Imagen Asistido por Computador , Tomografía de Emisión de Positrones , Embolia Pulmonar/diagnóstico , Choque Séptico/diagnóstico , Tomografía Computarizada por Rayos X , Absceso/cirugía , Articulación Acromioclavicular/cirugía , Antibacterianos/uso terapéutico , Terapia Combinada , Diagnóstico Diferencial , Progresión de la Enfermedad , Drenaje , Fluorodesoxiglucosa F18 , Fusobacterium necrophorum , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Enfermedades del Mediastino/diagnóstico , Enfermedades del Mediastino/cirugía , Metronidazol/uso terapéutico , Embolia Pulmonar/cirugía , Reoperación , Choque Séptico/cirugía , Síndrome , Adulto JovenAsunto(s)
Fracturas del Hombro , Factores de Edad , Anciano , Anciano de 80 o más Años , Placas Óseas , Femenino , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fijación Intramedular de Fracturas , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Osteoporosis/complicaciones , Factores de Riesgo , Factores Sexuales , Fracturas del Hombro/clasificación , Fracturas del Hombro/diagnóstico , Fracturas del Hombro/diagnóstico por imagen , Fracturas del Hombro/epidemiología , Fracturas del Hombro/etiología , Fracturas del Hombro/cirugía , Fracturas del Hombro/terapia , Tomografía Computarizada por Rayos XRESUMEN
Pigmented villonodular synovitis (PVNS) is a rare, strongly proliferative disease of the lining of thejoint, synovial bursa and tendon (synovial) sheath. If left untreated, it leads to severe destruction of the joint resulting in an early need for endoprosthetic replacement. The clinical signs are unspecific. Using the diagnostic gold standard MRI, the complete extent of PVNS can usually be determined non-invasively. Once histological confirmation has been obtained, radical tumor resection, synovectomy, possibly curettage, and postoperative irradiation must be applied.