[The correct tibial slope? Comparison of measuring methods]. / Der korrekte tibiale Slope? Messmethoden im Vergleich.

INTRODUCTION: From a biomechanical point of view, the tibial slope plays a significant role in relation to the loading of the ligament structures in the knee joint. Currently, there are various methods of measurement for the tibial slope, which makes it difficult to compare the measurement results obtained. These differences can be decisive factors for the indication and the extent respectively of the correction of the tibial slope. The aim of this work is to present the differences in results between the measurement methods, and to compare these with the posterior tibial slope (PTS). METHODS: By means of a comparative analysis, six measurement techniques for the tibial slope were examined. Using six parameters (correlation coefficient, range, deviation of the average slope value, correction coefficient, difference in the corrected measurements, range of the corrected measurements), these results were compared with the PTS. In this prospective study, the PTS was measured in 107 (49 male, 58 female, age 42.6 ± 23.4 years) strictly lateral plain radiological projections of the tibia with the talocrural joint in comparison with the measurement methods according to Han, Brazier, Moore and Harvey, Pietrini and LaPrade and a supratuberosity measurement. RESULTS: The posterior slope was observed at a mean value of 6.9° (±â€¯8.6°). Compared with the PTS, tibial slope values were increased in 55.5 % of all measurements examined and decreased in 42.4 %. In 2 % the values were identical to those of PTS. The deviations observed were significant at up to +2.9° (±â€¯1.7°) and -2.3° (±â€¯1.5°) respectively in comparison with the measured PTS (p < 0.001). 25.9 % of the results showed a slope value more than 2°too high and 17.6 % one less than -2° too low. Thus, in 43 % of the results clinically relevant results that were too high or too low were observed for the tibial slope compared with the PTS (p < 0.001). The correlation analyses showed very high linear connections with PTS (p < 0.001) for all methods, from r2 = 0.88 (in Moore and Harvey) up to r2 = 0.98 (in Han). The ranges varied between 13.90° (Moore and Harvey) and 18.30° (Han). CONCLUSION: Depending on the measurement method, the slope values obtained should be individually evaluated, in order to draw the correct clinical conclusions. In principle, the radiological assessment of the whole lower leg is essential, so that concomitant pathologies in the area of the entire tibia can be detected. In everyday clinical practice, the measurement according to Han et al., and thus a shorter X­ray projection, makes it possible to draw optimal conclusions about the PTS. LOE: Prospective diagnostic study, Level II.

Underutilization of deep brain stimulation for Parkinson's disease? A survey on possible clinical reasons.

BACKGROUND: Only 10% of the up to 15% of patients with advanced Parkinson's disease (PD) eligible for deep brain stimulation (DBS) are referred to specialized centers. This survey evaluated the reasons for the reluctance of patients and referring physicians regarding DBS. METHODS: Two different questionnaires containing multiple choice and open verbalized questions were developed, one for neurologists and one for patients with PD. The first questionnaire was sent to 87 neurologists in private practice in the catchment area of the authors' medical center, the second to patient support groups in the same region with the help of the German Parkinson Association. RESULTS: Of the addressed neurologists, 56.3% completed the questionnaire; 61.2% of them estimated the risk of intracerebral hemorrhage as the most severe complication at 4.3% on average; 30.6% were concerned about patients developing mood changes or depression after DBS. Only 16.3% felt unable to care for patients after DBS; 61.2% already had personal experience with patients after DBS and reported good clinical outcome in 90.0% of patients. Although 87.8% claimed to know the specific criteria for DBS, only 40.8% could actively describe them. Only 14.0% could state each of the three main criteria. Of the 46 patients, 88.1% completing the questionnaire had obtained information on DBS from regional patient organizations and 54.8% also from a physician; 44.7% assumed the risk of severe complications to be ≥5.0%. Not being satisfied with their medical treatment was reported by 22.2%, of whom more than 70% considered DBS a further treatment option. CONCLUSIONS: The latter numbers indicate that treating neurologists tend to overestimate the reluctance of their patients to undergo DBS. Therefore, education of patients and neurologists should be improved and give more realistic figures on the actual outcomes and frequencies of possible complications.