Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier's gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients.

OBJECTIVE: To determine predisposing or prognostic factors and mortality rates of patients with Fournier's gangrene compared to other necrotizing soft tissue infections (NSTI). MATERIAL AND METHODS: Data of 55 intensive care patients (1981-2010) with NSTI were evaluated. Data were collected prospectively. RESULTS: 43.4% of the patients were in septic condition and 27.3% were hemodynamically unstable. Half of the patients showed predisposing factors (52.7%). The lower extremity (63.2%), abdomen (30.9%), and perineum (14.5%) were most affected. Polymicrobial infections were frequent (65.5%, mean 2.8, range: 1-4). The mortality rate was 16.4% (n = 9). An increase was shown for diabetes mellitus (20%), cardiac insufficiency (22.3%), septic condition at presentation (33.3%), abdominal affection (47.1%), and hemodynamic instability (46.7%). Comparing survivors and nonsurvivors, statistical significance was seen with age (p < 0.001), septic condition at admission (p < 0.001), hemodynamic instability (p < 0.001), low blood pressure (p < 0.001), and abdominal affection (p < 0.001). In laboratory findings, an increase of creatine kinase (p < 0.001) and lactate (p < 0.001) and a decrease of antithrombin III (p < 0.007) and the Quick value (p < 0.01) proved to be significant. CONCLUSION: Patients with Fournier's gangrene do not differ in all aspects from those with other NSTI. Successful treatment consists of immediate surgical debridement, broad-spectrum antibiotic treatment, and critical care management. Supportive hyperbaric oxygen therapy should be considered.

[Open intraperitoneal hernia repair for treatment of abdominal wall defects--early results by placement of a polypropylene-ePTFE-mesh]. / Die offene intraperitoneale Netzplastik zur Versorgung ventraler Bauchdeckendefekte--erste Ergebnisse bei der Implantation eines mit ePTFE beschichteten Polypropylenenetzes.

BACKGROUND: Large incisional hernias are mainly repaired today by tension free implantations of prosthetic meshes using various placement methods. The advantages of the intraperitoneal open technique (IPOM) using a polypropylene mesh that is coated with ePTFE on the side facing the intestine, are described. METHODS AND RESULTS: 62 patients underwent an incisional hernia operation with the intraperitoneal positioning of a prosthetic mesh. The follow-up examinations after a range of 16.1 months showed a hernial recurrence rate of 6.4 %. A part of the resulting mesh infections (11.2 %) healed without surgical removal of the mesh. Clinical complications due to adhesion formation were not observed. CONCLUSION: The tissue sparing intraabdominal positioning technique simplifies the necessary overlap using healthy tissue as a prerequisite for a sufficient hernia repair exploiting the intraabdominal pressure.

Benefits of active motion for joint position sense.

Anterior cruciate ligament (ACL) ruptures lead to a proprioceptive deficit and therefore joint position sense. This study examined whether active motion is better suited than passive motion to address this deficit. Sixty patients with ACL rupture were prospectively randomised into two groups [continuous active motion (CAM)/continuous passive motion (CPM)]. All patients had an ACL reconstruction. An angle reproduction test was used to assess the proprioceptive deficit. The relevant examinations were performed before surgery (pre-op evaluation) and after the seventh postoperative day. No preoperative difference was found between the two groups. After postoperative treatment, the deficit was reduced in both groups. Significantly better results were, however, obtained in the CAM group (CPM, 4.2+/-1.6 degrees; CAM, 1.9+/-1.2 degrees; P<0.001). During the first postoperative week, a CAM device produced a significantly greater reduction in the proprioceptive deficit and should be the first choice in immediately postoperative rehabilitation after ACL replacement.

[The influence of a controlled active motion splint on proprioception after anterior cruciate ligament plasty. A prospective randomized study]. / Der Einfluss einer aktiven Bewegungsschiene auf die Propriozeption nach vorderer Kreuzbandplastik. Eine prospektiv randomisierte Studie.

BACKGROUND: A ruptured anterior cruciate ligament (ACL) leads to both mechanical and functional instability. Functional instability is caused by proprioceptive deficit. The aim of this study was to determine whether the proprioceptive deficit can be reduced by using a controlled active motion (CAM) splint postoperatively. PATIENTS AND METHODS: A total of 50 patients with ACL rupture were randomized into two groups. After ACL plasty the PT group received postoperative physiotherapy, while the CAM group were managed with a CAM splint and physiotherapy. Proprioceptive ability was measured with a passive angle-reproduction test. RESULTS: On the day of discharge 80% of the patients in the CAM group and 25% in the PT group had a reduced proprioceptive deficit. Overall the main measured value in the CAM group improved by 83.7%, but deteriorated by 39.3% in the PT group. There was no significant difference between the CAM group and a healthy control group. CONCLUSION: Using a CAM splint in addition to physiotherapy after ACL plasty in comparison to physiotherapy alone decreases the proprioceptive deficit significantly. We recommend the use of a CAM splint in the postoperative management following ACL plasty.

[Results 13 years after ACL plasty using a carbon prosthesis]. / Ergebnisse mit Kohlefaserimplantaten 13 Jahre nach Kreuzbandersatzplastik.

AIM: The retrospective results of carbon prostheses for ACL plasty from 1985 to 1989 are reported. The aim of this study was to determine the number and kind of necessary revisions and the rate of arthrosis and instability of the operated joints. METHOD: 101 patients out of 136 patients with ACL plasty using a carbon prosthesis could be reviewed clinically in this retrospective study. All patients answered a questionnaire. Additionally, the tibial translation was examined with the KT1000 at maximum power. Conventional X-rays were taken of the knee joints. The results were evaluated using different scores. RESULTS: 70 % of the patients had pathological findings in the clinically tested tibial translation and had a positive Lachmann sign. 66 patients had a tibial translation of 2 mm or above when tested with the KT1000 at maximum power. Radiological studies had shown a gonarthrosis of grades III and IV in 93 patients. An average of 77 points was found using the Lysholm score. CONCLUSION: The results 13.5 years after ACL plasty using a carbon prosthesis are unsatisfactory concerning joint stability and development of secondary arthrosis. There is a discrepancy between the results of the clinical tests and the subjective complaints of the patients.

Intraoperative direct mechanical stimulation of the anterior cruciate ligament elicits short- and medium-latency hamstring reflexes.

The anterior cruciate ligament (ACL) has not only a mechanical but also a sensorimotor function. Patients with injuries of the ACL frequently complain of knee instability despite good mechanical stabilization after surgical reconstruction. Compared with healthy subjects, their latencies of hamstring reflexes after anterior tibia translation are considerably increased. There is evidence for the existence of a reflex arc between the ACL and the hamstrings. The aim of this study was to determine if there is a direct reflex response after an isolated mechanical stimulation of the ACL in humans. In 10 patients who underwent arthroscopy, hamstring electromyographic (EMG) responses were assessed intraoperatively after applying an isolated load on the ACL. Latencies, amplitudes, and integrals of the EMG responses were analyzed. In four patients, the measurements were repeated after injection of local anesthetics into the ACL. In all subjects, responses with mean latencies of 42 +/- 4.4 (SD) ms corresponding to a medium latency response (MLR) were found. In seven subjects, they were preceded by responses with a short-latency (SLR) of 24 +/- 2.7 ms. The maximum amplitude was 8.6 +/- 7 mV, the integral 0.064 +/- 0.05 mV*s. The injection of local anesthetics reduced the amplitude by 34 +/- 12% and the integral by 50 +/- 20%. Direct mechanical stimulation of the ACL evokes considerably smaller SLRs and MLRs than anterior tibia translation during standing. It is argued that latency changes observed in patients with ACL ruptures may be rather due to changes in the sensorimotor integration of the afferent input from the knee joint than to the absence of the direct ACL reflex.

[The potential for training of proprioceptive and coordinative parameters in patients with chronic ankle instability]. / Die Trainierbarkeit von propriozeptiven und koordinativen Parametern bei der chronisch-funktionellen Sprunggelenkinstabilität.

AIM: This study was aimed at assessing the outcome of physical therapy based on both subjective patient's satisfaction and objective measurement of peroneal reaction time in patients with chronic ankle instability. METHOD: 25 patients with chronic ankle instability based on functional deficits were included. Physical therapy consisted in a 6 weeklong program with muscle strengthening and coordination exercises for one hour, three times a week. Before starting physical therapy as well as two weeks after finishing the program, patients underwent both a clinical exam as well as measurement of their peroneal reaction time. RESULTS: Following physical therapy peroneal reaction time of the long (p = 0.0001) and short (p = 0.0003) peroneal muscles significantly decreased. Prior to physical therapy the Kitaoka score was calculated to be 72.2 (+/- 18.7), the post treatment value was 93.3 (+/- 11.7) with a p-value of < 0.001. As for subjective patient's assessment on a scale of 1-10 with 1 being the least and 10 the most satisfied with therapeutical outcome, patients gave an average post treatment score of 8.3 (+/- 1.9). CONCLUSION: Measurement of PRT can be used as a helpful diagnostic parameter, as a parameter for quality control and for verification of therapy results. Specific physiotherapy leads to good clinical results and increased PRT.

Anatomical repair of lateral ligaments in patients with chronic ankle instability.

In a prospective study, 19 patients with chronic ankle instability underwent clinical and radiographic reexaminations 36 months after anatomical reconstruction. In addition, dynamic pedography was conducted and peroneal reaction time measured on a tilting platform for an evaluation of functional aspects. Prior to this examination, 32 patients had been asked to fill in a questionnaire and make a detailed subjective evaluation of current discomfort, stability, flexibility and sporting abilities. Eighty-eight percent of the patients reported satisfactory results; only 3% complained of persistent instability. In 71% the ability to take part in sports had improved after surgery, and 85% of the patients reported unrestricted walking abilities. Supination ability was impaired in 5% of the patients at the follow-up. The radiographic examination showed restored ankle stability with a significant reduction of talar tilt and talar translation; a postoperative increase in signs and symptoms of arthrosis was not observed. Dynamic pedography showed a large degree of symmetry of plantar pressure distribution after surgery. There were no significant differences in peroneal reaction time in the repaired and intact ankles. The results of the study show that it is possible to restore ankle stability with anatomical reconstruction without impairing the range of movement in the ankle joint complex. Progressive osteoarthrosis can be prevented.

[Functional ultrasound examination of the posterior cruciate ligament -- a new method of detecting ligament instability in the knee joint]. / Die funktionelle Sonographie des hinteren Kreuzbandes -- Eine neue Screeningmethode bei ligamentären Verletzungen des Kniegelenkes.

AIM: Detection of injuries to the posterior cruciate ligament (PCL) is difficult and dismissed in many cases. Here we introduce dynamic ultrasound examination as a safe and reproducible method to detect a PCL-insufficiency with or without fixed posterior tibia position and combined injuries to the cruciate ligament complex. PATIENTS AND METHOD: Dynamic ultrasound examination in a modified technique to Schwarz et al. was performed on 20 patients with a PCL-insufficiency (group 1) and 20 patients with an anterior cruciate ligament (ACL) insufficiency (group 2). Comparing both knee joints, we measured the resting value (RV), ventral translation value (VT) and dorsal translation value (DT). Mean value, standard deviation in mm and t-test for unpaired values were compared with each group and a healthy control population. RESULTS: In group 1 we could distinguish patients with fixed posterior position (PCL (mfix)) who showed a pathological dorsal RV (2.96 mm) from patients without fixation (PCL (ofix),: RV = 0.7 mm). DT was significantly prolonged (PCL (mfix): 6.4 mm; PCL (ofix): 5.6 mm) compared to healthy individuals. Group 2 showed a pathological RV (2,38 mm) and a significant prolonged VT (4.19 mm). 10 patients in this group had a spontaneous ventral tibia translation (RV: 3.7 mm) and 10 patients with ACL insufficiency showed a normal resting value (RV: 0.88 mm). CONCLUSION: Dynamic ultrasound examination allows us to distinguish between isolated ACL- or PCL-insufficiency and combined injuries of the cruciate ligament complex using a standardized flow sheet. PCL-insufficiency therefore can be separated into the entities of fixed posterior and partly reducible instability.

[Clinical results with A new retrograde femoral nail with a radiographical-free proximal locking device. A prospective study with 50 fractures]. / Ein neues retrogrades Femurmarknagelsystem mit durchleuchtungsfreier proximaler Verriegelung. Eine prospektive Studie an 50 Frakturen.

INTRODUCTION: Conventional retrograde nailing of the femur causes two important disadvantages: the proximal locking of the nail is difficult because of the anatomic conditions and a chondral defect was left into the knee. MATERIAL AND METHODS: After the retrograde implantation the new nail was lead through the greater trochanter. An additional proximal aiming device for proximal interlocking can be fixed. The entrance portal will be sealed by an osteochondral cylinder. 50 cases of femur fractures were selected for the prospective study. We recorded all intraoperative complications and technical difficulties. The cases were followed up for 52 weeks, both clinical and radiology examinations were performed. RESULTS: The mean follow up was 15.5+/-5 months. All fractures were healed. Knee movement was 125+/-14 degrees. The Leung Score was 84+/-12.6 points; HSS Score was 90+/-9 points. In two cases wound infections were developed. Mal-union was observed in three cases, in two cases nail brake down. CONCLUSIONS: The new retrograde interlocking nail could be used to manage femur fractures successfully. Two aiming devices enable a easy interlocking. Replacement of the osteochondral cylinder into the entry portal reduces cartilage damage.

Intramuscular pressure, tissue oxygenation and EMG fatigue measured during isometric fatigue-inducing contraction of the multifidus muscle.

Simultaneous measurement of intramuscular pressure (IMP), tissue oxygen partial pressure (pO(2)) and EMG fatigue parameters in the multifidus muscle during a fatigue-inducing sustained muscular contraction. The study investigated the following hypotheses: (1) Increases in IMP result in tissue hypoxia; (2) Tissue hypoxia is responsible for loss of function in the musculature. The nutrient supply to muscle during muscle contraction is still not fully understood. It is assumed that muscle contraction causes increased tissue pressure resulting in compromised perfusion and tissue hypoxia. This tissue hypoxia, in turn, leads to muscle fatigue and therefore to loss of function. To the authors' knowledge, no study has addressed IMP, pO(2) and EMG fatigue parameters in the same muscle to gain a deeper sight into muscle perfusion during contraction. As back muscles need to have a constant muscular tension to maintain trunk stability during stance and locomotion, muscle fatigue due to prolonged contraction-induced hypoxia could be an explanation for low back pain. Sixteen healthy subjects performed an isometric muscular contraction exercise at 60% of maximum force until the point of localized muscular fatigue. During this exercise, the individual changes of IMP, pO(2) and the median frequency (MF) of the surface EMG signal of the multifidus muscle were recorded simultaneously. In 12 subjects with a documented increase in intramuscular pressure, only five showed a decrease in tissue oxygen partial pressure, while this parameter remained unchanged in six other subjects and even increased in one. A fall in tissue pO(2) was associated with a drop in MF in only five subjects, while there was no correlation between these parameters in the other 11 subjects. To summarize, an increase in IMP correlated with a decrease in pO(2) and a drop in MF in only five out of 16 subjects. High intramuscular pressure values are not always associated with a hypoxia in muscle tissue. Tissue hypoxia is not automatically associated with a median frequency shift in the EMG signal's power spectrum.

[Indications and safety aspects of vacuum-assisted wound closure]. / Indikationen und Sicherheitsaspekte der Vakuumtherapie.

Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.

Differentiation of hamstring short latency versus medium latency responses after tibia translation.

After injuries to the anterior cruciate ligament (ACL) a functional instability is frequently observed which has been attributed to a disturbed sensorimotor function. In light of the clinical importance of ACL injuries and the resulting functional instability, it is of enormous clinical interest to elucidate the role of sensorimotor pathways that involve the ACL. In animals and humans a direct reflex pathway between the ACL and the hamstrings has been shown. The onset latencies of responses reported after ventral tibia translation were around 40-50 ms (range 17.9-65) and were regarded as medium latency responses (MLR). However, ventral tibia translation should also induce a stretch of the hamstring muscles and evoke a short latency response (SLR). Before any muscle response after ventral tibia translation can be ascribed to anatomical structures, it is crucial to analyze the obtained muscle responses carefully. The aim of the present study was the development of an algorithm to differentiate SLR and MLR responses after ventral tibia translation. In ten healthy subjects reflex responses of the hamstrings after anterior tibia translation and after tendon taps on the biceps femoris tendon were evaluated. To investigate the influence of skin afferents, control experiments were performed after lidocain injection of the dorsal calf. The mean onset latency of the tendon jerk reflex was 21.9 +/- 3.1 ms (range 17.3 - 28.7 ms). Both SLR responses (mean onset latency: 20.3 +/- 3.5 ms; range 15.4 - 25.8) and MLR responses (mean onset latency: 38.9 +/- 4.2 ms; range 32.9 - 46.7) were obtained in all subjects. Skin afferents from the calf do not play a major role. The development of an evaluation algorithm is presented that allows a safe differentiation between these partly superimposed SLR and MLR components. It is demonstrated that by measuring the first part of the SLR from the onset to the first peak the end of the SLR can be predicted and that the onset latency of the MLR component can be assessed reliably. Possible reasons are discussed why previous studies only reported responses at MLR latencies. The fact that both SLR and MLR components can be observed after anterior tibia translation underlines the necessity to differentiate the responses before they can be ascribed to any anatomical structures. As a basis for future work the algorithm presented may become a useful tool to differentiate which afferent pathways play a role in initiating hamstring activity.

[Removal of a thoracic impaling agent without direct observation. The significance of pre-operative diagnosis]. / Entfernung eines thorakalen Pfählungsgegenstandes ohne direkte Sicht. Die Bedeutung der präoperativen Diagnostik.

Impalement injuries are uncommon and only occasional reports exist in the literature, resulting in non standardized approaches. Depending on the location, completely different combinations of injuries occur, making every impalement unique. Nevertheless some basic principles for dealing with impalements exist. These principles, and some controversial statements in the literature on the value of preoperative diagnostics, especially CT, are discussed using the example of a spectacular thoracic impalement by a 2 x 2 cm square metal pole. Our deviation from the principal of removing an impaling object only under direct observation in this special case is also discussed.

[Pressure conditions under VVS-foams - an experimental in-vitro- and in-vivo-analysis]. / Druckwerte unter VVS-Schwämmen - eine experimentelle In-vitro- und In-vivo-Untersuchung.

The aim of this study was to determine the pressure conditions in the tissue beneath and on the surface of wounds. This was done in vitro both on a plain surface and on a bovine muscle. In comparison we measured the pressure of the anterior tibial muscle of a patient with compartment syndrome. Besides, we applied negative pressure using just one drape connector and measured the pressure in different distances to look if the pressure is constant in large V.A.C.(R) dressings. Both polyurethane and polyvinyl alcohol foams were used.

[Treatment of trans-symphyseal instability with an internal fixator. Outcome of a surgical technique on the basis of a case report]. / Die Versorgung der trans- symphysären Instabilität mittels Fixateur interne. Vorstellung einer Operationsmethode anhand eines Fallberichtes.

Treatment of traumatic trans-symphyseal instability by internal plate fixation is the most common procedure. Besides the trauma-induced muscle damage, the implantation induces additional damage at the symphyseal origin of the m. rectus abdominis. The aim of this clinical case study was to examine whether it is possible to reduce the iatrogenic soft tissue damage while correcting trans-symphyseal instability using an internal fixator. After a transverse skin incision, two pedicle screws were drilled into the corpus ossis pubis next to the symphysis. Afterwards the crossbar was implanted and fixed. Generally, implantation of two self-trapping pedicle screws using a skin incision with a length of 6 cm is possible. Additional detachment of the m. rectus abdominis is not necessary. As a result of the mobility of the skin and subcutaneous tissue, the implantation of the crossbar beneath the m. rectus abdominis is possible. Stabilization of traumatic trans-symphyseal instability by internal fixation is a safe and easy method. Additional soft tissue damage can be prevented, but to achieve multidirectional stability some small modifications of the implant are necessary.

Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study.

The role of magnetic resonance tomography (MRI) for the diagnosis of chondral lesions of the knee joint is still unclear. The sensitivity of the method ranges from 15% to 96%. The scope of our daily experiences showed that there were considerable deviations between the tomographical and arthroscopical results, which vary from the results of experimental studies. Therefore we have conducted a prospective study to investigate the question of how MRI can replace arthroscopy (ASC) in the diagnosis of cartilage damages in the scope of daily routine. All 195 patients included in this study received a magnetic resonance tomography followed by an arthroscopy. A clear diagnosis of supposition had to be determined before the magnetic resonance tomography. The patients were divided into 3 Groups. Group A (n=86) received a standard Military Hospital Ulm (MH) MRI--sagittal STIR TSE and PD TSE, coronal and transversal T2 FFE (TR=660 ms, TE=18 ms, FA=30 degrees, 512 matrix). In addition, one sub-Group, AK (n=21) was examined with a special cartilage sequence of the cartilage fs T1 W FFE. Neither patients in Group AK nor in Group A as a whole received any contrast medium. Group B (n=88) was examined with an alternate MRI protocol (Radiological Joint Practice, Neu-Ulm--sagittal T1 SE, T2 SE and T2 FLASH (TR=608 ms, TE=18 ms, FA=20 degrees, 256 matrix), coronal PD fs), employing gadolinium as a contrast medium. 156 cartilage lesions were found arthroscopically. In Group A the sensitivity was 33%, the specificity 99%, and the positive and negative prediction values 75% and 98% respectively. Group B reached a sensitivity of 53% and a specificity of 98%. The positive prediction value was 48% and the negative was 98%. Group AK showed a sensitivity of 38% and specificity of 98%; the positive and negative prediction values came to 50% and 97% respectively. In conclusion, our results indicate that the MRI examination techniques recommended in the literature at present are not able to replace the ASC for the diagnosis of cartilage damages of the knee joint. In view of the high specificity (97%-99%) and the high negative prediction value (97%-98%), MRI is suitable for the exclusion of cartilage lesions. For a negative MRI associated with a cartilage injury, a cautious attitude towards an operative cartilage treatment is therefore justified. Because the MRI can not replace the ASC for diagnostic of cartilage damage, the ASC still has to be seen as the method of choice for the evaluation of cartilage damage.

[Drainage in soft tissue surgery. What is "evidence based"?]. / Drainagen in der Weichteilchirurgie. Was ist "evidence based"?

Due to the advanced technical possibilities, there are now up to 30 different drainage systems available for soft tissue surgery. The differences between these systems involve the mode of drainage (open into the bandage, closed into bag/bottle), the kind of suction (gravity drainage, low-vacuum and high-vacuum up to 900 mbar) and the material of the tube (PVC, silicone or polyurethane). There also exists a marked controversy about the fundamental necessity for drainage after surgery. A survey of the literature indicates that there is a distinct discrepancy between scientific knowledge and daily routine action. For primarily uninfected wounds, the application of an open drainage system,with the secretion going directly into the bandage, is obsolete. Gravity drainage systems guarantee just as effective secretion drainage in comparison to high vacuum drainage according to Redon. In soft tissue wounds, high-vacuum suction leads to the sucking in of tissue and blood,whereby comparatively elevated quantities of secretion can be produced. During the removal of Redon-drainage, there is stronger pain than on the removal of gravity drainage systems consisting of silicone or polyurethane. Prophylactic insertion of drainage in uncomplicated thyroid surgery and for hernia repair is not necessary. Insertion of drainage for up to 72 h is not accompanied by an elevated infection rate. The routine microbiological examination of the tip of the drainage tube is not recommended.

[MRI vs. arthroscopy in the diagnosis of cartilage lesions in the knee. Can MRI take place of arthroscopy?]. / MRT versus Arthroskopie bei der Diagnostik von chondralen Läsionen des Kniegelenkes. Kann die MRT die Arthroskopie ersetzen? Eine prospektive Studie.

INTRODUCTION: The accuracy of magnet resonance imaging in diagnosing cartilage lesions is discussed controversially. The sensitivity of this examination ranges from 15 % to 96 %. Clinical evidence demonstrates that cartilage lesions, diagnosed by MRI, were not confirmed in arthroscopy. The purpose of this prospective study was to analyse the practicability of replacing arthroscopy by MRI in diagnosis of cartilage lesions. PATIENTS AND METHODS: 195 patients with acute or chronic knee pain were examined by reason of a pathological clinic result by MRI preoperatively. In group A (n = 86), a standard program was performed in the radiological department of German Army Hospital (sagittal STIR TSE und PD TSE, coronary und transversal T2 FFE [TR = 660 ms, TE = 18 ms, FA = 30 degrees, 512er-Matrix]), in 21 patients (subgroup AK) a cartilage specific sequence (fs T1 W FFE) without gadolinium was added. Patients in group B (n = 88) were examined in a private outpatient clinic (sagittal T1 SE, T2 SE and T2 FLASH [TR = 608 ms, TE = 18 ms, FA = 20 degrees, 256er-Matrix]) with the use of gadolinium. A clear clinical diagnosis had to be performed before MRI examination. RESULTS: 156 lesions of the cartilage were detected arthroscopically. The sensitivity of the examination was in group A 33 %; group B 53 %; group AK 38 %, specificity in group A 99 %; group B 98 % and group AK 98 %. The positive and negative predictive values were in group A 75 %/98 %; group B 48 %/98 % and in group AK 50 %/97 %. CONCLUSION: MRI was not able to detect reliable cartilage lesions. Until now, arthroscopy is the golden standard to detect cartilage lesions.