[Lateral ankle ligament bracing]. / "Ligament bracing" für das laterale Sprunggelenk.

OBJECTIVE: Covering the anatomic reconstruction (Broström procedure) with suture tape for more initial stability. Seat belt principle. INDICATIONS: Mechanical lateral ankle instability: athletes in sports at risk, patients with uncertain compliance with respect to the postoperative treatment regimen, patients with poor tissue quality, patients with generalized laxity, and patients with failed previous repairs. CONTRAINDICATIONS: Known implant intolerance, local or systemic infection, local soft tissue affections, hemorrhagic disorders. SURGICAL TECHNIQUE: Epimalleolar 5 cm skin incision. Anatomic repair of the lateral capsuloligamentous structures to the anterior facet of the lateral malleolus (e.g. Broström repair). Dissection down to origin and insertion of the anterior talofibular ligament (ATFL). Close proximal (fibula) and distal (talar neck) to the ATFL attachments to bone a 2.7 mm (fibular) and a 3.4 mm (talar) drill hole is created and taped with the respective tapes from the single use kit (Arthrex, Naples, FL, USA). Placement of a 3.5 mmâ€¯× 15.8 mm BioComposite SwiveLock® screw, preloaded with suture tape into the fibula. The free ends of this suture tape are inserted into a 4.75 mmâ€¯× 19.1 mm SwiveLock® anchor, which is screwed into the talar drill hole under moderate tension of the suture tapes. POSTOPERATIVE MANAGEMENT: Immobilization for 4-5 days postoperatively in a leg and foot ScotchcastTM. Then, full load bearing within 1-2 days in a stable shoe (OrthoTECH Stabil, OrthoTECH GmbH, Stockdorf, Germany) for 5 postoperative weeks for the day and a night splint (existing ScotchcastTM). Sensorimotor training initiated in the third and running in the eighth postoperative week. Return to competition in sports at risk (football, basketball, volleyball) 10-12 weeks postoperatively. RESULTS: Measured with the validated FAAM-G (Foot and Ankle Ability Measure-German version) questionnaire, 9 patients had a preoperative activities of daily living subscale median (minimum-maximum) of 65 (30-100) and increased to 98 (78-100) 12 months postoperatively. Preoperative FAAM-G sport subscale results were 35 (0-75) and 100 (19-100) after 12 months. With the Sefton Grading System, 7 of 8 followed patients had an excellent result and had unrestricted ankle mobility and stable ankles (talar tilt and anterior talar drawer), which is comparable to published suture tape augmentation reports.

[Ankle arthrometry for evaluation of the mechanical component in chronic ankle instability]. / Sprunggelenkarthrometrie zur Diagnostik der mechanischen Komponente der chronischen Sprunggelenkinstabilität.

BACKGROUND: Chronic ankle instability (CAI) is a term that is not well defined until now in spite of a large body of respective literature. Most frequently this umbrella term is used synonymously for functional ankle instability and the role of the mechanical component is not fully understood. PATIENTS/MATERIAL AND METHODS: In a cohort consisting of 15 patients suffering from CAI we preoperatively investigated the mechanical component using both stress radiographs and ankle arthrometry. The functional impact was measured with the FAAM-G (foot and ankle ability measure, German version). The results were compared with a respective group of 17 uninjured subjects. RESULTS: Relevant differences were found between the patients and the uninjured groups in the mechanical (stiffness in the 40 - 60 N region of the load deformation curves and the ratio between stiffness in the 125 - 175 N and 40 - 60 N region) and functional analyses (FAAM-G), respectively (p < 0.001 - 0.040). There was no difference found between groups in the upper (125 - 175 N) region of the load deformation curves. CONCLUSIONS: This article helps to clarify the role of the mechanical component in CAI. Patients suffering from both functional and mechanical ankle instability can be detected with the FAAM-G questionnaire and with different ankle stiffness parameters from ankle arthrometer stress testing. These measures differentiate CAI patients from uninjured persons with functionally and mechanically stable ankles. Therefore, these instruments can be recommended to diagnose and quantify the mechanical component in CAI.

[Extracorporeal shock wave therapy for patients suffering from recalcitrant Osgood-Schlatter disease]. / Einsatz der extrakorporalen Stoßwellentherapie bei therapieresistentem M. Schlatter.

BACKGROUND: Intensive physical load can damage epi-/apophyseal growth. Osgood-Schlatter disease is a well-known and sport-associated overuse injury of the tibial tuberosity apophysis. Long-lasting load-associated pain and a reduced ability to play sports can be the consequence. AIM OF THE STUDY: The aim of this study was to analyse the safety and effectiveness of extracorporeal shock wave therapy (ESWT) for recalcitrant Osgood-Schlatter disease. PATIENTS AND METHODS: 14 adolescent patients, median age 14 (13.2-14.7) years, suffering from recalcitrant Osgood-Schlatter disease (16 symptomatic knees) were treated with radial extracorporeal shock waves. The nine boys, median age 14 (13.5-15.0) years and the five girls, median age 12 (10.8-15.2) were retrospectively followed up 5.6 (3.4 - 6.7) years later using the disease specific VISA-P-G questionnaire which is validated for jumper's knee. RESULTS: At follow up the median VISA-P-G score was 100 (82.9-100.9). Twelve of 16 knees (75%) reached 100 out of 100 VISA-P-G points. Four patients changed their sports activity due to persisting problems at the distal patellar tendon insertion. Four knees had persisting tibial tuberosity pain when playing sport. Pain induced by activities of daily living (stair climbing) was stated in two cases. No side effects or long-term complications were reported. CONCLUSIONS: This pilot study demonstrates that radial ESWT is a safe and promising treatment for adolescent athletes with recalcitrant Osgood-Schlatter disease.

Translation, cross-cultural adaption and validation of the German version of the Foot and Ankle Ability Measure for patients with chronic ankle instability.

OBJECTIVES: The evaluation of health-related quality of life and physical function is important for determining therapeutic strategies following ankle injuries. The Anglo-American Foot and Ankle Ability Measure (FAAM) is a valid and reliable self-reported measure to detect functional deficits in chronic lateral ankle instability. The purpose of this study was to translate, cross-culturally adapt and validate the FAAM questionnaire for use with German-speaking patients with chronic lateral ankle instability. PATIENTS/PARTICIPANTS: Preoperative and conservatively treated patients with chronic lateral ankle instability. Sport students and volleyball athletes served as control groups. MAIN OUTCOME MEASUREMENTS: The FAAM was forward and back translated, cross-culturally adapted and validated. The study population completed the FAAM-G questionnaire twice within 3-5 days. Additionally, the patients were scored with the Good ankle laxity classification system. Test-Retest reliability, construct validity and internal consistency were calculated. RESULTS: Reliability and validity of the FAAM-G were examined in presurgical chronic ankle instability patients (n=24), conservatively treated chronic ankle instability patients (n=17), university sport students (n=31) and volleyballers (n=37). Test-retest reliability revealed fair, good, or excellent reliability (inter-class correlation coefficient (ICC)=0.590-0.998; ρ=0.528-1.000). Construct validity, tested between the FAAM-G subscores and the Good et al ankle laxity classification system demonstrated strong correlations (ρ = -0.819 to -0.861). CONCLUSIONS: The original FAAM questionnaire was successfully translated and cross-culturally adapted from English to German. Corresponding to the Anglo-American version, the FAAM-G is a reliable and valid questionnaire for self-reported assessment of pain and disability in German-speaking patients suffering from chronic ankle instability.

[Validation of the VISA-A-G questionnaire for German-speaking patients suffering from Haglund's disease]. / Validierung des VISA-A-G Fragebogens für deutschsprachige Patienten mit chronischer Bursitis subachillea.

BACKGROUND: The VISA-A questionnaire is currently the only valid, reliable, and disease specific patient administered questionnaire for research in Achilles tendinopathy. To perform multinational and multilingual investigations this instrument was already adapted to several languages. According to the "guidelines for the process of cross-cultural adaptation of self-report measures" we already translated and validated the VISA-A questionnaire for patients with Achilles tendinopathy. AIM OF THE STUDY: To cross-culturally adapt and validate the VISA-A Questionnaire for German-speaking patients suffering from Haglund's disease. METHODS: The VISA-A-G questionnaire was tested for reliability, validity, and internal consistency in 39 Haglund's disease patients and 79 asymptomatic persons. For concurrent validity the VISA-A-G was compared with the Curwin and Stanish tendon grading system and with the Percy and Conochie classification system for the effect of pain on athletic performance. VISA-A-G results in Haglund's disease were additionally compared with VISA-A-G results obtained from Achilles tendinopathy patients and with VISA-A results presented in the international literature. RESULTS: ICC for the VISA-A-G questionnaire in conservatively treated Haglund's disease patients was 0.96. In asymptomatic students and joggers ICC was 0.97 and 0.60. When correlated with the grading system of Curwin and Stanish and with the Percy and Conochie classification rho was -0.95 and 0.94, respectively. Internal consistency (Cronbach's alpha) for the total VISA-A-G scores of the patients was calculated to be 0.87. Compared with VISA-A-G results obtained from Achilles tendinopathy patients there was no relevant difference discernible. Compared with VISA-A results presented in the original publication no difference was found statistically for students, healthy people, conservative, and preoperative patients, respectively. CONCLUSIONS: This study confirms that the VISA-A-G is a valid and reliable measure for German-speaking patients suffering from Haglund's disease.

[Minimally invasive repair of an impingement induced partial tear of the anterior Achilles tendon in a top level athlete]. / Minimalinvasive Naht einer impingementbedingten Partialruptur der distalen ventralen Achillessehne bei einer Topathletin.

AIM: A rarely described Achilles tendon lesion resulting from Haglund's disease and its repair is presented. METHOD: An analysis of the respective clinical records was carried out. RESULTS: Haglund's resection was performed from a 3 cm lateral transverse approach. A coincidental anterior Achilles tendon partial tear was repaired by transversal U-sutures. CONCLUSION: A minimally invasive repair of a partial tear of the anterior Achilles tendon is feasible and effective.

[Balance therapy shoes - a comparative analysis with respect to immediate training effects]. / Sohlenaktivierte therapieschuhe - eine vergleichende trainingsmittelanalyse.

BACKGROUND: Manufacturers attribute specific shoes and sole construction to induce neuromuscular training. Thus injury prevention or rehabilitation from injury is aimed. HYPOTHESIS: H1=Different shoe and sole construction result in different load to the neuromuscular system and postural control. STUDY DESIGN: Controlled laboratory study. METHODS: 10 healthy subjects were tested postural stabilization using a force plate and EMG-recordings. First each person performed three 20 sec single leg unshod stance trial (control condition). Then MBT shoe, Finnamic-Rollenschuh and ReflexControl were applied and tested in a randomized order. RESULTS: No difference in the EMG- activity was detected comparing the barefoot condition with MBT and Finnamic-Rollenschuh (p=0,051-1,000). However with one exception (barefoot M. gastrocnemius. EMG-activity; p=0,110) putting on the ReflexControl shoe increased the EMG-activity relative to all three tested muscles and shoe/barefoot conditions (p=0,000-0,001). Moreover, the ReflexControl shoe led to a highly significantly higher postural sway (p=0,000-0,072), while MBT, Finnamic-Rollenschuh and barefoot conditions were not statistically different (p=0,818-1,000). CONCLUSIONS: This study confirms that during upright stance the ReflexControl shoe is a means for neuromuscular training, while MBT and Finnamic-Rollenschuh simulate barefoot stance.

[Proximal adductor longus tendon tear in high level athletes. A report of three cases]. / Die proximale Adduktor longus Sehnenruptur bei Leistungssportlern. Drei Fallberichte.

Chronic groin pain in athletes frequently results from adductor insertional tendinopathy. Adductor tenotomy has been proposed for cases recalcitrant to conservative treatment. However, acute tears of the proximal adductor tendons have rarely been described and all of them underwent early repair. This report reviews the relevant literature and adds three more acute proximal adductor longus insertional tears. Diagnosis has been made clinically and was confirmed by ultrasound and MRI. Following early repair using suture anchors and functional postoperative rehabilitation, full sports ability was re-established five, six and seven months, respectively.

Dorsal calcaneocuboid ligament versus lateral ankle ligament repair: a case-control study.

OBJECTIVE: Anatomic reconstruction is the treatment of choice for lateral ankle ligament instability. A similar technique has recently been described for stabilisation of a chronic unstable calcaneocuboid joint as an alternative to the previously proposed tenodesis and arthrodesis procedures. METHODS: Five consecutive young females experiencing recurrent giving way of six calcaneocuboid joints were treated operatively during a 4 year period using anatomic ligament repair reinforced by a periosteal flap. Results were compared to five patients who underwent anatomic lateral ankle ligament repair in a case-control design. Outcome was measured using the Foot and Ankle Outcome Score, physical examination, and stress radiographic and MRI (calcaneocuboid group) investigation. Functional neuromuscular performance was evaluated by isokinetic torque measurements, posturometry, single-leg drop jumps, and single-leg long jumps. RESULTS: Outcome scores at follow up (5-61 months after surgery) revealed excellent results for both groups. No relevant difference was found between the affected legs and the non-affected legs or between groups with respect to the outcome measures. MRI exhibited ligament-like structures at the repaired dorsal calcaneocuboid joints in five out of six joints. CONCLUSIONS: Results of anatomic repair of unstable lateral ankle and isolated calcaneocuboid joint instability equally lead to excellent results.

[Flexor hallucis longus tendon rupture as an impingement lesion induced by os trigonum instability]. / Flexor-hallucis-longus-Sehnenruptur als Impingementläsion bei instabilem Os trigonum.

A Flexor hallucis longus tendon lesion induced by an unstable Os trigonum has not been described heretofore. A 39 years old karateka complained increasing load induced pain at the posteromedial ankle. Because of this, he was unable to take part in sports activities. Clinical, X-ray and MRI investigation assumed a Flexor hallucis longus tendon tear induced by an impingeing Os trigonum. At surgery a longitudinal and a partial transverse tendon tear was present. The Flexor hallucis longus tendon pulley was narrowed by a partially unstable Os trigonum. Tendon reconstruction, Os trigonum removal and early functional posttreatment resulted in full ability in sport, leisure-time activities and profession five months later.

[Combined lateral ankle and calcaneocuboid joint instability]. / Kombinierte chronische Instabilität des lateralen oberen Sprung- und des dorsolateralen Calcaneocuboidalgelenks.

Up to now there was no publication describing a combined instability of the calcaneocuboid and lateral ankle joint. A 38 years old teacher (a former gymnast) complained about increasing giving way symptoms and pain at the lateral foot and ankle. Because of this, he was unable to take part in sports activities. Clinical investigation revealed lateral ankle and calcaneocuboid joint instability. Surgical treatment was done using periosteal flap augmented capsular reefing for both joints, resulting in full ability in sport and profession four months later.

[Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis-a therapeutic challenge]. / Die Impingementläsion der distalen Achillessehne bei Bursitis subachillae und Haglund-Pseudoexostose--eine therapeutische Herausforderung.

Retrocalcaneal bursitis in athletes is frequently misdiagnosed. Results of conservative treatment are not very promising. This investigation evaluates the results of 39 consecutive cases in 38 patients surgically treated due to chronic retrokalkaneal bursitis in a sport specific population. Preoperative MRI and ultrasound investigation showed corresponding lesions (focal degeneration, partial rupture) of the anterior Achilles tendon. This is possibly the result of a previously undescribed impingement lesion produced by the Haglund's bone and the chronically inflamed retrocalcaneal bursa. During operation this lesion was additionally addressed in 85% of the cases. Follow up was done after 32 months. Success rate was 54%. VISA-A Score at follow up was 80.6 points. Training and competition activities were started at 16 weeks and 9 months respectively. Unsatisfying results were analysed. In two cases Haglund's bone resection was incomplete and had to be removed in a reoperation. Additionally one deep wound infection had to be revised. Due to the distal Achilles tendon fiber extensions around the medial and lateral calcaneal bone, an unintended Achilles tendon lesion, induced by the edge of the osteotome seems to be possible. Two calcanear stress fractures complicated the postoperative rehabilitation.

Differential mutation frequency in mitochondrial DNA from thyroid tumours.

Lack of a chromatin structure and histone protection makes mitochondrial DNA susceptible to oxidative damage. Suboptimal DNA repair leads to a higher frequency of mitochondrial mutations, which are associated with aging, carcinogenesis and environmental insult. The instability of the hypervariable region II of the mitochondrial genome was investigated in radiation-associated thyroid tumours, which were diagnosed in children from Belarus after the accident at the Chernobyl nuclear power plant, and from 40 sporadic thyroid tumours from Munich. Two mutations were identified in two out of 126 tumours from Belarus, and eight mutations were found in six out of 40 tumours from Munich. All mutations were deletions or insertions of C in a poly-cytidine (C7TC6) microsatellite. The mutation frequency correlated with the age of the patients at surgery. Mutations with the typical pattern of base substitutions following oxidative DNA damage were not identified.

The c-myc oncogene: use of a biological prognostic marker as a potential target for gene therapy in melanoma.

The c-myc oncogene has been shown to be overexpressed in a number of malignancies, and may play an important role in the pathogenesis of malignant melanoma. Previous prognostic studies have demonstrated c-myc overexpression in a range of cutaneous melanomas, and levels of c-myc oncoprotein expression have been shown to correlate with clinical outcome in both primary and secondary disease. The purpose of this study was to investigate the in vitro manipulation of c-myc expression using antisense oligonucleotides. The human melanoma cell lines A375M, Be11 and WM115 were treated with c-myc antisense oligonucleotides, and the cellular growth was compared with controls. Antisense oligonucleotides reduced the growth rate of all three cell lines, and produced a reduction in c-myc gene expression as measured by flow cytometry. The growth inhibitions in the A375M, Be11 and WM115 cell lines at 72 h were 36.6%, 35.8% and 29.3%, respectively. Each of these was significantly different from control cultures (P<0.01). The c-myc antisense produced a mean 75% reduction in c-myc oncoprotein expression when compared with controls in the A375M cells (P<0.001), a 49% reduction in the Be11 cells (P<0.001) and a 28% reduction in the WM115 cells (P=0.005). This study demonstrates the importance of the c-myc oncogene in controlling melanoma growth. It suggests that blocking the expression of this gene, using an antisense approach, reduces melanoma cell growth, and may potentially provide a novel gene-therapy strategy for the treatment of advanced melanoma.

Instability of microsatellites in radiation-associated thyroid tumours with short latency periods.

PURPOSE: To determine the instability of microsatellite sequences in post-Chernobyl thyroid tumours from children and young adults, and to ascertain whether they correlated with the age of the patient at the time of the accident and the tumour latency period. MATERIALS AND METHODS: The stability of 26 microsatellite markers was investigated in 122 radiation-associated thyroid tumours (96 children, 26 adults) from Belarus and 39 spontaneous thyroid tumours (adults) from Munich without radiation history. RESULTS: A significant correlation between patient age at the time of the accident and the instability of microsatellite sequences was established. Also, a high instability of microsatellite sequences was found in 28 early thyroid tumours from Belarus with latency periods of 6-8 years, in contrast to a low instability of microsatellites in 94 tumours emerging 9-11 years after the accident. Microsatellite instability in the reference group from Munich proved similar to the early thyroid tumours from Belarus. CONCLUSION: Early, fast-growing and aggressive post-Chernobyl thyroid tumours are characterized by an increase in microsatellite instability.

[Orthopaedic examination of gymnasts]. / Grundlagen der orthopädischen Untersuchung im Kunstturnen.

A gymnast is prone to catch specific acute and overload injuries as well. Those injuries are concentrated at the spine due to the fact, that high load is administered to the growing apophyseal elements. Preventive X-ray examinations are useless in this respect, because the gymnasts training starts at the age of 5-6 years and apophyseal ossification nuclei develop not before the age of about 11-13 years. On the other hand regular performed preventive clinical examinations seem to be important for preventive reasons. For this purpose we developed specific clinical tests which allow early recognition of overuse injuries while they are in a latent phase and while the athlete does not complain any pain. Furthermore staging of the injury is possible and healing response can be controlled.

MP I joint giving way--a case study.

A case history of a 26 year old international class female 400 m hurdle sprinter is presented. While sprinting she felt a sudden and very intensive pain at her left hallux. After this she was unable to run and had episodes of giving way in the MP I joint elicited by minor activity. Operative investigation revealed a broad disruption of the MP I medial collateral ligament. After periosteal flap repair and early functional aftertreatment she returned to full high level sports ability.

Investigations into the molecular effects of single nucleotide polymorphism.

OBJECTIVES: DNA sequences are very rich in short repeats and their pattern can be altered by point mutations. We wanted to investigate the effect of single nucleotide polymorphism (SNP) on the pattern of short DNA repeats and its biological consequences. METHODS: Analysis of the pattern of short DNA repeats of the Thy-1 sequence with and without SNP. Searching for DNA-binding factors in any region of significance. RESULTS: Comparing the pattern of short repeats in the Thy-1 gene sequences of Turkish patients with ataxia telangiectasia (AT) with the "wild type" sequence from the DNA database, we identified a missing 8-bp repeat element due to an SNP in position 1271 (intron II) in AT-DNA sequences. Only the mutated sequence had the potential for the formation of a stem loop in DNA or pre-mRNA. In super-shift experiments we found that DNA oligomers covering the area of this SNP formed a complex with proteins amongst which we identified the proliferating cell nuclear antigen (PCNA) protein. CONCLUSION: SNPs have the potential to alter DNA or pre-mRNA conformation. Although no SNP-depeding formation of the DNA-protein complex was evident, future investigations could reveal differential molecular mechanisms of cellular regulation.

Microsatellite instability and loss of heterozygosity in radiation-associated thyroid carcinomas of Belarussian children and adults.

DNA from 129 paired thyroid tumorous and non-tumorous tissue samples of Belarussian children (102 patients; age at surgery