[Bone void fillers in osteotomies : If, when, and which type?] / Füllung des Osteotomiespalts : Ob, wann und womit?

Medial opening wedge high tibial osteotomy (HTO) is an established procedure for treating medial osteoarthritis of the knee. In order to achieve the desired amount of correction, the osteotomy gap is opened, which creates a bone void in the medial aspect of the proximal tibia. The resulting bone void can either be left alone or be addressed by interposing a variety of different bone void fillers. Autologous and allogenic fillers can be distinguished from synthetic materials. Up to now, few studies have dealt with the usefulness and necessity for bone void fillers in HTO. The following article provides an overview on the currently used bone void fillers, their specific advantages and disadvantages and their influence on clinical and radiographic outcome after HTO.

Magnetic resonance imaging of injuries to the ankle joint: can it predict clinical outcome?

OBJECTIVE: To predict clinical outcome after ankle sprains on the basis of magnetic resonance (MR) findings. DESIGN AND PATIENTS: Twenty-nine consecutive patients (mean age 32.9 years, range 13-60 years) were examined clinically and with MR imaging both after trauma and following standardized conservative therapy. Various MR abnormalities were related to a clinical outcome score. RESULTS: There was a tendency for a better clinical outcome in partial, rather than complete, tears of the anterior talofibular ligament and when there was no fluid within the peroneal tendon sheath at the initial MR examination (P = 0.092 for either abnormality). A number of other MR features did not significantly influence clinical outcome, including the presence of a calcaneofibular ligament lesion and a bone bruise of the talar dome. CONCLUSION: Clinical outcome after ankle sprain cannot consistently be predicted by MR imaging, although MR imaging may be more accurate when the anterior talofibular ligament is only partially torn and there are no signs of injury to the peroneal tendon sheath.

[Magnetic resonance tomography (MRI) of ligament injuries of the upper ankle joint]. / Magnetresonanztomographie (MRT) bei ligamentären Verletzungen des oberen Sprunggelenks.

This paper discusses MR imaging in injuries to the lateral collateral ankle ligaments. Based on recent publications and our own results MR imaging may be useful for demonstration of ankle ligament tears. However, clinical outcome can probably not be predicted by such diagnosis. MR imaging may still be useful in certain settings, such as suspected additional trauma to medial ligaments, bone, or articular cartilage. In chronic pain MR imaging may be indicated for demonstration of articular bodies, occult fractures, significant cartilage damage, tendon injuries and dislocations, and soft tissue scars.

Clinical examination and magnetic resonance imaging in the assessment of ankle sprains treated with an orthosis.

This is a prospective clinical study of treatment of ankle sprains with an ankle brace that permits ankle dorsiflexion and plantarflexion of 20 degrees, but limits inversion and eversion for 6 weeks. The ankle brace is followed by physiotherapy for another 6 weeks. Thirty patients were evaluated with clinical examination and magnetic resonance (MR) imaging before treatment and after 12 weeks of treatment. MR imaging revealed acute tears in the anterior talofibular ligament in all 30 ankles (100%) and tears in the calcaneofibular ligament in 25 of 30 ankles (83%). At 12 weeks after injury, MR evidence of healing was present for the anterior talofibular ligament in 22 of 30 ankles (73%) and for the calcaneofibular ligament in 23 of 25 ankles (92%). Postural sway analysis after therapy was used to quantify functional stability of the ankle. There was no correlation with MR findings, but there was a correlation with the subjective impression of functional instability. Twenty-eight of 30 patients (93%) had a functionally stable ankle after 12 weeks of treatment. MR findings after ankle sprain could not predict clinical outcome.

[Holmium-YAG laser in outlet impingement of the shoulder. Mid-term results]. / Holmium:YAG-Laser beim "outlet impingement" der Schulter. Mittelfristige Ergebnisse.

Arthroscopic widening of the subacromial space in the case of outlet impingement syndrome has many advantages over the open procedures. Arthroscopic subacromial decompression in case of impingement syndrome if refractory to conservative therapy, is an established procedure. The purpose of this study was to evaluate the results of arthroscopic subacromial decompression using the holmium:YAG laser and compare them with the result of the conventional arthroscopic procedure. In a prospective study, 47 patients with stage II and III impingement syndrome were divided into two groups. The first group (20 patients) underwent conventional arthroscopic subacromial decompression. The second group (27 patients) underwent arthroscopic subacromial decompression performed with the holmium:YAG laser. The results were assessed using the constant score preoperatively and postoperatively with a follow-up of at least 1 year for each patient. Improvement in the laser group was seen in the criteria of motion and pain. Abduction power, found to be improved after 1 week and 6 weeks in earlier investigation, showed no significant improvement at the follow-up time of 1 year. The average score of both groups increased after 1 year: in the laser group from 57.4 preoperatively to 75.3, in the conventional group from 49.7 to 65.7. There were no specific complications due to the laser application.