[Clinical examination, imaging and therapy of Osgood-Schlatter's disease]. / Klinik, Bildgebung und Therapie des Morbus Osgood-Schlatter.

BACKGROUND: Osgood-Schlatter's disease represents an often seen painful knee illness of temporary duration in adolescent sportsmen, caused by severe stress to the tibial apophysis. RESULTS: A study in 29 consecutive patients (∅ 12,7 yrs, 77 % male, 67 % non-dominant side affected, 4 patients both knee joints affected, always pain after performance, high sports activity in football, basketball, gymnastics/ballett, 41 % shortening of m. rectus fem.) shows that pure clinical diagnosis is sufficient. DISCUSSION: Imaging is only necessary in case of suspected concurrent origin, as it does not yield unique results and does not support therapy nor prognosis. Patients reduce their performance on their own. Late pain occurs at the apophyseal protuberance due to local compression. Restrictive recommendations to patients to leave their sport activity are not justified.

Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery.

Tear of the anterior cruciate ligament (ACL) secondary to knee sprain injury is also quite common among children and adolescents. Whether reconstruction is indicated and which technique should be employed is still controversial. The debate focuses on the possible risk of growth plate damages due to intraarticular operative reconstruction techniques. For more details on benefit and risks of operative stabilization, our clinic's large number of surgical results was to be evaluated retrospectively. In a total of 437 knee joint arthroscopies performed between 1982 and 1992 in children and adolescents with open physes, aged 3-16 years, 63 surgical repair/reconstructions according to an algorithm were carried out. The average age at surgery was 13.8 years. Follow-up an average 6.5 years after the operation consisted of clinical and radiological examination, Lysholm, Tegner, and IKDC scores. This report focuses on intraarticular ligament reconstruction methods. Forty-four patients could be followed up, comprising of five reinsertions, ten internal fixations, 15 cases semitendinosus tendon (ST) augmentations, and 14 primary reconstructions with the middle one-third of the patellar tendon (PT). In every ST and PT case, transtibial and transfemoral tunnels were drilled. The clinical stability examination was supplemented by KT-1000 arthrometer measurements and radiography in two planes. Averaged for all surgical techniques, good and very good results were obtained in over 75% of cases. There were no major growth defects and rarely signs of osteoarthrosis. According to literature, conservative treatment of ACL tears and even primary ACL repair is not infrequently followed by re-ruptures. Therefore, reconstruction is the preferred procedure for patients aged 12 years or more. As most authors hesitate to possibly block the physes by obtaining and anchoring patellar tendon grafts, the ST should be preferred. This study demonstrates in a large number of ACL stabilizations, despite transepiphyseal drilling and grafting, very good stabilization is achieved, but no growth defects have to be expected.

[Injuries in women soccer - results of a prospective study - in cooperation with the German Football Association (DFB)]. / Verletzungen im Frauenfussball - Ergebnisse einer prospektiven Jahresstudie - In Zusammenarbeit mit dem Deutschen Fussballbund (DFB).

Within the twelve female first division soccer teams 131 players of all 254 were injured during the season 2000/01. A total of 216 injuries was found, among them 74 minor (less than a week absence from sport), 84 moderate (max. 6 weeks) and 58 major injuries (more than 6 weeks). The average time to recover after an injury was 26.5 days. Within 116 joint injuries 16 sprains and 22 ligamental ruptures of the ankle, 16 meniscal lesions and 11 ACL ruptures could be found. Women soccer shows - compared to men - a higher selective risk of severe injuries, especially to the ankle joint and cruciate ligament. The accumulation of major injuries at the beginning of the season might be due to a too great demand during the preparation. There seems to be a need of improvement of the coordinative skills and to establish proprioceptive joint exercises as a relevant part of training.

[Degenerative joint and spine diseases]. / Degenerative Erkrankungen der Gelenke und der Wirbelsäule.

Degenerative joint and spine diseases account for more than 70% of all complaints and functional impairment in the human locomotor system. An expert assessor has to answer questions referring to loss of capability of earning a living and to the extent of an invalidity. He will often be confronted with questions whether or not the body damage is related to an accident. He therefore has to be familiar with accident mechanisms and typical injury patterns. Particular details of examination and imaging important for fulfilling the assessor's task are given. Special hints will be given referring to evaluation of rotator cuff lesions and spine syndromes.

[Value of ultrasound after endoprosthesis implantation of the knee joint]. / Der Wert der Sonographie nach endoprothetischer Versorgung des Kniegelenks.

PURPOSE: Ultrasound is often applied in the course of treatment after knee arthroplasty, although sonographic normal findings have not been described so far. Characterising these and comparing them to clinical disorders was the purpose of this study. Intra- and extra-articular hematoma and the imaging of the traumatised extension apparatus of the knee joint were of special interest. METHODS: During 4 weeks all consecutive patients after knee arthroplasty were examined clinically and sonographically. Furthermore, the blood parameters were controlled for signs of inflammation or coagulation disorders. These findings were then re-checked before the end of hospital rehabilitation treatment. RESULTS: In all of the patients, ultrasound revealed intra-articular fluid at the beginning and at the end of hospital treatment. The fluid area, differing in extension, was markedly reduced or showed less echogenicity concomitant with an organisation. The patellar tendon in all of the patients showed a loss of echogenicity at the site of operative incision, mostly at the patellar insertion, and a thickening extending throughout the middle part of the tendon even at control. Dynamic ultrasound examination displayed one case of a major defect which had to be revised. Blood parameters of inflammation were decreased, coagulation parameters were normal. CONCLUSION: After knee arthoplasty, extended intra-articular knee hematomas are not rare, only being resorbed or organised to a small degree during a rehabilitation period of three weeks, therefore not yielding relevant information for the course of treatment. CLINICAL RELEVANCE: The patellar ligaments show alterations comparable to acute tendopathy, thus not recommending use of maximal forces or too high stretching of the tendon tissue. Soft tissue defects with the need for interruption of the rehabilitation programme may be detected sonographically. Further studies will be necessary to explore the course of restructuring. Disorders of patellar sliding movement and signs of prosthetic loosening cannot be sufficiently judged at the present time.

Injuries in mountain biking.

Despite still growing attraction mountain biking as a matter of sports traumatology still lacks relevant data based on large cross-sectional surveys. To obtain an overview of risk factors, types, and main body sites of injuries occurring in mountain biking we assessed the results of a questionnaire answered by 3873 athletes. A total of 8133 single lesions were reported by 3474 athletes, 36% of whom regularly participated in competitions. The incidence of injuries in mountain biking is comparable to that in other outdoor sports, the majority of injuries being minor. Mountain biking athletes were found to have an overall injury risk rate of 0.6% per year and 1 injury per 1000 h of biking. The main risk factors included slippery road surface, cyclist's poor judgement of the situation, and excessive speed, representing personal factors that could be altered by preventive measures. Of all injuries 14% were due to collision with some part of the bike, especially the pedals and the handlebar. While 75% of the injuries were minor, such as skin wounds and simple contusions, 10% were so severe that hospitalization was required. A breakdown of the injuries according to body site and frequency of occurrence is presented.

[Sonographic changes after total hip joint replacement]. / Sonographische Veränderungen nach endoprothetischer Versorgung des Hüftgelenks.

UNLABELLED: The value of ultrasonographic imaging after total hip arthroplasty (THA) has not been described in the literature so far. AIM: The typical postoperative sonographical findings are to be presented thus creating a basis for detecting pathological alterations. METHOD: 73 consecutive patients after THA were sonographically and clinically examined at the beginning and the end of the clinical rehabilitation phase. Laboratory tests detecting signs of inflammation and coagulation disorders were also performed. RESULTS: In the early postoperative phase collection of liquid and its delayed resorption are the most important findings. The haematoma of the joint is usually organised within three weeks after the operation. It could be visualised in all patients as a region of homogeneous, slightly echogenic appearance--not clearly distinguishable from the surrounding tissue and not compressible. Areas of low echogenicity were rarely seen. The forming of a neo-capsule could be detected from the ninth postoperative week onwards. Peri-articular ossification was not seen in this study. A loosening of prosthetic material did not occur. In the area of surgical approach irregularly shaped slightly echogenic and hardly compressible zones representing large haematomas could be found. The volume of these lesions could not be measured exactly due to their highly irregular shape. We did not observe large areas of seroma or liquid haematoma interfering with the rehabilitation process. CONCLUSION: Experienced examiners are capable of demonstrating the sonographic features representing signs of the healing process. Thus pathological developments can be detected and adequate therapeutic measures be taken. Future studies will have to show to which degree ultrasonography can become relevant in the diagnosis of endoprosthetic loosening.

[Injuries and overuse syndromes due to rock climbing on artificial walls]. / Verletzungen und Uberlastungssyndrome beim Klettern an künstlichen Kletteranlagen.

The purpose of this study was to obtain an overview of acute injuries and chronic overuse syndromes due to rock climbing on artificial climbing walls. Strategies for prevention should then be developed based on these experiences. From October 1995 to December 1996 314 climbers of both sexes and all degrees of climbing abilities were individually interviewed at five different indoor climbing arenas with the help of a special questionnaire. Type, quantity and cause of typical injuries and overuse syndromes on artificial climbing walls were determined. Injuries (n = 204) as well as overuse syndromes (n = 266) increased with the performance level. Experienced climbers often suffered from injuries to the finger flexor tendons (n = 42) and the finger flexor pulleys (n = 37) while holding small grips. Beginners sustained skin injuries (n = 26) and joint distortions (n = 22) of the lower limb while falling. Reasons are a lack of experience in the techniques of belaying and falling as well as incomplete covering of the ground with crash mats. Chronic overuse syndromes mainly presented as swelling and pain in the finger joints (n = 140) and as epicondylitis in the elbow (n = 30). Especially knee problems (n = 12) were caused by new climbing techniques used on artificial climbing walls. Referring to injuries as well as to overuse syndromes climbing on artificial climbing walls is a very safe sport, compared to climbing on natural rock. Further prevention could be provided by a well-based instruction of beginners, especially in techniques of belaying and falling. The ground of climbing walls should always be completely covered by sufficient crash mats. More experienced climbers should minimize harmful climbing techniques, like using very small holds with a cling grip, long distance reaches and inside rotation of the leg under pressure.

["Tennis leg": ultrasound differential diagnosis and follow-up]. / Das "tennis leg": Sonographische Differentialdiagnostik und Verlaufskontrolle.

Tennis leg is a common muscle injury in men older than 40 years participating in racquet sports, alpine skiing and running. It is defined as a partial or total rupture of the medial head of the gastrocnemius muscle which usually is well demonstrable by ultrasound. Main symptom is a sudden sharp pain leading to an obligate immediate stop of sport activity. Clinically pain on local pressure or stretching of the muscle will be reported, local defects can be palpated. 25 patients were prospectively examined by ultrasound according to a new developed grading system. A grade-adapted conservative therapy program led to a wide relief of pain after about two weeks. Full range of sport ability was only regained after at least three weeks. Ultrasonography is able to clearly demonstrate the size and grade of the lesion, thus enabling a well defined therapy program and prognostic conclusions.

[Pattern and risk of injuries of profile athletes in snow boarding]. / Verletzungsmuster und -risiken von Profisportlern im Snowboardsport.

During winter 1994/95 and 1995/96 a retrospective study was carried out in which datasets supported by questionnaires from 31 female and 64 male professional snowboarders were evaluated. Included were personal data and details of other types of sports. Also the personal style preferred and equipment used was integrated. Particularly of interest were the localization and causes of injury-patterns with the degrees of severity and overexertion disorders. Among the professionals the most frequent injuries occurred in the metacarpals and fingers (37.3%), the shoulder (36.0%), knee joints (33.3%) and the ankles (28%). The predominating pattern of severe joint injuries were capsular/ligament lesions and fractures. Overexertion syndromes in the knee were predominant, followed by thigh and ankle-joint strains. In the alpine group the incidence of injuries and strains, the knee was the most frequent. 75 professionals suffered 195 traumas. In relation to 1000 snowboarding hours, the risk of injury among the professionals is 0.8. Self induced injuries were mostly cause of misjudgement in specific situations (40.1%).

[Injury and exertion patterns in football on artificial turf]. / Das Verletzungsspektrum und die Uberlastungsschäden beim Fussballsport auf Kunstrasen.

This controlled non-selected cross-sectional study supplies a basic survey on the topic analysing 1783 injuries in 433 of 736 athletes out of a closed collective. Aged 11 to 40 years and having played an average of 3.7 years an artificial turf the players had sustained 38% skin injuries (58% in the legs), 28% sprains (64% in the ankle joints, 21% in the knee joints) and 17% muscle injuries. 76% of all injuries were minor, i.e. leading to an interruption of under one week, only 8% were severe with a break of over 3 weeks. The average risk of injury was 6 per 1000 hours of participation, similar to that in football on natural grass. More than half of the players protocol pain in the joints, muscles or column persisting even one day after the game, which only led to medical assistance in 3% of all cases. Playing football on artificial grass displays a specific pattern of injuries and exertion syndromes without a higher rate or grade of injuries and therefore shows no medical need for restriction.

[Bilateral congenital radio-ulnar synostosis with hyperpronation--findings and surgical therapy]. / Beiderseitige angeborene radioulnare Synostose mit Hyperpronation--Befund und operative Therapie.

Congenital proximal synostoses of the ulna and radius do not require surgery in most of the cases, since the proximal synostosis can be sufficiently compensated by the wrist joint. In cases of considerable functional deficit, the synostosis has to be separated to enable re-ossification in a more advantageous position. We report on a patient with bilateral synostosis and a significant functional deficit due to the grotesque hyperpronation of the forearms. Following operative longitudinal separation and redressive casts, a good correction was obtained. X-ray imaging in lateral view documented the improved forearm position.

[Acute and chronic overuse injuries in extreme sport-climbing]. / Verletzungen und Uberlastungssyndrome beim extremen Sportklettern.

From May to September 1994 a study on acute and chronic overuse injuries in to rockclimbing was performed. The etiology of trauma was referred to trainingforms and climbing techniques. 112 climbers participating in the study climbed at level 9+/10- (8a). This study demonstrated that the incidence of overstrain syndromes increased with the performance level. The overall predominance of finger injuries was followed by acute spinal syndromes, knee, and ankle sprains. Among the most frequent overstrain complaints epicondylopathias, chronic complaints of the finger joins and flexor tendons, and nerve compression syndromes of the upper extremities could be seen. Most notable was the fact that the frequency of certain overstrain syndromes increased in relation to the years of climbing.

[Peroneus tertius tendon repair following old traumatic rupture of the anterior tibial tendon (casuistry)]. / Peronaeus-tertius-plastik nach veralteter traumatischer ruptur der tibialis-anterior-sehne (kasuistik).

The etiology of anterior tibial tendon rupture and the results after secondary operation are described in one patient. A new operative technique using his peroneus tertius tendon as a free graft was performed. Follow-up after only 5 months showed almost normalized function in comparison to the uninjured leg. No additional loss of function owing to the operative method was noted. Ultrasound is of the highest diagnostic value in detecting the injury and in controlling the course of healing.

[Postoperative evaluation of osteochondrosis dissecans of the talus with special reference to medial malleolar osteotomy]. / Die postoperative Bewertung der Osteochondrosis dissecans tali unter besonderer Berücksichtigung der Innenknöchelosteotomie.

58 out of 69 patients after open operation for osteochondritis dissecans (OD) of the upper ankle joint were reexamined retrospectively. In 44 cases the medial talar edge was concerned, in 15 the lateral one. Pain in activity resisting conservative treatment led to the operations. 31 excisions, 16 drillings, 10 autogenous bone graftings (2 external) and 2 diagnostic arthrotomies had been carried out. Medial malleolar osteotomy had to be performed in 22 cases, mainly concerning excisions and graftings to maintain sufficient survey of the lesion. Follow-up examination took place an average 67 months postoperatively. The results were obtained through a new scoring system with special regard to subjective and clinical criteria. 13 excellent, 29 good, 10 fair and 7 bad results were obtained. Results depended mainly on operative approach, location of the lesion and in lateral OD time of operation. Medial malleolar osteotomy frequently led to local osteoarthritis and less favourable clinical findings. No significant difference could be realized for size of the lesion and the applied operative technique. Stage and age at time of operation did not clearly influence the outcome. The indication for operation must be made dependant on individual complaints. Even in the era of arthroscopy medial malleolar osteotomy sometimes is necessary, but goes along with higher morbidity and worse prognosis. Operations have to be carried out according to stage and followed by proper rehabilitation to render proper assessment. Lateral lesions result from sprains and should be operated early.

[Surgical treatment of soccer player's ankle joint]. / Die operative Behandlung des Fussballer-Sprunggelenks.

In experienced football players spurring and calcifications of the ankle joint's capsule attachments may be found more often than in other sportsmen. Basing on functional and sometimes already established ankle joint instability pain may develop. Out of 374 football players throughout 1989-1992 with injuries to the ankle joint 49 were operated on. These showed chronical instability and radiologically visible alterations in accordance with the imaging of footballer's ankle joint. 40 of these patients could be followed up. 16 exact fibular ligament repairs and 19 reconstructions were performed, 15 tibioventral, 6 talodorsal, 12 fibular and three medial capsule calcifications and spurs were excised, 8 loose bodies removed, three cases of osteochondritis dissecans drilled. After an average follow up of 25.6 months we saw stable ankle joints in all patients with resting local pain in 15 patients, among them 7 load dependent and 6 with slight limitation of dorsiflexion. Sport activity level showed 25 patients improved, 11 equal, one worse and three with changed disciplines.