[Primary revision with replasty of the anterior cruciate ligament]. / Die primäre Revision mit Replastik des vorderen Kreuzbandes.

OBJECTIVE: Restoration of knee stability after rerupture of an anterior cruciate ligament (ACL) graft. INDICATION: Acute and chronic functional instability with rerupture of an ACL graft with subjective instability with anatomical or non-anatomical bone tunnel without tunnel widening. CONTRAINDICATIONS: Partial anatomical bone tunnels of the previous operation, significant tunnel widening of anatomical bone tunnels, local infection of the knee joint, local soft tissue damage. SURGICAL TECHNIQUE: Graft choices are hamstring tendons (semitendinosus muscle, gracilis muscle), the quadriceps tendon, patellar tendon and a peroneus tendon split graft. In cases with anatomical tunnels, careful debridement is performed down to the tunnel wall. In non-anatomical tunnels, a new femoral tunnel is drilled over a deep anteromedial portal with the knee flexed more than 110° in the insertion area of the ACL. Using drills and dilators, a tunnel is prepared. At the tibia, the anterior horn of the lateral meniscus serves as a landmark in the absence of an ACL stump. The cortical tibial tunnel aperture is probed with a guide wire and the tunnel is drilled stepwise until the tunnel wall is reached, which is debrided with a spoon or synovial resector to remove graft residues and implants from the tunnel. The femoral fixation can either be done with a flip button, an interference screw or in the case of a bone block graft implant-free. At the tibial side, the graft is fixed with a resorbable interference screw and fixation button. POSTOPERATIVE MANAGEMENT: The rehabilitation program comprises 4-5 phases. Inflammatory phase (weeks 1-2): control of pain and swelling (cooling, isometric tension exercises, 20 kg partial load). Phase 2 (weeks 2-6): increasing load and range of motion with closed chain exercises (target: extension/flexion 0-0-120°). Phase 3 (from week 6): strength and coordination exercises. Phase 4: balance, strength and jump exercises. Return to competitive sport not before postoperative month 6-10. RESULTS: Included were 51 patients with recurrent instability after ACL surgery where primary ACL replacement was performed with ipsilateral bone quadriceps tendon graft or contralateral semitendinosus-gracilis graft. All patients had anatomical or non-anatomical tunnel locations without significant widening (>11 mm). After 2 years, the side-to-side difference for anterior tibial translation measured with the KT 1000 arthrometer was 2.0 ± 1.2 mm for the quadriceps group and 3.0 ± 2.9 mm for the semitendinosus-gracilis group (P = 0.461). No difference in the rate of positive pivot shift tests (P = 0.661); no significant difference in the individual Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores or in the frequency of anterior knee pain.

[Arthroscopic suprapectoral tenodesis of the long head of the biceps tendon]. / Arthroskopische suprapektorale Tenodese der langen Bizepssehne am Schultergelenk.

OBJECTIVE: The aim of a tenotomy of the long biceps tendon is to remedy a painful pathology in the proximal region of the tendon. Tenodesis of the tendon can restore the motor and cosmetic function of the biceps brachii muscle. INDICATIONS: Partial rupture or tendopathy of the long biceps tendon, injuries of the anchor of the long biceps tendon (SLAP lesions; SLAP: superior labrum anterior posterior), lesions of the pulley system. CONTRAINDICATIONS: Infections or tumors, loss of the long head biceps tendon from the intertubercular groove. SURGICAL TECHNIQUE: Shoulder arthroscopy via a posterior standard portal in beach chair position. Anteroinferior portal. Standard diagnostic arthroscopy. Checking the stability of the biceps anchor and the pulley system with a probe. Testing the extra-articular portion of the long biceps tendon with the hook. By pulling the tendon into the joint, the course of the tendon can be assessed. Anterolateral portal superior of the intertubercular groove. Pulling the tendon out of the anterolateral portal. Arming of the tendon with Krackow stitches. Fixation of the tendon in the intertubercle groove with a knotless suture anchor. POSTOPERATIVE MANAGEMENT: Three weeks immobilization with an arm sling, 6 weeks no forced elbow flexion and forearm supination, 2 weeks active-assisted mobilization of the shoulder up to horizontal, 30° external rotation, internal rotation free. RESULTS: The results published in the literature show that epiossal anchor tenodisis improves the clinical scores (preoperative vs. postoperative) and leads to a better cosmetic result and a lower rerupture rate than soft tissue tenodesis.

Experiences with Osteoligamentoplasty According to Weiss for the Treatment of Scapholunate Dissociation.

BACKGROUND: In post-traumatic, dynamic, or static scapholunate (SL) instability, an SL ligament reconstruction is advisable to avoid long-term complications. However, a sufficient primary reconstruction is best achieved in acute injuries. For chronic SL dissociation, there is still no satisfying standard surgical technique. In this context, we evaluated the clinical outcome of Weiss's osteoligamentoplasty as a treatment option. METHODS: Over a three-year period, 16 patients with chronic and symptomatic SL dissociation Grade-II and III, without the signs of osteoarthrosis were, surgically treated using a bone-retinaculum-bone autograft from the distal radius. All patients underwent prior wrist arthroscopy. The clinical outcome was measured using the Mayo-Wrist, Krimmer, and DASH score. In addition, radiological measurements were also performed. RESULTS: The postoperative clinical outcome successfully increased the Mayo-Wrist score: 32 to 64 points, Krimmer score: 30 to 53 points and DASH score: 41 to 30 points. The radiological follow-up demonstrated no evidence of an SL gap or significant loss of reposition in the SL angle in 13 of the 16 cases. Till date, two patients had to be revised to an arthrodesis. CONCLUSIONS: The autogenous osteoligamentary span from the distal radius improves a chronic SL dissociation and, therefore, presents a suitable option to anatomically reconstruct the SL ligament. It leads to a proper realignment of the carpus and could help to prevent arthritic changes of the wrist. Nevertheless, in patients with postoperative high occupational physical strain, the procedure should be performed with reservations. As long as there is no satisfying standard surgical treatment, Weiss's osteoligamentoplasty is a convincing technique.

A Stable Finite-Difference Scheme for Population Growth and Diffusion on a Map.

We describe a general Godunov-type splitting for numerical simulations of the Fisher-Kolmogorov-Petrovski-Piskunov growth and diffusion equation on a world map with Neumann boundary conditions. The procedure is semi-implicit, hence quite stable. Our principal application for this solver is modeling human population dispersal over geographical maps with changing paleovegetation and paleoclimate in the late Pleistocene. As a proxy for carrying capacity we use Net Primary Productivity (NPP) to predict times for human arrival in the Americas.

[Arthroscopic refixation of acute proximal anterior cruciate ligament rupture using suture anchors]. / Arthroskopische Refixation einer akuten proximalen vorderen Kreuzbandruptur mittels knotenlosem Fadenanker.

OBJECTIVE: Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. INDICATIONS: Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. SURGICAL TECHNIQUE: Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL. POSTOPERATIVE MANAGEMENT: Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0­0-0°, then 0­0-90° for the following 4 weeks. RESULTS: A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (<3 mm), 3 patients had a 1+ Lachman and 4 patients had a 1+ pivot shift. IKDC (International Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.

Surgical treatment of acute acromioclavicular joint dislocations: hook plate versus minimally invasive reconstruction.

PURPOSE: This study was performed to compare the clinical results of a minimally invasive technique for acute acromioclavicular (AC) joint dislocation repair with the traditional hook plate fixation. METHODS: Forty-four patients with an acute (within 2 weeks after trauma) complete AC joint separation (35 male, nine female; median age 36.2 years, range 18-56) underwent surgical repair with either a minimally invasive AC joint repair or a conventional hook plate. Functional outcome was evaluated using the Constant-Murley Score (CMS), the TAFT score and the AC joint instability score (ACJI). Radiographic evaluation was performed with bilateral anterior-posterior (a.p.) stress and Alexander views. RESULTS: All patients were available after a median follow-up of 32 months (range 24-51). There were no significant differences in the mean CMS, Taft score and the ACJI between the two groups. The radiological assessment revealed no significant difference in the coracoclavicular distance. In both groups, a slight loss of reduction was observed. Periarticular ossification was seen in 11 patients of the minimally invasive AC joint repair and eight patients of the hook plate group but this did not affect the final outcome. Hook plates were removed after a median interval of 11.9 weeks (range 10-13). CONCLUSION: Good clinical results can be achieved with both minimally invasive AC joint repair and hook plate fixation. However, in the hook plate group a second operation is mandatory for plate removal. LEVEL OF EVIDENCE: III.

[Suturing and refixation of the medial collateral ligament in severe acute medial instability of the knee]. / Naht und Refixation des medialen Kollateralbandkomplexes bei schwerer akuter medialer Instabilität des Kniegelenks.

OBJECTIVE: Restoration of the medial stability after acute lesion of the medial collateral ligament (MCL) and of the posteromedial complex in case of a high grade instability of the MCL. Stabilization against valgus stress and prevention of an increased posterior drawer in case of a lesion of the posterior oblique ligament (POL). INDICATIONS: Acute high grade instability (grade 3) of the MCL. Rupture of the POL in combination with a rupture of the PCL and/or of the ACL. Multiligamentous injuries. Stener-like lesion of the tibial insertion of the MCL fibers with subluxation of the MCL superficial to the pes anserinus superficialis. CONTRAINDICATIONS: Local infection, poor soft tissue condition, severe soft tissue defects, intraligamentous injuries of the MCL (grade I-II instabilities). SURGICAL TECHNIQUE: The refixation of the MCL and the posteromedial complex has to respect anatomical situation. Femoral or tibial avulsions of the MCL can be reattached by the use of anchors at the anatomical insertion sites. Intraligamentous ruptures must be adapted. Additional framelike sutures may be used. The fixation and readaption of the MCL and the posteromedial complex can be combined with ACL and PCL procedures. POSTOPERATIVE MANAGEMENT: Use of a brace for 6 weeks to avoid valgus stress, partial weight bearing (10-20 kg). Weeks 1-3: ROM 0-20-60° extension/flexion; weeks 4-6: ROM 0-10-90° extension/flexion; after 7 weeks: free ROM. The postoperative protocol must be more restrictive in case of a combination of a MCL fixation and a PCL reconstruction (6 weeks immobilization in extension with posterior support, exercise only in prone position). RESULTS: Between 2010 and 2013, 34 cases of acute medial instability were treated. According to the injury pattern, some procedures were isolated MCL refixations, while others were combined procedures. While 25 patients showed a concomitant ACL injury, 13 patients had combined PCL and ACL injury. Postoperatively all medial instabilities had improved. Revision surgery was performed in 3 cases due to postoperative arthrofibrosis.

[Arthroscopic treatment of tibial plateau fractures]. / Arthroskopisch gestützte Versorgung der Tibiakopffraktur.

OBJECTIVE: The aim of arthroscopically assisted treatment of tibial plateau fractures is to achieve minimally invasive reduction and internal fixation of the joint fracture of the tibial plateau. Using the arthroscopic procedure, both the approach morbidity and the control of the articular reduction can be optimized. INDICATIONS: Displaced tibia plateau fractures of AO type A1 and B1/2/3 or Tscherne P2. CONTRAINDICATIONS: Strongly displaced tibial plateau fractures, which require an open surgical approach and stabilization with plate fixation (e.g., AO type C fractures or Moore type 5 fractures); 2nd and 3rd degree open fractures. Danger of compartment syndrome. SURGICAL TECHNIQUE: Planning of the surgical approach and confirmation of the indication by CT imaging. Diagnostic arthroscopy of the knee joint with treatment of associated injuries and confirming the indications for arthroscopically assisted reduction. Under arthroscopic control, insertion of an ACL tibial aiming device. In the central portion of the dislocated fracture fragment, a 2.4 mm K-wire is placed with the help of the aiming device. Opening of the outer cortex using a cannulated drill (9-11 mm diameter), introduction of a cannulated plunger below the fracture resulting in reduction of the fracture and compression of the cancellous bone below the fracture. Simultaneously the reduction is controlled by arthroscopy. Finally, the fracture is fixed using minimally invasive screw fixation (3.5-7.3 mm cancellous screws with washers) or by plate osteosynthesis (e.g., support plate). The metaphyseal defect can optionally be filled with bone substitute material. POSTOPERATIVE MANAGEMENT: Rehabilitation is dependent on the extent of the fracture. In arthroscopically treated fractures, partial weight bearing of 20 kg over a period of 6-12 weeks is usually necessary.

Alteration of biomechanical properties of skin in acute cold contact injury.

BACKGROUND: The prevalence of acute cold injury has increased recently. Despite new research findings, these injuries and their resulting tissue damage are still not entirely understood. Especially, little is known about alteration of skin biomechanical properties. METHODS: A total of 36 acute cold contact wounds with different depths were generated on the abdomen of six Göttingen minipigs. Alteration of biomechanical properties of skin was evaluated objectively after 15 and 360 min using a Cutometer device. Biopsies for histological evaluation were taken, and the depth of injury was correlated with biomechanical properties. RESULTS: Calculated elasticity (Ue), firmness of skin (R0) and overall elasticity (R8) demonstrated a continuous decrease, whereas other parameters demonstrated an initial increase with increasing depth of injury 15 min after wound generation. All parameters showed an increase compared to healthy skin, 360 min after wound generation. Furthermore, an alteration of values over time was detected. CONCLUSION: Alteration of biomechanical properties of skin is a function of damaged tissue structures. The presented results demonstrate a decrease of main elastic parameters with increasing depth of injury and indicate progressive tissue damage over time. Skin elasticity measurements are a valuable tool in acute cold contact injury depth assessment and may act as an influencing factor in management decisions.

[Anatomic reconstruction of the anterior cruciate ligament with the autologous quadriceps tendon. Primary and revision surgery]. / Anatomische Ersatzplastik des vorderen Kreuzbandes mit der autologen Quadrizepssehne. Primär- und Revisionsoperation.

OBJECTIVE: Restore function of the anterior cruciate ligament (ACL). INDICATIONS: Chronic functional instability with rupture of the ACL, giving way phenomena, acute rupture of the ACL with concomitant meniscus repair, rerupture of ACL graft with anatomical tunnels. CONTRAINDICATIONS: Local infection of the skin at the knee joint, local soft tissue damage, after rupture of the quadriceps tendon, enthesopathia of the quadriceps tendon, lack of patient compliance. SURGICAL TECHNIQUE: Harvest quadriceps tendon graft with a bone block via a 4-5 cm long incision, starting from the middle third of the proximal patella pole without damaging the tendon fibers. Drill the femoral tunnel via a deep anteromedial portal with the knee flexed of more than 110° (tunnel diameter 0.5-1 mm smaller in diameter than bone block). Gentle tunnel preparation using dilators. In absence of an ACL stump the lateral meniscus anterior horn serves as tibial landmark. In case of revision surgery, remove graft material and implants from the tunnel. Graft fixation using press fit method in the femoral tunnel. Tibial graft fixation archieved with a resorbable interference screw and a button. POSTOPERATIVE MANAGEMENT: Goal of the inflammatory phase (weeks 1-2) is pain and inflammation control (20 kg partial weight bearing). During the proliferative phase (weeks 2-6), load and mobility slowly increased (closed-chain exercises). During the remodeling phase (> 6 weeks), strength and coordination exercises are performed. In revision cases and in case of concomitant injuries, longer partial weight-bearing period might be necessary. Athletes should not return to competitive sports before 6-8 months. RESULTS: In a prospective study, 33 patients (age 16-48 years) were examined after replacement of the ACL with a quadriceps tendon graft after a minimum follow-up (FU) of 2 years (12 revision; 21 primary surgery). No post- or perioperative complications. Postoperative radiographs showed an anatomical tunnel location and no dislocation of the bone block. After 2 years the difference of a-p translation compared to the other leg was assessed by the use of KT 1000. The revision group improved from an average of 7.2 mm (pre-op) to 2.2 mm (FU). The group with primary surgery improved from 6.4 mm (pre-op) to 1.7 mm (FU). A sliding pivot shift phenomenon was detected in 2 patients in the revision group and 1 patient in the primary surgery group.

[Stage-adapted treatment of infection after reconstruction of the anterior cruciate ligament]. / Stadiengerechte Therapie bei Infekten nach Ersatzplastik des vorderen Kreuzbandes.

OBJECTIVE: Debridement and irrigation of the knee joint and the donor site to reduce the amount of bacteria and to remove bacterial enzymes and inflammatory cytokines in cases with infection after replacement of the anterior cruciate ligament (ACL). INDICATIONS: Proven infection, suspected infection. CONTRAINDICATIONS: High anesthesiological risk. SURGICAL TECHNIQUE: The therapy of infections after ACL reconstruction depends on the different stages as described by Gächter. In stage I and II, arthroscopic debridement and irrigation (about 10 l) of all compartments is performed. Several biopsies for microbiological analysis are obtained during surgery. Broad-spectrum antibiotic therapy started immediately after surgery. Once the resistance of the bacteria is known, antibiotic therapy may be changed according to the results. When pain, swelling, elevated CRP, or white blood cells persists, arthroscopic irrigation is repeated. In stage III, a complete arthroscopic synovectomy is performed. When the graft is intact, it is left in situ. Resection is performed in case of graft insufficiency, tunnel malplacement, or persistent infection. When the bone tunnels are affected, they should be debrided. In stage IV with osteolysis, an arthrotomy with open debridement may be required. The surgical therapy can be supported with the application of local antibiotics. REHABILITATION: Redon drainage is left in situ until the next irrigation is performed, control of wound and laboratory results, passive exercises, physiotherapy, systemic antibiotic therapy. RESULTS: Between 2008 and 2013, we treated 13 patients with an infection after replacement of the ACL. In all cases, complete healing was achieved. In 4 cases, the graft was resected. In 2 patients, arthrofibrosis developed and arthrolysis was required.

[Medial closing wedge osteotomy for correction of genu valgum and torsional malalignment]. / Osteotomie am distalen Femur zur Korrektur von Genu valgum und Torsionsfehlern.

OBJECTIVE: Femoral medial closing wedge osteotomy for the correction of valgus malalignment to unload the cartilage in the lateral compartment and/or correction of symptomatic torsional malalignment. INDICATIONS: Lateral unicompartmental osteoarthritis of the knee with genu valgum in young patients. Symptomatic torsional malalignement of > 30° and < 0°. CONTRAINDICATIONS: Grade 3 and 4 cartilage damage in the medial compartment. Heavy smoking. Medial meniscectomy. Extreme obesity. Inadequate soft tissue conditions. SURGICAL TECHNIQUE: The operation begins with arthroscopy of the knee joint. In case of grade 4 lateral cartilage damage, a microfracture is performed. The distal femur is exposed via an anteromedial longitudinal incision starting 10 cm above the patella and ending in the upper third of the patella. The medial femoral cortex is exposed using Hohmann retractors and an oblique closing wedge osteotomy is performed with an oscillating saw. In case of valgus correction, the lateral cortex is left intact. In case of correction of torsional malalignment, the osteotomy plane is horizontal and the lateral cortex is cut. The wedge height is determined preoperatively based on full leg x-rays. The leg axis is controlled intraoperatively with a long metal rod and the use of an image intensifier. The osteotomy is manually closed and stabilized with a locking plate. POSTOPERATIVE MANAGEMENT: The patient is mobilized under load with 20 kg body weight for the first 6 postoperative weeks. Full range of motion is permitted. RESULTS: We treated 23 patients with lateral cartilage damage (grades 3 and 4) and genu valgum with medial closing osteotomy of the distal femur (6 men and 17 women). After 3.5-years follow-up, the KOOS increased from 48.4 points to 84.9 points. In one case, there was an early loss of correction, with subsequent revision with bone grafting and lateral osteosynthesis. No peri-or postoperative complications such as infection, thrombosis, and embolism occurred. In 5 cases a torsional osteotomy was performed. The torsional osteotomy was performed 4 times due to chronic patellofemoral instability, and once due to a medial tibiofemoral instability. Healing complications were not observed in this population. Recurrent instability was not observed.

[Unicompartimental joint (Oxford III) with mobile bearing : Minimally invasive implantation of a in the medial compartiment]. / Unikompartimentelle Oxford-III-Prothese mit mobilem Gleitlager : Minimal-invasive Implantation im medialen Kniegelenkskompartiment.

OBJECTIVE: Replacement of the joint surfaces in the medial compartment by an endoprothesis with a mobile bearing. INDICATIONS: Unicompartimental anteromedial gonarthrosis with an intact anterior cruciate ligament. Avascular necrosis at the medial femoral condyle. CONTRAINDICATIONS: Third to fourth degree cartilage damage in the lateral compartment. Lateral menisectomy. Symptomatic osteoarthritis in the femoropatellar joint. Chronic polyarthritis. More than 15° varus. Varus passive not redressable. Medial or lateral subluxation. More than 15° extension deficit. Passive flexion less than 110°. Cruciate ligament lesions with instability. Poor soft tissue conditions. SURGICAL TECHNIQUE: The leg is mounted on an electric leg holder that allows flexion up to 120°. The joint is opened via an anteromedial arthrotomy starting at the medial border of the patella and ending 3 cm below the tibia plateau. The osteophytes are resected and the tibial resection is performed with an oscillating saw under guidance of a jig which is positioned according to the physiological tibial slope. The medial collateral ligament must be protected with a Hohmann retractor. The vertical cut is performed first; then the horizontal cut is performed. The size of the resected plateau should allow space for a tibial component and a meniscus implant of 4 mm. The resected plateau seves to determine the size of the plateau. The jig for the femoral preparation is adjusted according to the axis of femur and tibia. After the posterior resection the 0 mm spigot is inserted into the central drill hole and the distal part of the condyle is milled. The depth of milling is determined by equalizing the flexion and extension gap. Extension and flexion gap balancing is controlled with test inlays. Posterior osteophytes at the medial femur condyle are cut with a special chisel. In the anterior aspect bone resection is needed to prevent impingement of the meniscus implant. Then the tibia plateau is finally prepared. After inserting the test implants the femoral and tibial components are cemented in one or two stages. POSTOPERATIVE MANAGEMENT: The patient is mobilised under full weight bearing with two crutches. RESULTS: A total of 50 Oxford III hemiarthroplasties were implanted using the minimal invasive technique. Indication was an anteromedial gonarthrosis with intakt anterior cruciate ligament. Age varied between 59 and 79 years with a mean of 71 years. Follow-up was 5 years. There were three revisions till final follow-up. Cause was an inlay luxation in one case and in two cases with lateral arthrosis. The average KOOS score was 92.3 points (± 6 points).

[Anatomic reconstruction of the anterior cruciate ligament in single bundle technique]. / Die anatomische Ersatzplastik des vorderen Kreuzbands in Einzelbündeltechnik.

OBJECTIVE: Restore the knee stability by ACL reconstruction of the anterior cruciate ligament. INDICATION: Acute and chronic functional instability with rupture of the anterior cruciate ligament giving way phenomena, acute rupture of the anterior cruciate ligament with concomitant meniscus repair. CONTRAINDICATIONS: Local infection in the knee joint, local soft tissue damage, lack of cooperation of the patient. SURGICAL TECHNIQUE: The operation begins with the examination under anesthesia. It follows an arthroscopic examination of the knee and the arthroscopic treatment of accompanying intra-articular lesions (meniscus and cartilage damage). The semitendinosus tendon is harvested via a 3 cm skin incision medial to the tibial tuberosity. A four stranded tendon graft is prepared with a minimum length of 6.5 cm. Alternative grafts for this technique are the patellar tendon, quadriceps tendon, and allografts. The femoral tunnel for the ACL graft is drilled via a deep anteromedial portal under arthroscopic control. For precise placement of the guide wire a specific offset aimer is used. For drilling the knee must be flexed more than 110°. Landmarks are the intercondylar line and the cartilage-bone interface. The position of the guide wire is always controlled by the medial portal (medial portal view). The guide wire is overdrilled with a cannulated drill (4.5 mm when a flip tack is used). The drill diameter for the 30 mm long blind tunnel is chosen according to the graft diameter. A gentle tunnel preparation may be achieved with the use of dilators. At the tibia, the anterior horn of the lateral meniscus is used as a landmark in the absence of ACL stump. The guide wire is first overdrilled with a 6 mm drill. Slight adjustments to the tibial tunnel location can be archieved when the guide wire is overdrilled eccentrically with a larger drill. At the femur an extracortical fixation technique with a flip button is preferred. At the tibia, a hybrid fixation with absorbable interference screw and button is used. REHABILITATION: The rehabilitation program is divided into three phases. During the inflammatory phase (1st-2nd week) control of pain and swelling is recommended. The patient is immobilized with 20 kg partial weight bearing. During the proliferative phase (3 nd-6th week), load and mobility are slowly increased. Goal of this phase is it full extension. Exercises should be performed in a closed chain. During the remodeling phase strength and coordination exercises can be started. Athletes should not return to competitive sports before the 6th to 8th month. RESULTS: In a prospective study, we have examined 21 patients treated with an anatomic anterior cruciate ligament reconstruction in single-bundle technique, after two years. As graft the semitendinosus was used. The postoperative MRI diagnosis showed that all tunnels were positioned anatomically. KT 1000 measurement showed that the difference of anterior translation decreased from an average of 6.4-1.7 mm. A sliding pivot shift phenomenon was detected in only one patient. The postoperative Lysholmscore was 94.2 points.

[Arthroscopic arthrolysis of the elbow joint]. / Die arthroskopische Arthrolyse des Ellenbogengelenks.

OBJECTIVE: Arthroscopic assisted improvement of range of motion in elbow stiffness. Detailed diagnostic evaluation including medical history and preoperative radiographs, CT and MRI scans are necessary for planning the operative treatment. INDICATIONS: Restricted range of motion < 30° in extension and/or more than 100° in flexion related to intraarticular causes (loose bodies, osteophytes or contracture of the capsule). CONTRAINDICATIONS: Extension deficit > 30°, extraarticular causes (e.g., heterotopic ossifications), nerve irritation, incongruity of joint surfaces, acute joint infection. SURGICAL TECHNIQUE: Prone position, filling of the joint with irrigation fluid, arthroscopic examination of the anterior and posterior compartment. Partial synovectomy, debridement and capsular release, removal of loose bodies and resection of osteophytes. POSTOPERATIVE MANAGEMENT: Intensive physiotherapy, continuous passive motion. Plexus anesthesia and nonsteroidal antiphlogistic medication. RESULTS: A total of 29 patients who underwent arthroscopic arthrolysis of the elbow joint were evaluated after a mean follow up of 15.4 months after surgery. Average preoperative extension deficit improved from 23° to 5°. Mean preoperative flexion improved from 115° to 131°. Improvement of range of motion was 34° on average. No vascular or neurologic complications were noted. Infection was not observed. In one case, stiffness persisted and early arthroscopic revision was needed. Postoperative patient satisfaction on the VAS Scale was 8.9. The Mayo Elbow Performance Index was 92.9 points on average.

Root tear of the meniscus: biomechanical evaluation of an arthroscopic refixation technique.

BACKGROUND: Aim of the current study was to evaluate the structural properties of an arthroscopic refixation technique for meniscal root tears. HYPOTHESIS: Arthroscopic two suture root tear refixation technique using a transtibial approach restores the structural properties of the intact meniscus attachment more closely than a one suture technique. METHODS: Lateral root tear refixation was performed in a porcine knee model. Using a material testing machine, structural properties were determined after a cyclic loading protocol comparing transtibial tunnel reconstruction using one or a double suture technique. Intact posterior horn served as control group. RESULTS: Elongation after cyclic testing was significantly lower for intact and two suture technique when compared to single suture technique. Stiffness was significantly higher for intact constructs with a mean of 53.7 (±6.5) N/m and two suture technique with 44.8 (±9.9) N/m when compared to one suture technique with a mean of 37.1 (±5.4) N/m. In elongation and stiffness, no differences were found between intact and two suture technique. Ultimate failure loads were 325.6 (±77) N for the intact, 273.6 (±45.6) N for two suture technique and 149.8 (±24.3) N for the one suture technique. Both reconstruction techniques showed significantly lower ultimate failure load when compared to the intact control. CONCLUSION: Structural properties of root tear fixation using a transtibial single suture technique showed significantly higher elongation and lower stiffness and failure load after cyclic loading compared to the intact, whereas a two suture technique showed no difference in elongation and stiffness; however, lower failure load.

[Translation errors in ophthalmology]. / Übersetzungsfehler in der augenheilkunde.

As global networks are built up, interlingual communication in ophthalmology becomes more and more important. Similar to any other specialised discipline, this raises the dilemma that on one hand precision is mandatory for an exact translation, but on the other hand translators often do not have the scientific and physicians the linguistic knowledge to fulfill this need. Furthermore, even within one language ophthalmological terminology is partially ill defined, and this problem multiplies when translating it into various other languages. However, translation errors can have serious consequences, particularly in medical disciplines. This case study casuistically demonstrates the most common basic mechanisms for translation errors in ophthalmology and shows a potential approach for solution.