Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery.

OBJECTIVES: Patients with recurrent instability after anterior cruciate ligament (ACL) reconstruction often present with enlarged or misplaced tunnels and bone grafting is required prior to the actual revision reconstruction. Autologous bone grafting features limited quantity and donor site morbidity. These problems may be eliminated utilizing cancellous bone allografts, but their efficiency and reliability have not been investigated systematically. The aim of the present study was to compare tunnel filling rates attained by utilizing either allogenic or autologous cancellous bone grafts. MATERIALS AND METHODS: A total of 103 consecutive patients were enrolled retrospectively. All patients suffered from recurrent instability and underwent either allogenic or autologous cancellous bone grafting. Computed tomography (CT) was carried out before and after the bone grafting procedure. Based on preoperative CT scans, positioning and maximum diameter of the femoral and tibial tunnels were determined. Tunnel filling rates were calculated as a ratio of pre- and postoperative tunnel volumes. Primary outcome was the tibial tunnel filling rate. Femoral filling rates and density of the grafted bone were assessed secondarily. RESULTS: Preoperative CT scans revealed no significant differences between the two groups regarding distribution of misplacement and widening of the femoral or tibial tunnel. Postoperative CT scans were conducted after an interval of 5.2 months. Tunnel filling rates of 74.5% (± 14.3) femoral and 85.3% (± 10.3) tibial were achieved in the allogenic compared to 74.3% (± 15.9) femoral and 84.9% (± 9.4) tibial in the autologous group. With p values of 0.85 at the femur and 0.83 at the tibia, there were no significant differences between the groups. The density of the grafted bone revealed significantly higher values in the allogenic group. CONCLUSIONS: Utilizing cancellous bone allografts in two-staged revision ACL surgery provides for sufficient and reproducible filling of enlarged or misplaced tunnels. The filling rates are comparable to those achieved with autologous bone grafting. Advantages of allografts are the unrestricted quantity and the absence of any harvesting procedure.

Pain relieve without impairing muscle function after local infiltration anaesthesia in primary knee arthroplasty: a prospective randomized study.

PURPOSE: Purpose of the current study was to compare early effectiveness of pain relieve of 3 in 1 regional pain catheter to local infiltration anesthesia (LIA) in primary total knee arthroplasty (TKA). Secondary endpoint was quadriceps muscle strength after both procedures. MATERIAL AND METHODS: A single-center, prospective, randomized controlled trial was performed. Patients eligible to TKA were either randomized into group 3 in 1 regional pain catheter (C), or group local infiltration anesthesia (L). Pain relieve was assessed by visual analogue scale (VAS) at rest and under physical activity (PA) prior to surgery (t0) and at days one through six. In addition, quadriceps muscle strength ( = straight leg raise) was tested according to the Manual Muscle Testing Scale. Functional outcome was measured using the Oxford Knee Score (OKS) preoperatively and 6 months postoperatively. RESULTS: 121 patients were included in the study. 59 (48.8%) patients were allocated to group C, 62 (51.2%) patients to Group L. No differences concerning pain level evaluated by VAS could be detected between the groups at any time. Comparing straight leg raise test group L was significantly superior over the complete postoperative period (p < 0.03). The mean OKS decreased significantly (p < 0.001) from preoperatively 34.2 ± 7.5 points to 16.9 ± 6.0 points at the six months final follow-up. Regarding OKS there were no intergroup differences at the final follow-up at 6 months postoperative. CONCLUSION: There is no significant difference in pain relieve comparing LIA to 3 in 1 catheter in perioperative pain management in TKA. The advantage of LIA is unimpaired quadriceps muscle function in the short-term follow-up.

Central obesity and the Mediterranean diet: A systematic review of intervention trials.

Central obesity is associated with chronic low-grade inflammation, and is a risk factor for cardiometabolic syndrome. The Mediterranean diet pattern has a convincing evidence-base for improving cardiometabolic health. This review investigated the impact of Mediterranean diet interventions on central obesity, specifically. A systematic literature search was conducted in the MEDLINE, CINAHL, EMBASE and Cochrane library databases. Search terms included: 'Mediterranean Diet', 'Mediterranean dietary pattern', 'central obesity' and 'visceral fat'. The search was limited to English language and humans ≥18 years. Eighteen articles met the eligibility criteria and reported at least one outcome measure of central obesity with Mediterranean diet intervention. Central obesity measures included waist circumference (16 studies), waist-hip ratio (5 studies) and visceral fat (2 studies). Thirteen (72%) of the studies, totaling 7186 subjects (5168 subjects assigned to a Mediterranean Diet), reported a significant reduction in central obesity with a Mediterranean-type diet. However, seven out of these 13 interventions employed energy restriction, and only three showed a statistically significant favorable effect of the Mediterranean diet relative to a control group. This systematic review highlights the potential for a Mediterranean diet intervention to reduce central obesity and in turn reduce obesity-related chronic disease risk and associated public health burden.

Release behavior of VAN from four types of CaP-ceramic granules using various loading methods at two different degrees of acidity.

The release behavior of vancomycin (VAN) from beta-tricalciumphosphate (ßTCP), hydroxyapatite (HA), glass ceramic (GC) and sponge-like collagen ßTCP granule composite (sponge) was studied. Vacuum and drip loading methods were compared. The influence of VAN concentration and pH on release behavior was analyzed with respect to a stable release level of VAN above the minimum inhibitory concentration over 14 days. Initially the morphology of the granule carrier systems was examined with ESEM, stereomicroscopy, µCT-imaging and Camsizer® regarding porosity, interconnecting pores and granule size. Drug release patterns following a vacuum and a drip loading method with VAN at concentrations of 5 and 50 mg/ml were compared. The influence of pH 7.4 compared to pH 5.0 on release behavior was studied. The drug was released in bidistilled water at 37 °C, the concentration determined by photometry at 220 nm. For statistical purposes, the mean and standard deviation were calculated and analyzed by Origin 9.1 Professional SR1 (OriginLab). Due to low interconnectivity and low porosity, the vacuum loading method was unable to attain complete drug loading of the ceramic granules. The sponge showed an inhomogeneous distribution of ßTCP granules. Drug release was high at pH 7.4, at pH 5.0 it practically did not occur. All samples except for the collagen-complex show an initial VAN burst release with a following steady release. Loading with 5 mg/ml concentrated VAN resulted in a higher percentage of available drug being released. However, when loaded with 50 mg/ml, the absolute amount of drug released was higher.

[Complications of knee arthroscopy]. / Komplikationen arthroskopischer Eingriffe am Kniegelenk.

BACKGROUND: Today, knee arthroscopy is one of the standard interventions performed by an orthopaedist and usually has a low potential for complications. PURPOSE: The surgeon should still be aware of possible problems, and be able to control and explain them to the patient in detail before surgery. MATERIALS AND METHODS: The possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed. RESULTS: Evaluation of the patient's medical history and comorbidities is crucial to successful treatment, in addition to a correct diagnosis and indications with the assistance of appropriate imaging procedures. Nervous and vascular injuries, malplacement of arthroscopy portals, thrombosis, air embolism, material breakage and a possible compartment syndrome constitute the peri-and intraoperative complications. Postoperatively, the most frequent negative events are haemarthrosis, thrombosis, embolism and infection, and the appearance of synovial fistulas. In the case of a joint infection, consistent and immediate diagnosis and therapy are vital for joint preservation. Late complications after arthroscopic interventions include Ahlback's disease, arthrofibrosis and complex regional pain syndrome (CRPS). DISCUSSION: Nowadays, the systematic education of arthroscopic surgeons using simulators, models, and cadavers, in addition to shadowing experienced arthroscopists, is required to offer patients the best therapeutic options.

[Early results of gender-specific posterior stabilized total knee arthroplasty without patella resurfacing]. / Konventionelle und geschlechtsspezifische kreuzbandersetzende Knietotalendoprothesenimplantation. Vergleich frühfunktioneller Ergebnisse.

INTRODUCTION: To address anatomical gender differences in total knee arthroplasty (TKA) specific total knee prostheses have been developed for women. Potential benefits of these modified prostheses are currently under debate. The present study investigated whether the modified design features bring benefits compared to uni-sex TKA. METHODS: A total of 80 prospectively blinded and randomized patients underwent implantation of unilateral TKAs with NexGen LPS Gender Solutions (Zimmer, Warsaw, USA, group gender-specific GS prosthesis, n = 40) or NexGen LPS Flex (Zimmer, Warsaw, USA, control group standard prosthesis ST, n = 40) The follow-up was carried out 10 days and 6 weeks postoperatively. Clinical data and the subjective assessment of quality of life were evaluated using the Knee Society Clinical Rating System (KSS), the short form 36-item health survey (SF-36) and the Western Ontario and McMaster Universities OA Index (WOMAC). RESULTS: The two groups showed equal values in KSS, SF-36 and WOMAC preoperatively and ten days postoperatively the GS group reached an average KSS knee score of 62.6 ± 16.1 points (ST group 56.9 ± 14.7, p = 0.184) and a functional score of 28.5 ± 12.1 (ST group 24.3 ± 15.3, p = 0.082). In the overall score the GS group reached 91.1 ± 24.1 points (ST group 81.0 ± 27.1, p = 0.104). The GS group reached a knee score of 85.5 ± 14.4 points (ST group 77.8 ± 16.8, p = 0.03) and a functional score of 68.1 ± 20.7 points (ST group 62.3 ± 18.5, p = 0.185) 6 weeks postoperatively. In the overall score the GS group reached 153.7 ± 30.7 points (ST group 139.6 ± 32.4, p = 0.048). The analysis of SF-36 and WOMAC showed no significant differences at all time points. No evidence of loosening or migration was observed in both groups. CONCLUSIONS: Based on the data presented, gender-specific TKA type NexGen LPS Gender Solutions has advantages in terms of early functional outcome. This result is not reflected in the patient satisfaction and is not considered to be clinically relevant.

Adhesion and proliferation of human osteoblast-like cells on different biodegradable implant materials used for graft fixation in ACL-reconstruction.

INTRODUCTION: This study investigates the adhesion and proliferation behaviour of human osteoblast-like cells over time when incubated on surfaces of biodegradable screws and pins used for graft fixation in ACL reconstruction. MATERIALS AND METHODS: 2 mm-sized-wedges of four bioresorbable implants [1. poly-L-lactide acid (PLLA) screw, 2. PLLA/ß-tricalciumphosphate (PLLA/TCP) (70 %/30 %) screw, 3. poly-L-lactide-co-glycolic acid/ß-tricalciumphosphate (PLGA/TCP) (70 %/30 %) screw and 4. PLLA pin] were incubated with human osteoblast-like cells. All probes were evaluated after 3,7,14 and 21 days by cell number count, determination of cell proliferation, observation of cell adhesion of human osteoblast-like cells under an environmental scanning electron microscope (ESEM), and by a live-dead assay. RESULTS: Cell numbers were lower at all stages in both PLLA groups compared to the composite materials (PLLA/TCP and PLGA/TCP). A significant difference in cell proliferation was found after 21 days. The cells on both composite screws (PLLA/TCP and PLGA/TCP) maintained more contact points with the screw surface compared to the cells on PLLA screws under ESEM. No cytotoxicity could be observed in the live-dead assay. DISCUSSION: Mainly, ß-TCP as part of a composite implant seems to offer good ultrastructural properties for cell adhesion according to our in vitro study. Cell numbers seem to be influenced by the degradation behaviour with higher cell numbers in the composite groups.

Cartilage repair approach and treatment characteristics across the knee joint: a European survey.

INTRODUCTION: To describe indication, approach and treatment modalities for the management of knee cartilage lesions among a selected European population. METHODS: An electronic questionnaire covering general and specific items concerning cartilage repair at the knee joint was designed and disposed to survey cartilage treatment characteristics among a defined population of trained and accredited musculoskeletal surgeons. RESULTS: A total of 242 (80.13%) interviewees returned the questionnaire. Two-thirds of the respondents considered patient age to not limit (33.1%) or considered the age of 50 as the upper limit (32.2%) for interventional cartilage surgery. There was no consensus on when to correct mechanical axis deformation. Irrespective of lesion size, surgical debridement and microfracture are the techniques most frequently used. Surgical approach to full-thickness cartilage defects is commenced when the lesion size exceeds 1 cm(2) in 75.6% of respondents; mainly utilizing microfracture or debridement for defects smaller than 1, 2 and 3 cm(2). Controversy exists for treatment of lesions exceeding 3 cm(2), where autologous chondrocyte transplantation is utilized in the majority of cases (33.5%), while as well microfracture (19.0%) and with lesser frequency osteochondral plug (9.5%) transplantation are recommended. Debridement was indicated to be used in combination with other techniques, while microfracture, chondrocyte or osteochondral plug transplantation are applied as individual techniques. CONCLUSIONS: Microfracture with debridement are the two most frequently used operations in lesions up to 3 cm(2). There remains disagreement when indicating cartilage repair when age, mechanical axis deviation or treatment of lesions over 3 cm(2) are concerned.

[Recommendations of the AGA (German-speaking Arthroscopy Association) on equipment of facilities, process quality and qualification of surgeons for arthroscopic interventions]. / Empfehlungen der AGA (Sektion der DGOU) zur Ausstattung der Einrichtung, Prozessqualität und Qualifikation des Operateurs bei arthroskopischen Eingriffen.

Following closely the guidelines of the German Federal Medical Association for quality assurance of outpatient surgery, the AGA (German-speaking Arthroscopy Association) has formulated recommendations on quality standards in arthroscopic surgery. The surgical facility should implement a quality management system. Minimum standards of construction, apparatus, technical and hygiene facilities are included according to the directive of the German Federal Medical Association for quality assurance in outpatient surgery. General organizational requirements and process quality are described. These include the pre-operative diagnosis and therapy, outpatient surgery and anesthesia, the treatment after surgery and the assessment of the quality of the result. Requirements for the qualification of surgeons for authorization to independently execute arthroscopic services and training are formulated. The AGA recommends that in addition to the specialist status for authorization to independently execute arthroscopic services, the qualification "AGA arthroscopist" and for training of other doctors in the field of arthroscopic surgery, the qualification "AGA instructor" should be required.

Immunohistochemical analysis of sensory corpuscles in human transplants of the anterior cruciate ligament.

BACKGROUND: Sensory nerve endings in ligaments play an important role for the proprioceptive function. Clinical trials show that the sense of body position does not fully recover in the knee joint after reconstructive surgery of the ruptured anterior cruciate ligament. The aim of this study is to identify sensory corpuscles in autogenous and allogenous transplants of the ligament and to compare their quantity between the used allografts and autografts. METHODS: Thirty-three patients were included in this study. Three patellar tendon allografts, 14 patellar tendon autografts and 12 semitendinosus autografts were harvested during revision surgery after traumatic rerupture of the graft. The control consisted of 4 healthy anterior cruciate ligaments after fresh rupture. After haematoxylin staining, immunohistochemical analysis was performed using antibodies against S100, p75 and PGP9.5. Microscopical examination was carried out, and the number of mechanoreceptors was counted. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Two types of mechanoreceptors were identified in each graft: Ruffini corpuscles and free nerve endings. The number of Ruffini corpuscles per square centimeter was the highest in the control. Comparing the grafts, the highest number of receptors could be detected in the semitendinosus autograft. The amount of free nerve endings was higher in the semitendinosus and patellar tendon autografts than in the control; the allografts showed the lowest number of receptors. With increasing time after reconstruction, the number of both types of receptors showed a decrease in the semitendinosus graft, whereas it increased in the patellar tendon graft and allograft. The number of mechanoreceptors in the semitendinosus and patellar tendon graft decreased over time after graft-failure, whereas it increased slightly in the allograft. CONCLUSION: This study was the first to identify mechanoreceptors in human transplants of the anterior cruciate ligament. The partial increase in the number of receptors over time after reconstruction could indicate a reinnervation of the grafts.

Schatzker II tibial plateau fractures: Anatomically precontoured locking compression plates seem to improve radiological and clinical outcomes.

INTRODUCTION: The design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures. MATERIAL AND METHODS: The institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years. RESULTS: A total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group. CONCLUSION: Anatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.

Empirical models of the electron temperature and density in the nightside venus ionosphere.

Empirical models of the electron temperature and electron density of the late afternoon and nightside Venus ionosphere have been derived from Pioneer Venus measurements acquired between 10 December 1978 and 23 March 1979. The models describe the average ionosphere conditions near 18 degrees N latitude between 150 and 700 kilometers altitude for solar zenith angles of 80 degrees to 180 degrees . The average index of solar flux was 200. A major feature of the density model is the factor of 10 decrease beyond 90 degrees followed by a very gradual decrease between 120 degrees and 180 degrees . The density at 150 degrees is about five times greater than observed by Venera 9 and 10 at solar minimum (solar flux approximately 80), a difference that is probably related to the effects of increased solar activity on the processes that maintain the nightside ionosphere. The nightside electron density profile from the model (above 150 kilometers) can be reproduced theoretically either by transport of 0(+) ions from the dayside or by precipitation of low-energy electrons. The ion transport process would require a horizontal flow velocity of about 300 meters per second, a value that is consistent with other Pioneer Venus observations. Although currently available energetic electron data do not yet permit the role of precipitation to be evaluated quantitatively, this process is clearly involved to some extent in the formation of the nightside ionosphere. Perhaps the most surprising feature of the temperature model is that the electron temperature remains high throughout the nightside ionosphere. These high nocturnal temperatures and the existence of a well-defined nightside ionopause suggest that energetic processes occur across the top of the entire nightside ionosphere, maintaining elevated temperatures. A heat flux of 2 x 10(10) electron volts per square centimeter per second, introduced at the ionopause, is consistent with the average electron temperature profile on the nightside at a solar zenith angle of 140 degrees .

Pre-emptive intra-articular administration of local anaesthetics/opiates versus postoperative local anaesthetics/opiates or local anaesthetics in arthroscopic surgery of the knee joint: a prospective randomized trial.

AIM: Arthroscopic surgery on the knee joint is increasingly being performed as day-case surgery. This necessitates adequate postoperative pain therapy. We performed a study to compare three different intra-articular regimens of pain treatment. The hypothesis was that preoperative intra-articular pain management is superior to postoperative procedures. METHOD: In this study we compared the preoperative administration of 0.1 mg fentanyl + 5 ml bupivacaine 0.5% with the postoperative administration of either 0.1 mg fentanyl + 5 ml bupivacaine 0.5% or 5 ml bupivacaine 0.5% alone in a total of 564 patients. Participants were randomly assigned to three groups. Each group was subdivided into patients with and without synovitis. RESULTS: The preoperative administration of fentanyl and bupivacaine significantly decreased the perceived pain. The efficiency increased with major arthroscopic procedures. Postoperative administration of bupivacaine alone had the least effect. There was variation within each group depending on whether synovitis was present or not. CONCLUSION: This study demonstrated the superiority of the preoperative intra-articular administration of a combination of fentanyl and local anaesthetic over postoperative fentanyl and local anaesthetic or postoperative local anaesthetic alone.

Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting.

INTRODUCTION: Patients with widened or misplaced tunnels may require bone grafting prior to revision anterior cruciate ligament (ACL) reconstruction. Utilising reamer-irrigator-aspirator (RIA) harvested bone from the femur showed promising filling rates. Nevertheless, the procedure has neither been validated in a larger population nor been assessed with regards to radiological and clinical outcome of the subsequently conducted revision ACL reconstruction. Therefore, the aim of this study was to evaluate tunnel filling rates, positioning of the revision tunnels and outcome parameters of such two-staged revision ACL reconstructions. MATERIAL AND METHODS: A total of 15 consecutive patients were prospectively enrolled in this case series. CT scans were analysed before and after autologous RIA harvested bone grafting. Tunnel volumes and filling rates were calculated based on manual segmentation of axial CT scans. Revision ACL reconstruction was carried out after a mean interval of 6.2 months (±3.7) and positioning of the revision tunnels was assessed by plane radiographs. The mean follow-up was 19.8 months (±8.4) for objective evaluation and 37.1 months (±15.4) for patient reported outcomes. The clinical outcome was assessed by the quantification of the anterior tibial translation, the IKDC objective score, the Tegner activity scale and the Lysholm score. RESULTS: Initial CT scans revealed mean tunnel volumes of 3.8cm3 (±2.7) femoral and 6.1cm3 (±2.4) tibial. Filling rates of 76.1% (±12.4) femoral and 87.4% (±5.9) tibial were achieved. Postoperative radiographs revealed significantly improved tunnel positioning with anatomical placement in all but one case at the femur and in all cases at the tibia. At follow up, patients showed significantly improved anterior tibial translations with residual side-to-side differences of 1.7 mm (±0.8) and significantly improved IKDC objective scores. Furthermore, significantly higher values were achieved on the Tegner activity scale (5.3 ± 1.4 vs. 2.8 ± 0.5) and the Lysholm score (85.4 ± 7.9 vs. 62.5 ± 10.5) compared to the preoperative status. CONCLUSION: Autologous RIA harvested bone grafting ensures sufficient bone stock consolidation allowing for anatomical tunnel placement of the subsequently conducted revision ACL reconstruction. The two-staged procedure reliably restores stability and provides satisfying subjective and objective outcomes. Thus, RIA harvested bone grafting is an eligible alternative to autologous iliac crest or allogenic bone grafting.

Formation of osteoclast-like cells on HA and TCP ceramics.

An essential property of bone substitute materials is that they are integrated into the natural bone remodelling process, which involves the resorption by osteoclast cells and the formation by osteoblast cells. If monocyte cells adhere to a calcium phosphate surface (bone or bone substitute material), they can fuse together and form multinucleated osteoclast cells. In this study we show that osteoclast-like cells derived from a human leukoma monocytic lineage responded in a different way to tricalciumphosphate (TCP) than to hydroxyapatite (HA) ceramics. Both ceramics were degraded by resorbing cells; however, HA enhanced the formation of giant cells. The osteoclast-like cells on HA formed a more pronounced actin ring, and larger lacunas could be observed. TCP ceramics are medically used as bone substitute materials because of their high dissolution rate. On the other hand, highly soluble calcium phosphate ceramics like TCP seem to be inappropriate for osteoclast resorption because they produce a high calcium concentration in the osteoclast interface and in the environment.

Functional outcome after transphyseal anterior cruciate ligament reconstruction in young patients with open growth plates.

BACKGROUND: This study evaluates sports ability, rotational laxity and potential growth changes in children after transphyseal ACL reconstruction with metaphyseal fixation technique, considering physis biology by placing drill holes vertically in the femoral anatomic origin in order to reduce volumetric injury to the physis. METHODS: In this retrospective trial of 42 patients data were collected. Thirty-seven were reviewed measuring rotational laxity and anteroposterior tibial translation using the Laxitester (ORTEMA Sport Protection, Markgroeningen, Germany) and the KT1000. Clinical examination was evaluated with the IKDC 2000 knee examination form. Leg axis was determined with digital photography and leg length was assessed clinically. Sports ability was assessed with questionnaires including subjective IKDC, Tegner Activity Scale, Activity Rating Scale and a questionnaire on sports and level of sports. RESULTS: Mean follow-up was 24.9months. Mean age at surgery was 13.2years in boys and 13.1years in girls. IKDC 2000 grading was A or B in 28 patients and C in nine patients. Significant increased anterior tibial translation was observed in neutral position and in external tibia rotation. No growth abnormalities were seen. Fifty-seven percent of the patients were able to participate in competitive sports at follow-up. CONCLUSION: Transphyseal ACL reconstruction with metaphyseal fixation in children with open growth plates can be done with low risk of growth changes. Return to competitive sports is possible although low rotational laxity still exists. LEVEL OF EVIDENCE: IV.

Advantages of perfluorochemical perfusion in the isolated working rabbit heart preparation using 31P-NMR.

Quantitative 31P-NMR and enzymatic analysis of high-energy phosphates were used to characterize an isolated perfused working rabbit heart preparation. In this model, the left side of the heart works against a physiological after-load. Two perfusates, Krebs-Henseleit saline and the perfluorocarbon emulsion FC-43 (perfluorotributylamine), were evaluated in their ability to maintain cardiac function and high-energy phosphate metabolites over a period of 2-3 h. Adenine nucleotides ATP, ADP, phosphocreatine and inorganic phosphate (Pi) were measured by 31P-NMR while monitoring cardiac output and coronary flow. Intracellular pH was determined using the chemical shift of Pi. At the end of each experiment, hearts were freeze clamped and enzymatically assayed for adenine nucleotides, phosphocreatine and Pi. In every experiment, hearts perfused with FC-43 emulsion maintained the same rate of cardiac output as hearts perfused with Krebs-Henseleit saline, but with half the coronary flow rate: FC-43, 22 +/- 2.5 (n = 5), Krebs-Henseleit saline 42 +/- 2.7 (n = 6) ml/min, P less than 0.001. Hearts perfused with FC-43 emulsion showed higher [phosphocreatine] and [ATP] measured by 31P-NMR. For [phosphocreatine]: FC-43 3.2 +/- 0.7 (n = 5), Krebs-Henseleit saline 1.7 +/- 0.2 (n = 6) mumol/g wet wt., P less than 0.01. For [ATP]: FC-43 1.8 +/- 0.7 (n = 5), Krebs-Henseleit saline 0.9 +/- 0.2 (n = 6) mumol/g wet wt., P less than 0.02. [phosphocreatine] and [ATP] determined by 31P-NMR values were identical within experimental error to those values obtained by enzymatic analysis. Comparing [Pi] determined by both methods, 36% of Pi in FC-43-perfused hearts, and only 24% of Pi in Krebs-Henseleit saline-perfused hearts were visible by NMR, indicating that a large proportion of Pi is bound in the intact functioning heart. Similar results were obtained for [ADP]. Using the combined techniques of 31P-NMR and enzymatic assay, we have shown in this model of the isolated working rabbit heart preparation, that FC-43 emulsion maintains significantly better function and high-energy phosphate levels than Krebs-Henseleit saline.

A quantitative approach to polar organic reactivity.

A method is presented which allows one to predict toxic effects which are triggered by the formation of covalent bonds between electron-deficient (electrophilic) compounds and biological electron-rich (nucleophilic) targets, as proteins or nucleic acids. It is based on our comprehensive nucleophilicity and electrophilicity scales, which we constructed as an aid for the planning of organic syntheses. For the construction of these scales, rate constants for the reactions of benzhydrylium ions (aryl2CH(+)) and structurally related quinone methides with nucleophiles have been measured and correlated by the equation lg k(20 °C) = sN(E + N), which yields absolute rate constants k (L mol(-1) s(-1)) from one parameter for electrophiles (the electrophilicity E) and two for nucleophiles (the nucleophilicity parameter N and the susceptibility sN). A freely accessible database (http://www.cup.uni-muenchen.de/oc/mayr/DBintro.html) is described, which presently comprises data for 1000 nucleophiles and 260 electrophiles and provides links to the original literature reports. The kinetic scales are complemented by a thermodynamic counterpart, which enables one to calculate association constants K (L mol(-1)) of electrophiles with nucleophiles from the empirical Lewis acidity parameters LA and Lewis basicity parameters LB by the equation lg K (20°C) = LA + LB.

[Defect Reconstruction in Total Knee Arthroplasty with wedges and blocks]. [Corrected]. / Defektrekonstruktion in der Knieendoprothetik mit Wedges und Blöcken.

OBJECTIVE: Surgical technique for primary and revision total knee arthroplasty to reconstruct bone defects with metal augments and reproducible positioning of the implant at the right joint line. INDICATIONS: Primary and revision total knee arthroplasty with bone defects. CONTRAINDICATIONS: Complete destruction of the metaphysis. SURGICAL TECHNIQUE: Implantation of revision components performed in three consecutive steps: first, positioning of the tibia component at correct height and rotation; second, determination of the posterior joint line in flexion through the size and correct rotation of the femoral implant; third, determination of the distal joint line by use of positioning of the femoral component. These steps are performed independently from bone defects, which are subsequently reconstructed with metal augments. POSTOPERATIVE MANAGEMENT: Mobilization with weight bearing and range of motion as tolerated, depending on osseous and soft tissue condition at primary or revision surgery. RESULTS: In a prospective study, 132 consecutive knee revisions in 76 women and 56 men with an average age of 72.4 years (range 49-93 years) were followed up clinically and radiologically preoperatively and at a mean follow-up of 74 months (range 38-105 months). Clinical results were based on the American Knee Society score. The score was 46.3 (range 31-65) preoperatively and 82.5 (range 61-96) at follow-up. Radiologically 12.1 % of the knees showed lysis around the augment with no clinical signs of loosening. No revisions were performed due to aseptic loosening. The joint line was correctly reconstructed in 84.8 %.

[Management of Flexion Contracture in Primary Total Knee Arthroplasty]. / Umgang mit der Beugekontraktur in der primären Knieendoprothetik.

Flexion contracture is a common deformity of the arthritic knee. The present publication describes causes, clinical relevance and surgical technique in the presence of flexion contractures in total knee arthroplasty. Flexion contracture can be attributed to different causes. Basically it is a mismatch between flexion and extension gaps. Moderate and severe deformities have to be corrected by additional surgical interventions. In most cases soft tissue techniques with release of contracted structures, the removal of osteophytes and additional distal femoral bone resection are necessary. The goal of these interventions is to achieve full extension of the knee. During rehabilitation attention has to be paid to maintain it with intensive physical therapy. A remaining flexion contracture is associated with inferior functional outcome and persistent pain.