Knee Surgery Sports Traumatology Arthroscopy (Knee Surg Sports Traumatol Arthrosc )

Publisher: European Society of Sports Traumatology, Knee Surgery and Arthroscopy, Springer Verlag


Official journal of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA) Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery arthroscopy and sports traumatology. The goal of this European journal is to publish papers about innovative knee surgery sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition epidemiology diagnosis treatment and prevention and all types of arthroscopy (not only the knee but also the shoulder elbow wrist hip ankle etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints muscles and tendons are included. Although this is largely a clinical journal it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board assisted by an international Advisory Board you can be assured that the journal maintains the highest standards. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 86-23 revised 1985) were followed as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editor reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.

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Springer Verlag

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The anterolateral ligament, a structure that has been known for 130 years, has again attracted the attention both of orthopaedic doctors and anatomists. Since its initial description until now, this structure has had different names. Whether labelled as the mid-third lateral capsular ligament, the anterior oblique band of the fibular collateral ligament or the anterolateral ligament of the knee, this structure has been responsible for the so-called Segond avulsion fractures. The aim of this study was to determine the precise position and layer of the lateral knee compartment within which the anterolateral ligament is located, as well as its type.
    Knee Surgery Sports Traumatology Arthroscopy 11/2014;
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    ABSTRACT: PURPOSE: For deepening trochleoplasty, a procedure used worldwide to correct trochlear dysplasia, only few surgical steps are described precisely. Important surgical landmarks, such as optimal cartilaginous trochlear depth and percentages of the new lateral and medial facet, remain unanswered. METHODS: A cross-sectional study (January 2011-August 2012) was carried out in adult patients (16-35 years) without trochlear dysplasia, who underwent magnetic resonance imaging (MRI). The main outcome was trochlear depth. The secondary outcome was the lateral/medial facet ratio. Measurements were made on the first axial cut from proximal with complete cartilage coverage of the trochlea. Differences between men and women were assessed. RESULTS: Fifty-three patients (70 % men) were included. Mean age was 24.6 years (SD ± 5.5). Overall mean trochlear depth was found to be as 4.0 mm (95 % CI 3.6-4.3). Values differed significantly by gender (p = 0.0271) with a mean of 3.4 mm (95 % CI 3.0-3.8) for women and a mean of 4.2 mm (95 % CI 3.8-4.7) for men. The mean ratio between the lateral and medial facet was 1.71 (95 % CI 1.62-1.80), the lateral facet contributing 62.6 % (95 % CI 61.3-63.8) and the medial facet contributing 37.4 % (95 % CI 36.2-38.7) to the total cartilage length. For the facet ratio, there was no statistically significant gender difference (n.s.). CONCLUSIONS: This study provides data on important landmarks for deepening trochleoplasty based on average MRI measurements in the general population. The difference between the MRI measurement and actual cartilage surface measurement is likely to be minimal, but is yet to be evaluated. Further evaluation of these landmarks by prospectively performing deepening trochleoplasty will determine the value of the clinical implication. LEVEL OF EVIDENCE: II.
    Knee Surgery Sports Traumatology Arthroscopy 07/2014;
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    ABSTRACT: The current study was undertaken to better define the gross anatomical and dimensional characteristics of the proximal hamstring origin.
    Knee Surgery Sports Traumatology Arthroscopy 06/2014;
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    ABSTRACT: Purpose. The purpose of the present study was to determine the value of shoulder magnetic resonance imaging (MRI) obtained in the community setting interpreted by musculoskeletal radiologists in patients with shoulder pain initiated by a single non-dislocating shoulder trauma. METHODS: In 56 of 61 consecutive patients who underwent shoulder arthroscopy due to pain after a single non-dislocating shoulder trauma, the data sets of non-contrast MRI were complete. These were retrospectively interpreted by three radiologists specialized on musculoskeletal MRI who were blinded for patients' history and who did not have access to the reports of arthroscopy. Standard evaluation forms were used to assess the MRIs for superior labrum anterior and posterior (SLAP) lesions, anterior or posterior labrum lesions, lesions of the long head of biceps tendon (LHB) and for partial tears of the supraspinatus tendon and the upper quarter of the subscapularis tendon. Quality of the MRI was assessed by each radiologist on a four-point scale. RESULTS: The pooled sensitivity for the three radiologists for the detection of SLAP lesions was 45.0 %, for anterior or posterior labrum tears 77.8 and 66.7 %, for lesions of the LHB 63.2 % and for partial tears of the supraspinatus or subscapularis tendon tears 84.8 and 33.3 %. Corresponding inter-rater reliabilities were poor (SLAP lesions) to substantial (anterior labrum tears). Quality of MRI only influenced the accuracy for the detection of posterior labrum tears. CONCLUSION: A non-contrast shoulder MRI obtained in the community setting after non-dislocating shoulder trauma has a moderate sensitivity for most intraarticular pathologies when interpreted by musculoskeletal radiologists. Accuracy is dependent on the observer and not on the assessed quality. LEVEL OF EVIDENCE: Case series, Level IV.
    Knee Surgery Sports Traumatology Arthroscopy 06/2014; [Epub ahead of print].
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    ABSTRACT: The purpose of the present study was to determine the value of shoulder magnetic resonance imaging (MRI) obtained in the community setting interpreted by musculoskeletal radiologists in patients with shoulder pain initiated by a single non-dislocating shoulder trauma.
    Knee Surgery Sports Traumatology Arthroscopy 06/2014;
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    ABSTRACT: To evaluate whether screening radiographs as part of the initial workup of knee pain impacts clinical decision-making in a sports medicine practice. A questionnaire was completed by the attending orthopaedic surgeon following the initial office visit for 499 consecutive patients presenting to the sports medicine centre with a chief complaint of knee pain. The questionnaire documented patient age, duration of symptoms, location of knee pain, associated mechanical symptoms, history of trauma within the past 2 weeks, positive findings on plain radiographs, whether magnetic resonance imaging was ordered, and whether plain radiographs impacted the management decisions for the patient. Patients were excluded if they had prior X-rays, history of malignancy, ongoing pregnancy, constitutional symptoms as well as those patients with prior knee surgery or intra-articular infections. Statistical analyses were then performed to determine which factors were more likely do correspond with diagnostic radiographs. Overall, initial screening radiographs did not change management in 72 % of the patients assessed in the office. The mean age of patients in whom radiographs did change management was 57.9 years compared to 37.1 years in those patients where plain radiograph did not change management (p < 0.0001). Plain radiographs had no impact on clinical management in 97.3 % of patients younger than 40. In patients whom radiographs did change management, radiographs were more likely to influence management if patients were over age forty, had pain for over 6 months, had medial or diffuse pain, or had mechanical symptoms. A basic cost analysis revealed that the cost of a clinically useful radiographic series in a patient under 40 years of age was $7,600, in contrast to $413 for a useful series in patients above the age of 40. Data from the current study support the hypothesis that for the younger patient population, routine radiographic imaging as a screening tool may be of little clinical benefit. Factors supporting obtaining screening radiographs include age greater than 40, knee pain for greater than 6 months, the presence of medial or diffuse knee pain, and the presence of mechanical symptoms. LEVEL OF EVIDENCE: II.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
  • Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: The purpose of the study was to demonstrate the feasibility of a new measurement system using micro-electromechanical systems (MEMS)-based sensors for quantifying the pivot shift phenomenon. The pivot shift test was performed on 13 consecutive anterior cruciate ligament-deficient subjects by an experienced examiner while femur and tibia kinematics were recorded using two inertial sensors each composed of an accelerometer, gyroscope and magnetometer. The gravitational component of the acquired data was removed using a novel method for estimating sensor orientations. Correlation between the clinical pivot shift grade and acceleration and velocity parameters was measured using Spearman's rank correlation coefficients. The pivot shift phenomenon was best characterized as a drop in femoral acceleration observed at the time of reduction. The correlation between the femoral acceleration drop and the clinical grade was shown to be very strong (r = 0.84, p < 0.0001). The present study demonstrates the feasibility of quantifying the pivot shift using MEMS-based sensors and removing the gravitational component of acceleration using an estimation of sensor orientation for improved correlation to the clinical grade.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: The objective of the study was to clarify whether driving abstinence should be recommended when patients are discharged from hospital after unicompartmental knee arthroplasty (UKA). We tested the hypotheses that there are differences in the peri-operative course of brake response time in patients undergoing right-sided (1) or left-sided (2) UKA. Additionally, we tested whether brake response time is significantly influenced by pain (3), driving experience (4) or age (5). In 43 patients undergoing UKA, brake response time was measured with a custom-made driving simulator pre-operatively and 1 and 6 weeks after UKA. Patients' visual analogue scales for knee pain and their self-reported driving experience were also assessed. In patients with right-sided UKA, brake response time changed from 786 (261) ms pre-operatively to 900 (430) ms 1 week post-operatively (p = 0.029). At 6 weeks post-operatively, brake response time had returned to 712 (139) ms, which was deemed to be an insignificant change from the pre-operative reference benchmark. When surgery was performed on the contralateral left side, no effect was found onto the right side's brake response time. Knee pain and driving experience were significantly correlated with brake response time. No such correlations were found between brake response time and age. On the basis of the current findings, it is concluded that brake response time returns to pre-operative levels 6 weeks after UKA surgery. Therefore, it is proposed that driving be abstained from for that period. Therapeutic study, Level IV.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: Post-traumatic contracture is a common complication after elbow trauma. If conservative therapy fails to restore adequate elbow motion, surgical release is recommended. Increase in arthroscopy knowledge and skills, as well as technological advances in the passed decade of years, has made arthroscopic arthrolysis a safe and reliable treatment for patients with a post-traumatic elbow contracture. The aim of this study was to report on the clinical outcome and improvement of ROM in post-traumatic stiff elbow treated by arthroscopic arthrolysis. Between 2008 and 2012, 34 consecutive patients with post-traumatic stiffness were treated with arthroscopic arthrolysis. Active and passive elbow movement is encouraged the day after operation with the effective pain management. Mayo Elbow Performance Index (MEPI) and visual analogue scale were measured. At the final follow-up, the average arc of elbow motion increased from 48.6 ± 19.3 pre-operatively to 114.5 ± 25.7, with a mean improvement of 65.9°. The MEPI score improved from 68.2 ± 16.4 pre-operatively to 92.4 ± 21.6, with a mean improvement of 24.2 (p < 0.001). Results were good to excellent in 29 patients. Injuries are the most common cause of elbow stiffness requiring surgical release. The procedure of arthroscopic arthrolysis is a good option for the treatment of post-traumatic elbow stiffness as it restores normal elbow function. Early passive/active post-operative rehabilitation is very important. Case series, treatment study, Level IV.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: To prospectively investigate whether preoperative functional flexion axis in patients with osteoarthritis- and varus-alignment changes after total knee arthroplasty and whether a correlation exists both between preoperative functional flexion axis and native limb deformity. A navigated total knee arthroplasty was performed in 108 patients using a specific software to acquire passive joint kinematics before and after implant positioning. The knee was cycled through three passive range of motions, from 0° to 120°. Functional flexion axis was computed using the mean helical axis algorithm. The angle between the functional flexion axis and the surgical transepicondylar axis was determined on frontal (α (F)) and axial (α (A)) plane. The pre- and postoperative hip-knee-ankle angle, related to femur mechanical axis, was determined. Postoperative functional flexion axis was different from preoperative only on frontal plane, while no differences were found on axial plane. No correlation was found between preoperative α (A) and native limb deformity, while a poor correlation was found in frontal plane, between α (F) and preoperative hip-knee-ankle angle. Total knee arthroplasty affects functional flexion axis only on frontal plane while has no effect on axial plane. Preoperative functional flexion axis is in a more varus position respect to the transepicondylar axis both in pre- and postoperative conditions. Moreover, the position of the functional axis on frontal plane in preoperative conditions is dependent on native limb alignment, while on axial plane is not dependent on the amount of preoperative varus deformity. LEVEL OF EVIDENCE: IV.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: The goal of individualized anatomic anterior cruciate ligament reconstruction (ACL-R) is to reproduce each patient's native insertion site as closely as possible. The amount of the native insertion site that is recreated by the tunnel aperture area is currently unknown, as are the implications of the degree of coverage. As such, the goals of this study are to determine whether individualized anatomic ACL-R techniques can maximally fill the native insertion site and to attempt to establish a crude measure to evaluate the percentage of reconstructed area as a first step towards elucidating the implications of complete footprint restoration. This is a prospective pilot study of 45 patients who underwent primary single-bundle anatomic ACL-R from May 2011 to April 2012. Length and width of the native insertion site were measured intraoperatively. Using published guidelines, reconstruction technique and graft choice were determined to maximize the percentage of reconstructed area. Native femoral and tibial insertion site area and femoral tunnel aperture area were calculated using the formula for area of an ellipse. On the tibial side, tunnel aperture area was calculated with respect to drill diameter and drill guide angle. Percentage of reconstructed area was calculated by dividing total tunnel aperture area by the native insertion site area. The mean areas for the native femoral and tibial insertion sites were 83 ± 20 and 125 ± 20 mm(2), respectively. The mean tunnel aperture area for the femoral side was 65 ± 17, and 86 ± 17 mm(2) for the tibial tunnel aperture area. On average, percentage of reconstructed area was 79 ± 13 % for the femoral side, and 70 ± 12 % for the tibial side. Anatomic ACL-R does not restore the native insertion site in its entirety. Percentage of reconstructed area serves as a rudimentary tool for evaluating the degree of native insertion site coverage using current individualized anatomic techniques and provides a starting point from which to evaluate the clinical significance of complete footprint restoration. LEVEL OF EVIDENCE: IV.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) at 3-T magnetic resonance imaging for the assessment of meniscal tears. Ninety-four patients with tears in the medial meniscus (31) or lateral meniscus (64) imaged with conventional magnetic resonance imaging and SWI followed by knee arthroscopy within 1 month were selected. The diagnostic values of SWI for the detection of meniscal tears were evaluated using arthroscopy as the reference standard. The sensitivity, specificity and accuracy between spin-echo T1-weighted imaging (T1WI) and fat-suppressed proton density-weighted imaging (FS-PDWI) were compared. The diagnosis consistency with two radiologists was also compared. Receiver operating characteristic curve analyses were performed for each individual sequence to estimate their diagnostic performance in meniscal tear. Analyses from 31 patients of medial meniscus tears showed that SWI achieved comparable performance with T1WI and FS-PDWI with respect to sensitivity (96.8 vs. 93.5 and 89.2 %), specificity (66.7 vs. 66.7 and 66.7 %) and accuracy (91.9 vs. 89.2 and 93.5 %). In 64 patients of lateral meniscus tears, SWI was found to be a superior method over T1WI and FS-PDWI with regard to sensitivity (98.4 vs. 92.2 and 95.3 %), specificity (100 vs. 100 and 100 %) and accuracy (98.5 vs. 92.5 and 95.5 %). Upon combination of these patients, SWI is similar or superior to T1WI and FS-PDWI with sensitivity (97.9 vs. 92.6 and 94.7 %), specificity (77.8 vs. 77.8 and 77.8 %) and accuracy (96.2 vs. 89.2 and 93.3 %). SWI exhibited similar or better results with respect to sensitivity (97.9 vs. 92.6 and 94.7 %), specificity (77.8 vs. 77.8 and 77.8 %) and accuracy (96.2 vs. 89.2 and 93.3 %) over T1WI and FS-PDWI. These data suggest that SWI can be used for the diagnosis of meniscal tears. The sensitivity, accuracy and negative predictive value were same as those of T1WI and FS-PDWI according to the present study. Diagnostic study, Level II.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: Concussion is common in many sports, and the incidence is increasing. The medical consequences after a sport-related concussion have received increased attention in recent years since it is known that concussions cause axonal and glial damage, which disturbs the cerebral physiology and makes the brain more vulnerable for additional concussions. This study reports on a knocked-out amateur boxer in whom cerebrospinal fluid (CSF) neurofilament light (NFL) protein, reflecting axonal damage, was used to identify and monitor brain damage. CSF NFL was markedly increased during 36 weeks, suggesting that neuronal injury persists longer than expected after a concussion. CSF biomarker analysis may be valuable in the medical counselling of concussed athletes and in return-to-play considerations. Level of evidence IV.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;
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    ABSTRACT: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop(®) on the femoral side, and an IS/staple on the tibial side. Between 2006 and 2009, at a single institution, 72 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon grafting were retrospectively reviewed. Fixation was performed, and with the EndoButton-Continuous Loop(®) device (Group Ι) in 48 patients (mean age 29.1 ± 7.3 years) with a bioabsorbable IS (Group ΙΙ) in 24 patients (mean age 28.5 ± 8.4 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (n.s.). Femoral TW at the proximal and middle levels (on both AP and lateral views) in Group ΙΙ was significantly greater than in Group Ι (p < 0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (n.s.). Femoral TW is less after EndoButton-Continuous Loop(®) fixation and not reduced after IS fixation. Surgeons should be aware of TW when selecting a fixation device for hamstring graft. Therapeutic, retrospective comparative study, Level III.
    Knee Surgery Sports Traumatology Arthroscopy 05/2014;