Manfred Nelitz

Publications (33) View all

• Article: Combined Trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations in Severe Trochlear Dysplasia: A Minimum 2-Year Follow-up Study.

  Manfred Nelitz, Jens Dreyhaupt, Sabine Lippacher
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  ABSTRACT: BACKGROUND:Trochlear dysplasia is an important etiological factor for the development of patellofemoral instability. Because a dislocation of the patella as a result of trochlear dysplasia results in a traumatic disruption of the medial patellofemoral ligament (MPFL), a combined trochleoplasty and patellofemoral ligament reconstruction appears to be the most appropriate procedure to treat patients with severe trochlear dysplasia. HYPOTHESIS:Combined trochleoplasty and anatomic reconstruction of the MPFL will prevent redislocations of the patella and will lead to improved knee function. STUDY DESIGN:Case series; Level of evidence, 3. METHODS:Twenty-three consecutive patients (26 knees) with patellofemoral instability and severe trochlear dysplasia underwent combined trochleoplasty and anatomic reconstruction of the MPFL. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and the tibial tubercle-trochlear groove (TT-TG) distance. Evaluations included the detection of cartilage injuries, preoperative and postoperative physical examinations, and scores for the visual analog scale (VAS), Kujala knee function, International Knee Documentation Committee (IKDC), activity rating scale (ARS), and Tegner activity scale. RESULTS:The mean age at the time of operation was 19.2 years (range, 15.4-23.6 years). The mean follow-up after operation was 2.5 years after surgery (range, 2.0-3.5 years). No recurrent dislocation occurred postoperatively. Kujala scores improved from 79 to 96, IKDC scores from 74 to 90, and VAS scores from 3 to 1. All improvements were highly statistically significant (P < .01). The activity level according to the Tegner activity scale and the ARS decreased but was not statistically significant (P = .06 and P = .21, respectively). There were 95.7% of the patients who were satisfied or very satisfied with the procedure. CONCLUSION:Combined anatomic reconstruction of the MPFL and trochleoplasty reliably improved the stability of the patellofemoral joint in patients with severe trochlear dysplasia and no or mild degenerative changes. In addition, the described procedure showed significant improvement of knee function and good patient satisfaction without any episode of redislocations of the patella.
  The American journal of sports medicine 03/2013; · 3.61 Impact Factor
• Article: Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus.

  Julia V Woelfle, Heiko Reichel, Katayoun Javaheripour-Otto, Manfred Nelitz
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  ABSTRACT: Background: Osteochondral autologous transplantation (OAT) has been performed for years for osteochondritis dissecans of the knee with good clinical results. In osteochondritis dissecans of the talus, however, OAT represents a challenge to the orthopaedic surgeon as frequently malleolar osteotomy has to be performed for exposure of the talus and the harvesting of the osteochondral graft usually requires an arthrotomy of the knee. Methods: In this study, we evaluated the clinical outcome of OAT in 32 patients (mean follow-up 29 months) by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS), HSS Patella Score, and magnetic resonance imaging (MRI) of the osteochondral graft. Results: Median AOFAS score was 86, median ankle pain on VAS was 2.0, and median HSS Patella score was 95. Complications included 1 case of delayed wound healing and 1 case of nonunion of the malleolar osteotomy requiring revision surgery. MRI findings were abnormal in 14 out of 28 cases; however, with the numbers available in our study no correlation to clinical outcome could be detected. Conclusion: OAT in osteochondritis dissecans of the talus was a safe procedure with good clinical results. As abnormal MRI finding was not necessarily diagnostically conclusive, MRI might be of limited value in postoperative follow-up. Level of Evidence: Level IV, retrospective case series.
  The Foot and Ankle Online Journal 02/2013; 34(2):173-9. · 1.22 Impact Factor
• Article: Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia.

  M Nelitz, S Lippacher, H Reichel, D Dornacher
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  ABSTRACT: PURPOSE: Trochlear dysplasia is considered to be one of the major factors causing patellofemoral instability (PFI). Dejour's classification is widely used to assess the severity of trochlear dysplasia. Additionally, in current literature, different quantitative parameters are recommended to distinguish between a normal trochlea and a dysplastic trochlea. In order to achieve a more objective evaluation of the trochlea, the aim of this study was to evaluate whether specific measurements of the femoral trochlea can be assigned to the qualitative classification system of Dejour. METHODS: Transverse MRI T2-weighted scans of 80 knees with symptomatic PFI and varying severity of trochlear dysplasia were classified according to Dejour (type A to D). For all MRI scans, quantitative measurements with parameters as described in the literature were applied. The values were then allocated to Dejour's classification. In addition to the four-grade analysis, two-grade analysis was also performed (Dejour type A against type BCD). Dependent on the cut-off values, specificity, sensitivity and Youden index for each parameter was defined. RESULTS: The allocation resulted in the following distribution: type A trochlear dysplasia n = 25, type B n = 23, type C n = 18 and type D n = 14. In descriptive statistics, none of the measurements proposed in the literature could be assigned to the four-grade classification system of Dejour. For the two-grade analysis at the cut-off, sensitivity ranged from 75 to 86 % and specificity from 76 to 84 % for lateral trochlear inclination, trochlear facet asymmetry and depth of trochlear groove. All other measurements showed a poor sensitivity ranging from 49 to 67 % and specificity from 40 to 72 %. Interobserver and intraobserver repeatability for the measured parameters was fair to moderate (ICC values 0.34-0.58) in high-grade dysplasia (type BCD) and substantial to almost perfect (ICC values 0.71-0.88) in low-grade trochlear dysplasia (type A). CONCLUSION: Quantitative measurements of the femoral trochlea have shown to be of limited value for the assessment of trochlear dysplasia. None of the quantitative measurements of the trochlea on transverse images could be assigned to the four-grade descriptive classification of trochlear dysplasia of Dejour. Additionally, measurements could not be reliably performed in high-grade trochlear dysplasia. However, trochlear inclination, trochlear facet asymmetry and depth of trochlear groove may help to distinguish between low-grade and high-grade dysplasia. LEVEL OF EVIDENCE: II.
  Knee Surgery Sports Traumatology Arthroscopy 11/2012; · 2.21 Impact Factor
• Article: Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents With Open Growth Plates: Surgical Technique and Clinical Outcome.

  Manfred Nelitz, Jens Dreyhaupt, Heiko Reichel, Julia Woelfle, Sabine Lippacher
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  ABSTRACT: BACKGROUND:Recurrent lateral patellar dislocation is a common knee injury in the skeletally immature adolescent. Because of the open physis, operative therapy in children is challenging. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the medial patellofemoral ligament (MPFL) in children that respects the distal femoral physis. HYPOTHESIS:Anatomic reconstruction of the MPFL in children that maintains the distal femoral physis will prevent redislocation, preserve the distal femoral physis, and improve knee function. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Twenty-one consecutive patients with patellofemoral instability and open growth plates underwent anatomic reconstruction of the MPFL that maintained the distal femoral growth plate. Preoperative radiographic examination included AP and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. Evaluation included preoperative and postoperative physical examination, Kujala score, and Tegner activity score. RESULTS:The average age at the time of operation was 12.2 years (range, 10.3-13.9). The average follow-up after operation was 2.8 years after surgery (range, 2.0-3.6). No recurrent dislocation occurred, but 2 patients with high-grade trochlear dysplasia still had a positive apprehension sign. The Kujala score significantly improved from 72.9 (range, 37-87) preoperatively to 92.8 (range, 74-100) postoperatively (P < .01). The Tegner activity score decreased, but not significantly, from 6.0 (range, 3-9) preoperatively to 5.8 (range, 3-9) postoperatively (P = .48). CONCLUSION:Anatomic reconstruction of the MPFL that respects the distal femoral physis in skeletally immature patients is a safe and effective technique for the treatment of patellofemoral instability and allows patients to return to sports without redislocation of the patella.
  The American journal of sports medicine 10/2012; · 3.61 Impact Factor
• Article: Mid-term results after ultrasound-monitored treatment of developmental dysplasia of the hips: to what extent can a physiological development be expected?

  Daniel Dornacher, Sabine Lippacher, Heiko Reichel, Manfred Nelitz
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  ABSTRACT: The purpose of this study was to evaluate the radiological outcome after ultrasound-monitored treatment of developmental dysplasia of the hip at the age of 3 years. We retrospectively reviewed the findings of the second radiographic follow-up of 72 consecutive infants (mean age 31.3 months) with residual developmental dysplasia of the hip. Statistical analysis showed significant regression of acetabular index. Nevertheless, nine hips in seven children showed substantial residual dysplasia. Although remodelling of the acetabulum can be expected, there remains a risk of residual dysplasia. For this reason, radiographic follow-up of every once treated hip as well as the initially physiological contralateral hip is necessary.
  Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 09/2012; · 0.66 Impact Factor