G Hehl

Universität Ulm, Ulm, Baden-Wuerttemberg, Germany

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Publications (34)31.71 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this retrospective study was to evaluate arthroscopy in upper ankle osteoarthritis. In the period from 1988 to 1997, 358 arthroscopies of the upper ankle joint were performed in 178 cases due to arthritis. Of 132 accessible patients, 124 replied to our questionnaire: 90 (73%) of the responders underwent clinical examination 94 (37-152) months following the initial arthroscopy and were graded according to the score of Evanski and Waugh. All arthroscopies were performed under fluid filling using anterolateral and anteromedial approaches. In only five cases was the posterior compartment additionally investigated. Generally, neither tourniquet nor mechanical joint distraction were applied. Of a total of 12 (6.7%) complications, only 3 (1.7%) hematomas needed surgical revision. One hematoma was due to an arteriovenous fistula treated by double ligation. All complications including five hypesthesias were temporary and subsided spontaneously. The 124 patients of the questionnaire group assessed the result of arthroscopic surgery as excellent in 11%, good in 46%, fair in 22%, and poor in 21%. Of all patients, 22% required further surgery of the upper ankle: in 9% further arthroscopy, in 3% arthrodesis, and in 10% microsurgical denervation. The total range of motion increased from 10/0/40 degrees (extension/flexion) preoperatively to 15/0/44 degrees at the follow-up examination. The Evanski score improved significantly (p<0.001) from 41 to 76 points. Due to minimal invasiveness and low risk of complications, arthroscopy is recommended for the following indications of upper ankle osteoarthritis: focal arthrosis, limited range of motion caused by osteophytes, soft tissue impingement, corpora libera, and synovitis. Severity and extent of upper ankle arthritis, range of motion, pain, local bone and soft tissue quality as well as the age, physical activity and compliance of the patient concerned are decisive for the individual therapeutic protocol. Alternative surgical techniques in upper ankle osteoarthritis are assessed such as denervation, distraction arthroplasty, correction osteotomy, ankle arthrodesis and total ankle replacement.
    Der Unfallchirurg 06/2005; 108(6):461-9. · 0.64 Impact Factor
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    ABSTRACT: Fragestellung: Ziel der retrospektiven Studie war die Evaluation der Arthroskopie in der Therapie der Arthrose des oberen Sprunggelenks (OSG).Methodik: Im 10-Jahres-Zeitraum 1988–1997 wurden insgesamt 358 Arthroskopien des OSG durchgefhrt — in 178Fllen indiziert durch eine Arthrose. Von 132 erreichbaren Patienten beantworteten 124 einen Fragebogen. Davon wurden 90 (73%) Patienten 94 (37–152) Monate nach der Arthroskopie nachuntersucht und entsprechend dem Score nach Evanski und Waugh bewertet. Alle Arthroskopien erfolgten unter Flssigkeitsfllung ber einen anterolateralen und anteromedialen Zugang. Lediglich in 5Fllen wurde das posteriore Kompartment zustzlich gespiegelt. Generell wurde sowohl auf Blutsperren als auch auf mechanische Gelenkdistraktion verzichtet.Ergebnisse:Von insgesamt 12 (6,7%) Komplikationen waren lediglich 3 Hmatome (1,7%) revisionsbedrftig, eines davon mit arteriovenser (AV-)Fistel. 5 Sensibilittsstrungen waren passager, Infektionen traten nicht auf. Von den 124Patienten der Fragebogengruppe bewerteten 11% das Ergebnis nach der Arthroskopie als sehr gut, 46% als gut, 22% als befriedigend und 21% als schlecht. 22% der Patienten wurden in der Folgezeit erneut am OSG operiert, davon waren 9% arthroskopische Revisionen, 3% Arthrodesen und 10% Denervierungen. Der gesamte Bewegungsumfang vergrerte sich um 15% von properativ 10/0/40 Extension/Flexion auf 15/0/44 zum Zeitpunkt der Nachuntersuchung. Der Evanski-Score verbesserte sich statistisch hoch signifikant (pSchlussfolgerungen:Aufgrund der geringen Invasivitt und Komplikationsrate empfiehlt sich u.E. die Arthroskopie bei folgenden Indikationen: fokale Arthrosen, Bewegungseinschrnkungen bei Osteophyten, Impingement, freien Gelenkkrpern und Begleitsynovitis. Schweregrad und Ausdehnung der OSG-Arthrose, Bewegungsumfang des Gelenks, Schmerzhaftigkeit, lokale Knochen- und Weichteilqualitt sowie Patientenalter, -aktivitt und -compliance entscheiden u.a. ber das individuell angepasste Therapiekonzept. In Abhngigkeit davon werden therapeutische Alternativen wie Denervierung, Distraktionsarthroplastik, Korrekturosteotomien, Arthrodese und endoprothetischer Gelenkersatz diskutiert.Objektive:The purpose of this retrospective study was to evaluate arthroscopy in upper ankle osteoarthritis.Methods:In the period from 1988 to 1997, 358 arthroscopies of the upper ankle joint were performed in 178 cases due to arthritis. Of 132 accessible patients, 124 replied to our questionnaire: 90 (73%) of the responders underwent clinical examination 94 (37–152) months following the initial arthroscopy and were graded according to the score of Evanski and Waugh. All arthroscopies were performed under fluid filling using anterolateral and anteromedial approaches. In only five cases was the posterior compartment additionally investigated. Generally, neither tourniquet nor mechanical joint distraction were applied.Results:Of a total of 12 (6.7%) complications, only 3 (1.7%) hematomas needed surgical revision. One hematoma was due to an arteriovenous fistula treated by double ligation. All complications including five hypesthesias were temporary and subsided spontaneously. The 124 patients of the questionnaire group assessed the result of arthroscopic surgery as excellent in 11%, good in 46%, fair in 22%, and poor in 21%. Of all patients, 22% required further surgery of the upper ankle: in 9% further arthroscopy, in 3% arthrodesis, and in 10% microsurgical denervation. The total range of motion increased from 10/0/40 (extension/flexion) preoperatively to 15/0/44 at the follow-up examination. The Evanski score improved significantly (pConclusion:Due to minimal invasiveness and low risk of complications, arthroscopy is recommended for the following indications of upper ankle osteoarthritis: focal arthrosis, limited range of motion caused by osteophytes, soft tissue impingement, corpora libera, and synovitis. Severity and extent of upper ankle arthritis, range of motion, pain, local bone and soft tissue quality as well as the age, physical activity and compliance of the patient concerned are decisive for the individual therapeutic protocol. Alternative surgical techniques in upper ankle osteoarthritis are assessed such as denervation, distraction arthroplasty, correction osteotomy, ankle arthrodesis and total ankle replacement.
    Der Unfallchirurg 05/2005; 108(6):461-469. · 0.64 Impact Factor
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    ABSTRACT: In a prospective study we investigated the value regarding muscle strength of two stairclimbers with either coupled or non-coupled pedals at either high or low stepping frequency. Following autologous patellar tendon graft surgery 14 patients for each group completed a strict exercising program. After 6 weeks of training a clear advantage was found for the group stepping at low speed with coupled pedals when measuring: At 60 degree/s the average maximum torque of extension increased from 37.7 to 61.7% as compared to a control group (30 to 47.2%). Analogous the percent ratio of flexion/extension (H/Q ratio) improved significantly. During the second training period the improvement of the extension strength as well as the H/Q ratio was found to be only marginal. No negative effects of this type of training on ligament stability could be detected. CONCLUSIONS: Regarding a faster recovery of muscle strength and the improvement of the intermuscular coordination, the stairclimber training, beginning with week 7 after surgery and lasting over a period of 6 weeks, is considered advantageous, especially when exercising is done at low speed and with coupled pedals.
    Sportverletzung · Sportschaden 01/2004; 17(4):171-5. · 0.46 Impact Factor
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    ABSTRACT: The anterior cruciate ligament (ACL) rupture is among the most frequent injuries of the joints. Actually, there is no doubt regarding the necessity for surgical treatment. However, little is known about the progression of osteochondral damages and their distribution following reconstruction of the ACL. We treated 150 tears of the ACL either acute (median 7d) with augmented reinsertion (n = 41) and with autologous bone patella tendon graft (n = 24) or chronic (median 369d) with autologous bone patella tendon graft (n = 85). The study design was prospective. All osteochondral defects were documented in the six compartments. Second look arthroscopy and clinical examination were performed after twelve months in the course of removal of implants and possible changes of the osteochondral state were evaluated. Detoriation of osteochondral state was seen in 86 (57%) of 150 patients, while there was no statistical difference between the three groups. The time of operation had no influence on the osteochondral damage. There was a significant increase of chondral damages in the medial and retropatellar compartment after autologous bone patella tendon graft, while the changes after augmented reinsertion were diffuse. There were no significant differences in the clinical examination between the three groups regarding the Lysholm score and the functional and subjective outcome. However, postoperative instability was frequently observed (positive pivot-shift 25%, positive Lachmann test 57%). We suggest that postoperative instability should have led to the increased osteochondral damages.
    Der Unfallchirurg 08/2001; 104(7):629-38. · 0.64 Impact Factor
  • Mark Bischoff, Lothar Kinzl, Gerhard Hehl
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    ABSTRACT: This overview characterizes the mechanically caused occupational diseases of tendon sheaths, paratenon, and tendon and muscle insertions and bursitis. The clinical picture in each, the causative damage and the guidelines for expert medical assessment are discussed. Die vorliegende Arbeit charakterisiert die mechanisch bedingten Berufserkrankungen der Sehnenscheiden, des Sehnengleitgewebes und der Sehnen- oder Muskelansätze sowie der Schleimbeutel. Es werden das klinische Erscheinungsbild, die verursachende Schädigung und die Richtlinien der Begutachtung besprochen.
    Trauma und Berufskrankheit 06/2001; 3(2):135-137.
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    ABSTRACT: This study presents the five-year follow-up-results (range 56 to 63 months) of 76 of 119 patients who had had arthroscopically assisted reconstruction of the anterior cruciate ligament with use of the central third patellar tendon for acute rupture (19 patients = group A) or chronic ACL insufficiency (57 patients = group B) between may 1991 and october 1993 in the Department of Trauma Surgery University Hospital Ulm. The average Lysholm knee score was 94.6 points (group A = 97.1, group B = 93.8 points). The IKDC-score rated 21.1% of all patients as A (group A = 31.6%, group B = 17.5%), 57.9% as B (group A = 52.6%, group B = 59.6%), 19.7% as C (group A = 15.8%, group B 21.7%) and one patient of group B as level D. 9 patients (= 11.8%, group A = 21.1%, group B = 8.8%) showed up to 10 degree extension loss (compared with contralateral knee), one patient of group A (1.3%) more than 10 degree. A flexion loss up to 15 degree was seen in 12 patients (= 15.8%, group A = 21.1%, group B = 14.0%), of more than 15 degree in 3 patients (= 3.9%, group A = 5.3%, group B = 3.5%). The average KT-1000-side-to-side difference was 2.5 mm with 90 N (group A 2.4 mm, group B = 2.5 mm), 2.8 mm with 133 N (group A = 2.7 mm, group B = 2.8 mm) and 3.2 mm (both groups) for manual maximum. There was no statistically significant difference in quadriceps and hamstring isokinetic strength (Cybex) of operated vs. unaffected limb for 60/s as well as 240/s. X-ray analysis showed arthrotic signs of minimum one compartment in 22.3% of all patients (group A = 26.3%, group B = 21.1%). In summary, we found better long-term results of IKDC-score in patients with autogenous patellar tendon graft for acute ACL-rupture vs. chronic ACL insufficiency. In Lysholm knee score and KT-1000 arthrometric measurement we just saw little but not statistically significant differences between the two groups. The isokinetic strength of quadriceps and hamstring were similar between operated vs. unaffected limb as well as between group A and B.
    Der Unfallchirurg 05/2001; 104(4):317-24. · 0.64 Impact Factor
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    ABSTRACT: Patients and Methods: During a 12-year period (1/88-12/99), 4,526 arthroscopic (ASC) of the knee joint were performed at our clinic. 279 of the patients involved were aged between 0 an 17 years (at the time of the procedure). 162 out of these 279 ASCs were performed posttraumatically after fresh injuries; 32 patients were children (age 6-12 years), 130 adolescents (age 13-17 years). Results: In 131 patients (81%), we established findings requiring treatment, which led to immediate arthroscopic intervention or open surgery. Findings requiring no direct therapeutic action were established during the procedure in only 31 patients (19%), with hemostasis (eight patients = 5%) and/or flushing-out of the hemarthrosis with insertion of a drain being regarded as an extended diagnostic ASC. On the basis of the findings established during the procecure, a clarification by magnetic resonance imaging (MRI) would have been promising and sufficient in only one patient (0.6%) with an isolated synovitis. In the other 30 out of these 31 patients with extended diagnostic ASC (18%), sufficient diagnostic clarification was only achieved arthroscopically. Conclusions: In view of these results, we consider that only in rare, exceptional cases (e. g., relative or absolute contraindications to arthroscopy or anesthesia), there is a posttraumatic indication for a preoperative knee MRI in children and adolescents.
    European Journal of Trauma 04/2001; 27(2):75-80.
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    ABSTRACT: To identify an augmentation technique which would provide mechanical protection for the healing posterior cruciate ligament. Six human knee specimens were tested in vitro for posterior knee joint stability after augmenting the cut posterior cruciate ligament by six different techniques using a resorbable double strand Polydioxanone augmentation device. A fresh isolated rupture of the posterior cruciate ligament is often treated conservatively. Results have shown that it can heal, but ligament elongations occur frequently. Therefore a method is needed to provide posterior knee joint stability during ligament healing. The effect of different femoral augmentation insertions on posterior knee stability was tested by recording the antero-posterior (AP) position of the tibia and the augmentation force. Testing was performed during flexion--extension cycles and under posterior shear loads. The insertion combination that proved to stabilize the joints best consisted of one augmentation strand leading along the antero-lateral posterior cruciate ligament fibres and inserting at the distal end of the Blumensaat line and one strand leading along the posteriormedial fibres and inserting in the middle of the Blumensaat line. AP translations similar to those occurring in healthy knee joints could be achieved. It is possible to restore normal posterior knee joint stability by implanting a double strand augmentation device. This can help a posterior cruciate ligament to heal under non-elongated conditions.
    Clinical Biomechanics 04/2001; 16(3):222-8. · 1.87 Impact Factor
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    ABSTRACT: Diese Studie präsentiert die 5-Jahres-Ergebnisse (56–63 Monate postoperativ) von 76 der an unserer Klinik wegen vorderer Kreuzbandruptur (19 frische Rupturen = Gruppe A, 57 chronische vordere Instabilitäten = Gruppe B) zwischen Mai 1991 und Oktober 1993 operierten 119 Patienten (46 w., 73 m.) nach arthroskopisch gestützter autologer Patellarsehnenersatzplastik des vorderen Kreuzbands. Die Nachuntersuchung erbrachte für den Lysholm-Score eine durchschnittliche Punktezahl von 94,6 Punkten (Gruppe A = 97,1 Punkte, Gruppe B = 93,8 Punkte). Im IKDC-Score erreichten 21,1% der Patienten Level A (Gruppe A = 31,6%, Gruppe B = 17,5%), Level B 57,9% (Gruppe A 52,6%, Gruppe B 59.6%) sowie Level C 19,7% (Gruppe A 15,8%, Gruppe B 21,7%) und Level D in einem Fall aus Gruppe B. In 9 Fällen (11,8%, Gruppe A = 21,1%, Gruppe B = 8,8%) fand sich ein Streckdefizit bis zu 10° im Vergleich zur Gegenseite, in lediglich einem Fall aus Gruppe A (1,3%) von mehr als 10°. Eine Beugehemmung bis zu 15° zeigte sich bei 12 (15,8%, Gruppe A = 21,1%, Gruppe B = 14,0%), eine von mehr als 15° bei 3 (3,9%, Gruppe A = 5,3%, Gruppe B = 3,5%) der nachuntersuchten Patienten. Die KT-1000-Messung ergab im Vergleich zur nicht operierten Gegenseite eine durchschnittliche ventrale Translationsdifferenz von 2,5 mm bei 90 N (Gruppe A = 2.4 mm, Gruppe B = 2,5 mm), 2,8 mm bei 133 N (Gruppe A = 2,7 mm, Gruppe B 2,8 mm) sowie 3.2 mm (beide Gruppen) bei maximaler manueller Zugkraft. Der Unterschied der im Rahmen der Cybex-Messung erhobenen Maximalkraft (60°/s) und Kraftausdauer (240°/s) der Quadrizepsmuskulatur zwischen operierter und nicht operierter Seite war statistisch ebenso nicht signifikant wie der der Oberschenkelbeuger. Die konventionell radiographische Nachuntersuchung ergab in 22,3% aller Patienten (Gruppe A = 26,3%, Gruppe B = 21,1%) erst- oder zweitgradige Arthrosezeichen in mindestens einem Kompartiment. Zusammenfassend zeigten die Patienten nach autologer Patellarsehnenersatzplastik des vorderen Kreuzbands wegen frischer ACL-Ruptur im IKDC-Score die besseren Langzeitergebnisse als solche mit einer BTB-Plastik wegen chronischer vorderer Instabilität. Im Lysholm-Score und der KT-1000-Messung der objektiven Instabilität ergaben sich lediglich geringwertig, nicht signifikant bessere Ergebnisse für die Patellarsehnenersatzplastiken nach frischer ACL-Ruptur, in der Cybex-Messung der isokinetischen Muskelkraft dagegen keine Unterschiede. This study presents the five-year follow-up-results (range 56 to 63 months) of 76 of 119 patients who had had arthroscopically assisted reconstruction of the anterior cruciate ligament with use of the central third patellar tendon for acute rupture (19 patients = group A) or chronic ACL insufficiency (57 patients = group B) between may 1991 and october 1993 in the Department of Trauma Surgery University Hospital Ulm. The average Lysholm knee score was 94.6 points (group A = 97.1, group B = 93.8 points). The IKDC-score rated 21.1% of all patients as A (group A = 31.6%, group B = 17.5%), 57.9% as B (group A = 52.6%, group B = 59.6%), 19.7% as C (group A = 15.8%, group B 21.7%) and one patient of group B as level D. 9 patients (= 11.8%, group A = 21.1%, group B = 8.8%) showed up to 10 degree extension loss (compared with contralateral knee), one patient of group A (1.3%) more than 10 degree. A flexion loss up to 15 degree was seen in 12 patients (= 15.8%, group A = 21.1%, group B = 14.0%), of more than 15 degree in 3 patients (= 3.9%, group A = 5.3%, group B = 3.5%). The average KT-1000-side-to-side difference was 2.5 mm with 90 N (group A 2.4 mm, group B = 2.5 mm), 2.8 mm with 133 N (group A = 2.7 mm, group B = 2.8 mm) and 3.2 mm (both groups) for manual maximum. There was no statistically significant difference in quadriceps and hamstring isokinetic strength (Cybex) of operated vs. unaffected limb for 60 /s as well as 240 /s. X-ray analysis showed arthrotic signs of minimum one compartment in 22.3% of all patients (group A = 26.3%, group B = 21.1%). In summary, we found better long-term results of IKDC-score in patients with autogenous patellar tendon graft for acute ACL-rupture vs. chronic ACL insufficiency. In Lysholm knee score and KT-1000 arthrometric measurement we just saw little but not statistically significant differences between the two groups. The isokinetic strength of quadriceps and hamstring were similar between operated vs. unaffected limb as well as between group A and B.
    Der Unfallchirurg 03/2001; 104(4):317-324. · 0.64 Impact Factor
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    ABSTRACT: Die Ruptur des vorderen Kreuzbands (VKB) gehört zu den häufigsten Gelenkverletzungen. Die operative Versorgung ist heute als Mittel der Wahl anerkannt, doch ist bislang nur wenig über die postoperative Zunahme des Knorpelschadens und dessen Verteilung nach Rekonstruktion des VKB bekannt. In einer prospektiven Studie wurden 150 VKB-Rupturen akut (Median 7 Tage) mit augmentierter Reinsertion (n=41) bzw. Patellarsehnenersatzplastik (BTB, n=24) oder chronisch (Median 369 Tage) mit BTB (n=85) versorgt. Eine “Second-look”-Arthroskopie im Rahmen der Metallentfernung sowie eine klinische Nachuntersuchung ein Jahr nach dem chirurgischen Eingriff erfassten den klinischen Befund sowie Veränderungen des Knorpelstatus. Wir fanden eine Zunahme und Ausdehnung der Knorpelschäden bei 86 (57%) der 150 untersuchten Patienten. Die Unterschiede zwischen den Operationsgruppen waren jedoch nicht signifikant und unabhängig vom Zeitpunkt der Operation. Nach BTB zeigten sich signifikante Zunahmen der Knorpelschäden insbesondere im medialen und retropatellaren Kompartiment, nach augmentierter Reinsertion diffus. Die klinische Untersuchung ergab keine signifikanten Unterschiede bezüglich des Lysholm-Scores sowie des funktionellen und subjektiven Ergebnisses zwischen den Operationsgruppen. Der Anteil der postoperativen Instabilität war jedoch hoch (positiver Pivot-Shift 25%, positiver Lachmann-Test 57%), sodass wir am ehesten die postoperative Instabilität als Ursache für die große Zunahme der Knorpelschäden annehmen. The anterior cruciate ligament (ACL) rupture is among the most frequent injuries of the joints. Actually, there is no doubt regarding the necessity for surgical treatment. However, little is known about the progression of osteochondral damages and their distribution following reconstruction of the ACL. We treated 150 tears of the ACL either acute (median 7d) with augmented reinsertion (n=41) and with autologous bone patella tendon graft (n=24) or chronic (median 369d) with autologous bone patella tendon graft (n=85). The study design was prospective. All osteochondral defects were documented in the six compartments. Second look arthroscopy and clinical examination were performed after twelve months in the course of removal of implants and possible changes of the osteochondral state were evaluated. Detoriation of osteochondral state was seen in 86 (57%) of 150 patients, while there was no statistical difference between the three groups. The time of operation had no influence on the osteochondral damage. There was a significant increase of chondral damages in the medial and retropatellar compartment after autologous bone patella tendon graft, while the changes after augmented reinsertion were diffuse. There were no significant differences in the clinical examination between the three groups regarding the Lysholm score and the functional and subjective outcome. However, postoperative instability was frequently observed (positive pivot-shift 25%, positive Lachmann test 57%). We suggest that postoperative instability should have led to the increased osteochondral damages.
    Der Unfallchirurg 01/2001; 104(7):629-638. · 0.64 Impact Factor
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    ABSTRACT: Recently, the retrograde femoral nailing has become a procedure with increasing acceptance. Indications for the retrograde femur nail are distal femoral fractures including dia- and transcondylar fractures, supracondylar osteotomies and distal periprosthetic femur fractures after total knee joint replacement. Controversial discussion is carried on about the implant removal, which is potentially afflicted with further damage to the knee joint. To minimize the operative damage due to the implant removal, an arthroscopic assisted procedure has been selected. The arthroscopic assisted implant removal was possible in all of our patients. Intraoperatively, 2/3 of the patients showed normal age-related findings of the chondral and meniscal structures. The arthroscopic assisted implant removal is a gentle procedure, which allows minimal invasive extraction of retrograde femur nails and prevents secondary damage to the knee joint due to the otherwise difficult localisation of the implant. The advantages of this procedure concerning gentleness and diagnostic capabilities are as convincing, that we indicate implant removal of retrograde femur nails in all younger patients (< 60 years), except in periprosthetic fractures.
    Der Unfallchirurg 12/2000; 103(12):1116-20. · 0.64 Impact Factor
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    ABSTRACT: Die distale Femurmarknagelung ist in den letzten Jahren ein zunehmend gängiges Verfahren geworden. Die Hauptindikationsgebiete der retrograden Femurmarknagelung sind die distalen Femurfrakturen einschließlich der dia- und perkondylären Gelenkfrakturen des distalen Femur, Korrekturosteotomien und periprothetische distale Femurfrakturen nach Kniegelenkimplantation. In der Diskussion ist die Implantatentfernung, welche zu einem erneuten Schaden im Bereich des Kniegelenkes führt. Um den operativen Schaden der Implantatentfernung zu minimieren, wurde eine arthroskopisch gestützte Vorgehensweise gewählt. Die arthroskopisch unterstützte Metallentfernung war bei allen Patienten möglich. Intraoperativ konnten arthroskopisch bei 2/3 der Fälle unauffällige Gelenkverhältnisse gefunden werden. Die arthroskopisch gestützte Entfernung retrograder Marknägel ist eine schonende Vorgehensweise, welche die minimal-invasive Entfernung retrograder Marknägel ermöglicht und dabei mit Hilfe der arthroskopischen Sicht sekundäre Schäden im Bereich des Knies durch schwieriges Aufsuchen des Nageleintritts verhindert. Dieses Verfahren ist so schonend bei der Entfernung retrograder Marknägel des distalen Femur, dass wir die Metallentfernung – mit Ausnahme von periprothetischen Frakturen – bei jüngeren Patienten (<60 Jahre) für indiziert halten. Recently, the retrograde femoral nailing has become a procedure with increasing acceptance. Indications for the retrograde femur nail are distal femoral fractures including dia- and transcondylar fractures, supracondylar osteotomies and distal periprosthetic femur fractures after total knee joint replacement. Controversial discussion is carried on about the implant removal, which is potentially afflicted with further damage to the knee joint. To minimise the operative damage due to the implant removal, an arthroscopic assisted procedure has been selected. The arthroscopic assisted implant removal was possible in all of our patients. Intraoperatively, 2/3 of the patients showed normal age-related findings of the chondral and meniscal structures. The arthroscopic assisted implant removal is a gentle procedure, which allows minimal invasive extraction of retrograde femur nails and prevents secondary damage to the knee joint due to the otherwise difficult localisation of the implant. The advantages of this procedure concerning gentleness and diagnostic capabilities are as convincing, that we indicate implant removal of retrograde femur nails in all younger patients (<60 years), except in periprosthetic fractures.
    Der Unfallchirurg 10/2000; 103(12):1116-1120. · 0.64 Impact Factor
  • G Hehl, F Rapp, M Kramer, L Kinzl, G Krischak
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    ABSTRACT: Between January 1986 and August 1995, we treated 86 patients suffering from lateral displacement of the patella with arthroscopic medial tightening and lateral release after a conservative functional treatment remained unsuccessful. 49 patients were available for follow-up studies. 29 patients were treated after primary dislocation of the patella, and 20 patients after recurrent dislocations (2-20). The lateral release was performed by arthroscopy in 28 patients and in 21 patients in an open procedure. The mean follow-up time was 47.3 months. The rate of reluxation was 8%. In the opinion of the patients, 44 (90% of the follow-up) operations were evaluated as good/very good, the average Lysholm score was 87.3 +/- 13.9. The clinical results were influenced by the point of time of the operation. Patients with monoluxation showed a lower rate of reluxation (3% vs. 15%) and superior functional and subjective results than those with recurrent dislocation. However, there were no significant differences between the open and closed performed lateral release. We recommend the technique presented here as a minimal-invasive method especially for patients with monoluxation of the patella.
    Der Unfallchirurg 09/1999; 102(8):632-7. · 0.64 Impact Factor
  • G. Hehl, F. Rapp, M. Kramer, L. Kinzl, G. Krischak
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    ABSTRACT: Between January 1986 and August 1995, we treated 86 patients suffering from lateral displacement of the patella with arthroscopic medial tightening and lateral release after a conservative functional treatment remained unsuccessful. 49 patients were available for follow-up studies. 29 patients were treated after primary dislocation of the patella, and 20 patients after recurrent dislocations (2–20). The lateral release was performed by arthroscopy in 28 patients and in 21 patients in an open procedure. The mean follow-up time was 47.3 months. The rate of reluxation was 8 %. In the opinion of the patients, 44 (90 % of the follow-up) operations were evaluated as good/very good, the average Lysholm score was 87.3 ± 13.9. The clinical results were influenced by the point of time of the operation. Patients with monoluxation showed a lower rate of reluxation (3 % vs. 15 %) and superior functional and subjective results than those with recurrent dislocation. However, there were no significant differences between the open and closed performed lateral release. We recommend the technique presented here as a minimal-invasive method especially for patients with monoluxation of the patella. Zwischen Januar 1986 und August 1995 waren 86 Patienten mit Patellaluxation mit einer arthroskopischen medialen Kapselraffung und lateralem Release versorgt worden, davon standen 49 Patienten für ein Follow-up zur Verfügung. 29 Patienten waren nach Erstluxation und 20 Patienten nach mehrfachen Luxationen (2–20) operativ versorgt worden. Bei 28 Patienten erfolgte das laterale Release arthroskopisch, bei 21 Patienten offen. Die Nachuntersuchung erfolgte nach durchschnittlich 47,3 Monaten. Die Reluxationsrate betrug 8 %. Das Ergebnis war von 44 (90 % der nachuntersuchten) Patienten als gut bis sehr gut beurteilt worden, der Lysholm-Score betrug 87,3 ± 13,9. Beeinflußt wurde das Ergebnis vom Zeitpunkt der Indikationsstellung. Patienten mit Monoluxation (n = 29) wiesen eine niedrigere Reluxationsrate (3 vs. 15 %) und ein besseres funktionelles und subjektives Ergebnis auf, als Patienten mit rezidivierenden Luxationen (n = 20). Zwischen dem offenen und dem geschlossenen durchgeführten lateralen Release konnten wir keine signifikanten Unterschied feststellen. Die vorgestellte Methode stellt ein geeignetes, minimal-invasives Verfahren zur Therapie insbesondere der Monoluxation dar.
    Der Unfallchirurg 06/1999; 102(8):632-637. · 0.64 Impact Factor
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    ABSTRACT: The results of prospective anterior cruciate ligament (ACL) refixation in 33 patients with high proximal rupture is reported at 20-28 months' follow-up: mean age was 31.1 +/- 12.5 years. The surgical technique was a specially developed refixation of the ACL using a multiple suture loop (modified Marshall technique) augmented with intra-articular PDS II (polydioxanon, resorbable, Ethicon, Hamburg, Germany) to avoid derangement of blood circulation and to guarantee early functional rehabilitation. All patients were operated on within 7.3 +/- 4.5 days after injury. According to the IKDC evaluation score, 22 patients showed excellent and 10 patients good subjective function. Twenty regained their pre-injury level of activity. Anterior stability was tested manually and by KT-1000 max (Medmetric, San Diego). Twenty-eight patients had a firm end-point, although there was a positive Lachman test in 16 patients. Maximal joint laxity as measured by KT-1000 showed a 1-2 mm, 3-5 mm, 6-10 mm and > 10 mm anterior drawer for 16, 14, 2 and 1 patients, respectively. Twenty-five of the evaluated knee joints had a negative pivot shift test. Three patients had a limited range of motion. The potential advantages of PDS II-augmented refixation of acute proximal ACL ruptures are anatomic reconstruction without destruction of other anatomic structures used as grafts, early functional rehabilitation and possibly better proprioception.
    Knee Surgery Sports Traumatology Arthroscopy 01/1999; 7(2):102-6. · 2.68 Impact Factor
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    ABSTRACT: Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL) lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees was to compare the diagnostic accuracy of prone ultrasonographic Lachman testing with KT-1000 measurements in the same study population. Our technique is based on a prone position of the patient. The thigh lies on the table surface such that the patella has no contact. The lower leg is placed on a roll in the ankle area and flexed to 30 degrees . The transducer (5 MHz) is positioned over the medial aspect of the popliteal fossa to visualize the femoral condyle as well as the tibial head. Under ultrasound control the lower leg is manually lifted as far the thigh stays in contact with the surface defining the start position. The lower leg is then released and drawn by gravity into the anterior drawer position, the final position. The distance between the posterior tangent from the medial femoral condyle to the medial tibial plateau was registered by three independent ultrasound measurements of the injured knee. The uninvolved opposite knee served as an internal control. The same procedure was done using a KT-1000 device (89 and 133 Newton and manual maximum force). The patients were split into two groups: acute injury (A), and (B) 6 months following ACL repair with a patellar tendon graft. All patients then underwent arthroscopy. In group A with acute ACL lesions the anterior drawer resulted in 14.1 mm (+/- 3.5) and was significantly (P < 0.001) different from the contralateral knee (7.7 mm +/- 2.9). The KT 1000 showed a comparable difference with 14.4 mm (+/- 3.9) for the injured knee and 8.3 mm (+/- 3.4) for the uninjured (P < 0.001). Sonometrically, group B patients showed no clear difference between the repaired (9.9 mm +/- 2.7) knee and its control (8.1 mm +/- 2.5). This was found for the KT-1000 results as well. The results derived from the ultrasound evaluation of the anterior drawer correlated well with those from the KT-1000 (r = 0.46). Based on a minimum intra-individual difference of 5 mm in the ultrasound measured anterior drawer, the sensitivity of the test in group A resulted in 0.96, and the specificity in 0.98. The described technique is reproducible, painless and easy to perform in order to evaluate acute ACL tears using any commercially available ultrasound device. The reproducibility is similar to the KT-1000 device. We recommend this technique for use in cases of acute ACL tears as well as in the follow-up of ACL repair.
    Knee Surgery Sports Traumatology Arthroscopy 01/1999; 7(3):166-72. · 2.68 Impact Factor
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    ABSTRACT: Basically, four post-traumatic conditions of the proximal femur can be improved by corrective osteotomies: recurring luxations and subluxations of the hip joint; necrosis of the femoral head; non-unions; deformities. Dependent on the individual situation, the following procedure can be recommended, including diagnosis of deformities and indication and therapy of corrective osteotomies: analysis of the problem from the viewpoint of history, clinical findings and imaging techniques; indication for corrective osteotomy; graphic planning; operation technique. Particularities of post-traumatic conditions with regard to diagnosis, indication and surgical technique are indicated. Only with perfectly tailored concepts can we respond to the individual situation of an individual patient and reflect the variety and complexity of post-traumatic conditions of the proximal femur.
    Der Chirurg 12/1998; 69(11):1153-60. · 0.52 Impact Factor
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    ABSTRACT: Grundsätzlich sind 4 posttraumatische Zustände des proximalen Femur durch Osteotomien beeinflußbar: Rezidivierende Hüftluxationen und -subluxationen, Femurkopfnekrosen, Pseudarthrosen, Deformitäten. Unter Berücksichtigung der individuellen Situation ist dabei in allen Fällen ein diagnostisches, indikatorisches und therapeutisches Raster zu respektieren, das sich im wesentlichen aus folgenden Schritten aufbaut: 1. Analyse des Problems unter Berücksichtigung von Vorgeschichte, Klinik und bildgebender Diagnostik; 2. Indikation zur Osteotomie; 3. zeichnerische Planung; 4. Operationstechnik. Spezifische diagnostische, indikatorische und operationstechnische Besonderheiten dieser posttraumatischen Veränderungen werden beschrieben. Auf Korrekturen von Deformitäten in der Frontal- und Sagittalebene, von Translationen, von Längen- und Torsionsdifferenzen wird speziell eingegangen. Der klinischen, übersichtsradiographischen und computertomographischen/sonographischen Analyse der Beingeometrie kommt hierbei ein zentraler Stellenwert zu. Bei der Vielfalt und Komplexität posttraumatischer Zustände des proximalen Femur kann nur eine perfekte maßgeschneiderte Lösung die Antwort auf ein ganz individuelles Problem sein. Basically, four post-traumatic conditions of the proximal femur can be improved by corrective osteotomies: recurring luxations and subluxations of the hip joint; necrosis of the femoral head; non-unions; deformities. Dependent on the individual situation, the following procedure can be recommended, including diagnosis of deformities and indication and therapy of corrective osteotomies: analysis of the problem from the viewpoint of history, clinical findings and imaging techniques; indication for corrective osteotomy; graphic planning; operation technique. Particularities of post-traumatic conditions with regard to diagnosis, indication and surgical technique are indicated. Only with perfectly tailored concepts can we respond to the individual situation of an individual patient and reflect the variety and complexity of post-traumatic conditions of the proximal femur.
    Der Chirurg 10/1998; 69(11):1153-1160. · 0.52 Impact Factor
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    ABSTRACT: We examined 38 patients with an arthroscopic bioabsorbable tack repair for anterior shoulder instability in a prospective evaluation. The mean follow-up was 22 months (range 12 to 33). The average age was 28.4 years (range 15 to 57), the operation was performed at average of 50 months (3 to 244 months) after injury. Assessment using the Rowe score revealed excellent results in 33 and good results in 3 patients. 1 patient had a fair result and 1 had a poor result. 26 should obtained full range of motion, 11 had minor (< 10 degrees) loss of external rotation, 1 experienced greater (< 20 degrees) loss of external rotation. 3 of the 38 patients (8%) had recurrent instability, 1 patient with 2 preceding operations and atraumatic and voluntary dislocation, respectively. The recurrence rate of arthroscopic Bankart repair with bioabsorbable tacks are comparable to open Bankart procedures. Success of the procedure depends on appropriate surgical technique and suitable selection of patients with unidirectional, posttraumatic, anterior instability who are found to have well-developed ligamentous tissue.
    Der Unfallchirurg 08/1998; 101(7):537-42. · 0.64 Impact Factor
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    ABSTRACT: In a series of 1850 consecutive knee arthroscopies between 1991 and 1995, plicasyndrome was diagnosed and resected by arthroscopy in 102 patients (5.5%). Clinical response was evaluated for 38 of 54 patients with an isolated plicasyndrome by use of a modified Lysholm questionnaire at an average follow-up of 31 months (range, 8-78 months). Excellent or good results were obtained in 90% of 21 patients without plica-induced lesions of the cartilage (group 1) and poor results in 10%. Only 64% of 17 patients with plica-induced lesions of the cartilage (group 2) had excellent or good results. Both groups showed an improvement for range of motion and swelling post-operatively. The mean time for rehabilitation was 3.2 and 1.7 months for patients with and without cartilage lesions, respectively.
    Der Unfallchirurg 07/1998; 101(6):440-5. · 0.64 Impact Factor

Publication Stats

155 Citations
31.71 Total Impact Points

Institutions

  • 1994–2001
    • Universität Ulm
      • Clinic of Trauma, Hand, Plastic and Reconstructive Surgery
      Ulm, Baden-Wuerttemberg, Germany