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ABSTRACT: Purpose: The purpose of the present study was to evaluate the MRI of the hip musculature as well as specific blood parameters on comparison of the Bauer approach with the minimally invasive ALMI approach. Material and Methods: We compared two patient groups after total hip replacement, which were operated either via the Bauer or the ALMI approach. All 47 patients had the same cementless hip design. All surgeries were performed by two experienced hip surgeons with experience of more than 1200 ALMI approaches. The patient groups did not differ concerning age, sex or side which was operated on. All MRI were performed in a standardised technique with a Philips Outlook Proview (0.23 Tesla). Patients were scanned preoperatively, within 2 weeks after surgery and at time of follow-up 14 months after surgery. The evaluation of the MRI findings was performed by two independent and blinded examiners. In order to document the muscle damage we documented myoglobin (the day before surgery, 6 hours postoperatively and at the first postop. day) und troponin (6 hours postoperatively). Results: Preoperatively the male patients showed a significantly larger diameter of the gluteus medius muscle. We also could demonstrate in many patients a fatty degeneration even before surgery. At time of follow-up there was no significant difference between the two patient populations concerning the fatty degeneration. There was also no significant difference concerning the muscle atrophy. Muscle oedema, that was present before surgery, however, was no longer present at the time of follow-up. Two patients even preoperatively showed a lesion of the gluteus medius tendon. The range of the postoperative myoglobin level was high (118-5411 µg/L), in the ALMI group the standard deviation was 1445 µg/L, in the Bauer group it was 738 µg/L. There was no significant difference between both groups. Similar findings were documented for the troponin levels. Conclusion and Clinical Relevance: Even before THR many patients show significant degeneration in the hip muscles. Muscle oedema that was present before surgery had disappeared at the time of follow-up. The fatty degeneration was still present at the time of follow-up. There was no difference concerning the muscle atrophy between the ALMI and the Bauer groups.
Zeitschrift fur Orthopadie und Unfallchirurgie 12/2012; 150(6):615-23. · 0.52 Impact Factor
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ABSTRACT: Hintergrund. Die autologe Knorpelknochentransplantation ist durch die in den letzten Jahren entwickelten Techniken zu einem standardisierten
Verfahren in der Gelenkchirurgie geworden. Nachteilig ist jedoch nach wie vor, dass die notwendigen Knorpelknochenzylinder
aus intakten Arealen des Kniegelenks gewonnen werden.
Fragestellung. In unmittelbarer Nachbarschaft zum zu operierenden Kniegelenk findet sich die tibiofibulare Artikulation, in der es ebenfalls
ein Knorpelbelag gibt. Ziel der vorliegenden anatomischen und klinischen Untersuchung war die Frage, ob der Knorpelbelag dieses
Gelenks für eine Entnahme geeignet ist.
Material und Methode. An 44 anatomischen Präparaten wurde mögliche Operationszugänge zum Tibiofibulargelenk erprobt. In Kniestreckung wurde die
kürzeste Distanz zum N. fibularis dokumentiert. An den anatomischen Präparaten wurde die Knorpeldicke der tibialen und fibularen
Gelenkflächen dokumentiert. Die entwickelten Zugänge wurden an Patienten auf ihre klinische Relevanz und Machbarkeit hin untersucht.
Ergebnisse. Histologische und immunohistochemische Untersuchungen zeigen hyalinen Knorpel sowie Typ-II-Kollagen. Die Knorpeldickenmessung
ergibt einen Mittelwert von 1,9±0,29 mm mit einem Minimum von 1,5 mm und einem Maximum von 2,6 mm. Der N. fibularis ist durchschnittlich
24 mm vom TF-Gelenk entfernt (Min. 12 mm; max. 30 mm). Es sind unterschiedliche Operationszugänge möglich und klinisch durchführbar.
Klinische Relevanz. Das tibiofibulare Gelenk hat einen Knorpelüberzug, welcher selbst beim älteren Patienten prinzipiell für eine autologe Knorpelknochentransplantation
geeignet ist. Hierdurch könnte die iatrogene Schädigung von intraartikulären Knorpelanteilen des Kniegelenks vermieden werden.
Background. Within the last few years autologeous cartilage-bone-grafting is becoming an established standardized procedure in joint
surgery. One significant disadvantage of this technique is the harvesting of the bone plugs from the weight-bearing area of
the knee joint.
Purpose. The tibiofibular articulation is located close to the knee joint that is operated on. This articulation is covered with cartilage.
The purpose of this study was to evaluate the question, whether this joint is suitable as a donor site for bone-cartilage
transplants.
Material and methods. Favourable approaches and committing of anatomical landmarks were investigated on 44 fixed tibiofibular joints. In knee extension,
the shortest distance between the joint cleft and common fibular nerve was measured. The cartilage thicknees and histology
of both the fibular and tibial joint surface were documented. The developed surgical approach was evaluated in patients.
Results. Histological and immunohistochemical examination showed hyaline cartilage and type II collagen. The average cartilage thickness
was 1.9±0.29 mm (minimum: 1.5 mm; maximum: 2.6 mm). The peroneal nerve showed an average distance to the tibiobibular joint
of 24 mm (minimum: 12 mm; maximum: 30 mm). Different surgical procedures are possible and clinical relevant.
Clinical relevance. The tibiofibular joint contains cartilage, which may be a reasonable donor site even for the elderly patient. Harvesting
the graft from this area may avoid iatrogenic damaging of intraarticular weight bearing cartilage of the knee joint.
Der Unfallchirurg 04/2012; 105(2):134-139. · 0.61 Impact Factor
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ABSTRACT: The purpose of the study was to evaluate the effect of suprascapular nerve block (SSNB) in shoulder surgery. The study group consisted of 260 patients, which were subjected to shoulder operations. The patients were divided into two equal groups: group I with nerve block compared to a control group II without a nerve block. The mean age of the patients in group I was 56.2 +/- 6.86 years and that in group II was 54.5 +/- 7.06 years. The female to male ratio was 71:59 in group I and was 69:61 in group II. Surgical procedures were arthroscopic rotator cuff repair, arthroscopic subacromial decompression, arthroscopic acromioclavicular resection, arthroscopic removal of calcific tendonitis, arthroscopic reconstruction of instability, arthroscopic capsular release and shoulder replacement. In all cases the pain was documented by the visual analogue scale (VAS) preoperative, at the first, the second as well as at the third day after surgery. In order to evaluate the amount of fluid, which is needed for infiltration of the area of the supraspinatus fossa, we injected different amount of local anesthetic in combination with contrast dye in five patients. In this study to document the fluid distribution, after injecting with different milliliters, 10 ml is proved to be more than enough to have sufficient local anesthetic to block the SSN. Pre-operatively the mean VAS was comparable between both groups. We documented a significant difference in favour of SSNB from day 1 to day 3 after surgery. No specific complications due to this nerve block procedure were found in any patient post-operatively.
Knee Surgery Sports Traumatology Arthroscopy 07/2008; 16(6):602-7. · 2.21 Impact Factor
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ABSTRACT: We present our technique and preliminary results with endoscopic calcaneoplasty in ten patients resistant for conservative therapy for more than 6 months. All patients showed a Haglund spur on radiography; none had a cavovarus deformity. Follow-up ranged from 2 to 12 months (mean 5.2). All patients showed clinical improvement and would undergo for the procedure again. Three showed a good and seven an excellent result in Ogilvie-Harris score. Postoperative radiographic follow-up showed sufficient bone removal in all cases. Surgery lasted on average 46 min (range 28-84). There were no intra- or postoperative complications. Endoscopic calcaneoplasty is an effective minimally invasive treatment option for patients with retrocalcaneal bursitis.
Knee Surgery Sports Traumatology Arthroscopy 06/2003; 11(3):190-5. · 2.21 Impact Factor
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ABSTRACT: Hydatid disease is caused by the parasitic tapeworm Echinococcus. There are three species: E. granulosus, E. alveolaris and E. voegeli. Only E. alveolaris and E. granulosus are important for human infections. These two species are totally divergent in their manner of infestation. Hydatid disease is a rare parasitic disease that primary involves the liver and the lung. Skeletal disease is rare, accounting for less than 2% of all hydatid lesions, and often presents as a clinical and radiologic diagnostic problem. The skeletal involvement is usually due to secondary extension after haematogenous spread of the infection. The vertebral column, the pelvis and the skull are most commonly involved. Treatment is also difficult because of the invasive nature of bony involvement and the spillage of fluid with subsequent contamination seeding. We present a case of primary hyatid cyst of the tibia. We point out the importance of considering osseous hydatidosis in the differential diagnosis of destructive bone lesions and the necessity of radical resection.
Archives of Orthopaedic and Trauma Surgery 05/2003; 123(2-3):107-11. · 1.37 Impact Factor
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ABSTRACT: The purpose of the present study was to develop and present a computer program for preoperative simulation of implant components placement in total hip alloarthroplasty, and its influence on the possible range of motion (ROM). We evaluated a computer simulation for preoperative estimation of range of motion (movement mapping) in total hip replacement. The computer program was based on Borland C++. The system had an open data port, so the data could be transferred to an Excel spreadsheet for statistical evaluation. With the developed virtual computer simulation, a practical model was established. The model showed range of motion patterns which correspond to clinical experience. ROM was best at a shaft anteversion between 20 degrees and 30 degrees. ROM had its maximum with a CCD angle of 120 degrees -130 degrees. Acetabular cup anteversion was optimal between 10 degrees and 20 degrees, and cup inclinations were optimal below 40 degrees. The presented movement mapping system seems to be a reliable option for dynamic preoperative planning, which may be a prerequisite for the use of intraoperative navigation systems.
Archives of Orthopaedic and Trauma Surgery 08/2002; 122(6):342-5. · 1.37 Impact Factor
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ABSTRACT: Femoral component malalignment is one of the main causes of persisting anterior knee pain after knee replacement. This study examined interindividual reproducibility in perioperative definition of the transepicondylar axis (TEA) as a reference for measuring the rotational alignment of the femoral component. Eight surgeons experienced in knee prosthetic surgery marked on Thiel-embalmed cadaver specimens the reference points that they would normally use to define the TEA during knee replacement. These were digitized by a video system, and all the spots defined by the surgeon were translated into a reference picture, allowing a digital analysis of the distances between all the spots marked. The maximal distance between the spots that the participants had marked as relevant for the TEA was 13.8 mm at the lateral and 22.3 mm at the medial epicondyle. Projecting all spots marked into one picture resulted in an area of 116 mm2 on the lateral and 102 mm2 on the medial epicondyle. The median range of the fault between two different participants was 6.4 mm on the lateral side (range 13.2 mm) and 9.7 mm on the medial (range 21.6 mm). Because the rotational alignment of the femoral component is extremely relevant for successful implantation of total knee prosthesis, the interindividual discrepancy in defining the TEA as reference is rather high. As this reference line is commonly used, the perioperative variance and the resulting rotational discrepancy of the femoral component must be considered.
Knee Surgery Sports Traumatology Arthroscopy 06/2002; 10(3):194-7. · 2.21 Impact Factor
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ABSTRACT: The success of arthroscopic capsular release of the glenohumeral joint depends on complete incision of the inferior capsule. This study determined the distance between capsule and the axillary nerve in different joint positions. In 14 human shoulder specimens the anterior joint capsule and axillary nerve were dissected, and the anterior joint capsule was incised between the 1 and 5 o'clock positions. The shortest distance between the insertion of the inferior capsule and the axillary nerve was measured at the glenoid and humeral insertions in abduction, adduction, internal, and external rotation. The axillary nerve is surrounded from soft connective tissue and is closer to the humeral than to the glenoidal attachment of the joint capsule. During abduction and external rotation the nerve stays in its position while the glenohumeral capsule tightens, which increases the distance between the two structures. This results in the following distances: to the glenoidal/humeral capsule insertion: in adduction and neutral rotation, 21.2+/-4.2/14.2+/-2.6 mm; in abduction and neutral rotation, 24.0+/-4.9/15.0+/-5.0 mm; in abduction and internal rotation, 21.1+/-6.6/14.6+/-3.7 mm; and in abduction and external rotation, 24.9+/-3.8/16.4+/-4.4 mm. Thus, when performing arthroscopic capsular release the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and externally rotated shoulder.
Knee Surgery Sports Traumatology Arthroscopy 04/2002; 10(2):126-9. · 2.21 Impact Factor
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ABSTRACT: Within the last few years autologous cartilage-bone-grafting is becoming an established standardized procedure in joint surgery. One significant disadvantage of this technique is the harvesting of the bone plugs from the weight-bearing area of the knee joint.
The tibiofibular articulation is located close to the knee joint that is operated on. This articulation is covered with cartilage. The purpose of this study was to evaluate the question, whether this joint is suitable as a donor site for bone-cartilage transplants.
Favourable approaches and committing of anatomical landmarks were investigated on 44 fixed tibiofibular joints. In knee extension, the shortest distance between the joint cleft and common fibular nerve was measured. The cartilage thickness and histology of both the fibular and tibial joint surface were documented. The developed surgical approach was evaluated in patients.
Histological and immunohistochemical examination showed hyaline cartilage and type II collagen. The average cartilage thickness was 1.9 +/- 0.29 mm (minimum: 1.5 mm; maximum: 2.6 mm). The peroneal nerve showed an average distance to the tibiofibular joint of 24 mm (minimum: 12 mm; maximum: 30 mm). Different surgical procedures are possible and clinical relevant.
The tibiofibular joint contains cartilage, which may be a reasonable donor site even for the elderly patient. Harvesting the graft from this area may avoid iatrogenic damaging of intraarticular weight bearing cartilage of the knee joint.
Der Unfallchirurg 03/2002; 105(2):134-9. · 0.61 Impact Factor
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ABSTRACT: Hintergrund: Die direkte Inspektion des Gelenkraums durch die Arthroskopie stellt nach wie vor eine ideale Ergänzung zur klinischen Untersuchung
und zur radiologischen Diagnostik dar und hat den Zusammenhang von Gelenktrauma und pathologischer Anatomie wie kein anderes
Verfahren erhellt. Von nahezu allen orthopädischen Chirurgen, die sich mit Verletzungen und Erkrankungen des Sprunggelenks
befassen, wird die Arthroskopie heute als Routineverfahren voll akzeptiert. Komplikationen: Die Komplikationsrate bei der Arthroskopie des Sprunggelenks ist höher als bei anderen Gelenken. Dieses betrifft v. a. neurologische
Komplikationen; aber auch die Infektionsrate ist höher als bei anderen arthroskopischen Maßnahmen. Anhand der eigenen Erfahrung
sowie den Angaben in der Literatur werden Komplikationen bei arthroskopischen Operationen am Sprunggelenk beschrieben.
Background: Direct inspection of the joint area through arthroscopy is an ideal supplement to clinical examination and radiological diagnostics
and clarifies the context of joint injury and pathological anatomy as no other procedure does. Today, arthroscopy is fully
accepted as a routine procedure by virtually all orthopedic surgeons who deal with injuries and disease of the ankle joint.
Complications: The complication rate with arthroscopy of the ankle joint is higher than with other joints, involving above all neurological
complications; however, the rate of infection is also higher than with other arthroscopic measures. On the basis of our own
experience as well as the reports in the literature, complications with arthroscopic operations in the ankle joint are described.
Arthroskopie 07/2001; 14(3):221-225.
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ABSTRACT: Hintergrund: Die Arthroskopie des Ellbogens hat sich in den letzten Jahren aufgrund technischer Fortschritte stark fortentwickelt. Dennoch
ist dieser Eingriff wegen der Anatomie des Ellbogengelenks potenziell komplikationsträchtig. In einer Literaturübersicht rangieren
die publizierten Komplikationen von 0–14%. Es werden die anatomische Situation des Ellbogengelenks im Hinblick auf den chirurgischen
Zugang verdeutlicht sowie die Indikationsstellung für diesen Eingriff diskutiert. Ein standardisierter chirurgischer Zugang
wird dargestellt. Diskussion: Unter Beachtung der dargestellten Anatomie sowie mit Hilfe eines standardisierten Vorgehens können die Gefahr einer neurovaskulären
Verletzung minimiert werden und die Ellbogenarthroskopie ein wertvolles Instrument für die operative Behandlung dieses Gelenks
sein.
Background: Arthroscopy of the elbow joint has made rapid advances in recent years. Nonetheless, this procedure is demanding and includes
a risk of neurovascular complications, which occur in 0–14% of cases according to the literature. The anatomy of the elbow
regarding the arthroscopic approach as well as the indication for elbow arthroscopy are discussed, and a possible standardized
surgical approach is presented. Discussion: With this careful approach, inherent risks of neurovascular injury can be minimized, and arthroscopy of the elbow can be a
valuable tool for surgical interventions in this joint.
Arthroskopie 07/2001; 14(3):214-220.
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ABSTRACT: Two questions were investigated: Do ankle devices have any influence on sports performance? Are there any differences between the devices? 31 participants could be included. The average age was 24.5 (+/- 4.1). The participants exercised 5.8 hours/week. We tested 41 ankles without any previous injury. With the Cybex 6000 four parameters were evaluated. Torque maximum for the plantarflexion, range of motion, work in Joule. The ankles were tested with three different ortheses, ankle taping and without any device. The Friedman Test was used to evaluate differences between the five test conditions. All measurements showed significant worse results for the devices and taping. The protective effect of ankle devices is well known. In this investigation we could show a restriction of the performance. Thus it should be decided individually, if an ankle device is useful.
Sportverletzung · Sportschaden 07/2001; 15(2):36-9. · 0.61 Impact Factor
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J Jerosch
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ABSTRACT: Adhesive capsulitis of the glenohumeral joint is said to be a self-limiting process. However, in some patients the disease can last much longer than 1 year, which may lead patients to more invasive treatment than merely undergoing physiotherapy. Other patients do not accept this severe limitation and choose treatment options that restore the range of motion (ROM) more rapidly. Conventional open release techniques generally improve motion but involve extensive dissection. The purpose of this study was to develop a safe and reproducible technique of arthroscopic capsular release (ACR) and to present the results of this technique in the clinical situation. The technique for ACR was first defined in a cadaver study and then applied in 28 patients with primary adhesive capsulitis of the glenohumeral joint. The patients were selected for the arthroscopic release when conservative therapy had failed for at least 6 months. All of the patients had a global loss of shoulder motion and had motion restored with a combined anterior, posterior, superior, and inferior release of the of the capsule (360 degrees release). Additionally, in all patients synovectomy with electrocautery was performed. We documented the ROM in the different planes as well as the Constant score. The Constant score improved a mean of 41 points. Range of motion for all planes significantly improved (P < 0.01). Abduction improved from 75 degrees preoperatively to 165 degrees intraoperatively; 6 weeks after surgery, mean abduction was 168 degrees and at the time of follow-up it was 167 degrees. Mean external rotation in adduction improved from 3 degrees preoperatively to 75 degrees intraoperatively. After 6 weeks, the mean external rotation in adduction was 72 degrees and at the time of follow-up the external rotation reached 76 degrees. Mean external rotation in abduction improved from 4 degrees preoperatively to 81 degrees intraoperatively, 80 degrees after 6 weeks and 85 degrees at the time of the last follow-up. Internal rotation in abduction was 17 degrees preoperatively. Intraoperatively, mean internal rotation was 59 degrees. An angle of 58 degrees was documented at 6 weeks follow-up, and at the last follow-up an angle of 63 degrees was documented. No postoperative lesion of the axillary nerve was present. We concluded that arthroscopic capsular release is a reliable method for restoring motion with minimum morbidity in carefully selected patients. When performing an ACR the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and external rotated shoulder.
Knee Surgery Sports Traumatology Arthroscopy 06/2001; 9(3):178-86. · 2.21 Impact Factor
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ABSTRACT: Plantar pressure distribution in inline skating on straight was measured with a flexible insole in 13 experienced subjects at a speed of 18 and 24 km/h. The results showed three areas that were exposed to high pressures, i.e. the heel with 258 and 265 kPa, the first metatarsal head with 265 and 281 kPa, the hallux with 319 and 324 kPa at 18 and 24 km/h, respectively. All other areas showed peak pressures that were less than half of these values. Lowest values were found in the midfoot area. Changing speed from 18 to 24 km/h led to a small increase of peak pressures in all areas. Peak pressures were comparable to walking but showed the trend to be lower than in running.
Sportverletzung · Sportschaden 01/2001; 14(4):134-8. · 0.61 Impact Factor
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J Jerosch
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ABSTRACT: The anatomy and biomechanics of the acromioclavicular (AC) joint have been understood for a long time; however, the importance of this joint in the clinical setting is often underestimated. During clinical examination various sensitive functional tests can document any AC pathology. For X-ray documentation special techniques are necessary. Other imaging techniques are rarely indicated. The Rockwood classification for AC joint separation has increased our understanding of the pathology, which, in turn, leads to a better understanding of conservative and surgical therapy. Within the last few decades surgical treatment has shifted from AC to coracoclavicular stabilization. In patients with clinically relevant degenerative joint disease, resection of the lateral clavicle has proved to be a reproducible procedure. This operation can be performed using the conventional, open technique or with a minimally invasive procedure (arthroscopic resection of the AC joint; ARAC). In unstable joints, resection should be combined with a stabilization procedure.
Der Orthopäde 11/2000; 29(10):895-908. · 0.51 Impact Factor
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ABSTRACT: We evaluated the accuracy of the needle tip representation by different imaging techniques for the guidance of facet infiltrations. For visualisation of the lumbar facet joints we used a high-field magnetic resonance tomograph (MRT) with a 2.0 Tesla field and 3.5 mm slice thickness, an open low-field magnetic resonance tomography (MRT) with an 0.064 Tesla field and 9 mm slice thickness, and IMATRON electron beam computed tomograph (EBCT) with a slice thickness of 6 mm, and a mobile C-arm fluoroscope. The study was performed on 4 human cadaveric lumber spine preparations, each of which had 8 facet joints. Under imaging control, special injection needles were placed as close as possible to the facet joint space. Following placement of he needle, all specimens were scanned with the electron beam tomograph using a slice thickness of 1.5 mm. The thin-slice study served as the gold standard. The distance between the tip of the needle and the facet joint was measured in all the images. Comparison of the different modalities with the gold standard revealed the following results: 1) median values of the absolute differences were 1.25 mm for high-field MRI, 1.35 mm for 6 mm EBCT, 2.05 mm for low-field MRI, and 2.30 mm for X-ray fluoroscopy. 2) While there was no statistically significant difference in the accuracy of tip localization between high-field MRI and 6" EBCT (p = 0.293), both systems were more precise than low-field MRI (p = 0.04) and X-ray fluoroscopy (p = 0.009). When choosing the best imaging technique, such additional factors as radiation, costs and time, must also be considered. Provided necessary radiological precautions are taken, and assuming careful pre-interventional planning, CT. EBCT and X-ray fluoroscopy are currently more effective than the expensive, time-consuming and costly magnetic resonance tomography.
Biomedizinische Technik 10/2000; 45(9):228-37. · 0.86 Impact Factor
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ABSTRACT: The purpose of the present study was to increase the free range of motion in conventional trust-plate prosthesis design and to optimize the trust-plate contact as well as the osteointegration area below the trust-plate. For the first part of the study, the two-dimensional geometry of the osteotomy plane was demonstrated in 25 CT-reconstructed femora after performing a virtual cut at a CCD angle of 135 degrees. In the second part, we constructed a prototype of an anatomic adapted trust-plate prosthesis (A-TPP) with an optimized trust-plate and corpus geometry based on the three-dimensional data of three human cadaveric femurs (age 67-75 years). In the final step, we documented the range of motion with computer-aided movement-mapping and compared the conventional TPP with the A-TPP. The results showed a wide variance in osteotomy geometry in the 12 femurs. With the A-TPP, we were able to obtain a much better fit in the trust plate surface. The movement-mapping showed a much higher range of motion in the A-TPP implant. With the A-TPP, the implant surface area for osteointegration could also be significantly increased.
Der Orthopäde 08/2000; 29(7):605-13. · 0.51 Impact Factor
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J Jerosch
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ABSTRACT: This is a case report of a patient suffering from subcalcaneal pain syndrome due to plantar fasciitis that was resistant to non surgical treatment. After endoscopic partial release of the plantar fascia the patient was pain free for several weeks, before he became symptomatic again. This new pain was located more proximally. An MRI study showed a stress reaction of the calcaneus.
The Foot and Ankle Online Journal 07/2000; 21(6):511-3. · 1.22 Impact Factor
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ABSTRACT: Within the past few years autologous osteochondral transplantation has become an established standardized procedure in joint surgery. One significant disadvantage of this technique is the harvesting of the osteochondral grafts from the weight-bearing area of the knee joint. The tibiofibular articulation is located close to the knee joint that is operated on. This articulation is covered with cartilage. The purpose of this study was to evaluate whether this joint is suitable as a donor site for osteochondral grafts. Ten human knee specimens were freed of all soft tissues around the proximal calf. The age of the specimens ranged between 58 and 79 years. Next the tibiofibular articulation was identified, and both the ligaments and the capsule were removed. After opening the joint the tibial- and fibular-sided joint surfaces were inspected and measured. In all specimens the articular surfaces showed good cartilage coverage. In only a single joint did the cartilage macroscopically show degeneration. In all other joints the cartilage surface was in surprisingly good condition, especially considering the age of the specimens. The average diameter of the cartilage surface on the tibial side was 1.7 +/- 0.26 x 1.9 +/- 0.22 cm and on the fibular side 1.6 +/- 0.31 x 1.8 +/- 0.32 cm. This results in an area of cartilage for transplantation of 3.23 cm2 at the tibia and of 2.88 cm2 at the fibula. The total area for cartilage transplantation is 6.11 cm2. The tibiofibular joint contains cartilage, which may be a reasonable donor site even for the elderly patient. Harvesting the graft from this area may avoid iatrogenic damaging of intra-articular weight-bearing cartilage of the knee joint.
Knee Surgery Sports Traumatology Arthroscopy 02/2000; 8(4):237-40. · 2.21 Impact Factor
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ABSTRACT: Twenty-one subjects with functional ankle instabilities were provided with an ankle support for all athletic and other physical activities for 3 months. Standardized tests were carried out at the beginning and after 3 weeks, 6 weeks, and 3 months. The following evaluation methods were used: KAT-2000 (static and dynamic), side stepping over 8 m, isokinetic force (Cybex 6000), angle reproduction test, SF-36 score, and Weber ankle score. Use of the ankle support improved both sensomotor and sport-specific abilities, particularly regarding dynamic requirements such as in the dynamic KAT-2000 test. Subjects using the support with functional ankle instability also demonstrated improved sport-specific capabilities such as those required in the fast side-step run. We observed no negative effect on sport-specific skills requiring joint stabilization isokinetic strength, even after 3 months. This was also the case with mobility in the talocrural joint and speed in the side-step run. Our findings demonstrate that even after 3 months there are no detrimental effects on sport-specific skills that require joint stabilization.
Knee Surgery Sports Traumatology Arthroscopy 02/2000; 8(4):252-9. · 2.21 Impact Factor
