[Show abstract][Hide abstract] ABSTRACT: Total shoulder arthroplasty (TSA) can improve function in osteoarthritic shoulders, but the ability to perform activities of daily living (ADLs) can still remain impaired. Routinely, shoulder surgeons measure range of motion (ROM) using a goniometer. Objective data are limited, however, concerning functional three-dimensional changes in ROM in ADLs after TSA in patients with degenerative glenohumeral osteoarthritis.
[Show abstract][Hide abstract] ABSTRACT: Reverse total shoulder arthroplasty (RSA) can improve function in cuff tear arthropathy (CTA) shoulders, but limited exact data are available about the maximum values in 3D motion analysis, and as to how improvements translate into the normal range of motion (ROM) in activities of daily living (ADLs).
Archives of Orthopaedic and Trauma Surgery 06/2014; · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study aimed to investigate the prognosis of osteochondral affection (e. g., osteochondritis dissecans (OCD), cartilage lesions, fractures and bone edema in the elbows of high-performance gymnasts (n=30) compared to prognosis results with athletes not undergoing excessive stress on the upper extremity (n=29). The study also tested a novel isotropic 3D-FSE-sequence (CUBE) technique as an early diagnostic modality. Standard protocol was used to conduct the MRI examinations, which were then compared to results from the CUBE - sequence. The gymnast group (p=0.012) presented a significantly higher prevalence of complaints in the elbow joint compared to the other athlete group. Furthermore, osteochondral lesions in MRIs appeared more frequently in the group of gymnasts (n=10, 33%, p=0.033), including 7 cases (23%) of OCD. In the control athlete group 2 asymptomatic cases of OCD and one case of bone edema were detected. The MRI investigation with the CUBE - sequence showed similar results as the standard MRI protocol in terms of the diagnosis sensitivity. The current study indicates that juvenile gymnasts are at a higher risk for osteochondral lesions of the elbow than athletes without excessive stress on the upper extremities.
International journal of sports medicine. 05/2014;
[Show abstract][Hide abstract] ABSTRACT: A key element for movement of the arm is the position and motion of the scapula. A stable basis for efficient arm function is only possible if the scapula makes three dimensional movements coordinated with the upper arm.
This article presents a discussion of causes, diagnosis and therapy options for scapular dyskinesis.
The article is based on a literature search in the PubMed database and taking own experience into account.
Soft tissue and bony injuries, muscle insufficiency and dysbalance can alter the position and function of the scapula. This pathological position and motion is called scapular dyskinesis. This clinically presents as a prominent medial border and malrotation (lacking external rotation and posterior tilt) of the scapula when raising the arm. The clinical examination includes a visual inspection followed by clinical tests of the scapula at rest and during movement. Specific exercises of the musculature surrounding the scapula and specific techniques for schooling the senses for positioning and movement can harmonize the sequence of movements and restore the dynamic scapular stability.
A conservative stepwise and stage-adapted exercise program can be used to treat scapular dyskinesis with good results.
[Show abstract][Hide abstract] ABSTRACT: Low back pain (LBP) is a common symptom in the populations of western countries, and adolescent athletes seem to be prone to LBP. The main objective of this study was to analyze the point (LBP within the last 48 h), 1-year (LBP within the last 12 months) and lifetime (LBP within the entire life) prevalence rates of LBP in adolescent athletes participating in various sports. We also assessed the characteristics of LBP and its association with potential risk factors. To this end, 272 competitive adolescent athletes involved in 31 different sports (158 males, 113 females, 15.4±2.0 years, body mass index [BMI] 20.3±2.4 kg/m2) were enrolled in a 10-month prospective clinical trial that included a questionnaire and physical examination. We found a point prevalence of 14%, a 1-year prevalence of 57%, and a lifetime prevalence of 66% for LBP. The mean age of first appearance of LBP was 13.1±2.0 years. The lifetime prevalence was significantly higher in volleyball than in biathletes (74.3 vs. 45.7%, p=0.015). Our findings confirm that LBP is a common symptom in adolescent athletes; LBP prevalence correlates with sports participation and individual competitive level. Adolescent athletes with LBP should receive a thorough diagnostic work-up and adapt training and technique correspondingly when indicated.
International Journal of Sports Medicine 01/2014; · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die Skapula hat eine zentrale Funktion beim Bewegungsablauf des Arms. Sie kann nur dann als stabile Basis für eine effiziente Armfunktion dienen, wenn sie eine mit dem Oberarm koordinierte, dreidimensionale Bewegung durchführt.Darstellung der Ursachen, Diagnostik und Therapieempfehlungen der skapulothorakalen Dysbalance bei Überkopfsportlern.Diese Arbeit basiert auf einer Literaturrecherche in der Datenbank PubMed und der Berücksichtigung eigener Erfahrungen.Die Skapulaposition kann durch knöcherne und weichteilige Verletzungen, Muskelinsuffizienzen und -dysbalancen beeinflusst werden. Die veränderte Position bzw. Bewegung wird als Skapuladyskinesie bezeichnet. Sie imponiert klinisch durch ein Abheben des medialen Randes der Skapula und durch eine Fehlrotation (fehlende Außenrotation und posteriore Kippung) beim Bewegen des Arms. Die klinische Untersuchung beinhaltet eine optische Prüfung gefolgt von klinischen Tests der Skapula in Ruhe und bei Bewegung. Durch gezieltes Beüben der Muskulatur, die die Skapula umgibt, sowie durch gezielte Techniken zur Schulung des Positions- und Bewegungssinns kann eine verbesserte Positionierung und Bewegung des Schulterblatts erlernt werden.Skapuläre Muskeldysbalancen können im Rahmen eines konservativen stufenförmigen Trainingsprogramms stadienadaptiert mit gutem Erfolg behandelt werden.
Der Orthopäde 01/2014; 43(3). · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die autologe Chondrozytentransplantation (ACT) hat sich seit ihrer Einführung in den klinischen Alltag zu einem Standardverfahren zur Behandlung von großen umschriebenen Knorpeldefekten im Kniegelenk etabliert. Trotz der zunehmenden Ausweitung des Verfahrens bestehen noch viele Fragen hinsichtlich der optimalen postoperativen Therapie. Ziel unserer Untersuchung war eine Bestandserhebung der Nachbehandlung bei den Mitgliedern der AG Klinische Geweberegeneration und basierend auf den Ergebnissen die Erstellung einer Empfehlung auf der Basis einer Expertenmeinung (Level IVb nach EBM).Alle Mitglieder der AG Klinische Geweberegeneration wurden anhand eines standardisierten Fragebogens zu Nachbehandlungsschemata, Nachsorgeuntersuchungen und Empfehlungen zur Wiederaufnahme der sportlichen Betätigung nach ACT am Kniegelenk befragt.Keiner der Befragten wendete die konventionelle ACT mit der Periostlappenplastik an, alle verwenden zellbesiedelte Matrices (MACT). 94% der Befragten wenden in Abhängigkeit von der Lage des Defekts (femoral vs. patellar) spezifische Belastungs- und Bewegungseinschränkungen an. Die breiteste Übereinstimmung fand sich bei der Entlastung für durchschnittlich 6 Wochen nach femoraler MACT (78%). Hinsichtlich der Behandlung nach patellarer MACT variierten die Angaben zum Belastungsaufbau und der Bewegungslimitierung am stärksten. Regelmäßige postoperative MRT-Kontrollen werden durchgeführt, jedoch waren auch diese in Bezug auf Zeitpunkt und angewendete MRT-Sequenz starken Variationen unterworfen. Routinemäßige Second-look-Arthroskopien werden nicht durchgeführt. Circa 75% der Operateure empfehlen ihren Patienten eine Sportkarenz für 6–12 Monate nach MACT. Am häufigsten werden knieschonende Sportarten wie Radfahren (94%), Schwimmen (83%) oder Nordic Walking (44%) empfohlen.Klare Nachbehandlungsschemata existieren bisher nicht, obgleich eine Übereinstimmung zu elementaren Fragen wie der lokalisationsabhängigen differenzierten Bewegungseinschränkung und Belastung besteht. Die Magnetresonanztomographie (MRT) besitzt eine zentrale Rolle bei der routinemäßigen Nachkontrolle, aber auch hier liegen erheblich Unterschiede bei der Durchführung vor. Es bedarf einer weiteren Verbesserung der Empfehlungen zur Nachbehandlung nach MACT am Kniegelenk, um einen Standard zu entwickeln, der den behandelnden Ärzten Sicherheit gibt und einen besseren Vergleich der Ergebnisse nach MACHT zwischen verschiedenen Patientengruppen ermöglicht.
Der Unfallchirurg 01/2014; 117(3). · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Associated with the trend towards increased health consciousness and fitness, triathlon has established itself as a sport for the masses. The goals of this study were to evaluate injury risk factors of non-professional triathletes and to compare prospective and retrospective evaluation methods. Using an online survey, 212 triathletes retrospectively answered a questionnaire about their training habits and injuries during the past 12 months. Forty-nine of these triathletes participated in a 12-month prospective trial. Injuries were classified with regard to the anatomical location, type of injury, incidence and associated risk factors. Most injuries occurred during running (50%) followed by cycling (43%) and swimming (7%). Fifty-four per cent (retrospective) and 22% (prospective) of the injuries were contusions and abrasions, 38% (retrospective) and 46% (prospective) were ligament and capsular injuries, 7% (retrospective) and 32% (prospective) were muscle and tendon injuries and 1% (retrospective) and 0% (prospective) were fractures. The incidence of an injury per 1000 training hours was 0.69 (retrospective) and 1.39 (prospective) during training and 9.24 (retrospective) and 18.45 (prospective) during competition. The main risk factor for injury in non-professional triathlon is participation in a competitive triathlon event. A retrospective design may underestimate the rate of overuse injuries.
Journal of Sports Sciences 10/2013; · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Associated with the trend towards increased health consciousness and fitness, triathlon has established itself as a sport for the masses. The goals of this study were to evaluate injury risk factors of non-professional triathletes and to compare prospective and retrospective evaluation methods. Using an online survey, 212 triathletes retrospectively answered a questionnaire about their training habits and injuries during the past 12 months. Forty-nine of these triathletes participated in a 12-month prospective trial. Injuries were classified with regard to the anatomical location, type of injury, incidence and associated risk factors. Most injuries occurred during running (50%) followed by cycling (43%) and swimming (7%). Fifty-four per cent (retrospective) and 22% (prospective) of the injuries were contusions and abrasions, 38% (retrospective) and 46% (pro- spective) were ligament and capsular injuries, 7% (retrospective) and 32% (prospective) were muscle and tendon injuries and 1% (retrospective) and 0% (prospective) were fractures. The incidence of an injury per 1000 training hours was 0.69 (retrospective) and 1.39 (prospective) during training and 9.24 (retrospective) and 18.45 (prospective) during competition. The main risk factor for injury in non-professional triathlon is participation in a competitive triathlon event. A retrospective design may underestimate the rate of overuse injuries.
Journal of Sports Sciences 10/2013; · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although shoulder hemiarthroplasty (SHA) can improve function in osteoarthritic shoulders, the ability to perform activities of daily living (ADL) may remain impaired. Shoulder surgeons routinely measure parameters such as range of motion, pain, satisfaction and strength. A common subjective assessment of ADL is part of the Constant Score (CS). However, there is limited objective evidence on whether or not shoulder hemiarthroplasty can restore normal range of motion (ROM) in ADL.
The study included eight consecutive patients (n=8; seven women, one man), who underwent SHA for glenohumeral osteoarthritis. The patients were examined the day before, as well as 6 months and 3 years after shoulder replacement. They were compared with a control group with no shoulder pathology, and shoulder movement was measured with 3D motion analysis using the "Heidelberg Upper Extremity" (HUX) model. Measurements included static maximum values and four ADL.
Comparing the preoperative to the 3-year postoperative static maximum values, there were significant improvements for abduction from 50.5° (SD ±32.4°) to 72.4° (SD ±38.2°; p=0.031), for adduction from 6.2° (SD ±7.7°) to 66.7° (SD ±18.0°; p=0.008), for external rotation from 15.1° (SD ±27.9°) to 50.9° (SD ±27.3°; p=0.031), and for internal rotation from -0.6° (SD ±3.9°) to 35.8° (SD ±28.2°; p=0.031). There was a trend of improvement for flexion from 105.8° (SD ±45.7°) to 161.9° (SD ±78.2°; p=0.094) and for extension from 20.6° (SD ±17.0°) to 28.0° (SD ±12.5°; p=0.313). The comparison of the 3-year postoperative ROM between the SHA group and controls showed significant differences in abduction; 3-year postoperative SHA ROM 72.4° (SD ±38.2°) vs. 113.5° (SD ±29.7°) among controls (p=0.029). There were no significant differences compared to the control group in adduction, flexion/extension and rotation 3 years after SHA surgery. In performing the ADL, the pre- to the 6-month and 3-year postoperative status of the SHA group resulted in a significant increase in ROM in all planes (p<0.05). Comparing the preoperative to the 3-year postoperative ROM used in ADL, there was an improvement in the flexion/extension plane, showing an improvement trend from preoperative 85°-0°-25° to postoperative 127°-0°-38° (p=0.063). In comparison, controls used a significantly greater ROM during ADL with mean flexion/extension of 139°-0°-63° (p=0.028). For the abduction/adduction plane, ROM improved significantly from preoperative 25°-0°-19° to postoperative 78°-0°-60° (p=0.031). In comparison to controls with abduction/adduction of 118°-0°-37° 3 years postoperative, the SHA group also used significantly less ROM in the abduction/adduction plane (p=0.028).
While SHA improves ROM in ADL in patients with degenerative glenohumeral osteoarthritis, it does not restore the full ROM available for performing ADL compared to controls. 3D motion analysis with the HUX model is an appropriate measurement system to detect surgery-related changes in shoulder arthroplasty.
[Show abstract][Hide abstract] ABSTRACT: Autologous chondrocyte transplantation/implantation (ACT/ACI) is an established and recognised procedure for the treatment of localised full-thickness cartilage defects of the knee. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning potential consequences of primary cartilage lesions and the suitable indication for ACI. Based on current evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than 3-4 cm2; in the case of young and active sports patients at 2.5 cm2. Advanced degenerative joint disease is the single most important contraindication. The review gives a concise overview on important scientific background, the results of clinical studies and discusses advantages and disadvantages of ACI.
[Show abstract][Hide abstract] ABSTRACT: A key element for a harmonic movement of the arm is the position and motion of the scapula. A pathologic position and movement of the scapula what is called scapula dyskinesia may irritate the tendons and cause pain in high performing athletes. Scapula dyskinesia, however, may also occur in asymptomatic patients. Harmonizing the sequence of movements and restoration of the dynamic scapular stability are basic steps
to regenerate the irritated tendons (e.g. biceps tendon, rotator cuff). Electrophysiological studies have shown that the scapula bilizing muscles can effectively be exercised.
These exercises are part of a step by step program which is described in this article. In the first place, core stability is essential. Furthermore, proprioception, stability and translational movement exercises are in the focus initially. If these exercises can be performed without pain, complex movements and finally sports specific exercises are added.
[Show abstract][Hide abstract] ABSTRACT: Hintergrund
Die Ellenbogenarthroskopie ermöglicht effektiv die Diagnostik und Therapie von zahlreichen intra- und extraartikulären Pathologien des Ellenbogens. Das Indikationsspektrum der Ellenbogenarthroskopie hat sich in den letzten Jahrzehnten erweitert.
Das kleine Gelenk, die komplexe Anatomie und die Nähe zu den neurovaskulären Strukturen erschweren die arthroskopische Orientierung und machen eine Therapie technisch anspruchsvoll.
Arthroskopische Erfahrung, die genaue Kenntnis der Ellenbogenanatomie (intra- und periartikulär), die Lagerung des Patienten, die Wahl der arthroskopischen Instrumente und das Flüssigkeitsmanagement sowie die Portalwahl und -platzierung sind wichtige Faktoren, um die Ellenbogenarthroskopie erfolgreich durchführen und Komplikationen vermeiden zu können.
[Show abstract][Hide abstract] ABSTRACT: A key element for movement of the arm is the position and motion of the scapula.
Only if the scapula performs a coordinated three dimensional movement with
the upper limp, a stabile basis for the arm movement is created. Soft tissue and
bony injuries, muscle insufficiencies and dysbalancies can alter the position and
function of the scapula.
The pathologic position and motion is called scapula dyskinesis. The clinical examination
presents with a lift of the medial border and malrotation (missing external
rotation and posterior tilt) of the scapula during raising the arm. Scapula
dyskinesis can be found at asymptomatic patients, too. Furthermore, it can be
an unspecific reaction secondary to shoulder pathologies and it is not associated
with a specific glenohumeral pathology. The clinical examination includes the visualization
of the scapula at rest and in motion followed by specific clinical tests.
Specific excercises may harmonize the sequence of movements and restore the
dynamic scapular stability. A stepwise exercise program starts with core stabilization,
followed by stabilization exercises and translational motion exercises of
the scapula without movement in the shoulder. When these exercises can be performed
without pain, dynamic stabilization exercises and finally sports specific
exercises are added.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess the clinical and radiographic long-term outcomes of patients treated with a third-generation cemented total shoulder replacement and followed for at least ten years.
The results of thirty-nine arthroplasties were analyzed clinically with use of the Constant score and on radiographs in two projections, with special regard to glenoid component loosening, at a mean of eleven years (range, ten to fifteen years) postoperatively.
The mean Constant score was 27 points (range, 11 to 54 points) preoperatively and 61 points (range, 21 to 86 points) postoperatively (p < 0.0001). Mean shoulder flexion increased from 84° (range, 40° to 150°) preoperatively to 133° (range, 40° to 180°) postoperatively; mean abduction, from 77° (range, 40° to 110°) to 123° (range, 40° to 180°); and mean external rotation, from 11° (range, -20° to 40°) to 35° (range, 0° to 60°). No humeral components but 36% of the glenoid components were radiographically loose at the time of follow-up. Kaplan-Meier survivorship of the glenoid component was 100% after thirteen years with revision as the end point, whereas survivorship with radiographic loosening as the end point was only 48% after thirteen years. We found no correlation between glenoid loosening on radiographs and clinical findings such as the Constant score. Cranial migration of the humerus was seen in 69% of the cases.
With the implants, cementation, and surgical technique utilized in this group of patients with primary glenohumeral osteoarthritis, radiographic loosening of the glenoid component and rotator cuff deficiency were very common at the ten to fifteen-year review. The follow-up was not long enough to fully identify the clinical sequelae of these findings.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 12/2012; 94(23):e1711-10. · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Over the course of the past two decades autologous chondrocyte implantation (ACI) has become an important surgical technique for treating large cartilage defects. The original method using a periostal flap has been improved by using cell-seeded scaffolds for implantation, the matrix-based autologous chondrocyte implantation (mb-ACI) procedure. MATERIAL AND METHODS: Uniform nationwide guidelines for post-ACI rehabilitation do not exist. A survey was conducted among the members of the clinical tissue regeneration study group concerning the current rehabilitation protocols and the members of the study group published recommendations for postoperative rehabilitation and treatment after ACI based on the results of this survey. RESULTS: There was agreement on fundamentals concerning a location-specific rehabilitation protocol (femoral condyle vs. patellofemoral joint). With regard to weight bearing and range of motion a variety of different protocols exist. Similar to this total agreement on the role of magnetic resonance imaging (MRI) for postsurgical care was found but again a great variety of different protocols exist. CONCLUSIONS: This manuscript summarizes the recommendations of the members of the German clinical tissue regeneration study group on postsurgical rehabilitation and MRI assessment after ACI (level IVb/EBM).
[Show abstract][Hide abstract] ABSTRACT: Both platelet-rich plasma (PRP) and vascular endothelial growth factor (VEGF) can promote regeneration. The aim of this study was to compare the effects of these two elements on bone formation and vascularization in combination with bone marrow stromal cells (BMSC) in a critical-size bone defect in rabbits. The critical-size defects of the radius were filled with: (1) a calcium-deficient hydroxyapatite (CDHA) scaffold + phVEGF(165)-transfected BMSC (VEGF group), (2) CDHA and PRP, or (3) CDHA, autogenous BMSC, and PRP. As controls served: (4) the CDHA scaffold alone and (5) the CDHA scaffold and autogenous BMSC. The volume of new bone was measured by means of micro-CT scans, and vascularization was assessed in histology after 16 weeks. Bone formation was higher in the PRP + CDHA, BMSC + CDHA, and PRP + BMSC + CDHA groups than in the VEGF group (p < 0.05). VEGF transfection significantly promoted vascularization of the scaffolds in contrast to BMSC and PRP (p < 0.05), but was similar to the result of the CDHA + PRP + BMSC group. The results show that VEGF-transfected BMSC as well as the combination of PRP and BMSC improve vascularization, but bone healing was better with the combination of BMSC and PRP than with VEGF-transfected BMSC. Expression of VEGF in BMSC as a single growth factor does not seem to be as effective for bone formation as expanded BMSC alone or PRP which contains a mixture of growth factors.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare a third-generation cementing procedure for glenoid components with a new technique for cement pressurisation. In 20 pairs of scapulae, 20 keeled and 20 pegged glenoid components were implanted using either a third-generation cementing technique (group 1) or a new pressuriser (group 2). Cement penetration was measured by three-dimensional (3D) analysis of micro-CT scans. The mean 3D depth of penetration of the cement was significantly greater in group 2 (p < 0.001). The mean thickness of the cement mantle for keeled glenoids was 2.50 mm (2.0 to 3.3) in group 1 and 5.18 mm (4.4 to 6.1) in group 2, and for pegged glenoids it was 1.72 mm (0.9 to 2.3) in group 1 and 5.63 mm (3.6 to 6.4) in group 2. A cement mantle < 2 mm was detected less frequently in group 2 (p < 0.001). Using the cement pressuriser the proportion of cement mantles < 2 mm was significantly reduced compared with the third-generation cementing technique.
Journal of Bone and Joint Surgery - British Volume 05/2012; 94(5):671-7. · 2.69 Impact Factor