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ABSTRACT: Surgical treatment of proximal humeral fractures still remains a challenge. This is primarily due to the fact that sufficient
implant fixation in humeral head fractures is often not achieved due to substantial bone tissue loss with increasing age.
In the last few years the locking plates and locking nails have been introduced into clinical practice with varying results.
The biomechanical studies have focused on locking plate osteosynthesis as well. The following paper focuses on bone quality,
biomechanical studies and biology of proper osteosynthesis and reviews the most recent literature.
European Journal of Trauma and Emergency Surgery 04/2012; 33(4):337-344. · 0.33 Impact Factor
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ABSTRACT: Poor bone quality increases the susceptibility to fractures of the proximal humerus. It is unclear whether local trabecular and cortical measures influence the severity of fracture patterns. The goal of this study was to assess parameters of trabecular and cortical bone properties and to compare these parameters with the severity of fractures and biomechanical testing.
Twenty patients with displaced proximal humeral fractures planned for osteosynthesis were included. Fractures were classified as either 2-part fractures or complex fractures. Bone after core drilling was harvested during surgery from the humeral head in each patient. Twenty bone cores obtained from nonpaired cadaver humeral heads served as nonfractured controls. Micro-CT (μCT) was performed and bone volume/total volume (BV/TV), connectivity density (CD), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were assessed. The cortical index (CI) was determined from AP plain films. Biomechanical testing was done after μCT scanning by axially loading until failure, and ultimate strength and E modulus were recorded.
BV/TV, BMD and CD showed moderate to strong correlations with biomechanical testing (r = 0.45-0.76, all p < 0.05). No significant differences were detected between the 2-part and complex fracture groups and controls regarding μCT and biomechanical parameters. CI was not significantly different between the 2-part and complex fracture groups.
In our study population local trabecular bone structure and cortical index could not predict the severity of proximal humeral fractures in the elderly. Complex fractures do not necessarily imply lower bone quality compared to simple fractures.
Archives of Orthopaedic and Trauma Surgery 12/2011; 132(4):509-15. · 1.37 Impact Factor
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ABSTRACT: To evaluate the results of plate osteosynthesis using either polyaxial or nonpolyaxially locked screw-plate systems in proximal humeral fractures in the elderly.
Prospective, randomized.
Level I trauma center.
Fifty-six patients (older than 60 years) with isolated, displaced three- and four-part fractures were included. Twenty-five patients (median age, 75.5 years) were randomized to a polyaxial locking screw plate (Group 1), whereas 31 patients (median age, 72 years) were treated with a locking screw plate (Group 2). Follow-up evaluations were performed 3, 6, and 12 months postoperatively using the Simple Shoulder Test, Disabilities of the Arm, Shoulder and Hand score, and Constant score as well as radiographs. The results and the complications were compared between both groups.
Forty-eight patients were available for follow-up (Group 1, 20 of 25; Group 2, 28 of 31). The Simple Shoulder Test, Disabilities of the Arm, Shoulder and Hand, and Constant score improved significantly from 3 to 12 months and did not differ between groups. Twelve months after the index procedure, the Simple Shoulder Test score was 8.6 ± 3.2 points in Group 1 and 9.7 ± 1.8 points in Group 2. The Disabilities of the Arm, Shoulder and Hand score was 17.8 ± 16.2 in Group 1 and 15.7 ± 11.8 in Group 2. The mean Constant score amounted to 73% ± 17% in Group 1 and 81% ± 13% in Group 2. There were six complications in Group 1 and eight in Group 2.
Both the functional outcomes and the rate of complications after polyaxial locked plate osteosynthesis of proximal humeral fractures in elderly patients were comparable to those treated with nonpolyaxial implants. Despite the theoretical advantages of polyaxial locked plating in proximal humerus fractures, this study could not show a verifiable clinical advantage of these plates.
Journal of orthopaedic trauma 06/2011; 25(10):596-602. · 1.78 Impact Factor
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Bastian Marquass,
Ronny Schulz, Pierre Hepp,
Matthias Zscharnack,
Thomas Aigner,
Stefanie Schmidt,
Frank Stein,
Robert Richter,
Georg Osterhoff,
Gabriele Aust,
Christoph Josten,
Augustinus Bader
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ABSTRACT: The use of predifferentiated mesenchymal stem cells (MSC) leads to better histological results compared with undifferentiated MSC in sheep. This raises the need for a longer term follow-up study and comparison with a clinically established method.
We hypothesized that chondrogenic in vitro predifferentiation of autologous MSC embedded in a collagen I hydrogel leads to better structural repair of a chronic osteochondral defect in an ovine stifle joint after 1 year. We further hypothesized that resulting histological results would be comparable with those of chondrocyte-seeded matrix-associated autologous chondrocyte transplantation (MACT).
Controlled laboratory study.
Predifferentiation period of ovine MSC within collagen gel in vitro was defined by assessment of several cellular and molecular biological parameters. For the animal study, 2 osteochondral lesions (7-mm diameter) were created at the medial femoral condyles of the hind legs in 9 sheep. Implantation of MSC gels was performed 6 weeks after defect creation. Thirty-six defects were divided into 4 treatment groups: (1) chondrogenically predifferentiated MSC gels (pre-MSC gels), (2) undifferentiated MSC gels (un-MSC gels), (3) MACT gels, and (4) untreated controls (UC). Histological, immunohistochemical, and radiological evaluations followed after 12 months.
After 12 months in vivo, pre-MSC gels showed significantly better histological outcome compared with un-MSC gels and UC. Compared with MACT gels, the overall scores were higher for O'Driscoll and International Cartilage Repair Society (ICRS). The repair tissue of the pre-MSC group showed immunohistochemical detection of interzonal collagen type II staining. Radiological evaluation supported superior bonding of pre-MSC gels to perilesional native cartilage. Compared with previous work by our group, no degradation of the repair tissue between 6 and 12 months in vivo, particularly in pre-MSC gels, was observed.
Repair of chronic osteochondral defects with collagen hydrogels composed of chondrogenically predifferentiated MSC shows no signs of degradation after 1 year in vivo. In addition, pre-MSC gels lead to partially superior histological results compared with articular chondrocytes.
The results suggest an encouraging method for future treatment of focal osteochondral defects without donor site morbidity by harvesting articular chondrocytes.
The American journal of sports medicine 04/2011; 39(7):1401-12. · 3.61 Impact Factor
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ABSTRACT: Purpose. This is a case report of a patient with an osteoid osteoma of the proximal fibula. The objective is to illustrate a rare tumor location that requires open surgery due to closeness of neurological structures. Methods. Clinical and roentgenographic findings, treatment, and histological appearance are presented. Results. Local pain and swelling of the proximal fibula with improvement under salicylates led to the diagnosis of an osteoid osteoma, what was confirmed with an MRI scan. Due to proximity to the common peroneal nerve, we decided for open surgery. During the operation, the nerve was seen to cross the tumor site making it necessary to retract it to expose the entire tumor. Histologically, typical features of osteoid osteoma with a rather well-defined nidus surrounded by sclerotic bone were seen. A complete removal was performed. Conclusion. Osteoid osteomas of the proximal fibula are rare. When planning surgery, the common peroneal nerve must be identified, and its further distal course should be taken into account to avoid iatrogenic damage to the nerve.
Case reports in orthopedics. 01/2011; 2011:324650.
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ABSTRACT: The use of mesenchymal stem cells (MSCs) to treat osteochondral defects caused by sports injuries or disease is of particular interest. However, there is a lack of studies in large-animal models examining the benefits of chondrogenic predifferentiation in vitro for repair of chronic osteochondral defects.
Chondrogenic in vitro predifferentiation of autologous MSCs embedded in a collagen I hydrogel currently in clinical trial use for matrix-associated autologous chondrocyte transplantation facilitates the regeneration of a chronic osteochondral defect in an ovine stifle joint.
Controlled laboratory study.
The optimal predifferentiation period of ovine MSCs within the type I collagen hydrogel in vitro was defined by assessment of several cellular and molecular biological parameters. For the animal study, osteochondral lesions (diameter 7 mm) were created at the medial femoral condyles of the hind legs in 10 merino sheep. To achieve a chronic defect model, implantation of the ovine MSCs/hydrogel constructs was not performed until 6 weeks after defect creation. The 40 defects were divided into 4 treatment groups: (1) chondrogenically predifferentiated ovine MSC/hydrogel constructs (preMSC-gels), (2) undifferentiated ovine MSC/hydrogel constructs (unMSC-gels), (3) cell-free collagen hydrogels (CF-gels), and (4) untreated controls (UCs). Evaluation followed after 6 months.
With regard to proteoglycan content, cell count, gel contraction, apoptosis, compressive properties, and progress of chondrogenic differentiation, a differentiation period of 14 days in vitro was considered optimal. After 6 months in vivo, the defects treated with preMSC-gels showed significantly better histologic scores with morphologic characteristics of hyaline cartilage such as columnarization and presence of collagen type II.
Matrix-associated autologous chondrocyte transplantation with predifferentiated MSCs may be a promising approach for repair of focal, chronic osteochondral defects.
The results suggest an encouraging method for future treatment of focal osteochondral defects to prevent progression to osteoarthritis.
The American journal of sports medicine 09/2010; 38(9):1857-69. · 3.61 Impact Factor
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ABSTRACT: The ovine stifle has been increasingly used as a large animal model for the human knee. Still, comparative anatomical measurements of the knee in sheep and humans are missing. Thus, the purpose of this study was to describe and measure the osseous anatomy of the ovine stifle in comparison to the human knee. Twenty-four stifles of skeletal-mature merino-sheep and 24 human cadaver knees were obtained and distances between selected anatomical structures of the distal femur, the proximal tibia, and the patella were measured digitally and documented. Based on these, intercondylar ratio, tibial aspect ratio, patella aspect ratio and the cortical index were calculated. Regarding epicondylar width, lateral condylar width, medial condylar width and the tibial dimensions, the ovine stifle can be considered as a human knee scaled down by one third. However, sheep have a smaller trochlear width and a narrower femoral intercondylar notch than humans resulting in lower relative values for intercondylar width and intercondylar height. The distal femur's cortical index is the same in both species. In contrast, sheep have a massive bone stock below their tibial plateau and a proximal tibial shaft with remarkably thick cortical bone. The ovine stifle can be regarded as a useful model for the human knee. However, future studies should consider the differences in the femoral intercondylar notch width, the patellofemoral joint's biomechanics and the proximal tibia's cortical bone stock.
The Knee 02/2010; 18(2):98-103. · 1.74 Impact Factor
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ABSTRACT: Hepatic trauma is a rare surgical emergency with significant morbidity and mortality. Therapeutic strategies have been controversially discussed during the last decades.
The medical records of 47 consecutive patients with hepatic trauma treated at the University Hospital of Leipzig between 2004 and 2008 were retrospectively reviewed for the severity of liver injury, management, morbidity, and mortality and compared to a preceding cohort. Logistic regression analysis was performed to identify risk factors influencing mortality.
Compared to 63 patients treated between 1993 and 2003, moderate liver injuries (grades I-III) occurred more frequently (p = 0.0006), and the proportion of patients that were managed operatively decreased from 68.9% to 37.5%. Twenty patients (42.6%) were treated conservatively (all grades I to III) and 27 surgically (47.4%). In detail, five patients were treated by hepatic packing alone, 13 by suture or coagulation, five by atypical resection, and four by hemihepatectomy. The overall mortality was 8.5% with a liver-related mortality rate of 2.1%. According to severity grades I-III, IV, and V, mortality rates were 0%, 18.2%, and 50.0%, respectively. Univariate analysis identified Injury Severity Score (ISS) >30, Moore grades IV and V, hemoglobin at admission <6.0 mmol/L, and need for transfusion of >12 erythrocyte concentrates to be significant risk factors for early posttraumatic death, while multivariate analysis only ISS >30 revealed to be of prognostic significance for early postoperative survival.
Compared to a previous cohort in the same hospital, more patients were treated conservatively. Management of liver injuries presented with a low liver-related mortality rate. Grades I-III injuries can safely be treated by conservative means with excellent results. However, complex hepatic injuries may often require surgical treatment ranging from packing to complex hemihepatectomy. Hence, for selection of appropriate therapeutic options, patients with hepatic injuries should be treated in a specialized institution.
Langenbeck s Archives of Surgery 11/2009; 395(4):381-6. · 1.81 Impact Factor
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ABSTRACT: To analyse the radiogrammetric parameter "cortical index" (CI) and its predictive value for proximal humerus fractures. Furthermore, to investigate the reoperations and the cause of reoperations after locking plate osteosynthesis of displaced proximal humerus fractures.
113 consecutive patients (73 women and 40 men) with a median age of 66 years (range 18-100 years) were included in this study. The median follow-up time in our database was 4.7 years (range 45-72 months). For a comparative matched-group analysis of the CI, patients with a fall on the shoulder without fracture were selected. Demographic data and all reoperations were recorded after median 58 months postoperatively. The CI was measured at the proximal humeral diaphysis.
The CI showed to be significant lower in the fracture group (mean 0.28) when compared to the matched group (mean 0.47, p < 0.01). 39% patients underwent a reoperation within 40 months postoperatively. 24% were reoperated within the first 12 months postoperatively, and 15% were reoperated after 12 months or later. The reoperation was independent of bone quality (p = 0.85).
The risk for reoperation is independent of the CI even though the CI may be a predictor for proximal humerus fracture. Younger patients should be aware that surgical treatment of proximal humerus fractures might be a two-stage surgery. Regular follow-up visits for older patients during the first postoperative year must be assured.
Archives of Orthopaedic and Trauma Surgery 06/2009; 129(9):1251-9. · 1.37 Impact Factor
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ABSTRACT: The layered configuration of the rotator cuff tendon is not taken into account in classic rotator cuff tendon repair techniques.
The mechanical properties of (1) the classic double-row technique, (2) a double-layer double-row (DLDR) technique in simple suture configuration, and (3) a DLDR technique in mattress suture configuration are significantly different.
Controlled laboratory study.
Twenty-four sheep shoulders were assigned to 3 repair groups of full-thickness infraspinatus tears: group 1, traditional double-row repair; group 2, DLDR anchor repair with simple suture configuration; and group 3, DLDR knotless repair with mattress suture configuration. After ultrasound evaluation of the repair, each specimen was cyclically loaded with 10 to 100 N for 50 cycles. Each specimen was then loaded to failure at a rate of 1 mm/s.
There were no statistically significant differences among the 3 testing groups for the mean footprint area. The cyclic loading test revealed no significant difference among the 3 groups with regard to elongation. For the load-to-failure test, groups 2 and 3 showed no differences in ultimate tensile load when compared with group 1. However, when compared to group 2, group 3 was found to have significantly higher values regarding ultimate load, ultimate elongation, and energy absorbed.
The DLDR fixation techniques may provide strength of initial repair comparable with that of commonly used double-row techniques. When compared with the knotless technique with mattress sutures, simple suture configuration of DLDR repair may be too weak. Knotless DLDR rotator cuff repair may (1) restore the footprint by the use of double-row principles and (2) enable restoration of the shape and profile.
Double-layer double-row fixation in mattress suture configuration has initial fixation strength comparable with that of the classic double-row fixation and so may potentially improve functional results of rotator cuff repair.
The American journal of sports medicine 04/2009; 37(7):1363-9. · 3.61 Impact Factor
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ABSTRACT: Traumatic posterior dislocation of the shoulder is frequently associated with an osteochondral defect on the anterior articular surface of the humeral head (so-called reverse Hill-Sachs lesion). Possible treatment options are either filling or elevation of the osseous defect. Previously, an open technique has been described using a bioabsorbable interference screw. On the basis of a 64-year-old patient presenting with a reverse Hill-Sachs lesion after epileptic seizure, we describe an arthroscopic technique in which the defect is reconstructed under arthroscopic and fluoroscopic control and supported by a bioabsorbable interference screw.
Archives of Orthopaedic and Trauma Surgery 03/2009; 129(8):1103-7. · 1.37 Impact Factor
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ABSTRACT: The standard technique for restoring footprint after full-thickness tears of the rotator cuff includes double-row or transosseous-equivalent techniques. However, the anatomically typical bird's beak shape and profile of tendon insertion may not be originally restored and biomechanics may be altered. In this report, the authors describe a technique that involves creating two intratendinous stitches at different levels of the torn tendon. The first passes through the bursal-side layer, the second stitch through the joint-side layer. Both stitches may be performed in mattress suture configuration. The anchorage is performed by knotless anchors in order to avoid knots lying within the insertion area. The footprint is restored first medially then laterally by the use of double-row principles. The joint-side suture is anchored within the medially placed anchor. The bursal-side suture is anchored by a laterally placed anchor. The anatomic insertion and restoration of the shape and profile may be enabled by the described double-layer suture technique. Using a double-layer double-row repair may potentially improve functional results of rotator cuff repair constructs.
Archives of Orthopaedic and Trauma Surgery 05/2008; 129(8):1031-6. · 1.37 Impact Factor
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ABSTRACT: This report describes the case of a 26-year-old woman with a recurrent extraarticular diffuse-type tenosynovial giant cell tumor (D-TGCT) of the medial region of the knee affecting the pes anserinus and hamstring tendons. Presurgical MRI did not exclude infiltrative properties of the tumor. In the histological evaluation, the tumor showed an aggressive dispersion by infiltrating the collagenous tissue of the hamstring tendons. The treatment included a resection of the pes anserinus complex with distal semitendinosus and gracilis tendons. Regarding extraarticular D-TGCT a review of the literature showed a predominant affection of the medial region of the knee and thigh.
Archives of Orthopaedic and Trauma Surgery 03/2008; 128(2):155-8. · 1.37 Impact Factor
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ABSTRACT: Anterior cruciate ligament reconstruction is an increasingly established method even in patients over 40 years old. Recent studies with regard to this procedure used BTB transplants. We did a retrospective follow-up examination on over-40-year-old patients with anterior cruciate ligament reconstruction using hamstring transplants and compared them to a younger control group. Our hypothesis is that functional outcome after ACL-reconstruction is comparable in patients under and over 40 years of age.
Retrospective follow-up examinations in 28 patients, 11 women and 17 men. The average age at the time of operation was 43.5 years (range 40-61). The average follow-up period was 30.4 months. Half of the patients had a femoral fixation in TransFix technique (Arthrex, Naples, USA), while the other 14 patients had a femoral bioscrew fixation (Arthrex, Naples, USA). Objectivity was ensured by measurements of anterior tibial translation with the rolimeter (Aircast). The functional outcome was determined by clinical scores (Tegner activity scale, Lysholm knee score, OAK score and IKDC score). The degree of arthrosis was defined on the basis of tunnelview radiographs and compared to the non-operated site. Functional results and degree of laxity was compared to a sex matched control group (mean age 28.0).
The median values for the Lysholm knee score were 91.5 points (range 69-100), for the OAK score 93.5 points (range 67-100) and for the IKDC score 83.35 points (range 62.1-100). For the Tegner activity scale values of 4.5 points (range 3-8) were obtained. In the IKDC knee examination form we found normal and nearly normal values in 86% and in the OAK examination score good and very good results in 82%. Ninety-three percent had an AP side-to-side difference of <5 mm in the operated knee. Subjectively, 75% reported that they had no feeling of instability, even when practising sport. No significant correlation between functional outcome and patients' age was present. Furthermore there were no significant differences between the investigated and the younger control group. The most advanced signs of arthrosis were found in the medial compartment of the operated side (degree A: 36%; degree B: 46%; degree C: 14%; degree D: 4%).
The predominantly good results and a high level of patient satisfaction show that anterior cruciate ligament reconstruction is justified even in over-40-year-old patients with persistend subjective symptomatic anterior knee instability. The indication for reconstruction should be based on individual factors such as level of activity or subjective feeling of instability rather than on a dogmatic age limit. Advanced arthrotic changes compared to the healthy side, might be due to a too long period of preoperative decision making.
Archives of Orthopaedic and Trauma Surgery 12/2007; 127(9):835-43. · 1.37 Impact Factor
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ABSTRACT: The purpose of this study is to clinically evaluate hamstring tendon anterior cruciate ligament (ACL)-reconstruction using femoral fixation with bioresorbable interference screws and with a bioresorbable transfixation device.
The ACL-reconstruction using the transfixation device at the femoral side leads to less knee laxity and therefore to a better clinical outcome for the patient.
Prospective randomized clinical outcome study.
From February 2002 to December 2002, a total of 68 patients with hamstring ACL reconstruction using a femoral fixation once with TransFix (n=38; m:22 and f:16; median age=28.5 range 15-47) and the second with bioscrew (BS) (n=30; m:20, f:10; median age=25.5 range 13-61) completed the follow-up period. Patients in each group got a clinical assessment at 3, 6, and 12 months after surgery. The measurement of anterior translation of the tibia has been performed using the Rolimeter device.
No significant differences in the knee laxity testing using the Rolimeter device were seen between both groups and over time within these groups. Ninety percent of all patients had functionally normal or near normal International Knee Documentation Committee (IKDC) knee ligament ratings. The TF-group included 17 grade A, 19 grade B, and 2 grade C knees, and the BS-group had 12 grade A, 13 grade B, and 5 grade C knees. The IKDC rating, the OAK-score, the Tegner-activity-score, and the Lysholm-score did not show significant differences between the TF-group and the BS-group.
We disproved our hypothesis that the transfixation technique leads to less laxity and therefore to a better clinical outcome when compared to the use of BS. The clinical results in this study clarified that this technique is an effective and safe method for femoral hamstring fixation in ACL-reconstruction. However, this technique revealed no advantage compared to the bioscrew fixation technique within the short-term follow-up.
Knee Surgery Sports Traumatology Arthroscopy 09/2006; 14(8):730-8. · 2.21 Impact Factor
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ABSTRACT: Skeletal muscle functions regulated by NO are now firmly established. However, the knowledge about the NO synthase (NOS) expression related to a defined fibre type in human skeletal muscles necessitates further clarification. To address this issue, we examined localization of NOS isoforms I, II and III, in human skeletal muscles employing immunocytochemical labeling with tyramide signal amplification complemented with enzyme histochemistry and Western blotting. The NOS immunoreactivity was related to fibre types of different classification systems: physiological classification into slow and fast, ATPase classification into I, IIA, IIAX, IIX, and physiological-metabolic classification into slow-oxidative (SO), fast-oxidative glycolytic (FOG) and fast-glycolytic (FG). We found a correlation of NOS I-III immunoreactivity to metabolic defined fibre types with strong expression in FOG fibres. This implies that NO as modulator of muscle function is involved in oxidative metabolism in connection with fast force development, which only occurs in FOG fibres. The NOS expression showed no correlation to ATPase fibre subtypes due to the metabolic heterogeneity of ATPase fibre types. Healthy and affected vastus medialis muscles after anterior cruciate ligament rupture revealed similar NOS expression level as shown by Western blotting with, however, different expression patterns related to the fibre types in affected muscles. This suggests an altered modulation of force development in the fibres of diseased muscles.
Histochemie 06/2006; 125(5):567-73. · 2.59 Impact Factor
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ABSTRACT: The osteochondral transplantation (OCT) is a well accepted treatment option for focal cartilage lesions in the knee joint, whereas the fate of the transplanted cartilage is still unclear and the clinical outcome is variable. The purpose of this study was to evaluate the histological character of autologous transplanted cartilage and to correlate technical aspects and the patients' history with the clinical outcome.
The OCT was performed in 27 patients (median age of 32 (22-43) years) with a focal chondral lesion at the medial femoral condyle. We investigated the clinical outcome after a median follow-up of 13.5 (5-28) months using the Lysholm-score and the integration of the transplanted plugs using an MRI-scoring system. Biopsy specimens from representative patients (n = 8) were evaluated with histological staining and immunohistochemistry.
The median Lysholm-score was 80 (range 45-98). The wide range of the Lysholm-score in clinical outcome did not show significant differences in: follow-up, concomitant injuries, defect size or genesis. The MRI analysis revealed in all cases a regular osseous integration of the subchondral bone, but a failed chondral integration. The congruency of the plugs to the joint surface was often incorrect, however a correlation between the MRI-score and the clinical outcome could not be shown. Histology of the transplanted cartilage revealed small changes in immunohistochemistry after a relatively short-term follow-up, whereas the cartilage has still the typical hyaline character. Often, the surrounding cartilage consists of fibrous and granulation tissue.
The congruency of the joint surface can not be restored to the original status, particularly in larger defects with irregular shapes. However, we did not find any aspects which affected the function of the knee joint following OCT. It can be assumed that remaining lesions at the surrounding cartilage could maintain the inflammatory process and therefore maintain the pain and a low knee function. Further investigations are needed to specify the effects of the OCT on the transplanted cartilage and its influence on the later clinical outcome.
Archives of Orthopaedic and Trauma Surgery 12/2005; 125(9):628-37. · 1.37 Impact Factor
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ABSTRACT: We describe the case of a 14-year-old boy with patellar instability on both sides resulting from ligamentous hyperlaxity and dysplasia of the lateral femoral condyle who had previously undergone an arthroscopic lateral release as well as plication of the medial capsule. The patient presented to our clinic 2 years after surgery with a locked lateral patella dislocation on the left side. The surgical correction involved a substantial open lateral release including an excision of the scar tissue and stabilization of the patella in the patellofemoral groove by tibial tubercle medialization and plication of the medial capsule. Six months after surgery, the patient achieved a Lysholm score of 90 points and clinical examination indicated a stable knee with a centralized patella without any evidence of subluxation or dislocation. Open lateral release with partial resection of the lateral retinaculum, medial reconstruction, and tibial tubercle osteotomy was the procedure of choice in this patient with habitual patella dislocation caused by generalized ligamentous laxity.
Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2005; 21(5):628. · 3.02 Impact Factor
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ABSTRACT: Posttraumatic osteochondral defects following a tibial plateau fracture are common and a serious complication that may lead to the development of posttraumatic arthrosis. Successful reconstruction of the tibial plateau must include restoration of limb alignment, repair of bone defects, restoration of the articular cartilage, and preservation of the menisci. When osteochondral defects are present, the use of bulk bone grafts to restore the original articular surface anatomy of the tibial plateau is difficult due to incongruity between the graft and the original joint surface. Recognizing this, an autologous osteochondral transplantation utilizing the mosaic technique was performed successfully on a 32-year-old male alpine skier with a posttraumatic osteochondral defect following a tibial plateau fracture. At 2 years postsurgery, the patient had regained the capacity to perform most activities of daily living and to participate in sports. Clinical examination revealed an improvement of the Lysholm score from 48 points to 72 points.
Journal of Orthopaedic Trauma 04/2005; 19(3):217-22. · 2.13 Impact Factor
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Acta Orthopaedica Scandinavica 01/2005; 75(6):772-4.
