C. J. Wirth’s research while affiliated with Universitätsklinikum Jena and other places

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Publications (47)


Der derzeitige Stand der Transplantation flexibler Bindegewebstexturen
  • Chapter

January 1981

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2 Reads

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1 Citation

C. J. Wirth

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Basierend auf den bedeutenden Arbeiten von Lexer [4], Payr [7] und Rehn [8] zu Beginn des 20. Jahrhunderts gewann die Transplantation flexibler Bindegewebe einen immensen Aufschwung in der Wiederherstellungschirurgie. Unzählige autologe, homologe, heterologe und alloplastische Transplantate kamen zur Anwendung und wurden wieder verworfen.


Biomechanic studies reinserting the medial collateral ligament to correct a chronic anteromedial instability of the knee joint

April 1980

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5 Reads

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9 Citations

Archives of Orthopaedic and Trauma Surgery

One possibility to correct a chronic anteromedial instability of the knee joint is the osseous reinsertion and tightening of the medial collateral ligament. In experiments with a string model and strain gauges attached to the ligaments we investigated the advantages and/or disadvantages of the femoral and tibial reinsertion. Regarding the tension mechanism the medial collateral ligament reacts considerably more sensitively to the femoral reinsertion in proximal-dorsal direction than to the tibial reinsertion in distal-ventral direction. An accurate knee flexion between 40 and 60° has to be provided reinserting the ligament in proximal-dorsal direction to avoid excessive tension and resulting destruction of the ligament. However the reinsertion of the ligament in distal-ventral direction, independently from the flexion of the knee, always approximates the natural tension of the anterior and posterior margin of the untreated ligament. Biomechanically the reinsertion in distal-ventral direction to tighten the loose ligament seems to be preferable to the reinsertion in proximal-dorsal direction.


Experimental investigations of primary healing and remodeling of lyophilized connective tissue dependent on the graft bed

February 1980

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5 Reads

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6 Citations

Archives of Orthopaedic and Traumatic Surgery

In 57 grown up Merino sheep we investigated the influence of the graft bed on ingrowth and remodeling of lyophilized connective tissue. In 27 sheep an artificial defect of the fascia lata (hind leg) was repaired with lyophilized, gamma-irradiated dura mater. In 30 sheep the cruciate ligament of the left knee joint was replaced by lyophilized dura mater anchored into the bone. The graft bed for the fascia lata replacement was complete. However the graft bed for the ligament replacement was only the bone canal as insertion of the transplant, which had not support and tissue connection within the joint space. After implant periods from 2 until 40 weeks the specimen were evaluated histologically and mechanically. We could demonstrate that ingrowth and remodeling as well as strengthening of lyophilized gamma-irradiated dura occurred most rapidly in the case of fascia replacement, and it was already completed after 12 weeks. Ingrowth and remodeling of dura replacing the cruciate ligament lasted about twice as long and was completed after 24 weeks. Within the bone canal the above mentioned tissue reactions continued even until 40 weeks of implantation time. According to these observations the graft bed with its determined functional stimulus seemed to influence the period of ingrowth and remodeling of lyophilized connective tissue significantly.



[Intra-articular or extra-articular substitution of cruciate ligament--a critical study (author's transl)]

May 1979

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8 Reads

Zeitschrift für Orthopädie

Intra- and extra-articular methods of cruciate ligament substitution are available for treating old anteromedial knee-joint instability. Twelve patients with intra-articular cruciate ligament substitution (median third of the patellar ligaments as free transplant) and 24 patients with extra-articular cruicate ligament substitution (operation according to Nciholas) were examined with particular reference to improved stability as follow-up examinations, the results being subjected to comparative evaluation. Intra-artricular cruciate ligament substitution reduces or eliminates the pre-operative instability of the joint which is due to insufficiency of the cruciate liagment, whereas the extra-articular cruciate ligament substitution produces a significantly more frequent reduction of elimination of the instability of the valgus position and of the anteromedial instability. The combination of both methods to remove anteromedial instability of the knee joint may seem a very useful solution of the problem, but it should be limited to a restricted group of patients because it involves also contain disadvantages which make it unsuitable for indiscriminate application.



[Isolated rupture of the anterior cruciate ligament. Clinical and experimental study (author's transl)]

June 1978

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4 Reads

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5 Citations

Archives of Orthopaedic and Traumatic Surgery

The isolated rupture of the anterior cruciate ligament is possible. 5 own cases are described and compared with those of other authors. The mechanism of the injury is a forced inward rotation- and varus-stress of the knee joint under full pressure as a deceleration-twisting motion. Our own experimental measuremens on the ligaments of hte knee joint with strain gauges are proving this fact. The suspeced diagnosis of an isolated rupture of the anterior cruciate ligament is strengthened by a painful snapping or popping within the knee joint in the moment of the injury, a fast increasing swelling of the joint and a feeling of instability. Normaly an anterior dawer sign is not found. The treatment of choice is the suture of the ligament because unrepaired isolated anterior cruciate ligaments can lead to an increasing instability of the knee joint with time.




[The effectiveness of pes anserinus transfer for old anteromedial knee instability (author's transl)]

February 1978

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6 Reads

Zeitschrift für Orthopädie

Old anteromedial instability of the knee joint causes an increased external rotation of the tibia against the femur. To actively control this tendenoy to increased external rotation, Slocum and Larson advocated the pes anserinus transfer (1968). An increase of rotatory muscle function of 39% after this transfer could be demonstrated experimentally (Noyes and Sonstegard 1973). Contrary to these reports, an increase of rotatory muscle power was rather the exception than the rule in our dynamometric examinations of 49 patients after transfer of the pes anserinus for old anteromedial instability. The reasons for the lack of clinically effective increase in muscle power are discussed. The advancement of the tendon of the semimenbranaceus muscle seems more advantageous as an alternative measure.


Citations (10)


... From that moment, different autologous grafts have been used for transplantation. Brückner used a free patellar tendon graft for an arthroscopically assisted transplantation in 1966 [63] . Because of the high harvesting morbidity of the graft, the primary suture regained favor in the 1970s [64,65] . ...

Reference:

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques
Plastic reconstruction of old anterior cruciate ligament ruptures by the Br�ckner procedure
  • Citing Article
  • January 1974

... The determination of the system parameters for a linear model representing the skin-accelerometerattachment complex is similar to that described by Artmann et al. (1976). The cut-off frequencies reported by Artmann et al. (1976) are nearly identical with our results, in spite of the considerably higher weight of the accelerometer and its attachment used by Artmann et al. (1976). ...

Das Verhalten der Beschleunigungsübertragung vom Beckenkamm auf einen äußeren Beschleunigungsaufnehmer beim Menschen - Transmissionfunction of the acceleration from the os ilium to an outside used acceleration sensor
  • Citing Article
  • January 1976

... Despite its very high specificity, the pivot shift test and modifications of it that are described in the literature [18][19][20] have shown lower sensitivity levels, probably due to the difficulty involved in performing them [4-8, 13-17, 21, 22]. Since then, to our knowledge, there has only been one new original test leading to a clinical diagnosis of ACL tear-the ''fibular head sign'' of Zaid Al-duri [23]although there have been several suggestions for modified Lachman tests that have certainly proven useful in some cases, with demonstrated sensitivity and specificity [12,[24][25][26][27][28][29]. ...

Diagnostische Probleme bei frischen und veralteten Kreuzbandverletzungen des Kniegelenkes
  • Citing Article
  • December 1975

Archives of Orthopaedic and Trauma Surgery

... Cutting of the ATaFL + CFL entails a marked increase in adduction (Carothers 1942, Pennal 1943, Leonard 1949, Makhani 1962, an increase which has been quantitated at between 13.5" (Pascoet et al. 1972) and 30" (Anderson et al. 1952). When the ankle joint is in the neutral position the adduction is increased too (Cosentino 1956), allegedly to between 20" and 30" (Duquennoy et al. 1975, Wirth andArtmann 1977). ...

Chronische fibulare Sprunggelenksinstabilit�t ? Untersuchungen zur R�ntgendiagnostik und Bandplastik
  • Citing Article
  • September 1977

Archives of Orthopaedic and Trauma Surgery

... and over-constraint of the knee, or an insufficient and loose reconstruction, across the arc of knee motion [3,35]. There are significant differences of isometry, or length-change behaviour, across the widths of each of the medial ligaments [34], so it is apparent that accurate positioning is important if the normal patterns of restraint are to be reproduced. ...

Biomechanic studies reinserting the medial collateral ligament to correct a chronic anteromedial instability of the knee joint
  • Citing Article
  • April 1980

Archives of Orthopaedic and Trauma Surgery

... Еще в 1978 г. C.J. Wirth с соавторами с помощью лигатурного шва на трупах показали, что только непосредственное анатомическое восстановление наружных боковых связок голеностопного сустава гарантирует свободную подвижность в подтаранном и голеностопном суставах [47]. Отклонение от естественных точек прикрепления приводило либо к ограничению подвижности, либо к ослаблению связок. ...

Biomechanics and pathomechanics of the ankle joint
  • Citing Article
  • February 1978

Hefte zur Unfallheilkunde

... Johnson et al (6,7) used the medial third of the patellar tendon ; with 7 to 9 years follow-up, they noted residual primary laxity of the ACL graft, arthrosis, subpatellar crepitus, decreased mobility of the patella, patellar tenderness, thigh atrophy and parapatellar pain, but made no mention of maltracking. On the other hand, in another study, where the medial onethird of the patellar tendon was employed, the lateral mobility of the patella was actually found to be increased (16), and this is perhaps the basis of the disrepute of this procedure. ...

[The plastic replacement of old ruptured cruciate ligaments. II. Late results (author's transl)]
  • Citing Article
  • January 1977

Zeitschrift für Orthopädie

... From the biomechanical point of view, placing the graft in this location can also serve a more convenient time-zero stability and a lower tension-flexion pattern when compared with a central tunnel position. 17,23,24 However, women have more ligamentous laxity and are more prone to sustain ACL rupture; our study showed that 95.83% of the patients were males, this male predominance also demonstrated by other studies such as Razi et al. 25 (91.6% male), Sajjadi et al. 26 (86.6% male), and Cury et al. 27 (96.7% male), which may be related to a higher rate of male participation in sports activities. ...

[Investigation of the appropriate functional replacement of the anterior cruciate ligament (author's transl)]
  • Citing Article
  • March 1974

Zeitschrift für Orthopädie

... This retrospective study obtained the local ethical review committee approval and included 58 consecutive patients with clavicle non-unions (>6 months after injury) or delayed fracture healing (<6 months after injury) [20]. The distribution of hypertrophic and atrophic types of non-unions [21] is illustrated in Figure 1. ...

[Treatment of delayed union and nonunion of long bone fractures by internal plate fixation with or without autologeous bone graft (author's transl)]
  • Citing Article
  • January 1974

Archiv für Orthopädische und Unfall-Chirurgie