Arne Driessen

Microfracture technique for the treatment of articular cartilage lesions of the talus

The microfracture technique is an established method for treating articular cartilage lesions of the talus. Symptomatic chondral or osteochondral lesions of grade II or higher with softening or fraying of the chondral surface or an unstable rim are indications for débridement of the lesion and use of the microfracture technique. In advanced degenerative lesions, the indication must be determined critically. In a prospective study, significant (p<0.001) improvement was observed at a mean follow-up of 5.2 years (range 3.8-6.6 years) in 23 ankles. According to the Hannover scoring system, 87% of the patients were rated as excellent or good. Results for patients older than 50 years were not inferior to those for younger patients. Results for overweight patients were significantly (p=0.03) worse compared with patients of normal weight. Magnetic resonance imaging findings revealed that filling of the defect is accomplished in the majority of cases with an inhomogeneous structure of the cartilage repair tissue and a high incidence of subchondral alterations. The microfracture technique appears to be a reliable method for treating chondral and osteochondral lesions of the talus, with good outcomes in a mid-term follow-up.

Die Technik der Mikrofrakturierung zur operativen Therapie von Knorpelläsionen am Talus

The microfracture technique is an established method for treating articular cartilage lesions of the talus. Symptomatic chondral or osteochondral lesions of grade II or higher with softening or fraying of the chondral surface or an unstable rim are indications for débridement of the lesion and use of the microfracture technique. In advanced degenerative lesions, the indication must be determined critically. In a prospective study, significant (p<0.001) improvement was observed at a mean follow-up of 5.2 years (range 3.8-6.6 years) in 23 ankles. According to the Hannover scoring system, 87% of the patients were rated as excellent or good. Results for patients older than 50 years were not inferior to those for younger patients. Results for overweight patients were significantly (p=0.03) worse compared with patients of normal weight. Magnetic resonance imaging findings revealed that filling of the defect is accomplished in the majority of cases with an inhomogeneous structure of the cartilage repair tissue and a high incidence of subchondral alterations. The microfracture technique appears to be a reliable method for treating chondral and osteochondral lesions of the talus, with good outcomes in a mid-term follow-up.

Die autologe Knorpelzelltransplantation zur Behandlung von Knorpelläsionen am Talus

In contrast to the knee joint, autologous chondrocyte transplantation (ACT) is rarely used for treating articular cartilage lesions in the ankle joint. Matrix-associated autologous chondrocyte transplantation (MACT) with the use of biomaterials as cell carriers has facilitated operative application and fixation within the lesion. We have gained experience in the use of two different MACT techniques. According to the Hannover scoring system for the ankle and visual analog scores, results improved significantly (p<or=0.001) after MACT with the Hyalograft C in nine ankles at a mean follow-up of 3.7 years (range 2.6-4.8 years). All patients had undergone prior operative treatment for the cartilage lesion. Two patients were rated as excellent and seven as good. According to the ICRS cartilage repair assessment score, the transplanted areas were rated nearly normal (grade II) in seven patients who underwent undergone repeat arthroscopy. Magnetic resonance imaging revealed that in the majority of cases, filling of the defect was accomplished with a nonhomogeneous surface and structure of the graft. The use of a purely arthroscopically applicable three-dimensional MACT (ARTROcell 3D) with chondrospheres further facilitates the process and reduces operative morbidity. We have included eight patients in a prospective study so far. Six patients had undergone prior operative treatment for the cartilage lesion. In two cases, culturing of the cells failed for unexplained reasons; therefore, only six patients finally received the MACT with chondrospheres, and only four patients were evaluated at a 6-month follow-up examination. Thus, valid results cannot be reported. In revision cases, MACT is suggested to be a reliable alternative for treating articular cartilage lesions of the talus, but longer-term results in more patients remain to be evaluated.

Autologous chondrocyte transplantation in the treatment of articular cartilage lesions of the talus

In contrast to the knee joint, autologous chondrocyte transplantation (ACT) is rarely used for treating articular cartilage lesions in the ankle joint. Matrix-associated autologous chondrocyte transplantation (MACT) with the use of biomaterials as cell carriers has facilitated operative application and fixation within the lesion. We have gained experience in the use of two different MACT techniques. According to the Hannover scoring system for the ankle and visual analog scores, results improved significantly (p<or=0.001) after MACT with the Hyalograft C in nine ankles at a mean follow-up of 3.7 years (range 2.6-4.8 years). All patients had undergone prior operative treatment for the cartilage lesion. Two patients were rated as excellent and seven as good. According to the ICRS cartilage repair assessment score, the transplanted areas were rated nearly normal (grade II) in seven patients who underwent undergone repeat arthroscopy. Magnetic resonance imaging revealed that in the majority of cases, filling of the defect was accomplished with a nonhomogeneous surface and structure of the graft. The use of a purely arthroscopically applicable three-dimensional MACT (ARTROcell 3D) with chondrospheres further facilitates the process and reduces operative morbidity. We have included eight patients in a prospective study so far. Six patients had undergone prior operative treatment for the cartilage lesion. In two cases, culturing of the cells failed for unexplained reasons; therefore, only six patients finally received the MACT with chondrospheres, and only four patients were evaluated at a 6-month follow-up examination. Thus, valid results cannot be reported. In revision cases, MACT is suggested to be a reliable alternative for treating articular cartilage lesions of the talus, but longer-term results in more patients remain to be evaluated.

Reliable Alignment in Total Knee Arthroplasty by the Use of an iPod-Based Navigation System

Axial alignment is one of the main objectives in total knee arthroplasty (TKA). Computer-assisted surgery (CAS) is more accurate regarding limb alignment reconstruction compared to the conventional technique. The aim of this study was to analyse the precision of the innovative navigation system DASH® by Brainlab and to evaluate the reliability of intraoperatively acquired data. A retrospective analysis of 40 patients was performed, who underwent CAS TKA using the iPod-based navigation system DASH. Pre- and postoperative axial alignment were measured on standardized radiographs by two independent observers. These data were compared with the navigation data. Furthermore, interobserver reliability was measured. The duration of surgery was monitored. The mean difference between the preoperative mechanical axis by X-ray and the first intraoperatively measured limb axis by the navigation system was 2.4°. The postoperative X-rays showed a mean difference of 1.3° compared to the final navigation measurement. According to radiographic measurements, 88% of arthroplasties had a postoperative limb axis within ±3°. The mean additional time needed for navigation was 5 minutes. We could prove very good precision for the DASH system, which is comparable to established navigation devices with only negligible expenditure of time compared to conventional TKA.

Comparison of transportation related injury mechanisms and outcome of young road users and adult road users, a retrospective analysis on 24,373 patients derived from the TraumaRegister DGU ®

BackgroundMost young people killed in road crashes are known as vulnerable road users. A combination of physical and developmental immaturity as well as inexperience increases the risk of road traffic accidents with a high injury severity rate. Understanding injury mechanism and pattern in a group of young road users may reduce morbidity and mortality. This study analyzes injury patterns and outcomes of young road users compared to adult road users. The comparison takes into account different transportation related injury mechanisms.MethodsA retrospective analysis using data collected between 2002 and 2012 from the TraumaRegister DGU® was performed. Only patients with a transportation related injury mechanism (motor vehicle collision (MVC), motorbike, cyclist, and pedestrian) and an ISS ≥ 9 were included in our analysis. Four different groups of young road users were compared to adult trauma data depending on the transportation related injury mechanism.ResultsTwenty four thousand three hundred seventy three, datasets were retrieved to compare all subgroups. The mean ISS was 23.3 ± 13.1. The overall mortality rate was 8.61%. In the MVC, the motorbike and the cyclist group, we found young road users having more complex injury patterns with a higher AIS pelvis, AIS head, AIS abdomen and AIS of the extremities and also a lower GCS. Whereas in these three sub-groups the adult trauma group only had a higher AIS thorax. Only in the group of the adult pedestrians we found a higher AIS pelvis, AIS abdomen, AIS thorax, a higher AIS of the extremities and a lower GCS.DiscussionThis study reports on the most common injuries and injury patterns in young trauma patients in comparison to an adult trauma sample. Our analysis show that in contrast to more experienced road users our young collective refers to be a vulnerable trauma group with an increased risk of a high injury severity and high mortality rate. We indicate a striking difference in terms of the region of injury and the mechanism of injury when comparing the young versus the adult trauma collectives.ConclusionsYoung drivers of cars, motorbikes and bikes were shown to be on high risk to sustain a specific severe injury pattern and a high mortality rate compared to adult road users. Our data emphasize a characteristic injury pattern of young trauma patients and may be used to improve trauma care and to guide prevention strategies to decrease injury severity and mortality due to road traffic injuries.

Transosseous Repair of Root Tears of the Lateral Meniscus: Operative Technique and Short-Term Clinical Follow-Up of 28 Patients

An avulsion of the posterior tibial insertion of the lateral meniscus occurs during rotational distortion of the knee and can be associated with a tear of the anterior cruciate ligament (ACL). We performed a follow-up of 28 patients who, following anatomical ACL reconstruction using the ipsilateral semitendinosus graft, underwent either transosseous repair of the posterior lateral meniscus root () or no intervention (). The meniscus root tears were classified as Forkel I lesions. All patients were examined 6 months after surgery and undertook scoring using International Knee Documentation Committee Score (IKDC). Comparing the repair group with the no repair group the subjective IKDC 6 months after surgery was 75,72% (±1,019) and 75,56 (±1,058). Regarding the objective IKDC 8 × A (57,1%) and 6 × B (42,9%) could be ascertained in the repair group whereas 6 × A (42,9%), 6 × B (42,9%), and 2 × C (14,3%) scoring could be ascertained in the no repair group. It remains unclear if surgery on type Forkel I PLMRT provides benefits compared to the nonsurgical procedures as in both groups stability might occur. The purpose of this article was to report the outcome of surgical repair of lateral meniscus root tears.

Die autologe Knorpelzelltransplantation zur Behandlung von Knorpelläsionen am Talus@@@Autologous chondrocyte transplantation in the treatment of articular cartilage lesions of the talus

In contrast to the knee joint, autologous chondrocyte transplantation (ACT) is rarely used for treating articular cartilage lesions in the ankle joint. Matrix-associated autologous chondrocyte transplantation (MACT) with the use of biomaterials as cell carriers has facilitated operative application and fixation within the lesion. We have gained experience in the use of two different MACT techniques. According to the Hannover scoring system for the ankle and visual analog scores, results improved significantly (p<or=0.001) after MACT with the Hyalograft C in nine ankles at a mean follow-up of 3.7 years (range 2.6-4.8 years). All patients had undergone prior operative treatment for the cartilage lesion. Two patients were rated as excellent and seven as good. According to the ICRS cartilage repair assessment score, the transplanted areas were rated nearly normal (grade II) in seven patients who underwent undergone repeat arthroscopy. Magnetic resonance imaging revealed that in the majority of cases, filling of the defect was accomplished with a nonhomogeneous surface and structure of the graft. The use of a purely arthroscopically applicable three-dimensional MACT (ARTROcell 3D) with chondrospheres further facilitates the process and reduces operative morbidity. We have included eight patients in a prospective study so far. Six patients had undergone prior operative treatment for the cartilage lesion. In two cases, culturing of the cells failed for unexplained reasons; therefore, only six patients finally received the MACT with chondrospheres, and only four patients were evaluated at a 6-month follow-up examination. Thus, valid results cannot be reported. In revision cases, MACT is suggested to be a reliable alternative for treating articular cartilage lesions of the talus, but longer-term results in more patients remain to be evaluated.