Jörn Kircher

Age-related joint space narrowing independent of the development of osteoarthritis of the shoulder.

Purpose: It is commonly accepted that the glenohumeral joint space remains unchanged until the onset of osteoarthritis, at which point progressive degenerative changes, and joint space narrowing occur. The aim of this study was to evaluate the radiographic width of the glenohumeral joint space in patients of different ages: Those with otherwise normal radiographs, those with a history of instability, those with calcific tendonitis, and those with a radiologic diagnosis of osteoarthritis. Materials and Methods: In this retrospective study, two independent investigators measured the glenohumeral joint width on true anteroposterior and axillary views of standardized shoulder radiographs taken from 2002 to 2009. The digital image resolution was 0.01 mm. Group I comprised 60 patients with normal shoulder radiographs, Group II comprised 53 patients with instability but normal radiographs, Group III comprised 109 patients with radiologically proven calcific tendonitis, and Group IV comprised 120 patients with manifest osteoarthritis. Results: The interobserver reliability (r) was 0.621-0.862. The mean joint space width was significantly different among Groups I-IV (central anteroposterior: 4.28 ± 0.75 mm, 3.12 ± 0.73 mm, 2.87 ± 0.80 mm, and 1.47 ± 1.07 mm, respectively; P = 0.001; central axillary: 6.12 ± 1.09 mm, 3.92 ± 0.77 mm, 3.34 ± 0.84 mm, and 1.08 ± 1.12 mm, respectively; P = 0.001). There was a significant negative correlation between the joint space width and age at all measured levels in both projections (P < 0.001). Conclusions: The glenohumeral joint space width decreases with increasing age beginning in early adulthood, and this effect is enhanced by osteoarthritis. Level of Evidence: Level II, retrospective study.

Autologous chondrocyte implantation for post-traumatic cartilage defect of the capitulum humeri

Cartilage defects at the capitulum humeri (capitellum) are frequent, especially in overhead athletes. In many of these cases, young adolescents are affected and need treatment on the basis of osteochondritis dissecans (OCD) as the underlying disease. Although the pathomechanisms are not fully understood, these patients can be distinguished from another group affected by a growth disorder of the ossification center at the lateral distal humerus (Panner disease) with a peak at about 9 years, which is usually a self-limited condition with a good prognosis without active treatment. Treatment options for advanced stages of cartilage injury include open or arthroscopic débridement, microfracture, osteochondral transfer, autologous chondrocyte implantation (ACI), and, most recently, allogeneic cartilage transplantation (particulated juvenile cartilage transfer). Early-stage OCD lesions can be treated by anterograde or retrograde drilling or by fragment refixation. Although sufficient clinical data are lacking, it can be assumed that the better the restoration of the joint line with the best cartilage tissue possible, the more favorable the results in terms of pain reduction, function, and long-term benefit for the patient will be. Since the first description ofACI at the elbow by Sato et al, who used autologous cartilage cells in a commercial gel after 3 weeks of cultivation of chondrocytes from the knee and coverage of the defect with a periosteal flap from the proximal tibia, only 2 reports about ACI at the elbow have been published. Because the long-term results after osteochondral transfer are suboptimal and inconclusive, I present a single case report of a patient treated with a third-generation ACI technique. Preoperative and postoperative findings, including the clinical result after 1 year, are presented.

Joint failure after steroid therapy in tuberculous encephalitis

Abstract We report a case of multifocal avascular osteonecrosis (AVN) following steroid administration in a case of tuberculous encephalitis in a young patient. The risk of joint-related AVN as a side effect of adjunctive steroid therapy should be taken into consideration when evaluating the dosage and treatment duration in tuberculous encephalitis.

V 43 Gibt es einen Zusammenhang zwischen traumatischen SLAP- und Pulley-Läsionen?

Fragestellung Ein Makrotrauma als Ursache von SLAP- als auch Pulley-Lasionen ist generell akzepiert. Beide Entitaten sind durch die lange Bizepssehne in ihrem intraartikularen Verlauf verbunden und stehen biomechanisch in enger Beziehung. Ziel dieser Arbeit ist die Untersuchung der Fragestellung, ob ein Zusammenhang zwischen traumatischen SLAP- und Pulley-Lasionen besteht. Methodik Prospektive Analyse von 3 395 Arthroskopien (2004–2008). Einschlusskriterien: Makrotrauma mit Abuktion und Ausenrotation; SLAP-Lasion Typ II–VII. Ausschlusskriterien: Komplette RM-Rupturen, subtotale RM-Rupturen (Snyder IV), Luxation, Voroperation, Arthrose. Arthroskopische standardisierte Befundung. Pulley-Lasionen Habermeyer Grad I–IV. Auswertung: Statistische Analyse SPSS 13,0: T-Test fur unabhangige Stichproben. Bivariate Korrelationsanalyse (Spearman). Partielle Korrelationsanalyse. Ergebnisse Das mittlere Alter der 161 Patienten (113 Manner) war 45,9±13,4 ohne signifikanten Geschlechts-Unterschied (44,9±12,3 vs. 47,9±15,67). 48 (29,8%) Patienten mit Pulley-Lasion: Typ I: 16; Typ II: 17; Typ III: 8, Typ IV: 7. 61 (37,9%) Patienten mit SLAP-Lasion >2: Typ II: 49; Typ III: 4; Typ IV: 5; Typ V: 1; Typ VI: 0; Typ VII: 2. Das Vorhandensein einer SLAP-Lasion und Pulley-Lasion war hochsignifikant negativ miteinander korreliert (r=−0,300, p=0,001). In der partiellen Korrelation kontrolliert fur das Vorhandensein von Hyperlaxitat und Instabilitat war der Effekt immer noch vorhanden (r=−0,242, p=0,002). Eine SLAP-Lasion war positiv korreliert mit anteriorer Instabilitat (r=0,351, p=0,001); Pulley-Lasion mit LBS-Synovitis oder Ruptur und negativ mit anteriorer Instabilitat (r=0,200, p=0,011; r=0,213, p=0,007; r=−0,224, p=0,004). Schlussfolgerung Die Daten zeigen einen hochsignifikanten Zusammenhang von Trauma und SLAP- bzw. Pulley-Lasionen. SLAP-Lasionen sind positiv und Pulley-Lasionen negativ korreliert mit einer anterioren Instabilitat. Eine Erklarungshypothese ist eine direkte Traumawirkung des Humeruskopfes auf den SLAP-Komplex unabhangig von der Zugwirkung der LBS bei intaktem Pulley-System und der traumatischen Schadigung des Pulley-Systems andererseits. Biomechanische Untersuchungen mit differenziertem Traumamodell zur Aufklarung des Zusammenhanges sind notwendig.