M. Betsch

Optical coherence tomography-based parameterization and quantification of articular cartilage surface integrity

Loss of articular cartilage surface integrity is considered the earliest sign of osteoarthritis; however, its reliable detection has not been established by clinical routine diagnostics. This study comprehensively assesses a set of 11 algorithm-based 2-D Optical Coherence Tomography roughness parameters and investigates their clinical impact. Histology and manual irregularity quantification of 105 human cartilage samples with variable degeneration served as reference. The majority of parameters revealed a close-to-linear correlation with the entire spectrum of degeneration. Surface integrity should therefore be assessed by a combination of parameters to improve current diagnostic accuracy in the determination of cartilage degeneration.

Multicenter Comparison of 3D Spinal Measurements Using Surface Topography With Those From Conventional Radiography

INTRODUCTION In pediatric spinal deformity the gold standard for curve surveillance remains standing full-column radiographs, but repeated exposure to ionizing radiation motivates us to look for nonradiographic solutions. This study tests a modern system of surface topography (ST) to determine whether it is reliable and reproducible. METHODS Patients from 6 pediatric spinal deformity clinics were recruited for enrollment. Inclusion criteria were age 8-18; diagnosis of scoliosis measuring ≥10 and <50 degrees or increased kyphosis of ≥45 degrees. Standing radiographs and ST scans (DIERS Formetric, Diers Medical Systems, Chicago, IL) were obtained on all patients and then measured and compared. A single investigator using a validated electronic measurement tool performed all radiographic measurements. Analysis of reproducibility and comparison of ST and radiographs were done. RESULTS A total of 193 patients were enrolled (148 F [77%]). The mean age was 13.25 years (range 8-18). The scoliosis magnitude was as follows: thoracic average 22.7 ± 10 degrees; lumbar average 19.6 ± 9 degrees. The kyphosis magnitude was 54.0 ± 11 degrees. The reproducibility for each ST parameter for 3 repeated scans was strong (interclass correlation = 0.855-0.944). Comparison to radiographic measurements was strong in the thoracic (r = 0.7) and moderate in the lumbar curve (r = 0.5). There was an average difference of 5.8 degrees in the thoracic spine and 8.8 degrees in the lumbar spine between ST Cobb angle estimates and radiographs. Thoracic kyphosis also had a strong correlation (r = 0.8) with radiographs. CONCLUSIONS Although the results are intended to measure similar aspects of deformity as the traditional Cobb angle, the measurement is not intended to be an exact estimation. The utility of ST is in the reproducible quantification of deformity after the initial radiograph has been taken. This has the potential to make longitudinal assessment of change in deformity without serial radiographs.INTRODUCTION In pediatric spinal deformity the gold standard for curve surveillance remains standing full-column radiographs, but repeated exposure to ionizing radiation motivates us to look for nonradiographic solutions. This study tests a modern system of surface topography (ST) to determine whether it is reliable and reproducible. METHODS Patients from 6 pediatric spinal deformity clinics were recruited for enrollment. Inclusion criteria were age 8-18; diagnosis of scoliosis measuring ≥10 and <50 degrees or increased kyphosis of ≥45 degrees. Standing radiographs and ST scans (DIERS Formetric, Diers Medical Systems, Chicago, IL) were obtained on all patients and then measured and compared. A single investigator using a validated electronic measurement tool performed all radiographic measurements. Analysis of reproducibility and comparison of ST and radiographs were done. RESULTS A total of 193 patients were enrolled (148 F [77%]). The mean age was 13.25 years (range 8-18). The scoliosis magnitude was as follows: thoracic average 22.7 ± 10 degrees; lumbar average 19.6 ± 9 degrees. The kyphosis magnitude was 54.0 ± 11 degrees. The reproducibility for each ST parameter for 3 repeated scans was strong (interclass correlation = 0.855-0.944). Comparison to radiographic measurements was strong in the thoracic (r = 0.7) and moderate in the lumbar curve (r = 0.5). There was an average difference of 5.8 degrees in the thoracic spine and 8.8 degrees in the lumbar spine between ST Cobb angle estimates and radiographs. Thoracic kyphosis also had a strong correlation (r = 0.8) with radiographs. CONCLUSIONS Although the results are intended to measure similar aspects of deformity as the traditional Cobb angle, the measurement is not intended to be an exact estimation. The utility of ST is in the reproducible quantification of deformity after the initial radiograph has been taken. This has the potential to make longitudinal assessment of change in deformity without serial radiographs.

Treating patella fractures with a fixed-angle patella plate—A prospective observational study

INTRODUCTION Anterior tension wiring using Kirschner wires (K-wires) is still considered the standard treatment for patella fractures, despite its high complication rate. The objective of this prospective clinical study was to evaluate intra- and perioperative complications as well as the clinical outcome of patients with patella fracture treated with a new developed bilateral, polyaxial, fixed-angle 2.7mm patella plate. PATIENTS AND METHODS Between 2011 and 2014 all patients with a patella fracture were included in this prospective study and treated with a fixed-angle patella plate. Avulsion fractures of the inferior or superior pole of the patella were excluded. All fractures were classified according to the AO/OTA fracture classification. During a twelve-month follow up period all intra- and postoperative complications were recorded as well as the time until fracture healing. One year postoperatively the Lysholm Score, the pre- and postoperative Tegner Score, the Hospital for Special Surgery Knee Score (HSS), the Turba Score, the Oxford Knee Score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the Bostman Score and the Iowa Knee Score were surveyed. Altogether, 20 patella fractures in 19 patients were included in this prospective study. The most frequent type of fracture, n=10, was a simple transverse patella fracture (C1), followed by 7 comminuted patella fractures (C3) and 3 T-shaped patella fractures (C2). RESULTS During the 12-month follow up period two patients treated with the patella plate had a complication. In one patient a superficial wound infection occurred, which was treated successfully with hardware removal and in one patient a fracture dislocation due to an implant failure occurred. X-rays demonstrated complete bony healing in all fractures on average 3.2 months postoperatively. All knee scores showed good to excellent clinical results one year postoperatively. CONCLUSION The results of this first clinical study indicate that the fixed-angle patella plate is an effective and safe treatment option for patella fractures with a short operative learning curve. The treatment of communited patella fractures (C3) with a fixed-angle patella plate should be well-considered to avoid distending the indication and biomechanical properties.

Strahlenfreie Diagnostik bei Skoliosen

BACKGROUND Scoliosis is a complex three-dimensional deformity of the spine, which usually occurs during childhood and adolescence. Up to now, whole spine X-rays have been the therapeutic gold standard in the diagnosis and follow-up of scoliosis. AIM This review gives a brief overview of the history, technical background and possible fields of use for video-rasterstereography METHODS Alternative measurement systems have been developed over the past few years for the treatment of scoliosis, because of the risk of radiation exposure of X-rays. The rasterstereographic system Formetric (Diers International GmbH, Schlagenbad) allows a radiation-free, three-dimensional analysis of the back surface and the spine. OUTLOOK Even dynamic measurements can now be conducted with this rasterstereographic system, which will help to further understand and analyze the human spine.ZusammenfassungHintergrundSkoliosen sind komplexe dreidimensionale Deformitäten der Wirbelsäule, die häufig im Kindes- und Jugendalter auftreten. Bis heute stellen Wirbelsäulenganzaufnahmen den therapeutischen Goldstandard in der Diagnose und Verlaufskontrolle von Skoliosen dar. Aufgrund der hiermit verbundenen Strahlenbelastung wurde bereits früh nach alternativen Messmethoden gesucht.ZielEin Überblick über die Geschichte, den technischen Hintergrund sowie über die Einsatzmöglichkeiten der Videorasterstereographie wird präsentiert.MethodeDas rasterstereographische System Formetric (Diers International GmbH, Schlagenbad, Deutschland) ermöglicht die dreidimensionale und strahlungsfreie Darstellung der Rückenoberfläche und der darunterliegenden Wirbelsäule.AusblickDurch technische Weiterentwicklungen kann diese Technik auch unter dynamischen Bedingungen eingesetzt werden, wodurch sich in der Zukunft zusätzliche Einsatzmöglichkeiten ergeben.AbstractBackgroundScoliosis is a complex three-dimensional deformity of the spine, which usually occurs during childhood and adolescence. Up to now, whole spine X-rays have been the therapeutic gold standard in the diagnosis and follow-up of scoliosis.AimThis review gives a brief overview of the history, technical background and possible fields of use for video-rasterstereographyMethodsAlternative measurement systems have been developed over the past few years for the treatment of scoliosis, because of the risk of radiation exposure of X-rays. The rasterstereographic system Formetric (Diers International GmbH, Schlagenbad) allows a radiation-free, three-dimensional analysis of the back surface and the spine.OutlookEven dynamic measurements can now be conducted with this rasterstereographic system, which will help to further understand and analyze the human spine.

A comparative study of mechanical properties of fresh and frozen-thawed porcine intervertebral discs in a bioreactor environment

Limited availability of fresh intervertebral discs (IVDs) necessitates the use of frozen-thawed samples in biomechanical investigations. Several authors have reported the mechanical properties of frozen-thawed IVDs, but few studies have investigated the effects of storage temperature and cooling rate. The validity and reliability of the applied freezing-thawing procedures are still relatively unknown. The study aims to compare the mechanical responses of fresh porcine IVDs and porcine IVDs, which were frozen at different freezing temperatures with a controlled-rate cooling process and then thawed. The specimens were obtained from pigs aged 6 months. A total of 18 functional spine units (FSUs) were taken from seven porcine lumbar spines (L1-L6). The specimens were then split into three groups. The first group was tested fresh immediately and the other two groups were frozen at the same cooling rate and stored at -20°C and -80°C, respectively, before testing. The period of storage ranged between 12 and 43 days. The frozen specimens were thawed for 9h at room temperature before the tests. A special IVD bioreactor, which maintained the realistic behaviour of IVDs under various loading conditions, was developed. The analysis of variance (ANOVA) was used to determine if the observed results were statistically significant. The results indicated that frozen storage at -20°C decreases the comprehensive stiffness. In contrast, freezing to -80°C did not seem to have any effect on the mechanical properties of IVDs. No significant differences in outcome were observed for the samples, which had different spine levels. The study confirmed the reliability and usability of frozen-thawed samples stored at -80°C for biomechanical investigations.

Pathophysiology of traumatic bone marrow edema

ZusammenfassungHintergrundDas Knochenmarködem (KMÖ) stellt morphologisch eine vermehrte Flüssigkeitsansammlung im Knochenmark dar. Es ist mit der MRT frühzeitig zu erkennen, aber per se unspezifisch. Der genaue Pathomechanismus verbleibt unklar. Das KMÖ tritt sowohl als eigene Entität, aber auch begleitend bei vielen Krankheitsbildern auf. Eine Einteilung des KMÖ in 3 Gruppen (ischämisches, reaktives, mechanisches KMÖ) erscheint sinnvoll. Das mechanische KMÖ tritt nach Trauma oder bei repetitiver Überlastung auf. Es zeigen sich typische Veränderungen in der Histologie. Die Grenzen zwischen Ödem und Mikrofraktur sind hierbei fließend. Einige Traumata weisen KMÖ in typischen Lokalisationen auf. Hierdurch kann bei unbekanntem Traumamechanismus sowohl auf das Trauma als auch auf mögliche Begleitverletzungen indirekt geschlossen werden.SchlussfolgerungDas Knochenmarködem kann als eigenes Krankheitsbild oder als Begleiterscheinung auftreten. Zur Therapieeinleitung sind eine ausführliche Anamnese und eine zielführende Diagnostik unerlässlich. In manchen Fällen ist das KMÖ hinweisend auf den Traumamechanismus und mögliche weitere Begleitverletzungen.AbstractBackgroundMorphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with magnetic resonance imaging (MRI). The underlying pathomechanism remains unclear. The BME can occur as an individual entity and as an accompanying condition of many diseases. The BME can be divided into three groups, ischemic, reactive and mechanical BME. Mechanical BME occurs after trauma or repetitive strain. Typical histological changes are present and there is no clear boundary between edema and microfracture. Some forms of trauma show BME in typical localizations. Both the trauma and the possible accompanying injuries can be indirectly indicated in this way in cases with an unknown trauma mechanism.ConclusionThe BME can be present as an isolated entity or as a comorbidity. For initiation of therapy, a comprehensive medical history and targeted diagnostics are indispensable. In some cases BME is indicative of the trauma mechanism and possible further accompanying injuries.BACKGROUND Morphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with magnetic resonance imaging (MRI). The underlying pathomechanism remains unclear. The BME can occur as an individual entity and as an accompanying condition of many diseases. The BME can be divided into three groups, ischemic, reactive and mechanical BME. Mechanical BME occurs after trauma or repetitive strain. Typical histological changes are present and there is no clear boundary between edema and microfracture. Some forms of trauma show BME in typical localizations. Both the trauma and the possible accompanying injuries can be indirectly indicated in this way in cases with an unknown trauma mechanism. CONCLUSION The BME can be present as an isolated entity or as a comorbidity. For initiation of therapy, a comprehensive medical history and targeted diagnostics are indispensable. In some cases BME is indicative of the trauma mechanism and possible further accompanying injuries.

Pathophysiologie des traumatischen Knochenmarködems

ZusammenfassungHintergrundDas Knochenmarködem (KMÖ) stellt morphologisch eine vermehrte Flüssigkeitsansammlung im Knochenmark dar. Es ist mit der MRT frühzeitig zu erkennen, aber per se unspezifisch. Der genaue Pathomechanismus verbleibt unklar. Das KMÖ tritt sowohl als eigene Entität, aber auch begleitend bei vielen Krankheitsbildern auf. Eine Einteilung des KMÖ in 3 Gruppen (ischämisches, reaktives, mechanisches KMÖ) erscheint sinnvoll. Das mechanische KMÖ tritt nach Trauma oder bei repetitiver Überlastung auf. Es zeigen sich typische Veränderungen in der Histologie. Die Grenzen zwischen Ödem und Mikrofraktur sind hierbei fließend. Einige Traumata weisen KMÖ in typischen Lokalisationen auf. Hierdurch kann bei unbekanntem Traumamechanismus sowohl auf das Trauma als auch auf mögliche Begleitverletzungen indirekt geschlossen werden.SchlussfolgerungDas Knochenmarködem kann als eigenes Krankheitsbild oder als Begleiterscheinung auftreten. Zur Therapieeinleitung sind eine ausführliche Anamnese und eine zielführende Diagnostik unerlässlich. In manchen Fällen ist das KMÖ hinweisend auf den Traumamechanismus und mögliche weitere Begleitverletzungen.AbstractBackgroundMorphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with magnetic resonance imaging (MRI). The underlying pathomechanism remains unclear. The BME can occur as an individual entity and as an accompanying condition of many diseases. The BME can be divided into three groups, ischemic, reactive and mechanical BME. Mechanical BME occurs after trauma or repetitive strain. Typical histological changes are present and there is no clear boundary between edema and microfracture. Some forms of trauma show BME in typical localizations. Both the trauma and the possible accompanying injuries can be indirectly indicated in this way in cases with an unknown trauma mechanism.ConclusionThe BME can be present as an isolated entity or as a comorbidity. For initiation of therapy, a comprehensive medical history and targeted diagnostics are indispensable. In some cases BME is indicative of the trauma mechanism and possible further accompanying injuries.BACKGROUND Morphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with magnetic resonance imaging (MRI). The underlying pathomechanism remains unclear. The BME can occur as an individual entity and as an accompanying condition of many diseases. The BME can be divided into three groups, ischemic, reactive and mechanical BME. Mechanical BME occurs after trauma or repetitive strain. Typical histological changes are present and there is no clear boundary between edema and microfracture. Some forms of trauma show BME in typical localizations. Both the trauma and the possible accompanying injuries can be indirectly indicated in this way in cases with an unknown trauma mechanism. CONCLUSION The BME can be present as an isolated entity or as a comorbidity. For initiation of therapy, a comprehensive medical history and targeted diagnostics are indispensable. In some cases BME is indicative of the trauma mechanism and possible further accompanying injuries.

Effects of Athletic Training on the Spinal Curvature in Child Athletes

The purpose of this study was to examine the spinal posture in young athletes depending on training intensity. The spinal curvature of 245 children, age 8 to 12 years, was evaluated using rasterstereography. According to their weekly training time group 1 (mean age: 9.54 ± 1.18) did 2–6, group 2 (mean age: 9.49 ± 0.87) did 6–15 and group 3 (mean age: 9.68 ± 0.87) did over 15 hours of training. Group 1 had a significantly higher weight (p = 0.028) (33.86 ± 7. kg) than those of the more active groups (30.67 ± 6.49 kg and 29.46 ± 4.33 kg). The mean kyphotic angle decreased significantly (p < 0.001) with the amount of training per week from 46.86 ± 8.2° in group 1 to 40.08 ± 8° in group 3. We also found a significant decrease (p = 0.047) in lateral deviation with training from group 1 with 5.3 ± 3 mm to group 2 with 4.1 ± 1.6 mm. The results of our study suggest that higher training time can be associated with lower weight and decreases in thoracic kyphosis and lateral deviation of the spine.

[Radiation-free diagnosis of scoliosis : An overview of the surface and spine topography].

BACKGROUND Scoliosis is a complex three-dimensional deformity of the spine, which usually occurs during childhood and adolescence. Up to now, whole spine X-rays have been the therapeutic gold standard in the diagnosis and follow-up of scoliosis. AIM This review gives a brief overview of the history, technical background and possible fields of use for video-rasterstereography METHODS Alternative measurement systems have been developed over the past few years for the treatment of scoliosis, because of the risk of radiation exposure of X-rays. The rasterstereographic system Formetric (Diers International GmbH, Schlagenbad) allows a radiation-free, three-dimensional analysis of the back surface and the spine. OUTLOOK Even dynamic measurements can now be conducted with this rasterstereographic system, which will help to further understand and analyze the human spine.ZusammenfassungHintergrundSkoliosen sind komplexe dreidimensionale Deformitäten der Wirbelsäule, die häufig im Kindes- und Jugendalter auftreten. Bis heute stellen Wirbelsäulenganzaufnahmen den therapeutischen Goldstandard in der Diagnose und Verlaufskontrolle von Skoliosen dar. Aufgrund der hiermit verbundenen Strahlenbelastung wurde bereits früh nach alternativen Messmethoden gesucht.ZielEin Überblick über die Geschichte, den technischen Hintergrund sowie über die Einsatzmöglichkeiten der Videorasterstereographie wird präsentiert.MethodeDas rasterstereographische System Formetric (Diers International GmbH, Schlagenbad, Deutschland) ermöglicht die dreidimensionale und strahlungsfreie Darstellung der Rückenoberfläche und der darunterliegenden Wirbelsäule.AusblickDurch technische Weiterentwicklungen kann diese Technik auch unter dynamischen Bedingungen eingesetzt werden, wodurch sich in der Zukunft zusätzliche Einsatzmöglichkeiten ergeben.AbstractBackgroundScoliosis is a complex three-dimensional deformity of the spine, which usually occurs during childhood and adolescence. Up to now, whole spine X-rays have been the therapeutic gold standard in the diagnosis and follow-up of scoliosis.AimThis review gives a brief overview of the history, technical background and possible fields of use for video-rasterstereographyMethodsAlternative measurement systems have been developed over the past few years for the treatment of scoliosis, because of the risk of radiation exposure of X-rays. The rasterstereographic system Formetric (Diers International GmbH, Schlagenbad) allows a radiation-free, three-dimensional analysis of the back surface and the spine.OutlookEven dynamic measurements can now be conducted with this rasterstereographic system, which will help to further understand and analyze the human spine.

Skoliose im Wachstumsalter

Scoliosis affects up to 6 % of the population. The resulting spine deformity, the increasing risk of back pain, cosmetic aspects, pulmonary disorders if the Cobb angle is > 80°, and the progress of the deformity to > 50° after the end of growth indicate non-operative or operative therapy. In daily clinical practice, the classifications of scoliosis allow the therapy to be adapted. Classifications consider deformity, topography of the scoliosis, and the age at diagnosis. This publication gives an overview of the relevant and most common classifications in the treatment of adolescent scoliosis. For evaluation, the deformity measurement on the coronary radiographic projection of the total spine (Cobb angle) is relevant to therapy. The classification of topography, form, and the sagittal profile of the deformity of the spine are useful for preoperative planning of the fusion level. Classifications that take into account the age at the time of the diagnosis of scoliosis differentiate among early onset scoliosis (younger than 10 years of age), adolescent scoliosis (up to the end of growth), and adult scoliosis. Early onset scoliosis is subdivided by age and etiology. Therapy is derived from the classification of clinical and radiological findings. Classifications that take into account clinical and radiological parameters are essential components of modern scoliosis therapy.