Olaf Rolf

Rotator cuff tears associated with os acromiale.

Introduction Os acromiale is a rare anatomical condition; its incidence in cadaver studies has been found to be approximately 8%. In this retrospective study we investigated the incidence and types of os acromiale in patients with rotator cuff tears. Methods We assessed operation notes and axillary radiographs for the presence and the type of os acromiale in 1 000 consecutive patients with open rotator cuff repairs. Results 62 patients (6.2%) showed an os acromiale in the axillary radiographs. In 6 of these the os acromiale was not described in the operation notes. 57 os meso-acromiale and 5 os pre-acromiale were found. The average number of tendons involved in the cuff tear was the same (1.4) in patients with and without os acromiale. The average age of patients with os acromiale was 55 years, and 56 years in patients without os acromiale. Interpretation Os acromiale is a co-condition in patients with rotator cuff tear. The prevalence of os acromiale in patients with rotator cuff tear is similar to that in a standard population with unknown integrity status of the rotator cuff. Thus, it seems debatable whether an os acromiale is a pathological condition leading to rotator cuff tears.

Die Trizepsfaszienplastik zur Rekonstruktion der Kollateralbänder am Ellenbogengelenk

ZusammenfassungOperationsziel Anatomische Rekonstruktion der Kollateralbänder am Ellenbogengelenk.Wiederherstellung der Stabilität und Funktion des Ellenbogengelenks.Schmerzreduktion.Verbesserung des Bewegungsumfangs. Indikationen Instabilität des Ellenbogengelenks.Insuffizienz der ulnaren oder radialen Kollateralbänder.Zerstörung des Kapsel-Band-Apparats des Ellenbogengelenks, z. B. nach Entfernung ausgedehnter heterotoper Ossifikationen mit Verknöcherung des Kapsel-Band-Apparats. Kontraindikationen Schlechte Hautverhältnisse.Lokale Infektion.Schädigungen oder Voroperationen der Trizepssehne. Operationstechnik Dorsaler, dorsoulnarer oder -radialer Zugang zum Gelenk.Präparation unter Schonung des Nervus ulnaris, ggf. Neurolyse und subkutane Verlagerung. Möglichst vollständige Entfernung von Ossifikationen und Entfernung des knöchern umgewandelten ulnaren/radialen Kapsel-Band-Apparats.Präparation des Musculus triceps auf seiner oberflächlichen Faszie bis zum Ansatz am Olekranon. Je nach Bedarf wird ulnar, radial oder beidseits ein distal am Olekranon gestielter, ca. 12 cm langer und 1,5 cm breiter Trizepsfaszienstreifen entnommen. Mit dem Faszienstreifen werden die Kollateralbänder dem anatomischen Verlauf entsprechend dreieckförmig rekonstruiert und transossär fixiert. Adaptierende Subkutannähte. Hautverschluss. Ergebnisse Fünf Patienten (Alter 25–59 Jahre) erhielten eine offene Arthrolyse mit einer ulnaren Trizepsfaszienplastik, einmal kombiniert mit einer radialen Trizepsfaszienplastik und einmal kombiniert mit einer radialen Rekonstruktion der Kollateralbänder mit der Sehne des Musculus palmaris longus. Nachuntersuchungszeitraum durchschnittlich 2,2 Jahren (8 Monate bis 4,4 Jahre).Bewertungskriterien: Funktionelle Ergebnisse: deutlich verbesserte Funktion. Subjektive Ergebnisse: keine Instabilität. Gelenkstabilität: bei einem Patienten ulnare Aufklappbarkeit Grad I. Schmerzen: sehr gute Schmerzreduktion (Morrey-Score). Beweglichkeit: deutliche Zunahme des Bewegungsumfangs.AbstractObjective Anatomic reconstruction of the collateral ligaments of the elbow.Restoration of stability and function of the elbow.Reduction of pain.Improvement of range of motion. Indications Instability of elbow.Insufficiency of ulnar or radial collateral ligaments.Loss of the capsuloligamentous apparatus as seen after extensive resection of heterotopic ossifications involving ligaments and capsule. Contraindications Unfavorable skin condition.Local infection.Damage to or previous operation of triceps tendon. Surgical Technique Posterior, posterolateral or posteromedial approach. Dissection while always protecting the ulnar nerve. A neurolysis or a subcutaenous transposition may become necessary. Resection as complete as possible of ossifications and removal of ossified radial/ulnar capsuloligamentous apparatus.Exposure of the superficial fascia of triceps up to the olecranon. Harvesting of a fascial strip of the triceps 12 cm long and 1.5 cm wide on either the radial or ulnar side or both, left attached to the olecranon. Anatomic triangular reconstruction of the collateral ligaments with the fascial strip. Transosseous fixation. Wound closure in two layers. Results In five patients, aged 25–59 years, an open arthrolysis combined with an ulnar triceps fascioplasty was done. In one instance it was combined with radial fascioplasty and once with a reconstruction of the radial collateral ligament using the tendon of the palmaris longus.Average duration of follow-up 2.2 years (8 months to 4.4 years).Assessment criteria and results: Function: marked improvement. Subjective assessment: no instability. Joint stability: laxity of ulnar collateral ligament grade I in one patient. Pain. excellent pain reduction. Range of motion: marked increase.

Open reconstruction of the rotator cuff

Success rates relating to relief from pain and improved function following open reconstruction of the rotator cuff have been documented in many studies. At least for small to medium-size tears the question currently arises of whether an arthroscopic repair would not also give good treatment results. At present, however, the results of arthroscopic repair are not yet comparable to those yielded by the open techniques, at least in terms of recurrent defects especially in the case of massive tears (affecting more than two tendons). Open surgical repair is currently still recommended for all patients who require maximal postoperative function and strength and for elderly patients. Open repairs have a lower rate of re-rupture than arthroscopic repairs, but arthroscopic repair offers the benefits of lower morbidity. The decision on which technique is indicated should be made by an experienced surgeon with special training in this area and with due consideration for newer aspects in diagnostic imaging techniques, so as to avoid unsatisfactory results. In certain cases of irreparable cuff tears affecting two tendons and with fatty infiltration of the muscle and substantial loss of function muscle transfer can be considered in active patients; this can offer some functional improvement in the medium to long term, but do not lead to full restoration of function.

Offene Rekonstruktion der Rotatorenmanschette

Success rates relating to relief from pain and improved function following open reconstruction of the rotator cuff have been documented in many studies. At least for small to medium-size tears the question currently arises of whether an arthroscopic repair would not also give good treatment results. At present, however, the results of arthroscopic repair are not yet comparable to those yielded by the open techniques, at least in terms of recurrent defects especially in the case of massive tears (affecting more than two tendons). Open surgical repair is currently still recommended for all patients who require maximal postoperative function and strength and for elderly patients. Open repairs have a lower rate of re-rupture than arthroscopic repairs, but arthroscopic repair offers the benefits of lower morbidity. The decision on which technique is indicated should be made by an experienced surgeon with special training in this area and with due consideration for newer aspects in diagnostic imaging techniques, so as to avoid unsatisfactory results. In certain cases of irreparable cuff tears affecting two tendons and with fatty infiltration of the muscle and substantial loss of function muscle transfer can be considered in active patients; this can offer some functional improvement in the medium to long term, but do not lead to full restoration of function.

Die anatomisch präkonturierte Platte nach Meves

BACKGROUND Pseudarthroses of the clavicle after fractures of the medial third often present with local pain, compromised shoulder function, or neurovascular symptoms. Reconstruction of normal clavicular anatomy and solid fusion is a prerequisite for good clinical outcome after surgical treatment. In this study, 24 patients with clavicular pseudarthrosis were treated with the anatomical precontoured Meves plate. In 11 patients, additional bone grafting was done. METHOD Nineteen patients could be reexamined with a mean follow-up of 74.5 months. In all of them, solid fusion was achieved. RESULTS The Constant score improved from 70.4 points preoperatively up to 82.5 points postoperatively (89.3% age-related). Sixteen patients were satisfied or very satisfied with the operative result. CONCLUSION In our patients, secure healing of clavicular nonunion was achieved with the anatomical precontoured Meves plate, with good or excellent clinical outcomes.

Die anatomisch präkonturierte Platte nach Meves@@@The anatomical precontoured Meves compression plate: Operative Behandlung von Klavikulapseudarthrosen@@@Surgical treatment of clavicular nonunion

BACKGROUND Pseudarthroses of the clavicle after fractures of the medial third often present with local pain, compromised shoulder function, or neurovascular symptoms. Reconstruction of normal clavicular anatomy and solid fusion is a prerequisite for good clinical outcome after surgical treatment. In this study, 24 patients with clavicular pseudarthrosis were treated with the anatomical precontoured Meves plate. In 11 patients, additional bone grafting was done. METHOD Nineteen patients could be reexamined with a mean follow-up of 74.5 months. In all of them, solid fusion was achieved. RESULTS The Constant score improved from 70.4 points preoperatively up to 82.5 points postoperatively (89.3% age-related). Sixteen patients were satisfied or very satisfied with the operative result. CONCLUSION In our patients, secure healing of clavicular nonunion was achieved with the anatomical precontoured Meves plate, with good or excellent clinical outcomes.

Offene Rekonstruktion der Rotatorenmanschette@@@Open reconstruction of the rotator cuff

Success rates relating to relief from pain and improved function following open reconstruction of the rotator cuff have been documented in many studies. At least for small to medium-size tears the question currently arises of whether an arthroscopic repair would not also give good treatment results. At present, however, the results of arthroscopic repair are not yet comparable to those yielded by the open techniques, at least in terms of recurrent defects especially in the case of massive tears (affecting more than two tendons). Open surgical repair is currently still recommended for all patients who require maximal postoperative function and strength and for elderly patients. Open repairs have a lower rate of re-rupture than arthroscopic repairs, but arthroscopic repair offers the benefits of lower morbidity. The decision on which technique is indicated should be made by an experienced surgeon with special training in this area and with due consideration for newer aspects in diagnostic imaging techniques, so as to avoid unsatisfactory results. In certain cases of irreparable cuff tears affecting two tendons and with fatty infiltration of the muscle and substantial loss of function muscle transfer can be considered in active patients; this can offer some functional improvement in the medium to long term, but do not lead to full restoration of function.

Rotatorenmanschetten- und Weichteildefekte

Die Anerkennung einer Periarthritis humeroscapularis oder, der verbesserten Nomenklatur der DVSE folgend, eines subakromialen Schmerzsyndromes, wird derzeit in Deutschland sehr restriktiv gehandhabt. Dies hat historische Grunde, die einerseits in veralteten Vorstellungen zur Pathogenese wurzeln und andererseits aufgrund der Koinzidenz von Rotatorenmanschetten(=RM)- Defekten mit degenerativen HWS-Veranderungen im Rontgenbild eine neurogene Ursache [Reischauer 1949, Burkle de la Camp 1964] postulierten. Neuere Untersuchungen, insbesondere aus Skandinavien, England und den USA zur Inzidenz und Pravalenz dieser Symptomenkomplexe haben inzwischen einen Zusammenhang mit bestimmten Tatigkeiten belegt. Die Daten dieser Studien weisen darauf hin, dass die bisher geubte, auserst restriktive Haltung bei der Anerkennung von chronischen subakromialen Schmerzsyndromen (SAS) nicht mehr gerechtfertigt ist.