Oliver Miltner

Klinische Drei-Jahres-Ergebnisse der matrixgekoppelten ACT zur Behandlung osteochondraler Defekte am Kniegelenk

AIM The aim of this study was to examine the clinical results after the treatment of osteochondral defects of the knee with autologous bone grafting and matrix-supported autologous chondrocyte transplantation (ACT). METHOD In this study 13 patients with osteochondral defects of the knee (12 femoral, 1 tibial) with OCD ICRS grade IV or ICRS grade IV B were included. The osteochondral defects were reconstructed simultaneously with autologous monocortical cancellous bone cylinders or chips from cancellous bone and matrix-supported autologous chondrocyte transplantation (CaReS). Data were analysed in accordance with the ICRS criteria and the Brittberg score. Patients were followed up to 36 months after the operation. RESULTS The average age of the patients was 34.9 (16 - 47) years at the time of surgery. The size of the defect was 8.1 (3.8 - 13.5) cm(2). The subjective and objective IKDC scores, the Brittberg and the ICRS function score were statistically significantly improved during the observation time. In one patient the transplantation failed and another patient was not available for the follow-up at 36 months. The objective IKDC score and the ICRS function score increased from 0/13 (0 %) to 11/12 (91.7 %) in categories A and B, or I and II, respectively, after 3 years. At this point of time 83.4 % (10/12) of the patients voted the treatment as excellent or good. The subjective IKDC score improved from 38.4 (+/- 12.7) preoperatively to 66.1 (+/- 17.0) after 3 years. CONCLUSION The treatment of osteochondral defects of the knee with autologous bone grafting and matrix-supported autologous chondrocyte transplantation shows promising results even for larger defects. But for a final decision about this therapy the present sample size was too small. There is a need for further long-term investigation with a larger number of patients.

Perioperatives Management in der ambulanten arthroskopischen Chirurgie des Kniegelenks

AIM Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluate the current standards of perioperative management following outpatient arthroscopic surgery of the knee in Germany. METHODS A questionnaire consisting of 18 questions was sent to 215 members of the German Association of Outpatient Arthroscopy (BVASK e. V.), dealing with the following topics: antibiotic prophylaxis, DVT prophylaxis, use of a tourniquet and suction drain, physical therapy, physiotherapy, analgesia, anaesthesia and emergency management. More than 51% of the forms were returned and considered suitable for statistical analysis. RESULTS A total of 62% of the surgeons reported the use of an antibiotic prophylaxis (i. v. single shot) in every arthroscopic case, while 19% administer antibiotics only occasionally, especially in ACL reconstruction. Postoperative antibiotic treatment was reserved for special situations, such as prior joint infection. Prophylaxis of DVT by means of low molecular weight heparin was carried out in 96% of the cases. 51% prescribed anticoagulant agents for 1 week, 39% for the duration of reduced weight bearing. Half of the surgeons used a tourniquet cuff, 22% exsanguinate the limb prior to cuff inflation. A suction drainage was applied by 36% of the surgeons regularly and by 45% occasionally. The drain is left for one day by 79% of the surgeons, while 11% reported a shortened use of only several hours. With regard to analgesia, 66% of all surgeons apply some kind of local anaesthetic into the knee joint post surgery. Systemic preoperative analgesics or anti-inflammatory agents are given regularly in 56 % of the cases. A total of 92% of the procedures are carried out under general anaesthesia. In 36% of the cases, some kind of additional regional peripheral anaesthesia is used. With regard to postoperative care, cryotherapy is considered standard (97%) and 64% of the surgeons recommend physiotherapy. Nearly all surgeons (97%) offer the patients the opportunity to reach them personally via mobile phone during the first night following arthroscopic surgery. CONCLUSIONS DVT prophylaxis with LMWH, general anaesthesia, postoperative cryotherapy and personal availability by phone can be considered part of the standard perioperative management following outpatient knee arthroscopy in Germany. However, a wide variety of treatment options can be found regarding topics such as analgesia, antibiotic prophylaxis, tourniquet, knee drainage and physiotherapy.

Procalcitonin (PCT) als Verlaufsparameter der Spondylodiszitis

AIM The diagnosis of spondylodiscitis is often prolonged, but it is an important differential diagnosis of backache. The discrimination between a bacterial infection and an aseptic inflammation with laboratory examinations like ESG, CRP or leukocytes is not possible. The aim of the present study was to determine the value of procalcitonin (PCT) as a diagnostic tool and monitoring parameter for spondylodiscitis and for the discrimination between bacterial infection and aseptic inflammation of the spine. METHOD A total of 17 patients with spondylodiscitis and 18 patients with disc herniation as control were included in this study and ESG, CRP, leukocytes, fibrinogen, PNM elastase und PCT were examined for 50 days. The median age was 65 (17-78) years and the ratio of males to females was 8 : 9 in patients with spondylodiscitis and 62 (32-87) years and 7 : 11 in patients with disc herniation. For microbiological examination, CT-guided punctures were performed in patients with spondylodiscitis. RESULTS In 64 % of the 17 patients with spondylodiscitis a microbiological agent was detected, in 73 % of these cases staphylococcus aureus was isolated. The laboratory parameters indicating an infection were increased except for two cases in patients with spondylodiscitis, the mean value of CRP was 115 mg/dL. Influenced by the therapy these parameters decreased during the observation period. Except for one patient with an infection of a cardiac pacemaker, the PCT concentration was not elevated in both groups (< 0.5 ng/mL). In the group with disc herniation there were no elevated laboratory parameters during the entire observation period. CONCLUSION PCT is not useful as diagnostic tool or monitoring parameter for spondylodiscitis. Furthermore, it is not useful for the discrimination between a bacterial infection and an aseptic inflammation of the spine.

Prävention von Verletzungen – Review zu Strategien und Evidenz

Injury prevention becomes increasingly important. Essential precondition for this is an understanding of risk factors and injury mechanisms. Prevention strategies aim to modify intrinsic and extrinsic factors. Extrinsic factors, i.e. external conditions or rules can only be modified in parts and effectiveness is not yet proven. Intrinsic factors aim particularly to changeovers of problematic movements by prevention programs. There is moderate evidence that prevention programs based on neuromuscular training can reduce the injury rate. Most effective component is plyometrics with high intensity. The integration of prevention programs in training is recommended.

Prevention of injuries – Review on Strategies and Evidence

Injury prevention becomes increasingly important. Essential precondition for this is an understanding of risk factors and injury mechanisms. Prevention strategies aim to modify intrinsic and extrinsic factors. Extrinsic factors, i.e. external conditions or rules can only be modified in parts and effectiveness is not yet proven. Intrinsic factors aim particularly to changeovers of problematic movements by prevention programs. There is moderate evidence that prevention programs based on neuromuscular training can reduce the injury rate. Most effective component is plyometrics with high intensity. The integration of prevention programs in training is recommended.

ReviewPrävention von Verletzungen – Review zu Strategien und EvidenzPrevention of injuries – Review on Strategies and Evidence

Injury prevention becomes increasingly important. Essential precondition for this is an understanding of risk factors and injury mechanisms. Prevention strategies aim to modify intrinsic and extrinsic factors. Extrinsic factors, i.e. external conditions or rules can only be modified in parts and effectiveness is not yet proven. Intrinsic factors aim particularly to changeovers of problematic movements by prevention programs. There is moderate evidence that prevention programs based on neuromuscular training can reduce the injury rate. Most effective component is plyometrics with high intensity. The integration of prevention programs in training is recommended.

Injury rates of the German Women's American Football National Team from 2009 to 2011

American football is one of the leading causes of athletic-related injuries. Injury rates in female elite players are mostly unknown. We hypothesized that the injury rates of female was comparable to those in mens football during practice, as well as games. From 2009 to 2011, injury data were collected from the German female national team during training camps, World Championship 2010 and International friendly matches. The injury was categorized by location on the body and recorded as fracture/dislocation, strain, concussion, contusion or other injury. Injury rates were determined based on the exposure of an athlete to a game or practice event. The injury rate was calculated as the ratio of injuries per 1000 athlete exposures (AE). The rate of injury was significantly higher during games (58.8/1000 AE) than practices [16.3/1000 AE, (P<0.01)]. Furthermore, the injury rate in the tryouts was significantly higher (24.05/1000 AE) compared to other training sessions with the national team (11.24/1000 AE). Our findings show that the injury rates in female elite American football players can be compared to those described for male players. Higher injury rates during matches than in training should also be underlined.

ÜBERKOPFSPORTARTEN: Wurfsportarten in der Leichtathletik

Zusammenfassung Es finden sich akute Muskelverletzungen im Bereich der Huftadduktoren und akute Muskel- und Sehnenverletzungen im Bereich der Schultergurtelmuskulatur. Beim Werfen finden sich Uberlastungssyndrome der capsulo-labro-ligamentaren Strukturen, primare und sekundare Instabilitaten, akut traumatische Instabilitaten und das postero-superiore Glenoidimpingement.

CASE REPORT: Fraktur des Os triquetrum bei einem jugendlichen Fußballtorwart

Zusammenfassung Die Fraktur des Os triquetrum ist eine seltene Verletzung. Sie entsteht in der Regel durch einen Sturz auf die dorsal extendierte Hand. Hierbei kommt es haufig zu einer dorsalen Kantenfraktur und selten zu einer Corpusfraktur. Wir berichten uber einen 15-jahrigen Fusballtorwart, bei dem ein ungewohnlicher Verletzungsmechanismus, namlich der Anprall eines Fusballes beim Abwehren, zu einer isolierten, nicht dislozierten Triquetrumcorpusfraktur gefuhrt hat. Die Diagnose wurde erst durch die MRT gestellt. Durch konservative Therapie mittels Gipsruhigstellung kam es zur Frakturausheilung und vollstandigen Wiederherstellung der sportlichen Leistungsfahigkeit.