Raymond Best

Anterior knee pain after total knee arthroplasty: a narrative review

Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136)

PurposeThere is a lack of consensus regarding biomechanical effects of unloader braces for the treatment of medial osteoarthritis (OA) of the knee. The purpose of this study was to perform a systematic review of studies examining the biomechanical effect of unloader braces.MethodsA systematic search for articles about the biomechanical effect of unloader braces was performed. Primary outcome measure was the influence of the brace on the knee adduction moment. Data sources were Pubmed central and google scholar.ResultsTwenty-four articles were included. Twenty articles showed that valgus unloader braces significantly decrease the knee adduction moment. Seven of those studies reported a decrease of pain in braced patients (secondary outcome measure). Positive effects on the knee adduction moment could be found for custom made braces for conventional knee braces and for a foot ankle orthosis. Four studies could not show any effect of knee unloader braces on the knee adduction moment although one of these studies found decreased pain in braced patients. One of these studies examined healthy patients with a neutral axis.ConclusionThis systematic review could demonstrate evidence that unloader braces reduce the adduction moment of the knee. Foresighted, a systematic review about the clinical effect of unloader braces is required.

Residual Mechanical Effectiveness of External Ankle Tape Before and After Competitive Professional Soccer Performance

Objective:To evaluate the presupposed preventive residual mechanical effectiveness of the widespread use of adhesive elastic ankle tape after a nonlaboratory, realistic soccer-specific outfield intervention reflecting a soccer halftime. Design:A prospective nonrandomized test–retest design was used. Setting:Laboratory. Participants:Seventeen professional male outfield players (mean age, 25.5) without any signs of chronic ankle instability. Intervention:Participants were investigated before and after a 45-minute soccer-specific field intervention. Main Outcome Measures:The passive inversion range of motion (ROM) of the ankle was tested unloaded on a self-developed inversion device with and without a standardized ankle tape before and after the intervention. Additionally, electromyography signal was taken to assure the inactivity of the protective evertor muscles, and reliability tests for the inversion device (test–retest and trial to trial) were conducted in 12 healthy controls. Results:Tape restricted the maximum passive inversion ROM of the uninjured ankle significantly to 50.3%. The protection declined nearly completely after 45 minutes of outfield soccer performance to a negligible nonsignificant ROM restriction of 9.7%. Pearson correlation coefficient for the reliability was 0.931 (P ⩽ 0.001) for the test–retest and 0.983 (P ⩽ 0.001) for the trial-to-trial test. Conclusions:The initial significant protection of external ankle-tape support declines almost completely without relevant remaining residual mechanical effect after 45 minutes, reflecting a soccer halftime. The so far presupposed residual mechanical effectiveness of tape to prevent injury is increasingly irrelevant during soccer performance and consequently antidromic to the increasing injury risk toward the end of a soccer halftime.

Evidenz der Versorgung der akuten Syndesmosenverletzung im Sport

ZusammenfassungInsbesondere im Hochleistungsmannschaftssport stellt die Verletzung der unteren Syndesmose im Rahmen von Distorsionen des Sprunggelenks eine häufige Begleitverletzung dar. Während kleinere Partialrupturen der Syndesmose vor dem Hintergrund der symptomatisch oft eindrucksvollen Läsion des ventrolateralen Kapsel-Band-Apparats übersehen werden können, stellt die höhergradige Syndesmosenverletzung meist eine zweifelsfreie Diagnose dar. Weiterhin besteht Einigkeit bei der Notwendigkeit einer operativen Stabilisierung bei signifikant instabilen Situationen sowie der vorwiegend konservativen Behandlung kleinerer inkompletter Partialrupturen. Die größte Herausforderung in puncto Diagnostik, Quantifizierung und optimalem Therapieregime ergibt sich folglich bei kompletten Partialrupturen, welche zudem die häufigste Form der Sportassoziierten Syndesmosenverletzung darstellen. Der vorliegende Übersichtsartikel fasst daher die sportassoziierte Syndesmosenverletzung vor dem Hintergrund der aktuellen Literatur zusammen und beleuchtet diese von der Anatomie über die Pathobiomechanik, Therapie bis hin zur Therapie nach evidenzbasierten Kriterien.AbstractInjuries of the distal syndesmosis often accompany acute ankle sprains especially in professional team sports. While small partial syndesmosis lesions can often be missed as a consequence of impressive symptoms due to ventrolateral capsuloligamentous injuries, higher grade injuries of the syndesmosis can mostly be diagnosed without any problem. Furthermore, there is a consensus concerning the necessity of operative treatment in significantly unstable situations as well concerning conservative treatment of incomplete partial lesions. Consequently, the greatest challenge regarding diagnostic tools, quantification and optimal therapy arises in the most common form of sport-associated, complete or partial lesions of the distal syndesmosis. This review article summarizes sports-associated injuries of the distal tibiofibular syndesmosis considering the current literature and placing the emphasis on the anatomy, pathobiomechanics, diagnostics and therapy of syndesmosis lesions from an evidence-based viewpoint.Injuries of the distal syndesmosis often accompany acute ankle sprains especially in professional team sports. While small partial syndesmosis lesions can often be missed as a consequence of impressive symptoms due to ventrolateral capsuloligamentous injuries, higher grade injuries of the syndesmosis can mostly be diagnosed without any problem. Furthermore, there is a consensus concerning the necessity of operative treatment in significantly unstable situations as well concerning conservative treatment of incomplete partial lesions. Consequently, the greatest challenge regarding diagnostic tools, quantification and optimal therapy arises in the most common form of sport-associated, complete or partial lesions of the distal syndesmosis. This review article summarizes sports-associated injuries of the distal tibiofibular syndesmosis considering the current literature and placing the emphasis on the anatomy, pathobiomechanics, diagnostics and therapy of syndesmosis lesions from an evidence-based viewpoint.

Aktuelle Behandlungskonzepte bei Muskelverletzungen

Muscular lesions represent the most common form of sports injury. The four large muscle groups hamstrings, adductors, gastrocnemius and knee extensor muscles are most often affected. Most injuries occur during excentric tension impact. Diagnostics begin with an exact medical history and detailed clinical investigations. Imaging with ultrasound and magnetic resonance imaging (MRI) are important to differentiate between structural lesions and functional disorders and to determine the extent of the injury. Most frequently treatment remains conservative and is oriented to the three phases of the healing process. In most cases (leisure sports) the rest, ice, compression and elevation (RICE) concept with subsequent pain-adapted load increase suffices for a return to sport activities. Infiltration therapy including platelet-rich plasma (PRP) is an additional therapy option but should not be used to accelerate the healing process. Surgical treatment only rarely becomes necessary for treatment of muscular injuries.ZusammenfassungMuskelverletzungen stellen die häufigste Sportverletzung dar. Die 4 großen Muskelgruppen (Hamstrings, Adduktoren, Gastrocnemius und die Kniestrecker) stehen hier im Mittelpunkt der Behandlung. Meist handelt es sich um akute Verletzungen, die durch exzentrische Krafteinwirkungen entstehen. Die Diagnose beginnt mit einer genauen Anamneseerhebung des Traumas, gefolgt von einer exakten klinischen Untersuchung. Die Bildgebung mit Sonographie und Magnetresonanztomographie (MRT) stellt einen wichtigen Baustein in der Diagnostik dar, mit dem Ziel, die strukturelle Verletzung von der funktionellen Störung zu unterscheiden und das Ausmaß der Verletzung festzustellen. Die häufigste Therapieoption in der Behandlung der Muskelverletzung stellt die konservative Therapie dar und orientiert sich an den Phasen der Muskelheilung. In vielen Fällen (Freizeitsport) reicht eine konservative Therapie nach dem RICE-Prinzip mit nachfolgender beschwerdeabhängiger Aufbelastung aus, um die Rückkehr zum Sport zu gewährleisten. Die Infiltrationstherapie einschließlich Platet-rich-Plasma (PRP) kann eine Therapieoption darstellen, soll aber nicht zur Beschleunigung des Heilungsprozesses eingesetzt werden. Die operative Versorgung von Muskelverletzungen ist seltenen Indikationen vorbehalten.AbstractMuscular lesions represent the most common form of sports injury. The four large muscle groups hamstrings, adductors, gastrocnemius and knee extensor muscles are most often affected. Most injuries occur during excentric tension impact. Diagnostics begin with an exact medical history and detailed clinical investigations. Imaging with ultrasound and magnetic resonance imaging (MRI) are important to differentiate between structural lesions and functional disorders and to determine the extent of the injury. Most frequently treatment remains conservative and is oriented to the three phases of the healing process. In most cases (leisure sports) the rest, ice, compression and elevation (RICE) concept with subsequent pain-adapted load increase suffices for a return to sport activities. Infiltration therapy including platelet-rich plasma (PRP) is an additional therapy option but should not be used to accelerate the healing process. Surgical treatment only rarely becomes necessary for treatment of muscular injuries.

Current treatment concepts for muscular injuries

Muscular lesions represent the most common form of sports injury. The four large muscle groups hamstrings, adductors, gastrocnemius and knee extensor muscles are most often affected. Most injuries occur during excentric tension impact. Diagnostics begin with an exact medical history and detailed clinical investigations. Imaging with ultrasound and magnetic resonance imaging (MRI) are important to differentiate between structural lesions and functional disorders and to determine the extent of the injury. Most frequently treatment remains conservative and is oriented to the three phases of the healing process. In most cases (leisure sports) the rest, ice, compression and elevation (RICE) concept with subsequent pain-adapted load increase suffices for a return to sport activities. Infiltration therapy including platelet-rich plasma (PRP) is an additional therapy option but should not be used to accelerate the healing process. Surgical treatment only rarely becomes necessary for treatment of muscular injuries.ZusammenfassungMuskelverletzungen stellen die häufigste Sportverletzung dar. Die 4 großen Muskelgruppen (Hamstrings, Adduktoren, Gastrocnemius und die Kniestrecker) stehen hier im Mittelpunkt der Behandlung. Meist handelt es sich um akute Verletzungen, die durch exzentrische Krafteinwirkungen entstehen. Die Diagnose beginnt mit einer genauen Anamneseerhebung des Traumas, gefolgt von einer exakten klinischen Untersuchung. Die Bildgebung mit Sonographie und Magnetresonanztomographie (MRT) stellt einen wichtigen Baustein in der Diagnostik dar, mit dem Ziel, die strukturelle Verletzung von der funktionellen Störung zu unterscheiden und das Ausmaß der Verletzung festzustellen. Die häufigste Therapieoption in der Behandlung der Muskelverletzung stellt die konservative Therapie dar und orientiert sich an den Phasen der Muskelheilung. In vielen Fällen (Freizeitsport) reicht eine konservative Therapie nach dem RICE-Prinzip mit nachfolgender beschwerdeabhängiger Aufbelastung aus, um die Rückkehr zum Sport zu gewährleisten. Die Infiltrationstherapie einschließlich Platet-rich-Plasma (PRP) kann eine Therapieoption darstellen, soll aber nicht zur Beschleunigung des Heilungsprozesses eingesetzt werden. Die operative Versorgung von Muskelverletzungen ist seltenen Indikationen vorbehalten.AbstractMuscular lesions represent the most common form of sports injury. The four large muscle groups hamstrings, adductors, gastrocnemius and knee extensor muscles are most often affected. Most injuries occur during excentric tension impact. Diagnostics begin with an exact medical history and detailed clinical investigations. Imaging with ultrasound and magnetic resonance imaging (MRI) are important to differentiate between structural lesions and functional disorders and to determine the extent of the injury. Most frequently treatment remains conservative and is oriented to the three phases of the healing process. In most cases (leisure sports) the rest, ice, compression and elevation (RICE) concept with subsequent pain-adapted load increase suffices for a return to sport activities. Infiltration therapy including platelet-rich plasma (PRP) is an additional therapy option but should not be used to accelerate the healing process. Surgical treatment only rarely becomes necessary for treatment of muscular injuries.

Evidence for treatment of acute syndesmosis injuries in sports

ZusammenfassungInsbesondere im Hochleistungsmannschaftssport stellt die Verletzung der unteren Syndesmose im Rahmen von Distorsionen des Sprunggelenks eine häufige Begleitverletzung dar. Während kleinere Partialrupturen der Syndesmose vor dem Hintergrund der symptomatisch oft eindrucksvollen Läsion des ventrolateralen Kapsel-Band-Apparats übersehen werden können, stellt die höhergradige Syndesmosenverletzung meist eine zweifelsfreie Diagnose dar. Weiterhin besteht Einigkeit bei der Notwendigkeit einer operativen Stabilisierung bei signifikant instabilen Situationen sowie der vorwiegend konservativen Behandlung kleinerer inkompletter Partialrupturen. Die größte Herausforderung in puncto Diagnostik, Quantifizierung und optimalem Therapieregime ergibt sich folglich bei kompletten Partialrupturen, welche zudem die häufigste Form der Sportassoziierten Syndesmosenverletzung darstellen. Der vorliegende Übersichtsartikel fasst daher die sportassoziierte Syndesmosenverletzung vor dem Hintergrund der aktuellen Literatur zusammen und beleuchtet diese von der Anatomie über die Pathobiomechanik, Therapie bis hin zur Therapie nach evidenzbasierten Kriterien.AbstractInjuries of the distal syndesmosis often accompany acute ankle sprains especially in professional team sports. While small partial syndesmosis lesions can often be missed as a consequence of impressive symptoms due to ventrolateral capsuloligamentous injuries, higher grade injuries of the syndesmosis can mostly be diagnosed without any problem. Furthermore, there is a consensus concerning the necessity of operative treatment in significantly unstable situations as well concerning conservative treatment of incomplete partial lesions. Consequently, the greatest challenge regarding diagnostic tools, quantification and optimal therapy arises in the most common form of sport-associated, complete or partial lesions of the distal syndesmosis. This review article summarizes sports-associated injuries of the distal tibiofibular syndesmosis considering the current literature and placing the emphasis on the anatomy, pathobiomechanics, diagnostics and therapy of syndesmosis lesions from an evidence-based viewpoint.Injuries of the distal syndesmosis often accompany acute ankle sprains especially in professional team sports. While small partial syndesmosis lesions can often be missed as a consequence of impressive symptoms due to ventrolateral capsuloligamentous injuries, higher grade injuries of the syndesmosis can mostly be diagnosed without any problem. Furthermore, there is a consensus concerning the necessity of operative treatment in significantly unstable situations as well concerning conservative treatment of incomplete partial lesions. Consequently, the greatest challenge regarding diagnostic tools, quantification and optimal therapy arises in the most common form of sport-associated, complete or partial lesions of the distal syndesmosis. This review article summarizes sports-associated injuries of the distal tibiofibular syndesmosis considering the current literature and placing the emphasis on the anatomy, pathobiomechanics, diagnostics and therapy of syndesmosis lesions from an evidence-based viewpoint.

Evidenz der Versorgung der akuten Syndesmosenverletzung im Sport@@@Evidence for treatment of acute syndesmosis injuries in sports

ZusammenfassungInsbesondere im Hochleistungsmannschaftssport stellt die Verletzung der unteren Syndesmose im Rahmen von Distorsionen des Sprunggelenks eine häufige Begleitverletzung dar. Während kleinere Partialrupturen der Syndesmose vor dem Hintergrund der symptomatisch oft eindrucksvollen Läsion des ventrolateralen Kapsel-Band-Apparats übersehen werden können, stellt die höhergradige Syndesmosenverletzung meist eine zweifelsfreie Diagnose dar. Weiterhin besteht Einigkeit bei der Notwendigkeit einer operativen Stabilisierung bei signifikant instabilen Situationen sowie der vorwiegend konservativen Behandlung kleinerer inkompletter Partialrupturen. Die größte Herausforderung in puncto Diagnostik, Quantifizierung und optimalem Therapieregime ergibt sich folglich bei kompletten Partialrupturen, welche zudem die häufigste Form der Sportassoziierten Syndesmosenverletzung darstellen. Der vorliegende Übersichtsartikel fasst daher die sportassoziierte Syndesmosenverletzung vor dem Hintergrund der aktuellen Literatur zusammen und beleuchtet diese von der Anatomie über die Pathobiomechanik, Therapie bis hin zur Therapie nach evidenzbasierten Kriterien.AbstractInjuries of the distal syndesmosis often accompany acute ankle sprains especially in professional team sports. While small partial syndesmosis lesions can often be missed as a consequence of impressive symptoms due to ventrolateral capsuloligamentous injuries, higher grade injuries of the syndesmosis can mostly be diagnosed without any problem. Furthermore, there is a consensus concerning the necessity of operative treatment in significantly unstable situations as well concerning conservative treatment of incomplete partial lesions. Consequently, the greatest challenge regarding diagnostic tools, quantification and optimal therapy arises in the most common form of sport-associated, complete or partial lesions of the distal syndesmosis. This review article summarizes sports-associated injuries of the distal tibiofibular syndesmosis considering the current literature and placing the emphasis on the anatomy, pathobiomechanics, diagnostics and therapy of syndesmosis lesions from an evidence-based viewpoint.Injuries of the distal syndesmosis often accompany acute ankle sprains especially in professional team sports. While small partial syndesmosis lesions can often be missed as a consequence of impressive symptoms due to ventrolateral capsuloligamentous injuries, higher grade injuries of the syndesmosis can mostly be diagnosed without any problem. Furthermore, there is a consensus concerning the necessity of operative treatment in significantly unstable situations as well concerning conservative treatment of incomplete partial lesions. Consequently, the greatest challenge regarding diagnostic tools, quantification and optimal therapy arises in the most common form of sport-associated, complete or partial lesions of the distal syndesmosis. This review article summarizes sports-associated injuries of the distal tibiofibular syndesmosis considering the current literature and placing the emphasis on the anatomy, pathobiomechanics, diagnostics and therapy of syndesmosis lesions from an evidence-based viewpoint.

Aktuelle Behandlungskonzepte bei Muskelverletzungen@@@Current treatment concepts for muscular injuries

Muscular lesions represent the most common form of sports injury. The four large muscle groups hamstrings, adductors, gastrocnemius and knee extensor muscles are most often affected. Most injuries occur during excentric tension impact. Diagnostics begin with an exact medical history and detailed clinical investigations. Imaging with ultrasound and magnetic resonance imaging (MRI) are important to differentiate between structural lesions and functional disorders and to determine the extent of the injury. Most frequently treatment remains conservative and is oriented to the three phases of the healing process. In most cases (leisure sports) the rest, ice, compression and elevation (RICE) concept with subsequent pain-adapted load increase suffices for a return to sport activities. Infiltration therapy including platelet-rich plasma (PRP) is an additional therapy option but should not be used to accelerate the healing process. Surgical treatment only rarely becomes necessary for treatment of muscular injuries.ZusammenfassungMuskelverletzungen stellen die häufigste Sportverletzung dar. Die 4 großen Muskelgruppen (Hamstrings, Adduktoren, Gastrocnemius und die Kniestrecker) stehen hier im Mittelpunkt der Behandlung. Meist handelt es sich um akute Verletzungen, die durch exzentrische Krafteinwirkungen entstehen. Die Diagnose beginnt mit einer genauen Anamneseerhebung des Traumas, gefolgt von einer exakten klinischen Untersuchung. Die Bildgebung mit Sonographie und Magnetresonanztomographie (MRT) stellt einen wichtigen Baustein in der Diagnostik dar, mit dem Ziel, die strukturelle Verletzung von der funktionellen Störung zu unterscheiden und das Ausmaß der Verletzung festzustellen. Die häufigste Therapieoption in der Behandlung der Muskelverletzung stellt die konservative Therapie dar und orientiert sich an den Phasen der Muskelheilung. In vielen Fällen (Freizeitsport) reicht eine konservative Therapie nach dem RICE-Prinzip mit nachfolgender beschwerdeabhängiger Aufbelastung aus, um die Rückkehr zum Sport zu gewährleisten. Die Infiltrationstherapie einschließlich Platet-rich-Plasma (PRP) kann eine Therapieoption darstellen, soll aber nicht zur Beschleunigung des Heilungsprozesses eingesetzt werden. Die operative Versorgung von Muskelverletzungen ist seltenen Indikationen vorbehalten.AbstractMuscular lesions represent the most common form of sports injury. The four large muscle groups hamstrings, adductors, gastrocnemius and knee extensor muscles are most often affected. Most injuries occur during excentric tension impact. Diagnostics begin with an exact medical history and detailed clinical investigations. Imaging with ultrasound and magnetic resonance imaging (MRI) are important to differentiate between structural lesions and functional disorders and to determine the extent of the injury. Most frequently treatment remains conservative and is oriented to the three phases of the healing process. In most cases (leisure sports) the rest, ice, compression and elevation (RICE) concept with subsequent pain-adapted load increase suffices for a return to sport activities. Infiltration therapy including platelet-rich plasma (PRP) is an additional therapy option but should not be used to accelerate the healing process. Surgical treatment only rarely becomes necessary for treatment of muscular injuries.