Die Meniskusverletzungen des Kniegelenks

Ohne Zusammenfassung     

Die Spontanverkalkungen der Menisken des Kniegelenks

Langenbeck's Archives of Surgery - Bericht von 7 Fällen von spontaner Meniscusverkalkung unter 3500 Knieaufnahmen. Zusammenstellung der bisher veröffentlichten 45 Fälle des...     

Die Arthrolyse bei chronischen Beugedefiziten des Kniegelenks

AIM AND METHOD: Limitations to the range of motion of the knee reduce knee function and life quality. Flexion deficits inhibit using stairs and shoe closure, and may cause social deprivation. We present a pathophysiological concept of arthrolysis of the knee for flexion deficit. Our concept divides into intra- and extra-articular factors involving knee stiffness. Extra-articular problems can be located proximally in the quadriceps mechanism and distally in the patellar tendon. RESULTS: The main proximal factor is fibrosis of the vastus intermedius muscle (MVI) which is treated by MVI-resection; the main distal factor is shortening of the patellar tendon which is treated by z-plasty of the this tendon or transposition of the tibial tuberosity. Intra-articular factors are adhesions and fat pad fibrosis. These conditions can be treated by arthroscopic or limited open arthrolysis and eventually z-plasty of the retinacula. CONCLUSION: A strict postoperative protocol is obligatory for pain control and physiotherapy. In 19 cases treated with this algorithm there was a mean flexion gain of 26 degrees. The AOSSM subjective outcome score was excellent in ten and good in seven cases after a mean follow-up of 8.2 months. This treatment protocol allows improvement in flexion, even in difficult revision cases.     

Die posttraumatische Dystrophie

Background

Posttraumatic dystrophy manifests as signs and symptoms of endothelial dysfunction in the microcirculation with pronounced involvement of arteriovenous (AV) anastomosis.

Patients and methods

Blood gas analysis was performed in 28 patients with persistent painful swelling 6-14 weeks after distal radius fracture or hand injury. The patients showed higher levels of venous oxygenation on the affected side in comparison to the contralateral arm. Furthermore, an increased perfusion and an AV shunt situation were proven by radionuclide angiography. These findings correlate with insufficient oxygen utilization by the tissue (dystrophy = capillary malperfusion). Pathophysiologically, complex processes must be assumed which require a multimodal therapy and treatment focuses on open AV shunts.

Results

The disastrous consequences of hand dystrophy (loss of function due to fibrosis) could be prevented in all patients. Statistical analyses between affected and normal hands showed significant differences.

Conclusion

Posttraumatic dystrophy needs early detection for successful therapy and should not be identified under the umbrella term “complex regional pain syndrome” (CRPS).     

Die konservative Behandlung der Einrisse des inneren Seitenbandes des Kniegelenks

Ohne Zusammenfassung     

Die Sudecksche posttraumatische Knochendystrophie im Kriege

Ohne Zusammenfassung Mit 5 Textabbildungen (7 Einzelbidern)     

Drehtrauma des Kniegelenks

Torsion fractures of the knee are frequently followed by injuries of the internal structures of the knee joint. The attendant physician is required to follow a course of investigation that combines a secure diagnosis with what is economically viable. The most important elements of this are the case history and the clinical examination, which, together with plain radiographs (knee a-p and lateral views, patella tangential view), often allows a clear clinical diagnosis and planning of further therapy. If the clinical diagnosis is not clear, in MRI investigation we now have a method available that allows highly accurate recognition of menisceal ruptures and lesions of the cruciate ligament lesions and of cartilage. It can make a decisive contribution to reducing the number of purely diagnostic arthroscopies performed and thus to cost reduction. The procedure followed for spiral injury to the knee joint is a classic illustration of how diagnostic algorithms can make a contribution to the quality of treatment outcome while economic aspects are taken account of at the same time.     

Die Quadrizepsplastik nach Judet zur Therapie der myogenen Extensionskontraktur des Kniegelenks

Objective

Knee flexion is increased by detachment of contracted quadriceps muscle from the pelvis and femur in combination with arthrolysis of the knee.

Indications

Flexion contracture of the knee caused by extraarticular changes of quadriceps muscle (fibrosis, soft-tissue damage, infection, fracture). Failed intraarticular arthrolysis. Intraarticular treatment insufficient.

Contraindications

Isolated intraarticular fibrosis of the knee. Infection of the knee or the soft tissues. Soft tissue defects in the area of the incision. Noncompliance of patient. Neurologic reasons for flexion contracture.

Surgical technique

Medial arthrotomy. Arthrolysis and resection of adhesions in the superior recess and lateral gutters. Incision of retinaculae preparing a lengthening. The vastus medialis muscle is dissected from the intermuscular septum from distal to proximal. The proximal third of the muscle is spared. The incision is now extended proximally and laterally. The vastus lateralis muscle is released from the intermuscular septum from distal to proximal. The insertion of vastus lateralis muscle is detached at the proximal femur. The conjoint tendons of rectus femoris muscle are released at the anterior inferior iliac spine. The knee is gradually flexed, residual adhesions are addressed. The proximal part of the vastus medialis has to be preserved since it covers the neurovascular supply of the quadriceps muscle. The knee is closed in flexion. The retinaculae are adapted as far as possible. Soft tissues and skin are closed in layers.

Postoperative management

The patient in placed on a continuous passive motion device for 7 days under peridural anesthesia. Partial weight bearing with crutches is advised for 6 weeks, quadriceps training is started early to treat the active extension deficit.

Results

Our results reveal that operative treatment of complex flexion deficits lead to objective and subjective improvements. After 8.2 months, 17 of 19 patients had a mean gain of flexion of 26°. Subjectively 10 patients were highly satisfied and 7 were satisfied after operative treatment.     

Die klinische Anwendung der Bandfixationsplatte am Beispiel von Seitenbandrupturen des Kniegelenks

Operationsprinzip Refixation von kn?chernen und knochennahen Bandausrissen der Kollateralb?nder des Kniegelenks in anatomischer Position mit Hilfe einer speziellen Ein-Loch-Fixationsplatte.      

Kapsel-Band-Verletzung des Kniegelenks

The first step in rehabilitation is to analyze of the cause of the trauma. A rehabilitation schedule that is oriented to individual wound healing stages must be used. The rehabilitation-tree analyses the basic physical qualities that have to be established and optimized at the end of rehabilitation. Speed, strength and endurance are the essential requirements for athletic or physical performance. These individual components are assembled algothithmically in the rehabilitation-tree. If a defined level of performance is not reached, rehabilitation will not proceeded to the following level. In order to control rehabilitation, orthopedic, clinical-dynamic performance diagnostics are used. These include evaluation of mobility and strength-endurance ability using barbells and, at a later stage, the evaluation of jumping ability. Such examinations can be used to evaluate the general physical performance of traumatized athletes during rehabilitation and their athletic ability at the end of rehabilitation. Controlled clinical trials are necessary to assess dynamic performance diagnostics so that standard methods can be evaluated. Standardized dynamic performance diagnostics should also be developed to aid prevention by identifying individual risk factors and further develop scientifically testable prevention programs.     

Bandverletzungen des Kniegelenks

Trauma und Berufskrankheit - Das vordere Kreuzband (VKB) besteht aus 2 funktionellen, in unterschiedlichen Gelenkstellungen gespannten Bündeln. Es stabilisiert gegen die anteriore tibiale...