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.     

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...     

Revisionsendoprothetik des Kniegelenks

Recognizing the rising number of primary total knee arthroplasties (TKA) over the last decade, one may assume an increasing number for revisions after a certain time delay. Studies showing a rate of only 78% satisfied patients provide a hint that there is still room for improvement. Therefore, it seemed worthwhile to evaluate the benefits of the computer assisted technique in revision TKA and compare the alignment results with the conventional technique.In a prospective study, 120 patients were operated for revision TKA using either the Vector-Vision navigation system (n=60) or the conventional technique (n=60). The axial limb alignment was evaluated on standardized pre- and postoperative full length weight-bearing radiographs and the variation of the joint line was determined by the method of Figgie from 1986.A precise reconstruction of the mechanical limb axis was achieved in 57/60 Patients (95%) in the computer assisted group and in 48/60 (80%) in the conventional group. A reconstruction of the joint line with a variation of less then 4 mm was achieved in 47/60 (78%) in the computer assisted and in 33/60 (55%) in the conventional group.Revision TKA remains a challenging procedure for the surgeon. Modern navigation systems offer additional information intraoperatively and might therefore simplify the procedure. In particular, the adjustment of the extension and flexion gap and the reconstruction of the joint line the results were superior. Furthermore, the use of a CT-free navigation system provides a significant improvement of prosthesis and leg alignment in revision TKA.     

Die Meniskusverletzungen des Kniegelenks

Ohne Zusammenfassung     

Diabetisch-neuropathische Osteoarthropathie des Kniegelenks

Since the clinical entity of diabetic neuropathic osteoarthropathy has become known as a possible complication of the diabetic foot syndrome, the number of cases reported in the literature has increased. Up to 50 cases worldwide have been described since 1970 although the number of unknown cases is likely much higher. This dreaded complication poses a difficult challenge for the orthopedic surgeon. Reports on long-term results seem to show that surgical intervention is a relative indication. This contribution describes a case of acute neuro-osteoarthropathy of the knee joint and subsequent successful conservative management after an unsuccessful osteosynthesis. In addition, the literature published since 1970 dealing with this rare complication is examined and critically discussed.     

Zur Pathologie des Kniegelenks

Ohne Zusammenfassung Eine erg?nzende Mittheilung über die Druckverh?ltnisse im Kniegelenk wird noch weiter folgen.     

Verletzungen des kindlichen Kniegelenks

Injuries to bones and joints in skeletally immature patients are found in increasing numbers in specialised hospitals. The incidence of injuries of the knee and their consequences, in particular, is often underestimated. Clinical examination and even modern imaging techniques, such as MRI, often do not allow appreciation of the true extent of the lesions. If we assume that haemarthrosis is the main symptom, most lesions of the knee are intra-articular lesions requiring arthroscopic or open surgery. In the period from 1 January 2000 to 31 October 2001, 121 children and adolescents underwent operations to treat knee injuries in the traumatology department of the Berufsgenossenschaftliche Unfallklinik Ludwigshafen. The most common lesions were rupture of the anterior cruciate ligament and patellar dislocation. The purpose of this study is to compare the principles of treatment followed in our hospital and compare them with those detailed in the current literature.     

Die Sudecksche Dystrophie des Kniegelenks

Zusammenfassung Die Arbeit stützt sich auf die Auswertung von 59 Kniegelenksdystrophien verschiedener Ätiologie. Das Gliedmaßensyndrom nach Frakturen, Luxationen und anderen schweren Verletzungen blieb unberücksichtigt, unbekanntere Sudeckursachen wie leichtere Traumen, unspezifische Synovitiden Polyarthritis, Tuberkulose und Poliomyelitis wurden herausgestellt und je ein Beispiel einer Dystrophie bei Endangitis obliterans und Osteomyelitis ausführlicher mitgeteilt, weil darüber in der Literatur noch keine einheitliche Auffassung besteht.Die Symptomatologie der Sudeckschen Erkrankung des Kniegelenks und die sich daraus ergebenden differentialdiagnostischen Probleme werden besprochen und auf den Wert einer ausgiebigen Probeexcision in unklaren Fällen hingewiesen. Die größten Schwierigkeiten entstehen manchmal bei der Abgrenzung der Dystrophie von der Gonitis tbc., dem Meniscusschaden und den unspezifischen Synovitiden, zumal diese Krankheiten auch von einem Gliedmaßensyndrom begleitet werden können.Die frühzeitige Erkennung und kausale Behandlung des S. S. ist für das weitere Schicksal des Kniegelenks von entscheidender Bedeutung. Selbst im 3. Stadium lassen sich aber bei entsprechender Geduld seitens des Arztes und des Patienten noch eindrucksvolle Teilerfolge erzielen.Die histologische Untersuchung von 8 Gewebsproben aus Kapselweichteilen dystrophisch veränderter Kniegelenke erbrachte jeweils den Nachweis einer unspezifischen Synovitis. Pathologisch-anatomische Befunde, die für eine Dystrophie typisch wären, blieben aus, dürfen wohl auch nicht erwartet werden.Mit 10 Textabbildungen (20 Einzelbilder)Herrn Professor Dr. K. Lindemann zum 60. Geburtstag gewidmet.     

Bänder des Kniegelenks

The ligaments of the knee can be divided into four groups. Ventral reinforcements are the patellar retinaculae. The posteromedial complex stabilizes the valgus stress. It consists of the medial collateral ligament, the thickened posteromedial capsule and a branch of the tendon of the semimembranosus muscle as well as the oblique popliteal ligament. On the lateral side the posterolateral complex protects the knee against varus stress. Here the lateral collateral ligament, the tendon of the popliteus muscle and the so-called popliteofibular fibres work together. The cruciate ligaments control the contact between femoral condyles and tibial plateau during flexion-extension of the knee. They course between the two layers of the capsule, the membranous and the synovial layer.     

Fallstricke bei Verletzungen des Kniegelenks

Trauma und Berufskrankheit - Bei Verletzungen des Kniegelenks ist eine ausführliche Untersuchung des Patienten zur Vermeidung von Falschdiagnosen und zur Erkennung von Begleitverletzungen...     

Xanthom des Kniegelenks als Unfallfolge

Ohne Zusammenfassung