VKB-Verletzungsmuster und Augmentation von Partialrupturen

The anterior cruciate ligament (ACL) consists of the anteromedial (AM) and posterolateral (PL) bundles. In the clinical scenario a complete rupture of the ACL from the femoral footprint is most common. Partial ruptures are less frequently seen and involve intact tibial ACL fibres that attach to the posterior cruciate ligament (PCL) or intact tibial ACL fibres that attach high (AM) or low (PL) to the lateral wall of the notch. Conventional imaging techniques mostly miss the distinction between two bundles. The same is true for the conventional arthroscopist who is used to a standard diagnostic arthroscopy, which does not routinely include separation of the AM bundle from the PL bundle through the septum. An isolated rupture of the AM bundle (greatest tension in knee flexion) mainly influences the outcome of the anterior drawer test, whereas an isolated rupture of the PL bundle (greatest tension near knee extension) influences the Lachman test. The pivot shift test is utilized to diagnose anterolateral rotational instability (ALRI) and in some cases to diagnose PL ruptures. The pivot shift can, however, be negative in cases of isolated AM ruptures. Partial ruptures of the ACL should be treated with partial ACL reconstructions (augmentation). Techniques for reconstruction of the PL bundle and AM bundle are described in this article.     

Arthroskopischer transtendin?ser ?Suture-Bridge�� Repair der retrahierten Subskapularissehne

Previously named ??the forgotten tendon??, it has been discovered that subscapularis lesions need to be repaired in roughly one third of shoulder arthroscopies. For the difficult group of completely retracted tears we have developed a transtendinous technique that yields good results. The technique is reproducible for the experienced shoulder arthroscopist. The preservation of the ligamentous arc of the ??comma sign?? is important. An ??inferior comma sign?? is also regularly observed.     

Symptomatische Partialrupturen des vorderen Kreuzbands

The anterior cruciate ligament (ACL) consists of two anatomical and functional bundles, the anteromedial (AM) and posterolateral (PL) bundles. Different injury pattern demonstrate a wide spectrum of partial ACL tears. Clinical interest has recently focused on performing selective ACL augmentation according to the specific injury pattern. Theoretically, sparing the intact parts of the ACL may increase vascularization and proprioception, can optimize the accuracy of ACL reconstruction and result in better stability and improved clinical outcome for the patient. However, isolated reconstruction of the AM or PL bundle is an advanced arthroscopic procedure that requires precise preoperative and intraoperative diagnostic assessment of the injury pattern, exact anatomical definition of the insertion sites and careful debridement and bone tunnel placement while preserving the intact parts of the ACL. This article presents the concept of partial ACL rupture, describes the clinical, radiological and arthroscopic assessment of partial tears as well as the arthroscopic reconstruction.     

Die Einbindung und Anwendung der Physiotherapie in der Hospiz- und Palliativversorgung

Background

Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role.

Aim

This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany.

Methods

A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out.

Results

The response rate was 43.5?% (n = 296). Physiotherapy is predominantly applied in palliative care units (79?%) but rarely in hospices (38?%) and outpatient palliative care teams (30?%). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26?%). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea.

Conclusion

Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.

     

Verbesserung der Diagnostik und Therapie der Glossopharyngeusneuralgie

Differential diagnosis of neuralgias affecting the cranial nerves and of facial pain is often difficult. Glossopharyngeal neuralgia is much less common than trigeminal neuralgia and is not well known. Idiopathic neuralgia of the glossopharyngeal nerve sometimes occurs in association with neurovascular compression syndrome of the vagus and trigeminal nerves. High-resolution MRI of the brain stem with three-dimensional visualization allows a secure diagnosis of neurovascular compression and is useful in the planning of appropriate microsurgical decompression (Jannetta’s operation).     

Diagnose der Dysfunktion und Therapie der Kopfgelenkregion

Functional disorders of the craniocervical region are often the cause of headache or upper cervical neck pain. Many symptoms occur which are also collectively known as cervicocephalic syndrome. The neuroanatomical interrelationships in the brainstem region explain this varied symptomatic inclusive of vertigo-like symptoms in connection with the craniocervical region. An exact clinical manual medical examination requires precise knowledge of the special biomechanics of the region. With this knowledge the functional disorder can be assigned to the individual spinal segments C0/1–C2/3 or to myofascial structures. Manual therapy has proved to be effective for functional disorders but a structural pathology in this region must be clinically excluded beforehand.     

Grundlagen und Technik der arthroskopischen Rekonstruktion der Rotatorenmanschette

Zusammenfassung Bei der arthroskopischen Rotatorenmanschettenrekonstruktion spielen die verbesserten Techniken, Materialien und Fixierungsmöglichkeiten neben der arthroskopischen Erfahrung und den Fertigkeiten des Operateurs heute die entscheidende Rolle. Die Befunddarstellung und Manschettenmobilisation sind heute arthroskopisch zu lösen, bzgl. der Fixation werden resorbierbare Fadenanker in der aufgezeigten Zweischritttechnik von uns bevorzugt. Die anspruchsvollsten Teile der Operation sind dabei der Transport des Fadens durch die Manschette und der spannungsfreie Verschluss der Manschette. Die Vorteile des arthroskopischen Vorgehens liegen neben der guten Darstellung und der Behandlung von Begleitveränderungen wie Bizepsinstabilitäten in der schnelleren und schmerzärmeren Rehabilitation. Inzwischen sind mit vertretbarem Aufwand auch größere Läsionen arthroskopisch zu rekonstruieren.     

Kolloidosmotischer Druck der Galle und Chlorresorption der Gallenblase

Research in Experimental Medicine -