Die arthroskopisch unterstützte Stabilisierung der akuten AC-Gelenksprengung

Background

The aim of this study was to compare the results of the single (STR) versus double TightRope? (DTR) technique for stabilisation of acute separations of the AC joint with the hypothesis that DTR achieves lower CC distance.

Patients and methods

A total of 29 consecutive patients treated operatively with the TR technique (mean age 38.1 years, n=26 male) were analysed in a cohort study with a mean follow-up of 13.3 months (12.0–21.7). Acute AC joint separations types III and V according to Rockwood (R) were included; R types I, II, IV and VI were excluded. The prospective scores determined pre-op and 3, 6 and 12 months post-op and X-rays were evaluated.

Results

Of the patients 12 suffered an R type III and 17 an R V separation; 14 were treated with STR and 15 with DTR. With STR, 8 R III and 6 R V injuries and with DTR 4 R III and 11 R V injuries were treated arthroscopically. STR achieved an increased CC distance >125% compared to the contralateral AC joint in five cases (36%). Two of them occurred as R V and three as R III injury. DTR achieved a CC distance >125% in two cases of an R V injury (13%).

Conclusion

The DTR technique provides lower CC distance compared to the STR technique, without a significant difference of CC distance and scores.     

Methadone disposition following oral versus parenteral dose administration in rats during chronic treatment

A single radiolabeled dose of dl-methadone was administered by the oral, subcutaneous and intravenous routes to rats that had been chronically treated with dl-methadone. Radiolabeled compound (methadone and metabolites) was found in all organs at all time points studied after 30 minutes to 24 hours. Thin-layer chromatographic analysis showed that approximately 30–40 per cent of this compound is unchanged methadone at the 1-hour time point in the liver of rats receiving an oral or intravenous dose and in the brain of rats receiving an oral dose. Ninety-four per cent of compounds in brain is unchanged methadone at 1 hour after intravenous dose administration. Twenty-four hours following dose administration, levels of methadone within any organ are found to be similar irrespective of route of administration. The liver was found to contain the largest amounts of methadone in all animals studied with whole blood, lungs, and kidneys also containing large total amounts of methadone and metabolites. The liver and adrenals contained the highest concentrations of radiolabeled compounds.     

Arthroscopic and clinical evaluation after isolated, augmented anterior cruciate ligament replacement. A prospective study

80 patients were examined in to perform a prospective essay on the isolated substitute of the anterior crucial ligament being done by Miniarthrotomie and two channel technique. All patients received a substitute of the anterior cruciate ligament by using an autogenous, TETRA-L3 augmentated bone tendon bone graft from the middle third of the patellar ligament of the injured knee. Clinical and arthroscopical examination was carried out in the average 28 months (24-36) after crucial ligament reconstruction, by the routinely removal of the augmentation and fixation material. Clinical examination was carried out using the strict and objective IKDC-Score. The arthroscopical evaluation of the ACL-graft was performed with our recently developed Score for ACL-graft evaluation (Marburger Arthroscopy Score for graft evaluation). The Score distinguishes between four stages: type I: tight, crucial ligament like structured graft, type II: a firm, more bundle like structured graft, type III: a lax, untidy structured graft and type IV: the rudimentary graft. A statistical analysis was performed on the question whether there is a correlation between the clinical and the arthroscopical results. Furthermore, with the Marbuger Arthroscopy Score for graft Evaluation we introduced a standardised, simple-to-use new score for the arthroscopical ACL-graft evaluation. We find a high correlation (r = 0.77) between the clinical results and the arthroscopical findings, so that from clinical evaluation there might be draw conclusion to the arthroscopical expective results with high probability. Due to our previous experience we assume the Marburger Arthroscopy Score For Graft Evaluation to be a standardised and simple assessment method for the evaluation of the ACL-graft, considering pathobiomechanical influences on the ACL-substitute.     

Knee function and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: long-term follow-up

Purpose  

The aim of this investigation was to study patient-reported long-term clinical outcome, instrumental stablitity and prevalence of radiological osteoarthritis (OA) a minimum of ten years after isolated anterior cruciate ligament (ACL) reconstruction.     

Morbidity after autogenous bone-patellar-bone graft harvest from the opposite knee

Summary After cruciate ligament reconstruction using an autogenous central bone-patellar tendon-bone graft persistent complaints are described in the literature. There is the difficulty to distinguish the morbidity associated with the graft harvest and the morbidity caused by the injury and the reconstruction procedure. In order to clarify the morbidity resulting from the graft harvest alone, we evaluated those patients who had transplantat harvest from the opposite knee. Between 1990 and 1995 a central bone-tendon-bone graft has been taken from the contralateral uninjured knee in 37 patients, in 22 cases for anterior and in 15 cases for posterior cruciate ligament reconstruction. 27 patients were clinically (IKDC Score), isokinetically and radiologically followed up in an average of 25,3 months after the operation (range: 9–73 months). 21 patients were classified into IKDC group A. Except of one patient with an extension deficit of 5 ° all others showed normal range of motion. Only 5 of 27 patients expressed minimal knee pain during vigorous activities. Three of them reported about weather sensitivity in addition. These 6 patients were ranked in group B. No patient was classified into IKDC group C or D. The isokinetic examination showed a normal level of quadriceps strength. At final followup, the technique of Blackburne and Peel was used to assess patellar height. There was no radiographic evidence of patella contracture or baja. According to our results taking the autogenous CBTB graft used for cruciate ligament reconstruction leads to no serious morbidity.