Publications by authors named "Klaus Stürmer"

35 Publications

German validation of Quality of Life after Brain Injury (QOLIBRI) assessment and associated factors.

PLoS One 2017 24;12(5):e0176668. Epub 2017 May 24.

Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany.

The consequences of traumatic brain injury (TBI) for health-related quality of life (HRQoL) are still poorly understood, and no TBI-specific instrument has hitherto been available. This paper describes in detail the psychometrics and validity of the German version of an internationally developed, self-rated HRQoL tool after TBI-the QOLIBRI (Quality of Life after Brain Injury). Factors associated with HRQoL, such as the impact of cognitive status and awareness, are specifically reported. One-hundred seventy-two participants after TBI were recruited from the records of acute clinics, most of whom having a Glasgow Coma Scale (GCS) 24-hour worst score and a Glasgow Outcome Scale (GOSE) score. Participants had severe (24%), moderate (11%) and mild (56%) injuries as assessed on the GCS, 3 months to 15 years post-injury. The QOLIBRI uses 37 items to measure "satisfaction" in the areas of "Cognition", "Self", "Daily Life and Autonomy", and "Social Relationships", and "feeling bothered" by "Emotions"and "Physical Problems". The scales meet standard psychometric criteria (α = .84 to .96; intra-class correlation-ICC = .72 to .91). ICCs (0.68 to 0.90) and αs (.83 to .96) were also good in a subgroup of participants with lower cognitive performance. The six-subscale structure of the international sample was reproduced for the German version using confirmatory factor analyses and Rasch analysis. Scale validity was supported by systematic relationships observed between the QOLIBRI and the GOSE, Patient Competency Rating Scale for Neurorehabilitation (PCRS-NR), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Short Form 36 (SF-36), and Satisfaction with Life Scale (SWLS). The German QOLIBRI contains novel information not provided by other currently available measures and has good psychometric criteria. It is potentially useful for clinicians and researchers, in post-acute and rehabilitation studies, on a group and individual level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176668PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443488PMC
September 2017

Osteoarthritis of the carpometacarpal joint of the thumb: a new MR imaging technique for the standardized detection of relevant ligamental lesions.

Skeletal Radiol 2014 Oct 1;43(10):1411-20. Epub 2014 Aug 1.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Center Göttingen, Goettingen, Germany,

Objective: To assess ligament lesions and subluxations of the carpometacarpal joints of the thumbs (CMC I) of asymptomatic volunteers and of patients with CMC I osteoarthritis using advanced magnetic resonance imaging (MRI).

Materials And Methods: A total of 20 CMC I joints of 14 asymptomatic volunteers (6× both sides) and 28 CMC I joints of 22 patients (6× both sides) with symptomatic and X-ray-diagnosed osteoarthritis of CMC I joints were studied. During extension, flexion, abduction and adduction of the thumb, the anterior oblique (AOL), intermetacarpal (IML), posterior oblique (POL) and dorsal radial (DRL) ligaments were evaluated using 3-T MRI on two standard planes, and translation of metacarpal I (MC I) was assessed.

Results: The MRI demonstrated that ligament lesions of the AOL and IML are frequent. Isolated rupture of the AOL was found in 6 of 28 (21%), combined rupture of the AOL + IML in 5 of 28 (18%) and isolated IML rupture in 4 of 28 (14%) joints. The patients had a significantly increased dorsal translation of MC I during extension with a median of 6.4 mm vs. 5.4 mm in asymptomatic volunteers (p < 0.05).

Conclusion: MRIs of CMC I in two standardized planes frequently show combined ligament ruptures. The dorsal subluxation of MC I, which is increased in patients, correlates with OA severity based on X-ray and can be quantified by MRI. For joint-preserving surgical procedures and for prosthesis implantation of the CMC I, we recommend performing an MRI in two planes of the thumb-extension and abduction-to evaluate the ligaments and dorsal subluxation of MC I.
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http://dx.doi.org/10.1007/s00256-014-1955-xDOI Listing
October 2014

Characteristics of femorotibial joint geometry in the trochlear dysplastic femur.

J Anat 2014 Sep 10;225(3):367-73. Epub 2014 Jul 10.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Centre, Göttingen, Germany.

The medial and lateral tibia plateau geometry has been linked with the severity of trochlear dysplasia. The aim of the present study was to evaluate the tibial slope and the femoral posterior condylar offset in a cohort of consecutive subjects with a trochlear dysplastic femur to investigate whether the condylar offset correlates with, and thus potentially compensates for, tibial slope asymmetry. Magnetic resonance imaging was used to assess the severity of trochlear dysplasia as well as the tibial slope and posterior offset of the femoral condyles separately for the medial and lateral compartment of the knee joint in 98 subjects with a trochlear dysplastic femur and 88 control subjects. A significant positive correlation was found for the medial tibial slope and the medial posterior condylar offset in the study group (r(2) = 0.1566; P < 0.001). This relationship was significant for all subtypes of trochlear dysplasia and was most pronounced in the severe trochlear dysplastic femur (Dejour type D) (r(2) = 0.3734; P = 0.04). No correlation was found for the lateral condylar offset and the lateral tibial slope in the study group or for the condylar offset and the tibial slope on both sides in the control group. The positive correlation between the medial femoral condylar offset and the medial tibial slope, that is, a greater degree of the medial tibial slope indicated a larger offset of the medial femoral condyle, appears to represent a general anthropomorphic characteristic of distal femur geometry in patients with a trochlear dysplastic femur.
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http://dx.doi.org/10.1111/joa.12214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166977PMC
September 2014

Vastus medialis obliquus muscle morphology in primary and recurrent lateral patellar instability.

Biomed Res Int 2014 29;2014:326586. Epub 2014 Apr 29.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Center, Robert-Koch-Street 40, 37075 Göttingen, Germany.

The morphology of the vastus medialis obliquus (VMO) muscle in the anatomical setting of an unstable patella has not been described. Therefore, the purpose of this study was to investigate the morphological parameters of the VMO muscle that delineate its importance in the maintenance of patellofemoral joint stability. Eighty-two consecutive subjects were prospectively enrolled in this study. The groups were composed of thirty patients with an acute primary patellar dislocation, thirty patients with recurrent patellar dislocation, and twenty-two controls. Groups were adjusted according to sex, age, body mass index, and physical activity. Magnetic resonance imaging was used to measure the VMO cross-sectional area, muscle-fiber angulation, and the craniocaudal extent of the muscle in relation to the patella. No significant difference was found with respect to all measured VMO parameters between primary dislocation, recurrent dislocation, and control subjects with a trend noted for only the VMO cross-sectional area and the VMO muscle-fiber angulation. This finding is notable in that atrophy of the VMO has often been suggested to play an important role in the pathophysiology of an unstable patellofemoral joint.
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http://dx.doi.org/10.1155/2014/326586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020533PMC
September 2015

Novel single-loop and double-loop knot stitch in comparison with the modified Mason-Allen stitch for rotator cuff repair.

Knee Surg Sports Traumatol Arthrosc 2015 May 23;23(5):1552-8. Epub 2014 Apr 23.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Göttingen, Robert Koch Straße 40, 37075, Göttingen, Germany,

Purpose: In rotator cuff repair, strong and long-lasting suturing techniques that do not require additional implants are needed. This study examines the ultimate load to failure and the Young's modulus at the suture-tendon interface for a novel single-loop knot stitch and double-loop knot stitch. These values are compared to those of the modified Mason-Allen stitch.

Methods: Twenty-four infraspinatus muscles with tendons were dissected from porcine shoulders (twelve Goettingen minipigs). The preparations were randomly allocated to three groups of eight samples. Load-to-failure testing of the single-loop knot stitch, the double-loop knot stitch and the mMAS were performed using a Zwick 1446 universal testing machine (Zwick-Roell AG, Ulm, Germany).

Results: The highest ultimate load to failure for the three techniques occurred with the double-loop knot stitch with a median value of 382.2 N (range 291.8-454.2 N). These values were significantly higher than those of the single-loop knot stitch, which had a median value of 259.5 N (range 139.6-366.3 N) and the modified Mason-Allen stitch, which had a median value of 309.3 N (range 84.55-382.9 N). The values of the single-loop knot stitch and the modified Mason-Allen stitch did not differ significantly. Regarding the Young's modulus, no significant differences were found between the double-loop knot stitch with a median value of 496.02 N/mm² (range 400.4-572.6 N/mm²) and the modified Mason-Allen stitch with 498.5 N/mm² (range 375.5-749.2 N/mm²) with respect to the stiffness of the suture-tendon complex. The median value for the Young's modulus of the single-loop knot stitch of 392.1 N/mm² (range 285.7-510.6 N/mm²) was significantly lower than those of the double-loop knot stitch and modified Mason-Allen stitch.

Conclusion: This in vitro animal study demonstrated that both the single-loop knot stitch and the double-loop knot stitch have excellent ultimate load-to-failure properties when used for rotator cuff repair. The introduced single-loop knot stitch and double-loop knot stitch offer an alternative to other common used stitch techniques in rotator cuff repair.
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http://dx.doi.org/10.1007/s00167-014-2976-7DOI Listing
May 2015

Which patellae are likely to redislocate?

Knee Surg Sports Traumatol Arthrosc 2014 Oct 5;22(10):2308-14. Epub 2013 Sep 5.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Centre, Robert-Koch-Str. 40, 37075, Göttingen, Germany,

Purpose: The purpose of this study was to identify the risk factors for recurrent lateral patellar dislocations and to incorporate those factors into a patellar instability severity score.

Methods: Sixty-one patients [male/female 35/26; median age 19 years (range 9-51 years)] formed the study group for this investigation. Within the study group, 40 patients experienced a patellar redislocation within 24 months after the primary dislocation, whereas 21 patients, who were assessed after a median follow-up of 37 months (range 24-60 months), had not experienced a subsequent episode of lateral patellar instability. In all patients, age at the time of the primary dislocation, gender, the affected body side, body mass index, bilateral instability, physical activity according to Baecke's questionnaire, the grade of trochlear dysplasia, patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, and patellar tilt were assessed. The odds ratio (OR) of each factor with regard to the patellar redislocation was calculated using contingency tables. Based on these data, a "patellar instability severity score" was calculated.

Results: The patellar instability severity score has six factors: age, bilateral instability, the severity of trochlear dysplasia, patella alta, TT-TG distance, and patellar tilt; the total possible score is seven. Reapplying this score to the study population revealed a median score of 4 points (range 2-7) for those patients with an early episode of patellar redislocation and a median score of 3 points (range 1-6) for those without a redislocation (p=0.0004). The OR for recurrent dislocations was 4.88 (95% CI 1.57-15.17) for the patients who scored 4 or more points when compared with the patients who scored 3 or fewer points (p=0.0064).

Conclusion: Based on the individual patient data, the patellar instability severity score allows an initial risk assessment for experiencing a recurrent patellar dislocation and might help differentiate between responders and non-responders to conservative treatment after primary lateral patellar instability.

Level Of Evidence: Case-control study, Level III.
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http://dx.doi.org/10.1007/s00167-013-2650-5DOI Listing
October 2014

Radiologically Hyperdense Zones of the Patella Seem to Be Partial Osteonecroses Subsequent to Fracture Treatment.

J Knee Surg 2013 Oct 26;26(5):e1. Epub 2013 Feb 26.

Department of Trauma Surgery and Reconstructive Surgery, Surgery and Trauma Centre, Asklepios Clinic St. Georg, Hamburg, Germany.

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http://dx.doi.org/10.1055/s-0033-1336595DOI Listing
October 2013

Radiologically hyperdense zones of the patella seem to be partial osteonecroses subsequent to fracture treatment.

J Knee Surg 2013 Oct 4;26(5):319-26. Epub 2013 Jan 4.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Göttingen, Göttingen, Germany.

The blood supply to the proximal patella is provided primarily via intraosseous vessels from the inferior patella. Two vascular systems within the patella are distinguished: Tiny arteries penetrate the middle third of the anterior patellar surface via vascular foramina and continue in a proximal direction. Additional vessels enter the patella at its distal pole, between the patellar ligament and the articular surface, and also run proximally. As a result of the double vascular supply to the distal portion and the vulnerable blood supply to the proximal part, localized osteonecroses subsequent to fracture may occur within the patella and nearly exclusively affect the upper portion of the patella. Such focal regions of osteonecrosis may appear radiographically as localized regions of hyperdensity within the patella. The aim of this study was to investigate the extent to which radiologically hyperdense areas, possibly representing localized osteonecrosis, may occur subsequent to surgical treatment of a patella fracture and the influence that they have on the outcome of the fracture. Retrospective analysis of 100 patients who had been treated operatively for a patella fracture from January 1998 to December 2008 was conducted. The subjective pain rating, clinical scores, and patient satisfaction scores were recorded. Existing X-rays were assessed with regard to possible increased radiological dense areas. After an average of 60.61 ( ± 33.88) months, it was possible to perform a clinical follow-up on 60 patients aged 45.48 ( ± 18.51) years. Radiographic follow-up of all patients revealed that nine patients (9%) exhibited a hyperdense area in the proximal patella portion. X-rays showed radiopaque areas between 1 and 2 months after surgery. In seven cases, the radiological finding disappeared after six months. In two patients with persisting radiologically dense areas, bone necrosis was verified by means of magnetic resonance imaging (MRI) examination and a histological assessment, respectively. The clinical outcome of these patients with a hyperdense area on the patella, in this small series, was not shown to be worse than those who demonstrated normal healing. Radiologically hyperdense areas subsequent to patella fracture may represent partial osteonecrosis caused by localized vascular compromise. This was confirmed by MRI and histological examinations in two patients with persistent hyperdense lesions. The clinical outcome of patients with hyperdense zones seems to be poorer than that of patients without such findings, but no statistical difference was shown in this small series. It is possible that earlier surgical treatment and thus a shorter ischemic period as well as tissue-conserving operative techniques could prevent the occurrence of partial necroses. This hypothesis would require further study.
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http://dx.doi.org/10.1055/s-0032-1332805DOI Listing
October 2013

Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability.

Knee Surg Sports Traumatol Arthrosc 2013 Sep 25;21(9):2155-63. Epub 2012 Oct 25.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.

Purpose: The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint has gained increased significance. However, no quantitative data are available regarding the inclination of the medial and lateral tibial slope in patients with patellar instability. It was therefore the purpose of this study to evaluate tibial slope characteristics in patients with patellar dislocations and to assess the biomechanical effect of medial-to-lateral tibial slope asymmetry on lateral patellar instability.

Methods: Medial and lateral tibial slope was measured on knee magnetic resonance images in 107 patients and in 83 controls. The medial-to-lateral tibial slope asymmetry was assessed as the intra-individual difference between the medial and lateral tibial plateau inclination considering severity of trochlear dysplasia. The effect of tibial slope asymmetry on femoral rotation was calculated by means of radian measure.

Results: Severity of trochlear dysplasia was significantly associated with an asymmetric inclination of the tibial plateau. Whereas the medial tibial slope showed identical values between controls and study patients (n.s.), lateral tibial plateau inclination becomes flatter with increasing severity of trochlear dysplasia (p < 0.01). Consequently, the intra-individual tibial slope asymmetry increased steadily (p < 0.01) and increased internal femoral rotation in 20° and 90° of knee flexion angles in patients with severe trochlear dysplasia (p < 0.01). In addition, the extreme values of internal femoral rotation were more pronounced in patients with patellar instability, whereas the extreme values of external femoral rotation were more pronounced in control subjects (p = 0.024).

Conclusion: Data of this study indicate an association between tibial plateau configuration and internal femoral rotation in patients with lateral patellar instability and underlying trochlear dysplasia. Thereby, medial-to-lateral tibial slope asymmetry increased internal femoral rotation during knee flexion and therefore might aggravate the effect of femoral antetorsion in patients with patellar instability.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-012-2247-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751338PMC
September 2013

Navigated cementless total knee arthroplasty - medium-term clinical and radiological results.

Open Orthop J 2012 16;6:160-3. Epub 2012 Apr 16.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Göttingen, D-37099 Göttingen, Germany.

Purpose: The objective of this prospective study was to evaluate the medium-term clinical and radiological results after navigated cementless implantation, without patella resurfacing, of a total knee endoprosthesis with tibial and femoral press-fit components, with a focus on survival rate and clinical outcome. The innovation is the non-cemented fixation together with the use of a navigation system.

Scope And Methods: Sixty patients with gonarthrosis were included consecutively in this study. In all cases, the cementless Columbus total knee endoprosthesis with a coating out of pure titanium was implanted, using a navigation system. The Knee Society Score showed a statistically significant increase from 75 (± 21.26) before surgery to 180 (± 16.15) after a mean follow-up of 5.6 (± 0.25) years. The last radiological examination revealed no osteolysis. No radiolucent lines were seen at any time in the area of the femoral prosthetic components. In the tibial area, radiolucent lines were seen in 24.4 % of the cases, mostly in the distal uncoated part of the stem. During follow-up, no prosthesis had to be replaced because of aseptic loosening while in 2 cases revision surgery was necessary due to septic loosening and in 1 case due to unexplainable pain.

Results And Conclusions: Navigated cementless implantation of the Columbus total knee endoprosthesis yielded good clinical and radiological results in the medium term. The excellent radiological osteointegration of the prosthetic components, coated with a microporous pure titanium layer and implanted with a press-fit technique, should be emphasized.
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http://dx.doi.org/10.2174/1874325001206010160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339558PMC
August 2012

Bioabsorbable interference screw versus bioabsorbable cross pins: influence of femoral graft fixation on the clinical outcome after ACL reconstruction.

Knee Surg Sports Traumatol Arthrosc 2012 Nov;20(11):2251-6

Department of Trauma Surgery, Plastic and Reconstructive Surgery, Medical University of Göttingen, Göttingen, Germany.

Purpose: The aim of this study was to evaluate the clinical outcome and differences in anterior–posterior laxity of ACL reconstruction using a bioabsorbable interference screw for femoral graft fixation when compared to femoral bioabsorbable cross pin fixation.

Methods: Clinical outcome was evaluated among 59 patients 1 year after arthroscopic ACL reconstruction with hamstrings graft in a prospective, non-randomised study. In 31 cases, femoral fixation of the graft was performed using a bioabsorbable interference screw. In 28 cases, two bioabsorbable cross pins were used for femoral fixation. Patients were evaluated using Tegner, Lysholm and Marshall scores, the visual analogue scale for pain and KT-1000 arthrometer measurement.

Results: No significant difference (P ≥ 0.05) was observed at follow-up for the knee scores. The average Tegner score was 5.83 points (±2.00) for the interference screw fixation and 5.83 points (±1.24) for the cross pin fixation; the average Lysholm score was 93.58 (±5.79) to 92.72 (±6.34) points; and the average Marshall score 46.72 (±2.4) to 47.30 (±2.35) points. No significant difference was found for the visual analogue scale for pain. KT-1000 arthrometer measurement revealed a significant (P < 0.05) difference in the mean side-to-side anterior translation at all applied forces. At 67 N, the mean difference was 1.53 mm (±1.24) in the interference screw group and 0.47 mm (±1.18) in the cross pin group (P < 0.05). At 89 N, the mean differences were 1.85 mm (±1.29) versus 0.59 mm (±1.59), respectively, (P < 0.05), and maximum manual displacements were 2.02 mm (±1.26) versus 1.22 mm (1.18; P < 0.05).

Conclusions: In ACL reconstruction with hamstrings graft, similar clinical results are obtained for the use of bioabsorbable cross pins when compared to bioabsorbable interference screws for femoral fixation. Cross pin fixation was superior with regard to the anteroposterior laxity as measured with KT-1000.
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http://dx.doi.org/10.1007/s00167-011-1875-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477476PMC
November 2012

Interleukin-7 levels in synovial fluid increase with age and MMP-1 levels decrease with progression of osteoarthritis.

Acta Orthop 2012 Feb 29;83(1):59-64. Epub 2011 Dec 29.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg-August University, Goettingen, Germany.

Background And Purpose: Little is known about biochemical mediators that correlate with the initiation and progression of knee osteoarthritis (OA). We therefore valuated the roles of cytokines and metalloenzymes in knee OA in relation to OA grading, age, and BMI.

Patients And Methods: A multiplex ELISA-based immunoassay (Luminex technology) was used to measure biochemical mediators in the synovial fluid (SF) of 82 patients undergoing knee surgery. All patients were classified according to age, BMI, and OA grade. 24 patients had no signs of OA (knee reconstruction surgeries). The mediators that were tested for included interleukins (IL-1Ra, IL-6, IL-7, and IL-18), chemokines (CCL2 (MCP-1), CCL3 (MIP-1a), and CXCL8 (IL-8)), growth factors (HGF and VEGF), and matrix metalloproteinases (MMP-1, MMP-2, MMP-9, and MMP-13).

Results: There was a correlation between IL-7 levels in SF and age (p < 0.01). The 11 highest IL-7 levels were seen in patients who were aged between 59 and 72 but had different OA grades. In contrast, all patients who had severe OA in all 3 knee compartments (pan-OA) had only low or medium IL-7 levels. There was a negative correlation between MMP-1 levels in synovial fluid and grade of OA (p < 0.001). Correlation studies between pairs of mediators revealed two groups of mediators that are important in OA progression, dominated by MCP-1 and IL-1Ra.

Interpretation: IL-7 levels in SF are elevated in elderly people suffering from OA of different grades, but they are depressed in patients with severe 3-compartment OA, possibly due to widely impaired chondrocytes embedded in the affected cartilage tissue. The observed decrease in MMP-1 levels in SF, which is dependent on the severity of OA, may be caused by deterioration of superficial cartilage layers during progression of OA.
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http://dx.doi.org/10.3109/17453674.2011.645195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278659PMC
February 2012

MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first-time patellar dislocations.

Knee Surg Sports Traumatol Arthrosc 2012 Aug 18;20(8):1575-80. Epub 2011 Nov 18.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Robert-Koch-Str. 40, 37075, Göttingen, Germany.

Purpose: The purpose of this study was to investigate whether the femoral part of the medial patellofemoral ligament (MPFL) and its injury can be accurately assessed by standard knee arthroscopy in first-time patellar dislocations or whether preoperative MRI is required to determine injury location in patients where primary MPFL repair is attempted.

Methods: Twelve patients with acute first-time dislocations and MRI-based injury of the femoral MPFL and ten patients with recurrent patellar dislocations underwent knee arthroscopy with the use of a 30-degree optic and standard antero-medial and antero-lateral portals. The femoral origin was marked with a cannula under lateral fluoroscopy. Arthroscopic findings of the location of the native femoral MPFL and its injury were compared to the results of MRI and mini-open exploration.

Results: In acute cases, the average time from primary patellar dislocation to MRI evaluation was 3 days (1-9 days), and the average time from MRI to surgery was 8 days (3-20 days). The native femoral origin of the MPFL was not visible in any of the chronic cases during arthroscopy. In addition, in all acute cases, arthroscopy failed to directly visualize injury of the femoral MPFL (0 of 12), but mini-open exploration confirmed injury in 11 of 12 patients. This means that arthroscopy was less accurate than MRI for the diagnosis of femoral MPFL injury (P < 0.05).

Conclusion: The results of this study indicate the limitations of knee arthroscopy in identifying the femoral disruption of the MPFL, a crucial injury that occurs in patellar dislocations. Thus, if a primary MPFL repair is planned, determination of the site of repair should be based on the preoperative MRI.

Level Of Evidence: Diagnostic study of non-consecutive patients, Level III.
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http://dx.doi.org/10.1007/s00167-011-1775-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402660PMC
August 2012

Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete.

Am J Sports Med 2011 Aug 12;39(8):1756-61. Epub 2011 May 12.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Göttingen, Germany.

Background: A lateralized tibial tubercle may be a relevant anatomic factor in patients with patellar instability and can be used as an indication for a distal realignment procedure. However, parameter values for the tibial tuberosity-trochlear groove (TT-TG) distance in the young patient have not been defined. It also remains to be determined how this parameter contributes to patellar instability in the growing knee joint.

Purpose: The purpose of this study was to evaluate the value of the TT-TG distance in patellar instability in the young athlete.

Study Design: Case control study; Level of evidence, 3.

Methods: Knee magnetic resonance images were collected from 109 patients with lateral patellar instability and from 136 control subjects. Student t test and multiple logistic regression analysis were used to compare the absolute and relative values of the TT-TG distance between patients and controls. The relative value was defined as the ratio between the TT-TG distance and the total width of the distal femur.

Results: The TT-TG distance (absolute and relative to femur width) differed significantly between patients with patellar dislocation and the control group (both P < .01). The TT-TG distances were on average 4 mm larger in patients with patellar dislocation; TT-TG distance divided by femur width was on average 5% larger in patients with patellar dislocation. Multiple logistic regression analysis confirmed the TT-TG distance as a significant risk factor for patellar dislocation (P = .04), but showed no significant interaction with patient age or femur width (P = .95 and P = .15, respectively).

Conclusion: A lateralized tibial tubercle is a relevant anatomic factor in the young athlete and in the adult patient with lateral patellar instability. Its parameter values and its influence on patellar dislocation are independent of patient age and should therefore be evaluated as in adults.
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http://dx.doi.org/10.1177/0363546511404883DOI Listing
August 2011

Physiologically shaped knee arthroplasty induces natural roll-back.

Technol Health Care 2011 ;19(2):91-102

Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg-August-University, Goettingen, Germany.

After total knee replacement the persistence of pain represents a significant problem. In this study, a novel knee arthroplasty (Aequos G1 knee arthroplasty) is investigated that was designed to replicate main features of human knee morphology to reduce the periodically occurring pain after knee replacement. Previous work showed theoretically that this arthroplasty design may reconstruct the four-bar linkage mechanism as it occurs in human knee by contriving a convex lateral tibial compartment and a sagittal offset of the centre of the medial and lateral femur condyles - inducing a roll-back mechanism as it exists in human. The aim of this study was to determine whether this potential roll-back mechanism can be confirmed by in-vivo measurements. This retrospective study showed that the patellar tendon angle decreases during flexion of 0.21° per degree of flexion on average in the 16 knees studied. This amount is similar to physiological knee kinematics and in contrast to existing results in the literature after implantation of conventional total knee replacements which lack physiological knee kinematics. The results suggest that physiological motion after implantation of the Aequos G1 knee arthroplasty occurs during loaded motion up to approximately 45° knee flexion.
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http://dx.doi.org/10.3233/THC-2011-0616DOI Listing
August 2011

Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella.

Am J Sports Med 2010 Nov 16;38(11):2320-7. Epub 2010 Aug 16.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Robert-Koch-Str. 40, 37075 Göttingen, Germany.

Background: A trend toward young women being at greatest risk for primary and recurrent dislocation of the patella is evident in the current literature. However, a causative factor is missing, and differences in the anatomical risk factors between men and women are less defined.

Purpose: To identify differences between the sexes in the anatomy of lateral patellar instability.

Study Design: Case control study; Level of evidence, 3.

Methods: Knee magnetic resonance images were collected from 100 patients treated for lateral patellar instability. Images were obtained from 157 patients without patellar instability who served as controls. Using 2-way analyses of variance, the influence of patellar dislocation, gender, and their interaction were analyzed with regard to sulcus angle, trochlear depth, trochlear asymmetry, patellar height, and the tibial tubercle-trochlear groove (TT-TG) distance. Mechanisms of injury of first-time dislocations were divided into high-risk, low-risk, and no-risk pivoting activities and direct hits.

Results: For all response variables, a significant effect was observed for the incidence of patellar dislocation (all P < .01). In addition, sulcus angle, trochlear asymmetry, and trochlear depth depended significantly on gender (all P < .01) but patellar height did not (P = .13). A significant interaction between patellar dislocation and gender was observed for the TT-TG distance (P = .02). The mean difference in TT-TG distance between study and control groups was 4.1 mm for women (P < .01) and 1.6 mm for men (P = .05). Low-risk and no-risk pivoting injuries were most common in women, whereas first-time dislocations in men occurred mostly during high-risk pivoting activities (P < .01).

Conclusion: The data from this study indicate that trochlear dysplasia and the TT-TG distance is more prominent in women who dislocate the patella. Both factors might contribute to an increased risk of lateral patellar instability in the female patient as illustrated by the fact that dislocations occurred most often during low-risk or no-risk pivoting activities in women.
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http://dx.doi.org/10.1177/0363546510373887DOI Listing
November 2010

[A minimally invasive dorsal approach to the medial femoral condyle as a donor site for osteochondral transfer procedures].

Oper Orthop Traumatol 2010 May;22(2):212-20

Abteilung Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsmedizin Göttingen.

Objective: Long-lasting reconstruction of joint surface by using an osteochondral transfer procedure (OCT). Reduction of donor site morbidity by using a minimally invasive approach to the dorsal medial femoral condyle.

Indications: Grade 3 and 4 cartilage lesions (according to ICRS [International Cartilage Repair Society]), osteochondral lesions, and osteochondrosis dissecans.

Contraindications: Grade 2 or higher-graded cartilage lesions at the dorsal medial femoral condyle, infection, axis deviation of more than 5 degrees in the frontal plane, advanced osteoarthritis.

Surgical Technique: Cylinders at recipient site are removed first, thereby determining number and diameter of donor cylinders. Supine position, skin incision over the dorsal medial femoral condyle. After dissection of soft tissue and superficial fascia, semitendinosus tendon and medial gastrocnemius muscle are retracted to the lateral side, followed by arthrotomy, introduction of two Hohmann retractors medial and lateral of the condyle, and harvesting of the donor cylinders with a tubular chisel. Advantages of the described approach: reduction of soft-tissue trauma, easy surgical technique, additional donor site area besides femoral trochlea and intercondylar notch.

Postoperative Management: Partial weight bearing of 10-20 kg for 4-6 weeks. Limitation of knee flexion to 90 degrees for 6 weeks.

Results: Between 01/2006 and 04/2007, the dorsal medial femoral condyle was used as a donor site in 16 patients. All patients were evaluated preoperatively and after 1 year using the American Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC) Score, the Tegner Score, and the visual analog scale (VAS) pain. The mean follow- up was 13.9 (+/-4.3) months. The mean defect area was 4.6 (+/-2.2) cm(2). The mean KSS, Tegner Score, and WOMAC Score improved from 123.1 (+/-41.5), 2.8 (+/-0.9), and 73.3 (+/-50.2) points preoperatively to 171.3 (+/-16.9), 3.4 (+/-0.6), and 26.1 (+/-17.6) points after 13.9 months (p < 0.05). The VAS pain improved from 5.3 (+/-2.7) to 2.4 (+/-1.8) points (p < 0.05). One patient with an osteochondral defect of 8 cm(2) at the medial femoral condyle (Ahlbäck's disease) still complains of pain during deep squatting. The dorsal medial femoral condyle can be recommended as donor site for OCT. The minimally invasive approach has proven to be safe and simple with a low complication rate.
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http://dx.doi.org/10.1007/s00064-010-8063-4DOI Listing
May 2010

A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures.

J Orthop Trauma 2010 Aug;24(8):515-20

Department of Trauma and Reconstructive Surgery, Asklepios Clinic St Georg, Hamburg, Germany.

The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. These aims are difficult to reach through a lateral or anterolateral approach. The standard posterolateral approach with fibula osteotomy and release of the posterolateral corner is a traumatic procedure, which includes the risk of fragment denudation. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue and allows for good visual control of fracture reduction. The approach involves a lateral arthrotomy for visualizing the joint surface and a posterolateral approach for the fracture reduction and plate fixation, which are both achieved through one posterolateral skin incision. Using this approach, we achieved reduction of the articular surface and stable fixation in six of seven patients at the final follow-up visit. No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network.
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http://dx.doi.org/10.1097/BOT.0b013e3181e5e17dDOI Listing
August 2010

Patellar dislocations in children, adolescents and adults: a comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy.

Eur J Radiol 2011 Sep 16;79(3):415-20. Epub 2010 Jul 16.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Göttingen, Germany.

Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint.

Materials And Methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation.

Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p>0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p=0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p>0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults.

Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus, physicians are confronted with similar anatomical risk factors and similar injuries to the medial soft-tissue restraints in children when compared to adults with patellar instability.
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http://dx.doi.org/10.1016/j.ejrad.2010.06.042DOI Listing
September 2011

Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance.

Arthroscopy 2010 Jul 3;26(7):926-35. Epub 2010 Mar 3.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Robert-Koch-Strasse 40, Göttingen, Germany.

Purpose: The objective of this study was to analyze the injury patterns of the medial patellofemoral ligament (MPFL) in acute lateral patellar dislocations (LPDs) considering the anatomically relevant factors of patellar instability.

Methods: Knee magnetic resonance images were collected from 73 patients within 7 weeks after LPD, and the injury patterns of the MPFL were evaluated for trochlear dysplasia, for patellar height, and for the tibial tuberosity-trochlear groove (TT-TG) distance.

Results: Injury to the MPFL was found in 98.6% of the patients (72 of 73) after the acute LPD, with a complete tear in 51.4% (37 of 72), most frequently localized at the femoral attachment site, and a partial tear in 48.6% (35 of 72). Injury to the femoral origin (Fem), to the midsubstance (Mid), and to the patellar insertion (Pat) of the MPFL was found in 50.0% (36 of 72), 13.9% (10 of 72), and 13.9% (10 of 72), respectively. More than 1 site of injury was found in 22.2% (16 of 72), most frequently as a combined injury at the femoral origin and at the patellar insertion sites (Pat+Fem) (13 of 16). The study population, as well as the Pat, Fem, and Pat+Fem subgroups, showed significantly different values of trochlear dysplasia and patellar height when compared with the control group, whereas the data of the Mid group were not significantly different. In addition, injury at the patellar insertion (Pat) was accompanied by a significantly increased TT-TG distance when compared not only with the control group but also with the Fem, Mid, and Pat+Fem groups.

Conclusions: The data from our study indicate that patterns of MPFL injury depend on trochlear dysplasia, patellar height, and TT-TG distance. They show a new aspect in the complex interplay between active, passive, and static stabilizers of the patellofemoral joint.

Level Of Evidence: Level IV, diagnostic case-control study.
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http://dx.doi.org/10.1016/j.arthro.2009.11.004DOI Listing
July 2010

[A modified posterolateral approach for the treatment of tibial plateau fractures].

Oper Orthop Traumatol 2010 Mar;22(1):107-19

Abteilung Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsmedizin Göttingen, Göttingen, Germany.

Objective: Open reduction and internal fixation of posterolateral tibial plateau fractures.

Indications: Tibial plateau fractures involving the posterolateral quadrant.

Contraindications: Critical soft-tissue conditions. Tibial plateau fractures which do not involve the posterolateral quadrant.

Surgical Technique: 90 degrees side positioning on the contralateral side, skin incision along the fibular head, exposure of the peroneal nerve, lateral arthrotomy and exposure of the joint, dissection of the popliteal cavity between the lateral head of the gastrocnemius muscle and soleus muscle. Blunt preparation between popliteus muscle and soleus muscle under preservation of the popliteal artery and vein. Sharp dissection of the soleus muscle from the dorsal parts of fibula and tibia until the peroneal nerve at the fibular neck enters into the muscle. Exposure of the posterolateral tibial head. The dorsal joint capsule and the popliteal corner are prevented from any soft-tissue damage. Visual control of fracture reduction by viewing in the joint gap through lateral arthrotomy. Reduction of the fracture from dorsal with pointed reduction forceps. A conventional or locking radius T-plate can be pinched off with lateral cutters and anatomically bent for fracture fixation and is dorsally fixed at the tibial plateau.

Postoperative Management: 10 kg partial weight bearing for 6-8 weeks. Limited range of motion 0-0-90 degrees for 6 weeks.

Results: In a period of 2 years, seven patients with posterolateral tibial plateau fractures received open reduction and internal fixation by using the modified posterolateral approach. The patients were examined at follow-up between 12 and 24 months after surgery. Six patients were free of pain with full range of motion and stable knee joints. Radiologically, a good fracture reduction was achieved in six cases. In one patient with a posterolateral comminuted dislocation fracture, a small fracture step and a gap could be observed. No approach-related complications were found.
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http://dx.doi.org/10.1007/s00064-010-3008-0DOI Listing
March 2010

["Surgical intermediate care unit" outcomes, facts and experiences after 5 years].

Wien Med Wochenschr 2010 Feb;160(3-4):85-90

Abteilung Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsmedizin Göttingen, Göttingen, Germany.

The increasing economic pressure has resulted in strategies to use efficient treatment forms. The aim of our study was to evaluate to which extent the intermediate care unit (IMC-unit) relieves the intensive care unit and the wards. We analyzed: patient population, age, gender, admission criteria and the rate of patients with intensive nursing procedures between January 1, 2005 and December 31, 2007. The level of care was calculated according to the standard patient categories. The mean age amounted to 58.9 years. Intensive care patients made up 43.6% and patients from the emergency ward 36.6% of the total IMC-allocation. After IMC care 54.3% of all IMC-patients could be taken over by wards. The confused patients amounted to 27.5% and isolated patients 4.3%. The average care intensity amounted to 4.5 hours per patient daily and the mean length of stay in hospital was 9 days. Particularly the relief of nursing intensity and the possibility of primary treatment of severely injured persons reflect the requirements of IMC.
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http://dx.doi.org/10.1007/s10354-009-0696-2DOI Listing
February 2010

Impact of monopolar radiofrequency energy on subchondral bone viability.

Knee Surg Sports Traumatol Arthrosc 2010 May 17;18(5):673-80. Epub 2009 Oct 17.

Department of Trauma Surgery, Plastic-and Reconstructive Surgery, University Medicine, Georg-August University, Robert-Koch-Str 40, 37075 Göttingen, Germany.

The purpose of this study was to analyze the impact of monopolar radiofrequency energy treatment on subchondral bone viability. The femoral grooves of six chinchilla bastard rabbits were exposed bilaterally to monopolar radiofrequency energy for 2, 4 and 8 s, creating a total of 36 defects. An intravital fluorescence bone-labeling technique characterized the process of subchondral bone mineralization within the 3 months following exposure to radiofrequency energy and was analyzed by widefield epifluorescence optical sectioning microscopy using an ApoTome. After 2 s of radiofrequency energy exposure, regular fluorescence staining of the subchondral bone was evident in all samples when compared to untreated areas. The depth of osteonecrosis after 4 and 8 s of radiofrequency energy treatment averaged 126 and 942 microm at 22 days (P < .05; P < .01). The 4 s treatment group showed no osteonecrosis after 44 days whereas the depth of osteonecrosis extended from 519 microm at 44 days (P < .01), to 281 microm at 66 days (P < .01) and to 133 microm at 88 days (P < .05) after 8 s of radiofrequency energy application. Though radiofrequency energy may induce transient osteonecrosis in the superficial zone of the subchondral bone, the results of this study suggest that post-arthroscopic osteonecrosis appears to be of only modest risk given the current clinical application in humans.
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http://dx.doi.org/10.1007/s00167-009-0949-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855021PMC
May 2010

Quantified contours of curvature in female index, middle, ring, and small metacarpophalangeal joints.

J Hand Surg Am 2009 Feb;34(2):317-25

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University of Göttingen, Göttingen, Germany.

Purpose: To study and quantify the morphology of the curvature of the surfaces of metacarpophalangeal metacarpophalangeal joints and to relate joint morphology to joint function.

Methods: Forty metacarpophalangeal joints of the index, middle, ring, and small fingers from 5 right and 5 left hands were taken from female cadavers. The articulating surfaces of the metacarpal head and the base of the proximal phalanx were copied in a true-to-scale fashion. The hard plaster models were sliced in 7 sagittal and 7 transverse planes. The curvatures of the section contours were determined with circular gauges. Statistical analyses were performed by analysis of variance and paired Student t-tests.

Results: In the sagittal plane, the cartilaginous surface of the metacarpal head is divided into 2 functional regions and a third dorsal region that does not articulate with the base of the proximal phalanx. The articulating surface of the base of the proximal phalanx approximates a circle in the midsagittal plane. The mean median sagittal radius of curvature of the dorsal articulating aspect of the metacarpal head (6.9 mm) is 33% smaller than that of the base of the proximal phalanx (10.3 mm). The palmar articulating aspect of the metacarpal head (5.8 mm) is 44% smaller than that of the base of the proximal phalanx (10.3 mm). In the median transverse section, the mean radius of curvature of the metacarpal head (7.3 mm) is 18% smaller than that of the base of the proximal phalanx (8.9 mm).

Conclusions: The data demonstrate the highly significant incongruity in the curvature of the articulating pair. This incongruity provides a joint space with its greatest dimension in the sagittal plane. From a mechanical perspective, the metacarpophalangeal joint mechanically represents a joint with 5 kinematic degrees of freedom: 2 for flexion and extension, 2 for abduction and adduction, and 1 for axial rotation.
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http://dx.doi.org/10.1016/j.jhsa.2008.10.004DOI Listing
February 2009

Long-term effects of saw osteotomy versus random fracturing on bone healing and remodeling in a sheep tibia model.

J Orthop Res 2009 May;27(5):680-6

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University of Göttingen, Robert Koch Strasse 40, D-37075 Göttingen, Germany.

This article is about the evaluation of possible differences in biomechanical or histomorphological properties of bone healing between saw osteotomy and random fracturing after 6 months. A standardized, 30 degrees oblique monocortical saw osteotomy of sheep tibia was carried out, followed by manual fracture completion of the opposed cortical bone. Fixation was performed by bridge plating (4.5 mm, LCDCP, broad). X-rays were taken immediately after surgery and at the end of the study. Polychrome fluorescent staining was performed according to a standardized protocol in the 2nd, 4th 6th, 10th, 14th, 18th, 22th and 26th week. Ten sheep were comprehensively evaluated. Data for stiffness and histomorphology are reported. The average bending stiffness of the operated bone was higher (1.7 (SD 0.3) with plate (MP) vs. 1.5 without plate) than for the intact bone (1.4 (SD 0.2), though no significant differences in bending stiffness were observed (P>0.05). Fluorescence staining revealed small numbers of blood vessels and less fragment resorption and remodeling in the osteotomy gap. Bone healing after saw osteotomy shows a very close resemblance to 'normal' fracture healing. However, vascular density, fragment resorption, fragment remodeling, and callus remodeling are reduced at the osteotomy.
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http://dx.doi.org/10.1002/jor.20795DOI Listing
May 2009

Myoclonus-induced bilateral acetabular fracture dislocations.

J Arthroplasty 2009 Aug 13;24(5):826.e11-5. Epub 2008 Aug 13.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Goettingen, Germany.

An uncommon case of myoclonus-induced bilateral central acetabular fracture-dislocation is presented. Although different fracture types due to forceful muscular contractions have been reported, this is an exceedingly uncommon injury pattern. Bilateral total hip arthroplasty, in combination with a reinforcement ring and autologous bone grafting, was performed after open reduction and internal fixation.
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http://dx.doi.org/10.1016/j.arth.2008.05.030DOI Listing
August 2009

Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells.

Cells Tissues Organs 2009 11;189(5):317-26. Epub 2008 Aug 11.

Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg August University Göttingen, Göttingen, Germany.

Background/aims: Autologous chondrocyte (CC) transplantation has the disadvantages of requiring two surgical interventions and in vitro expansion of cells, implying the risk of cellular dedifferentiation. Our clinical aim is to develop a one-step procedure for autologous CC transplantation, i.e. harvesting, isolation and reimplantation of CC performed in one single surgical procedure. Platelet-rich plasma (PRP) is a source of autologous growth factors reported to have mitogenic effects. The objective of this study was to test the influence of PRP as an autologous scaffold on freshly isolated CC and mesenchymal stem cells (MSC).

Methods: CC and MSC were subjected to two- or three-dimensional (3D) growth systems, either with or without PRP. Chondrogenic differentiation was determined via quantification of collagen type II mRNA and immunohistochemical staining.

Results: We observed a proliferative effect for MSCs exposed to PRP in monolayer culture and an increase in the expression of chondrogenic markers when cells are exposed to a 3D environment. CCs exposed to PRP show a decrease in the chondrogenic phenotype with increasing proliferative activity.

Conclusion: PRP has a proliferative effect on CCs and MSCs. In a one-step procedure for autologous CC transplantation, this might be an advantage over other scaffold materials, but confirmation in in vivo studies is required.
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http://dx.doi.org/10.1159/000151290DOI Listing
June 2009

Delayed cyclops syndrome: symptomatic extension block four years after anterior cruciate ligament reconstruction.

Acta Orthop Belg 2008 Apr;74(2):261-5

Department of Trauma Surgery, Plastic- and Reconstructive Surgery, University Medicine, Göttingen, Germany.

Loss of knee extension after reconstruction of the anterior cruciate ligament may occur due to a neoproliferative fibrous nodule located anterolateral to the tibial tunnel, termed cyclops syndrome. This nodule occurs usually within the early postoperative period and results in diminished knee extension due to impingement on the intercondylar notch. We report a case of a 24-year-old female patient with an uncommon delayed-onset loss of knee extension due to a cyclops syndrome four years after anterior cruciate ligament reconstruction.
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April 2008

Morphology of the interphalangeal joint surface and its functional relevance.

J Hand Surg Am 2008 Jan;33(1):9-18

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University of Göttingen, Göttingen, Germany.

Purpose: To study and to clarify the curvature morphology of the articular surfaces of the proximal interphalangeal (PIP) joint and to relate joint morphology and joint kinematics.

Methods: The radii and centers of curvature of 40 PIP joints were determined by sagittal and transverse intersections of highly precise replicas that were prepared by dental methods.

Results: The PIP joint is proved to be a nonconforming joint: the articular surface of the proximal end of the middle phalanx has lesser curvatures than the condyles of the proximal phalanx. In intersections through the apex of the radial and ulnar condyles, the measured differences of the radii between the articular surfaces of the PIP joint were sagittally about 30% and transversely about 49% of the respective radii of the condyles. Incongruity of the joint results in 2 morphologically given axes for extension respective to flexion: (1) an axis given by the articular surfaces of both condyles of the proximal phalanx; and (2) a second axis given by the articular surface of the proximal end of the middle phalanx. Both articulating surfaces have 2 contact points in the transverse plane, one each, central to the apex of radial and ulnar condyles, respectively. In the middle of the joint, in the intercondylar groove, a small joint cavity was present in 37 of 40 joints.

Conclusions: The physiological incongruity of the 2 articular surfaces of the PIP joint was defined quantitatively. This allows the derivation of a theoretical model for PIP joint function that explains the kinematics and mechanical stability of the joint as well as the lubrication and nutrition of the cartilaginous structures.
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http://dx.doi.org/10.1016/j.jhsa.2007.09.001DOI Listing
January 2008

Prognostic reliability of the Hawkins sign in fractures of the talus.

J Orthop Trauma 2007 Sep;21(8):538-43

Department of Trauma, Plastic, and Reconstructive Surgery, Göttingen University Hospital, Göttingen, Germany.

Objective: To determine the prognostic reliability, sensitivity, and specificity of the Hawkins sign. The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral radiographs.

Design: Retrospective study.

Setting: University hospital.

Patients And Methods: Between January 1995 and December 2000, a total of 41 patients (13 female, 28 male) with displaced talar fractures were operated on in our hospital. Thirty-four patients with a mean age of 35 years (range 12-60) were followed for more than 36 months (range 36-52). The prognostic reliability of the Hawkins sign was studied in 31 of these patients using a two-by-two table. The Ankle-Hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) was used as an outcome measure.

Results: No Hawkins sign was found in the five patients who developed avascular necrosis (AVN) of the talus. In the remaining 26 patients who did not develop AVN, a positive (full) Hawkins sign was observed 11 times, a partially positive Hawkins sign 4 times, and a negative Hawkins sign 11 times. The Hawkins sign thus showed a sensitivity of 100% and a specificity of 57.7%. The Hawkins sign (if present) appeared between the 6th and the 9th week after trauma. Mean [range] AOFAS scores were: Pain, 31 [10-40] out of 40; Function, 39 [14-50] out of 50; and Alignment, 7 [0-10] out of 10. The clinical results were satisfactory.

Conclusion: The Hawkins sign is a good indicator of talus vascularity following fracture. If a full or partial positive Hawkins sign is detected, it is unlikely that AVN will develop at a later stage after injury.
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http://dx.doi.org/10.1097/BOT.0b013e318148c665DOI Listing
September 2007