Aim

The purpose of this study was to evaluate the results after arthroscopic reconstruction of isolated SSP lesions. Does double row repair in smaller lesions lead to better results and a lower retear rate?

Objectives

Juxtafacet cysts of the spine can cause radicular pain, neurological symptoms and are often associated with spinal degeneration. The mainstay of treatment of juxtafacet cysts is surgical resection with laminotomy and resection of the cyst. Other methods, including epidural steroid and facet injections are mostly temporarily effective. The aim of this study is the sufficient decompression with reduced traumatization and destabilization with the full-endoscopic interlaminar and transforaminal technique.

Ouery: Matrix-coupled autologous chondrocyte transplantation (MACT) has become increasingly widespread in the therapy of cartilage defects. The objective of this controlled prospective study was to examine the mid-term results of MACT compared to those of Microfracturing (MF) for the treatment of cartilage defects in the knee joint and to determine possible advantages or disadvantages of the two methods.

Method: In order to compare the two treatment methods, 40 patients with discrete cartilage defects were treated with MACT and 40 with MF between 4/01 – 4/03. As inclusion criterion, the patients had a chondral defect of at least 1.5 cm and as exclusion criterion, there could be no additional cartilage damage in the other areas of the knee. MRI examinations were performed preoperative (T2 gew. TSE-Sequence, fetts. FLASH-3D) and could be repeated after 6 and 12 months. Knee joint function, the activity level and the patient’s quality of life were evaluated in both groups pre- and postoperative using the modified Cincinnati Score and the Tegner Activity Index.

Results: There was significant improvement in the scores used for the study in both the MF group and the MACT group. Comparison of the two groups revealed significantly greater clinical improvement in the MACT patients than in the MF patients (3.8 point increase MACT versus 2.6 point increase MF in the Cincinnati Score). Taking the size extent of the treated cartilage damage into account, there was, however, no relevant difference in defects less than 2,5 qcm.

Conclusion: The study could demonstrate that both methods are successful in treating localized cartilage damage in the knee joint. Comparison of the two forms of therapy showed a greater extent of improvement in the MACT group. However, classification by the size of the defect revealed that this effect was relevant only in larger defects, so that the size of the defect should be a decisive criterion for the selection of therapy.

Query: In the past few years, chevron osteotomy has become more widespread in the treatment of mild Hallux valgus deformities thanks to its low rate of complications and excellent results. The results in moderate to severe deformities are not as convincing, depending on the surgical procedure used. The objective of this study was to examine the influence which the choice of surgical procedure and thus the osteotomy has on the clinical, radiological and pedobarographic results in the forefoot.

Method: In a prospective study, we examined the surgical results of 140 feet treated between August 2004 and March 2005 in our clinic for moderate Hallux-Valgus deformity. In 70 patients, Ludloff osteotomy and in 70 the Scarf osteotomy was selected as the method. The patients underwent pre- and postoperative clinical, radiological and pedobarographic examination. In addition, patient satisfaction was determined using the Kitaoko Forefoot Score. Indication for performance of the osteotomy was a Hallux-Valgus deformity up to an intermetatarsal angle (IMA) of 17°.

Results: The mean preoperative IMA was 14.5 °, the Hallux-Valgus angle (HVA) 31.3°. The IMA could be improved by Scarf osteomy on average by 7.6°, by Ludloff osteotomy by 8.1°. With suitable plantarisation of the 1st metatarsal head, better and more even pressure distribution in the forefoot could be achieved with both surgical procedures and the load peaks reduced overall. The complication rate was somewhat lower overall in the Scarf osteomy.

Conclusion: Both the Scarf osteotomy, and the Ludloff ostetomy enable achieving of good results in moderate deformity. The extent to which one procedure should be preferred over the other could not be determined. Both procedures have advantages as well as disadvantages. Further attention to this area of Hallux-valgus surgery is definitely needed to meet the higher demands of the patients.

Aim: The purpose of this study was to evaluate the results after arthroscopic cuff repair using suture anchors with associated lesions of the long head of the biceps. Does biceps tenodesis lead to better results?

Method: 80 patients (age 41 to 74) with one or two tendon lesons of the rotator cuff and associated lesions of the biceps (instability, partial tear) were treated with arthroscopic ruff repair using suture anchors. Preop examination included MRI and ultrasound. The fatty degeneration and infiltration of the tendon was noted according to Goutallier and Thomazeau. Patients were devided into 2 groups. 40 patients were treated with a biceps tenodesis and 40 cases with a tenotomy. Tenodesis was performed using suture anchors. Patients in both groups were comparable in age, sex, tear size and fatty degeneration. Rehanilitation protocol was equal in both groups. Prospective follow up was done at 3, 6, 12, 24 and 36 months using the Constant score. Ultrasound was documented at all follow-ups, MRI at last follow up.

Results: 73 Patients could be completely evaluated, 37 in the tenodesis and 36 in the tenotomy group. The constant score gained 42,3 points from 44,3 to 87,6 overall. There were 4 complete re-tears of the cuff in the tenodesis and 5 in the tenotomy group during follow up, requiring 2 revisions in each group. There was one revision due to stiffness in the tenodesis group, no infections were noted. 29 patients in tenotomy group had a visuable deformity compared to 3 cases in tenodesis group, whereas Ultrasound examination revealed 5 not healed tenodesis.

32 patients in the tenodesis group were satisfied with the result and would do surgery again compared to 25 in the tenotomy group, complaining about the visual deformity. There was no statistical difference in score result between the tenodesis or tenotomy group.

Discussion: The arthroscopic treatment of rotator cuff lesions leads to good results after 36 months. The way a lesion of the biceps tendon is treated does not seem to have an effect on the postoperative score result. Cosmetic appearance was better in tenodesis group, leading to better patient acceptance.

Query: The means for treating Osteochondrosis dissecans (OD) of the knee joint in adolescents remains today a matter of controversial discussion. Not only the different treatments, whether purely conservative or one of the various surgical procedures, are rated differently with respect to their benefit, but also the question of the right time to operate is not easy to answer. The objective of this prospective study was to examine the long-term results of a bioabsorbable fixation system in the treatment of OD and to determine possible relationships between the baseline conditions, such as stage of disease, patient’s age, severity or localization and the results in each case.

Method: Between 1995 and 2005, 312 patients aged 7 to 19 years with Osteochondrosis dissecans were treated by means of arthroscopic operation on the knee joint. In 257, fixation using ethipins could be performed, the dissecate had to be removed in 31 patients. An MRT was performed preoperative in all patients, the knee joint function, activity level and patient’s quality of life were evaluated postoperative using the modified Cincinnati Score, the Tegner Activity Index and the Lysholm Score.

Results: 255 of the 312 patients were available to follow-up over a longer period (Ø 7.9 years). The Lysholm Score for all patients 5 years after surgery was 87.6 points, after 10 years 76.5. Classified by baseline stage, it was found that the postoperative course was clearly better in those patients in whom fixation was required. Moreover, an early stage of OD and younger patient age were prognostically favorable factors. The MRT follow-up examination showed re-integrated vital cartilage areas without signs of fixation residuals in patients in whom fixation was performed.

Conclusion: Surgical treatment of Osteochondrosis dissecans brings different results depending on the stage of the disease. Moreover the results depend on patients age, location of the defect, duration of symptoms. If fixation of the dissecate using bioabsorbable pins is successful, the long-term results achieved are good to excellent. Overall, the data obtained justify an early decision for a surgical procedure in the treatment of Osteochondrosis dissecans of the knee joint in children and adolescents.

Query: Persistent complaints following implantation of a knee prosthesis are often a problem which is hard to overcome. On the one hand, general diagnostics do not reveal the cause of the complaints, on the other, pain symptoms in connection with deficient patella control cannot always be attributed to insufficient equilibrium of the soft tissues. In this prospective study, the rotation of the components was examined in connection with the pain described by 49 patients.

Method: The rotation of the prosthesis components was examined by means of axial CT scans in 49 patients with the complaint symptoms described above and without signs of loosening or malpositioning at the frontal or sagittal level. The results were set in relation to clinical symptoms, the Knee Society Score and a VAS.

Results: A direct relationship was found between the extent of the added inner rotation malpositioning of the components and a deteriorated Knee Score. No difference in the pain score in dependence on the extent of improper implantation could be observed. Incorrect tibial rotation was responsible in particular for patellar lateralization, subluxation or tipping.

Conclusion: The correlation between inner rotation malpositioning and deficient patellar control or signs of instability underlines the importance of intraoperative rotation adjustment in the prevention of knee pain. In unclear knee pain following knee endoprosthesis implantation, performance of a CT to determine the component rotation is indicated. If there is a rotation malpositioning, correction in a revision procedure should be considered.

Aim: The purpose of this study was to evaluate the results after arthroscopic treatment of traumatic AC joint dislocation using a Bosworth screw.

Method: 18 Patients with acute AC Joint dislocation type Rockwood 3 were arthroscopically treated with temporary transfixation using a 7.0mm cannulated titanium screw of the clavicle to the coracoid process. The coracoid process is arthroscopically visualized and a drill guide for tibial anterior cruciate ligament positioning is used to exactly place the screw into the coracoid process. The screws were removed after 8 weeks. Patients were followed using a prospective study using the Constant Score after 3, 6, 12 and 24 months.

Results: 17 Patients were completely evaluated. One screw slipped out of the coracoid process 3 days after surgery requiring revision surgery. No screw breakage was observed. There were no other operation conditioned complications. Constant score showed a mean of 94,7 at last follow up. At follow up, no patient hat a redislocation without weight bearing. With 10kg weight a mean clavicular elevation of 1,8mm was observed. All remaining patients were satisfied with the functional and cosmetic result.

Discussion: There is some controversy about the surgical treatment of acute traumatic AC joint dislocation type Rockwood 3. Most open surgery techniques have the disadvantage of a poor cosmetic result or a difficult and dangerous hardware removal, because the scar of the AC joint capsule that is supposed to stabilize the clavicle has to be opened. The Bosworth screw technique does not touch the AC joint at all, but the open procedure has poor cosmetic outcome. It is also important to use a large screw to ensure proper hardware stability to avoid hardware failure. Our technique might be an alternative for the operative treatment of acute AC joint instability, because it is safe and all anatomical structures remain intact in case revision surgery with i.e. arthroscopic AC joint resection and ligamentoplasty is necessary.

Introduction: A far lateral access is required in fullen-doscopic operations of sequestered lumbar disc herniations to achieve a sufficient decompression of the ventral epidural space. The conventional endoscopes and instruments had very narrow limits especially in the mobility and possibility to resect hard tissue and to clean the intervertebral space sufficiently. The aim of this prospective study was to investigate the extended possibilities of the new endoscopes and instruments with regard to the efficacy of decompression, the advantages and problems of this technique in comparison to previous data.

Methods: 368 patients with lumbar disc herniations have been treated in 2002 and 2003 in a full endoscopic transforaminal technique using a lateral access. A 7-mm endoscope with 4 mm-working canal and new designed instruments were used. Follow-up lasted at least 12 months. 298 patients (81%) could be followed.

Results: No intraoperative complication occurred. 6 patients reported a transient dysaesthesia postoperatively. The average operation time was 28 minutes. A sufficient decompression could be achieved in all cases. 244 patients (82%) reported no more leg pain after surgery, 42 patients (14%) had transient persistence in the first 6 weeks. 8 patients (2,7%) showed a recurrent herniation, 7 of those were reoperated in the same technique.

Discussion/Conclusion: As a minimally invasive technique wich efficacy of decompression is equal to an open procedure we see advantages over conventional operations of lumbar disc herniations. Within the inclusion criterias of indication this technique is sufficient and safe. The technical developments on endoscopes and instruments lead to a decrease of recurrence, increase of mobility as well as the possibility of resection of hard tissue and sufficient cleaning of the intervertebral space. The combination of a far lateral access with other approaches extends the spectrum of indications with regard to full endoscopic bony decompression and fusion.

Introduction: Revision procedures in pain syndromes following spinal operations can bring unsatisfactory results. When all therapies fail, there is the possibility of implantation of SCS. The 8-pole electrode and double-electrode technique broaden the spectrum. The purpose of this prospective study is to evaluate the results of the use of SCS in the technique cited in chronic lumbar pain syndrome of previously-operated patients.

Methods: An SCS system was implanted in 37 previously-operated patients (16 f, 21 m; mean age 42 years) with therapy-resistant chronic lumbar pain syndrome (duration 31–62 months, all MPSS Grade III). All patients had undergone multiple surgery (2–5 times). 13 patients had also undergone fusion operation. The daily morphine dose applied ranged from 60–200 mg MST retard or equivalent. All patients also presented with somatizing tendencies. In addition to general criteria special measuring instruments were used. The follow-up period lasted 3 years. All patients could be included.

Results: The external test phase lasted 15 to 45 days. 29 patients needed a double-electrode system. With the exception of one patient who was not included in the study, all patients desired permanent receiver implantation. Three times during the test phase there was dislocation of the electrode which could be corrected during receiver implantation. Three late dislocations could be corrected in one case by external repoling of the electrodes and in one case by revision under local anesthesia.. One patient required open implantation of a 16-pole plate electrode. All patients attained a reduction to MPSS grade II. The VAS revealed reduction by at least 4 categories, with maximum 7. Similar results were found in the specific back scores. In the SF-36, the level of the normal sample with back pain, ischias and disk damage was attained. The morphine dose could be reduced by at least 50%. 9 patients no longer required long-term medication. All results were stable throughout the follow-up period. All patients said they would have the procedure repeated.

Discussion/Conclusion: SCS in 8-pole and double-electrode technique is a sufficient procedure in the therapy of chronic lumbar pain syndrome in previously-operated patients. Accurate indication and test phase are necessary. Even somatizing tendencies do not represent an absolute contraindication. Special attention must be paid to the complication of electrode dislocation.

Aims: In this prospective study, we examined the value of capsular shrinkage in the arthroscopic stabilization of the posttraumatic antero-inferior instability of the shoulder.

Methods: We treated 58 patients (38 men and 20 women) at the age of 29.7 (19–43) with the diagnosis posttraumatic antero-inferior shoulder instability with an arthroscopic stabilization.

The patients were divided in two groups: In the first group with 31 patients we performed a capsule-labrum refixation with Fastak-anchors. In the second group (27 patients), we performed additionally a capsular shrinkage of the antero-inferior capsule with the Hol-Yag-laser.

The re-examination was done in a postoperative time of 6, 12 and 24 months.

Results: 50 patients (35 men and 15 women, 27 patients of the group 1 and 23 patients of the group 2) could be re-examined.

Operation-conditioned complications did not occur. 3 postoperativ reluxations were seen in each group. 22 patients of the group 1 and 19 patients of the group 2 indicated to be content with the postoperative result. The Constant Score rose in the group 1 from 46 (37–59) praeoperativ to 88 (67–100) postOP. In the group 2 the Constant Score of 42 (33–61) rose to 86 (64–100) postOP.

Conclusions: There was no significant improvement regarding the re-dislocation rate, the subjective patient satisfaction and the obtained Constant Score by additionally performing capsular shrinkage of the antero-inferior joint capsule, as by the exclusive capsule-labrum refixation.

The anatomical reconstruction of the capsule-labrum-complex seems to be the crucial component in the arthroscopic stabilisation regarding to the postoperative results.

Purpose of the study: Autologous chondrocyte transplantation has become in the last years more and more popular for the treatment of chondral knee lesion. The standard procedure has good result, however important disadvantages represent the difficulty to manage liquid chondrocyte culture solution and the necessity to create the hermatic periosteum suture.The aim of the our study was to investigate the short time results of a matrix-induced chondrocyte transplantation (MACT) for treatment cartilage defects in the knee und to analyse ad- or disadvantages.

Method: Since June 2001 we use for the autologous chondrocyte transplantation (ACT) instead of a periosteum flap the 3-dimensional matrix or resorbarble fleece. 35 patients with defects in cartilage of the knee have been treated so far. Average defect size was 4,8 qcm, all patients had a follow up with clinical investigations and MRI studies. The results were evaluated by different scores.

Results: 33 of 35 patients were after six months satisfied with the operation result or justed it more better. All of the subjective or objektive parameters of the different scores were improved after one year. The clinical outcome was good in the follow-up.

Conclusion: In the follow up the results can be compared with the one found in literature of the standard periost method. The matrix-induced chondrocyte transplantation has the advantage, that no periost flap is needed and that the chondrocyte culture is not liqiud. The first results are promising.