bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical Properties of Tensile Strength of ITB Graft, a Promising Graft for Labral Reconstruction of the Hip
Authors: Mahda F , Sasetyo DR 
Published: May 2020

Introduction: Labral repair gives good results on damage in the labral area of the hip, but in cases with extensive labral damage, labral repair is less effective, reconstruction of labral is needed, recently labral reconstruction has been done using the Iliotibial band (ITB), but no one has measured the tensile strength of the ITB. this study intends to measure the ITB tensile strength based on diameter. Methode: This is an experimental research, the sample was taken from 8 cadaveric, consisted of 6 cadavercic male sex and 2 cadaveric female sex, the youngest cadaveric age was 25 years and the oldest 63 years with an average age of 47 years. Each cadaver was treated by taking ITB, The ITB were then measured by applying the Hydraulic Servo Pulser tensile test apparatus. ITB was rolled oval and tied with an unabsorbed polyster suture, the ITB which was oval shaped and had been tied with an unabsorbed polyster suture then measured its diameter from 4mm, 5mm, 6mm, 7mm, to 8mm. Samples that have been prepared are measured using a tensile strength gauge to assess ITB tensile strength ranging from 4mm, 5mm, 6mm, 7mm, to 8mm. Results: ITB’s tensile strength curve is sigmoid shape , the average tensile strength for all samples is 647 Psi. The larger the sample diameter, the greater the tensile strength it has. The largest tensile strength is obtained in 8 mm diameter, and the smallest tensile strength is obtained in 4 mm diameter. Conclusion: ITB is a promising autograft and can be used as an ingredient for the reconstruction of labral.
The Role of Hip Arthroscopy in the Management of Acute Arthritis of Hip
Authors: Ho Sheung Tung , Ip Hoi Yeung , Chiu Ming Yu , Wong Sze Hung 
Published: May 2020

Septic arthritis of hip is an orthopaedic emergency requiring early diagnosis and prompt surgical treatment to avoid grave complications like avascular necrosis and chondrolysis and post-infectious arthrosis. This is a retrospective review of 9 patients who underwent hip arthroscopy for suspected septic arthritis of hip from 2012 to 2018. Medical charts were reviewed to determine the efficacy of the use of hip arthroscopy in the diagnosis and treatment of acute hip arthritis. The age of patients ranged from 9 to 82. The mean follow-up was 29 months (1 to 49). All presented with hip pain and effusion in imaging by CT scan or ultrasonography. Fever was present in 5 out of 9 patients. Hip arthroscopy with 2 portals technique and joint lavage +/- debridement was done. Two patients had whitish suspension in the joint fluid and pathology confirmed pseudogout of hip. The remaining 7 patients were diagnosed and treated as septic hip arthritis. Only 3 had positive culture, probably related to the prior use of antibiotics. All except one responds well to arthroscopic debridement and lavage with infection eradicated, good hip motion and hip function. One patient of delayed treatment (2 weeks after onset of hip pain) had ongoing infection, requiring further arthrotomy and Girdlestone operation for uncontrolled hip infection with intramuscular abscess of vastus lateralis. Hip arthroscopy is a useful diagnostic tool in acute hip arthritis. Besides septic arthritis, monoarticular attack of psuedogout is an important differential diagnosis of acute hip pain in elderly. Early hip arthroscopy can result in rapid postoperative recovery. Arthroscopic lavage and debridement is safe and a good alternative to open arthrotomy in hip septic arthritis.
Quadriceps- vs. semitendinosus tendon in ACL reconstruction - a prospective study comparing autologous transplants regarding their clinical outcome
Authors: Karpinski Katrin , Bierke Sebastian , Häner Martin , Hees Tilman , Petersen Wolf 
Published: May 2020

Aims and Objectives: The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon. Materials and Methods: We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score. Results: The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups. Conclusion: Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.
The arthroscopic popliteus bypass reconstruction for posterolateral instabilities of the knee - clinical results > 2 year follow up
Authors: Drenck Tobias C. , Müllner Maximilian , Preiss Achim , Alm Lena , Kühne Christian A. , Akoto Ralph , Frosch Karl-Heinz 
Published: May 2020

Aims and Objectives: Injuries of the posterior cruciate ligament (PCL) are most often accompanied by injuries of the posterolateral corner (PLC) and the ligamentum collaterale fibulare (LCL). This leads to a combined dorsal- and external rotational instability. Prior to this study a novel arthroscopic technique was developed to treat posterolateral injuries (Popliteus Bypass Graft). To date, there are no long term results reported for arthroscopic techniques to treat these injuries. This study evaluated the clinical outcome of patients undergoing this surgery with a minimum follow up of 2 years. Materials and Methods: In the ongoing study, 47 patients with posterolateral instabilities of the knee were treated with an arthroscopic reconstruction of the popliteus bypass graft in combination with a PCL reconstruction. Patients with a minimum follow up of 2 years were included in this study. The clinical outcome was evaluated by subjective and objective scores for stability, pain and activity level: Lysholm, Tegner, KOOS, Dial test, subjective scores (0-10) for function (0 good, 10 poor) und pain (0 no pain, 10 intense pain). The dorsal stability was measured with the rolimeter. Results: At the time of the abstract submission 17 patients where evaluated. The mean age at the time of the operation was 36.8 (±15.5) years, the mean BMI was 27.7 (±5.5). The mean time from the injury to the treatment was 6.9 (±5.3) months. The mean follow up time was 46.35 (±12.7) months. The mean postoperative Lysholm score was 88.7 (± 13.4). The mean Tegner score was 6.0 (±2.2) preoperative and changed to 5.3 (±2.2) postoperative. The KOOS score was evaluated for pain 87.2 (±19.5), symptoms 92.5 (±11.1), daily activity 89.2 (±16.9), function 73.1 (±28.9) and life quality 78.5 (±21.7). The mean Rolimeter measurement for the uninjured knee was 7.16mm (±2.2) compared to the operated side with 8,18mm (±1.7). The VAS score for function was 1.6 (±2.1) and 1.6 (±2.2) for pain. Conclusion: The arthroscopic reconstruction of posterolateral injuries provides good clinical and subjective results after a minimum follow up of 2 years.
Extra articular lateral tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior instability
Authors: Alm Lena , Frosch Karl-Heinz , Akoto Ralph 
Published: May 2020

Aims and Objectives: While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. Failure rates of 14 to 33% have been reported for revision ACLR. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure. Materials and Methods: Between 2013 and 2016, 150 patients were operated with revision ACLR (revision surgery after primary ACL reconstruction). Out of these patients, 73 patients preoperative had a high-grade anterior instability and were included in the retrospective study. High-grade knee anterior instability was defined as high-grade pivot-shift and/or side- to- side difference of more than 5mm in Rolimeter®-testing. An additional extra articular tenodesis was performed in 59 patients during revision ACLR. Patients were clinically examined with a minimum of 2 years after revision surgery (mean 35±6 months) and identified as “failed revision ACLR” and “stable revision ACLR”. Results: Failure of the revision ACLR occurred in 8.2% (n=6) of the cases. Extra articular lateral tenodesis leads to significant lower failure rates in patients with high-grade anterior instability in comparison to patients without further peripheral stabilization (5% vs. 21%, p=0.045). Also, higher postoperative functional scores were shown in the group of additional extra articular lateral tenodesis (Lysholm 89.5±17 vs. 69.5±12, p=0.041; Tegner 6.6±1.4 vs. 4.5±1.4, p=0.009; Cincinnati Rating Scale 91.2±14 vs. 68.5±17, p=0.006). Failure was associated with male sex (n=6 male failures, p=0.017) and obesity (n=4 obese failures with a BMI >30 kg/m2, p<0.001). Conclusion: Additional extra articular tenodesis in patients with revision ACL instability and accompanying high-grade anterior instability significantly reduces the risk of failure of revision ACLR. General risk factors of failure of the revision ACLR are obesity and male sex.
Is the Independent Tape Reinforcement a valid technique to reduce the rerupture rate of ACL reconstructions? A technical instruction and case series with 2-year follow up
Authors: Schneider Stefan , Kaiser René , Ilg Ansgar , Holz Johannes 
Published: May 2020

Aims and Objectives: Although there is an ongoing development in ACL reconstruction techniques, a rerupture rate up to 20% still is discussed in the literature. Is the ACL reconstruction using a quadriple semitendinosus in combination with a polyurethane tape reinforcement a valid technique to reduce the retare rate? A clinical trial with 35 Patients compared to 320 patients using an isolated semitendinosus reconstruction without internal bracing. Materials and Methods: Additionally, to the quadruple semitendinosus technique with cortical button fixation, the transplant is parallelly stabilized by a polyurethane tape which is individually fixed in the femoral button. The tape secures the transplant during the remodeling episode since repeated small tensions on the transplant during this time are discussed as a reason for a rerupture. In this prospective case series 35 patients were treated with this technique, reexamined and VAS, Tegner, KOOS Jr. and SANE are preoperatively, two and six weeks, three and six month and after one, two and five years recorded using a PROMS system. Clinical instability and proprioceptive function were also surveyed at these timepoints. The results and rerupture rates were compared with 320 patients of our database who underwent a comparable reconstruction without using the internal brace. Patients with fractures and multi-ligament injuries were excluded. Results: Until now no reruptures were reported, there are no significant subjective or objective differences compared to the group without internal bracing. The two years results are pending. Preoperatively the VAS score was 2.2 +/- 2.0. Two weeks after the surgery 2.1 +/- 1.8 and one year postoperatively 0.5 +/- 0.7. Tegner score preoperatively: 4.6 +/- 2.7 after one year 4.7 +/- 3.0. KOOS jun. improves in both groups around 15%. Conclusion: Until now the ACL reconstruction using an internal brace seems to be a safe and effective technique. Biomechanical studies show beneficial stabilizing results and a minor rerupture rate might be possible due to reduced microlesions during the remodeling period. The study is still ongoing, longtime results are pending.
Comparison of articular exposure through extended lateral approaches to the tibial plateau
Authors: Frings Jannik , Krause Matthias , Isik Hüseyin , Frosch Karl-Heinz 
Published: May 2020

Aims and Objectives: Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy? Materials and Methods: Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p < 0.05). Results: The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p < 0.001). Conclusion: The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.
High incidence of tunnel collision in combined ACL reconstruction and LET
Authors: Jaecker Vera , Herbort Mirco , Bouillon Bertil , Günther Daniel , Shafizadeh Sven 
Published: May 2020

Aims and Objectives: Lateral extra-articular tenodesis (LET) procedures are being increasingly performed as concomitant procedures to both primary and revision intra-articular ACL reconstructions with the purpose of controlling excessive anterolateral rotatory instability and to reduce tension on the ACL graft. There is, however, a lack of evidence on benefits and pitfalls of different femoral LET attachment positions. The purpose of this study was to assess the risk of tunnel convergence in combined ACL and LET procedures comparing two different femoral attachment sites (Lemaire and MacIntosh). Materials and Methods: 10 fresh-frozen cadaver knees were examined. In each specimen an anatomic ACL femoral tunnel and two LET tunnels were drilled applying the Lemaire and MacIntosh position. Following knee dissection, minimal distances between ACL and LET tunnels were directly measured on the lateral femoral cortex. Furthermore, computed tomography (CT) scans were obtained to measure inter-tunnel convergence and lateral femoral condyle (LFC) width. Based on the average LFC width, knees were divided into large and small knees to determine a relationship between knee size and tunnel convergence. Results: Convergence of ACL and LET tunnels occurred in 7 of 10 cases (70%) using the Lemaire attachment position. All tunnel collisions occurred directly on the lateral femoral cortex, while inter-tunnel conflicts were not observed. Collisions emerged in both, small (n=4) and large (n=3) knees. Critical tunnel convergence did not occur using the MacIntosh position. The mean minimal distance between the LET and ACL tunnel using the Lemaire and MacIntosh position was 3.1±4.6 mm and 9.8±5.4 mm, respectively. Conclusion: A high risk of tunnel convergence was observed in combined ACL and LET reconstruction using the Lemaire technique, independent of the knee size. LET femoral tunnel positioning according to the MacIntosh reconstruction can significantly reduce the risk of tunnel collision. These findings help to intraoperatively raise the awareness for the risk of tunnel convergence in combined ACL and LET procedures. Adjustments on ACL reconstruction techniques and especially on the femoral fixation have to be considered when applying an additional Lemaire reconstruction.
Outcome after polyaxial locking plate osteosynthesis in proximal tibia fractures (VALCP ® vs. NCB-PT®): a prospective randomized clinical trial
Authors: Völk Dominik , Neumaier Markus , Einhellig Heike , Biberthaler Peter , Hanschen Marc 
Published: May 2020

Aims and Objectives: The use of polyaxial locking plates is an established technique for the treatment of proximal tibia fractures. At the moment different polyaxial locking implants from numerous manufactures are available, though at the moment there are no clinical trials regarding their differences. In this prospective clinical trail we compared the NCB-PT® (Zimmer) and the VA-LCP® (Synthes) by analysing primary and secondary quality criteria of the osteosynthesis (clinical and radiological). Materials and Methods: This study enrolled 28 patients suffering from a proximal tibia fracture (AO/ASIF 41 B-C). The follow-up examinations were conducted over 12 months after the surgery. Clinical (e.g. range of motion, Rasmussen score, Tegner score) as well as radiological parameters (e.g. primary and secondary loss of reduction, fracture healing) were collected. For the analysis of continuous parametric variables the Student’s t-test was used and for non-parametric variables the Mann-Whitney U test. For binominal variables the Fisher’s exact test was preformed. In all analysis the significance level was set at a p-value <0,05. Results: Comparing the epidemiologic data of both groups only very small or no differences with no statistical significance could be found. The intraoperative data showed a significant longer surgery duration for the NCB-group (NCB-PT® 196,3 min vs. VA-LCP® 121,7 min, p-value 0,0335). Furthermore the median length of implants used in each group proved to be significant longer in the NCB-group (NCB-PT® 8,1 holes vs. VA-LCP® 5,1 holes, p-value 0,0007), most likely because of the imbalance of severe fractures in between the groups (type C fractures: NCB-PT® 78% vs. VA-LCP® 26%). The analysis of the clinical data as well as the clinical scores showed reduced scoring values of the NCB-group. Only the results of the Lysholm score (p-value: 0,03) and MKQ (Munich Knee Questionnaire) (p-value: < 0,0001) proved to be statistically significant. Regarding the radiological data only the radiologic Rasmussen score had a significant difference in favour of the VA-LCP®-group (p-value 0,0153). Conclusion: This study constitutes the first prospective clinical trial to compare the outcome of the VALCP® an NCB-PT® for the treatment of proximal tibia fractures. Despite the limitation of this study, low case numbers and heterogeneity of fracture types, differences regarding the clinical and radiological outcome could be found. The treatment with the VA-LCP® had a significantsuperior outcome in separate clinical scores (Lyshom score/ Munich Knee Questionnaire) as well as in a single radiologic score (radiologic Rasmussen score) in comparison to the treatment with the NCB-PT®. Our data underlines the necessity for an extended study with a higher case number.
Trauma Mechanisms of Acute Knee injuries in Bouldering and Sport Climbing
Authors: Lutter Christoph , Tischer Thomas , Cooper Carrie , Frank Luisa , Hotfiel Thilo , Lenz Robert , Schöffl Volker 
Published: May 2020

Background There is limited insight into trauma mechanisms of knee injuries in bouldering and sport climbing for both non-competitive and competitive athletes. Purpose Based on a recent rapid increase of knee injuries caused by bouldering and sport climbing, we aimed to examine traumatic mechanisms of injury, demographics, distribution and severity of knee injuries in affected athletes. Study Design Case series; Level of evidence, 4. Methods Within a four-year period, we performed a retrospective multi-center analysis of acute knee injuries in both competitive and non-competitive climbers. Traumatic mechanisms were inquired and severity levels, therapies and outcomes recorded using Visual Analog Scale (VAS), Tegner, Lysholm and a climbing-specific outcome score. Results A total number of 71 patients (35% competitive athletes and 65% non-competitive athletes) with 77 independent acute knee injuries were identified. Four different trauma mechanisms were thereby recorded: High step (20.8%), Drop knee (16.9%), Heel hook (40.3%) and (ground) Fall (22.1%). The leading structural damage was medial meniscal tear (29.3%), found significantly more often in non-competitive athletes. A specific climbing injury is iliotibial band strain during the heel hook position, causing 46.8 % of all injuries; most injuries resulted from indoor bouldering. Surgical procedures were predominantly necessary within the non-competitive group. One year after the injury, the average Tegner score was 5.6 ± 0.6 (3-6), Lysholm score was 97 ± 4.8 (74-100) and climbing specific outcome score was 4.8 ± 0.6 (2-5). Conclusion: Increased attention on the climber’s knee is required, especially due to the worldwide rise of indoor bouldering. Sport specific awareness- and training programs for both noncompetitive and competitive climbers to reduce acute knee injuries should be developed and sports medical supervision is mandatory.