RESUMEN
OBJECTIVES: Treatment of pathologies of the central and peripheral compartment of the hip using arthroscopic assisted mini-open arthrotomy via the Smith-Petersen approach. INDICATIONS: Cam- and pincer-type femoroacetabular impingement (FAI), labral tear, loose bodies. (RELATIVE) CONTRAINDICATIONS: Osteoarthritis of the hip with Tönnis classification grade ≥â¯2. SURGICAL TECHNIQUE: After mini-open approach to the hip joint via direct anterior muscular gap, the anterior capsule is split with protection of the labrum. Decompression allows the joint to be inspected using an arthroscope. Depending on the intra-articular findings, additional procedures can be performed (e.g., curettage of the cartilage, microfracturing, matrix-induced autologous chondrocyte implantation [MACI]). Cases with pincer-type FAI or labral tear can also be addressed. After partial release, the cam-type FAI can be resected using a surgical burr. POSTOPERATIVE MANAGEMENT: Partial weightbearing for 2-6 weeks with 10-20â¯kg or half body weight using crutches depending on the intraoperative treatment. RESULTS: Radiological analysis of the pre- and postoperative Xrays (nâ¯= 69) prove that this surgical technique is suitable to address pathologies especially FAI syndromes. The αangle according to Nötzli could be reduced from a mean preoperative value of 72.8° to 49.4° postoperative. In combined cam-type and Pincer-type FAI syndrome (nâ¯= 16), the lateral center-edge angle could be reduced from a mean preoperative value of 50.2° to 37.6° postoperatively. The clinical follow-up (nâ¯= 29) revealed good midterm outcomes after arthroscopic assisted mini-open arthrotomy (modified Harris Hip Score [mHHS] 84.8 points after 4.9 years [range 4.2-5.7; ±0.43]).
Asunto(s)
Artroplastia de Reemplazo de Cadera , Pinzamiento Femoroacetabular , Artroscopía/métodos , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/cirugía , Articulación de la Cadera/cirugía , Humanos , Resultado del TratamientoRESUMEN
INTRODUCTION: Short femoral hip stems with a metaphyseal anchoring concept have been designed to treat younger patients with good bone quality. The aim of this study was to reconstruct the centre of rotation and soft tissue balancing and preserve bone in the long-term perspective. MATERIALS AND METHODS: Eighteen human femurs were randomised into three groups: (1) metaphyseal anchoring short stem, (2) shortened straight stem, (3) straight stem). Prior to the implantation of the hip stems, a computed tomography (CT) of the bones was performed and the femoral ante-torsion and ante-tilt was measured and compared to the results of the post-implantation CT. This could be calculated based on the 3D coordinates taken from the pre- and post-op CT scans, which were transformed into the same coordinate systems. RESULTS: The mean preoperative caput-collum-diaphyseal (CCD) angle for the three groups was 126.87° ± 3.50° (Group 3: 129.64° ± 3.53°, Group 1: 123.76° ± 5.56°, Group 2: 127.53° ± 1.42°) and was consistent with published reports. The postoperative CCD angles with 126.85° ± 3.43° were within a very good reconstruction range for all three groups. The anterior offset comparison among these three groups showed significant difference in reconstruction. The smallest difference between the anatomical (preoperative) and postoperative condition was seen in Group 1 (1.47° ± 0.60°), followed by Group 2 (3.60° ± 0.23°) and Group 3 (8.00° ± 0.70°) groups. The horizontal offset showed no significant difference among the groups and was within the window of ± 5 mm. CONCLUSION: In this cadaver study, we found that the metaphyseal anchoring, partially neck-preserving short hip stem best reconstructs the ante-torsion and the ante-tilt of the femoral neck. Therefore, it can be a useful stem in younger or active middle-aged patients.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Cadáver , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUCTION: Femoroacetabular impingement of the hip is considered a prearthrotic deformity, which should be treated at an early state to prevent complications. MATERIAL: This video demonstrates the arthroscopic-assisted mini-open technique for the treatment of femoroacetabular impingement of the hip. In the case presented a combined Pincer and Cam-deformity is treated with rim trimming, translabral labral refixation with two suture anchors and reconstruction of the head-neck junction. CONCLUSION: The arthroscopic-assisted mini-open technique is a safe and reproducible procedure for treatment of femoroacetabular impingement. It provides an alternative to hip arthroscopy and an additional treatment option in the portfolio of hip surgeons.
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Artroscopía , Pinzamiento Femoroacetabular/terapia , Acetábulo , Articulación de la Cadera , Humanos , Anclas para Sutura , Resultado del TratamientoRESUMEN
PURPOSE: This cadaveric study compares the biomechanical properties of femoral graft fixation in ACL reconstruction of either quadriceps or hamstring tendon grafts with four different interference screws. The hypothesis was that quadriceps tendon grafts provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared to hamstring tendon grafts with four different interference screws. METHODS: Eighty porcine femora underwent interference screw fixation of human tendon grafts for ACL reconstruction. Either quadriceps (Q) or hamstring (H) tendon grafts and four different bioabsorbable interference (Wolf (W), Storz (S), Mitek (M), Arthrex (A)) screws were used, resulting in 8 groups with 10 specimens per groups (WQ, WH, SQ, SH, MQ, MH, AQ, AH). Biomechanical analysis included pretensioning the constructs with 60 N for 30 s, then cyclic loading of 500 cycles between 60 and 250 N at 1 Hz in a servohydraulic testing machine, with measurement of elongation and stiffness including video measurements. After this, ultimate failure load and failure mode analysis were performed. RESULTS: No statistically significant difference could be noted between the groups regarding gap formation during cyclic loading [Cycles 21-500 (mm): WQ 3.6 ± 0.8, WH 3.9 ± 1.4, SQ 3.6 ± 0.8, SH 3.3 ± 1.5, MQ 4.3 ± 0.8, MH 4.6 ± 1.0, AQ 4.8 ± 0.8, AH 4.3 ± 1.5, n.s.], stiffness during cyclic loading [Cycles 21-500 (N/mm): WQ 72.9 ± 16.9, WH 71.6 ± 20.7, SQ 69.5 ± 23.9, SH 77.4 ± 25.1, MQ 59.6 ± 11.2, MH 48.4 ± 15.4, AQ 48.8 ± 12.7, AH 51.9 ± 22.2, n.s.], and ultimate failure load [(N): WQ 474.4 ± 88.0, WH 579.3 ± 124.2, SQ 493.9 ± 105.2, SH 576.0 ± 90.4, MQ 478.6 ± 59.0, MH 543.9 ± 119.7, AQ 480.2 ± 93.8, AH 497.8 ± 74.2, n.s.]. CONCLUSIONS: Quadriceps tendon grafts yield comparable biomechanical results for femoral interference screw fixation in ACL reconstruction compared to hamstring tendon grafts. From a clinical perspective, quadriceps tendon grafts should therefore be considered as a good option in ACL reconstruction in the future.
Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/instrumentación , Reconstrucción del Ligamento Cruzado Anterior/métodos , Tornillos Óseos , Fémur/cirugía , Tendones/trasplante , Animales , Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Diseño de Equipo , Femenino , Músculos Isquiosurales , Humanos , Masculino , Persona de Mediana Edad , Músculo Cuádriceps , Porcinos , Tendones/fisiología , Resistencia a la TracciónRESUMEN
BACKGROUND: The volleyball game has a high complexity and thus entails a lot of strain to the players. Due to this high and different training and competition strain comprehensive and individual training plans should be developed with competing training objectives in order to prevent injuries. OBJECTIVE: The aim of the study was to analyse prospectively over six seasons the acute and overuse injuries of a German male professional volleyball team. METHODS: The study included 34 male national league players from season the 2007/08 to 2012/13. All players received a sport medicine examination and a functional diagnosis before each season. Based on the results the players received an individual training plan. RESULTS: The players suffered 186 injuries. The prevalence of acute injuries was 1.94 per player and overuse injuries 0.64 per player. The incidence of acute injuries was 3.3/1000 h volleyball and overuse injuries 1.08/1000 h volleyball. The largest number of injuries was found in the spine. The players had most likely minor injuries. The players had significantly fewer injuries in their second season (1.92) than in their first season (3.25; p= 0.004). CONCLUSION: It could be concluded that volleyball is a sport with a relative low prevalence of injuries compared to other team sports. The prevalence of injury is 2.58 per player. Due to an injury a player dropped out 16.91 days per season. An individual training program seems to reduce the incidence of injury.
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Traumatismos en Atletas/epidemiología , Trastornos de Traumas Acumulados/epidemiología , Voleibol/estadística & datos numéricos , Adulto , Alemania , Humanos , Incidencia , Masculino , Estudios Prospectivos , Factores de Riesgo , Índices de Gravedad del TraumaRESUMEN
Femoroacetabular impingement (FAI) and its therapy has gained importance in the last decade and several studies could show that if untreated it may lead to osteoarthritis of the hip joint. In this article an overview of the pathology of FAI, the diagnosis and treatment options are presented. A closer look is taken at the treatment of elite athletes regarding the different techniques. The first own clinical and radiological results of 91 patients treated by the arthroscopically-assisted anterior mini-open approach are presented with very good results and significant postoperative improvement regarding the hip injury and osteoarthritis outcome score (HOOS), the Western Ontario and McMasters University (WOMAC) osteoarthritis index and the University of California Los Angeles (UCLA) activity score, as well as alpha angle correction. This technique which is poorly represented in the literature can be used as a treatment option for FAI. The rehabilitation program is comparable to hip arthroscopy.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/cirugía , Pinzamiento Femoroacetabular/diagnóstico , Pinzamiento Femoroacetabular/cirugía , Acetábulo/patología , Acetábulo/cirugía , Adolescente , Adulto , Anciano , Artroscopía/métodos , Traumatismos en Atletas/patología , Rendimiento Atlético , Femenino , Pinzamiento Femoroacetabular/patología , Cabeza Femoral/patología , Cabeza Femoral/cirugía , Alemania , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Osteoartritis de la Cadera/prevención & control , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Adulto JovenRESUMEN
BACKGROUND: The ability to stabilize the body center (core stability) against dynamic movements of the extremities and capability to absorb repetitive loading forces in the trunk play a crucial role in any professional sport specific performance. OBJECTIVE: The aim our cross sectional level of evidence 3 study was to determine, if athletes of different sport disciplines showed specific trunk strength profiles and if these were different from a control group. METHODS: 20 ironman triathletes, 18 amateur volleyball and 18 amateur soccer players were tested for their individual isometric strength of the lumbar spine in three planes of motion using a standartized test device. RESULTS: The test profile revealed similar strength parameters for extension and lateral flexion to the left in each of the 3 study groups tested. The lateral flexion to the right was significantly stronger than in the control group (soccer > volleyball > triathlon). In all 3 groups, weaknesses were found in the abdominal musculature, showing highly significant differences in flexion and bilateral rotation compared to the control group (p=0.001). CONCLUSIONS: Our study shows that sports specific training for triathlon, as well as the team sports soccer and volleyball, does not lead to balanced trunk musculature and core stability. In consequence predisposing injury and muscle dysbalane can trigger pain syndromes.
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Músculos de la Espalda/fisiología , Vértebras Lumbares/fisiología , Fuerza Muscular/fisiología , Deportes/fisiología , Adulto , Atletas , Estudios Transversales , Humanos , Contracción Isométrica/fisiología , Masculino , Rango del Movimiento Articular/fisiología , Fútbol/fisiología , Voleibol/fisiologíaRESUMEN
BACKGROUND: Many short stems for total hip arthroplasty have been introduced by the manufacturers only during the last decade. One of them is the Nanos short stem (Smith and Nephew, Marl, Germany). The development of short stems was aimed at preserving bone and soft tissue by utilizing a minimally invasive approach, thus allowing a quick return to an active life. It was purpose of this study to evaluate the radiological changes after using this device. METHODS: We present the radiological results of 202 cementless THAs which were performed in 172 patients using the Nanos stem. Radiological evaluation was performed using standing anterior-posterior (AP) and lateral radiographs of the proximal femur preoperatively, postoperatively and during the follow up. We analyzed the preoperative and postoperativ CCD angle, the subsisdence, preoperative and postoperative offset, osteolysis, bone resorption, increased density, neocortex and periarthricular ossifications. RESULTS: One stem had to be revised due to subsidence four days after implantation. Two cups (BiconPlus, Smith and Nephew, Marl, Germany) had to be revised during the time of follow up due to an aseptic cup loosening. Two stems showed radiolucent lines at the implant-bone-interface at the last follow-up. An increase of bone density could be detected in 18 hips (8.9%). 14 hips showed periarticular ossifications. Measurable subsidence was detected in a total of four stems (1.9%). The preoperative neck-shaft-angle angle was 133.8 ± 4.4° (range: 118.5-146.2) and the neck-shaft-angle angle at the time of follow up was 134.6 ± 4.3° (range: 123.3-147; P< 0.05). The preoperative and postoperative offset changed from 109.3 ± 11.9 mm (range: 80.9-131.6) to 109.7 ± 12.3 mm (range: 79.7-155.6; P< 0.05). CONCLUSION: In summary, this study shows that a correct anatomical reconstruction is possible with a device of this design. The outcome is comparable to that of other short stems. Further studies should be performed in a prospective and randomized design to evaluate the advantage of such a device with a higher level of evidence.
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Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Diseño de Prótesis , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , RadiografíaRESUMEN
Prostheses with single radius (SR) design were supposed to be as good as the physiological kinematic and stability of the knee. This in-vitro biomechanical study compared SR to a multiple radius (MR) design on the one hand and seven left human knee specimens were used. The SR and MR knee prosthesis where implanted with a navigation system. We measured varus/valgus deviation of the mechanical axis and the deviation of the joint-line to the epicondyle-line in different knee flexion degrees (0°, 30°, 45°, 60° and 90°) with and without 15 Nm of varus and valgus stress. Without varus/valgus-stress in all three groups (physiological knee, SR and MR prosthesis) the results were located on the varus-site. The variation of the SR was less than the MR, without being significant. Under varus and valgus stress varus/valgus axis deviation constantly grew. From 0-60° no significant deviation between the two prosthesis models was found. At 90° flexion varus/valgus deviation with the SR component was significantly (p ⩽ 0.05) smaller compared to the MR design. This in-vitro study showed that the SR prosthesis is significantly more stable in the coronal plane than the MR in higher flexion degrees. This could have an improved effect on biomechanical stability with a higher clinical function after SR-TKA.