Purpose
Due to the increased importance of revision ACL reconstruction, this study aims to evaluate the outcome 4 years after the surgery, compare two revision strategies and identify factors that ...influence the results.
Methods
Seventy-nine patients who received a revision ACL reconstruction were retrospectively evaluated. All patients were assessed with an average follow-up of 4.4 years (range 3.3–5.5 years). The results of patients treated with a quadriceps autograft were compared with those treated with a hamstring autograft.
Results
Ninety-seven percent of patients had a KT-1000 side-to-side difference of ≤ 5 mm (mean 1.7 ± 2.0 mm). Pivot-shift test was absent or minor in 95%. In the SLTH-test, 70% of patients reached 90% of the contralateral side. The mean Lysholm score on follow-up was 83 ± 12 (56% excellent/good). The mean IKDC 2000 subjective evaluation score was 81 ± 14 (58% normal/almost normal). The median Tegner activity score was 6 (range 3–10), a median of 2 levels worse than before the first injury. Return to sport rate was 89% but only 34% of patients reached their pre-injury sport level. Most common cause for this reduction was fear of another injury. Three patients suffered a re-rupture. Patients with a hamstring autograft performed pivoting sports more often, but had worse pivot-shift results compared to those with a quadriceps autograft. No significant influence was seen for other parameters. Young, male patients with a high activity level and no chondral damage had the best results.
Conclusion
Through revision ACL reconstruction, the goal of stabilizing the knee can be achieved in the majority of patients. However, a good function and a high activity level are significantly less common in these patients. The main reason for this is fear of a renewed ACL-injury. Both quadriceps and hamstring autografts were able to achieve a good outcome. Young, male, patients with a normal BMI, a high activity level and without cartilage damage seem to benefit the most from revision ACL surgery. The discrepancy between the good laxity restoration and the lower activity rate should therefore be a main point in clinical counseling when deciding for or against revision ACL-Reconstruction.
Level of evidence
III.
ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with ...wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (
P
< 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2.
In this retrospective case series 80 patients divided in 40 matched pair groups with an arthroscopically proven ACL insufficiency were followed up for 15 years. One half was reconstructed using an ...autologous BTB patella graft, the other half was treated by a conservative physiotherapeutic based rehabilitation program. At follow-up the clinical scores (Lysholm, IKDC) showed no significant differences between subjects who had undergone ACL reconstruction and those who had not. Furthermore there was no detectable difference in the incidence of osteoarthritis between the cohorts. Patients having a negative pivot shift test showed significantly less signs of radiographic osteoarthritis and better functional assessment scores whether reconstructed or not. Based on these results and a review of the literature there is no clear evidence that ACL reconstruction reduces the rate of OA development or improves the long-term symptomatic outcome. Probably review of reconstruction by an anatomical approach will be more successful than operative techniques decades ago.
A fully electromechanically coupled, three dimensional phenomenological constitutive model for relaxor ferroelectric materials was developed for the use in a finite-element-method (FEM) solution ...procedure. This macroscopic model was used to simulate the macroscopic electromechanical response of lead-free ergodic
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relaxor materials. The presented constitutive model is capable of accounting for the observed pinched hysteretic response as well as non-deviatoric polarization induced strain and internal order transitions. Time integration of the history dependent internal variables is done with a predictor-corrector integration scheme. The adaptability of the constitutive model regarding the pinching of the hystereses is shown. Simulations are compared to experimental observations.
Anterior cruciate ligament (ACL) reconstruction in double-bundle technique is advocated to more closely restore the anatomy and function of the native ligament than conventional single-bundle ...technique. But up to now there are only a few clinical investigations comparing both techniques in a prospective manner. We hypothesized that double-bundle ACL reconstruction reveals superior clinical and subjective results compared to single-bundle technique in a high-demand collective. A total of 50 male patients (mean age 29.4 years) were prospectively randomized consecutively into one of the two reconstruction techniques. Group 1 (SB) underwent a 4-stranded single-bundle reconstruction with a ST graft in femoral position at 10:00 and 02:00 o’clock, respectively. In group 2 (DB), reconstruction was performed by using a 2-stranded ST graft with double-bundle, four tunnel technique. Before surgery and at a 2 year follow-up (range 23–25 months) patients were evaluated by the same blinded observer. There was no significant difference in the side-to-side anterior laxity-measurement with the KT-1000 between both groups. As evaluated by the pivot shift, no significant correlation could be noted (Fisher exact test
P
= 0.098) between rotational stability and any of the both reconstruction techniques. However, the anterior and rotational stability improved significantly at 2-year follow-up compared to preoperatively (
P
= 0.003) in both groups. The statistical analysis showed a significant increase for the IKDC (subjective, objective) and the Lysholm Score at final follow-up among each single technique, while we found no significant difference between the two reconstruction methods. On the basis of our investigation, we conclude that reconstruction of the ACL by a double-bundle ST graft with an extracortical anchorage can achieve excellent clinical results. But in contrast to our initial hypothesis, we could not quote any significant advantages by creating two independent bundles. Reconstruction of the anterior cruciate ligament in conventional single-bundle technique with a more horizontal femoral tunnel placement obtains comparable clinical results in the present high-demand collective.
Summary Objective To prospectively compare chemical-exchange saturation-transfer (CEST) with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping to assess the biochemical cartilage ...properties of the knee. Method Sixty-nine subjects were prospectively included (median age, 42 years; male/female = 32/37) in three cohorts: 10 healthy volunteers, 40 patients with clinically suspected cartilage lesions, and 19 patients about 1 year after microfracture therapy. T2 mapping, dGEMRIC, and CEST were performed at a 3 T MRI unit using a 15-channel knee coil. Parameter maps were evaluated using region-of-interest analysis of healthy cartilage, areas of chondromalacia and repair tissue. Differentiation of damaged from healthy cartilage was assessed using receiver-operating characteristic (ROC) analysis. Results Chondromalacia grade 2–3 had significantly higher CEST values ( P = 0.001), lower dGEMRIC (T1-) values ( P < 0.001) and higher T2 values ( P < 0.001) when compared to the normal appearing cartilage. dGEMRIC and T2 mapping correlated moderately negative (Spearman coefficient r = −0.56, P = 0.0018) and T2 mapping and CEST moderately positive ( r = 0.5, P = 0.007), while dGEMRIC and CEST did not significantly correlate ( r = −0.311, P = 0.07). The repair tissue revealed lower dGEMRIC values ( P < 0.001) and higher CEST values ( P < 0.001) with a significant negative correlation ( r = −0.589, P = 0.01), whereas T2 values were not different ( P = 0.54). In healthy volunteers' cartilage, CEST and dGEMRIC showed moderate positive correlation ( r = 0.56), however not reaching significance ( P = 0.09). ROC-analysis demonstrated non-significant differences of T2 mapping vs CEST ( P = 0.14), CEST vs dGEMRIC ( P = 0.89), and T2 mapping vs dGEMRIC ( P = 0.12). Conclusion CEST is able to detect normal and damaged cartilage and is non-inferior in distinguishing both when compared to dGEMRIC and T2 mapping.
Purpose
Although the short- and mid-term outcomes of ACL reconstruction with a hamstring graft are promising, clinical investigations reporting the long-term results after ten years or longer are ...rare. Therefore we performed a retrospective single-blinded evaluation of ACL reconstruction using a four-stranded single-bundle reconstruction with a semitendinosus tendon graft with extracortical fixation.
Methods/Results
At follow-up patients obtained at least the same level in the clinical outcome scores (Lysholm, IKDC, Tegner) compared to previous studies with a similar follow-up time using a STG graft. Furthermore there was no detectable difference in the incidence of osteoarthritis. Patients having a negative pivot shift test showed significantly fewer signs of radiographic osteoarthritis and better functional assessment scores.
Conclusion
On the basis of our investigation, we conclude that the reconstruction of the ACL by a quadrupled semitendinosus tendon graft with extracortical anchorage can achieve excellent clinical and subjective results after a follow-up of ten years.
Pathology of the acetabular labrum plays an increasing role in the treatment of hip pain. Hip arthroscopy has proven its clinical value as a useful procedure for successful treatment of labral tears. ...Until today, only a few studies have investigated the influence of articular cartilage defects on the clinical outcome of partial arthroscopic labrum resection in a larger patient population. We prospectively evaluated patients with an intraoperatively proven labral lesion/tear without any radiological and arthroscopical sign of a concomitant bony femoroacetabular impingement or hip dysplasia for a minimum postoperative follow-up of 2 years. Cartilage defects were classified according to Outerbridge and divided into two subgroups: Outerbridge ≤ 1 and Outerbridge ≥ 2, respectively. To evaluate combined results, various established scoring systems (visual analogue scale, modified Harris Hip Score, Larson Hip Score) were used. Out of 54 originally enrolled patients, 50 individuals (29 female, 21 male) with a median age of 33 years (range 15–49) were available for follow-up after a mean of 34 (range 24–48) months. At follow-up, the total study population experienced significant improvement in pain and in the combined evaluation scales (Larson Hip Score/MHHS). When patients were categorized into two subgroups, either with intraoperatively present or absent articular cartilage defects, our data indicated that subjects with no degenerative changes of the articular cartilage surface significantly improved in the applied clinically scoring systems. In contrast, in patients with an articular cartilage lesion during hip arthroscopy score values had a tendency to be unimproved or even deteriorated at follow-up. Regression analysis revealed a significant negative correlation between postoperative outcome and the grading of the coexistent articular cartilage defect. On the basis of our investigation, we conclude that partial arthroscopic resection of a torn labrum without attending bone deformity (dysplasia or femoroacetabular impingement) can reveal good and satisfied results. Depending on the extent of a coexisting articular cartilage defect subjective clinical results are compromised.
Background The Sauvé-Kapandji procedure can result in instability of the proximal ulnar stump
Patients and methodsWe reviewed 44 patients (mean follow-up time 6 (0.6-13) years) to investigate ...predictive factors for ulnar instability after Sauvé-Kapandji operation. We used several scores including an instability score specifically designed for this study
Results Patients with a longer proximal ulnar stump had significantly lower instability scores, significantly better Mayo Modified wrist scores and DASH scores, and also less pain than those with shorter proximal ulna
Interpretation If the shortening of the proximal stump is less than 35 mm, a reliable improvement in motion and a high patient satisfaction can be expected. The risk of a painful ulnar instability is related to the amount of resection, and can be reduced by creating a long upper ulnar stump.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
In the last decade the concept of disaster diplomacy has drawn interest to the links between major natural disasters and international conflict. This paper reviews the disparate set of works covering ...this relationship. This body of work, which draws on multiple disciplinary traditions extending over three generations, holds vast potential for political scientists that seek to understand the intersection of ecological catastrophe and politics. The latest wave of publications has the greatest potential to yield valuable and generalizable insight into political phenomena as well as to produce practical knowledge for disaster-related organizations and agencies, policymakers, and citizens. This paper reviews the three generations of literature and then makes suggestions along three lines of argument: (1) refining definitions of variables, (2) refining the concept of 'disaster diplomacy', and (3) using existing theories and concepts of interstate conflict.
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