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Background: Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention. Objectives: Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given. Material and methods: Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation. Discussion: The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.

Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

Eine hohere Lebenserwartung und gesteigerte Aktivitat der Bevolkerung fuhren zu einer Zunahme von degenerativ gepragten Krankheitsbildern wie der Achillessehnenruptur. Die Anamnese und die korperliche Untersuchung sind Mittel der Wahl zur Diagnosestellung der Achillessehnenruptur. Sonographie und Rontgendiagnostik stellen erweiterte, sinnvolle Diagnostika dar. Fur die Indikationsstellung der Therapie mussen multifaktoriell die Vor- und Nachteile der konservativen gegen die operative Therapie individuell abgewogen werden. Fur beide Verfahren gibt es klare Kontraindikationen. In den operativen Verfahren stehen die offene Nahttechnik, minimalinvasive Verfahren als auch rekonstruktive Verfahren zur Verfugung. Genauso wichtig wie die Wahl des richtigen Operationsverfahrens ist eine adaquate Nachbehandlung des Patienten. Unter richtiger Indikationsstellung und Betreuung konnen sowohl mit der konservativen als auch der operativen Therapie auserst zufriedenstellende Ergebnisse fur den Patienten erreicht werden.

Unter dem Begriff Ruckfusdeformitat lassen sich viele Krankheitsbilder subsumieren, die mit Achsfehlstellungen einhergehen. Komplexe Beispiele sind die Ruckfusdestruktionen, die durch rheumatologische oder diabetische Grunderkrankungen bedingt sind. Dieser Artikel soll den Leser befahigen, die wichtigsten und haufigsten (adulten) Ruckfusdeformitaten zu diagnostizieren und uber stadiengerechte konservative und operative Therapiemoglichkeiten zu entscheiden.

Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention.Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given.Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation.The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.

Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

Arthroscopy of the wrist has developed in the shadow of arthroscopy of the large joints. Nowadays, wrist arthroscopy has a relevant importance in the diagnostics and therapy in hand surgery and is indispensable for serious surgery of the wrist. Special equipment and extensive knowledge of the surgeon are necessary for carrying out the procedure.

Beim Knochenmarkodem (KMO) handelt es sich um eine pathologische Vermehrung der interstitiellen Flussigkeit im Knochen mit unspezifischem Erscheinungsbild im Magnetresonanztomogramm (MRT). Unterschieden werden das traumatische, das atraumatische, oft ischamische, das reaktive und das mechanische KMO. Das schmerzhafte KMOS wird uneinheitlich als eigene Entitat oder als reversibles Vorstadium der Osteonekrose (ON) betrachtet. Die Gefahr seines Ubergangs in eine ON mit Gelenkdestruktion ist immer gegeben. Am haufigsten sind das Huft-, Knie- und obere Sprunggelenk betroffen. Diagnostische Methode der Wahl ist das MRT. Je nach Atiologie ist eine konservative oder operative Therapie zu diskutieren. Das KMOS wird primar konservativ behandelt. Die Infusion von Prostazyklin oder Bisphosphonaten stellt eine gute Option fur viele KMO dar. Etabliertes Verfahren ist die sog. „core decompression“. Beim ischamischen KMO sowie im Fruhstadium einer ON konnte eine Kombination beider Verfahren von Vorteil sein.

The differentiation of physiological pediatric flat feet and the pathological course as well as adequate initiation of therapeutic options represents a challenge the importance of which should not be underestimated. Fears and worries of parents and their insistence on inducement of therapeutic measures take center stage in the physician-patient relationship. The problem is that there are insufficient data from scientific studies dealing with the conservative treatment of flat feet in children. This paper intends to give a survey of the current status in the literature concerning indications and therapeutic success using insoles in the treatment of flat feet in children.

A superior life expectancy and an increased activity in the population result in an increase in degenerative diseases, such as Achilles tendon ruptures. The medical history and physical examinations are the methods of choice to diagnose Achilles tendon ruptures. Ultrasound and radiography represent reasonable extended diagnostic procedures. In order to decide on the medical indications for the therapy concept, the advantages and disadvantages of conservative and surgical treatment options have to be weighed up on an indivdual basis. There are explicit contraindications for both treatment options. For the surgical treatment concept open suture techniques, minimally invasive methods and reconstructive procedures are available. The postoperative management of the patient is as important as the choice of surgical technique. With the correct medical indications and supervision of the patient it is possible to achieve extremely satisfying results for the patient with both conservative and surgical treatment options.

The term hindfoot deformity denotes many different disease patterns that are associated with malformations of the axis. Destruction of the hindfoot caused by chronic polyarthritis or diabetic diseases are complex examples. This article aims to qualify the reader to diagnose the most important and most common hindfoot deformities in adults and to make decisions about stage-adjusted conservative and surgical therapeutic options.

Arthroscopy of the wrist has developed in the shadow of arthroscopy of the large joints. Nowadays, wrist arthroscopy has a relevant importance in the diagnostics and therapy in hand surgery and is indispensable for serious surgery of the wrist. Special equipment and extensive knowledge of the surgeon are necessary for carrying out the procedure.

Bone marrow edema (BME) syndrome represents a pathologic accumulation of interstitial fluid in bone - with a traumatic BME being differentiated from a non-traumatic, often ischemic, and a reactive as well as a mechanical BME. Atraumatic/ischemic BME is inconsistently described as a separate entity or as a reversible preliminary stage of osteonecrosis (ON). However, there is always the risk of transformation of BME into ON and subsequent joint destruction. The most common sites of BME are the hip, knee, and ankle. Magnetic resonance imaging is the diagnostic gold standard. Differential diagnoses of the transient BME as osteonecrosis, osteochondrosis dissecans, and a reflex dystrophy should be considered. Conservative or surgical treatment is considered, depending on the etiology of BME. BME syndrome is generally treated conservatively. Infusion of prostacycline or bisphosphonates is a promising option. Ischemic BME and early stages of ON can be successfully treated by core decompression. A combination of both treatment options may also offer advantages.

The differentiation of physiological pediatric flat feet and the pathological course as well as adequate initiation of therapeutic options represents a challenge the importance of which should not be underestimated. Fears and worries of parents and their insistence on inducement of therapeutic measures take center stage in the physician-patient relationship. The problem is that there are insufficient data from scientific studies dealing with the conservative treatment of flat feet in children. This paper intends to give a survey of the current status in the literature concerning indications and therapeutic success using insoles in the treatment of flat feet in children.

Besides the primary goal of functional improvement and pain reduction, the operative treatment of unicompartmental arthritis in younger patients is focused on preservation of intact bone and joint structures. The question arises whether an interpositional knee implant based on magnetic resonance imaging (MRI) data can be an alternative treatment option to the established procedures of high tibial osteotomy and unicompartmental knee arthroplasty.From June 2004 to May 2008 a total of 33 patients suffering from unicompartmental knee arthritis received a patient-specific interpositional implant (31 medial and 2 lateral) within a single arm trial. The mean follow-up time was 26.6 months (range 1-48 months) and the mean age of the patients was 54.5 years (range 39-65 years). In addition to the clinical results the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) function scale and the Knee Society scores were measured. A descriptive data analysis, a variance analysis for repeated measurements and a determination of significance level were carried out.The 2-4 year results showed a significant improvement in the WOMAC function scale as well as the Knee Society scores. The knee function after 2 years was comparable to the preoperative situation with an extension to flexion of 0/2/130°. The dislocation rate was 6% and the overall revision rate 21%.Despite acceptable functional results a significant pain relief, a complete preservation of bone and a lower rate of dislocations compared to the off-the-shelf Unispacer implant there were only limited indications for the customized interpositional knee implant with respect to the given contraindications due to the high 2 year revision rate.

Preiser's disease--first described by Preiser in 1910--presents the rare avascular necrosis of the carpal scaphoid. There is no consensus with regard to cause and therapeutic procedure to this day. The initially postulated idiopathic origin of the disease is controversial and rare. It is mainly caused by trauma or repetitive microtrauma, but can also occur as a complication of drug therapy. The rare occurrence of necrosis of the carpal scaphoid following chemotherapy is presented. The treatment was resection of the scaphoid and mediocarpal arthrodesis. Clinical appearance, diagnostic work-up, and therapy of the disease are discussed.