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Oral and intra-articular injections of cortisone will lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder.In a prospective randomized evaluation, 40 patients with idiopathic adhesive capsulitis of the shoulder were treated with an oral corticoid treatment regimen or 3 intra-articular injections of corticosteroids. Follow-up was after 4, 8, and 12 weeks, and 6 and 12 months. For the clinical evaluation, the Constant-Murley (CM) score, the Simple Shoulder Test (SST) and visual analog scales (VAS) for pain, function, and satisfaction were used.In the patients treated with oral glucocorticoids, significant improvements were found for the CM score (P.0001), SST (P=.035), VAS (P.0001), and range of motion (P.05) at the 4-week follow-up. The patients treated with an intra-articular glucocorticoid injection series also significantly improved in the CM score (P.0001), SST (P.0001), the VAS (P.0001), and range of motion (P.05) after 4 weeks. These results were confirmed at all other follow-up visits. Superior results were found for intra-articular injections in range of motion, CM score, SST, and patient satisfaction (P.05). Differences in the VAS for pain and function were not significant (P.05).The use of cortisone in the treatment of idiopathic shoulder adhesive capsulitis leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior results in objective shoulder scores, range of motion, and patient satisfaction compared with a short course of oral corticosteroids.

Zusammenfassung Die chronische Tendinose der Patellarsehne entsteht durch intrinsische und extrinsische Faktoren, welche zu einer Uberlastung des Extensormechanismus fuhren. Neben der Sportart und der Sportfrequenz ist moglicherweise ein prominenter unterer Patellarpol ein weiterer pradisponierender Faktor. Die operative Behandlung der chronischen Tendinose der Patellarsehne (Jumper's Knee) sollte mit einer rein arthroskopischen Therapie erfolgen, welche die Vorteile einer minimal-invasiven Technik mit schneller Rehabilitation und geringer Komplikationsrate mit exzellenten klinischen Ergebnissen, die mit den in der Literatur beschriebenen Resultaten der offenen operativen Behandlung vergleichbar sind, kombiniert.

Summary Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active patient. Various implants can be used that differ with regard to fixation stability, design and osteotomy technique. Some risk factors are associated with a poor clinical outcome, such as a fracture of the opposite cortex and an imprecise osteotomy. In this clinical study, serial Radiostereometric Analysis (RSA) and long lower limb weight-bearing radiographs were used to (1) quantify micromotion between fixated tibial segments and (2) the amount of revarisation over time. It was found that a high primary stability offered by a long and rigid internal fixator is associated with favorable clinical results.

The aim of this prospective study is to evaluate the clinical results of arthroscopic resection of the lower patellar pole in patients with patellar tendinosis.Twenty patients underwent an arthroscopic resection of the lower patellar pole between 2002 and 2004. All of them were evaluated at 6 weeks and 3, 6, 12, and 24 months after surgery using the Tegner activity level, the Lysholm score, the Kujala score, a modified jumper's knee classification according to Blazina, and visual analog scales for pain, function, and satisfaction. Clinical evaluation was performed 2 years after surgery. In addition, magnetic resonance imaging was performed preoperatively and at a 2-year follow-up.By 6 weeks postoperatively and at every other follow-up visit, significant improvements were seen in the Lysholm score (P = .001), the Kujala score (P = .001) and the visual analog scales. The Tegner score improved significantly by 3 months postsurgery (P = .01). Two years after surgery, the Tegner score improved from 4.4 +/- 2.9 to 7.95 +/- 1.6 (P.0001); the Lysholm score from 57.1 +/- 17.1 to 97.3 +/- 4.4 (P.0001); and Kujala score from 53.7 +/- 14.7 to 95.4 +/- 7.8 (P.0001). The jumper's knee classification showed excellent (stage 0) or good (stage I) results in 18 of 20 patients. At follow-up, all but one magnetic resonance image showed hypodens areals in the proximal aspect of the patellar tendon, and small osteophytes were seen in some cases at the resection area. These findings did not seem to have any influence on the results.The arthroscopic resection of the lower patellar pole as a minimal invasive method to treat jumper's knee provides satisfactory clinical results in knee function and pain reduction with fast recovery and return to sport activities.Level IV, therapeutic case series.

The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair using the FasT-Fix repair system.Prospective case series.Sixty-one meniscal repairs with the FasT-Fix meniscal repair system in 58 patients with a mean age of 32.6 years were performed between 2001 and 2002. Concurrent anterior cruciate ligament reconstruction was performed in 36 patients (62%). All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation also included the Tegner and Lysholm knee scores, and KT-1000 arthrometry. In addition, all patients were evaluated preoperatively with magnetic resonance imaging.The average follow-up was 18 months (range, 14 to 28 months). Six of 61 repaired menisci (9.8%) were considered failures according to our criteria. Therefore, the success rate was 90.2%. Time required for meniscal repair averaged 11 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. The mean Lysholm significantly improved from 43.6 preoperatively to 87.5 postoperatively (P.001). Fifty-one patients (88%) had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in 1 of them. Analysis showed that age, length of tear, simultaneous anterior cruciate ligament reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome.Our results show that arthroscopic meniscal repair with the FasT-Fix repair system provided a high rate of meniscus healing and appeared to be safe and effective in this group of patients.Level IV, therapeutic study, case series (no control group).

Purpose To review the literature concerning surgical treatment options for chronic patellar tendinosis (jumper's knee), a common problem among athletes. When conservative treatment fails, surgical treatment is required. Methods Systematic review of the literature concerning the results of current surgical treatment options for chronic patellar tendinosis. All articles of studies with an evidence level ≥IV from January 2000 until February 2015 presenting the surgical outcome after arthroscopic as well as open treatment of chronic patellar tendinosis were included. The literature research of the PubMed database was performed using the following key words: "patellar" and "tendinitis," "tendonitis," "tendinosis" or "tendinopathy"; "inferior patellar pole"; "jumper's knee"; "surgical treatment" and "open" or "arthroscopic patellar tenotomy." Results A systematic review of the literature was performed especially to point out the effectiveness of arthroscopic treatment of chronic patellar tendinosis. The results revealed good clinical results for arthroscopic as well as open treatment of chronic patellar tendinosis that is refractory to conservative treatment in athletes. An average success rate of 87% was found for the open treatment group and of 91% for the arthroscopic treatment group. However, after open surgery, the mean time of return to the preinjury level of activity is 8 to 12 months, with a certain number of patients/athletes who cannot return to the preinjury level of activity. Conclusions Minimally invasive, arthroscopically assisted or all-arthroscopic procedures may lead to a significantly faster return to sporting activities and may, therefore, be the preferred method of surgical treatment. Level of Evidence Level IV, systematic review of Level I-IV studies.

Introduction Influence of the initial tear size and repair technique of single-row and double-row repairs on the biomechanical properties and footprint coverage. Methods 25 (Bateman grade II) and 35mm (Bateman grade III) artificial defects were created in the rotator cuff of 24 human cadaver shoulders. The reconstructions were performed as either a single-row repair using triple-loaded suture anchors (2-3) and a modified suture configuration or a modified suturebridge double-row repair (4-6). Reconstructions were cyclically loaded from 10-60N. The load was stepwise increased up to 100, 180, and 250N. Cyclic displacement and load-to-failure were determined. Furthermore, footprint widths were quantified before and after the repair. Results In the 25mm rupture, 533±107N were achieved for the SR-repair and 681±250N were measured for the DR-suturebridge technique. In the 35mm artificial tear, ultimate failure load was 792±122N for the SR-reconstruction and 891±174N for the DR-reconstruction. There were no differences in load-to-failure between the tested repairs (p>.05). Cyclic displacement showed no significant differences between the tested configurations at 60, 100, 180 und 250N (p>.05) for the 25mm tear. In the reconstruction of the 35mm RC tear, significant lower gap formation was found for the SR-reconstruction at 180N (p=.037) and 250N (p=.020). No significant differences were found at 60 and 100N (p>.05). A significantly greater footprint width was seen with the double-row technique compared to the single-row repair. However, both reconstructions were able to achieve a complete footprint coverage compared to the initial footprint. Conclusion The single-row repair technique using a modified suture configuration showed similar results in load-to-failure and cyclic displacement compared to the modified double-row suturebridge technique independent of the initial size of the rupture. The double-row repair consistently restored a larger footprint than the single-row method. However, both repair techniques achieved complete footprint coverage.

Fragestellung Objektive Messung der postoperativen Kniegelenkslaxizitat nach Rekonstruktion des vorderen Kreuzbandes mittels zwei nicht-invasiver Messgerate. Methodik 52 konsekutive Patienten wurden durchschnittlich 17 Monate nach VKB-SB-Rekonstruktion mittels autologer Patellarsehne nachuntersucht. Die ap-Laxizitat wurde mit Hilfe eines neuen Messgerates (GNRB) mit einer definierten Kraft von 67,89 und 134 N gemessen. Die Messung der Rotationsstabilitat erfolgte ebenfalls mittels objektivem Messgerat (Rotameter) bei definiertem Drehmoment von 5 Nm, 8 Nm und 10 Nm. Tegner Score, Lysholm Score und IKDC Score wurden eingesetzt, um die gemessenen Ergebnisse der Laxizitat mit dem klinischen Ergebnis zu vergleichen. Resultate Der Pivot shift war negative (33) oder glide (16) in 49 Patienten, negative Lachman tests wurden in 50 Patienten gefunden. Die subjektive Evaluation des IKDC Score zeigte ein A in 44 Patienten, 5 Patienten erreichten ein B und 3 ein C. Der durchschnittliche Lysholm Score betrug 94,5±9,5 Punkte, der durchschnittliche Tegner Score 6,5±1,4 praoperativ und 5,9±1,8 bei der Nachuntersuchung (p=0,003). Im operierten Knie wurde mittels GNRB eine ap-Translation von 2,1±0,7 mm bei 67 N, 3,1±0,9 mm bei 89 N und 4,9±1,2 mm bei 134 N gemessen. Die kontralaterale, nicht operierte Seite zeigte 1,5±0,7 mm bei 67 N, 2,2±0,8 mm bei 89 N und 3,6±1,0 mm bei 134 N. Die durchschnittlichen Seit-zu-Seit-Differenzen (0,6–1,3 mm) zeigten zwar signifikante Unterschiede (p 0,05). Schlussfolgerung Die Kniegelenkslaxizitat nach Rekonstruktion des VKB kann mit den eingesetzten, nicht-invasiven Messgeraten objektiv quantifiziert werden. Daruber hinaus konnte gezeigt werden, dass sowohl die ap-Laxizitat, als auch die Rotationsstabilitat mittels Einbundel-VKB-Rekonstruktion wieder hergestellt werden konnte.

Fragestellung Objektive Messung des Einflusses des vorderen Kreuzbandes auf die tibiofemorale Rotation zur Erfassung vorderer Kreuzbandrupturen und zur Evaluation von Rotationsinstabilitaten. Methodik Messung der tibiofemoralen Rotation von 20 humanen Kniepraparaten mittels eines nicht-invasiven Messgerates und einer Knienavigation als invasives Standardverfahren. Die Messungen der Innen- und Ausenrotation wurden bei einem applizierten Drehmoment von 5, 10 und 15 Nm mit intaktem vorderem Kreuzband und jeweils nach Durchtrennung des posterolateralen Bundels sowie nach kompletter Resektion des vorderen Kreuzbandes durchgefuhrt. Die statistische Analyse erfolgte mittel posthoc-Scheffe-Test, der Pearson-Korrelations-Koeffizient wurde zum Vergleich der beiden Messverfahren eingesetzt. Ergebnisse Der Vergleich der Messungen zwischen intaktem VKB und nach Resektion des posterolateralen Bundels zeigte einen signifikanten Anstieg der tibiofemoralen Rotation bei annahernd allen Drehmomenten (p 0,05). Die parallel durchgefuhrten Messungen der Knienavigation bestatigten die Ergebnisse des nicht-invasiven Messgerates. Im Pearson-Korrelations-Koeffizienten wurde eine hohe Korrelation bei allen applizierten Drehmomenten gefunden (>0,80). Schlussfolgerungen Das vordere Kreuzband und insbesondere das posterolaterale Bundel des VKB hat einen signifikanten Einfluss auf die isolierte tibiofemorale Rotation. Die Messung der tibiofemoralen Rotation mit einem externen Messgerat eignet sich als nicht-invasives und objektives Verfahren zur Erkennung vorderer Kreuzbandrupturen. Zusatzlich kann durch die Messung vor und nach kniechirurgischen Eingriffen eine Aussage bezuglich der Wiederherstellung der Rotationsstabilitat gemacht werden.