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The goal was to examine gender differences of patient characteristics and outcome after cartilage repair based on a collective of nearly 5,000 patients. Patient characteristics, accompanying therapies, and outcome (Knee Injury and Osteoarthritis Outcome Score [KOOS], reoperations, patient satisfaction) of 4,986 patients of the German cartilage register DGOU were assessed by t test for possible gender differences. P values

Background/aim Colon interposition counts among the most common techniques for reconstruction after esophagectomy. Availability of data on metachronous mucosal pathologies is weak. The aim of this review was to identify all reports on the development of metachronous adenoma and adenocarcinoma in colon interposition after esophagectomy in adulthood. Materials and methods A comprehensive search was conducted in MEDLINE/PubMed, Science Direct, Cochrane Library, Bayerische Staatsbibliothek Munchen. All studies reporting on patients who received colon interposition as substitute after esophagectomy in adulthood for benign and malignant reasons were included. Results Five retrospective studies were included, reporting on 1016 patients. Therein, no interval lesion was identified. One further study, which formally must be excluded for a misfit to inclusion criteria reports on three interval carcinomas within 365 patients. Because these lesions were the only ones found within a cohort analysis, results were supplementary reported in this review. Additionally, 31 case reports including 32 patients with benign (n=7) or malignant (n=25) findings were analyzed. Median age was 63.5 years (interval carcinoma) and 69 years (benign lesion). Benign and malignant lesions were diagnosed after a median of 8.5 years. Conclusion Due to the rareness of respective cohort studies, the frequency of metachronous lesions cannot be calculated accurately. The estimated rate of interval carcinoma is 0-0.22%. Life-long endoscopic surveillance of patients with colon interposition is recommended.

Background Even though realignment procedures have gained popularity as concomitant techniques in cartilage repair approaches with underlying malalignment, the clinical efficacy has not been proven to full extent. Methods Out of 5474 patients from the German Cartilage Registry, 788 patients with focal cartilage defects on the medial femoral condyle having received either no accompanying surgery or high tibial osteotomy (HTO) were identified. After a 1:1 propensity score matching, outcome of 440 patients was evaluated using KOOS (Knee Injury and Osteoarthritis Outcome Score), VAS (visual analogue scale), and satisfaction during the 3-year follow-up. Results Patients having received a concomitant HTO had significantly higher postoperative KOOS values (12 months: 67.26 ± 15.69 vs.75.10 ± 16.12, P = 0.001; 24 months: 67.14 ± 23.85 vs. 77.11 ± 16.50, P = 0.010; 36 months: 74.40 ± 16.57 vs. 81.75 ± 14.22, P = 0.023) and lower pain levels (6 months: 3.43 ± 2.18 vs. 2.89 ± 2.15, P = 0.009; 12 months: 3.64 ± 2.20 vs. 2.17 ± 1.96, P < 0.001; 24 months: 4.20 ± 3.12 vs. 2.94 ± 2.45, P = 0.005; 36 months: 3.20 ± 2.18 vs. 2.02 ± 1.98, P = 0.003). One and 3 years postoperatively, concomitant HTO led to significantly higher satisfaction in patients. These advantages of accompanying HTO were also seen in the group of patients with a varus deformity of 5° or more, in which pain levels without concomitant HTO even increased during the 3-year follow-up. Conclusion The results of the present study underline the importance and safety of concomitant HTO in patients with cartilage defects and varus deformity. HTO should therefore be considered and recommended generously in patients with focal cartilage defects of the medial femoral condyle and varus deformity.

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated diverticular abscess is still controversial. The primary aim of this study is to assess the risk of interval emergency surgery by systematic review and meta-analysis.Methods and analysisThe systematic review and meta-analysis will be conducted in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE will be screened for the predefined searching term: (Diverticulitis OR Diverticulum) AND (Abscess OR pelvic abscess OR pericolic abscess OR intraabdominal abscess) AND (surgery OR operation OR sigmoidectomy OR drainage OR percutaneous drainage OR conservative therapy OR watchful waiting). All studies published in an English or German-speaking peer-reviewed journal will be suitable for this analysis. Case reports, case series of less than five patients, studies without follow-up information, systematic and non-systematic reviews and meta-analyses will be excluded. Primary endpoint is the rate of interval emergency surgery. Using the Review Manager Software (Review Manager/RevMan, V.5.3, Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2012) meta-analysis will be pooled using the Mantel-Haenszel method for random effects. The Risk of Bias in Non-randomized Studies of Interventions tool will be used to assess methodological quality of non-randomised studies. Risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool.Ethics and disseminationAs no new data are being collected, ethical approval is exempt for this study. This systematic review is to provide a new insight on the need for surgical treatment after a first attack of acute diverticulitis, complicated by intra-abdominal or pelvic abscesses. The results of this study will be presented at national and international meetings and published in a peer-reviewed journal.PROSPERO registration numberCRD42020164813.

IntroductionDiverticulitis is among the most common abdominal disorders. The best treatment strategy for this complicated disease as well as for recurrent stages is still under debate. Moreover, little knowledge exists regarding the effect of different therapeutic strategies on the health-related quality of life (HrQoL). Therefore, the PREDIC-DIV (PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease) study aims to assess predictors of a change in HrQoL in patients after elective sigmoidectomy for diverticular disease.Methods and analysisA prospective multicentre transnational observational study was started in November 2017. Patients undergoing elective sigmoid resection for diverticular disease were included. Primary outcome includes HrQoL 6 months postoperatively, staged by the Gastrointestinal Quality of Life Index (GIQLI). Secondary outcomes include HrQoL 6 months after sigmoidectomy, assessed using the Short Form 36 Questionnaire and a custom-made Visual Analogue Scale-based inventory; HrQoL after 12 and 24 months; postoperative morbidity; mortality; influence of surgical technique (conventional laparoscopic multiport operation vs robotic approach); histological grading of inflammation and morphological characteristics of the bowel wall in the resected specimen; postoperative functional changes (faecal incontinence, faecal urge, completeness of emptying, urinary incontinence, sexual function); disease-specific healthcare costs; and changes in economic productivity, measured by the iMTA Productivity Cost Questionnaire. The total follow-up will be 2 years.Ethics and disseminationThe protocol was approved by the medical ethical committee of the Bavarian Medical Council (report identification number: 2017-177). The study was conducted in accordance with the Declaration of Helsinki. The findings of this study will be submitted to a peer-reviewed journal (BMJ Open,Annals of Surgery,British Journal of Surgery,Diseases of the Colon and the Rectum). Abstracts will be submitted to relevant national and international conferences.Trial registration numberThe study is registered with the ClinicalTrials.gov register asNCT03527706; Pre-results.

To evaluate the factors influencing the baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with knee cartilage defects and planned cartilage repair surgery and to provide baseline KOOS data from a large patient population. Between October 2013 and April 2017, a total of 2815 patients assigned for cartilage repair surgery were included into the German Cartilage Registry (KnorpelRegister DGOU) and their data were analyzed for the present study. Multivariate regression model and ANOVA were used to detect patient- and defect-specific factors with an influence on baseline KOOS. In addition, KOOS baseline data was calculated and compared according to these parameters. Sex, age, body mass index (BMI), and smoking status were revealed as patient-specific factors, and defect location and the number of previous knee and cartilage operations were revealed as defect-specific factors with a significant influence on baseline KOOS. Most subscores were affected in accordance with the total KOOS. Interestingly, defect ICRS grade, defect size, and symptom duration had no significant influence. The mean baseline KOOS was 56.7 (± 17.9). Men had significantly higher mean overall KOOS (60 ± 17.3 vs. 51.8 ± 17.6, p

Acute appendicitis is one of the most frequent disorders in abdominal surgery. Therefore, appendectomy is a matter of significant interest in that field. Yet, four different techniques are available: open appendectomy, (conventional) laparoscopic appendectomy, single port laparoscopic appendectomy and NOTES-appendectomy with its different variations. To evaluate the current state of the art in appendectomy a bibliographic search was conducted. All prospectively randomized trials and national register cohort studies published between 1/2010 and 5/2016 were included into the analysis. Overall, 25 respective studies were identified. All studies were screened for the following parameters: surgical site infection (SSI) (wound infection (WI) or intraabdominal abscess (IAA)), postoperative pain (PP), length of surgery (LoS), length of hospital stay (LHS), return to normal activities (RNA). Today the rate of laparoscopic appendectomy is reported to be up to 86% in the recent literature. Open appendectomy remains a safe and effective technique. Single port laparoscopic appendectomy presented almost equal in terms of safety and patient satisfaction. The method is still not as widespread as conventional three port laparoscopic appendectomy, presumably due to the necessity of special equipment and training. NOTES appendectomy is the newest development in appendectomy technique. First prospective cohort studies proved the safety and feasibility in experienced hands. However, the method is still experimental and further prospectively randomized trials are necessary. Concluding the current evidence, a laparoscopic approach, which is most commonly and increasingly frequently used, could be called "state of the art" in the treatment of appendicitis.

Druckreduktion des medialen Kompartiments bei Patienten mit medialer Varusgonarthrose und Entlastung v. a. der posterolateralen Bandstrukturen bei Varusdeformitat und komplexen Bandinstabilitaten. Mediale Varusgonarthrose bei noch gut erhaltenem lateralen und patellofemoralen Gelenkabschnitt. Komplexe Bandinstabilitaten bei gleichzeitig vorliegender Varusdeformitat. Erhebliche Bewegungseinschrankungen Mediale Hautinzision am proximalen Unterschenkel. Darstellung des Pes anserinus. Markierung der Osteotomie vom tiefsten Punkt der medialen Metaphyse ansteigend nach lateral. Biplanare Stufenosteotomie unter Schutz der posterioren neurovaskularen Strukturen mit ventraler Ausleitung der Osteotomie nach proximal der Tuberositas tibiae oder nach distal in Abhangigkeit von Begleitpathologien. Fixation mit winkelstabilem Plattenfixateur. Im Grundsatz ist eine fruhe Belastung bei Verwendung eines winkelstabilen Plattenfixateurs moglich. Oft erfordern jedoch Begleitpathologien wie z. B. eine begleitende knorpelregenerative Therapie eine langere Entlastungsphase. Die Beweglichkeit kann bei alleiniger Osteotomie ebenfalls fruh freigegeben werden. Eine orthetische Versorgung ist fur viele Falle empfohlen. Bei korrekter Indikationsstellung lassen sich unter der Voraussetzung einer standardisierten Operationstechnik mit der Open-Wedge-Osteotomie (OW-HTO) – trotz statistisch vergleichsweise hoher Komplikationsrate – gute Ergebnisse mit hoher Patientenzufriedenheit erzielen. Ein tendenziell schlechteres Outcome zeigen Patienten mit Body-Mass-Index uber 30 und hoheren Arthrosegraden.

Aims and Objectives: In the context of cartilage repair, identification of the underlying pathologies depends on detailed preoperative evaluation. High tibial osteotomy (HTO) for varus deformities is one of the most common concomitant treatments, though scientific evidence about efficiency of concomitant HTO is still limited. The present study was initiated to describe preoperative analysis of alignment and to analysis outcome comparing patients with combined cartilage repair and HTO with those who received cartilage repair procedures alone. Materials and Methods: The multicenter data (3855 data sets on April 15, 2018) was provided by the attending physician and a self-reported outcome analysis (KOOS). Inclusion criteria: Existence of a leg full length portrait, a single defect at the medial femoral condyle, either no accompanying surgery or a HTO and information on leg axis misalignment. For outcome evaluation patients were divided into three different groups with regard to the extent of varus deformity: MILD (0-4° varus), MODERATE (5-9° varus) and SEVERE (> 10°). Statistical Analysis was performed using SPSS (IBM) Version 23. For detection of significances between different groups one-way ANOVA test was applied. P-values < 0.05 were considered statistical significant. Results: In 55.1% (n=2125) of the patients a full leg weight-bearing radiographs has been performed preoperatively. Out of these 834 (39%) cases with isolated defects of the medial femoral condyle have been identified of which 179 received HTO in combination with the cartilage repair procedure (21.5%), while 411 cases have been treated with isolated cartilage repair (49.3%). From the remaining 385 patients, 256 patients were considered MILD (67,3%), 113 MODERATE (29.5%) and 4.2% (n=16) SEVERE. Incidence of HTO significantly depended on the degree of varus deformity for mild (19% HTO) and moderate (83% HTO) deformity, but there was no significance between the moderate and severe (81% HTO) group. Significant differences of the KOOS score could be shown preoperatively between the mild (mean: 57.3), as well as moderate (mean: 55.95), and the severe group (mean 39.53) and six months postoperatively between the mild (mean: 71.48) and the severe (mean: 52.6) group. Conclusion: The present analysis of a large patients cohort extracted from the German Cartilage Registry (KnorpelRegister DGOU) demonstrates that, against common guidelines, full-leg weigth-bearing radiographs are not conducted on a regular basis in patients assigned for cartilage repair procedures. In those cases with detailed preoperative analysis of alignment, the degree of deformity seems to influence the decision, whether a realignment procedure (HTO) is performed. For the moderate subgroup a trend towards better clinical outcome was found for combined treatment in terms of realignment and cartilage repair in comparison to cartilage repair alone. Since there was no difference in the MILD subgroup, more evidence is needed to proof, whether those patients benefit from a HTO or not.

The purpose of this chapter is to highlight arthroscopic and supplementation treatment options in osteoarthritis of the knee. Respective therapies are described with indications, contraindications, and literature workup.

Surgical-site infections (SSIs) and intra-abdominal abscesses (IAAs) are the most frequent complications of appendectomy. The role of laparoscopy in the treatment of appendicitis remains controversial concerning the complication rate. The aim of this retrospective cohort study was to compare open and laparoscopic appendectomy for SSI and IAA.All patients undergoing appendectomy between January 1, 2007 and May 31, 2010 were included in the study. Perioperative data and data on postoperative complications were collected from patient files. A questionnaire was used to assess complications after discharge. Main outcome parameters were SSI and IAA. Open appendectomy (OAG) and laparoscopic appendectomy (LAG) were compared with univariate and multivariate analyses for the outcome parameters.Four hundred thirty patients were included in the study. SSI (all: 10.6%, OAG: 11.7%, LAG: 7.5%, P=0.293) and IAA (all: 2.8%, OAG: 2.4%, LAG: 3.8%, P=0.506) were not significantly different between OAG and LAG. Risk factors for SSI were age (P=0.003), body mass index (P=0.017), ASA score (P=0.001), the intraoperative grade of inflammation (P=0.004), and the histologic grade of inflammation (P=0.015). The only risk factor for IAA was the intraoperative grade of inflammation (P=0.028). ASA score (odds ratio: 1.992, P=0.032) and the intraoperative grade of inflammation (odds ratio: 1.573, P=0.006) remained significant in the multivariate analysis for SSI.A higher ASA score correlates with SSI. A higher grade of intraoperative inflammation correlates with SSI and IAA. Laparoscopy has no impact on SSI and IAA in appendectomy.

The purpose of this study was to compare the clinical outcomes of rehabilitation after ACL reconstruction using a water-filled soft brace to those using a hard brace. The method used in this study was a prospective randomised clinical trial including 36 patients wearing a hard brace and 37 patients wearing a water-filled soft brace for 6 weeks after surgery. Preoperative and postoperative (seven examinations) clinical evaluation within a follow-up period of 1 year including effusion status, swelling and range of motion (ROM), IKDC 2000, KT1000 Arthrometer, Lysholm knee scoring scale and Tegner activity score. Mean values are presented with standard deviations. Data was analysed using descriptive statistics and Student's t-test for unpaired samples. Significantly less effusion was found in the soft brace group from 5 days (p=0.002) to 12 weeks (p

Gegenstand In einer klinischen Vergleichsstudie an Patienten, die sich einer arthroskopisch kontrollierten Vorderen Kreuzbandplastik unter Verwendung der Hamstrings unterzogen, wurde untersucht, ob sich die funktionellen Ergebnisse der Vorderen Kreuzbandplastik unter Verwendung eines neu entwickelten wassergefullten Soft Braces im Vergleich zum Hard Brace unterscheiden. Hypothese Die Nachbehandlung von Kniebandrekonstruktionen mit einem wassergefullten Soft Brace fuhrt zu einer geringeren Schwellung und Stauung des Beines und einer fruhzeitigeren Wiedererlangung einer physiologischen Kniefunktion. Methoden In einer prospektiv randomisierten klinischen Vergleichsstudie (Evidenzlevel 2) trugen 73 Patienten entweder ein standardisiertes Hard Brace (n=36) oder ein wassergefulltes Soft Brace mit seitlichen Scharnier-Verstrebungen (n=37). Die Patienten wurden einmal praoperativ und siebenmal postoperativ untersucht. Postoperatives Bracing: sechs Wochen. Nachuntersuchungszeit: ein Jahr. Gesammelte Daten: Erguss-Status, Schwellung, Oberschenkelumfang, Bewegungsumfang, Stabilitat (KT1000-Arthrometer™), IKDC 2000. Statistik: t-Test fur unverbundene Stichproben, Signifikanz: p Ergebnisse Soft Brace: signifikant geringerer Erguss nach funf Tagen (p=0,002), 12 Tagen (p Schlussfolgerung Das getestete neu entwickelte Soft Brace war unter Berucksichtigung des Ergusses, der Schwellneigung und des mittelfristigen IKDC “subjective ratings” uberlegen. Es konnte kein Grund fur die generelle Verwendung eines Hard Braces nach vorderer Kreuzbandplastik gefunden werden. Das Soft Brace stellt eine sichere und Kosten-effektive Alternative zum Hard Brace in der Nachbehandlung der vorderen Kreuzbandplastik dar.