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Rotator cuff lesions are a common shoulder pathology mainly affecting patients aged50 years. This condition is accompanied by not only pain and loss of function but also impaired quality of life and psychological stress. A frequently employed treatment option is arthroscopic repair. But expectations regarding the outcome after surgery might differ between patients and surgeons and therefore lead to dissatisfaction on both sides. The aim of this study was to document patient expectations of a planned arthroscopic rotator cuff repair and compare the results with the assessment of shoulder surgeons.A total of 303 patients and 25 surgeons were involved in this study. Patients with partial- or full-thickness tear of the rotator cuff scheduled for arthroscopic repair were included in this study. Preoperatively, they were asked to fill out questionnaires inquiring sociodemographic data, scores of the underlying pathology, as well as expectations regarding the operation with regard to pain relief, gain of range of motion and strength, as well as the effect on activities of daily life, work, and sports. Furthermore, 25 surgeons were surveyed on what they think their patients expected using the same standardized questions.Among the patients, 43.9% considered gain of range of motion to be the most important goal after rotator cuff repair, followed by pain relief (30.6%) and gain of force (13.7%). Among the surgeons, 72% believed pain relief to be the most important for their patient followed by movement (20%) and strength (8%). When asked which parameter was the most important to achieve after operation, for patients, movement was on first place, pain second, and strength third. For shoulder specialists, the ranking was pain, movement, and strength. Surgeons significantly overrated pain relief when ranking against movement compared with their patients.The expectations of patients regarding their operation differ from the surgeon's assessment. Whereas gaining range of motion was more important for patients, surgeons clearly voted for pain relief. Different expectations should therefore be discussed within the pretreatment interview and taken into account when planning the right therapy. This might lead to better satisfaction on both sides.

The aim of this study was to generate more information on the etiology and pathogenesis of medial (MM) and lateral (LM) meniscus root tears. Our hypothesis was that root tears of the MM predominantly result from degenerative damage, whereas root injuries of the LM are mainly of traumatic origin.Consecutively, 53 patients with a root tear of the medial meniscus (MMRT) and 51 patients with a root tear of the lateral meniscus (LMRT) were included in this study. The diagnosis was confirmed radiologically by MRI as well as arthroscopically. In addition to patient-specific data such as age, BMI and trauma history, the leg axis was determined and accompanying injuries (ligamentous and chondrogenic) were documented.The mean age of the MMRT group was 57.2 (± 11.2) years, and that of the LMRT group 33.9 (± 11.4) years. The BMI was significantly higher in the MMRT group compared to the LMRT (30.5 vs. 25.1). 82.4% of patients in the LMRT group demonstrated an accompanying anterior cruciate ligament (ACL) rupture, whereas only 5.7% of the MMRT were associated with an ACL injury. A trauma was described in only 13.2% of patients of the MMRT group in contrast to 88.2% of the LMRT group. An extrusion 3 mm of the MM in the coronal plane of MRI images could be detected in 86.8% of patients, whereas in the LMRT group, it was 15.7%. The mechanical varus angle was 5.6° in the MMRT group and 2.4° in the LMRT group. The rate and degree of concomitant cartilage damage in the affected compartment was significantly higher in the group with medial root injuries than in the group with lateral root tears.The root injuries of the MM and LM show significant differences in terms of patient age, etiology and accompanying injuries. Root injuries to the medial meniscus are mostly of non-traumatic origin and more likely to occur in the context of medial osteoarthritis and varus deformity of the knee. Lateral root tears tend to be predominantly traumatic and are frequently associated with ACL ruptures. However, in the MMRT group, a small subgroup with a traumatic etiology and in the LMRT group a small subgroup of patients with non-traumatic etiology could be identified.III.

Ersatz des lateralen oder medialen Meniskus mit einem allogenen Transplantat. Kompletter Verlust des Innen- oder Ausenmeniskus. Dritt- bis viertgradige Knorpelschaden im entsprechenden Kompartiment, unkorrigierte Varus- oder Valgusdeformitaten > 5°, symptomatische Instabilitaten. Kniegelenkarthroskopie uber das hohe anterolaterale Standardportal und Uberprufen der Indikation. Auftauen des allogenen Meniskustransplantates in NaCl bei Raumtemperatur und Inkubation in Vancomycin-Losung. Anfrischung der Kapsel und Resektion von Meniskusresten. Aufsuchen der Insertionszonen am Tibiaplateau, Debridement, Einbringen eines transtibialen Zielgerates und Bohren von Zieldrahten in die Mitte der Insertionszonen. Uberbohren der Zieldrahte mit einem 4,5-mm-Bohrer. Kurze mediale oder laterale Arthrotomie (ca. 2 cm). Armierung von Vorder- und Hinterhorn des Meniskustransplantates mit nichtresorbierbarem Nahtmaterial (z. B. „Fiber wire“ Starke 5). Einbringen von K‑Drahten mit Fadenschlaufe in den tibialen Knochentunnel. Uber die Fadenschlaufen Einzug der Armierungsfaden des Meniskustransplantates in die Knochentunnel sowie Einzug des Meniskustransplantates in das Gelenk. Reposition der Meniskusbasis an die Kapsel und Refixation des Meniskus an der Kapsel mit Inside-out- oder All-inside-Nahten. Sechs Wochen Entlastung, danach schrittweise Belastungssteigerung. Beweglichkeit: 4 Wochen 0‑0-60°, 5. bis 6. Woche 0‑0-90°, danach frei. In der in dieser Arbeit beschriebenen Operationstechnik wurden in unserer Klinik 15 Patienten (6-mal medial, 9‑mal lateral) behandelt. Nach einem Mindestzeitraum von 1 Jahr (Mittelwert = 14,2 Monate) lag die Meniskusextrusion – gemessen in der MRT – bei durchschnittlich 2,7 mm. Der Lysholm-Score stieg von durchschnittlich 70,2 (±7,4) auf 90,1 Punkte (±10,6). In einem Fall musste aufgrund einer fruhen Reruptur 10 Tage nach der Operation eine Revision mit erneuter Meniskusrefixation durchgefuhrt werden. In einem weiteren Fall erfolgte 6 Monate nach der Meniskustransplantation aufgrund einer Reruptur eine Meniskusresektion. Thrombosen, Infektionen oder Arthrofibrosen traten nicht auf.

Background: Isolated soft tissue injuries of the posterior capsulolabral complex can be addressed arthroscopically, with various anchor systems available for repair. Purpose: To evaluate clinical and patient-reported outcomes after arthroscopic capsulolabral repair in patients with posterior shoulder instability (PSI) and to compare differences in outcomes between patients treated with a suture-first technique (PushLock anchor) and an anchor-first technique (FiberTak all-suture anchor). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 32 patients with dynamic structural PSI (type B2 according to the ABC classification) treated with an arthroscopic posterior capsulolabral repair. After a mean follow-up time of 4.8 ± 3.4 years (range, 2-11) patients were evaluated clinically, and standardized outcome scores were obtained for the Subjective Shoulder Value (SSV), the Western Ontario Shoulder Instability Index (WOSI), Rowe, Kerlan-Jobe Orthopaedic Clinic (KJOC), patient satisfaction (0-5 [best]), and pain on a visual analog scale (VAS; 0-10 [worst]). Results: The overall satisfaction level with the outcome of the surgery was 4.6 ± 0.5 (range, 4-5). No patient suffered from instability events. The mean VAS level for pain was 0.4 ± 0.9 (range, 0-4) at rest and 1.9 ± 2.0 (range, 0-6) during motion. The mean SSV was 80 ± 17 (range, 30-100), the mean postoperative WOSI score 75% ± 19% (range, 18-98), the mean Rowe score 78 ± 20 (range, 10-100), and the mean KJOC score was 81 ± 18 (range, 40-100) for the entire cohort. There was no significant difference between the techniques with regard to range of motion, strength, or clinical outcome scores. Conclusion: Arthroscopic posterior capsulolabral repair was a satisfactory method to treat structural PSI type B2 with regard to stability, pain relief, and functional restoration. The majority of patients had good outcomes. No differences in outcomes were observed between the anchor-first and suture-first techniques.

The aim of the present study was to evaluate if the vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. The hypothesis was that local antibiotic prophylaxis by soaking ACL grafts in vancomycin results in significantly less infections than ACL reconstruction without local antibiosis. In group 1, 636 patients who were operated between 1.9.2014 and 31.8.2016 received no local antibiotic treatment with vancomycin. In group 2, 536 patients who were operated between 1.9.2016 and 31.8.2018 received local antibiotic treatment with vancomycin (1 mg/ml). In this group the graft was soaked in the vancomycin solution for 10 min prior to graft passage and fixation. In group 1 (ACL reconstruction without vancomycin application), a postoperative infection was detected in ten patients (infection rate: 1.6%). In group 2 (ACL reconstruction with 1 mg/ml vancomycin), no postoperative infection was detected (infection rate: 0%). The statistical analysis showed a clear significant difference between the two groups (p = 0.002). The re-rupture rate and the rate of arthrofibrosis differed not significantly between the two treatment groups (p = 0.526). The results of the present study show that graft soaking in vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. III.

Background: The goal of this study was to compare the effectiveness of a rotator cuff-sparing postero-inferior (PI) approach with subdeltoidal access to the traditional subscapularis-takedown deltopectoral approach, in terms of implant sizing and positioning in anatomical total shoulder arthroplasty (aTSA). Methods: This study involved 18 human cadaveric shoulders with intact rotator cuffs and no evidence of head deforming osteoarthritis. An Eclipse stemless aTSA (Arthrex, Naples, FL, USA) was implanted in nine randomly selected specimens using a standard subscapularis-tenotomy deltopectoral approach, and in the other nine specimens using the cuff-sparing PI approach. Pre- and postoperative antero-posterior (AP) and axillary fluoroscopic radiographs were analyzed by two independent, blinded raters for the following parameters: (1) anatomic and prosthetic neck-shaft angle (NSA); (2) the shift between the anatomic and prosthetic center of rotation (COR); (3) anatomical size matching of the prosthetic humeral head; (4) the calculated Anatomic Reconstruction Score (ARS); (5) glenoid positioning; as well as (6) glenoid inclination and version. Results: While the COR was slightly but significantly positioned (p = 0.031) to be more medial in the PI approach group (3.7 ± 3.4%, range: −2.3% to 8.7%) than in the deltopectoral approach group (−0.2 ± 3.6%, range: −6.9% to 4.1%), on average, none of the remaining measured radiographic parameters significantly differed between both groups (PI approach group vs. deltopectoral group: NSA 130° vs. 127°, p = 0.57; COR supero-inferior, 2.6% vs. 1.0%, p = 0.35; COR antero-posterior, 0.9% vs. 1.7%, p = 0.57; head size supero-inferior, 97.3% vs. 98.5%, p = 0.15; head size antero-posterior, 101.1% vs. 100.6%, p = 0.54; ARS, 8.4 vs. 9.3, p = 0.13; glenoid positioning supero-inferior, 49.1% vs. 51.1%, p = 0.33; glenoid positioning antero-posterior, 49.3% vs. 50.4%, p = 0.23; glenoid inclination, 86° vs. 88°, p = 0.27; and glenoid retroversion, 91° vs. 89°, p = 0.27). Conclusions: A PI approach allows for sufficient exposure and orientation to perform rotator-cuff sparing aTSA with acceptable implant sizing and positioning in cadaveric specimens.

Purpose Aim of this systematic review was to analyze long-term results after meniscus refixation. Methods A systematic literature search was carried out in various databases on studies on long-term results after meniscus refixation with a minimum follow-up of 7 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were radiological signs of osteoarthritis (OA) and clinical scores. Results A total of 12 retrospective case series (level 4 evidence) were identified that reported about failure rates of more than 7 years follow-up. There was no statistical difference in the failure rates between open repair, arthroscopic inside-out with posterior incisions and arthroscopic all-inside repair with flexible non-resorbable implants. In long-term studies that examined meniscal repair in children and adolescents, failure rates were significantly higher than in studies that examined adults. Six studies have shown minor radiological degenerative changes that differ little from the opposite side. The reported clinical scores at follow-up were good to very good. Conclusion This systematic review demonstrates that good long-term outcomes can be obtained in patients after isolated meniscal repair and in combination with ACL reconstruction. With regard to the chondroprotective effect of meniscus repair, the long-term failure rate is acceptable. Level of evidence IV.

The purpose of this study was to perform a systematic review of randomized controlled trials comparing the results of matrix-induced chondrogenesis with other therapies for local chondral lesions of the knee. A systematic search for randomized controlled trials (RCT) about matrix-induced chondrogenesis for focal chondral lesions in the knee was performed according to the PRISMA guidelines. Data source was PubMed central, EMBASE and Google scholar. Five articles could be included, whereas two originated from the same study group. Three studies compared matrix-induced chondrogenesis to microfracture (MFx) only. One trial compared AMIC® to collagen-covered autologous chondrocyte implantation (ACI-C). One study assessed the improvements given by the combination of AMIC® with bone marrow aspirate concentrate (BMAC). In three studies, clinical improvements compared to baseline were seen at 2-year postoperation, irrespective of the technique used. After 5 years, one trial showed better results for the AMIC® group compared to MFx, including MRI defect filling. One study showed also good results after AMIC® with faster recovery for patients with AMIC® + BMAC 12 months postoperatively. Results of RCTs comparing matrix-induced chondrogenesis with other treatment options showed that matrix-induced chondrogenesis is a valid and safe cartilage repair option for small- to medium-sized cartilage defects of the knee. This one-stage surgical technique presents a good alternative for patients. I.

Meniskuslasionen sind zwar bei Kindern und Jugendlichen im Vergleich zum Erwachsenen selten, aufgrund der Bedeutung des Hochleistungssports und einer fruhen Sportspezialisierung werden sie aber immer haufiger beobachtet. Meist treten sie im Rahmen eines Knietraumas auf und sind mit einer begleitenden Ruptur des vorderen Kreuzbandes (VKB) assoziiert. Im Rahmen einer VKB-Lasion auftretende Meniskuslasionen betreffen meist die Hinterhorner. Sie konnen sich aber bis zum Korbhenkelriss ausdehnen. Auch die selten – auch isoliert – vorkommende radiare Rissbildung im Bereich der Pars intermedia des Ausenmeniskus ist meist traumatisch bedingt. Die MRT gilt auch beim Kind in der Meniskusdiagnostik als die Methode der Wahl und sollte daher zur Anwendung kommen, wenn der klinische Verdacht auf eine Meniskuslasion vorliegt. Da die Heilungseigenschaften bei kindlichem und jugendlichem Meniskusgewebe besser sein sollen als beim Erwachsenen und zusatzlich ein hohes Arthroserisiko im Langzeitverlauf bei einem Meniskusverlust in jungen Jahren vorliegt, wird die Indikation zur Meniskusrefixation bei Kindern und Jugendlichen sehr groszugig gesehen. Bei Kombinationsverletzungen von VKB und Meniskus wird eine Meniskusnaht in Kombination mit einer VKB-Plastik angestrebt. Bei Radiarlasionen des Ausenmeniskus wird eine partielle Meniskektomie im inneren Drittel mit Horizontalnahten der peripheren zwei Drittel kombiniert. Bei diskoiden Menisken richtet sich die Therapie nach der Risslokalisation. Bei zentralen Lasionen erfolgt meist eine Teilresektion mit Verkleinerung des diskoiden Meniskus, periphere Meniskuslasionen werden refixiert. Beim symptomatischen hypermobilen Meniskus erfolgt eine Augmentation der meniskopoplitealen Bander durch Meniskusnahte.

Mit dem Ausbruch der COVID-19-Pandemie ist das Interesse an telemedizinischen Versorgungsmoglichkeiten gewachsen. Diese betreffen einerseits den Bereich der Diagnostik, aber auch die Uberwachung von Therapieverlaufen und Rehabilitationsmasnahmen. Aufgrund der derzeitigen Ressourcenbeschrankungen sahen sich viele Orthopaden und Unfallchirurgen gezwungen, Videosprechstunden einzurichten, obwohl Standards fur orthopadische Konsultationen bisher nur unzureichend entwickelt sind. Um die Effizienz der virtuellen Orthopadie zu maximieren, sollten die Patienten auf den virtuellen Besuch vorbereitet werden (Checkliste mit spezifischen Anweisungen zur Kamerapositionierung, Korperpositionierung, Einstellung und Kleidung, Prufung der audiovisuellen Fahigkeiten). Klassische diagnostische Masnahmen wie Anamnese, Inspektion und Beurteilung radiologischer Befunde sind in der Videosprechstunde moglich. Es entfallt jedoch die Moglichkeit der funktionellen Untersuchung (Stabilitat des Kniegelenkes, Schultertests). Auch wenn erste wissenschaftliche Studien gezeigt haben, dass die telemedizinische Diagnostik der konventionellen Diagnostik nicht unterlegen ist, so fehlen doch validierte Untersuchungsprotokolle und Methoden. Die postoperative Uberwachung von Rehabilitationsmasnahmen kann z. B. durch den Einsatz von Sensoren erleichtert werden. Mit moderner Sensorik ist mittlerweile eine kostengunstige Erfassung der Gelenkbeweglichkeit und Gelenkstellung moglich und wird bereits im Bereich der Rehabilitation nach Rekonstruktion des vorderen Kreuzbandes eingesetzt. Auch hier ist sicher weitere Forschung notwendig, um diese Methoden zu validieren. Wir glauben, dass die derzeitige Pandemie Chancen bietet, die Moglichkeiten der Telemedizin fur die Orthopadie und Unfallchirurgie auszubauen, um sie auch in der Zukunft weiter zu nutzen (z. B. bei der Versorgung von Patienten aus dem Ausland oder in dunn besiedelten Gebieten sowie der Betreuung von Hochleistungs- und Profisportlern).

Um die Auswirkungen von COVID-19 zu beurteilen, mussen allen Mitarbeitern im Gesundheitssystem die Symptome und Verlaufe der Erkrankung bekannt sein. Erfahrungen und Studien aus den initial am starksten betroffenen Regionen China und Italien geben erste Ruckschlusse auf Fragen wie Verlauf der Infektion und Risiko fur das Krankenhauspersonal. Hier deutet sich an, dass operativ versorgte COVID-19-Patienten ein hoheres Risiko im Vergleich zu Nichtinfizierten haben. Weiterhin scheint das OP-Personal einem Infektionsrisiko ausgesetzt zu sein. Um das Gesundheitssystem vor einem Kollaps zu bewahren, mussen Ressourcen an anderer Stelle eingespart werden. Dazu mussen elektive Operationen reduziert werden. Um Kriterien zu entwickeln, wann welche Operationen durchgefuhrt werden konnen, wird die Pandemie in verschiedene Phasen eingeteilt. Diese orientieren sich an der Entwicklung der Pandemiekurve. Dabei sollten bei der Entscheidung, ob eine Operation durchfuhrbar ist, verschiedene Aspekte berucksichtigt werden (Stadium der Pandemie, Funktionsstorung bei Unterlassung, Konflikt mit Ressourcen zur COVID-19-Behandlung, Alternative: ambulante Operation). Die Empfehlungen zur Durchfuhrung von Operationen sollten immer an die aktuelle, regionale und epidemiologische Situation des Hauses und des jeweiligen Einzugsgebietes angepasst werden. Zu diesem Zwecke ist es sinnvoll, ein lokales Komitee im Krankenhaus zu bilden, das diese Lagebeurteilung taglich vornimmt. Generelle Operationsverbote erscheinen medizinisch nicht sinnvoll.

In the treatment of anterior shoulder instability with glenoid bone loss, free bone graft transfers have proven to be a viable anatomic alternative to the commonly performed, nonanatomic Latarjet procedure. Implant-free fixation of the free bone grafts, in particular, has rendered excellent short- and long-term results. However, a drawback remains the source of the graft. We describe an arthroscopic bone block cerclage technique using a tricortical scapular spine autograft, which provides an anatomic arthroscopic glenoid reconstruction with the combined benefit of sparing the subscapularis, metal-free fixation, and intraregional donor site for autograft harvesting.

Background Remnant-preserving anterior cruciate ligament reconstruction (ACLR) should have advantages for postoperative remodeling and proprioception. However, it has been suggested that the larger diameter of the graft tends to lead to impingement phenomena with a higher rate of cyclops lesions. The aim of this work was to find out whether the remnant-preserving ACLR actually leads to an increased rate of range of motion restraints compared to the remnant-sacrificing technique. Methods Patients, who fulfilled the inclusion criteria, were followed up for one year after surgery. The primary endpoint was arthrolysis due to extension deficit or cyclops syndrome. Secondary outcome measures were pain (NRS), knee function (KOOS), patient satisfaction and return to sports rate. Results One hundred and sixty-four patients were included in the study, 60 of whom received the “remnant augmentation” procedure (group 1). In the remnant augmentation group, one cyclops resection was performed, whereas in the non-remnant augmentation group three cyclops lesion resections had to be performed (odds ratio 0.6). There was no difference between the groups in pain (NRS) and knee function (KOOS) and patient satisfaction. The return to sports rate after one year was higher in the remnant augmentation group. Conclusions Patients who have undergone the sparing “remnant augmentation” ACLR have no increased risk of cyclops lesion formation or extension deficit in the first year after surgery. An improvement of the proprioceptive abilities by remnant augmentation ACLR should be investigated in further studies. Level of evidence III (prospective cohort study).

„Fast-Track-Konzepte“ dienen der Verminderung des Risikos fur peri- und postoperative Komplikationen nach Implantation einer Knievollprothese. Die beschriebenen Konzepte werden eingesetzt bei Patienten mit der Indikation zur Implantation einer Knievollprothese. Kontraindikationen fur „Fast-Track-Konzepte“ sind: hochbetagte Patienten, Demenz, ASA-Klasse IV (gemas American Society of Anesthesiologists), Implantation groser Revisions- oder Tumorprothesen. Kontraindikationen fur Tranexamsaure sind: Blutungen im Harntrakt, Vorsicht bei bekannter Epilepsie, individuelle Risikoabwagung bei bestehenden Thrombosen bzw. erhohtem Thromboserisiko, frischer Herzinfarkt, Z. n. frischer Lungenembolie, Z. n. perkutaner transluminaler Koronarangioplastie (PTCA) oder Z. n. Stentimplantation. Kontraindikationen fur Ropivacain sind: Uberempfindlichkeit (Allergie) gegen Ropivacain und andere Lokalanasthetika vom Amidtyp, Hypovolamie. Praoperativ wird die Gabe von 1 g Tranexamsaure und intraoperativ eine lokale Infiltrationsanasthesie durchgefuhrt. Dazu erfolgt nach der femoralen und tibialen Knochenresektion, vor der Zementierung der femoralen und tibialen Komponenten, die Injektion von etwa 40 ml Ropivacain (2 %) in die posteriore Kapsel. Weiter erfolgt die Injektion von jeweils etwa 20 ml Lokalanasthetikum in die medialen und lateralen Seitenbander und die Infiltration des Hoffa-Fettkorpers sowie des Streckapparats mit ebenfalls etwa 20 ml Lokalanasthetikum. Nach der Zementierung wird das Subkutangewebe mit etwa 50 ml Ropivacainlosung infiltriert. Noch am Operationstag wird der Patient unter krankengymnastischer Anleitung mobilisiert. Dabei soll der Patient, wenn moglich, bereits einige Schritte an 2 Unterarmgehstutzen gehen. Die systemische analgetische Therapie erfolgt nach WHO-Stufenschema II mit einem schwach wirksamen Opioid und Nichtopioidanalgetika der ersten Stufe (nichtsteroidale Antirheumatika, NSAR, und/oder Metamizol). Als adjuvante Komedikation kann Gabapentin eingesetzt werden. Die medikamentose Thromboseprophylaxe erfolgt fur 2 Wochen postoperativ mit einem niedermolekularen Heparin. Bei 100 Patienten, die praoperativ 1 g Tranexamsaure sowie eine intraartikulare Infiltrationsanasthesie erhalten hatten, lag der Schmerz am Abend des Op.-Tags auf der numerischen Ratingskala (NRS) durchschnittlich bei 2,1 (±1,8). Bei einem Patienten bestand ein sensibles Defizit am Unterschenkel und Fus. Ein motorischer Ausfall wurde nicht beobachtet. Es konnten 90 Patienten das gestreckte Bein anheben. Am Op.-Tag konnten 68 Patienten mehr als 10 Schritte gehen, 22 Patienten konnten in den Stand mobilisiert werden. Die mittlere stationare Verweildauer lag bei 6,6 Tagen (5–11 Tage). Infektionen, Thrombosen und Lungenembolien traten nicht auf.

Wiederherstellung der Kniestabilitat nach Reruptur einer vorderen Kreuzband-(VKB-)Plastik. Akute und chronische funktionelle Instabilitat mit Reruptur eines VKB-Transplantats bei anatomischen oder nichtanatomischen Knochentunneln ohne Tunnelweitung. Partiell anatomische Knochentunnel der vorherigen Operation, signifikante Tunnelweitung anatomischer Knochentunnel, lokale Infektion im Bereich des Kniegelenks, lokale Weichteilschadigung. Geeignete Revisionstransplantate sind die autologen Beugesehnen (M. semitendinosus, M. gracilis), die Quadrizepssehne, die Patellarsehne sowie ein Peroneussehnen-Split-Graft. Bei anatomischen Tunneln sorgfaltiges Debridement bis auf die Tunnelwand; bei nichtanatomischen Tunneln der Voroperation Bohren des femoralen Kanals uber ein tiefes anteromediales Portal bei mehr als 110° gebeugtem Knie im VKB-Insertionsgebiet. Eine schonende Tunnelpraparation gelingt mit Dilatatoren. An der Tibia dient das Ausenmeniskusvorderhorn bei fehlendem VKB-Stumpf als Landmarke. Sondieren der gelenkfernen Tunneloffnung mit einem Zieldraht und schrittweises Aufbohren der Tunnel bis zum Erreichen der Tunnelwand, die mit einem Loffel oder Synovialresektor debridiert wird. Dabei Entfernen von Transplantatresten und Implantaten aus dem Tunnel. Die femorale Fixation erfolgt mit einem Kippanker, einer Interferenzschraube oder bei einem Knochenblocktransplantat auch implantatfrei. Transplantatfixierung tibial mit resorbierbarer Interferenzschraube und Fixationsknopf. Nachbehandlungsschema besteht aus 4–5 Phasen. Entzundungsphase I (1.–2. Woche): Schmerz- und Ergussprophylaxe (Kuhlung, isometrische Anspannungsubungen, 20-kg-Teilbelastung). Phase II (2.–6. Woche): Langsame Steigerung von Belastung und Beweglichkeit mit Ubungen in geschlossener Kette (Ziel: Extension/Flexion 0–0–120°). Phase III (ab der 6. Woche): Kraftaufbau und Koordinationsubungen. Phase IV: Balance, Kraft und Sprungubungen. Wiederkehr zum Wettkampfsport nicht vor dem 6.–10. postoperativen Monat. Nachuntersucht wurden 51 Patienten mit Rezidivinstabilitat nach VKB-Plastik, bei denen ein primarer Reersatz des VKB mit ipsilateralem Knochen-Quadrizepssehnen-Transplantat oder kontralateralem Semitendinosus-Gracilis-Transplantat durchgefuhrt wurde. Alle Patienten hatten anatomische oder nichtanatomische Bohrkanalpositionen ohne signifikante Bohrkanalweitung (>11 mm). Nach 2 Jahren betrug der Seit-zu-Seit-Unterschied fur die anteriore Translation gemessen mit dem KT-1000-Arthrometer 2,0 ± 1,2 mm fur die Quadrizeps-Gruppe und 3,0 ± 2,9 mm fur die Semitendinosus-Gracilis-Gruppe (P = 0,461). Kein Unterschied in der Rate positiver Pivot-Shift-Tests (P = 0,661), kein signifikanter Unterschied in den einzelnen Subscores des KOOS (Knee Injury and Osteoarthritis Outcome Score) sowie beim vorderen Knieschmerz.

Extrusion of the medial meniscus evaluated on magnetic resonance imaging (MRI) has been described as indirect radiological sign for meniscus root tears. However, ultrasound detectable dynamic extrusion is observed in normal physiological settings. The aim of the present study was to analyze the dynamic meniscal extrusion using ultrasound (US) examination in patients with MRI-confirmed meniscal root tears. The hypothesis was that dynamic meniscus extrusion is reduced in patients with medial root tear but not in the healthy meniscus. Twenty-five patients with a medial root lesion of the meniscus (group I) and 25 healthy controls (group II) were enrolled in this study. The medial meniscus extrusion (MME) of the index knee was determined using ultrasound (US) in supine position and under full weight bearing. Standard knee MRI was used for determining whether the patients were eligible for this study according to the inclusion and exclusion criteria, respectively. In group I, the mean MME was 3.6 mm (± 1.0 mm) in supine position and 3.7 mm (± 0.9 mm) under full weight bearing according to US measurements. The mean Δ-extrusion was 0.1 mm (± 0.2 mm) and the ratio was 1.0 (± 0.1). Mean medial meniscus extrusion on MRI was 3.9 mm (± 0.9 mm). In group II, mean MME was 1.3 mm (± 0.3 mm) in supine position (US) and 2.3 mm (± 0.4 mm) under full weight bearing (US). The mean Δ-extrusion was 1.0 mm (± 0.4 mm) and the extrusion ratio was 1.8 (± 0.4). In this group, mean extrusion in MRI was 1.4 mm (± 0.7 mm). The difference in mean ultrasound Δ-extrusion, ratio, and MRI extrusion between both groups was statistically significant (p

Replacement of the lateral or medial meniscus with an allogeneic graft.Complete loss of inner or outer meniscus.Grade 3 to 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities 5°, symptomatic instabilities.Knee joint arthroscopy via the high anterolateral standard portal and checking the indication. Thaw the allogeneic meniscus graft in NaCl at room temperature and incubate in vancomycin solution. Refreshment of the capsule and resection of remnants of the meniscus. Search for the insertion zones on the tibial plateau, debridement, insert a transtibial targeting device and drill target wires in the middle of the insertion zones. Overdrill the target wires with a 4.5 mm drill. Short medial or lateral arthrotomy (approx. 2 cm). Reinforcement of the anterior and posterior horns of the meniscus graft with nonresorbable suture material (e.g. "fiber wire" size 5). Insertion of K‑wires with thread loops into the tibial bone tunnel. The reinforcement threads of the meniscus transplant are drawn into the bone tunnel via the thread loops, and the meniscus transplant is drawn into the joint. Reduction of the meniscus base to the capsule and refixation of the meniscus to the capsule with "inside out" or "all inside" sutures.Six weeks partial weight-bearing using a hinged brace, then gradually increased load. Range of motion: 4 weeks 0‑0-60°, then 2 weeks 0‑0-90°, followed by no restrictions.In our hospital, 15 patients (6 × medial, 9 × lateral) were treated using the described surgical technique. After a minimum period of 1 year (mean = 14.2 months), meniscus extrusion-measured in the MRI-averaged 2.7 mm. The Lysholm score rose from an average of 70.2 (±7.4) to 90.1 points (±10.6). In one case, due to an early reruption, revision with renewed meniscus refixation had to be performed 10 days after the operation. In another case, meniscus resection was performed 6 months after the meniscus transplant due to a reruption. Thrombosis, infection and arthrofibrosis were not observed.OPERATIONSZIEL: Ersatz des lateralen oder medialen Meniskus mit einem allogenen Transplantat.Kompletter Verlust des Innen- oder Außenmeniskus.Dritt- bis viertgradige Knorpelschäden im entsprechenden Kompartiment, unkorrigierte Varus- oder Valgusdeformitäten 5°, symptomatische Instabilitäten.Kniegelenkarthroskopie über das hohe anterolaterale Standardportal und Überprüfen der Indikation. Auftauen des allogenen Meniskustransplantates in NaCl bei Raumtemperatur und Inkubation in Vancomycin-Lösung. Anfrischung der Kapsel und Resektion von Meniskusresten. Aufsuchen der Insertionszonen am Tibiaplateau, Débridement, Einbringen eines transtibialen Zielgerätes und Bohren von Zieldrähten in die Mitte der Insertionszonen. Überbohren der Zieldrähte mit einem 4,5-mm-Bohrer. Kurze mediale oder laterale Arthrotomie (ca. 2 cm). Armierung von Vorder- und Hinterhorn des Meniskustransplantates mit nichtresorbierbarem Nahtmaterial (z. B. „Fiber wire“ Stärke 5). Einbringen von K‑Drähten mit Fadenschlaufe in den tibialen Knochentunnel. Über die Fadenschlaufen Einzug der Armierungsfäden des Meniskustransplantates in die Knochentunnel sowie Einzug des Meniskustransplantates in das Gelenk. Reposition der Meniskusbasis an die Kapsel und Refixation des Meniskus an der Kapsel mit Inside-out- oder All-inside-Nähten.Sechs Wochen Entlastung, danach schrittweise Belastungssteigerung. Beweglichkeit: 4 Wochen 0‑0-60°, 5. bis 6. Woche 0‑0-90°, danach frei.In der in dieser Arbeit beschriebenen Operationstechnik wurden in unserer Klinik 15 Patienten (6-mal medial, 9‑mal lateral) behandelt. Nach einem Mindestzeitraum von 1 Jahr (Mittelwert = 14,2 Monate) lag die Meniskusextrusion – gemessen in der MRT – bei durchschnittlich 2,7 mm. Der Lysholm-Score stieg von durchschnittlich 70,2 (±7,4) auf 90,1 Punkte (±10,6). In einem Fall musste aufgrund einer frühen Reruptur 10 Tage nach der Operation eine Revision mit erneuter Meniskusrefixation durchgeführt werden. In einem weiteren Fall erfolgte 6 Monate nach der Meniskustransplantation aufgrund einer Reruptur eine Meniskusresektion. Thrombosen, Infektionen oder Arthrofibrosen traten nicht auf.

Purpose Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in orthopedics in these procedures has increased significantly. The aim of this systematic review was to find out to what extent there is scientific evidence for the use of telemedicine in the orthopedic field. Methods A systematic literature search was carried out in various databases on randomized controlled trials (RCTs) on telemedical applications in orthopedics. Results Altogether, 14 articles were identified that reported about a total of eight RCTs of telemedical applications in orthopedics. Two RCTs were about a patient-to-doctor video consultation and six RCTs were about telerehabilitation after knee and hip arthroplasty (4 × knee arthroplasty, one hip and knee arthroplasty, one hip arthroplasty). For the majority of outcome parameters evaluated, there were no significant differences between the study groups. The cost effectiveness of videoconsultations depended on the workload (number of patient consultations) as well as the effectiveness of telerehabilitation on the distance of the patient's home to the health care center (30 km round-trip). Conclusion There is sufficient evidence to recommend the use of telemedical methods in orthopedics. However, more research is necessary to further expand the possibilities of telemedical methods with regard to physical examination.

Aims and Objectives: The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon. Materials and Methods: We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score. Results: The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups. Conclusion: Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.

Ziel der Revisionsoperation nach Versagen einer vorderen Kreuzbandplastik ist es, das Kniegelenk erneut mit einem autologen Sehnentransplantat zu stabilisieren. Eine einzeitige Revision ist nur moglich bei korrekter anatomischer oder nichtanatomischer Tunnellage ohne signifikante Tunnelweitung. Die autologe Quadrizepssehne ist hier ein ideales Transplantat fur die Revisionschirurgie. Nach praoperativer klinischer und radiologischer Diagnostik werden zunachst die Tunnelpositionen arthroskopisch begutachtet. Dann erfolgen bei anatomischer Tunnellage das Debridement sowie die Grosenbestimmung des femoralen Tunnels. Bei extraanatomischem femoralem Tunnel wird dieser uber das mediale Portal mit Hilfe eines speziellen Portalzielgerats bei mehr als 110° gebeugtem Knie neu angelegt. Als Landmarken dienen die Linea intercondylaris und die Knorpel-Knochen-Grenze am lateralen Femurkondylus. Die Position des Zieldrahts wird kontrolliert, indem das Arthroskop in das mediale Portal eingefuhrt wird. Die Entnahme der autologen Quadrizepssehne erfolgt mit speziellem Instrumentarium. Das Transplantat wird mit einem Knochenblock entnommen. An der Tibia wird die ehemalige Hautinzision am Tibiakopf eroffnet und der Tunneleingang aufgesucht. Dann wird in den ehemaligen Tunnel ein Fuhrungsdraht eingefuhrt und dieser soweit uberbohrt, bis samtliche Transplantatreste entfernt und die Sklerose der Tunnelwand eroffnet ist. Das Transplantat wird in das Gelenk gezogen und am Femur mit dem Knochenblock in Press-fit-Technik fixiert. An der Tibia wird eine Hybridfixation mit resorbierbarer Interferenzschraube sowie Fixationsbutton durchgefuhrt. Die autologe Quadrizepssehne ist eine wichtige Transplantatalternative in der Revisionschirurgie des vorderen Kreuzbands (VKB).

Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors.

Background: The choice of graft in anterior cruciate ligament (ACL) reconstruction is still under discussion. The hamstrings are currently the most used grafts for primary ACL reconstruction in Europe. However, increased interest has arisen in the quadriceps tendon (QT) as an alternative autologous graft option for primary ACL reconstruction. Purpose: To evaluate knee stability and the subjective outcome after ACL reconstruction using either autologous QT graft in implant-free femoral press-fit fixation technique or semitendinosus tendon (ST) graft. Study Design: Cohort study; Level of evidence, 2. Methods: We evaluated 50 patients who underwent ACL reconstruction, including 25 patients who received autologous ipsilateral QT graft (QT group) and 25 patients who received the ipsilateral ST graft (ST group). The follow-up for this prospective comparative study was at least 2 years after surgery, comprising KT-1000 arthrometer testing, pivot-shift test, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and rerupture rate. Results: The mean patient age was 31.72 years (9 women, 16 men) in the QT group and 32.08 years (13 women, 12 men) in the ST group. The mean ± standard deviation postoperative side-to-side difference assessed using KT-1000 arthrometer was 1.56 ± 1.56 mm for the QT group and 1.64 ± 1.41 mm for the ST group, with no significant difference. No significant difference was found on any of the KOOS subscale scores ( P = .694) or the Lysholm score ( P = .682). No rerupture or positive pivot-shift test occurred during follow-up. No difference was found in donor-site morbidity between the study groups. Conclusion: Clinical outcomes were not significantly different between QT and ST grafts in the current study. Thus, the QT may serve as a good alternative graft for primary ACL reconstruction.

Wir berichten uber einen 19-jahrigen Patienten, der beim Rugby ein Hyperextensionstrauma des rechten Kniegelenks mit traumatischen Horizontallasion des Innen- und Ausenmeniskus erlitten hatte. Diese Art von Meniskusriss tritt normalerweise im Rahmen eines degenerativen Geschehens auf. In unserem vorgestellten Fall sprachen neben einem adaquaten Unfallmechanismus arthroskopisch die im Meniskusriss erkennbaren Koagel fur die traumatische Genese der Horizontallasionen.

Aims and Objectives: Extrusion of the medial meniscus in MRI is an indirect radiological sign for a meniscus root tear. However, a recent study has shown that ultrasound-detectable dynamic extrusion is considered physiological in healthy volunteers. The aim of our study was to analyze the dynamic meniscal extrusion in patients with proven root injury in ultrasound. Our hypothesis was that dynamic extrusion is reduced in patients with root injury of the medial meniscus compared to healthy volunteers. Materials and Methods: Inclusion criteria for this prospective study were MRI signs for a root lesion of the medial meniscus (ghost sign, extrusion > 3 mm). An age matched group of healthy volunteers served as control. Exclusion criterion was osteoarthritis > II° of the medial compartment according to Kellgren & Lawrence. The extrusion of the medial meniscus (MME) of the affected knee was measured by ultrasound (US) in supine position and under full weight bearing. Results: 25 patients with a medial root lesion were included in the study. The evaluation of the ultrasound results revealed a significant decreased dynamic medial displacement of the meniscus in patients with root injury. In the supine position, the mean medial meniscus extrusion was 3.60 mm (± 1.00 mm). In the standing position, the mean medial meniscus extrusion increased to 3.72 mm (± 0.96 mm). The mean delta-extrusion was 0.11 mm (± 0.17 mm). This difference was statistically not significant. In 14 patients, no dynamic extrusion was detectable at all. All patients belonging to the medial root tear group had a significant varus deformity (mechanical axis hits the tibial joint line more than 15 mm medially form the center). In the control group, the mean medial meniscus extrusion was 1.34 mm (± 0.37 mm) in supine position and 2.20 mm (± 0.34 mm) under full weight bearing. The mean delta-extrusion was 0.85 mm (± 0.30 mm). The difference in mean delta-extrusion between the root tear and control group was statistically significant. Conclusion: Ultrasonography is a diagnostic tool to detect the dynamic extrusion of the medial meniscus. Lack of dynamic extrusion (“dead meniscus sign”) may serve as an indicator for medial root injury.

Background The effects of psychological factors on the short-term outcome after uncomplicated total knee arthroplasty (TKA) have been described in several studies. However, the effects of mental factors on the midterm (5-year) outcome have not been described in the literature. This study was performed to examine the influence of pain catastrophizing, anxiety, depression symptoms, and somatization dysfunction on the outcome of TKA during a 5-year follow-up. Methods One hundred fifty patients were enrolled in this prospective study. The following mental parameters were assessed in all patients: pain catastrophizing (Pain Catastrophizing Scale), anxiety (State-Trait Anxiety Inventory), depressive symptoms and somatization dysfunction (Patient Health Questionnaire). The primary outcome measure was postoperative pain on a numerical rating scale. The secondary outcome measures were the Knee Injury and Osteoarthritis Outcome Score and patient satisfaction. Intergroup differences were tested using an independent t-test. Odds ratios were calculated to determine the probability of an unsatisfactory outcome. Results At the 5-year follow-up, only depressive symptoms and somatization dysfunction had a significant effect on postoperative pain (numerical rating scale score). This significant effect was also observed for the different Knee Injury and Osteoarthritis Outcome Score subscales and patient satisfaction (P = .010-.020). Pain catastrophizing and anxiety had only a small effect on the clinical outcome at 5 years postoperatively. Conclusion The effects of psychopathological factors (depressive symptoms and somatization dysfunction) on the clinical outcome after uncomplicated TKA persist for up to 5 years. Preoperative screening for and subsequent treatment of these psychological disorders may improve patient-reported outcomes after TKA. Level of Evidence Level II, diagnostic study.

Fast track concepts are used to reduce the risk of perioperative and postoperative complications after total knee arthroplasty.The described concepts are used for patients with indications for the implantation of a total knee prosthesis.Contraindications for fast track concepts are aged patients, dementia, American Society of Anesthesiologists (ASA) grade IV and implantation of large revision or tumor prostheses. Contraindications for tranexamic acid are bleeding in the urinary tract, caution in cases of known epilepsy, individual risk assessment in existing thromboses or increased thrombosis risk, fresh myocardial infarction, conditions following fresh pulmonary embolism, percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. Contraindications for ropivacaine are hypersensitivity (allergy) to ropivacaine and other amide type topical anesthetics and hypovolemia.Preoperative administration of 1 g tranexamic acid and intraoperative local infiltration anesthesia are carried out. After femoral and tibial bone resection and before cementing the femoral and tibial components, approximately 40 ml of ropivacaine (2%) is injected into the posterior capsule. This is followed by injection of the medial and lateral collateral ligaments with approximately 20 ml each and infiltration of Hoffa's fat pad and the extensor apparatus also with approximately 20 ml local anesthetic. After cementing, the subcutaneous tissue is infiltrated with approximately 50 ml ropivacaine solution.On the same day as the operation the patient is mobilized with the help of a physiotherapist. The patient should, if possible, walk a few steps on crutches. Systemic analgesic treatment is carried out according to the World Health Organization (WHO) staged scheme II with a weak opioid and first stage non-opioid analgesic (nonsteroidal anti-inflammatory drug, NSAID and/or metamizole). Gabapentin can be used as an adjuvant comedication. Medicinal thrombosis prophylaxis is carried out with a low molecular weight heparin for 2 weeks postoperatively.In 100 patients who preoperatively received 1 g tranexamic acid and intra-articular infiltration anesthesia, in the evening of the day of the operation the pain was on average 2.1 (±1.8) on the numeric pain rating scale (NPRS). In one patient, there was a sensitive deficit of the lower leg and foot. A motor deficit was not observed. A total of 90 patients were able to raise and straighten leg. On the day of surgery 68 patients were able to walk more than 10 steps and 22 patients could be mobilized to a standing position. The mean length of hospital stay was 6.6 days (5-11 days). No infections, thromboses or pulmonary embolisms occurred.

The purpose of this study was to perform a systematic review of prospective randomized controlled trials comparing arthroscopic treatment for knee osteoarthritis (OA) with either other therapeutic interventions or sham treatment. A systematic search for randomized controlled trials (RCT) about arthroscopic treatment (AT) for knee OA was performed according to the PRISMA guidelines. Arthroscopic treatment included procedures such as lavage, debridement and partial meniscectomy of the knee. Data source was PubMed central. Fourteen articles could be included. Five studies compared interventive AT with either sham surgery, lavage or diagnostic arthroscopy. Nine trials compared AT with another active intervention (exercise, steroid injection, hyaluronic acid injection). In ten trials, the clinical scores improved after arthroscopic treatment of knee OA in comparison to the baseline. In seven trials, there was a significant difference in the final clinical outcome with higher scores for patients after arthroscopic OA treatment in comparison to a control group. In four trials, the intention to treat analysis revealed no significant difference between arthroscopic OA treatment and the control group. In one of those trials, which compared arthroscopic partial meniscectomy (APM) with exercise, the cross over rate from exercise to AT was 34.9%. The clinical scores of cross-over patients improved after APM. In one study, the subgroup analysis revealed that patients with tears of the anterior two-thirds of the medial meniscus or any lateral meniscus tear had a higher probability of improvement after arthroscopic surgery than did patients with other intraarticular pathology. There was no difference in the side effects between patients with AT and the control group. Despite acceptable scores in the methodological quality assessment, significant flaws could be found in all studies. These flaws include bad description of the exact surgical technique or poor control of postoperative use of non-steroidal anti-inflammatory drugs (NSAID). Results of RCTs comparing AT with other treatment options were heterogeneous. AT in OA patients is not useless because there is evidence that a subgroup of patients with non-traumatic flap tears of the medial meniscus or patients with crystal arthropathy benefit from arthroscopy. This topic has a high relevance because several health insurances do not reimburse arthroscopy for patients with OA anymore. The results of these randomized studies, however, should be interpreted with care because in many studies, the use of other therapeutic variables such as pain killers or NSAIDs was not controlled or reported. I.

Osteoporosis as a systemic skeletal disorder is characterized by increased bone fragility and the risk of fractures. According to the World Health Organization, osteoporosis is one of the 10 most common diseases and affects approximately 75 million people in Europe, the United States, and Japan. In this context, the identification of specific microRNA (miRNA) signatures is an important step for new diagnostic and therapeutic approaches. The focus of interest on miRNAs as biomarkers came with new publications identifying free circulating extracellular miRNAs associated with various types of cancer. This study aimed to identify specific miRNAs in patients with osteoporotic fractures compared with nonosteoporotic fractures. For the array analysis, miRNAs were isolated from the serum of 20 patients with hip fractures, transcribed, and the samples were pooled into 10 osteoporotic and 10 nonosteoporotic specimens. With each pool of samples, human serum and plasma miRNA PCR arrays were performed, which are able to identify 83 different miRNAs. Subsequently, a separate validation analysis of each miRNA found to be regulated in the array followed with miRNA samples isolated from the serum of 30 osteoporotic and 30 nonosteoporotic patients and miRNA samples isolated from the bone tissue of 20 osteoporotic and 20 nonosteoporotic patients. With the validation analysis of the regulated miRNAs, we identified 9 miRNAs, namely miR-21, miR-23a, miR-24, miR-93, miR-100, miR-122a, miR-124a, miR-125b, and miR-148a, that were significantly upregulated in the serum of patients with osteoporosis. In the bone tissue of osteoporotic patients, we identified that miR-21, miR-23a, miR-24, miR-25, miR-100, and miR-125b displayed a significantly higher expression. A total of 5 miRNAs display an upregulation both in serum and bone tissue. This study reveals an important role for several miRNAs in osteoporotic patients and suggested that they may be used as biomarkers for diagnostic purposes and may be a target for treating bone loss and optimizing fracture healing in osteoporotic patients.