Funktion des Schultergelenkes nach dorsal verhakter Schultergelenksluxation

$\bf Problem:$ Die dorsale Schultergelenksluxation macht weniger als 3% aller Schulterluxationen aus. Diese Studie soll die das Ergebniss beeinflussenden Faktoren identifizieren. $\bf Methode:$ Insgesamt wurden 35 Patienten klinisch nachuntersucht, geröntgt und mit einem Fragebogen befragt (Durchschnittsalter 49). $\bf Ergebnisse:$ Der Constant-Score der konservativ behandelten Patienten lag mit 85 höher als der der operativ behandelten Patienten. Der Constant-Score bei anatomischer Rekonstruktion betrug 92 während der Wert bei nicht anatomischer Rekonstruktion auf 65 Punkte abfiel. Die Auswertung der Röntgenaufnahmen bestätigte zudem unsere klinischen Untersuchungsergebnisse mit erhöhten Zeichen für posttraumatische Arthrosen. $\bf Schlussfolgerung:$ Die Ergebnisse dieser Arbeit unterstreichen die Bedeutung der frühen und richtigen Diagnosestellung. Zudem wurde deutlich, dass im Rahmen der gegebenen Möglichkeiten die anatomische Rekonstruktion der nicht-anatomischen Rekonstruktion vorzuziehen ist

Finger Joint Reconstruction with Rib Perichondrium

Difficulties in repairing and reconstructing articular cartilage damaged by trauma or disease remain unsolved and are one of the major challenges confronting orthopedic and hand surgeons in their clinical work. Relevant research has not adequately described the long-term clinical results, nor has it made a direct comparison to implant surgery after finger joint reconstruction with rib perichondrium. The role of the transplanted perichondrium and the resulting tissue's quality after transplantation have not been detailed with methods investigating gene and protein expression. Therefore, the overall aim of this thesis was to investigate the role and suitability of perichondrium transplants for finger joint reconstruction of cartilage defects and its potential for the field of tissue engineering. Study I is a longitudinal cohort study to evaluate the long-term clinical outcome of finger joint reconstruction with perichondrium transplants. The study cohort included all 11 traceable and alive patients after a median follow-up of 37 (range 34-41) years. The clinical results regarding range of motion, grip strength, pain and scores on the disability of the arm, shoulder, and hand (DASH) were good to excellent without any donor site morbidity. Study II is a retrospective cohort study evaluating 163 joints in 124 patients, divided into 138 surface replacement (SR) implants in 102 patients and 25 perichondrium transplants in 22 patients. The median follow-up was 6 years for the SR group and 26 years for the transplant group. Revision rates and 10-year survival favored patients treated with perichondrium transplants, but below the threshold of statistical significance. Study III is an in vitro study to develop highly sensitive and specific protocols for immunohistochemistry, immunofluorescence, and in situ hybridization on bone tissue. The protocol modifications in this study represent critical steps that can empower highly sensitive and specific mRNA and protein localization in formalin-fixed and decalcified skeletal tissues needed for study IV. In Study IV, an experimental animal study, perichondrium transplants from enhanced green fluorescent protein (EGFP) positive rats were transplanted to wild type recipients. The reconstructed cartilage's cellular contribution and quality were assessed by immunohistochemistry, immunofluorescence, confocal microscopy and in situ hybridization at different times after surgery. The study showed that perichondrium transplants differentiated into a cartilage structure that filled out the defects with chondrocytes expressing elevated levels of Col2a1 and producing a matrix rich in proteoglycans. Study V is a case series of four patients with a mean age of 40 (range 37-47) years with osteoarthritis in the distal radioulnar joint. Our retrospective clinical follow-up is presented and discussed in relation to more traditional techniques. Pain, range of motion, strength, and patient-rated outcome measures improved and were stable at the mid-term follow-up 7.5 years after surgery. In conclusion, perichondrium seems to be a suitable tissue for joint reconstruction and tissue engineering

Finger Joint Reconstruction with Rib Perichondrium

Difficulties in repairing and reconstructing articular cartilage damaged by trauma or disease remain unsolved and are one of the major challenges confronting orthopedic and hand surgeons in their clinical work. Relevant research has not adequately described the long-term clinical results, nor has it made a direct comparison to implant surgery after finger joint reconstruction with rib perichondrium. The role of the transplanted perichondrium and the resulting tissue's quality after transplantation have not been detailed with methods investigating gene and protein expression. Therefore, the overall aim of this thesis was to investigate the role and suitability of perichondrium transplants for finger joint reconstruction of cartilage defects and its potential for the field of tissue engineering. Study I is a longitudinal cohort study to evaluate the long-term clinical outcome of finger joint reconstruction with perichondrium transplants. The study cohort included all 11 traceable and alive patients after a median follow-up of 37 (range 34-41) years. The clinical results regarding range of motion, grip strength, pain and scores on the disability of the arm, shoulder, and hand (DASH) were good to excellent without any donor site morbidity. Study II is a retrospective cohort study evaluating 163 joints in 124 patients, divided into 138 surface replacement (SR) implants in 102 patients and 25 perichondrium transplants in 22 patients. The median follow-up was 6 years for the SR group and 26 years for the transplant group. Revision rates and 10-year survival favored patients treated with perichondrium transplants, but below the threshold of statistical significance. Study III is an in vitro study to develop highly sensitive and specific protocols for immunohistochemistry, immunofluorescence, and in situ hybridization on bone tissue. The protocol modifications in this study represent critical steps that can empower highly sensitive and specific mRNA and protein localization in formalin-fixed and decalcified skeletal tissues needed for study IV. In Study IV, an experimental animal study, perichondrium transplants from enhanced green fluorescent protein (EGFP) positive rats were transplanted to wild type recipients. The reconstructed cartilage's cellular contribution and quality were assessed by immunohistochemistry, immunofluorescence, confocal microscopy and in situ hybridization at different times after surgery. The study showed that perichondrium transplants differentiated into a cartilage structure that filled out the defects with chondrocytes expressing elevated levels of Col2a1 and producing a matrix rich in proteoglycans. Study V is a case series of four patients with a mean age of 40 (range 37-47) years with osteoarthritis in the distal radioulnar joint. Our retrospective clinical follow-up is presented and discussed in relation to more traditional techniques. Pain, range of motion, strength, and patient-rated outcome measures improved and were stable at the mid-term follow-up 7.5 years after surgery. In conclusion, perichondrium seems to be a suitable tissue for joint reconstruction and tissue engineering

Reconstruction of the distal radioulnar joint with rib perichondrium - midterm follow-up

Background: Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time. Methods: Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7-10) and 4.2 (range 2-5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118 degrees and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016. Results: At clinical follow-up at a mean of 3.1 years (range 1-5) after surgery, pain level had decreased to VAS 1.5 (0-5) under load and all patients were pain free at rest. Forearm rotation was on average 156 degrees (range 100-180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0-45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5-9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported. Conclusion: Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time

Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints : a retrospective cohort study with a mean follow-up time of 6 respectively 26years

BackgroundThe aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints.MethodsWe evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint.ResultsThe median follow-up time was 6years (0-21) for the SR implants and 26years (1-37) for the perichondrium transplants. Median age at index surgery was 64years (24-82) for SR implants and 45years (18-61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4-100.0) than in the SR implant group (75%; CI 53.8-96.1), but not statistically significantly so (p=0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55-100) than in the SR implant group (74.7%; CI 66.6-82.7), but below the threshold of statistical significance (p=0.8).ConclusionIn conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants.Level of evidenceIII (Therapeutic)

Reconstruction of finger joints using autologous rib perichondrium - an observational study at a single Centre with a median follow-up of 37 years

Background Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation. Methods The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974-1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34-41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR). Results None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost pain-free at activity (VAS 0,6) (range 0-4), had an average range-of-motion of 41 degrees (range 5-80) and a mean DASH-score of 8,3 (range 1-51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0-1). The ROM was on average 80 degrees (range 70-90) and the mean DASH-score was 2 (range 1-3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%). Conclusions Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures

Interosseous-lumbrical adhesions - a rare condition? : A series of five cases

Adhesions between the interosseous and lumbrical muscles involving the deep transverse metacarpal ligament (dTML) can be a cause of chronic pain and reduced range of motion. New reports on this condition are rare. We identified five patients experiencing pain, swelling and decreased range of motion in the metacarpophalangeal (MCP) joints during manual load. The condition was caused by a direct trauma. After not responding to conservative treatment, patients underwent surgery. Time between trauma and surgery was on average 16 months and the mean postoperative follow-up was 8 months. The lumbrical-interosseus junction was exposed by volar or dorsal incision, adhesions were widely released and the distal third of the dTML was resected. This resulted in normal passive excursion of the muscles and the tendon junction. At the mean follow-up time 8.2 months (3-18) after surgery, all patients were pain-free and had gained near normal range of motion in the MCP joints. Interosseous-lumbrical adhesions may be more common than reflected by the literature. Hand surgeons should keep this condition in mind in cases with chronic inter-metacarpal pain after trauma or infection. Surgical exploration is relatively straight forward and tends to lead to gratifying results. Level of Evidence: IV (therapeutic