Scapholunäre Achsenmethode (SLAM) zur Rekonstruktion von dynamischen SL-Bandläsionen am Handgelenk im Vergleich zu bisherigen Standardverfahren - eine klinische Studie an 27 Patienten

Die gängigen Verfahren zur sekundären Rekonstruktion des skapholunären (SL) Bandes erzielen eine Schmerzreduktion und Sicherung des Repositionsergebnisses meist nur auf Kosten der Beweglichkeit und Kraft. Dahingegenscheint die SLAM- (scapholunate axis method) Technik eine Stabilisierung von Skaphoid und Lunatum ohne Verlust an Beweglichkeit zu erlauben. Wir haben die Technik durch zusätzliche Fixierung eines Endes des Sehnentransplantates am Kapitatum modifiziert, hoffend dass so eine Palmarkippung des Skaphoids noch besser verhindert wird. Die Studie hatte zum Ziel, ob mittels der modifizierten SLAM-Technik eine Stabilisierung von Skaphoid und Lunatum sowie Schmerzreduktion möglich ist, ohne dass es zu einem Verlust an Beweglichkeit und Kraft kommt

Use of Cis-[18F]Fluoro-Proline for Assessment of Exercise-Related Collagen Synthesis in Musculoskeletal Connective Tissue

Protein turnover in collagen rich tissue is influenced by exercise, but can only with difficulty be studied in vivo due to use of invasive procedure. The present study was done to investigate the possibility of applying the PET-tracer, cis-[18F]fluoro-proline (cis-Fpro), for non-invasive assessment of collagen synthesis in rat musculoskeletal tissues at rest and following short-term (3 days) treadmill running. Musculoskeletal collagen synthesis was studied in rats at rest and 24 h post-exercise. At each session, rats were PET scanned at two time points following injection of cis-FPro: (60 and 240 min p.i). SUV were calculated for Achilles tendon, calf muscle and tibial bone. The PET-derived results were compared to mRNA expression of collagen type I and III. Tibial bone had the highest SUV that increased significantly (p<0.001) from the early (60 min) to the late (240 min) PET scan, while SUV in tendon and muscle decreased (p<0.001). Exercise had no influence on SUV, which was contradicted by an increased gene expression of collagen type I and III in muscle and tendon. The clearly, visible uptake of cis-Fpro in the collagen-rich musculoskeletal tissues is promising for multi-tissue studies in vivo. The tissue-specific differences with the highest basal uptake in bone are in accordance with earlier studies relying on tissue incorporation of isotopic-labelled proline. A possible explanation of the failure to demonstrate enhanced collagen synthesis following exercise, despite augmented collagen type I and III transcription, is that SUV calculations are not sensitive enough to detect minor changes in collagen synthesis. Further studies including kinetic compartment modeling must be performed to establish whether cis-Fpro can be used for non-invasive in-vivo assessment of exercise-induced changes in musculoskeletal collagen synthesis

Die modifizierte SLAM (scapholunate axis method) Technik zur sekundären SL-Band-Rekonstruktion – Erste Ergebnisse

Background The common techniques for scapholunate (SL) ligament reconstruction achieve pain relief and maintenance of reposition at the expense of mobility and grip strength. In contrast, the scapholunate axis method (SLAM) technique seems to stabilise the scaphoid and lunate bones without a loss of function. We modified the technique with an additional anchor fixation of the tendon graft to the capitate bone in order to prevent palmar dislocation of the scaphoid bone. Purpose This study aimed to examine whether or not it is possible to stabilise the scaphoid and lunate bones and to reduce pain without a loss of function and grip strength using the modified SLAM technique. Patients and Methods The SLAM technique was performed on 5 male patients aged between 36 and 60 years with an SL ligament lesion (3-10 months old). Preoperatively and after 12 months, the postoperative range of motion, grip strength, pain, SL angle, DASH Score and Mayo Wrist Score were assessed and compared to each other. Results An improvement of the DASH Score (60.4 to 34.4 on average) and the Mayo Wrist Score (41 to 74 on average) was observed at the 12-month follow-up. Grip strength was enhanced from an average of 24.6 kg to 38 kg. Pain was improved from an average of 1.4 to 0.2 (at rest) and from 5.4 to 1.4 (under load). The SL angle changed only marginally from an average of 64.8 degrees preoperatively to 63.2 degrees postoperatively. The average range of motion was improved (extension/flexion: 58-0-60 vs. 50-0-49; radial/ulnar duction: 19-0-45 vs. 15-0-25 und supination/pronation: 87-0-90 vs. 81-0-81): However, function did not improve in every patient and all planes. Conclusion The modified SLAM technique improved the DASH Score, the Mayo Wrist Score, grip strength and pain. However, the SL angle and range of motion did not improve in every patient and plane. Consequently, it cannot be confirmed that the modified SLAM technique ensures a reliable stabilisation of the scaphoid and lunate bones and reduction of pain without a loss of function

Reconstruction of chronic scapholunate dissociation with the modified scapholunate axis method (SLAM)

Introduction Injury to the scapholunate (SL) ligament represents a common trauma of the wrist but is frequently misdiagnosed because of non-specific pain. Established methods for SL reconstruction mainly focus on reducing pain and maintaining the reposition result at the expense of mobility and strength. This study aimed at restoring stability and reducing pain while simultaneously maintaining mobility and strength using the scapholunate axis method (SLAM). Material and methods 22 patients (19 male and 3 female) aged between 26 and 64 years with an SL ligament lesion underwent SLAM reconstruction. Mean duration between injury and operation was 7.9 +/- 5 (1-24) months. Hand functions using DASH, Mayo Wrist Score, range of motion, pain (at rest and weight-bearing) and grip strength were assessed prior and 12 months postoperative. Additionally SL angle was collected pre- and postoperative. Results Each of the 22 patients improved significantly postoperative in DASH and Mayo Wrist Score with regard to pain at rest and under weight-bearing. Additionally, grip strength could be improved up to 31% compared to preoperatively. In contrast, range of motion and SL angle and grip strength did not change essentially. Conclusions The secondary SL ligament reconstruction technique SLAM shows promising results. Pain was significantly relieved and grip strength was significantly increased. Additionally, DASH and Mayo Wrist Score could be significantly improved. However, SL angle and range of motion could not be improved in every patient and plane

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes