International Center for Hip

Heidelberg, Germany

International Center for Hip

Heidelberg, Germany
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Becher C.,International Center for Hip | Attal R.,Klinik fur Unfallchirurgie | Balcarek P.,ARCUS Kliniken und Praxen Sportklinik | Dirisamer F.,Orthopadie and Sportchirurgie | And 5 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2017

Purpose: The aim of this study was to adapt, translate, and validate the Banff Patella Instability Instrument (BPII) 2.0 into German, enabling its use by German-speaking professionals for the evaluation of patients who present with patellofemoral instability. Methods: Forward and backward translation was performed according to international recommendations. The final German version of the BPII 2.0 was investigated in patients with confirmed diagnoses of recurrent patellofemoral instability in Germany, Austria, and Switzerland. All patients received two packages of questionnaires, each containing the BPII 2.0, Kujala scoring questionnaire, Norwich Patella Instability scoring questionnaire, Short Form-36 (SF-36), and a visual analogue scale (VAS)—scale for pain and disability. The first and second packages of questionnaires were to be completed 7 days apart. The following parameters were assessed: internal consistency, test–retest reliability, floor and ceiling effects, and construct validity. Results: The study population consisted of 64 patients (24 males and 40 females). The average age of the patients was 22 ± 6 years. The internal consistency (Cronbach’s alpha) was excellent at both time points (0.93 and 0.95), and the test–retest reliability (ICC) was good (0.89). There were no floor or ceiling effects. There were statistically significant correlations between the BPII 2.0 and all other outcome measures apart from SF-36 mental health. Conclusion: The BPII 2.0 was successfully adapted into German. It is a reliable and valid instrument for evaluation of German-speaking patients who present with patellofemoral instability. Level of evidence: III. © 2017 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)


Korner D.,University of Tübingen | Gueorguiev B.,AO Research Institute Davos | Niemeyer P.,Albert Ludwigs University of Freiburg | Bangert Y.,University of Heidelberg | And 6 more authors.
Archives of Orthopaedic and Trauma Surgery | Year: 2017

Introduction: Patients with osteochondral lesions of the ankle represent a heterogeneous population with traumatic, posttraumatic and idiopathic forms of this pathology, where the etiology of the idiopathic form is principally unknown. The aim of this study was to classify the heterogeneous patient population according to the patients’ complaints and joint function. Data from the German Cartilage Registry (KnorpelRegister DGOU) was analyzed for this purpose to investigate whether traumatic and posttraumatic lesions cause more complaints and loss of joint function than idiopathic lesions. Moreover, it was sought to determine if lesion localization, defective area, stage, patient age, gender, and body mass index (BMI) are related to patients’ complaints and loss of joint function. Materials and methods: A 117 patients with osteochondral lesions of the ankle were operated in 20 clinical centers in the period between October 2014 and January 2016. Data collection was performed by means of a web-based Remote Data Entry system at the time of surgery. Patients’ complaints and joint function were assessed with online questionnaires using the German versions of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS), followed by statistical data evaluation. Results: No significant difference was indicated between the groups with traumatic/posttraumatic lesions and idiopathic lesions with regard to most of the patients’ complaints and joint function, excluding the category Life quality of the FAOS score, where patients with idiopathic lesions had a significantly better quality of life (p = 0.02). No significant association was detected between lesion localization, defective area, patient age, gender, and BMI on the one hand, and patients’ complaints and joint function on the other. Similarly, no significant association was found between lesion stage according to the International Cartilage Repair Society (ICRS) classification and patients’ complaints and joint function. However, a higher lesion stage according to the classification of Berndt and Harty, modified by Loomer, was significantly associated with more complaints and loss of joint function in some categories of the FAAM and FAOS scores (p ≤ 0.04). Conclusions: Etiology of the lesion, lesion localization, defective area, lesion stage according to the ICRS classification, patient age, gender, and BMI do not seem to be of considerable relevance for prediction of patients’ complaints and loss of joint function in osteochondral lesions of the ankle. Using the classification of Berndt and Harty, modified by Loomer, seems to be more conclusive. © 2017 Springer-Verlag Berlin Heidelberg


Becher C.,International Center for Hip | Cantiller E.B.,International Center for Hip
Archives of Orthopaedic and Trauma Surgery | Year: 2017

Introduction: The rationale of focal articular prosthetic resurfacing used as a primary arthroplasty procedure in the treatment of articular cartilage defects is still under debate. Conflicting reports raise concern about high rates of re-operations and continued development of osteoarthritis, while others have reported good outcomes. The goal of this paper is to present the long-term results of two patients with a 12-year follow-up and to report the results of a literature review. Materials and methods: Two patients (male, 70 years; female 63 years) with a follow-up of 12 years were reviewed. Patients were evaluated with standard radiographs to assess the progression of osteoarthritis (OA), a clinical examination including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale. The literature review was performed using the search terms HemiCAP, focal, femoral, condyle, inlay, and resurfacing to identify articles published in the English language up until September 25, 2016. Results: The clinical and radiographic follow-ups of the patients were 11.9 and 11.8 years, respectively. Both patients were satisfied with their outcome and would have the operation again. Comparing the first postoperative to 12-year follow-up X-rays, the radiographic results demonstrated no signs of periprosthetic loosening, preservation of joint space, and no change in the osteoarthritic stage. KOOS Scores were 86 and 83 for pain, 89 and 93 for symptoms, 88 and 100 for activities of daily living (ADL), 75 and 65 for sports and recreation, and 75 and 81 for quality of life (QOL). The Tegner activity level was 5 and 4. The literature review comprised 6 studies with 169 focal articular prosthetic resurfacing procedures in 169 patients (84 male, 85 female) with a mean age at implantation ranging from 44.7 to 53.7 years and a follow-up range of 20 months to 7 years. Five studies were classified as level 4 and one as level 3. Clinical and radiographic results showed mainly good to excellent outcomes but were different among the studies depending on the indication. Re-operation rates ranged from 0 to 23% depending on the length of follow-up. Conclusions: The results suggest that focal articular prosthetic resurfacing is an effective and safe treatment option in selected cases. © 2017 Springer-Verlag Berlin Heidelberg


Siebold R.,University of Heidelberg | Siebold R.,International Center for Hip | Takada T.,International Center for Hip | Takada T.,Hiroshima University | And 5 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016

Purpose: To analyse the clinical, rotational and radiological (MRI) results of paediatric anatomical “C-shaped” double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with anteromedial and posteromedial bundle compared to single-bundle (SB) ACL reconstruction. Methods: Between 2008 and 2014, 57 consecutive patients received a paediatric ACL reconstruction with open physis and were allocated into two groups, according to the surgical procedure. Transepiphyseal SB technique was used until 2012 and DB consecutively thereafter. Follow-up consisted of a clinical evaluation with assessment of the International Knee Documentation Committee (IKDC) form, the Lysholm knee score, Tegner activity score, KT-1000 arthrometer evaluation, VAS Scores for satisfaction, MRI and testing of rotational stability using a robotic system. Results: The mean time from ACL reconstruction to follow-up was 48.1 ± 15.8 in the SB group (n = 17) and 23.1 ± 13.2 in the DB group (n = 16; p < 0.001). No differences were found in the subjective scores. Biomechanically, there were significant differences identified in the KT-1000 (p < 0.03) and total tibial axial rotation (p < 0.04) when evaluating the reconstructed knee only. Ten of 17 (59 %) of the SB patients had a Joint Play Area within the acceptable range of the median healthy knee value compared to 100 % in the DB group. Decreased patient satisfaction was associated with increased total tibial axial rotation. No growth disturbance was observed. Overall, 98 % of patients were reached and either examined or interviewed. Re-rupture rate was 3 of 21 (14.3 %) for DB and 9 of 35 (25.7 %) for SB. All but one re-ruptures (92 %) happened in the first 16 postoperative months independent of technique. Conclusions: The re-rupture rate after pre-adolescent ACL reconstruction is too high both historically and in this mixed cohort. Anatomical transepiphyseal DB ACL reconstruction with open physis may result in a reduction in this re-rupture rate, which may be related to a tighter control of the Joint Play Area. While subjective clinical results were similar between SB and DB, decreased patient satisfaction was associated with increased total tibial axial rotation in the entire cohort. Despite the need for two transepiphyseal tunnels in the DB technique, there did not appear to be an increased risk in growth plate disturbance. Transepiphyseal DB ACL reconstruction appears to be a reasonable alternative to current techniques in pre-adolescent children with an ACL rupture. Level of evidence: IV. © 2016, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).


Stinton S.K.,University Orthopedics | Siebold R.,University of Heidelberg | Siebold R.,International Center for Hip | Freedberg H.,Suburban Orthopaedics | And 3 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016

Purpose: The purpose of this study was to: (1) determine whether a robotic tibial rotation device and an electromagnetic tracking system could accurately reproduce the clinical dial test at 30° of knee flexion; (2) compare rotation data captured at the footplates of the robotic device to tibial rotation data measured using an electromagnetic sensor on the proximal tibia. Methods: Thirty-two unilateral ACL-reconstructed patients were examined using a robotic tibial rotation device that mimicked the dial test. The data reported in this study is only from the healthy legs of these patients. Torque was applied through footplates and was measured using servomotors. Lower leg motion was measured at the foot using the motors. Tibial motion was also measured through an electromagnetic tracking system and a sensor on the proximal tibia. Load-deformation curves representing rotational motion of the foot and tibia were compared using Pearson’s correlation coefficients. Off-axis motions including medial–lateral translation and anterior–posterior translation were also measured using the electromagnetic system. Results: The robotic device and electromagnetic system were able to provide axial rotation data and translational data for the tibia during the dial test. Motion measured at the foot was not correlated to motion of the tibial tubercle in internal rotation or in external rotation. The position of the tibial tubercle was 26.9° ± 11.6° more internally rotated than the foot at torque 0 Nm. Medial–lateral translation and anterior–posterior translation were combined to show the path of the tubercle in the coronal plane during tibial rotation. Conclusions: The information captured during a manual dial test includes both rotation of the tibia and proximal tibia translation. All of this information can be captured using a robotic tibial axial rotation device with an electromagnetic tracking system. The pathway of the tibial tubercle during tibial axial rotation can provide additional information about knee instability without relying on side-to-side comparison between knees. The translation of the proximal tibia is important information that must be considered in addition to axial rotation of the tibia when performing a dial test whether done manually or with a robotic device. Instrumented foot position cannot provide the same information. Level of evidence: IV. © 2016, The Author(s).


PubMed | International Center for Hip, University of Heidelberg and University Orthopedics
Type: Comparative Study | Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2016

To analyse the clinical, rotational and radiological (MRI) results of paediatric anatomical C-shaped double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with anteromedial and posteromedial bundle compared to single-bundle (SB) ACL reconstruction.Between 2008 and 2014, 57 consecutive patients received a paediatric ACL reconstruction with open physis and were allocated into two groups, according to the surgical procedure. Transepiphyseal SB technique was used until 2012 and DB consecutively thereafter. Follow-up consisted of a clinical evaluation with assessment of the International Knee Documentation Committee (IKDC) form, the Lysholm knee score, Tegner activity score, KT-1000 arthrometer evaluation, VAS Scores for satisfaction, MRI and testing of rotational stability using a robotic system.The mean time from ACL reconstruction to follow-up was 48.1 15.8 in the SB group (n = 17) and 23.1 13.2 in the DB group (n = 16; p < 0.001). No differences were found in the subjective scores. Biomechanically, there were significant differences identified in the KT-1000 (p < 0.03) and total tibial axial rotation (p < 0.04) when evaluating the reconstructed knee only. Ten of 17 (59%) of the SB patients had a Joint Play Area within the acceptable range of the median healthy knee value compared to 100 % in the DB group. Decreased patient satisfaction was associated with increased total tibial axial rotation. No growth disturbance was observed. Overall, 98% of patients were reached and either examined or interviewed. Re-rupture rate was 3 of 21 (14.3%) for DB and 9 of 35 (25.7%) for SB. All but one re-ruptures (92%) happened in the first 16 postoperative months independent of technique.The re-rupture rate after pre-adolescent ACL reconstruction is too high both historically and in this mixed cohort. Anatomical transepiphyseal DB ACL reconstruction with open physis may result in a reduction in this re-rupture rate, which may be related to a tighter control of the Joint Play Area. While subjective clinical results were similar between SB and DB, decreased patient satisfaction was associated with increased total tibial axial rotation in the entire cohort. Despite the need for two transepiphyseal tunnels in the DB technique, there did not appear to be an increased risk in growth plate disturbance. Transepiphyseal DB ACL reconstruction appears to be a reasonable alternative to current techniques in pre-adolescent children with an ACL rupture.IV.

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