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Heidelberg, Germany

Thorey F.,Center for Hip | Budde S.,Hannover Medical School | Ettinger M.,Hannover Medical School | Albrecht U.V.,Hannover Medical School | Ezechieli M.,Hannover Medical School
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: Different pathologies leading to psoas tendon pain and chronic bursitis of the greater trochanter are well known. The purpose of the study was to underline the accessibility of the psoas tendon at lesser trochanter, reproduce the results and measure the distances to anatomical landmarks. Methods: Twelve hips of six human cadavers underwent hip arthroscopy. The accessibility of the iliopsoas tendon at the lesser trochanter and the bursa at the greater trochanter was documented with the camera. In addition to the usual access portals, alternative ventral ports were analysed concerning accessibility of the lesser trochanter. Afterwards, arthroscopy needles were placed along the extra-articular portals followed by dissection. The distances of the portals in relation to important anatomical landmarks were analysed. Results: The accessibility to the iliopsoas tendon at the lesser trochanter and to the bursa at the greater trochanter throughout the conventional portals was reproducible. Sufficient distances to the important anatomical landmarks could be shown. The mean distance of the distal ventro-lateral and the wide distal ventro-lateral portal to the nervous cutaneous femoris lateralis was 26.8 ± 5.4 mm and 32.2 ± 3.9 mm. The mean distance from the more ventral located portals to the nervous arteria and vena femoralis was 28.3 ± 2.1 mm. Conclusion: This is the first study known to us that describes in detail the accessibility of the extra-articular structures underlined by anatomical preparation. In addition, it was demonstrated that a more ventrally located portal had sufficient distance to the important neurovascular structures of the ventral femur and can also be used in addendum if necessary. © 2012 Springer-Verlag. Source

Paessler H.H.,Center for Hip
American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

Neuromuscular electrical stimulation (NMES) is defined as the application of an electric current to neuromuscular tissue to elicit a muscle contraction. It is typically applied in a clinical setting to strengthen muscle, particularly the quadriceps femoris, through repetitive contractions. Most studies to date involving NMES have been conducted using conventional lead-wired, or "single path" devices, and while effective, these devices have inherent limitations around comfort and incomplete muscle recruitment. In a prospective, randomized, controlled, single-blind trial, investigators found that using a novel "Multipath" device was effective when combined with standard rehabilitation in accelerating recovery after anterior cruciate ligament reconstruction. Additional research is warranted to explore whether this effect also occurs after other types of knee surgery. Source

Thermann H.,Center for Hip | Becher C.,Hannover Medical School | Vannini F.,Rizzoli Orthopaedic Institute | Giannini S.,Rizzoli Orthopaedic Institute
Operative Techniques in Orthopaedics | Year: 2014

The treatment of osteochondral defects of the talus is still controversial. Matrix-guided treatment options for covering of the defect with a scaffold have gained increasing popularity. Cellular-based autologous chondrocyte implantation (ACI) has undergone a generational development overcoming the surgical drawbacks related to the use of the periosteal flap over time. As ACI is associated with high costs and limited in availability, autologous matrix-induced chondrogenesis, a single-step procedure combining microfracturing of the subchondral bone to release bone marrow mesenchymal stem cells in combination with the coverage of an acellular matrix, has gained increasing popularity. The purposes of this report are to present the arthroscopic approach of the matrix-guided autologous matrix-induced chondrogenesis technique and generational development of ACI in the treatment of chondral and osteochondral defects of the talus. © 2014 Elsevier Inc. Source

Becher C.,Hannover Medical School | Zuhlke D.,Hannover Medical School | Plaas C.,Hannover Medical School | Ewig M.,Radiologie am Raschplatz | And 3 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: To compare repaired cartilage with native cartilage, and inter-observer reliability, using T2 mapping at 3 T for assessing cartilage repair in osteochondral defects of the talus after the microfracture technique. Methods: We enrolled eight females and seven males undergoing arthroscopic microfracture for osteochondral defects of the talus at an average follow-up of 7.9 ± 2.2 years (range 5–13 years). Cartilage tissue was assessed using a 3-T magnetic resonance imaging unit with an 8-channel phased array foot and ankle coil (gradient strength, 50 mT/m; slew rate, 200 T/m/s). T2 maps were then calculated. Three independent boarded specialists evaluated the images, and magnetic resonance observation of cartilage repair tissue scores was used to assess the cartilage and joint status. Clinical results were assessed using the Hannover Scoring System (HSS) for the ankle and the American Orthopaedic Foot and Ankle Society (AOFAS) hind-foot score. Results: No significant mean differences were found between the T2 properties of the repair tissue and those of the native reference cartilage (T2 = 38.6 ± 5.3 ms, range 30.2–55.8 ms vs. 40.3 ± 8.5 ms, range 31.4–59.8 ms, respectively; intra-class correlation coefficient = 0.94; confidence interval 0.84–0.99, P ≤ 0.001). Despite ≥50 % defect filling in all patients, subchondral bone changes were considerable. The HSS at the follow-up revealed a mean score of 87 ± 12 (range 51–97), and the AOFAS-Score was 90 ± 13 (range 59–100). Conclusions: 3 T T2 maps were similar in repaired and native cartilage with good inter-observer reliability. Level of evidence: IV. © 2014, Springer-Verlag Berlin Heidelberg. Source

Windhagen H.,Hannover Medical School | Chincisan A.,University of Geneva | Choi H.F.,University of Geneva | Thorey F.,Center for Hip
Orthopedics | Year: 2015

The growing numbers of short stem hip implants have redefi ned total hip arthroplasty with new stem geometries and possible functional differences. Several systematic reviews have reported good clinical results with this new class of stems, although kinematic alterations are still unclear in many aspects. The good clinical results obtained at the authors' institution led to the current study. The authors hypothesized that the geometric alignment of the prosthetic components may be closer to the anatomy of the healthy hip joint, thus leading to better function and clinical satisfaction. An examination via fi nite element analysis was chosen to model the hip joint and virtually implant a short and a standard straight stem. Findings indicated that anchoring of the short stem allowed favorable positioning in the proximal femur, with the femoral head already in the center of the cup. This positioning was not possible for the straight stem, which required further reduction of the femur by a signifi cant translation into the cup, leading to abnormal soft-tissue balancing. The results from the simulation showed an absolute average deviation of ligamentous fi ber strains of 6% for the short stem in 30° of fl exion and extension versus 29% and 36% for the standard straight stem in 30° of fl exion and extension, respectively. A femoral neck guided orientation of the short stem implant seems to allow a more anatomical reconstruction and thus a more balanced hip in terms of the modeled soft tissues. In contrast, the straight stem alters the head position and induces nonphysiological capsular strains. Source

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