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Zürich, Switzerland

Grueninger P.,Waid Hospital Zurich | Nikolic N.,Institute for Clinical Radiology | Schneider J.,Waid Hospital Zurich | Lattmann T.,Triemli Hospital Zurich | And 4 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2014

Purpose The purpose of this study was to prospectively assess the efficacy of arthroscopic repair of isolated high-grade subscapularis (SSC) tendon lesions by means of clinical follow-up combined with magnetic resonance imaging investigations. Methods Between January 2008 and September 2010, 11 patients (9 men and 2 women; mean age, 45 ± 10 years) with Lafosse type III or IV traumatic isolated SSC tendon lesions underwent arthroscopic repair including tenodesis of the long head of the biceps tendon. All patients were preoperatively assessed by clinical examination (Constant-Murley score [CMS]) and contrast-enhanced magnetic resonance arthrography. At 1 year of follow-up, specific clinical SSC tests, the CMS, and the loss of external rotation were evaluated. A native magnetic resonance investigation was performed to assess the structural integrity of the repair. The SSC muscle was compared with its preoperative condition regarding fatty infiltration and size (cross-sectional area). Patient satisfaction was graded from 1 (poor) to 4 (excellent). Results The mean time interval from trauma to surgery was 3.7 months. A concomitant lesion of the biceps tendon was observed in 10 patients (91%). The mean CMS improved from 44 to 89 points (P <.001). The functional tests showed a significant increase in strength (P <.05) (belly-press test, 4.8 v 2.9; lift-off test, 4.8 v 2.9). The mean loss of external rotation at 0° of abduction was 10°compared with the contralateral side (P <.05). Patient satisfaction was high. Magnetic resonance imaging evaluation showed complete structural integrity of the tendon repair in all studies. The SSC showed a significant decrease in fatty infiltration and increase in the cross-sectional area. Conclusions Arthroscopic repair of higher-grade isolated SSC lesions provides reliable tendon healing accompanied by excellent functional results 1 year after surgery. Level of Evidence Level IV, prospective therapeutic case series. © 2014 by the Arthroscopy Association of North America.


Dirr F.,Institute for Clinical Radiology | Hempel J.M.,Ludwig Maximilians University of Munich | Krause E.,Ludwig Maximilians University of Munich | Muller J.,Ludwig Maximilians University of Munich | And 3 more authors.
Otology and Neurotology | Year: 2013

Objective: To analyze the value of a routine x-ray position check after cochlear implantation and to assess if an increased resistance during electrode insertion is a sufficient predictor of electrode misplacement. Study Design: Retrospective data collection. Setting: University hospital. Methods: Plain x-rays (Stenvers' projection) and the respective surgery reports of 218 patients having received cochlear implantation (243 ears) were analyzed for possible electrode misplacements and intraoperative conspicuities during electrode insertion. Results: Electrode misplacement (tip-over, loop, kinking, scalar transition, and incomplete insertion) was observed in 8% of the entire study cohort, but only in 5% if cases with inner ear dysplasia or labyrinthine ossification (n = 28) were excluded from analysis. Intraoperatively, an increased resistance during electrode insertion was found in 16% but only in 8% when cases with inner ear dysplasia or labyrinthine ossification were excluded. The intraoperative finding of an increased resistance during electrode insertion had a sensitivity of 55% and a specificity of 88% for predicting radiographically confirmed electrode misplacements (positive predictive value, 29%; negative predicting value, 96%). Conclusion: Nearly half of the cases of electrode misplacement would have been overlooked if radiographic position checks would have been done only in patients with intraoperative conspicuities during electrode insertion. This finding advocates routine radiographic position checks, although electrode misplacements are relatively rare in patients with regular inner ear anatomy. © 2013, Otology & Neurotology, Inc.


Grueninger P.,Waid Hospital Zurich | Nikolic N.,Institute for Clinical Radiology | Schneider J.,Waid Hospital Zurich | Lattmann T.,Triemli Hospital Zurich | And 3 more authors.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2015

PURPOSE: To prospectively assess arthroscopic repair of massive cuff tears (MCT) in a highly selective patient group with large subscapularis (SSC) tendon tears by means of clinical results and magnetic resonance imaging (MRI) studies.METHODS: Between April 2009 and December 2010, 26 patients with MCT were treated with arthroscopic rotator cuff repair. Only lesions involving a large tear of the SSC tendon (Lafosse III or IV) in combination with a complete tear of the supraspinatus (SSP) tendon and a tear of at least the anterior third of the infraspinatus (ISP) tendon were included. Minimum follow-up was 1 year. Pre- and postoperative assessment included a standardized clinical examination, subjective patient outcome, and MRI (structural integrity, fatty muscle infiltration, and muscular mass).RESULTS: Mean follow-up was 17 months (range, 12 to 34 months). MRI was performed in 25 patients. In 21 (84%) the cuff repair was intact. A partial retear of the SSC was found in 2 patients (8%). In 2 patients (8%) a full-thickness retear of the posterosuperior cuff was observed (1 SSP, 1 SSP/ISP). A significant increase of the muscle mass and decrease of fatty infiltration was observed for the SSC and SSP but not for the ISP. The mean Constant-Murley score improved from 36 to 86 points (P < .001) with all its subscores as well (P < .001). Muscular strength improved for the SSC (4.9 v 3.0, P < .001), SSP (4.6 v 2.9, P < .001), and ISP (4.8 v 3.4, P < .001). Overall patient satisfaction was high (3.6 ± 0.8).CONCLUSIONS: Arthroscopic repair of MCT involving the ISP, SSP, and large tears of the SSC provides a reliable tendon healing, in particular for the SSC tendon, combined with good functional results.LEVEL OF EVIDENCE: Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.


Strobl F.F.,Institute for Clinical Radiology | Haeussler S.M.,Institute for Clinical Radiology | Paprottka P.M.,Institute for Clinical Radiology | Hoffmann R.-T.,Institute for Clinical Radiology | And 3 more authors.
Skeletal Radiology | Year: 2014

Purpose: To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Materials and methods: Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. Results: We treated 99 consecutive patients (mean age 53.1∈±∈21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n∈=∈99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n∈=∈1), hemorrhagic shock (n∈=∈1), or cardiac event (n∈=∈1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv∈±∈7.25 mSv. Mean procedural time was 72.1∈±∈37.4 min. Conclusions: CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose. © 2014 ISS.


Grueninger P.,Waid Hospital Zurich | Nikolic N.,Institute for Clinical Radiology | Schneider J.,Waid Hospital Zurich | Schneider J.,Institute for Clinical Radiology | And 4 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2015

Purpose To prospectively assess arthroscopic repair of massive cuff tears (MCT) in a highly selective patient group with large subscapularis (SSC) tendon tears by means of clinical results and magnetic resonance imaging (MRI) studies. Methods Between April 2009 and December 2010, 26 patients with MCT were treated with arthroscopic rotator cuff repair. Only lesions involving a large tear of the SSC tendon (Lafosse III or IV) in combination with a complete tear of the supraspinatus (SSP) tendon and a tear of at least the anterior third of the infraspinatus (ISP) tendon were included. Minimum follow-up was 1 year. Pre- and postoperative assessment included a standardized clinical examination, subjective patient outcome, and MRI (structural integrity, fatty muscle infiltration, and muscular mass). Results Mean follow-up was 17 months (range, 12 to 34 months). MRI was performed in 25 patients. In 21 (84%) the cuff repair was intact. A partial retear of the SSC was found in 2 patients (8%). In 2 patients (8%) a full-thickness retear of the posterosuperior cuff was observed (1 SSP, 1 SSP/ISP). A significant increase of the muscle mass and decrease of fatty infiltration was observed for the SSC and SSP but not for the ISP. The mean Constant-Murley score improved from 36 to 86 points (P <.001) with all its subscores as well (P <.001). Muscular strength improved for the SSC (4.9 v 3.0, P <.001), SSP (4.6 v 2.9, P <.001), and ISP (4.8 v 3.4, P <.001). Overall patient satisfaction was high (3.6 ± 0.8). Conclusions Arthroscopic repair of MCT involving the ISP, SSP, and large tears of the SSC provides a reliable tendon healing, in particular for the SSC tendon, combined with good functional results. Level of Evidence Level IV, therapeutic case series. © 2015 Arthroscopy Association of North America.

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