Biomedical subjects

A B Imhoff

Publications and source records attributed to A B Imhoff.

At least 37 records · Page 2Linked to original sources

PubMed2002

[Axis deviation, cartilage damage and cruciate ligament rupture--concomitant interventions in replacement of the anterior cruciate ligament].

BACKGROUND: Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability and varus malalignment. We present the indications, operative technique, and results for the combined operation of high tibial osteotomy and cruciate ligament reconstruction. MATERIALS AND METHODS: From April 1996 until December 2000, 58 patients (average age: 33 years) underwent simultaneous osteotomy (57 correcting valgus, 1 valgus malalignment) and cruciate ligament reconstruction (49 ACL, 7 PCL, 2 ACL & PCL) which was routinely performed with an arthroscopic technique after completion of the osteotomy (closed wedge technique). Average correction angle of the osteotomy was 7 degrees (4-10 degrees) with a mean malalignment of 5 degrees (0-10 degrees). Thirteen patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), and two patients were implanted with a collagen meniscus (CMI) at the same time. RESULTS: Preoperatively the Lysholm score was 66 (35-81) points and increased to 81 (74-95), 87 (79-99), and 93 (88-99) points 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in four patients. CONCLUSIONS: Unstable knees with varus malalignment can be sufficiently treated by osteotomy and cruciate ligament reconstruction at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost-effective therapy delaying the progression of osteoarthritis and minimizing clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and the return of these patients to the activities of daily living and sports.

Adult↗

PubMed2002

[Revision of failed anterior cruciate ligament reconstruction].

Failures of ACL reconstruction still occur despite improved arthroscopic methods and new technical instruments. The reasons for failures, which are mostly related to technical surgical errors, must be recognized, analyzed, and considered for the planning and execution of revision ACL surgery. This review article describes the reasons for failed ACL reconstructions, indications, preoperative evaluation, planning, and performance of the operative procedure as well as the issue of rehabilitation. The strategies are evaluated for graft selection, staging of the revision, and the steps of the operative procedure including hardware removal, tunnel placement, graft fixation, or additional operations. Special attention is given to the dilemma of arthrofibrosis and its management in ACL revision cases. Since the results are worse after revision than following primary ACL surgery, the operative procedure has to be tailored to the needs of the patient, planned carefully, and performed by an experienced knee surgeon.

Anterior Cruciate Ligament↗

PubMed2001

[Therapy of cartilage damage--more current than ever].

Explore the source record for details and available documents.

Arthroscopy↗

PubMed2001

[Surgical therapeutic possibilities of cartilage damage].

Therapy of cartilage damage is a frequent problem, especially in the young and active patient. For the treatment of a cartilage damage we have to consider the size of the defect, age and weight of the patient, meniscal tears, ligament instabilities and varus-/valgus-malalignment. Lavage, shaving and debridement are only sufficient for a short time and have no long term effect. Abrasio and drilling could be useful in eldery people. Microfracturing seems to be an effective alternative for small defects. The restoration of the cartilage surface with the use of autologous chondrocyte transplantation, osteochondral autograft transplantation and posterior condyle transfer seems to be an adequate treatment for younger patients.

Arthroscopy↗

PubMed2001

[Operative therapy of osteochondral lesions of the talus with autologous cartilage-bone transplantation].

Since 1996 we have gained experience in the development and clinical application of the OATS technique in 167 cases. Operative management, technical demands and early results of osteochondral cylindrical autograft plugs at the talus are presented. Between April 1996 and November 2000 we treated 39 patients (21 male, 18 female) with an average age of 28.4 years (range: 16-57 years) for osteochondral defects with an average size of 8 x 15 mm-20 x 15 mm at the medial (n = 31) and lateral (n = 6) talar dome as well as at the distal tibia (n = 2) with an OATS technique. Indications were osteochondral defects after trauma in 12 patients (med., n = 5; lat., n = 5; dist. tibia n = 2) and osteochondrosis dissecans (grades III and IV) in 27 patients (med., n = 26; lat., n = 1). The donor site was the proximal lateral femoral condyle in all patients. An additional osteotomy of the malleolus was necessary in 30 patients. All patients were scored pre- and postoperatively by a Lysholm Bruns score and monitored by postoperative MRI. The follow-up extended for an average of 19.6 months (6-42). The Lysholm score for all patients rose from 62 points (range: 20-77) up to 92 points (range: 63-100). There was no correlation between patients with and without an osteotomy of the malleolus. The postoperative MRI showed a complete incorporation and vitality of the transplanted cylinders as well as a congruence of the joint surface. Complications were pain in three cases in the region of the osteotomy, which decreased after removal of the screws, and synovialitis in one case. One patient reported femoropatellar pain for about 4 weeks. The OATS technique achieves encouraging results in limited osteochondral defects in the talar dome even in preoperated osteochondral defects. Because of the mostly posterior localization of the defect zone, osteotomy of the malleolus is necessary in most cases. Harvesting the donor cylinders from the ipsilateral knee joint by mini-arthrotomy shows a low mortality. The OATS technique is a suitable, causal and cost-effective therapy, which can possibly prevent and at least delay the development of an arthrosis.

Adolescent↗

PubMed2001

Scapular neck fracture--the influence of permanent malalignment of the glenoid neck on clinical outcome.

A scapular neck fracture is considered unstable if it is associated with an ipsilateral clavicular fracture or an acromioclavicular (AC) joint dislocation. Currently, it is recommended that stabilization of a disrupted shoulder girdle must be achieved through open reduction and internal fixation of the clavicular fracture or by reduction of the AC joint, without addressing the scapular neck. However, if the displaced glenoid neck is not simultaneously reduced, malalignment of the glenoid neck may persist. The purpose of this retrospective study was to analyze the effect of associated shoulder girdle injury on glenoid displacement and the influence of glenoid malalignment on clinical outcome. Nineteen patients with scapular neck fractures were reviewed clinically and radiologically at a mean of 8 years (range 2-21 years) after injury. None of them has developed nonunion of the scapular neck, and only one showed radiological signs of mild degenerative joint disease. The glenopolar angle (GPA), which assesses the rotational malalignment of the glenoid about an anteroposterior axis perpendicular to the scapular plane on plain X-rays was measured less than 20 degrees in six patients. Three of them had sustained an associated clavicular fracture or AC joint dislocation. The other 3 patients had permanent severe malalignment of the glenoid neck in the absence of an associated shoulder girdle injury. Five patients with GPA less than 20 degrees complained of moderate or severe pain, whereas of the 13 patients with mild or no glenoid rotational displacement or medial displacement alone, 11 patients had no or mild pain, and only 2 had moderate or severe pain (P = 0.0095). Five patients presented with reduced activities of daily living, 4 of them had severe glenoid rotational displacement (P = 0.0173). Loss of motion was found in only 2 patients, and both had a severely displaced glenoid neck (P = 0.088). In conclusion, severe displacement of the glenoid neck may occur with or without associated fracture of the clavicle or dislocation of the AC joint and can be identified as a GPA less than 20 degrees. Scapular neck fractures with such malalignment have a less favorable long-term outcome compared with otherwise comparable cases with absence of glenoid malalignment as measured with the glenopolar angle.

Adult↗

PubMed2001

Acromion reconstruction after total arthroscopic acromionectomy: Salvage procedure using a bone graft.

We report 2 cases of acromion reconstruction with a bone graft as a salvage procedure after total arthroscopic acromionectomy. Complete removal of the acromion had produced severe shoulder abnormality with pain and joint stiffness. We present the operative technique of acromion reconstruction using a corticocancellous bone graft from the iliac crest. Recreation of the acromion as a fulcrum of the shoulder joint as well as an important physiological insertion area for the deltoid muscle markedly improved pain and range of motion in these patients. In conclusion, based on these cases, we believe that total acromionectomy is an inadequate procedure for treatment of shoulder impingement syndrome. Acromion reconstruction with a bone graft is an alternative that may lead to improvement of clinical symptoms.

Acromion↗

PubMed2001

[Arthroscopic shoulder stabilization].

Beside electro-thermic procedures (ETACS, LACS) several suture-anchor system for labrum fixation have been developed in the last years. From 4/96 to 10/00 we performed 242 arthroscopic shoulder stabilizations with FASTak-(n = 159) Panalok-(n = 26) and Suretac suture anchors (n = 57) in our clinic. The patients were re-examined with a follow-up of at least 12 months. The best results were in the FASTak-group. After 2 years 4.7% suffered a redislocation. 28.6% (2 patients) needed a revision. The Rowe score was 83.1 +/- 20.9 points. There was a high satisfaction of the patients with the operative result and 60.9% could go back to their pre-op sports level. Compared to open procedures the arthroscopic shoulder stabilization has many advantages. At 24-months follow-up this study demonstrates good results of arthroscopic shoulder stabilisation with FASTak suture anchors.

Adult↗

PubMed2000

[Diagnostic imaging after autologous chondrocyte transplantation. Correlation of magnetic resonance tomography, histological and arthroscopic findings].

Autologous chondrocyte transplantation (ACT) is a newly therapy option for treatment of cartilage damage. Since 1996 we performed the ACT in 10 patients with 14 cartilage damages. Magnetic resonance imaging (MRI) is a non-invasive method for postoperative controlling the transplantation area. The MRI showed in the first 3-6 months postoperatively signal irregularities with partial gadolinium uptake at the transplantation site. Arthroscopically the transplantation site was spongy, when it was probed and at the histological examination there was a hyalinlike appearance of the cells. 1 year postoperatively it seemed that process of reparation was finished. There was no more Gadolinium-uptake at the transplantation site and the borders of the transplant were hardly visible. The histological examination revealed hyalinlike repair tissue with a more columnar appearance of the cells. The Lysholm Score improved from 78 to 92 points, 1 year postoperatively.

Adult↗

PubMed2000

Sonographic imaging of a spinoglenoid cyst.

Spinoglenoid cysts can be the reason for suprascapular nerve entrapment syndrome resulting an isolated atrophy of the infraspinatus muscle. The syndrome usually presents painless and is frequently observed in professional volleyball players. The incidence of these cysts in volleyballplayers is still unknown. Diagnosis is made by neurological examination using electromyography and magnetic resonance imaging. Our case shows the potential of ultrasound as a possible imaging method of ganglion cysts that could be used as a screening method to prevent suprascapular neuropathy.

Female↗

PubMed2000

[Superior labrum pathology in the athlete].

Since their first description several years ago, superior glenoid labral lesions have increasingly been blamed for shoulder problems associated with sports. Originally merely describing arthroscopically visible upper labral/biceps abnormalities, the current understanding is that often clinical problems such as impingement pain or even rotator cuff disease can be secondary to these lesions, especially in overhead athletes. Impingement in these cases is caused by superior shoulder instability originating from an unstable biceps insertion that is present for example in SLAP (superior labrum from anterior to posterior) lesions. Additional problems such as internal or posterosuperior impingement that are often found simultaneously in these patients are pathomorphologically located in the same anatomical region and therefore make exact diagnosis and thus treatment more complex. Magnetic resonance imaging with intra-articular contrast enhancement and particularly arthroscopy are the primary tools for exact diagnosis and classification of superior labral/biceps pathology. Therapeutically, lesions with unstable biceps origin (SLAP types 2 and 4) require operative refixation, as we have seen in our 50 cases in the last 4 years, in order to reestablish the stabilising effect of the biceps tendon for the shoulder joint. The arthroscopic technique for repair of these lesions using different devices of implantable suture anchors is presented. Long-term pain-free shoulder function in competitive athletes, throwers in particular, thus requires anatomical reconstruction of the originally unstable biceps, which is the causal therapy for these lesions.

Arthroscopy↗

PubMed1999

[Autologous osteochondral transplantation on various joints].

A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. The goal of articular cartilage repair is restoration of cartilage congruity, accomplishing full painfree range of motion and elimination of cartilage detoriation. The use of autologous grafts was first reported by Wagner 1964. Now the use of cylindrical autograft plugs was described by Bobic 1996 and Hangody 1996. Operative management and early results of osteochondral cylindrical autograft plugs in the femoral condyle, patella, elbow and talar dome are presented. The arthroscopic/open use of autologous osteochondral grafts from the knee is indicated in osteochondral lesions in diameter from 1 to 3 cm, which can not be primarily refixed and in osteonecrosis at femoral condyle, patella, elbow, talar dome as well as shoulder.

Adolescent↗

PubMed1999

[Transfer of the posterior femoral condyle. First experience with a salvage operation].

In this study large osteochondral defects on the weight-bearing surface of the medial and lateral femoral condyle were treated by transplantation of the autologous posterior condyle in 20 patients. The cartilage defects, type Outerbridge IV, ranged in size from 2 x 1.5 cm to 5 x 3.5 cm. 8 condyle transfers were done from 1984-1996 at the orthopaedic clinic of the university of Balgrist, Zürich. 12 condyle transfers at the department of orthopedic sports medicine at the technical university of Munich from 1996-1998. Patients were operated before the condyle transfer, 2 times on average. In 9 patients a high tibial osteotomy was performed simultaneously. Clinical evaluation was done according to the Lysholm score. The Lysholm score improved in the patient serie from 1996 from preoperatively 62 (54-81) points to postoperatively 85 (74-95) points. The follow-up was on average 9.8 (2-26) months. 18 patients reported about pain relief, 2 patients didn't improve. We describe the operative technique. Despite the lack of long-term results the transfer of the autologous posterior condyle seems to be an effective alternative for the knee prosthesis, especially for young patients with a great cartilage damage in the weight bearing area.

Adolescent↗

PubMed1999

A technical solution for secondary arthritis due to chronic proximal tibiofibular joint instability.

Chronic instability of the proximal tibiofibular joint is an uncommon diagnosis and not frequently reported in the literature. The management options of this joint instability, complicated with secondary arthritis, have rarely been discussed and consist mainly of fibular head resection or arthrodesis of this joint. We describe a new technical procedure for addressing both the instability and the joint secondary arthritis. Stability of the joint is achieved by ligament reconstruction using a biceps femoris split passed through the tibial metaphysis and fixated back to the fibular head using bone anchors. The arthritic changes are addressed by interposition of a vascularized fascia lata strip. The described procedure offers a firm stabilization with no need for postoperative restrictions and an alternative to the inadvisable joint arthrodesis or resection.

Arthritis↗

PubMed1999

Arthroscopic and open techniques for transplantation of osteochondral autografts and allografts in various joints.

Journal Article↗

PubMed1998

[Chondral and osteochondral lesions of the upper ankle joint. Clinical aspects, diagnosis and therapy].

Chondral and osteochondral lesions as well as bone bruises of the ankle are caused in the most cases by trauma and are localized almost exclusively at the talus. For diagnosis, operative management and follow up, magnetic resonance imaging was useful, which can be further improved by application of intravenous or intraarticullar contrast enhancement (Gadolinium). In adults operative therapy is favored. Due to new techniques, arthroscopy became an important alternative to arthrotomy. According to the stage of the disease, drilling or curettage, removal or fixation of the fragment, autologous bone transplantation or osteochondral graft can be performed. All procedures can be managed arthroscopically.

Adult↗

PubMed1998

[Arthroscopic shoulder stabilization. Differentiated treatment strategy with Suretac, Fastak, Holmium: YAG-laser and electrosurgery].

The goal for arthroscopic stabilization of anterior glenohumeral instability is to achieve an outcome equivalent to or better than open procedures. A number of arthroscopic procedures have been advocated to reestablish continuity of the inferior glenohumeral ligament complex (IGHLC) with the glenoid. Implantable suture anchors were developed to avoid the problems associated with arthroscopic staple capsulorrhaphy like iatrogenic injury of the glenoid or humeral surface, loosening and migration of the staple. Several transosseous techniques include the need for an accessory posterior incision, the possibility of neurovascular injury (Suprascapular or axillary nerve), and the loosening of the repair after typing over the fascia of the infraspinatus posteriorly. The preferred techniques are cannulated, absorbable fixation device (Suretac) and easy implantable suture anchors made of titanium (Fastak). Even in the hands of experienced arthroscopists, unacceptably high recurrence rates for arthroscopic shoulder stabilization have been reported, due to the steep learning curve for both technical performance and patient selection. Our experience suggests, that if proper selection criteria are employed, normal patients and overhead-athletes may benefit from the advantages of an arthroscopic repair without accepting an increased risk for recurrence. We performed a prospective analysis of 105 shoulders, who underwent arthroscopic stabilization with Suretac or Fastak between 4/96 and 7/98. 48 shoulders were available for followup at least one year. The redislocation rate was 6.25% (3 shoulders) and the rate of subluxation without dislocation also was 6.25%, but none of the shoulders required a second open stabilization. The reason for redislocation or subluxation were 5/6 traumatic injuries, participating in contact sports or in one case a generalized ligamentous laxity. In combination with the LACS-Procedure or the Electro thermally assisted capsular shift (ETACS) not only the capsular detachment but also the capsular redundancy may be adressed and a lower failure rate can be expected.

Arthroscopy↗

PubMed1998

[Anterior cruciate ligament-plasty and high valgus tibial osteotomy as a combined procedure in anterior instability and varus deviation].

Besides patients having an acute rupture of the ACL with a clear therapeutical strategy there are increasingly young patients with chronical anterior instability and degenerative arthritis of the medial compartment and varus malalignment. This constellation is taxing severely the operative procedure considering that there is not only the instability which has to be treated but that also an improvement of the arthritis symptomatology has to be achieved. In this paper we present a therapeutical concept of high tibial osteotomy combined with an arthroscopic assisted reconstruction of the ACL which is performed as a single procedure since the early 80-ies. The goal is to remove two severe arthrogenic factors correcting the instability and the pathological anatomical axis, to reduce the medial knee pain and to improve the use of the knee in life activities.

Anterior Cruciate Ligament↗