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Biomedical subjects

A Weiler

Publications and source records attributed to A Weiler.

At least 19 recordsLinked to original sources
PubMed2006

Follow-up costs up to 5 years after conventional treatments in patients with cartilage lesions of the knee.

In this retrospective cross-sectional study, we contacted patients who had been diagnosed with (and, if necessary, treated for) knee cartilage defects by arthroscopy at one of seven treatment centres in Germany between 1997 and 2001. In early 2003, patients completed a questionnaire on the health care resources they had used since the time of the arthroscopy. Based on this information, we determined follow-up costs. Data from a total of 1,708 patients were included in the final analysis. Of these, 1,070 were assigned to the initial operation (IO) group (61% men, 49+/-15 years; 39% women, 52+/-14 years) and 638 were assigned to the re-operation (RO) group (64% men, 44+/-13 years; 36% women, 47+/-14 years). The cumulative direct medical costs caused by knee complaints for the first 5 years following the arthroscopy were 1,984 Euro for the IO population and 4,203 Euro for the RO population. The cumulative indirect costs (i.e. costs associated with loss of productivity), however, amounted to 7,669 Euro and 15,265 Euro, respectively, and were thus almost four times as high as the cumulative direct costs. This is the first study that quantifies the considerable follow-up costs in patients who have undergone surgery for knee cartilage defects. As such, it may provide a yardstick for future treatments.

Adult↗
PubMed2006

[Diagnostics and treatment of posterior cruciate ligament injuries].

Over the last few years, the posterior cruciate ligament (PCL) has taken over from the anterior cruciate ligament (ACL) as the new challenge in knee diagnosis and treatment. PCL injuries are much more frequent than previously thought. Despite increasing experience, we are often still confronted with an inappropriate and delayed diagnosis of this injury and its concomitant lesions. Additionally, the outcome of surgical treatment has not yet reached an acceptable rate of satisfaction. Therefore, the goal of this concept review is to give a comprehensive insight into injury mechanisms, diagnostics and treatment regimes based on our experience and data from the international literature. Furthermore, diagnostic problems with respect to clinical examination and imaging techniques are discussed. We also present a differential concept for the perioperative and conservative management of PCL deficient knees in order to adequately address concomitant injuries such as posterolateral rotatory instability and combined ACL injuries, with the aim of further improving results.

Aged↗
PubMed2005

Biomechanical comparison of human bone-patellar tendon-bone grafts after sterilization with peracetic acid ethanol.

Recent reports of disease transmission following ACL reconstruction with fresh-frozen non-sterilized allografts have highlighted the need for new sterilization techniques that do not impair the mechanical properties as it was shown for most of the current sterilization techniques. In this in-vitro biomechanical study, it was investigated if peracetic acid ethanol sterilization (PES) has any adverse effects on the mechanical properties of human bone-patellar tendon-bone grafts (BPTB). Paired human BPTB grafts either underwent PES or were used as fresh-frozen non-sterilized grafts. Viscoelastic properties (strain, creep) were analyzed during cyclic submaximal loading and mechanical properties were investigated during load-to-failure (LTF) testing. It was found that there were no differences in viscoelastic and mechanical properties between both groups. The findings of this study provide baseline data for future in vitro and in vivo analyses of this promising new sterilization technique for soft-tissue allografts.

Biomechanical Phenomena↗
PubMed2005

Magnetic resonance imaging of hyaline cartilage defects at 1.5T and 3.0T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences.

PURPOSE: To evaluate and compare the diagnostic accuracy of appropriate magnetic resonance (MR) sequences in the detection of cartilage lesions at 1.5T and 3.0T. MATERIAL AND METHODS: Twelve chondral defects of varying depths, widths, and locations were created in the retropatellar hyaline cartilage in six sheep cadaver limbs. Axial images employing three fat-suppressed imaging sequences--(1) a T2-weighted fast spin-echo (FSE) sequence, (2) a two-dimensional (2D) and (3) three-dimensional (3D) gradient-echo (GE) sequence at 1.5T and 3.0T using an extremity quadrature coil--were evaluated by three experienced radiologists. Statistical analysis of the results consisted of receiver operating characteristics (ROC) and significant testing using the bivariate chi-square test. In addition, signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were evaluated with significance testing using the Wilcoxon test. RESULTS: The 3D GE sequence compared favorably with other sequences at 3.0T and 1.5T (Az=0.88 at 3.0T and Az=0.85 at 1.5T) missing only one small grade 2 lesion. 2D GE imaging was inferior to 3D imaging at both field strengths (P<0.05) in general. However, compared to 1.5T, lesion detectability was improved at the higher magnetic field of 3.0T (Az=0.81 and 0.73 at 3.0T and 1.5T, respectively). FSE images showed significantly inferior sensitivity and less anatomical detail compared to the GE sequences at both field strengths (Az=0.64 and 0.72 at 3.0T and 1.5T, respectively; P<0.05). However, compared to 1.5T, lesion detectability SNR and CNR values were superior in all sequences tested at 3.0T. CONCLUSION: MRI at 3.0T improves SNR and CNR significantly in the most common sequences for cartilage MRI, resulting in an improvement in chondral lesion detection. GE imaging therefore allows resolution to be increased in an acceptable time manner for patient comfort, and the 3D GE fat-suppressed sequence at 3.0T appears to be best suited for cartilage imaging in a clinical setting.

Animals↗
PubMed2004

[Value of various MR sequences using 1.5 and 3.0 Tesla in analyzing cartilaginous defects of the patella in an animal model].

PURPOSE: Comparison of MRI and macropathologic evaluation using various sequences and field strengths in the detection, localization and measurement of cartilage defects in an animal model. MATERIALS AND METHODS: After open creation of retropatellar cartilage defects of various widths, depths and locations in 8 cadaveric sheep knee joints, the knees were examined using a fat-suppressed (FS), proton density-weighted (PD) fast spin echo (FSE), and 2D and 3D gradient echo (GE) sequences on 1.5 T and 3.0 T MR scanners. The images were analyzed by two independent radiologists in a blinded manner, by dividing the patella into 15 virtual segments. The results were correlated with the macropathologic findings with regards to location, width, and depth of the defects. RESULTS: The highest sensitivity (67.1 %), diagnostic accuracy (85.4 %), positive (87.3 %), and negative (84.7 %) predictive values in detecting defects were obtained using the 3.0 T FS-3D-GE sequence. The highest specificity (95.6 %) yielded the 3.0 T FS-2D-GE sequence, with the other sequences inferior by no more than 2.6 %. In general, FS-3D-GE sequences were superior to FS-2D-GE (3.0 T: p < 0.05; 1.5 T: p < 0.05) and especially to FS-PD-FSE sequences (3.0 T: p < 0.01; 1.5 T: p < 0.05). In determining the defects' widths, the 3.0 T FS-3D-GE sequence was superior to all other sequences (correct measurements: 50.0 %), with only slight superiority to the 1.5 T FS-3D-GE sequence (46.9 %, p > 0.05) but clear superiority to the other sequences (28.1 - 40.6 %, vs. 1.5 T FS-PD-FSE: p < 0.05, vs. other sequences: p > 0.05). To determine the defects' depths, the 1.5 T FS-3D-GE sequence was most reliable (correct measurements: 53.1 %), followed by the 3.0 T FS-3D-GE sequence (50.0 %, significance of difference: p > 0.05). CONCLUSION: In detecting cartilage defects, the field strength of 3.0 Tesla was only superior to 1.5 T MRI using fat-saturated 3D- or 2D-GE-sequences but not in fat-saturated proton density-weighted SE-sequences. In determination of depth and length of the defects, the higher field strength was not advantageous.

Adult↗
PubMed2003

Epidemiology of posterior cruciate ligament injuries.

BACKGROUND: The epidemiology of posterior cruciate ligament (PCL) injuries has not been well clarified. Isolated and combined PCL injuries are a frequently missed diagnosis. A better understanding of typical injury mechanisms may help in more accurate diagnosis of these injuries. METHODS: In this study the epidemiology of PCL insufficiency in 494 patients was retrospectively analysed. Stress-radiography was used to quantify posterior tibial displacement. RESULTS: The mean age at the time of injury was 27.5+/-9.9 years. Traffic accidents (45%) and athletic injuries (40%) were the most common injury causes. Motorcycle accidents (28%) and soccer-related injuries (25%) accounted for the main specific injury causes. The most common injury mechanisms were dashboard injuries (35%) and falls on the flexed knee with the foot in plantar flexion (24%). The mean side-to-side difference of posterior tibial displacement on posterior stress-radiographs in 90 degrees of flexion was 13.4+/-4.7 mm. According to the posterior displacement values, 232 (47%) patients had isolated PCL ruptures, while 262 (53%) patients with a posterior displacement of >12 mm were classified as having a combined posterior instability. There were significantly more combined PCL lesions due to vehicular trauma as compared with athletic trauma ( p<0.0001). CONCLUSIONS: In many PCL lesions, initiation of an adequate treatment regimen is delayed despite typical injury mechanisms and symptoms. In the future, a better understanding of the epidemiology of PCL injuries should enable us to diagnose the injury more reliably through a detailed history and a thorough physical and radiographic examination in the acute setting.

Accidents, Traffic↗
PubMed2003

Systemic application of growth hormone enhances the early healing phase of osteochondral defects--a preliminary study in micropigs.

Healing of osteochondral defects following trauma remains a significant clinical problem, often leading to osteoarthritis. Growth hormone (GH) has been shown to accelerate formation of bone and cartilage tissue in the growth plates and in cell cultures. To investigate the influence of systemically administered recombinant porcine growth hormone (r-pGH) on the healing of osteochondral defects we performed a histomorphometrical analysis of full-thickness cartilage defects in the femoral condyle of micropigs. Forty-eight mature female Yucatan micropigs were divided into two groups, one receiving a daily injection of r-pGH (100 microg/kg), the other receiving sodium chloride as placebo. A circular 6-mm-diameter full-thickness defect of the cartilage was created, extending 1.5 mm into the subchondral bone. The animals were sacrificed after 4 (n = 24) and 6 (n = 24) weeks. The von-Kossa stain was used to visualise the calcified structures; cartilage and the fibrous tissue were marked with a combined Safranin-O/light-green stain. The defect filling and the percentage of bone, cartilage, and fibrous tissue into the defect were evaluated using an image analysis system. Furthermore, histological grading was performed using the modified Wakitani score. After 4 weeks no differences were observed between both groups. The defect filling after 6 weeks with newly formed bone was significantly higher in the r-pGH-treated group. The formation of cartilage and fibrous tissue showed a trend towards better healing in the GH-treated group; however, there was no significant difference. In the r-pGH-treated group, the percentage of total defect filling was significantly higher. The evaluation of the vascularity showed a significantly lower number of vessels in the GH-treated group after 6 weeks. Histomorphological grading revealed a significantly lower total Wakitani score in the GH-treated group, which represents a better healing result compared to the controls. The results of the present study suggest that circulating r-pGH or one of its mediators may accelerate osteochondral defect healing by stimulating the formation of osseous and chondral tissue. The analysis of the vascularity leads to the assumption of an advanced maturation of the osteochondral defects under the influence of GH.

Actins↗
PubMed2003

[Computed tomography of the patellofemoral alignment after arthroscopic reconstruction following patella dislocation].

PURPOSE: To evaluate the diagnostic impact of different CT-based measurements to analyze the patellofemoral alignment after arthroscopic reconstruction in patients with patella dislocation. MATERIALS AND METHODS: In 18 patients with dislocation of the patella, CT of the patellofemoral joint was performed after arthroscopic reconstruction. Various methods recommended in the literature were used to analyze the structure and the alignment of the patellofemoral joint with a relaxed quadriceps muscle. Axial CT scans were taken in four different knee flexion angles (15 degrees, 30 degrees, 45 degrees, 60 degrees ). RESULTS: After arthroscopic stabilization in patients with patella dislocation, only the lateral patellofemoral angle (15 degrees and 30 degrees knee flexion) and the congruence angle (15 degrees knee flexion) showed significant differences between the CT-measurements in the normal and the operated group. The differences of the remaining mean values were not significant due to a high standard deviation. With increasing flexion of the knee, the differences between the normal and the dislocation group almost disappeared. Only the lateral patellofemoral angle, the patella tilt and the lateral patella shift revealed differences between the normal and the group with recurrent dislocation in every degree of knee flexion. With increasing knee flexion above 30 degrees and especially at 60 degrees, the majority of the measured values returned to the normal range. CONCLUSIONS: For CT-measurements of the patellofemoral joint after arthroscopic stabilization, the patellofemoral angle and the congruence angle seemed to be most useful. The measurements of the patellofemoral joint should be taken in various degrees of knee flexion.

Adolescent↗
PubMed2002

[Transplant selection for primary replacement of the anterior cruciate ligament].

Various graft choices have evolved over the past few decades for the primary reconstruction of the anterior cruciate ligament (ACL). Three predominant autologous graft choices exist today: patellar, hamstring, and quadriceps tendons. Clinical studies have as yet failed to demonstrate significant differences in clinical outcome among these grafts, irrespective of their varying fixation techniques. Therefore, other factors such as graft harvest morbidity have become more important when comparing different grafts. These factors can differ substantially between the grafts, depending on the type of patients' activities, the injury pattern, and the associated injuries of the knee joint. A basic knowledge of these factors and the parameters that affect the mechanical and biological behavior of the reconstructed ACL can help to find the appropriate graft choice for each individual patient. Factors such as harvest site morbidity, fixation techniques, osseous integration, and tunnel widening are discussed based on current clinical and basic science studies. Finally, an outlook is given for future alternatives with evolving techniques for tissue-engineered grafts, allografts, or the transplantation of xenogeneic donor tissue.

Anterior Cruciate Ligament↗
PubMed2002

Recombinant species-specific growth hormone increases hard callus formation in distraction osteogenesis.

The effect of growth hormone (GH) on secondary fracture healing and callus formation has been demonstrated in several previously investigated animal models. The aim of this study was to investigate and quantify the effects of GH on bone regenerates in a distraction osteogenesis model. In 20 mature female Yucatan micropigs, the tibia and fibula were osteotomized, stabilized with an external fixator, and distracted at 2 mm/day for 10 days after a 4 day latency period. The regenerates were allowed to consolidate for 10 days. Micropigs in the study group (ten animals) received a daily injection of 100 microg per kilogram body weight of recombinant porcine growth hormone (r-pGH). Micropigs in the control group (ten animals) received sodium chloride as placebo. After killing on day 25, a quantitative histomorphometrical analysis of the formed callus and the adjacent cortical bone was performed and the results of polychrome in vivo labeling were assessed. The regenerates of the r-pGH-treated animals showed a significantly larger callus area but no change in callus structure. We found islands of cartilage tissue in the regenerates of both groups; the calli from the control group exhibited a higher fraction of cartilage compared with the r-pGH group, but this was not significant. Quantification of the fluorescent in vivo labeling revealed that the distraction gap in GH-treated group showed significant ossification even during distraction. These results demonstrate that growth hormone can accelerate the maturation of the regenerate in distraction osteogenesis without changing the callus microstructure. This may prove to be a useful clinical tool for shortening the healing time in limb lengthening and bone segment transport.

Animals↗
PubMed2001

[Mechanical comparison of biodegradable intervertebral lumbar cages].

INTRODUCTION: A biodegradable interbody cage for lumbar spine fusion would be able to solve several problems associated with the use of metallic cages. In a biomechanical in vitro study using human lumbar spines three different biodegradable poly(L-lactide-co-D,L-lacitide)(PLDLLA) cages were compared to metallic cages of the same design. MATERIAL AND METHOD: 40 human cadaver lumbar specimens (L3-S1) were tested in flexion, extension, rotation, and bending with a non-destructive flexibility method using a nonconstrained testing apparatus. Seven different groups were examined: (1) control group (intact) (n = 40); (2) unstable group (after discectomy L4/5) (n = 40), (3) autologous iliac crest bone graft (n = 8), (4) BAK-Cage (n = 8), (5) BIO-Cage 1 (PLDLLA) (n = 8), (6) BIO-Cage 2 (PLD-LLA/hydroxylapatite-buffer) (n = 8) and (7) BIO-Cage 3 (PLDLLA/hydroxylapatite particles of different size) (n = 8). Additionally, destructive compression tests of all implants were performed. RESULTS: In comparison to the intact motion segment all cages showed significantly lower range of motion (ROM) in all test modes (P < 0.01). There was no significant difference in stiffness values and ROM between BIO-Cages and metallic cages. Axial compression stiffness and failure load were significantly highest for metallic BAK-cages (P < 0.05). No significant difference for failure load was observed between BIO-cage 1 and the intact motion segment. However, in comparison to the intact motion segment failure load was significantly lower for BIO-cage 2 and 3 (P < 0.05). CONCLUSION: The results of this study are encouraging, because the biodegradable cages were able to limit lumbar spine motion similar to the metallic cages. Especially, the biodegradable PLDLLA cage consisting of pure polymer (BIO-Cage 1) showed adequate initial compression strength. However, further in vivo animal experiments are essential prior to the clinical application of biodegradable lumbar interbody fusion cages.

Absorbable Implants↗
PubMed2001

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons.

Recent biomechanical studies have shown that an anatomic double-bundle posterior cruciate ligament (PCL) reconstruction is superior in restoring normal knee laxity compared with the conventional single-bundle isometric reconstruction. We describe a modification of an endoscopic PCL reconstruction technique using a double-bundle Y-shaped hamstring tendon graft. A double- or triple-bundle semitendinosus-gracilis tendon graft is used and directly fixed with soft threaded biodegradable interference screws. In the medial femoral condyle, 2 femoral tunnels are created inside-out through a low anterolateral arthroscopic portal. First, in 80 degrees of flexion, the double-stranded gracilis graft is fixed with an interference screw inside the lower femoral socket, representing the insertion site of the posteromedial bundle. In full extension the combined semitendinosus-gracilis graft is pretensioned and fixed inside the posterior aspect of the single tibial tunnel. The double- or triple-stranded semitendinosus tendon is inserted in the higher femoral tunnel, presenting the insertion site of the anterolateral bundle. Finally, pretension is applied to the semitendinosus bundle in 70 degrees of flexion and a third screw is inserted. Using this technique, the stronger semitendinosus part of the double-bundle graft, which mimics the anterolateral bundle of the PCL, is fixed in flexion, whereas the smaller gracilis tendon part (posteromedial bundle) is fixed in full extension. Thus, a fully arthroscopic anatomic PCL reconstruction technique is available that may better restore normal knee kinematics as compared to the single-stranded isometric reconstruction.

Arthroscopy↗
PubMed2001

The EndoPearl device increases fixation strength and eliminates construct slippage of hamstring tendon grafts with interference screw fixation.

PURPOSE: The EndoPearl (Linvatec, Largo, FL), a biodegradable device to augment the femoral interference screw fixation of hamstring tendon grafts has been developed. The first objective of this study was to compare the initial fixation strength of quadrupled hamstring tendons and biodegradable interference screw fixation with and without the application of the EndoPearl device. The second objective was to determine the influence of the EndoPearl device on the fatigue behavior under incremental cyclic loading conditions in a simulation of critical fixation conditions. TYPE OF STUDY: Biomechanical study. METHODS: Fresh human hamstring tendons were harvested and grafts were fixed with biodegradable poly-L-lactide interference screws. Twenty proximal calf tibias were used to compare the initial fixation strength of the study and the control group. In the study group, the EndoPearl device was secured to the graft using two No. 5 Ethibond sutures (Ethicon, Somerville, NJ). Specimens were loaded until failure in a materials testing machine. For cyclic testing, human hamstring tendons and 20 distal porcine femurs were used. Critical graft fixation conditions were simulated by increasing tunnel diameter 2 mm over the graft diameter. Grafts were loaded progressively in increments of 100 N until failure; 100 cycles were applied per load increment. RESULTS: Graft fixation with the additional EndoPearl device had a significantly higher maximum load to failure (658.9 +/- 118.1 N v 385.9 +/- 185.6 N, P =.003) and stiffness (41.7 +/- 11 N/mm v 25.7 +/- 8.5 N/mm). Graft fixation with the EndoPearl device sustained a significant higher total number of cycles (388.5 +/- 125.6) compared with the control group (152.8 +/- 144.9, P =.002). CONCLUSIONS: We demonstrated that the augmentation of a hamstring tendon graft with the EndoPearl device increases interference screw fixation strength significantly. Under dynamic loading conditions, specimens of the study group sustained substantially higher loads and a larger number of cycles, which indicates a greater resistance to graft slippage. The application of the EndoPearl device may also allow for a secure soft-tissue graft fixation with interference screws in cases of critical fixation conditions.

Absorbable Implants↗
PubMed2001

Reflex extension loss after anterior cruciate ligament reconstruction due to femoral "high noon" graft placement.

We describe a rare case of a painful reflex extension loss due to femoral malplacement of an anterior cruciate ligament (ACL) graft in a female high-level athlete. The graft was placed on the femoral site in the "high noon" position combined with a slight medial tibial tunnel placement. The resulting anterior-posterior cruciate ligament impingement near extension caused a persistent functional extension deficit of 20 degrees. Under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a proprioceptive reflex leading to a functional extension loss while the patient is awake. After sacrifice of the graft and subsequent replacement of the ACL, full range of motion was achieved within 2 months. After a 3-year postinjury history of 3 arthroscopies and 2 ACL reconstructions, the athlete reached her preinjury activity level again. This rare cause of a reflex extension loss due to femoral high noon graft placement has not been described previously and should be included as a differential diagnosis when evaluating patients with an extension deficit after ACL reconstruction.

Adolescent↗
PubMed2001

The effect of growth hormone on insulin-like growth factor I and bone metabolism in distraction osteogenesis.

Limb lengthening in the left tibia of 30 mature female Yucatan micropigs was performed using distraction osteogenesis. A treatment group of 15 animals received recombinant porcine growth hormone (r-pGH) (100 microg/kg/day) while the others served as controls. Serial serum measurements of total insulin-like growth factor I (IGF-I), free IGF-I, IGF binding proteins -1, -2, -3 and -4 (IGFBP-1 to -4) were performed. Bone-specific alkaline phosphatase (bone-ALP) and the serum carboxyl-terminal telopeptide of type I collagen (ICTP) were measured as bone turnover markers. The GH-treated animals showed a significant increase in total IGF-I, free IGF-I and IGFBP-3 after surgery (P<0.001). Similarly, the treated animals showed a significantly higher level of bone-ALP (P<0.001) throughout the experiment compared to the controls. There was a significant correlation between bone-ALP and total IGF-I (r=0.76) in the GH-treated group and an even higher correlation for free IGF-I (r=0.90). There was no difference in the ICTP serum levels between the two groups. These data indicate that the application of species-specific growth hormone results in a stimulation of bone formation in distraction osteogenesis which may be mediated by IGF-I. The stronger correlation between free IGF-I and bone-ALP indicates that the anabolic effect of IGF-I may be regulated through the IGFBPs by binding and inactivating IGF-I.

Alkaline Phosphatase↗
PubMed2000

Gas-phase production and photoelectron spectroscopy of the smallest fullerene, C20

Fullerenes are graphitic cage structures incorporating exactly twelve pentagons. The smallest possible fullerene is thus C20, which consists solely of pentagons. But the extreme curvature and reactivity of this structure have led to doubts about its existence and stability. Although theoretical calculations have identified, besides this cage, a bowl and a monocyclic ring isomer as low-energy members of the C20 cluster family, only ring isomers of C20 have been observed so far. Here we show that the cage-structured fullerene C20 can be produced from its perhydrogenated form (dodecahedrane C20H20) by replacing the hydrogen atoms with relatively weakly bound bromine atoms, followed by gas-phase debromination. For comparison we have also produced the bowl isomer of C20 using the same procedure. We characterize the generated C20 clusters using mass-selective anion photoelectron spectroscopy; the observed electron affinities and vibrational structures of these two C20 isomers differ significantly from each other, as well as from those of the known monocyclic isomer. We expect that these unique C20 species will serve as a benchmark test for further theoretical studies.

Journal Article↗