S. Suzuki et al.: Ultrasound diagnosis of pathology of the anterior and posterior cruciate ligaments of the knee joint.
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Anterior Cruciate Ligament↗
Biomedical subjects
H Gerngross
Publications and source records attributed to H Gerngross.
Ultrasound scanning for the diagnosis of meniscal lesions of the knee joint.
We report on the efficacy of ultrasound scanning as a noninvasive method of the preoperative diagnosis of meniscal lesions of the knee joint, using the 7.5-Hz head of a real-time scanner. In studies on cadaveric knee joints we found a high efficacy in diagnosing meniscal lesions using ultrasound. Comparative clinical studies on 51 patients who had undergone preoperative ultrasound scanning showed a strong correlation of ultrasound diagnosis with intraoperative findings. Arthrography was performed in 24 of the 51 patients, yet ultrasound studies proved to be more effective than arthrography in diagnosing meniscal lesions. Consequently, we believe that ultrasonic scanning as a noninvasive method of diagnosis is more helpful in identifying meniscal lesions of the knee joint.
Arthrography↗
[Experimental and clinical studies of the use of thin-lumen polyurethane gravity drainage in accident surgery].
A clinical randomized study was conducted to compare 28 closed polyurethane (PU) drainage systems and 28 open polyvinylchloride (PVC) (Redon) drainage systems. The aim was to find whether the Redon drains could be replaced by PU drains without suction in the field of joint and soft tissue surgery. In another study, 27 PU gravity-drainage systems were implanted for surface electron microscopy. There was no difference in the volume of fluid drained. The tendency to diversion of the secretion induced by a thrombus in the drain was significantly lower in the PU drainage group than in the PVC-Redon group. Extraction of the drain was significantly less painful in the PU group than in the group with Redon drains. No complications occurred in either group. The surface electron-microscope study revealed slight adherence of thrombotic material to the inner wall of the drain in the PU group only. The thrombi were mobile and had a smooth surface, so that they could not block the drainage of secretions. In our opinion, PU gravity-drainage systems could be substituted for PVC-Redon drainage systems in the field of traumatology. This would exclude the potential toxic effects of PVC.
Drainage↗
[What suction drainage is optimal for drainage of wound secretion? A clinico-experimental study exemplified by the knee joint].
In a randomized clinical study on 40 intraarticular knee joint drainages the effect of a high vacuum, middle vacuum, low vacuum and suction free drainages were examined. The maximum of the volume that was drained had been in the group of the suction free drainages. Drains with a long period of suction had a minimum of evaluated ultrasonographic effusion in the knee joint. The group with high vacuum was obviously not as long as open as in the other groups. Thrombi in the drainages could be found in every group. This refers to the observation that the finding of adherent thrombi is related to the material the drain is made of. Adherent thrombi decrease the possibility of secretion, not adherent thrombi do not decrease suction volume. Referring to these results it is obvious that not the high-vacuum drainage is the matter of choice for intraarticular drains. The suction-free drainages or drains with reduced vacuum have more advantages in respect to simple, secure and fast implantation and handling.
Equipment Design↗
[Invasive measurement of compartment pressure based on piezo-resistance principles].
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Compartment Syndromes↗
[The use of bioresorbable implants (Biofix) in surgery. The indications, technic and initial clinical results].
Carrying out osteosyntheses with absorbable implants is a dream cherished by traumatologists for a long time. The absorbable rods available on the medical market comply within narrow ranges with the necessary conditions with regard to stability, absorption time and biocompatibility. In our clinical department 38 osteosyntheses with Biofix rods were performed. The complication rate amounted to 13%-5 abacterial disturbances of wound healing and secretions. The indications assured so far are limited to refixation of chondral and osteochondral fragments as well as the fixation of cortical-cancellous bone grafts.
Absorption↗
[Reduction of postoperative swelling. Objective measurement of swelling of the upper ankle joint in treatment with serrapeptase-- a prospective study].
Using a quantitative standardized procedure, the swelling of the ankle produced by supination trauma was measured. In the 66 patients with fresh rupture of the lateral ligament treated surgically at our Department between December 1986 and April 1987, a prospective study of the effect of serrapeptase (Aniflazym) on post-operative swelling and pain was carried out in 3 randomized groups of patients. In the group receiving the test substance, the swelling had decreased by 50% on the third post-operative day, while in the other two control groups (elevation of the leg, bed rest, with and without the application of ice) no reduction in swelling had occurred at that time. The difference is statistically significant (p = 0.013). Decreasing pain correlated for the most part with the reduction in swelling. Thus, the patients receiving the test substance more rapidly became pain-free than did the control groups. On the basis of these results, serrapeptase would appear to be an effective preparation for the post-operative reduction of swelling, in comparison with the classical conservative measures, for example, the application of ice.
Adult↗
[Diagnostic value of sonography and double contrast arthrography in meniscus lesions].
Using a real time scanner and a 7.5 mHz transducer, the meniscus can bei visualised as a homogeneous triangle. It is clearly distinguishable from the tibial plane und the condyle of the femur. Tears in the meniscus show up as a double contour rich in echoes with an intervening low-echo area, or as a contour rich in echoes with an adjacent low-echo area. The posterior horn area can be visualised most clearly. Assessment of the interior part of the meniscus is somewhat easier than visualising the exterior part. In a clinical study with 107 menisci examined by sonography and controlled by arthroscopy or arthrotomy the rate of accurate diagnoses by sonography of the meniscus is 82%. 42 of these menisci were additionally examined by double contrast arthrography besides sonography. This yielded an accuracy rate of 74% for double contrast arthrography; the latter is superior to sonography only in the anterior horn area. Problems in respect of meniscus sonography occur only in case of transverse ruptures, scars and longitudinal meniscus ruptures presenting as bucket handle tears near the base. The typical longitudinal tear in the area of the posterior horn can be visualised most clearly. Analysis of the results shows that sonography of the meniscus is a noninvasive, painless and randomly reproducible and risk-free examination method which has a diagnostic value especially in the area of the posterior horn that can be compared with double contrast arthrography. Further studies must show whether with an increasing spread of the method it would be possible to replace double contrast arthrography by sonography in diagnosis of menisceal trouble.
Adult↗
[Incidence and course of early local complications following surgery of the locomotor system (2)].
In the department of traumatology, hand surgery, plastic and rehabilitation surgery of the University of Ulm, a prospective study was carried through over a period of 5 years (1980-1984) to record all early local complications; their course and final outcome were observed throughout this period. A total of 30,217 operations were performed, and we observed a total of 527 (i.e. 1.74%) perioperative and early postoperative complications in 447 patients. This rate remained nearly the same throughout the observation period. The complication most often found was postoperative hematoma, with an incidence of 0.61%; the hematoma had to be removed in a second operation in two-thirds of all cases. The next most frequent complication was infection of soft tissue and bones (incidence 0.49%), followed by lesions of nerve fibres (0.22%) and disturbances of wound healing and necrosis (0.15%). In comparison with those complications we were seldom confronted with luxations after implantation of femoral head prostheses, incorrect internal fixation, refractures and ischaemia after lesion of blood vessels. Most complications were localised in the knee (21.2%) and the lower leg (18.3%). We only observed 148 early complications (infection rate 0.49%), with 54 occurring in bones and joints and only 94 in soft tissue. In open fractures the infection rate totalled 2.03% and in closed fractures, 0.16%. We observed 14 joint infections (infection rate 0.16%), with 3 infections after the implantation of femoral head prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)
Follow-Up Studies↗
[Gravity drainage versus suction drainage: an experimental and clinical study].
The importance of wound drainage in casualty and plastic surgery is unquestioned. The most common form is suction drainage. This involves the disadvantage that the drain can become attached to the tissue by suction, stopping the flow and blocking the drain. In addition, the secretion reservoir must be made of rigid material, which means large package sizes are inevitable. Encouraged by our knowledge of silicone drains, we carried out a study comparing silicone drains (without vacuum) and PVC drains (with vacuum suction). Electron-microscope studies of the PVC drains used for suction drainage revealed adhesion of wound secretion and cell detritus to the inner wall and the drainage perforations after less than 24 h. No occlusion and almost no adherence was observed with silicone gravity drains. When compared in clinical use for joint drainage, neither system had any severe complications. Removal of gravity drains was considerably less painful than withdrawal of suction drains. In soft tissue drainage the volume of secretion drained off was more constant and obviously larger with gravity drainage. From these results we conclude that gravity drainage can replace suction drainage to considerable advantage.
Clinical Trials as Topic↗
Experimental studies on the influence of fibrin adhesive, factor XIII, and calcitonin on the incorporation and remodeling of autologous bone grafts.
In an experimental study on sheep the effects of fibrin adhesive system (FAS), plasma factor XIII (FXIII), and calcitonin on autologous cancellous bone grafts were studied. Drill holes in the tibia were filled with transplant bone, either untreated or locally treated with fibrin adhesive, with or without plasma factor XIII. We used 24 sheep, divided into three groups. Plasma factor XIII and calcitonin were administered parenterally; the third group received no treatment. For evaluation we carried out quantitative bone and fluorescence morphometry and microangiography. We found that local fibrin adhesive significantly decreased the remodeling and growth of the transplanted cancellous bone. Plasma factor XIII, given parenterally, increased the amount of bone in the transplant site; calcitonin showed no visible effect.
Animals↗
Total "internal" hemipelvectomy.
Several authors have described resections of tumorbearing parts of the pelvis including reconstructive plastic surgery. With extensive tumor growth present mutilating hemipelvectomies often have been the last resort. Even the most sophisticated prostheses hardly ever enabled the patients to walk again. We have therefore performed total "internal" hemipelvectomies in three cases. The necessary substitute consisted of half a pelvis made of polyacetal resin produced from a given model. The model's measures and shape was established by computer tomograms thus resulting in an individually shaped pelvis half. The operative procedure aims at the maintenance of osseous muscular insertions and origins and their reconstruction. Utmost care has to be taken in avoiding damage to nerves and vessels. Fixation of the implant is performed by screws aiming through the sacroiliac joint into ala and corpus of the sacrum and corticocancellous grafts incorporated in the implant. The symphyses are united by means of plate fixation. The hip joint is substituted by a total prosthesis. With the procedure described we have managed three cases of extensive malignant tumors of the pelvis. One patient suffered a nerve lesion and skin necrosis with infection. The two remaining patients are capable of weight-bearing and standing on the inflicted leg alone.
Adolescent↗