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H Steckel

Publications and source records attributed to H Steckel.

At least 19 recordsLinked to original sources
PubMed2006

The double-bundle technique for anterior cruciate ligament reconstruction: a systematic overview.

In traditional anterior cruciate ligament reconstruction, there is a subset of patients complaining of knee instability, especially rotational instability, and athletes not able to return to their preinjury level of sports activity. Currently, controversy exists over the usefulness of the double bundle technique (DBT) in addressing these problems. In order to evaluate the DBT, we completed a literature review from 1969 to February 2006 focusing on anatomy, magnetic resonance imaging, graft incorporation, biomechanics, kinematics, surgical techniques, complications and outcome. The DBT is not a standardized technique, which makes it difficult to compare results. Cadaver studies have proven biomechanical advantages with respect to ap-stability, but assessing the rotational stability remains difficult. There is a lack of available outcome studies with sufficient follow-up to demonstrate the potential advantages of DBT. The theoretical advantages of DBT require careful evaluation with outcome, biomechanical and kinematic studies. In addition, studies are needed to address issues such as graft incorporation and complications. An advantage offered by DBT is the possibility to identify rupture patterns that can lead to surgical preservation of an intact and augmentation of an injured bundle. The approach of augmentating a single bundle technique reconstruction with adequate anterior-posterior but poor rotational stability is promising.

Anterior Cruciate Ligament↗
PubMed2006

Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis.

Frozen shoulder is said to be a self-limiting entity but full recovery often takes more than 2 years. For that, most patients are unwilling to tolerate painful restriction while awaiting resolution. We prospectively investigated 30 patients (16 women, 14 men) for the outcome of arthroscopic capsular release in idiopathic frozen shoulder. Results were determined by the assessment of subjective and objective parameters to estimate both shoulder function and general health status. Symptoms persisted without improvement for a minimum of 6 months of conservative treatment. Preoperative average American shoulder and elbow surgeons score (ASES) was 35, visual analog scale (VAS) to measure pain was 7, and simple shoulder test (SST) was 4. Mean scores of the physical component of SF-36 were considerably reduced. Mean forward elevation was 85 degrees , average abduction was 70 degrees , mean internal rotation was 15 degrees , and mean external rotation was 10 degrees . Patients were followed-up at 6 weeks, 3, 6, 12 months and by a mean of 36 months. Range of motion for all planes improved (P < 0.05). Median VAS reduced to 2, average ASES increased to 91, and SST enhanced to a mean of 10 (P < 0.05). We stated improvement of the physical components in the SF-36 questionnaire in particular bodily pain and the role-physical score. There were no significant differences between the measurements in the early postoperative phase compared to the mid-term follow-up (P > 0.05). Our results demonstrate that arthroscopic release of refractory idiopathic frozen shoulder combined with a gentle manipulation provides reliable expectations for improvement in both clinical and general health status for most patients. We recommend the use of a limb-specific and a general-health-status questionnaire to conclude the benefit of the surgical intervention and contribute the optimization of a therapy concept more effectively.

Arthroscopy↗
PubMed2006

Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation.

INTRODUCTION: Traditional anterior cruciate ligament (ACL) surgery has demonstrated good results, but there is still a subset of unsatisfactory outcomes. Trends in reconstruction technique have changed from bone-patella-tendon-bone to hamstring refixation, and the next step appears to be the double bundle concept. METHODS: We examined six fresh-frozen cadaver knees to evaluate the double bundle structure, dynamic motion characteristics and the relationship of knee flexion and relative position of the femoral insertion sites of the ACL. RESULTS: In all knees, we identified an anteromedial (AM) and posterolateral (PL) bundle. The motion pattern demonstrated that the AM and PL bundles are oriented near parallel with the knee extended, and twist around each other as the knee is flexed. The visualization of the femoral footprint anatomy differs with knee flexion. DISCUSSION: The double bundle model facilitates restoration of the original footprint anatomy and biomechanics more easily than the concept of the ACL as a one-bundle structure and the use of the o'clock position. It is essential to be aware of the degree of knee flexion when drilling the femoral tunnels. PERSPECTIVE: Anatomic ACL reconstruction is a concept, not a technique, and allows a more refined surgical approach to ACL reconstruction including revision cases and partial ACL tears.

Adult↗
PubMed2006

[A comparison of orthopaedic sports medicine education in Germany and the US].

INTRODUCTION: The international exchange of German doctors especially in the US makes it important to compare both educational systems. The goal of this article is to discuss the differences and similarities between the German and US American curricula for Orthopaedic Sports Medicine. METHODS: The German and US American curricula for Sports Medicine and their education and fellowship programs were compared. RESULTS: The title 'Specialist for Sports Medicine' can be obtained in both countries. In Germany the curriculum is not speciality specific but offers a general Sports Medicine education that can be obtained through courses or fellowships. In the US this title can be obtained in two different ways, either through the American Board of Family Medicine (ABFM), or the American Board of Orthopaedic Surgery (ABOS) and their respective fellowship programs. DISCUSSION: The Sports Medicine curriculum in Germany and in the US is different with a general Sports Medicine program in Germany and a specific Sports Orthopaedic program in the US.

Curriculum↗
PubMed2006

Autologous chondrocyte transplantation for treating cartilage defects of the talus.

BACKGROUND: Despite its highly specialized nature, articular cartilage has a poor reparative capability. Treatment of symptomatic osteochondral defects of the talus has been especially difficult until now. METHODS: We performed autologous chondrocyte transplantation in twelve patients with a focal deep cartilage lesion of the talus. There were seven female and five male patients with a mean age of 29.7 years. The mean size of the lesion was 2.3 cm(2). All patients were studied prospectively. Evaluation was performed with use of the Hannover ankle rating score, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a visual analogue scale for pain, and magnetic resonance imaging. RESULTS: All patients were available for follow-up at a mean of sixty-three months. There was a significant improvement in the Hannover score, from 40.4 points preoperatively to 85.5 points at the follow-up examination, with seven excellent results, four good results, and one satisfactory result. The AOFAS mean score was 88.4 points compared with 43.5 points preoperatively. Magnetic resonance imaging showed a nearly congruent joint surface in seven patients, discrete irregularities in four, and an incongruent surface in one. The patients who had been involved in competitive sports were able to return to their full activity level. CONCLUSIONS: The promising clinical results of this study suggest that autologous chondrocyte transplantation is an effective and safe way to treat symptomatic osteochondral defects of the talus in appropriately selected patients.

Adolescent↗
PubMed2005

Effect of milling and sieving on functionality of dry powder inhalation products.

Alpha-lactose monohydrate is the standard excipient used as diluent or carrier in dry powder inhaler (DPI) formulations. Earlier studies have already revealed that raw materials for the production of inhalation grade lactose have to be carefully selected in order to avoid batch-to-batch variability. In the present study, the effect of milling and milling intensity on the flow properties and the physico-chemical characteristics of lactose crystals has been determined. The milled lactoses were then further processed by sieving to give lactose qualities with identical size distribution data, but different batch history (non-milled and milled at different conditions). These were then used to manufacture low concentration (0.25%) drug blends with the model drugs salbutamol sulphate (SBS) and beclometasonedipropionate (BDP); the blends were analysed with a Multistage Liquid Impinger (MLI) after delivery from an Easyhaler and an Aerolizer device. It could be shown that gentle milling already results in surface defects on the lactose crystal which are further enhanced by using a higher milling intensity. Produced fine lactose particles during the milling process strongly adhere to the lactose surface and cannot be removed by compressed air which is used for the particle sizing. By trend, a higher milling intensity resulted in higher fine particle fractions (FPF) with both devices. Also, SBS was found to generally give higher fine particle fractions than BDP, independent from the device used. In conclusion, lactose pre-treatment by gentle or strong milling affects the carrier surface and thereby the aerosolization properties of drug/lactose blends produced.

Aerosols↗
PubMed2005

Treatment option in a SLAP-related ganglion cyst resulting in suprascapular nerve entrapment.

INTRODUCTION: Our report shows a rare case of suprascapular nerve palsy due to a SLAP-related ganglion cyst resulting in isolated weakness of the infraspinatus muscle. CASE REPORT: We report on a 31-year old volleyball player with severe shoulder pain. A ganglion cyst was excised in an open procedure and was completely resolved in a postoperative magnetic resonance imaging (MRI). But the patient again had pain and disability 7 months after this procedure. A renewed MRI scan showed a cystic mass in the spinoglenoid notch. An electromyography revealed an isolated lesion of the suprascapular nerve. The patient was treated by shoulder arthroscopy with refixation of a type-II-SLAP-lesion and drainage of the cyst formation. At latest follow-up 29 months after surgery, the patient's pain and shoulder function improved with a constant score of 94 points. A MRI scan documented complete cyst resolution. CONCLUSIONS: Treatment options for ganglion cysts at the spinoglenoid notch are various and can be handled in conservative and operative ways. We believe that the arthroscopic concept with the management of a SLAP lesion as the cause of cyst formation, and the drainage of the ganglion is an effective way with low surgical morbidity that shows good postoperative results.

Adult↗
PubMed2005

[Therapy of enchondroma in long bones].

The treatment of enchondroma in long tubular bones has been the subject of controversial discussions for several years. Whereas secondary malignancy is very rare when the enchondroma is located in a hand, a position near to the trunk represents a high risk of transformation into a chondrosarcoma. For an enchondroma in long tubular bones, authors recommend a whole variety of approaches ranging from regular controls to radical en bloc resection. Between 1989 and 2001 we followed a concept of intralesional resection and cement filling. After an interval without recurrences, the cement was extracted and replaced by a spongiosaplasty. Of 16 patients 12.5% suffered from an intralesional fracture in the course of the treatment, and 25% complained of persistent pain and loss of function after surgery. These complications led us to change our concept. Though there were two cases of secondary transformation into chondrosarcoma G1, we now prefer to keep the patients under close clinical and radiological control without performing surgery.

Adolescent↗
PubMed2005

[Tumor-like bone lesions of the forearm after karate training].

INTRODUCTION: Differentiation between malignant bone tumors and tumor-like lesions after repetitive microtrauma following sport activities can be difficult just using radiographic methods. METHODS: We present the case of a fifteen year old karate fighter, who was examined by imaging diagnostics because of a progressive swelling and pain in the distal right forearm. RESULTS: A tumor-like appearance with bone mass formation in the x-ray, an enhancement in the surrounding tissue shown in the MRI and an increased activity in the bone scintigraphy made the diagnosis of an osteosarcoma very likely. Blood tests were not helpful. Only the evaluation of a bone biopsy could demonstrate hypertrophic reparative bone formation after multiple osseous microtrauma. Cast immobilisation reduced the osseous alteration. With the start of the training the swelling reappeared again but then finally vanished after modifying the training technique. DISCUSSION: The case demonstrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports. It also stresses the importance of a correct technique in sports like karate.

Adolescent↗
PubMed2005

[Bilateral stress fracture of the medial malleolus].

INTRODUCTION: A stress fracture can be defined as a partial or complete fracture of bone that results from repeated application of stress to the bone. Stress fractures are common injuries in athletes with an incidence of 0.12 - 4.4 %. Running and jumping are the most common sporting activities that have resulted in stress fractures. Stress fractures of the medial malleolus are extremely rare. Diagnosis and therapy are often difficult, result in a delayed begin of therapy and are a demanding task in sports medicine. Both surgical and conservative treatment are possible. METHODS: We present the case of an athlete, who presented stress fractures of both medial malleolus in 21 months. RESULTS: The patient was treated on one side with arthroscopy and an osteosynthesis and with arthroscopy on the other side. Each time the fracture healed without any problems. DISCUSSION: Based on literature and our patient we believe that surgical and conservative treatment are possible options. However surgical procedures seem to bring back the athlete earlier to sporting activities. Surgery should be considered early in the right patients.

Ankle Injuries↗
PubMed2005

[Cruciate ligament reconstruction in knees with congenital cruciate ligament aplasia].

INTRODUCTION: The absence of the cruciate ligament is a rare pathology which is described as a congenital entity often being bilateral and in combination with other malformations. Patients mostly deny symptoms of instability but demonstrate signs of laxity. There is not a standardized treatment yet. METHODS: We report a case of congenital cruciate ligament aplasia which was treated with an ACL reconstruction. RESULTS: In the described case, the patient had a bad clinical result after ACL reconstruction with a fixed posterior subluxation of the tibia. Resection of the ACL reconstruction and physical therapy led to a better clinical result. DISCUSSION: While some authors report favourable results with cruciate ligament reconstruction, others report good results with a conservative regime of symptomatic treatment. When patients do not complain of instability conservative treatment might be one option, since the knee joint is adjusted to this abnormality. Surgical treatment should be considered when conservative therapy is frustrane. If however reconstructive surgery is done in cruciate ligament aplasia both cruciate ligaments need to be reconstructed. After isolated ACL reconstruction the tibia might be fixed posteriorly, leading to extension problems and severe patellofemoral pain as seen in our case.

Anterior Cruciate Ligament↗
PubMed2004

Functionality testing of inhalation grade lactose.

Lactose monohydrate for inhalation is commonly produced by sieving out customer-specific size fractions of a crystallized bulk material of lactose. It was the aim of this study to investigate the influence of the raw material on the physico-chemical properties of the inhalation grade lactose and on the efficacy of powders for inhalation produced from these batches. The selected raw material lactose batches differed in the size distribution characteristics, the fines and the agglomerate content. These differences in the raw material could also be found to a smaller extent in the intermediate products and could not be completely levelled out in the final inhalation grade lactose. Efficiency testing was done using salbutamol sulphate in two different concentrations (drug-to-carrier ratio of 1:36 and 1:400) as a model drug; the powder blends were delivered using the Aerolizer and the Easyhaler device. With the high drug load, nearly no differences could be observed between both the delivery systems and the different produced lactose batches. The fine particle fraction (FPF) (%<5 microm) was on a high level of >39% in all cases. With the low drug load significant differences between the devices and the lactose batches were found. The FPF was distinctly reduced to 15-30%, with the Easyhaler generating a higher fraction of fine particles than the Aerolizer device. Although the observed differences between the lactose batches could not be linked to one specific physico-chemical parameter determined for the carrier, they led to the conclusion that the differences between the test batches of inhalation grade lactose especially manufactured for this study can affect the functionality of an inhalation powder. The effects are significantly smaller with high drug load formulations than using a low drug concentration.

Administration, Inhalation↗
PubMed2004

Production of chitosan pellets by extrusion/spheronization.

Chitosan pellets were successfully prepared using the extrusion/spheronization technology. Microcrystalline cellulose was used as additive in concentrations from 70 to 0%. The powder mixtures were extruded using water and diluted acetic acid solution in different powder to liquid ratios. The effects on bead formation using water and different acetic acid concentrations and solution quantities were analysed. Also, the morphological and mechanical characteristics of the obtained beads were investigated. With demineralized water as granulation fluid, pellets with a maximum of 50% (m/m) of chitosan could be produced. The mass fraction of chitosan within the pellets could be increased to 100% by using diluted acetic acid for the granulation step.

Acetic Acid↗
PubMed1998

Metered-dose inhaler formulations with beclomethasone-17,21-dipropionate using the ozone friendly propellant R 134a.

Metered-dose inhalers (MDI) are the most widely prescribed devices in the treatment of lung diseases but the continued use of chlorofluorocarbons (CFC) as propellants has made them unpopular due to their influence on the stratospheric ozone layer. The purpose of this study was to show possibilities of formulating beclomethasone-17,21-dipropionate (BDP) with the alternative propellant R 134a as a solution or as a suspension-type metered-dose inhaler. Influencing factors such as surfactant concentration, cosolvent content and actuator tube design were investigated. Metered-dose inhaler formulations were manufactured using a pressure filling technique. The resulting formulations were characterized with regard to their emitted fine particle fraction using the two-stage impinger, BP 93. Fine particle fraction was found to be independent on the surfactant concentration but highly dependent on the cosolvent content and the actuator tube design. In vitro fine particle fractions of 50% were obtained with solution phase MDIs. Formulating BDP as a suspension resulted in unstable dispersions in most cases because of the partial solubility of the drug in the liquified propellant. Stable suspension formulations gave an in vitro fine particle fraction of about 30%. A comparison with established marketed BDP suspension formulations which were found to emit a fine particle fraction in the range 10-50% showed the equivalence of the new CFC-free formulations.

Aerosol Propellants↗
PubMed1998

Metered-dose inhaler add-on devices: an in vitro evaluation of the BronchoAir inhaler and several spacer devices.

Spacer devices minimize the drug deposition in the oropharyngeal region as they retain between 30% and 50% of the nominal drug dose. Additionally, they should increase the fine particle fraction of the emitted aerosol. A new effort to increase the lung deposition was the design of a new actuator, the BronchoAir inhaler, (BronchoAir Medizintechnik GmbH, Munich, Germany). This study was carried out to evaluate the usefulness of this new actuator device by comparing its fine particle fraction with that emitted with the standard actuators and with spacer devices. The fine particle fraction's of commercially available metered dose inhalers (MDIs) marketed with specific spacers were determined using a multistage liquid impinger (MSLI). The effect of the BronchoAir inhaler on fine particle fractions was quite dependent on the formulation causing a decrease as great as 43% with Beclomet forte (beclomethasone-17, 21-dipropionate [BDP]) and an increase as great as 35% with Arubendol (salbutamol) but causing a difference of less than 20% with the other six tested formulations. Deposition in the upper stages of the impinger was sometimes higher than it was for the standard actuator. Spacer devices decreased the deposition in the upper stages of the impinger significantly, and in some cases, the fine particle fractions were also decreased. Varying the spacer design showed the superiority of large-volume open spacers compared with spacers with other designs.

Bronchodilator Agents↗
PubMedDate not supplied

[Long-term results of the Blauth knee prosthesis--current status of hinged knee prostheses].

AIM: Currently there is widespread use of unconstrained knee arthroplasty even in severe deformities of the knee. In order to ascertain the value and future of constrained knee prostheses, we have assessed the results of the Blauth knee prosthesis and compared them with the results of unconstrained knee prostheses. METHODS: In a retrospective analysis we examined 227 Blauth knee prosthesis implantations performed between 1985 and 1997. Using endpoints of prosthesis removal, infection and aseptic loosening, the 10-year survivorship analysis was evaluated. RESULTS: The analysis shows a 10-year survivorship of 90.1 % using aseptic loosening or infection as an endpoint and 96.2 % using removal as an endpoint. CONCLUSION: The first designs of constrained knee prostheses were associated with a high failure rate, while more recent designs like the St. Georg knee prosthesis and the Blauth knee prosthesis show long-term results similar to condylar designs. Since there has been a large increase of knee endoprosthesis implantations in the last years, a constrained knee prosthesis with excellent long-term results remains a valuable implant in cases of revisions and difficult knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

[Current status of wrist arthrodesis].

AIM: In order to ascertain the value and future of wrist arthrodesis we assessed the results of 47 wrist arthrodeses performed at the Departments of Orthopaedic and Trauma Surgery of the University of Goettingen between 1980 and 1998. METHOD: In a retrospective analysis we examined the patients clinical and radiological records. Evaluating the results we used the score described by Lohmann and Buck-Gramcko in order to consider function, pain, strength and assessment of the patient him/herself. RESULTS: 93.6 % of all cases could be examined. We found a wrist arthrodesis in posttraumatic arthritis in 22 cases and in rheumatoid arthritis in 25 cases. Plate (n = 30) and Rush-Pin osteosynthesis (n = 17) were used as surgical procedures. In all patients we found a successfully stabilised wrist, although in 3 trauma cases a further surgical procedure was necessary. A better function of the wrist was reached in every patient. The majority of the patients had no pain and an acceptable strength. The results obtained showed good and excellent results in 86.4 % of the wrist arthrodesis for post-traumatic arthritis and in 90.9 % for rheumatoid arthritis. CONCLUSION: The increase in quality of life, especially in patients suffering from rheumatoid arthritis, shows the procedure of wrist arthrodesis to be a still worthwile surgery.

Adolescent↗