Biomedical subjects

I Hoffstetter

Publications and source records attributed to I Hoffstetter.

8 recordsLinked to original sources

PubMed1996

Current treatment modalities of osteochondritis dissecans of the knee joint: results of a nation-wide German survey.

In a nation-wide survey 350 knee surgeons were asked for their current diagnostic and treatment modalities in patients with osteochondritis dissecans (OD) of the knee joint: 255 questionnaires were analyzed. With respect to the different imaging techniques, standard xray studies were performed by all surgeons. Other techniques were used in the following decreasing order of preference: xray tomography, MRI, CT-scan, ultrasound, bone scan, and arthrography. The indication for surgery was primarily influenced by the standard xray, and secondarily by xray tomography, then by MRI, and CT-scan. Regarding cartilage-inducing treatment methods, Pridie drilling (antegrade) was by far predominant over abrasion arthroplasties and Beck drilling (retrograde). Cartilage or perichondrium transplantation was performed rarely. For fixation of a loose fragment most of the surgeons preferred "Ethipins" followed by screws and K wires. Only one-third of the surgeons used MRI as one of the first diagnostic tools, but a higher percentage of surgeons recommended MRI in special cases. Especially in young patients MRI was used as often as plain xray, whereas the use of MRI in older patients was remarkably reduced. Concerning treatment modalities, the majority of surgeons treated young patients with protection from weight bearing. For cartilage stabilization, "Ethipins" were preferred, whereas screws were rarely recommended. Approximately 25% of the physicians would not treat asymptomatic patients at all. Even patients with typical symptoms were not treated by less than 15% of the surgeons. In general, adults with OD still embedded in the cartilage bed are treated more aggressively. In cases with a loose body the cartilage-inducing procedures are preferred. Perichondrium or cartilage transplantations are only rarely performed.

Adult↗

PubMed1995

The influence of orthoses on the proprioception of the ankle joint.

The ankle joints of 14 healthy volunteers and 16 patients with unstable ankle joints were tested regarding their functional and proprioceptive capabilities. All of them were active athletes. Three tests were used of the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace/"Mikros", stirrup-brace/"Aircast", taping) on the proprioceptivity of stable and unstable ankle joints was evaluated. The scores of the single-leg jumping course without any stabilizing device (category "standard") ranged between 8.06 and 13.68 (10.65 +/- 1.29). In the categories "Mikros" (9.85 +/- 0.99), and "Aircast" (9.99 +/- 1.14) as well as with the tape bandage (10.27 +/- 0.81) better scores were achieved. The differences "standard vs. Mikros" and "standard vs. Aircast" revealed a significant reduction of the scores with orthoses (P < 0.01). The error rate in the single-leg stance test was within the range of 0-16 (5.12 +/- 2.85) for the category "standard". It was lower for the categories "Mikros" (3.65 +/- 2.65) and "Aircast" (4.17 +/- 2.59). The error rate was highest in the group with a tape bandage (5.79 +/- 3.53). The differences "standard vs Mikros" as well as "standard vs. Aircast" were significant (P < 0.01). There was also a significant difference between these categories regarding injured and not injured ankle joints (P < 0.01). The angle-reproduction-test showed higher values for the category "standard" (2.36 degrees +/- 0.97) in comparison to the categories "Mikros" (1.46 degrees +/- 0.72), "Aircast" (1.62 degrees +/- 0.91) and "taping" (1.84 degrees +/- 0.41).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Septic arthritis: Arthroscopic management with local antibiotic treatment.

In a retrospective study, the results of arthroscopic treatment of septic arthritis were evaluated in 12 patients. Ages ranged from 4 to 57 years. The knee joint was affected in 9 cases, the elbow in 2 cases, and the shoulder joint in one case. In 3 patients the infection was hematogenous. Four patients had a postoperative infection and in 5 patients the infection followed an intraarticular injection. The indication for arthroscopic treatment was based on clinical findings, an increased ESR and/or CRP, an increase in leukocyte count in the joint fluid and no bone involvement on x-ray. Arthroscopic management was performed according to the intraoperative findings (lavage, debridement, synovectomy). The procedure was completed by intraarticular placement of an antibiotic collagenous fleece. Additionally systemic antibiotics, active against staphylococcus aureus, were used for perioperative therapy before starting a specific antibiotic treatment according to the cultured organism. In 10 out of 12 cases the infection was cured by one operation. Because of the advantages of arthroscopic treatment, it should be performed as soon as joint infection is confirmed.

Adult↗

PubMed1995

Combined realignment procedure (femoral and acetabular) of the hip joint in ambulatory patients with cerebral palsy and secondary hip dislocation.

In a retrospective study we evaluated the results of 11 patients with cerebral palsy and concomitant hip dislocation who were still able to walk. They had been surgically treated with proximal femoral osteotomy (varization and derotation) and acetabular osteotomy (triple osteotomy) in order to achieve stabilization of the hip joint. The patients' mean age was 14.4 +/- 3.7 years. The female:male ratio was 7:4. All 11 hip joints were successfully stabilized. The range of passive abduction significantly increased from 20 degrees preoperatively to 42 degrees postoperatively. The range of flexion slightly decreased from 101 degrees to 92 degrees. Internal rotation significantly decreased from 51 degrees to 37 degrees. External rotation increase from 27 degrees preoperatively to 41 degrees postoperatively. Preoperatively 4 of the 11 patients had been able to walk without any walking aids; 7 had been able to walk with support. Concerning the ambulatory status, mild improvement was achieved postoperatively in 3 patients. The CCD-angle decreased significantly from 138.9 degrees preoperatively to 118.7 degrees postoperatively. The migration index according to Reimers improved significantly from 50.2% preoperatively to 24.2% postoperatively. Prior to surgery 4 cases showed a grade 1 dislocation, 6 cases a grade 2 dislocation, and 1 case a grade 3 dislocation. We succeeded in performing a complete reposition in all patients. Preoperatively the CE- angle was only -3 degrees (+/- 11.3 degrees) and was improved to 27.1 degrees (+/- 5.3 degrees). The ACM-angle measured 45.4 degrees preoperatively and 49.5 degrees postoperatively. The sitting balance was improved in all patients. Furthermore the problem of anal care was reduced.

Acetabulum↗

PubMed1995

Secondary effects of knee braces on the intracompartmental pressure in the anterior tibial compartment.

UNLABELLED: In 31 healthy volunteers aged 18 to 33 years we investigated the intracompartmental pressure in the anterior tibial compartment while running on a treadmill with, and without, a functional knee brace. All volunteers performed two test series with a constant running speed of 8 km/h. Prior to running, the pressure was documented in the supine, sitting and standing position as well as during running. The intracompartmental pressure in the supine position was significantly less without a brace compared to the pressure with a brace. This was also true for the sitting position and the standing position. While running on the treadmill the average pressure was also significantly higher with, than without, a brace. CLINICAL RELEVANCE: Running with a functional knee brace leads to increased intracompartmental pressure in the anterior tibial compartment and, as a consequence, may lead to a chronic compartment syndrome. Wearing a functional knee brace may cause secondary muscle ischemia and may be one reason for the increased incidence of injuries in athletes.

Adolescent↗

PubMed1994

Shoulder joint stability after arthroscopic subacromial decompression.

In 55 patients with type I or type II impingement lesions we performed arthroscopic subacromial decompression. Fifty-two patients are followed up 1 year postoperatively. In all patients the condition of the affected shoulder before and after decompression was documented using a 100-point shoulder score (pain on activity, 15 points; pain without activity, 15 points; function, 20 points; weight lifting, 10 points; muscle strength, 15 points; range of motion, 25 points). At follow-up we also documented the extent of passive inferior shift of the humeral head by ultrasound. The mean score preoperatively was 60.9 (+/- 13.8). Postoperatively there was a significant increase to 84.7 (+/- 12.5). The average postoperative hospital stay was 8.8 days (+/- 2.1). In 12 patients (23%) the postoperative score was less than 85 points, and in these the treatment was considered to have failed. Comparison of these patients as a group with those in whom the treatment was successful revealed no difference in age, a small but not significant difference in the preoperative duration of shoulder complaints, and no difference in the postoperative length of stay in hospital. However, there was a significant difference in the extent of passive inferior shift of the humeral head: in the failure group the mean inferior shift was 4.6 +/- 1.9 mm, while in the other patients the shift was only 2.7 +/- 1.0 mm. This difference was statistically highly significant. There was a statistical highly significant negative Pearson correlation coefficient of -5.56 between postoperative score and inferior shift of the humeral head. We conclude that patients with subacromial pathology and hypermobile glenohumeral joints may not be good candidates for subacromial decompression.

Acromion↗

PubMed1994

Strain-related long-term changes in the menisci in asymptomatic athletes.

UNLABELLED: In 82 asymptomatic subjects aged 8-62 years we evaluated the menisci by magnetic resonance imaging [MRI; 1.0 tesla; spin-echo (SE 700/20), PS (partial saturation; 500/10), STIR (short time inversion recovery sequence; 1600/130/30)]. For grading the degeneration of the meniscus we used a standard classification (grades 0-4). MR findings were correlated with the patients' age, weight, profession, and athletic activity. Statistic analysis revealed a correlation between athletic activity and meniscal degeneration of both anterior horns and the posterior horn of the lateral meniscus. Especially the anterior horn of the lateral meniscus seems to be loaded during athletic activities. Correlation of meniscus degeneration with subjects' age showed an increase in grade 3 and grade 4 lesions with advancing age. Among subjects older than 50 years, grade 3 and 4 lesions were present in the SE sequence in 28.5% of cases, in PS sequences in 40.7% of case, and in STIR sequences in 25% of cases. CLINICAL RELEVANCE: Athletic activity seems to load the anterior knee compartments, especially the lateral compartment. MRI shows meniscal lesions in a significant number of asymptomatic subjects, especially those older than 50 years.

Adolescent↗

PubMed1994

Long-term results of elbow arthroscopy in 67 patients.

Based on the results of a retrospective study of 67 patients with diagnostic and surgical arthroscopy of the elbow from 1977 until 1991, we present our technique, results, complications, and indications for elbow arthroscopy. The average age of the patients was 26 years (range: 11-59). At the time of follow-up the patients were examined clinically as well as radiologically. The results were scored according to Figgie's score, which is based on the criteria of pain, function, power and range of motion. The overall score significantly increased from 61.6 preoperatively to 85.3 postoperatively. The age of the patient did not influence the results. However, patients who were laborers had a poorer outcome than the others. Patients with preoperative pain for 2 months to two 2 years had better results than patients with a preoperative course of more than 2 years.

Adolescent↗