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W Schultz

Publications and source records attributed to W Schultz.

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

Migration of fallout radiocaesium in a grassland soil from 1986 to 2001. Part I: activity-depth profiles of (134)Cs and (137)Cs.

The temporal changes of the vertical distribution of (134)Cs (deposited by the Chernobyl fallout in 1986) and (137)Cs (deposited by the Chernobyl and the global fallout) in the soil were investigated at an undisturbed Bavarian grassland site in Germany. At ten sampling dates between 1986 and 2001, the activity density of (134)Cs and (137)Cs was determined in various soil layers down to 80 cm depth. In 2001, the small-scale spatial variability of the radiocaesium activity was determined by sampling five plots within 10 m(2) (coefficient of variation about 20% for the upper soil layers). Between 1987 and 1990, substantial changes of the activity-depth profiles were observed. The percentage depth distributions of (134)Cs and (137)Cs were rather similar. The 50%-depth of the accumulated activity increased from 2.4 cm in 1988 to 5.3 cm in 2001 for (134)Cs and from 2.7 to 5.8 cm for (137)Cs. This indicates that at the study site the migration data of Chernobyl-derived (137)Cs can be estimated by those of total (137)Cs. In the second part of this study, the activity-depth profiles will be evaluated by the convection-dispersion model [Schimmack, W, Feria Márquez, F. Migration of fallout radiocaesium in a grassland soil from 1986 to 2001. Part II: Evaluation of the activity-depth profiles by transport models. Sci Total Environ 2006-this issue].

Cesium Radioisotopes↗
PubMed2006

Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction.

Poly-L: -lactic acid biodegradable screws have been used effectively for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of this implant is low, although some authors reported complications, such as osteolysis and aseptic effusion of the knee joint. We report a case of a 29-year-old female patient with a failure of a biodegradable interference screw at 22 months after ACL reconstruction using bone-patellar tendon-bone graft. In this illustrated case, the screw broke and migrated into the knee joint. In addition, we performed a detailed review of the medical literature from 1990-2005 to identify possible causes of biodegradable screw failures. We identified six published cases of bioabsorbable interference screw failure with migration into the knee joint. Several authors have reported small diameter of the screw, poor bone quality, bone resorption, and screw divergence as potential causes for intraarticular migration of metallic interference screws. With regard to bioscrews, no specific risk factors for screw breakage and intraarticular migration have been reported. ACL reconstruction with the use of bioabsorbable interference screws for fixation is considered to be reliable. However, we need to be aware of potential problems associated with the use of this implant. Early recognition of bioscrew failure may prevent associated morbidities, such as subsequent cartilage damage.

Absorbable Implants↗
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

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

The Nottingham health profile-experiences after hip revision arthroplasty.

INTRODUCTION: Considering patients after hip revision arthroplasty postoperative quality controls allows an evaluation of the individual implant situation as well as the achieved postoperative quality of life. With regard to a possible loss of data reliable statements about the used implant system with special consideration to the implant survival rate could not be received. In this connection standardized self-assessment questionnaires like the Nottingham Health Profile (NHP) are in the centre of interest. The main focus of this study was to demonstrate a correlation between the Nottingham Health Profile and the Merle d'Aubigne (MDA) Score. PATIENTS AND METHODS: Fifty-one patients after femoral stem revision were re-examined. All patients received a written appointment for an ambulatory re-examination together with the NHP 4 weeks before. The clinical evaluation was carried out by using the MDA Score. Correlations between the NHP and the MDA were calculated. RESULTS: Overall the data of 39 patients could be evaluated completely. Three patients (5.9%) did not appear to the ambulatory re-examination, four patients (7.8%) deceased in the meantime. With further five patients (9.8%) the NHP questionnaire could not be rated due to an incorrect treatment. The mean follow-up after revision was 5.8 years. Correlations between the category 'Pain' NHP/MDA as well as to the combination of the NHP-categories 'Pain' + 'Physical Mobility' and the total MDA-Score could be demonstrated. CONCLUSION: Out of our personal experiences the use of the NHP makes an individual follow-up evaluation after revision hip arthroplasty possible. Patient-referred changes can lead to direct re-examinations. Correlation coherences between the NHP and the MDA could be demonstrated equivalent to already published results. In what way a survival rate analysis of an implant by using the NHP is possible could not be answered clearly. It has to be included that wrong answered questionnaires lead to an additional drop-out rate beneath the lost to follow-up rate.

Activities of Daily Living↗
PubMed2005

Expandable vertebral body replacement in patients with thoracolumbar spine tumors.

INTRODUCTION: The objectives of surgical interventions for tumoral lesions of the spine include the establishment and improvement of tumor-related symptoms. Anterior tumor resection followed by reconstruction indicated if surgical treatment allowed a marginal removal of the tumor or could extend the individual survival rate in combination with adjuvant therapy options. Sufficient re-stabilization depends on adequate anterior column reconstruction. The purpose of this retrospective study was to present our experiences and results after anterior tumor resection followed by reconstruction with the expandable vertebral body replacement device (VBR, Ulrich, Germany) based on clinical application over 4 degrees years. PATIENTS AND METHODS: We carried out an anterior tumor resection followed by reconstruction using an anterior extendable device in 32 patients with different spine tumors between 1996 and 2000. A retrospective evaluation was executed considering the patients medical records and radiological findings. Additionally, a clinical and radiological investigation of still living postoperative patients was carried out. RESULTS: The mean surgical time of all evaluated patients was 317.2 min. The average blood loss was 1,272.5 ml. According to the Tokuhashi score, patients with a postoperative survival time of at least 12 months demonstrated a score value > or = 9 points. According to our evaluated patients group metastatic lesions of the spine represented the largest group (78.1%). The average survival rate of this group amounted to 18.4 months postoperatively. Considering primary tumors the average survival rate at the time of last re-examination amounted to 34.8 months postoperatively. Preoperative neurological pathologies were present in 12 patients (Frankel stage C-D). During the postoperative monitoring period 58.3% of the patients demonstrated an improvement in initial neurological findings. There were no intraoperative complications or perioperative deaths. Implant dislocations were not observed. CONCLUSION: On account of the underlying, the anterior tumor resection with supplementary instrumentation represented a sufficient procedure in spinal tumor surgery. Adjuvant therapy can influence the postoperative survival period positively in addition to the surgical procedure. Following anterior tumor resection, extendable vertebral body replacements like the VBR device provide immediate spine stability by excellent defect adaptation. With regard to their intraoperative flexibility, expandable cages are more advantageous in contrast to non-expandable implants or bone grafts.

Adult↗
PubMed2005

Leaching of depleted uranium in soil as determined by column experiments.

The basic features of the leachability of depleted uranium (DU) projectiles in soil was investigated by using 12 projectiles (145-294 g DU) and 16 columns installed in an air-conditioned laboratory. Two soils widely distributed in Europe, a sandy-loamy cambisol and a silty-loamy luvisol, were filled into the columns (3.3 kg dry soil each). The effluents of all columns were collected weekly during the observation period of 1 year. In 648 samples, 235U and 238U were determined by inductively coupled plasma mass spectrometry. The leaching rates of 238U from natural uranium were in general about 0.01 microg week-1 or smaller, while those of 238U from the DU munitions varied considerably and reached values of up to 100 microg week-1, for the different columns. In total, about 0.3 microg natural uranium corresponding to 20 ppm of its inventory in the soil was leached during the observation period. From the projectiles, an average of about 50 microg DU were leached corresponding to 18 ppm of the corroded DU mass (about 1.6% of the mean initial DU mass of the projectiles). Assuming that corrosion and leaching continue as observed, the mobilisation of 238U from DU munitions will last, on an average, for thousands of years in the soils investigated, while the munitions themselves will have been corroded after a much shorter time. It is proposed to use, for the investigated soil types, the mean leaching rates of the six columns with projectiles for transport calculations of 238U to the groundwater and, thus, for a better risk assessment of the water-dependent uptake pathways of DU.

Diffusion↗
PubMed2005

Clinical outcome of the arthroscopic management of sports-related "anterior ankle pain": a prospective study.

Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. We reviewed 26 (16 male and 10 female) athletes with a mean age of 27 years treated arthroscopically for symptoms due to soft-tissue (group I, n = 12) and bony obstruction (group II, n = 14). They suffered from anterior pain, reduction of dorsiflexion and recurrent swelling with severe impairment in their sports activities. There was no clinical improvement for at least 6 months despite of conservative treatment with a mean duration of symptoms about 20 months. There were no further operations. Evaluation included the Karlsson ankle rating score, the activity score of Tegner, and a visual analogue scale (VAS) reflecting patients' pain. Conventional radiographs and Magnetic resonance imaging (MRI) were done preoperatively. All patients were available for follow up after 31 months (range, 25-48 months) with a significant improvement (p < 0.05) of the Karlsson score from 66 to a mean of 92 at the follow-up examination. The mean Tegner score was eight points compared to three points preoperatively. Regarding the subjective assessment observed by the decrease of pain and the ability of the athelete to return to competition sport, there were 25 very satisfied and one unsatisfied athlete. No significant difference in the outcome of group I and II (p > 0.05) could be estimated. The results demonstrate ' excellent ' to ' good ' results for arthroscopic treatment of sports-related anterior ankle pain in a group of athletes who were involved in competition sport. The promising clinical results confirm an effective way of treating soft-tissue and bony impingement. In addition, we recommend prior to surgery, an adequate course of non-operative treatment, including modifications in the exercise program and athletic activity.

Adult↗
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↗
PubMed2003

Soil-to-grain transfer of fallout 137Cs for 28 winter wheat cultivars as observed in field experiments.

In order to find wheat cultivars with a minimum soil-to-grain transfer of fallout (137)Cs, 28 winter wheat cultivars were investigated at 3 different sites with different soil types in Bavaria, Germany. Each cultivar was grown on an area of 10 m(2) and harvested in August 1999. The soil-to-grain concentration ratios (C(r)) of (137)Cs varied by a factor of up to 3 from cultivar to cultivar at a given site and from site-to-site for a given cultivar. The mean C(r) values at the three sites, 4.2 x 10(-4), 4.9 x 10(-4) and 7.5 x 10(-4), differed significantly. The fact that no cultivar showed similar C(r) values at the three sites indicates a strong influence of the soil on C(r). The cultivars Flair, Kornett and Previa showed a minor uptake of (137)Cs compared with the mean of all cultivars at each site. Unlike (137)Cs, the (40)K concentrations in the wheat grains varied only within a small range (122-190 Bq kg(-1)) at each site, which is due to the potassium regulation by the plants. For both radionuclides, the differences between the root uptake characteristics of the cultivars may not only be explained by an inter-cultivar variability due to genetic differences between the cultivars, but also by an intra-cultivar variability due to different soil conditions.

Cesium Radioisotopes↗
PubMed2003

Autologous osteochondral grafts in the treatment of cartilage defects of the knee joint.

Autologous osteochondral grafting (mosaicplasty) was performed on 18 patients with grade IV cartilage defects of the knee joint. The average age of these 12 men and 6 women was 36 years, follow-up time was 27.2 months and defect size was 252 mm(2) (18 x 14 mm). After plain anteroposterior and lateral radiographs and MRI (STIR sequence) examination, diagnostic arthroscopy was performed, followed by autologous osteochondral grafting, avoidance of weight bearing for 6-8 weeks, physiotherapy and continuous passive motion. All patients showed, radiologically (MRI), a full coverage of the defect with articular surface congruity postoperatively. The postoperative ICRS score was normal for 12 and nearly normal for 6 patients. Seven patients showed early persistent joint effusion for an average of 5.3 months. Hyaline-like cartilage coverage was found in four patients on second-look arthroscopy. The transplantation of autologous osteochondral grafts is being applied in an effort to reconstruct the affected articular surface with properties similar to those of hyaline cartilage. This method retains the integrity and function of a damaged joint, providing promising results in terms of preventing the development of early arthritis in young patients.

Adult↗