Operative Orthopadie Und Traumatologie最新文献

{"title":"Arthroscopic techniques in ankle surgery.","authors":"Anna Altemeier, Sarah Ettinger","doi":"10.1007/s00064-025-00909-6","DOIUrl":"10.1007/s00064-025-00909-6","url":null,"abstract":"<p><strong>Surgical objective: </strong>Arthroscopy of the ankle joint is one of the standard procedures for treating many pathologies of the ankle joint. Ventral and posterior arthroscopy can be performed. The aim is to gain an overview of the joint using minimal incisions. There are many indications to perform ankle arthroscopy.</p><p><strong>Indications: </strong>Arthroscopy can be used diagnostically to check the cartilage status or the ligamentous apparatus. In traumatology, arthroscopy can be used to check for intra-articular damage or step formation following osteosynthesis. Arthroscopy can also be performed for cartilage therapy, ligament reconstruction or to support arthrodesis of the ankle joint.</p><p><strong>Contraindications: </strong>Absolute contraindications are rare. The most important contraindication is noncompliance. Relative contraindications include acute infection, severe vascular disorders, complex regional pain syndrome (CRPS), osteopenia or coagulation disorders. Nicotine consumption and obesity should be discussed critically with the patient.</p><p><strong>Postoperative management: </strong>Postoperative treatment depends on the addressed concomitant pathology. Suture material can be removed 14 days postoperatively. If an isolated arthroscopy is performed (e.g., diagnostic, arthrolysis, exclusion of infection), the authors recommend pain-adapted full weight-bearing, possibly in a lower leg orthosis until the wound has healed properly.</p><p><strong>Results: </strong>The results of arthroscopy depend on the pathology addressed. The primary advantage is a significantly reduced risk of wound healing disorders due to small incisions.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"293-304"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Arthroscopy in the treatment of acute and chronic syndesmotic injuries of the ankle joint].","authors":"Judith Schrempf, Boris M Holzapfel, Hans Polzer, Sebastian F Baumbach","doi":"10.1007/s00064-025-00907-8","DOIUrl":"10.1007/s00064-025-00907-8","url":null,"abstract":"<p><strong>Objective: </strong>Identification and treatment of concomitant intra-articular pathologies, verification of syndesmotic instability, debridement of syndesmotic structures in chronic injuries, reduction, and retention of the fibula in the distal tibiofibular joint.</p><p><strong>Indications: </strong>Acute and chronic two- or three-ligamentous syndesmotic ruptures in active patients.</p><p><strong>Contraindications: </strong>Soft tissue injuries, general risk factors, e.g., circulatory disorders, diabetic foot syndrome, complex regional pain syndrome.</p><p><strong>Surgical technique: </strong>Diagnostic arthroscopy of the ankle joint using anterolateral and -medial portals; identify and treat concomitant intra-articular pathologies; verify syndesmotic instability by inserting an instrument > 4 mm into the incisura fibularis; in case of chronic syndesmotic injuries, debridement of syndesmotic structures, and if necessary debridement of the deltoid ligament complex; reduction of the fibula in the incisura fibularis; retention of the fibula using a screw or flexible implant.</p><p><strong>Postoperative management: </strong>Partial weight-bearing with 20 kg for 6 weeks, no immobilization, exercise for the mobility of the ankle joint, X‑ray after 6 weeks, then increase of weight-bearing.</p><p><strong>Results: </strong>Acute syndesmotic injuries: 19 patients (37 ± 13 years) were examined 38 ± 17 months after arthroscopically assisted treatment of an acute syndesmotic injury. 53% suffered a two-ligament injury, 16% a three-ligament injury, and in 32% a bony syndesmotic injury. Grade II cartilage damage was observed in 35%, grade IV damage in 20%, and loose bodies were removed in 16%. 94% of patients achieved a treatment outcome in line with the healthy reference population for the Olerud and Molander Ankle Score (OMAS; primary outcome parameter) and Foot and Ankle Ability Measure (FAAM). Type of syndesmotic injury and severity of cartilage damage had no significant influence on treatment outcomes. Chronic syndesmotic injuries: a systematic literature search identified 17 studies with 196 patients following surgically treated chronic syndesmotic injuries, 16 of which were retrospective case series and one prospective case series. Arthroscopically assisted surgery was performed in 13 studies. Regardless of the surgical technique, surgery resulted in an improvement in the American Orthopaedic Foot and Ankle Society (AOFAS) score in 10 studies. Overall, the study quality was low and the information on complications, secondary diastasis, treatment results, etc. was very limited.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"338-353"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ankle arthroscopy-developments, significance and perspectives].","authors":"Ioannis Stratos, Maximilian Rudert, Hazibullah Waizy","doi":"10.1007/s00064-025-00913-w","DOIUrl":"https://doi.org/10.1007/s00064-025-00913-w","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"37 5","pages":"291-292"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modified Z-plasty of the patellar tendon for patella baja and flexion deficits].","authors":"Wolf Petersen, Hasan Al Mustafa, Johanna Schulze Borges, Martin Häner","doi":"10.1007/s00064-024-00886-2","DOIUrl":"10.1007/s00064-024-00886-2","url":null,"abstract":"<p><strong>Objective: </strong>Lengthening of the patellar tendon to normalize patellar height and improve knee flexion deficits.</p><p><strong>Indications: </strong>Flexion deficits in combination with patella baja (Caton index < 0.6).</p><p><strong>Contraindications: </strong>Infection.</p><p><strong>Surgical technique: </strong>Arthroscopy of the knee and resection of adhesions in suprapatellar pouch and additional intraarticular adhesions. Approximately 15 cm long incision from tibial tuberosity up to the patella. Exposition of the patellar tendon. Longitudinal incision in the middle from the tibial tuberosity towards the proximal patella. Division of the tendon into two strands. Detachment of the lateral tendon strand with periosteum from the bone of the patella and detachment of the medial strand with periosteum from the bone of the tibial tuberosity. Resection of fibrotic adhesions within Hoffa's fad pad and detachment of the longitudinal retinacula. Lengthening of the patella tendon of maximal 2.5 cm. Refixation of the medial strand to the upper part of the tibial tuberosity and the lateral strand to the distal patella pole with a soft anchor. Drilling of small transverse bone tunnels in the patella and tibial tuberosity for application of a McLaughlin cerclage for augmentation of the z‑plasty with a thick braided suture cord.</p><p><strong>Postoperative management: </strong>Six weeks partial weight bearing with 10 kg within a straight leg brace. Free passive range of motion.</p><p><strong>Results: </strong>Previously published results show that the Z‑plasty technique presented here on the patellar tendon can normalize the Caton index and improve mobility and clinical scores.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"362-370"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Arthroscopic matrix-associated bone marrow stimulation of ankle joint lesions].","authors":"Sebastian Frischholz, Annette Eidmann, Markus Walther, Maximilian Rudert, Ioannis Stratos","doi":"10.1007/s00064-025-00910-z","DOIUrl":"10.1007/s00064-025-00910-z","url":null,"abstract":"<p><strong>Objective: </strong>Arthroscopic matrix-associated bone marrow stimulation enables treatment of symptomatic osteochondral lesions of the ankle joint to alleviate pain and improve function.</p><p><strong>Indications: </strong>Symptomatic osteochondral lesions caused by trauma, osteochondritis dissecans, or isolated degenerative cartilage damage. Unstable lesions with nonrefixable fragments.</p><p><strong>Contraindications: </strong>Acute infections, ubiquitous advanced osteoarthritis.</p><p><strong>Surgical technique: </strong>Treatment of intra-articular pathologies and resection of hypertrophic synovia. Unstable cartilage tissue is debrided, and stable margins are created. The subchondral bone is microfractured to promote bleeding and cell migration. For deeper defects, a spongiosa graft can be performed. A tailored collagen matrix is introduced through a mini-arthrotomy and fixed with fibrin glue.</p><p><strong>Postoperative management: </strong>Partial weightbearing of 10-20 kg, depending on the procedure performed. From week 7, load-bearing is gradually increased; full weight-bearing is possible after 12 weeks. Sports activities can be resumed after 6 months.</p><p><strong>Results: </strong>In a retrospective analysis of 10.611 inpatient procedures in Germany from 2006-2022, the numbers for arthroscopies and arthrotomies initially increased, whereby the number of arthrotomies peaked in 2020, followed by a decline. Arthroscopic procedures increased steadily, especially from 2014 onward, indicating a preference for the minimally invasive technique.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"312-326"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hand surgery for rheumatoid arthritis : Current concepts and changes over the past 20 years].","authors":"Jakob C Schindele, Stephan F Schindele","doi":"10.1007/s00064-025-00912-x","DOIUrl":"10.1007/s00064-025-00912-x","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic inflammatory, immune-mediated disease of the musculoskeletal system that predominantly affects the hands and feet. The introduction of highly potent biologic disease-modifying drugs (bDMARDs) has led to a reduction in severe joint destruction and surgical interventions over the last two decades. Nevertheless, hand surgery remains an essential component of interdisciplinary therapy. Joint-preserving measures such as selective arthroplasty and partial arthrodesis are increasingly being performed today instead of arthrodesis, which was more common in the past. At the same time, the perioperative management of biologics is individually adapted to minimize the risk of infection. The following article draws on more than 30 years of personal experience in the treatment of patients with underlying rheumatic diseases and discusses current treatment recommendations for the hand and wrist.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"371-384"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Arthroscopic cartilage surgery of the ankle : Chondroplasty, retrograde drilling, nano-/microfracture].","authors":"O Gottschalk, A Röser, H Hörterer, A Mehlhorn, L Deiß, M Walther","doi":"10.1007/s00064-025-00904-x","DOIUrl":"10.1007/s00064-025-00904-x","url":null,"abstract":"<p><strong>Objective: </strong>Repair of the cartilage surface to prevent progression of cartilage pathologies that are associated with pain and limited mobility.</p><p><strong>Indications: </strong>Talar cartilage lesions up to 1 cm².</p><p><strong>Contraindications: </strong>Joint infection, generalized arthritis, poor compliance.</p><p><strong>Surgical technique: </strong>If the cartilage layer is arthroscopically intact: retrograde drilling to increase blood flow and decompress a bone marrow edema or cyst. Superficial cartilage damage: chondroplasty and surface smoothing to limit loose bodies or damage progression. Deep cartilage damage down to the subchondral plate: nano- or microfracture with surface growth cell protrusion to gain replacement cartilage.</p><p><strong>Postoperative management: </strong>For primary smoothing of the cartilage surface, immobilization with partial loading is recommended until proper wound healing. However, if there is cartilage damage that requires replacement cartilage to form, prolonged partial loading for up to 6 weeks, followed by increased loading is required.</p><p><strong>Results: </strong>Chondroplasty is usually used in combination with other treatment steps, so few results are available for this treatment alone. Retrograde drilling shows good results in young patients with still open growth plates. Furthermore, a recurrence rate of up to 50% can occur. Nano- or microfracture shows good to excellent results for lesions up to 1 cm². For larger lesions this procedure alone appears to be insufficient.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"305-311"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Arthroscopic Haglund deformity exostosis resection].","authors":"Klaus Edgar Roth, Kajetan Klos, Robert Ossendorff, Philipp Drees, Hazibullah Waizy","doi":"10.1007/s00064-025-00908-7","DOIUrl":"10.1007/s00064-025-00908-7","url":null,"abstract":"<p><strong>Objective: </strong>Treatment of symptomatic Achilles tendinopathy.</p><p><strong>Indications: </strong>Impingement between the calcaneus and the Achilles tendon.</p><p><strong>Contraindications: </strong>General contraindications. Active soft tissue infection.</p><p><strong>Surgical technique: </strong>Incision medial and lateral to the distal portion of the Achilles tendon at the level of the lower ankle joint, if necessary under X‑ray control. Blunt preparation of the two portals (laterally, taking into account the course of the sural nerve) towards the posterior process of the calcaneus with a curved clamp. Insertion of the arthroscope into the lateral portal and the shaver into the medial portal. Resection of the bursa and visualization of the insertion area of the tendon. Insertion of the bone acromionizer or a burr to resect the offending bone; changing the portal and removing bone portions on the medial side of the calcaneus. If necessary, additional transachillary incision to remove the bone near the insertion. Wound closure.</p><p><strong>Postoperative management: </strong>Immobilization of the foot in equinus position for 3-5 days in a dorsal splint. Retention in a walker for a further 2 weeks after the swelling has subsided. Weight bearing after 3 weeks.</p><p><strong>Results: </strong>A total of 26 patients were retrospectively evaluated with a mean follow-up time of 25 ± 6 months. The Foot Function Index (FFI) improved from 62 preoperatively to 7 points at the last follow-up examination. The final visual analog scale foot and ankle (VAS-FA) score was recorded as 89. Residual symptoms were present in 15% of patients.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"354-361"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modified medial wedge osteotomy for correction of double varus deformity and increased tibial slope].","authors":"Wolf Petersen, Yizhou Ge, Amelie Klaumünzer, Martin Häner","doi":"10.1007/s00064-025-00917-6","DOIUrl":"https://doi.org/10.1007/s00064-025-00917-6","url":null,"abstract":"<p><strong>Objective: </strong>Correction of a double varus deformity and an increased tibial slope.</p><p><strong>Indications: </strong>Medial osteoarthritis (OA) and anterior instability in combination with a double varus deformity (MPTA < 84°, JLCA > 2°) and an increased tibial slope (> 12°).</p><p><strong>Contraindications: </strong>Femoral varus deformity with lateral distal femoral angle of > 91°, severe lateral cartilage damage, lateral OA, lateral loss of the meniscus.</p><p><strong>Surgical technique: </strong>Skin incision medial to the tibial tuberosity of approximately 8-10 cm. Insertion of two converging guide wires directly above the pes anserinus, ascending obliquely above the fibula tip. Check the position of the wires with the image intensifier. Incomplete osteotomy below the guide wires with the oscillating saw. Complete osteotomy of the posterior tibial cortex with a chisel to move the hinge anterolateral. Insertion of two Schanz screws in the proximal and distal fragments from anterior. Ascending osteotomy and removal of a small anterior wedge. Careful opening of the osteotomy with chisels at the level of the posterior tibial cortex. Correction of the tibial reclination with the help of the Schanz screws (\"joystick\"). Check the correction with the image intensifier in two planes. Osteosynthesis with medial angle-stable plate.</p><p><strong>Postoperative management: </strong>Partial weight bearing with 10 kg for 2-6 weeks, then gradually increase the load. Range of motion: free.</p><p><strong>Results: </strong>Using the described surgical technique, 28 patients (7 women, 21 men, age: 36.8 years) with chronic anterior instability or recurrent instability were treated. All patients had a double varus deformity (MPTA < 84°, JLCA > 2°) and a posterior tibial reclination of > 12°. The mean postoperative tibial reclination was 9.1°. The postoperative hip-knee-ankle angle was -0.4°. The Lysholm score increased from an average of 75.2 points to 90.3 points.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Revision anterior cruciate ligament reconstruction with fluoroscopically controlled positioning of the femoral and tibial bone tunnel].","authors":"Christopher Gries, Markus Fink, Maurice Balke, Jürgen Höher","doi":"10.1007/s00064-025-00915-8","DOIUrl":"https://doi.org/10.1007/s00064-025-00915-8","url":null,"abstract":"<p><strong>Objective: </strong>The goal of the fluoroscopically controlled tunnel positioning in anterior cruciate ligament (ACL) revision surgery is the prevention of malpositioning of femoral and tibial tunnel resulting in a reduced risk of rerupture of the ACL graft.</p><p><strong>Indications: </strong>Remaining instability of the ACL after performed surgery, either after tunnel filling or as a single-stage surgery.</p><p><strong>Contraindications: </strong>Relative: minor instability, contraindications against performing intraoperative x‑rays, advanced osteoarthrosis. Absolute: general contraindications against surgery.</p><p><strong>Surgical technique: </strong>Supine position with tourniquet in place and lateral thigh support. Creation of the portals analogous to ACL surgery. Positioning of the drill wires using a targeting device, first femoral, then tibial. Now use of the C‑arm to fluoroscopically check the wire position using the ACL X‑app; correct it if necessary. If the position is adequate, use the quadrant method according to Bernard and Hertel (femoral) or according to Stäubli (tibial) to drill over to the target size of the drill channel. Subsequently, the transplant is drawn in and fixed. If necessary, add additional peripheral stabilization.</p><p><strong>Postoperative management: </strong>Knee brace for 6 weeks postoperatively, limited flexion at 90° for 2-3 weeks, partial weight bearing (20 kg) for 2-3 weeks.</p><p><strong>Results: </strong>In the 51 performed ACL revisions performed, there was a postoperative difference of 1 mm in Rolimeter measurement after 6 months.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}