Operative Orthopadie Und Traumatologie最新文献

{"title":"[Proximalization of the tibial tuberosity as a salvage operation of the symptomatic patella baja].","authors":"Yannick J Ehmann, Michael Götz, Andreas B Imhoff, Sebastian Siebenlist, Julian Mehl","doi":"10.1007/s00064-025-00911-y","DOIUrl":"10.1007/s00064-025-00911-y","url":null,"abstract":"<p><strong>Objective: </strong>Improvement of flexion and thereby restoration of function of the knee joint as well as pain reduction by proximalization of the tibial tuberosity in combination with arthrolysis and release of the patellar retinaculum.</p><p><strong>Indications: </strong>Salvage surgery if conservative or arthroscopic treatment for a patella baja (Canton-Deschamps index < 0.6) has failed, especially in the case of mechanical and pain-related limitation of mobility. The timing for the surgery is crucial; surgery should only be performed after the end of the inflammatory phase and fibrosis of the patella ligament is complete.</p><p><strong>Contraindications: </strong>Possible conservative and arthroscopic therapy attempts, local infection, pseudarthrosis, bone defects of the patella, fracture in the area of the tuberosity, active inflammatory process.</p><p><strong>Surgical technique: </strong>Median longitudinal incision. Combined medial and lateral arthrotomy alongside the patellar tendon. Wedge-shaped tuberosity osteotomy over approximately 7 cm. The patella is thereafter reflected proximally to expose the entire knee joint. Extensive open arthrolysis especially of the superior recess and release of the retinaculum. Proximalized refixation of the tuberosity with at least two screws, depending on the preoperative planning and intraoperative movement control. If necessary, lengthening of the medial and lateral retinaculum to completely close the joint.</p><p><strong>Postoperative management: </strong>Postoperative (post-OP) week 1-6: partial weight bearing 20 kg, knee brace, continuous passive motion (CPM) training, limitation of the range of motion (ROM) to flexion/extension: 90°/0°/0°. Post-OP week 7: additional load of 20 kg per week, free ROM.</p><p><strong>Results: </strong>The authors followed a series of 7 patients with proximalization of the tibial tuberosity in symptomatic patella baja. The authors recorded pre- and postoperative patient-reported outcome measures with an average follow-up of 3.0 ± 2.6 years (range 0.6-7.6 years). The patients were 43 ± 11 years old (6 women, 1 men). There was a significant improvement in the 2000 International Knee Documentation Committee (IKDC)-subjective score (pre-OP: 40 ± 17 vs. post-OP: 72 ± 10; p = 0.011) and in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscore for activities of daily living (pre-OP: 20 ± 23 vs. post-OP: 60 ± 20; p = 0.014). The authors were also able to identify a trend towards improvement, particularly in the Kujala score and the KOOS subscores for pain and physical activity; however no significant improvements were observed. These results make it clear that the proximalization of the patellar tuberosity can improve the subjective outcome in symptomatic patella baja.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"68-75"},"PeriodicalIF":1.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709951","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":"[Tumour-related extra-articular knee joint resection].","authors":"S V Hattem, M M Plöger, D Alex, R Placzek, D C Wirtz, S Koob","doi":"10.1007/s00064-025-00929-2","DOIUrl":"10.1007/s00064-025-00929-2","url":null,"abstract":"<p><strong>Surgical objective: </strong>Wide 'en bloc' extra-articular resection of the knee joint while maintaining the necessary safety margins for adequate oncological therapy and reconstruction using a knee joint endoprosthesis with the aim of preserving good extensibility of the knee joint.</p><p><strong>Indications: </strong>Infiltration of the knee joint by soft tissue or bone sarcomas, pathological intra-articular fractures, (potential) contamination of the knee joint due to inappropriate biopsy approach.</p><p><strong>Contraindications: </strong>Advanced tumour manifestation with no possibility of wide tumour resection with preservation of the extremity, progressive multiple metastatic tumour disease with a short prognosis, florid infections.</p><p><strong>Surgical technique: </strong>Lateral approach, circular incision of the biopsy approach, patella osteotomy in the frontal plane with prior K‑wire marking, careful separation of the retinaculum from the fascia, osteotomy of the distal femur corresponding preoperative planning, distal separation of the gastrocnemius origins for dorsal capsular reconstruction, flexion of the knee joint for better medial separation of the retinaculum from the fascia, marking of the proximal osteotomy of the tibia proximal to the tibial tuberosity to protect the patellar tendon, reconstruction using a modular tumour endoprosthesis after tumour resection.</p><p><strong>Postoperative management: </strong>Axial 20 kg partial weight-bearing for 6 weeks postoperatively in an extension brace and then gradually increasing flexion 30° every 2 weeks in a flexion-limiting knee joint brace. Oncological therapy and aftercare as determined by the tumour board.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"44-54"},"PeriodicalIF":1.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013353","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":"[Resection of soft tissue sarcomas on the thigh].","authors":"Maya Niethard, Daniel Mahr, Sebastian Geis","doi":"10.1007/s00064-025-00924-7","DOIUrl":"10.1007/s00064-025-00924-7","url":null,"abstract":"<p><strong>Objective: </strong>Complete tumor resection while maintaining oncologically required safety margins. The focus is on functional limb preservation, taking into account tumor spread in the individual compartments and the positional relationship to vascular and nerve courses.</p><p><strong>Indications: </strong>Localized tumor disease and complete resection possible. No to acceptable postoperative functional restrictions. Palliative tumor resection in the case of imminent or existing exulceration, for pain reduction or in the case of solitary metastases.</p><p><strong>Contraindications: </strong>Tumors that are not surgically accessible. Advanced or progressive tumors with extensive metastases and short life expectancy. Complete postoperative loss of function of the extremity.</p><p><strong>Surgical technique: </strong>Interdisciplinary planning in the tumor board. Access with consideration of the compartments, whereby the biopsy tract is resected. Dissection taking into account high quality (fascia/adventitia/perineurium/periosteum) and low quality (muscle/fat) resection margins. If necessary: muscular refixation, plastic reconstruction. Multilayer wound closure to reduce the dead space volume with drainage insertion.</p><p><strong>Postoperative management: </strong>Compression therapy using thigh compression stockings or single-leg compression tights compression class 2 with pad. Lymphatic drainage. Physiotherapeutic mobilization taking functional restrictions into account. Oncological therapy/follow-up taking into account grading, resection margins and regression.</p><p><strong>Results: </strong>The outcomes of soft tissue sarcoma resection in the thigh are generally favorable, both oncologically and functionally. Early diagnosis and treatment in specialized centers can improve survival and reduce the amputation rate.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"11-22"},"PeriodicalIF":1.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726884","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":"[Osteoporotic fractures of the posterior pelvic ring : Minimally invasive stabilization via transiliac internal fixation].","authors":"Patrick Gahr, Angelina Garkisch, Manuel Matthis, Sven Märdian","doi":"10.1007/s00064-025-00914-9","DOIUrl":"10.1007/s00064-025-00914-9","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive stabilization of osteoporotic fractures of the posterior pelvic ring to ensure rapid and low-pain mobilization and timely fracture healing while avoiding progressive fracture instability.</p><p><strong>Indications: </strong>Primarily unstable osteoporotic fractures of the posterior pelvic ring, in particular sacroiliac fracture dislocations (OF 5) and bilateral sacral fractures (OF 4), unilateral sacral fractures (OF 3) in constellations indicating a higher degree of instability. In addition to the type of fracture, important clinical parameters and modifiers that indicate greater instability should be taken into account when deciding on treatment options. An important aid for decision-making is the OF Pelvis Score, in which a score above 8 indicates surgical treatment.</p><p><strong>Contraindications: </strong>Major soft tissue damage, decubital ulcers or infections at the surgical site; voluminous implants or defect zones/osteolysis in the transiliac screw corridor; sacroiliac dislocation fractures with a large crescent fragment, which are treated similarly to iliac fractures; high degree of vertical instability with the need for spinopelvic support.</p><p><strong>Surgical technique: </strong>Fluoroscopically assisted minimally invasive implantation of long large-caliber polyaxial screws in both transiliac screw corridors, subfascial insertion of a connecting rod, fixation on both sides with set screws.</p><p><strong>Postoperative management: </strong>Rapid mobilization with weight-bearing as tolerated (WBAT).</p><p><strong>Results: </strong>Between 5/2024 and 3/2025, 10 patients underwent transiliac internal fixation (TIFI) surgery for unstable fractures of the posterior pelvic ring: in 8 cases alone and in the remaining 2 cases in combination with osteosynthesis of the anterior pelvic ring. In 1 patient, the wound had to be revised due to a suture granuloma, otherwise there were no complications requiring revision. In all cases, postoperative computed tomography (CT) imaging confirmed the correct position of the implant. Stabilization of the posterior pelvic ring using TIFI is a minimally invasive, safe and highly stable osteosynthesis with a relatively simple surgical technique.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"457-470"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042431","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":"[Medial collateral ligament bracing].","authors":"Maiti Münchgesang, Daniel Günther","doi":"10.1007/s00064-025-00921-w","DOIUrl":"10.1007/s00064-025-00921-w","url":null,"abstract":"<p><strong>Objective: </strong>Addressing all injured structures and medial stabilization against both valgus stress and rotation.</p><p><strong>Indications: </strong>Acute, isolated medial collateral ligament (MCL) rupture grade III (especially distal and midsubstance rupture) and combined injuries/multiligamentary injury.</p><p><strong>Contraindications: </strong>Contraindications are chronic medial instability or rotational instability with indication for medial reconstruction as well as intolerance/allergy to material or other injuries requiring soft tissue consolidation/other operations (open wounds in the surgical area, fracture especially in the area of fixation). Relative contraindications are open growth plates.</p><p><strong>Surgical technique: </strong>Recommendation for combination of arthroscopy and (mini) open procedure with refixation of superficial MCL (sMCL), if necessary deep MCL (dMCL) and posterior oblique ligament (POL), using suture anchors in anatomical position and under X‑ray control. Additional brace augmentation of the sMCL using tape.</p><p><strong>Postoperative management: </strong>Weeks 1-6 partial weight bearing with 20 kg on crutches. Regardless of the leg axis, the range of motion is gradually increased every 2 weeks in a stabilizing hard-frame orthosis (extension/flexion): week 1-2: 0-20-60°, week 3-4: 0-10-90°, week 5-6: 0-0-90°, From the 7th week onwards, free range of motion, training off orthosis.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"407-420"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490866","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":"[Repair of proximal anterior cruciate ligament tears and internal brace augmentation : Technical note].","authors":"Louisa Bell, Christian Egloff","doi":"10.1007/s00064-025-00919-4","DOIUrl":"10.1007/s00064-025-00919-4","url":null,"abstract":"<p><strong>Objective: </strong>Refixation of anterior cruciate ligament (ACL) tears and augmentation using an Internal Brace® (Arthrex Inc., Naples, FL, USA) has become increasingly popular in recent years. The aim is to preserve the native ligament structure and, thus, improve clinical outcomes.</p><p><strong>Indications: </strong>Indications are proximal ACL tears of Sherman type I and II in the acute phase postinjury. For multiligament injuries, internal brace augmentation can contribute to increased joint stability.</p><p><strong>Contraindications: </strong>ACL refixation is not recommended for distal or middle segment tears and should not be delayed for more than 4 weeks posttrauma to ensure adequate healing.</p><p><strong>Surgical technique: </strong>The rupture is bridged by an ultrahigh-molecular-weight polyethylene tape to reattach the ACL to the femoral footprint.</p><p><strong>Postoperative management: </strong>Functional postoperative treatment involves partial weight-bearing of 15 kg on crutches within 3 weeks postoperatively. High-impact activities should be avoided for the first 6 months postoperatively.</p><p><strong>Results: </strong>The clinical results of ACL augmentation with an Internal Brace® show a slightly increased re-rupture rate compared to ACL replacement, with good to excellent functional outcomes.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"431-438"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12672627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ligament bracing-augmentation techniques for ligament ruptures].","authors":"Wolf Petersen, Andrea Achtnich","doi":"10.1007/s00064-025-00923-8","DOIUrl":"10.1007/s00064-025-00923-8","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"37 6","pages":"385-386"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656459","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":"[Synthetic medial patellofemoral ligament reconstruction in the surgical management of patellar instability].","authors":"Peter Balcarek, Danko Dan Milinkovic, Felix Zimmermann","doi":"10.1007/s00064-025-00918-5","DOIUrl":"10.1007/s00064-025-00918-5","url":null,"abstract":"<p><strong>Objective: </strong>Restoration of passive medial stability of the patella by reconstruction/augmentation of the medial patellofemoral ligament complex.</p><p><strong>Indications: </strong>Treatment of first-time patellar dislocation requiring surgery and recurrent dislocation as an isolated procedure or in combination with concomitant osseous intervention.</p><p><strong>Contraindications: </strong>Patellofemoral pain without objective instability/dislocation of the patella; known material intolerance.</p><p><strong>Surgical technique: </strong>A synthetic ligament is inserted in a V-shaped fashion into the second layer of the medial retinaculum via a 2-incision technique after soft tissue fixation in the area of the patellar medial patellofemoral complex (MPFC) and fixed at the femoral insertion using an interference screw.</p><p><strong>Postoperative management: </strong>Partial weight-bearing for 2-3 weeks as tolerated; active and passive exercises without restriction of range of motion; immediate exercises for quadriceps muscle control, and coordinative exercises as well as stabilization of the functional pelvis-leg axis after full weight-bearing is achieved.</p><p><strong>Results: </strong>The clinical results in the literature consistently show significant improvements in the patient-reported outcome measures and are so far-along with the biomechanical data-comparable with those of autologous tendon reconstruction.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"387-394"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234113","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":"[Flexible suture button construction for the treatment of tibiofibular syndesmosis injuries].","authors":"Ute Petersen, Cara Winter, Yizhoe Ge, Wolf Petersen","doi":"10.1007/s00064-025-00920-x","DOIUrl":"10.1007/s00064-025-00920-x","url":null,"abstract":"<p><strong>Objective: </strong>Stabilization of the distal fibula and tibia to enable elongation-free healing of the ruptured syndesmotic ligaments.</p><p><strong>Indications: </strong>Unstable syndesmotic injuries. Unstable syndesmotic injuries in combination with an ankle fracture. Subacute or chronic syndesmotic injury in combination with another procedure (debridement, fibular osteotomy, new osteosynthesis, ligament reconstruction).</p><p><strong>Contraindications: </strong>Soft tissue infection.</p><p><strong>Surgical technique: </strong>Stabilization of the distance between the fibula and tibia after repositioning using a strong suture cord, which is fixed to the cortex of the tibia and fibula via two buttons. The cord-button construct is inserted minimally invasively under image intensifier control.</p><p><strong>Postoperative management: </strong>Two weeks of partial weight bearing with 15 kg weight, rigid ankle joint orthosis (walker) for 6 weeks, accompanied by physical therapy.</p><p><strong>Results: </strong>The results published to date demonstrate with strong evidence that cord-and-button fixation is superior to screw fixation in terms of clinical scores, correct reduction, and reoperation rates. This applies both to isolated unstable syndesmotic injuries and to syndesmotic injuries combined with fibula fractures. Another advantage of this surgical technique is that implant removal is not necessary in most cases. The disadvantage of this procedure is the high implant cost.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"421-430"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260117","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":"[Augmented reconstruction of the posterior cruciate ligament for acute and chronic posterior instability].","authors":"Svenja Höger, Sebastian Siebenlist, Julian Mehl, Andrea Achtnich","doi":"10.1007/s00064-025-00916-7","DOIUrl":"10.1007/s00064-025-00916-7","url":null,"abstract":"<p><strong>Objective: </strong>Anatomical reconstruction of the posterior cruciate ligament (PCL) with suture tape augmentation to enhance primary stability.</p><p><strong>Indications: </strong>Acute or chronic PCL ruptures, either isolated or as part of multiligamentous injuries, in cases of symptomatic instability or failure of conservative treatment.</p><p><strong>Contraindications: </strong>Fixed posterior drawer, active infection, bony avulsion.</p><p><strong>Surgical technique: </strong>Supine positioning, use of standard portals for arthroscopic PCL reconstruction. Femoral and tibial tunnels are created using a targeting device following preparation of the insertion sites. The hamstring graft is augmented with nonresorbable suture tape. The augmentation suture is fixed separately using a suture anchor under continuous anterior drawer stress. Graft fixation is performed via extracortical device at the femur and with an interference screw at the tibia.</p><p><strong>Postoperative management: </strong>Six weeks of extension bracing with posterior tibial support, worn 24 h/day, and 20 kg partial weight-bearing. This is followed by 6 weeks of continued mobile bracing with posterior tibial support and progressive mobilization and load increase, accompanied by physiotherapy.</p><p><strong>Results: </strong>Biomechanical and early clinical studies suggest promising benefits of augmentation for stability and function, though robust long-term data are still lacking.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"395-406"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006855","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}