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Reifarth E, Naendrup JH, Garcia Borrega J, Altenrath L, Shimabukuro-Vornhagen A, Eichenauer DA, Kochanek M, Böll B. [Handoffs in the intensive care unit]. Med Klin Intensivmed Notfmed 2024; 119:253-259. [PMID: 38498181 DOI: 10.1007/s00063-024-01127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Effective handoffs in the intensive care unit (ICU) are key to patient safety. PURPOSE This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement. MATERIALS AND METHODS Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived. RESULTS The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety. CONCLUSION Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.
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Affiliation(s)
- Eyleen Reifarth
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Jan-Hendrik Naendrup
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jorge Garcia Borrega
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lisa Altenrath
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | | | | | - Matthias Kochanek
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Boris Böll
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Rutz J, Naendrup JH, Bruns C, Classen AY, Salmanton-García J, Seifert H, Sprute R, Stemler J, Walker SV, Cornely OA, Liss BJ, Mellinghoff SC. Individual and institutional predisposing factors of MRSA surgical site infection and outcomes-a retrospective case-control-study in 14 European high-volume surgical centres. JAC Antimicrob Resist 2024; 6:dlae046. [PMID: 38577701 PMCID: PMC10993902 DOI: 10.1093/jacamr/dlae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives To assess incidence rates of surgical site infections (SSI) by MRSA and to determine related factors and clinical outcome compared to MSSA, including country-specific, institutional and patient determinants. Patients and methods We performed a subgroup analysis of the Europe-wide SALT (NCT03353532) study population with MRSA SSI from 14 centres in France, Germany, Italy, Spain and the UK. Results An overall MRSA SSI incidence of 0.06% (n = 104) was found in 178 903 patients undergoing invasive surgery in 2016. Frequently observed comorbidities were chronic cardiovascular disease, diabetes and solid tumours. Compared to the overall MRSA SSI incidence, incidence rates were significantly higher in Spain (58 of 67 934 cases) and lower in Germany (16 of 46 443 cases; both P < 0.05). Centres with antibiotic stewardship (ABS) and infectious disease (ID) consultation programmes (n = 3/14) had lower MRSA rates (17 of 43 556 cases versus 61 of 83 048 cases, P < 0.05). In bivariate analyses, MRSA SSI patients were significantly older, had higher BMI and more comorbidities compared to MSSA (P < 0.05 each). Surgery performed between 6:00 and 12:00 pm led to higher MRSA proportions among S. aureus SSI (17 of 104 cases versus 62 of 640 cases, P < 0.05). Conclusions This study shows low overall and country-specific incidence rates of MRSA SSI in Europe. We could show significant differences between countries as well as between centres with established ABS and ID consultation programmes were observed. The number of those programmes seems too small against this background.
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Affiliation(s)
- Jule Rutz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik Naendrup
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
| | - Caroline Bruns
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Annika Y Classen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Medical Microbiology, Immunology and Hygiene, Cologne, Germany
| | - Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Jannik Stemler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Sarah V Walker
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Medical Microbiology, Immunology and Hygiene, Cologne, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Blasius J Liss
- HELIOS University Clinic of Wuppertal, Department of Haematology, Oncology, Palliative Care and Infectious Disease, Wuppertal, Germany
- University of Witten, Faculty of Health, Witten, Germany
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
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Naendrup JH, Hertrich AC, Briegel J, Reifarth E, Hoffmann J, Mucha A, König V, Weber T. [Onboarding in intensive care and emergency medicine in Germany]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01108-0. [PMID: 38305906 DOI: 10.1007/s00063-024-01108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/14/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND The treatment of acute life-threatening conditions in intensive care and emergency medicine requires in-depth training and education, with initial training playing a key role. RESEARCH QUESTION What is the structure and quality of the initial training of physicians and nurses in intensive care units and emergency departments in Germany? METHODS With the help of survey software, an online questionnaire comprising 40 questions in German on the aforementioned topic was designed. It was distributed via the website of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and via pertinent social media channels. RESULTS In total, 103 nurses and 125 physicians participated in the survey. The average work experience of the participating nurses and physicians was 8.5 ± 5.1 and 3.0 ± 3.1 years, respectively. The majority of participants worked primarily in intensive care units (59%) or in emergency departments (22%). On average, the initial training lasted 45 ± 27 and 13 ± 13 days for nurses and physicians, respectively. Only 20% of the initial training comprised seminars or hands-on workshops taught outside of routine clinical care. In all, 47% of the participants stated that they were not able to complete the entire initial training period. Only 49% had been officially certified for usage of the technical equipment in their department. A total of 35% reported feeling confident or somewhat confident in handling predictable tasks after initial training, but only 15% in handling acute emergencies. DISCUSSION The present study revealed that initial training in intensive care and emergency medicine is frequently incomplete, unstructured, as well as inadequate and bears both safety and liability risks. New concepts are needed to improve the initial training across clinics.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Klinik I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Anna Carola Hertrich
- Zentrum für Anästhesiologie und Intensivmedizin, Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Janika Briegel
- Innere Medizin III - Kardiologie und Angiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Eyleen Reifarth
- Klinik I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Julian Hoffmann
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Abteilung für Intensivmedizin, Klinikum Nürnberg, Nürnberg, Deutschland
| | - Anuschka Mucha
- Klinik I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | | | - Theresa Weber
- Zentrum für Anästhesiologie und Intensivmedizin, Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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Naendrup JH, Steinke J, Garcia Borrega J, Stoll SE, Michelsen PO, Assion Y, Shimabukuro-Vornhagen A, Eichenauer DA, Kochanek M, Böll B. Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome-A Multicenter Propensity Score-Matched Analysis. J Intensive Care Med 2024; 39:84-93. [PMID: 37861125 DOI: 10.1177/08850666231207303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: There are limited and partially contradictory data on the effects of airway pressure release ventilation (APRV) in COVID-19-associated acute respiratory distress syndrome (CARDS). Therefore, we analyzed the clinical outcome, complications, and longitudinal course of ventilation parameters and laboratory values in patients with CARDS, who were mechanically ventilated using APRV. Methods: Respective data from 4 intensive care units (ICUs) were collected and compared to a matched cohort of patients receiving conventional low tidal volume ventilation (LTV). Propensity score matching was performed based on age, sex, blood gas analysis, and APACHE II score at admission, as well as the implementation of prone positioning. Findings: Forty patients with CARDS, who were mechanically ventilated using APRV, and 40 patients receiving LTV were matched. No significant differences were detected for tidal volumes per predicted body weight, peak pressure values, and blood gas analyses on admission, 6 h post admission as well as on day 3 and day 7. Regarding ICU survival, no significant difference was identified between APRV patients (40%) and LTV patients (42%). Median duration of mechanical ventilation and duration of ICU treatment were comparable in both groups. Similar complication rates with respect to ventilator-associated pneumonia, septic shock, thromboembolic events, barotrauma, as well as the necessity for hemodialysis were detected for both groups. Clinical characteristics that were associated with increased mortality in a Cox proportional hazards regression analysis included age (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.04-1.1; P < .001), severe acute respiratory distress syndrome (HR 2.62, 95% CI 1.02-6.7; P = .046) and the occurrence of septic shock (HR 17.18, 95% CI 2.06-143.2; P = .009), but not the ventilation mode. Interpretation: Intensive care unit survival, duration of mechanical ventilation, and ICU treatment as well as ventilation-associated complication rates were equivalent using APRV compared to conventional LTV in patients with CARDS.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jonathan Steinke
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jorge Garcia Borrega
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Sandra Emily Stoll
- Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
| | - Per Ole Michelsen
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz Hospital Cologne, Cologne, Germany
| | - Yannick Assion
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Porz am Rhein Hospital Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Dennis Alexander Eichenauer
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Matthias Kochanek
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Boris Böll
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
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5
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Teschner D, Berisha M, Panse J, Schmitt T, Fiegle E, Naendrup JH, Neitz J, Schmidt-Hieber M, Hentrich M, Böll B, Schalk E. Chlorhexidine gluconate-coated gel pad dressings for prevention of central venous catheter-related bloodstream infections in patients with hematologic diseases or autologous stem cell transplantation: A registry-based matched-pair analysis. Eur J Haematol 2023; 111:914-921. [PMID: 37705250 DOI: 10.1111/ejh.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Chlorhexidine gluconate (CHG)-coated gel pad dressings for central venous catheter (CVC) may prevent CVC-related bloodstream infections (CRBSI). However, real-world data showing beneficial effects in patients with hematologic malignancies are scarce. METHODS In a matched-pair analysis with data from a multicenter CVC registry, non-tunneled jugular and subclavian vein CVC in adults with hematologic malignancies or germ cell tumors (including patients receiving autologous hematopoietic stem cell transplantation [ASCT]) with CHG were compared with non-CHG dressings. The primary endpoint was definite CRBSI rate within 14 days (dCRBSI14) of CVC insertion; secondary endpoints were combined rate of definite or probable CRBSI within 14 days (dpCRBSI14), overall (dpCRBSI), and CRBSI incidences of all estimates. RESULTS In total, 2070 CVCs were assessed. There was no statistically significant difference in dCRBSI14 (2.3% vs. 3.5%) between patients with and without CHG gel dressings. Likewise, with regards to dpCRBSI14 (6.2% vs. 6.3%) and the overall dpCRBSI rate (9.2% vs. 10.5%), no significant difference was detected. Furthermore, dCRBSI14 incidence (2.0 vs. 3.2/1000 CVC days), dpCRBSI14 incidence (5.4 vs. 5.6/1000 CVC days), and overall CRBSI incidence (5.5 vs. 6.0/1000 CVC days) showed no significant differences. CONCLUSIONS CRBSI rates were not reduced by the use of CHG gel dressings in patients with hematologic malignancies and/or ASCT.
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Affiliation(s)
- Daniel Teschner
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Department of Hematology, and Medical Oncology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mirjeta Berisha
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Faculty, Magdeburg, Germany
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology, and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Timo Schmitt
- Department of Hematology, and Medical Oncology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Hamm Hospital Nahetal, Bad Kreuznach, Germany
| | - Eva Fiegle
- Department of Oncology, Hematology, Hemostaseology, and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Jan-Hendrik Naendrup
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Julia Neitz
- Department of Hematology, and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, Pneumology, and Nephrology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Marcus Hentrich
- Department of Hematology, and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Boris Böll
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Faculty, Magdeburg, Germany
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Wolff J, Becker J, Naendrup JH, Borrega JG, Heger JM, Hamacher L, Böll B, Eichenauer DA, Shimabukuro-Vornhagen A, Kochanek M. [Team-specific impacts of the corona pandemic on intensive care medicine personnel of a maximum care hospital]. Med Klin Intensivmed Notfmed 2023; 118:556-563. [PMID: 36121481 PMCID: PMC9484350 DOI: 10.1007/s00063-022-00959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/01/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
The ongoing strain on personnel in the healthcare system during the COVID-19 pandemic is considerable and poses major emotional and psychological challenges for the personnel. In a team evaluation (physicians and nurses), team-specific stress, possible relief strategies, positive and negative experiences, and wishes for improvement of the situation in an intensive care unit were collected. While both occupational groups perceived equally high emotional stress intensities, nursing additionally perceived high stress intensities in the organizational and physical areas. Thus, the occupational group of nurses proves to be the most stressed by the COVID-19 pandemic. The findings presented here can be used to derive instructions for future actions.
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Affiliation(s)
- Jochen Wolff
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
- Seelsorge Uniklinik Köln, Universitätsklinik Köln, Köln, Deutschland
| | - Jürgen Becker
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jorge Garcia Borrega
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jan-Michel Heger
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Laura Hamacher
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Boris Böll
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Dennis A Eichenauer
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Matthias Kochanek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland.
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7
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Mellinghoff SC, Bruns C, Albertsmeier M, Ankert J, Bernard L, Budin S, Bataille C, Classen AY, Cornely FB, Couvé-Deacon E, Fernandez Ferrer M, Fortún J, Galar A, Grill E, Guimard T, Hampl JA, Wingen-Heimann S, Horcajada JP, Köhler F, Koll C, Mollar J, Muñoz P, Pletz MW, Rutz J, Salmanton-García J, Seifert H, Serracino-Inglott F, Soriano A, Stemler J, Vehreschild JJ, Vilz TO, Naendrup JH, Cornely OA, Liss BJ. Staphylococcus aureus surgical site infection rates in 5 European countries. Antimicrob Resist Infect Control 2023; 12:104. [PMID: 37726843 PMCID: PMC10507841 DOI: 10.1186/s13756-023-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To determine the overall and procedure-specific incidence of surgical site infections (SSI) caused by Staphylococcus aureus (S. aureus) as well as risk factors for such across all surgical disciplines in Europe. METHODS This is a retrospective cohort of patients with surgical procedures performed at 14 European centres in 2016, with a nested case-control analysis. S. aureus SSI were identified by a semi-automated crossmatching bacteriological and electronic health record data. Within each surgical procedure, cases and controls were matched using optimal propensity score matching. RESULTS A total of 764 of 178 902 patients had S. aureus SSI (0.4%), with 86.0% of these caused by methicillin susceptible and 14% by resistant pathogens. Mean S. aureus SSI incidence was similar for all surgical specialties, while varying by procedure. CONCLUSIONS This large procedure-independent study of S. aureus SSI proves a low overall infection rate of 0.4% in this cohort. It provides proof of principle for a semi-automated approach to utilize big data in epidemiological studies of healthcare-associated infections. Trials registration The study was registered at clinicaltrials.gov under NCT03353532 (11/2017).
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Affiliation(s)
- Sibylle C Mellinghoff
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Caroline Bruns
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Juliane Ankert
- Institute of Infectious Diseases and Infection Control, University Hospital Jena, Jena, Germany
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Sofia Budin
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Camille Bataille
- INSERM, CHU Limoges, UMR 1092, Université Limoges, Limoges, France
| | - Annika Y Classen
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian B Cornely
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Maria Fernandez Ferrer
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Fortún
- Infectious Diseases Department, CIBERINFEC, Hospital Ramón y Cajal, Madrid, Spain
| | - Alicia Galar
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
| | - Thomas Guimard
- Service de Médecine Post-Urgence, CH Départemental de Vendée, La Roche Sur Yon, France
| | - Jürgen A Hampl
- Faculty of Medicine and University Hospital Cologne, Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Sebastian Wingen-Heimann
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- FOM University of Applied Sciences, Cologne, Germany
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Felix Köhler
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Department II of Internal Medicine and Centre for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carolin Koll
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Joan Mollar
- Preventive Medicine Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, University Hospital Jena, Jena, Germany
| | - Jule Rutz
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jon Salmanton-García
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Harald Seifert
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | | | - Alex Soriano
- Department of Infectious Diseases, Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERINF, Ciber in Infectious Diseases, Barcelona, Spain
| | - Jannik Stemler
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Janne J Vehreschild
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine and University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Tim O Vilz
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Jan-Hendrik Naendrup
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Oliver A Cornely
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Blasius J Liss
- Department I of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany
- School of Medi-Cine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Heger JM, Böll B, Naendrup JH, Simon F, Gräf CM, Hallek M, Shimabukuro-Vornhagen A, Kochanek M, Eichenauer DA, Garcia Borrega J. Hyperleukocytosis in patients with acute myeloid leukemia admitted to the intensive care unit: a single-center retrospective analysis. Leuk Res 2023; 132:107352. [PMID: 37423072 DOI: 10.1016/j.leukres.2023.107352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
A relevant proportion of patients with acute myeloid leukemia (AML) presenting with hyperleukocytosis are admitted to the intensive care unit (ICU). However, data on characteristics and outcomes of these patients are limited. We therefore conducted a single-center retrospective analysis including 69 consecutive AML patients with a white blood cell (WBC) count > 100.000/µl who had been treated on the ICU between 2011 and 2020. The median age was 63 years (range: 14-87 years). Males accounted for the majority of cases (n = 43; 62.3%). Mechanical ventilation (MV), renal replacement therapy and the use of vasopressors were necessary in 34.8%, 8.7% and 40.6% of patients, respectively. Cardiopulmonary resuscitation was performed in 15.9% of patients. The ICU, hospital, 90-day and 1-year survival rates were 53.6%, 43.5%, 42% and 30.4%, respectively. Age (p = 0.002), SOFA score (p < 0.001) and MV (p < 0.001) were independently associated with a reduced survival probability. A score comprising the factors age > 70 years, lactate dehydrogenase level > 1500 U/l, WBC count > 150.000/µl, elevated lactate level and SOFA score > 7 allowed the discrimination of 3 distinct risk groups (low-risk: 0-1 points, intermediate-risk: 2 points, high-risk: 3-5 points) with regard to survival (p < 0.0001). Taken together, the present analysis indicates that more than two-thirds of AML patients with hyperleukocytosis treated on the ICU die within 1 year. However, outcomes vary considerably depending on the presence of risk factors.
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Affiliation(s)
- Jan-Michel Heger
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Boris Böll
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Jan-Hendrik Naendrup
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Florian Simon
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Claus Moritz Gräf
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Michael Hallek
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Matthias Kochanek
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Dennis A Eichenauer
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany.
| | - Jorge Garcia Borrega
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
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Pfeiffer TR, Althoff A, Krombholz S, Dautert M, Naendrup JH, Guenther D, Bouillon B, Thevis M. Vancomycin Concentrations in Synovial Fluid Do Not Reach Chondrotoxic Thresholds After Anterior Cruciate Ligament Reconstruction With Vancomycin-Soaked Autologous Soft Tissue Grafts: An In Vivo Prospective Observational Study in Humans. Am J Sports Med 2023:3635465231169040. [PMID: 37161935 DOI: 10.1177/03635465231169040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Studies have revealed that vancomycin soaking of the anterior cruciate ligament (ACL) graft can drastically reduce the incidence of postoperative infections after ACL reconstruction. However, it remains unknown whether the chondrotoxic threshold of vancomycin in synovial fluid is exceeded during this process. Several studies investigated the chondrotoxic properties of vancomycin in in vitro experiments and described a concentration of 1000 µg/mL as the critical threshold. PURPOSE/HYPOTHESIS The purpose of the study was to measure the vancomycin concentration in synovial fluid after ACL reconstruction with vancomycin-soaked autografts. It was hypothesized that intra-articular vancomycin concentrations in the synovial fluid would not reach the chondrotoxic threshold of 1000 µg/mL after vancomycin soaking of autologous semitendinosus tendon and soft tissue quadriceps tendon grafts for ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study enrolled 10 patients undergoing ACL reconstruction using 4-strand semitendinosus tendon autografts and 10 patients undergoing ACL reconstruction using soft tissue quadriceps tendon autografts. Before implantation, each harvested graft was intraoperatively wrapped in gauze swabs that had been soaked in a 5-mg/mL vancomycin solution. After wound closure, an aspirate of 5 mL of synovial fluid was taken from each patient. The vancomycin concentration of the aspirate was analyzed using high-performance liquid chromatography-tandem mass spectrometry. Spearman rho correlation coefficients were used to identify relationships between the parameters, and the t test was used to test for differences between graft types. A P value of <.05 was considered statistically significant. RESULTS The study included 20 patients (14 women and 6 men; age, 29.35 ± 11.3 years). The mean vancomycin concentration measured in the synovial fluid was 23.23 ± 21.68 µg/mL, with a minimum concentration of 2.32 µg/mL and a maximum concentration of 71.56 µg/mL. No significant difference was found between the 2 graft types (P = .911). Significant positive correlation (r = 0.644; P < .05) was observed only between the vancomycin concentration and the mean duration from initiation of vancomycin soaking of semitendinosus tendon grafts to implantation (13.4 ± 6 minutes). No correlations were observed between the vancomycin concentration and the duration from implantation to fluid aspiration or between the vancomycin concentration and the graft diameter (median, 8.5 mm; range, 6.0-10.0 mm) for both graft types. CONCLUSION Chondrotoxic vancomycin concentrations ≥1000 µg/mL were not reached in any aspiration of synovial fluid after ACL reconstruction using soft tissue autografts that were intraoperatively soaked in a 5-mg/mL vancomycin solution. Against the backdrop of multiple studies that showed significantly reduced infection rates after ACL reconstruction when vancomycin soaking was used, this study suggests that the chondrotoxic properties of this method are negligible because of its submarginal intra-articular concentrations.
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Affiliation(s)
- Thomas R Pfeiffer
- Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Arne Althoff
- Department of Experimental Sports Traumatology, Witten/Herdecke University, Witten, Germany
| | - Sophia Krombholz
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Max Dautert
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Jan-Hendrik Naendrup
- Department of Experimental Sports Traumatology, Witten/Herdecke University, Witten, Germany
| | - Daniel Guenther
- Department of Experimental Sports Traumatology, Witten/Herdecke University, Witten, Germany
| | - Bertil Bouillon
- Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Mario Thevis
- Center for Preventive Doping Research, Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
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Hentrich M, Böll B, Teschner D, Panse J, Schmitt T, Naendrup JH, Schmidt-Hieber M, Neitz J, Fiegle E, Schalk E. Impact of the insertion site of central venous catheters on central venous catheter-related bloodstream infections in patients with cancer: results from a large prospective registry. Infection 2023:10.1007/s15010-023-02029-4. [PMID: 37016194 DOI: 10.1007/s15010-023-02029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Overall, insertion of central venous catheter (CVC) into femoral veins (FV) has been shown to be associated with a higher risk of infection compared with subclavian and internal jugular (IJV/SCV) CVC, but no data are available on the impact of the FV insertion site on the CVC-related bloodstream infections (CRBSI) risk in patients with cancer. The objective of the study is to compare CRBSI rates and incidences of FV with those of internal jugular and subclavian vein (IJV/SCV CVC) as observed in the prospective SECRECY registry. METHODS SECRECY is an ongoing observational, prospective, clinical CRBSI registry active in six departments of hematology/oncology in Germany. Each case of FV CVC was matched at a ratio of 1:1 to a case with IJV/SCV CVC. The propensity score was estimated using a multivariable logistic regression model adjusting for age, sex, cancer type, and duration of indwelling catheter. RESULTS Of 4268 CVCs included in this analysis, 52 (1.2%) were inserted into the FV and 4216 (98.8%) into the IJV/SCV. 52 cases of FV CVC were matched with 52 IJV/SCV CVC. There was no significant difference in the CRBSI rate (3.8% vs. 9.6%), the CRBSI incidence (5.7 vs. 14.2/1000 CVC days), and the median CVC time (5.5 vs. 5 days) between the FV and the IJV/SCV group. CONCLUSION Based on this data, inserting FV CVCs in patients with cancer does, at least in the short-term, not appear to be associated with an increased risk of CRBSI as compared to IJV/SCV CVC.
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Affiliation(s)
- Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, University of Munich, Nymphenburger Str. 163, 80634, Munich, Germany.
| | - Boris Böll
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Daniel Teschner
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Panse
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Timo Schmitt
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the, Johannes Gutenberg University Mainz, Mainz, Germany
- Hamm Hospital Nahetal, Bad Kreuznach, Germany
| | - Jan-Hendrik Naendrup
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, Pneumology and Nephrology, Carl-Thiem Hospital Cottbus, Cottbus, Germany
| | - Julia Neitz
- Department of Hematology and Oncology, Red Cross Hospital Munich, University of Munich, Nymphenburger Str. 163, 80634, Munich, Germany
| | - Eva Fiegle
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Center, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
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Mutschler M, Naendrup JH, Pfeiffer TR, Jaecker V, Arbab D, Shafizadeh S, Buchhorn T. Current status of the management of isolated syndesmotic injuries in Germany. Arch Orthop Trauma Surg 2023; 143:2019-2026. [PMID: 35403865 PMCID: PMC10030432 DOI: 10.1007/s00402-022-04423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/10/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Although non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany. MATERIALS AND METHODS An online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS. RESULTS Each question of the questionnaire was on average answered by 431 ± 113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior-posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices. CONCLUSIONS While arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.
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Affiliation(s)
- Manuel Mutschler
- Witten/Herdecke University, Witten/Herdecke, Germany, Alfred-Herrhausen-Straße 50, 58448.
- Department of Foot Surgery, Waldkrankenhaus Bonn, Johanniter GmbH, Bonn, Germany, Waldstraße 73, 53177.
| | - Jan-Hendrik Naendrup
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
- Department of Oncology, HaematologyInfectiology and Internistic Critical Care Medicine, University of Cologne, Cologne, Germany
| | - Thomas R Pfeiffer
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Vera Jaecker
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Dariusch Arbab
- Witten/Herdecke University, Witten/Herdecke, Germany, Alfred-Herrhausen-Straße 50, 58448
- Department of Orthopaedic Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Sven Shafizadeh
- Witten/Herdecke University, Witten/Herdecke, Germany, Alfred-Herrhausen-Straße 50, 58448
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Sana Medical Centre Cologne, Cologne, Germany
| | - Tomas Buchhorn
- Foot and Ankle Department, Sporthopaedicum Straubing-Regensburg, Straubing, Germany
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Naendrup JH, Steinke J, Grans-Siebel J, Koehler P, Böll B. COVID-19-associated pulmonary aspergillosis (CAPA) might be associated with increased risk for pneumopleural fistula. Intensive Care Med 2023; 49:606-608. [PMID: 36976304 PMCID: PMC10044053 DOI: 10.1007/s00134-023-07040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Jan-Hendrik Naendrup
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jonathan Steinke
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Judit Grans-Siebel
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Philipp Koehler
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, Translational Research, University of Cologne, Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Garcia Borrega J, Böll B, Kochanek M, Naendrup JH, Simon F, Sieg N, Hallek M, Borchmann P, Holtick U, Shimabukuro-Vornhagen A, Eichenauer DA, Heger JM. Characteristics and outcomes of patients undergoing high-dose chemotherapy and autologous stem cell transplantation admitted to the intensive care unit: a single-center retrospective analysis. Ann Hematol 2023; 102:191-197. [PMID: 36394583 PMCID: PMC9807528 DOI: 10.1007/s00277-022-05028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplantation (ASCT) can be associated with adverse events necessitating treatment on the intensive care unit (ICU). Data focusing on patients admitted to the ICU during hospitalization for high-dose chemotherapy and ASCT are scarce. We thus conducted a single-center retrospective analysis comprising 79 individuals who had high-dose chemotherapy and ASCT between 2014 and 2020 and were admitted to the ICU between the initiation of conditioning therapy and day 30 after ASCT. The median age was 57 years (range: 20-82 years); 38% of patients were female. B-cell non-Hodgkin lymphoma (34%) and plasma cell disorders (28%) were the most common indications for high-dose chemotherapy and ASCT. Sepsis represented the major cause for ICU admission (68%). Twenty-nine percent of patients required mechanical ventilation (MV), 5% had renal replacement therapy, and 44% needed vasopressors. The ICU, hospital, 90-day, and 1-year survival rates were 77.2%, 77.2%, 72.2%, and 60.3%, respectively. Stable disease or disease progression prior to the initiation of high-dose chemotherapy (p = 0.0028) and MV (p < 0.0001) were associated with an impaired survival. A total of 36 patients died during observation. The most frequent causes of death were the underlying malignancy (44%) and sepsis (39%). Taken together, the present analysis indicates a favorable overall outcome for patients admitted to the ICU during hospitalization for high-dose chemotherapy and ASCT. Thus, this patient group should not be denied admission and treatment on the ICU.
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Affiliation(s)
- Jorge Garcia Borrega
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Matthias Kochanek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Florian Simon
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Noelle Sieg
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Michael Hallek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Udo Holtick
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Dennis A. Eichenauer
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jan-Michel Heger
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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14
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Schalk E, Schmitt T, Panse J, Fiegle E, Naendrup JH, Schmidt-Hieber M, Böll B, Hentrich M, Teschner D, Mougiakakos D. Central venous catheter-related bloodstream infections in patients with haematological malignancies during the SARS-CoV-2 pandemic. Br J Haematol 2022; 199:e16-e20. [PMID: 36017820 PMCID: PMC9538284 DOI: 10.1111/bjh.18442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Enrico Schalk
- Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Timo Schmitt
- Department of Haematology, Medical Oncology and Pneumology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Eva Fiegle
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Jan-Hendrik Naendrup
- Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany.,Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Martin Schmidt-Hieber
- Clinic of Haematology, Oncology and Pneumology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Boris Böll
- Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany.,Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Marcus Hentrich
- Department of Haematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Daniel Teschner
- Department of Haematology, Medical Oncology and Pneumology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Dimitrios Mougiakakos
- Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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15
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Panse J, Tölle D, Fiegle E, Naendrup JH, Schmidt-Hieber M, Böll B, Hentrich M, Teschner D, Schalk E. Scheduled removal of central venous catheters (CVC) to prevent CVC-related bloodstream infections in patients with hematological disease or autologous stem cell transplantation: a registry-based randomized simulation-study. Ann Hematol 2022; 101:2317-2324. [PMID: 35978182 PMCID: PMC9463193 DOI: 10.1007/s00277-022-04958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/13/2022] [Indexed: 12/02/2022]
Abstract
Although not generally recommended, scheduled central venous catheter (CVC) removal is sometimes carried out in order to reduce the CVC-related bloodstream infection (CRBSI) incidence. We conducted a simulation for scheduled CVC removal within the multicenter CRBSI registry (SECRECY). Non-tunneled jugular and subclavian CVC in patients with hematological disease or with germ cell tumors (including patients receiving autologous stem cell transplantation [SCT]) were included. Cases were randomized in a 1:1:1:1 ratio to either a simulated, scheduled CVC removal after 7, 14, and 21 days, or to non-simulated, unscheduled CVC removal (control group). The primary endpoint was definitive CRBSI incidence for a scheduled CVC removal after 14 days (dCRBSI-D14rmv). Among other, secondary endpoints were definite CRBSI incidence for a scheduled removal after 7 days (dCRBSI-D7rmv) and 21 days (dCRBSI-D21rmv). Data on 2984 CVC were included. Patients’ median age was 59 (range 16–95) years, 58.8% being male. The vast majority (98.4%) were patients with hematological malignancies. Jugular veins were the main insertion site (93.2%). dCRBSI-D14rmv was 3.10/1000 CVC days as compared to 4.15/1000 CVC days in the control group (p = 0.23). There was a significant difference between dCRBSI-D7rmv (0.86/1000 CVC days) and controls (p < 0.001), but not between dCRBSI-D21rmv (4.10/1000 CVC days) and controls (p = 0.96). Our data suggest that in patients with hematological diseases or autologous SCT recipients scheduled CVC removal after 14 days does not result in a lower CRBSI incidence compared to unscheduled removal. Trial registration: DRKS00006551, 2014/09/29, retrospectively registered.
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Affiliation(s)
- Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Daniela Tölle
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Fiegle
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Jan-Hendrik Naendrup
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany.,Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, and Pneumology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Boris Böll
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany.,Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Daniel Teschner
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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16
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Graef CM, Gödel P, Falderbaum P, Balke-Want H, Simon F, Sieg N, Naendrup JH, Neumann MAC, Gillessen S, Bröckelmann PJ, Eichenauer DA, Borchmann P, von Tresckow B, Heger JM. Impact of timing and precision of histopathological diagnosis on outcomes of patients with Burkitt lymphoma and high-grade B-cell lymphoma. Eur J Haematol 2022; 108:403-412. [PMID: 35090068 DOI: 10.1111/ejh.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) are aggressive B-cell non-Hodgkin lymphomas (B-NHL) with a generally favorable prognosis after immunochemotherapy. The outcome of BL is superior to DLBCL. In 2016, a distinct group of lymphomas displaying characteristics of both BL and DLBCL (high grade B-cell lymphoma, HGBL) was introduced into the WHO classification. Histopathological discrimination of BL, DLBCL, and HGBL may be challenging. Data on the frequency of histopathological difficulties resulting in revision of the final diagnosis of BL/DLBCL/HGBL and its impact on the prognosis are limited. METHODS We assessed histopathological features and clinical outcomes of 66 patients with suspected diagnosis of BL at the reporting institution between 2010 and 2020. RESULTS The median age was 51 years (range 19-82) and final histopathological diagnosis revealed BL (n = 40), DLBCL (n = 12), or HGBL (n = 14). Patients with DLBCL and HGBL were either treated with DLBCL-directed (83.3% and 35.7%) or BL-directed (16.7% and 64.3%) protocols. Patients in whom diagnosis was revised from DLBCL to BL after initiation of DLBCL-directed treatment had a significantly inferior progression-free survival (PFS) than patients initially diagnosed with BL (p = 0.045), thus resembling rather the prognosis of DLBCL/HGBL. There was no difference between patients with DLBCL and HGBL, respectively, regarding PFS and OS (p = 0.38 and p = 0.27). CONCLUSION These results suggest that timely and precise histopathological diagnosis as well as reference histopathological review of the underlying lymphoma is critical to determine up-front treatment strategies. Consequently, selection of more aggressive treatment protocols in case of difficulties with discrimination between DLBCL/HGBL/BL may be a reasonable approach.
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Affiliation(s)
- Claus Moritz Graef
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Philipp Gödel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Philipp Falderbaum
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany
| | - Hyatt Balke-Want
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, USA.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Florian Simon
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Noëlle Sieg
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Jan-Hendrik Naendrup
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Marie Anne-Catherine Neumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Sarah Gillessen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Paul J Bröckelmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Dennis A Eichenauer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Jan-Michel Heger
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University of Cologne, University Hospital of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
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17
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Naendrup JH, Garcia Borrega J, Eichenauer DA, Shimabukuro-Vornhagen A, Kochanek M, Böll B. Reactivation of EBV and CMV in Severe COVID-19-Epiphenomena or Trigger of Hyperinflammation in Need of Treatment? A Large Case Series of Critically ill Patients. J Intensive Care Med 2021; 37:1152-1158. [PMID: 34791940 PMCID: PMC9396115 DOI: 10.1177/08850666211053990] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Reactivation of viruses such as Epstein-Barr virus (EBV) and cytomegalovirus
(CMV) are common in critically ill patients and have been described in
patients with severe COVID-19. However, it is unclear whether these
reactivations are associated with increased mortality and whether targeted
treatments are beneficial. Methods In a retrospective single-center cohort study, patients with severe COVID-19
treated on our intensive care unit (ICU) were screened for EBV and CMV
reactivation as detected by polymerase chain reaction. If present, patient
characteristics, temporal connections to severe acute respiratory syndrome
coronavirus 2 diagnosis and corticosteroid use, the use of targeted
treatments as well as the course of disease and outcome were analyzed. As
control group, non-COVID-19 patients with sepsis, treated within the same
time period on our ICU, served as control group to compare incidences of
viral reactivation. Results In 19 (16%) of 117 patients with severe COVID-19 treated on our ICU EBV
reactivations were identified, comparable 18 (14%) of 126 in the
non-COVID-19 control group (P = .672). Similarly, in 11
(9%) of 117 patients CMV reactivations were identified, comparable to the 16
(13%) of 126 in the non-COVID-19 sepsis patients
(P = .296). The majority of EBV (58%) and CMV reactivations
(55%) were detected in patients under systemic corticosteroid treatment. 7
(37%) of 19 patients with EBV reactivation survived the ICU stay, 2 (29%) of
7 patients with rituximab treatment and 5 (42%) of 12 patients without
treatment (P = .568). Five (50%) of 10 patients with CMV
reactivation survived the ICU stay, 5 (83%) of 6 patients with ganciclovir
treatment and 0 of 4 patients without treatment (P = .048).
Follow-up analysis in these patients showed that the initiation of treatment
lead to decrease in viral load. Conclusion Critically ill patients with COVID-19 are at a high risk for EBV and CMV
reactivations. Whether these reactivations are a cause of hyperinflammation
and require targeted treatment remains uncertain. However, in patients with
clinical deterioration or signs of hyperinflammation targeted treatment
might be beneficial and warrants further studying.
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Affiliation(s)
| | | | | | | | | | - Boris Böll
- 27182University of Cologne, Cologne, Germany
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18
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Garcia Borrega J, Naendrup JH, Heindel K, Hamacher L, Heger E, Di Cristanziano V, Deppe AC, Dusse F, Wetsch WA, Eichenauer DA, Shimabukuro-Vornhagen A, Böll B, Kochanek M. Clinical Course and Outcome of Patients with SARS-CoV-2 Alpha Variant Infection Compared to Patients with SARS-CoV-2 Wild-Type Infection Admitted to the ICU. Microorganisms 2021; 9:1944. [PMID: 34576839 PMCID: PMC8470850 DOI: 10.3390/microorganisms9091944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022] Open
Abstract
The alpha variant of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is associated with higher transmissibility and possibly higher mortality compared with wild-type SARS-CoV-2. However, few data are available on the clinical course of infections with the alpha variant compared with wild-type SARS-CoV-2 in critically ill patients in intensive care units (ICUs). Therefore, we retrospectively analyzed patients admitted to our ICU due to SARS-CoV-2 Alpha variant infection and compared characteristics and course to patients with SARS-CoV-2 wild-type infection. The median age of patients with Alpha variant infections was 57 years compared to 62 years in the wild-type group. ICU survival was 41/80 (51%) in the Alpha variant group and 35/80 (44%) in the wild-type group (p = 0.429). Results of a matched-pair analysis based on age and sex illustrated that 45/58 patients (77.6%) in the Alpha variant group and 38/58 (65.5%) patients in the wild-type group required mechanical ventilation (p = 0.217). ICU survival was documented for 28/58 patients (48.3%) in the Alpha variant group and 27/58 patients (46.6%) in the wild-type group (p = 1). Thus, ICU mortality among patients with SARS-CoV-2 infections remains high. Although the Alpha variant group included younger patients requiring mechanical ventilation, no significant differences between patients with the SARS-CoV-2 Alpha variant and the SARS-CoV-2 wild-type, respectively, were detected with respect to clinical course and ICU mortality. For future VOCs, we believe it would be important to obtain valid and rapid data on the clinical course of critically ill patients who test positive for COVID-19 in order to perform appropriate epidemiological planning of intensive care capacity.
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Affiliation(s)
- Jorge Garcia Borrega
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Katrin Heindel
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Laura Hamacher
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Eva Heger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.H.); (V.D.C.)
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.H.); (V.D.C.)
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, ECMO Centre Cologne, Heart Centre, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Fabian Dusse
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (F.D.); (W.A.W.)
| | - Wolfgang Alois Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (F.D.); (W.A.W.)
| | - Dennis Alexander Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Boris Böll
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Matthias Kochanek
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
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Sieg N, Naendrup JH, Gödel P, Balke-Want H, Simon F, Deckert M, Gillessen S, Kreissl S, Bröckelmann PJ, Borchmann P, von Tresckow B, Heger JM. Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX-based regimens in clinical routine. Eur J Haematol 2021; 107:202-210. [PMID: 33960535 DOI: 10.1111/ejh.13639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high-dosed methotrexate (MTX)-based therapies. METHODS We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010-2020 at the University Hospital of Cologne, Germany. RESULTS Patients were 23-88 years of age and either treated with MTX-based regimens (PRIMAIN, MARTA, MATRix), individual regimens, or best supportive care, respectively. Overall response rates were generally high (66,7-83,8%), but different organ toxicities required dose adjustments in most groups. Two-year overall survival rates were 57,9% (PRIMAIN), 63,6% (MARTA), 65,4% (MATRix), and 37,5% (Other), respectively. Out of 9 patients suffering from relapse >12 months from primary diagnosis, 7 patients (77,8%) received methotrexate-based salvage therapy with 2-year overall survival of 4/6 patients (66,7%). CONCLUSION Although a relevant proportion of patients are not eligible for clinical trials due to age, performance status, or comorbidities, these results prove feasibility of different MTX-based treatment strategies in clinical routine. Even elderly patients displayed surprisingly favorable outcomes. However, with compromising organ toxicities, reduction of intensity should be part of strategies in future clinical trials.
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Affiliation(s)
- Noëlle Sieg
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Jan-Hendrik Naendrup
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Philipp Gödel
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Hyatt Balke-Want
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA.,Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Simon
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Martina Deckert
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA.,Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sarah Gillessen
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Stefanie Kreissl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Paul J Bröckelmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Peter Borchmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Bastian von Tresckow
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA.,Cancer Center Cologne Essen (CCCE), Cologne and Essen, Germany
| | - Jan-Michel Heger
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Cologne Lymphoma Working Group, Cologne, Germany.,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
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Naendrup JH, Marche B, de Sa D, Koenen P, Otchwemah R, Wafaisade A, Pfeiffer TR. Vancomycin-soaking of the graft reduces the incidence of septic arthritis following ACL reconstruction: results of a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2020; 28:1005-1013. [PMID: 30656372 DOI: 10.1007/s00167-019-05353-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/11/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE (1) To compare the incidence of post-operative septic arthritis following anterior cruciate ligament reconstruction (ACLR) between patients receiving routine pre-operative intravenous (IV) prophylaxis only intravenous (IV) infection prophylaxis and patients receiving additional graft-soaking in a vancomycin solution (5 mg/ml) perioperatively. (2) To review the literature regarding effects of graft-soaking in vancomycin solutions on outcomes, complication rates and tendon properties in ACLR. METHODS To identify studies pertaining to routine pre-operative IV prophylaxis and additional usage of intra-operative vancomycin-soaked grafts in primary ACLR, the Cochrane Library, SCOPUS and MEDLINE were searched till June 2018 for English and German language studies of all levels of evidence following the PRISMA guidelines. Additionally, all accepted abstracts at the ESSKA 2018, ISAKOS 2017, AGA 2017 and AOSSM 2017 meetings were screened. Data regarding the incidence of septic arthritis were abstracted and combined in a meta-analysis. Data including outcome scores, complication rates and in vitro analyses of tendon properties were collected and summarized descriptively. RESULTS Upon screening 785 titles, 8 studies were included. These studies examined 5,075 patients following ACLR and followed from 6 to 52 weeks post-operatively. Of those 2099 patients in the routine pre-operative IV prophylaxis group, 44 (2.1%) cases of early septic arthritis were reported. In contrast, there were no reports of septic arthritis following ACLR in 2976 cases of vancomycin-soaked grafts. The meta-analysis yielded an odds ratio of 0.04 (0.01-0.16) favouring the addition of intra-operative vancomycin-soaking of grafts. Across all available studies, no differences in clinical outcome (i.e. incidence of ACL revision, IKDC score, Tegner score), biomechanical tendon properties, or cartilage integrity between patients with and without vancomycin-soaked grafts were identified. CONCLUSION The incidence of septic arthritis following ACLR can be reduced dramatically by vancomycin-soaking the grafts intra-operatively prior to graft passage and fixation. Within the limitation confines of this study, intra-operative graft-soaking in vancomycin appears to be a safe and effective method to reduce the incidence of septic arthritis following ACLR. Still, it remains debatable if the available data facilitate the recommendation for a universal application of vancomycin-soaking for all ACLR patients or if it should be reserved for patients at risk, including the use hamstring tendons, revision cases and in the presence of medical preconditions. LEVEL OF EVIDENCE Level IV, systematic review of Level III and Level IV studies.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany.,Department of Orthopaedic Surgery, University of Pittsburgh-UPMC Rooney Sports Complex, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Benedikt Marche
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Darren de Sa
- Department of Orthopaedic Surgery, University of Pittsburgh-UPMC Rooney Sports Complex, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Paola Koenen
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Robin Otchwemah
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Arasch Wafaisade
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Thomas R Pfeiffer
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany. .,Department of Orthopaedic Surgery, University of Pittsburgh-UPMC Rooney Sports Complex, 3200 S Water St, Pittsburgh, PA, 15203, USA.
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21
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Patel NK, Murphy CI, Pfeiffer TR, Naendrup JH, Zlotnicki JP, Debski RE, Hogan MV, Musahl V. Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study. J Exp Orthop 2020; 7:18. [PMID: 32232587 PMCID: PMC7105555 DOI: 10.1186/s40634-020-00234-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Disruption of the syndesmosis, the anterior-inferior tibiofibular ligament (AITFL), the posterior-inferior tibiofibular ligament (PITFL), and the interosseous membrane (IOM), leads to residual symptoms after an ankle injury. The objective of this study was to quantify tibiofibular joint motion with isolated AITFL- and complete syndesmotic injury and with syndesmotic screw vs. suture button repair compared to the intact ankle. METHODS Nine fresh-frozen human cadaveric specimens (mean age 60 yrs.; range 38-73 yrs.) were tested using a six degree-of-freedom robotic testing system and three-dimensional tibiofibular motion was quantified using an optical tracking system. A 5 Nm inversion moment was applied to the ankle at 0°, 15°, and 30° plantarflexion, and 10° dorsiflexion. Outcome measures included fibular medial-lateral translation, anterior-posterior translation, and external rotation in each ankle state: 1) intact ankle, 2) AITFL transected (isolated AITFL injury), 3) AITFL, PITFL, and IOM transected (complete injury), 4) tricortical screw fixation, and 5) suture button repair. RESULTS Both isolated AITFL and complete injury caused significant increases in fibular posterior translation at 15° and 30° plantarflexion compared to the intact ankle (p < 0.05). Tricortical screw fixation restored the intact ankle tibiofibular kinematics in all planes. Suture button repair resulted in 3.7 mm, 3.8 mm, and 2.9 mm more posterior translation of the fibula compared to the intact ankle at 30° and 15° plantarflexion and 0° flexion, respectively (p < 0.05). CONCLUSION Ankle instability is similar after both isolated AITFL and complete syndesmosis injury and persists after suture button fixation in the sagittal plane in response an inversion stress. Sagittal instability with ankle inversion should be considered when treating patients with isolated AITFL syndesmosis injuries and after suture button fixation. LEVEL OF EVIDENCE Controlled laboratory study, Level V.
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Affiliation(s)
- Neel K Patel
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Conor I Murphy
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Thomas R Pfeiffer
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
- Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne Merheim Medical Centre, Ostmerheimer Strasse 200, 51109, Köln, Germany
| | - Jan-Hendrik Naendrup
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
- Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne Merheim Medical Centre, Ostmerheimer Strasse 200, 51109, Köln, Germany
| | - Jason P Zlotnicki
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - MaCalus V Hogan
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA.
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Naendrup JH, Pfeiffer TR, Chan C, Nagai K, Novaretti JV, Sheean AJ, Shafizadeh ST, Debski RE, Musahl V. Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament: Response. Am J Sports Med 2020; 48:NP25-NP27. [PMID: 32003639 DOI: 10.1177/0363546519897012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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Otchwemah R, Naendrup JH, Mattner F, Tjardes T, Bäthis H, Shafizadeh S. Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction. J Knee Surg 2019; 32:1111-1120. [PMID: 30477043 DOI: 10.1055/s-0038-1675794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ± 9.9) years and admitted 14 ( ± 7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.
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Affiliation(s)
- Robin Otchwemah
- Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany.,Institute for Hygiene, Clinics Cologne, Cologne-Merheim Medical Center, Köln, Germany
| | - Jan-Hendrik Naendrup
- Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
| | - Frauke Mattner
- Institute for Hygiene, Clinics Cologne, Cologne-Merheim Medical Center, Köln, Germany
| | - Thorsten Tjardes
- Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
| | - Holger Bäthis
- Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
| | - Sven Shafizadeh
- Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
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Naendrup JH, Pfeiffer TR, Chan C, Nagai K, Novaretti JV, Sheean AJ, Shafizadeh ST, Debski RE, Musahl V. Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament. Am J Sports Med 2019; 47:3195-3202. [PMID: 31560563 DOI: 10.1177/0363546519872964] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal ramp lesions are possible concomitant injuries in cases of anterior cruciate ligament (ACL) deficiency. Although recent studies have investigated the influence of ramp lesions on knee kinematics, the effect on the ACL reconstruction graft remains unknown. PURPOSE/HYPOTHESIS The purpose was to determine the effects of ramp lesion and ramp lesion repair on knee kinematics, the in situ forces in the ACL, and bony contact forces. It was hypothesized that ramp lesions will significantly increase in situ forces in the native ACL and bony contact forces and that ramp lesion repair will restore these conditions comparably with those forces of the intact knee. STUDY DESIGN Controlled laboratory study. METHODS Investigators tested 9 human cadaveric knee specimens using a 6 degrees of freedom robotic testing system. The knee was continuously flexed from full extension to 90° while the following loads were applied: (1) 90-N anterior load, (2) 5 N·m of external-rotation torque, (3) 134-N anterior load + 200-N compression load, (4) 4 N·m of external-rotation torque + 200-N compression load, and (5) 4 N·m of internal-rotation torque + 200-N compression load. Loading conditions were applied to the intact knee, a knee with an arthroscopically induced 25-mm ramp lesion, and a knee with an all-inside repaired ramp lesion. In situ forces in the ACL, bony contact forces in the medial compartment, and bony contact forces in the lateral compartment were quantified. RESULTS In response to all loading conditions, no differences were found with respect to kinematics, in situ forces in the ACL, and bony contact forces between intact knees and knees with a ramp lesion. However, compared with intact knees, knees with a ramp lesion repair had significantly reduced anterior translation at flexion angles from full extension to 40° in response to a 90-N anterior load (P < .05). In addition, a significant decrease in the in situ forces in the ACL after ramp repair was detected only for higher flexion angles when 4 N·m of external-rotation torque combined with a 200-N compression load (P < .05) and 4 N·m of internal-rotation torque combined with a 200-N compression load were applied (P < .05). CONCLUSION In this biomechanical study, ramp lesions did not significantly affect knee biomechanics at the time of surgery. CLINICAL RELEVANCE From a biomechanical time-zero perspective, the indications for ramp lesion repair may be limited.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Thomas R Pfeiffer
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Calvin Chan
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kanto Nagai
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - João V Novaretti
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | - Andrew J Sheean
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sven T Shafizadeh
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Sana Medical Centre Cologne, Cologne, Germany
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Naendrup JH, Patel NK, Zlotnicki JP, Murphy CI, Debski RE, Musahl V. Education and repetition improve success rate and quantitative measures of the pivot shift test. Knee Surg Sports Traumatol Arthrosc 2019; 27:3418-3425. [PMID: 30715594 DOI: 10.1007/s00167-019-05370-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Clinicians have different techniques and varying levels of experience with the pivot shift test, introducing variability into its performance. The purpose of this study was to evaluate the influence of teaching and repetition on the success rate and anterior translation of the lateral knee compartment during the pivot shift test in a cadaveric ACL injury model. METHODS Twenty-five participants (five each of medical students, orthopaedic surgery residents, physical therapists, athletic trainers, sports medicine fellows) were recruited and a senior orthopaedic surgeon served as gold standard examiner. Each participant performed 20 pivot shift tests on lower extremity cadaveric specimens with ACL deficiency and lateral meniscectomy: 5 prior to education (baseline), 10 after watching an instructional video (passive teaching), and 5 after an interactive education session (active teaching). The anterior translation of the lateral knee compartment was recorded during each pivot shift test using electromagnetic tracking system. RESULTS For medical students and orthopaedic surgery residents, significant improvement in success rate was found when compared to baseline (12% and 24%, respectively) after both passive (36% and 60%, respectively) and active teaching (52% and 72%, respectively) (p < 0.5). Medical students and residents were the only participants that independently achieved significant increases in anterior translation of the lateral knee compartment, each tripling the respective baseline value (p < 0.5). In the entire study population, significant increases in anterior translation of the lateral knee compartment and success rate of the pivot shift test were seen with continuous repetition (p < 0.5). However, the standard deviation of anterior translation of the lateral knee compartment was more than twice the gold standard examiner's standard deviation, indicating a high degree of variability. CONCLUSION Teaching of the pivot shift test plays a major role in the development of a proper technique. However, variability persisted despite teaching and repetition. New methods may be needed to improve the teaching of the pivot shift test.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. .,Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
| | - Neel K Patel
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jason P Zlotnicki
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Conor I Murphy
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
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Jaecker V, Naendrup JH, Pfeiffer TR, Bouillon B, Shafizadeh S. Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures. Am J Sports Med 2019; 47:2572-2576. [PMID: 31381359 DOI: 10.1177/0363546519864580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral extra-articular tenodesis (LET) is being increasingly performed as an additional procedure in both primary and revision anterior cruciate ligament reconstruction in patients with excessive anterolateral rotatory instability. Consistent guidelines for femoral tunnel placement would aid in intraoperative reproducible graft placement and postoperative evaluation of LET procedures. PURPOSE To determine radiographic landmarks of a recently described isometric femoral attachment area in LET procedures with reference to consistent radiographic reference lines. STUDY DESIGN Descriptive laboratory study. METHODS Ten fresh-frozen cadaveric knees were dissected. The footprints of the lateral femoral epicondyle (LFE) apex and the deep aspects of the iliotibial tract, with its Kaplan fiber attachments (KFAs) on the distal femur, were marked with a 2.5-mm steel ball. True lateral radiographic images were taken. Mean absolute LFE and KFA distances were measured from the posterior cortex line (anterior-posterior direction) and from the perpendicular line intersecting the contact of the posterior femoral condyle (proximal-distal direction), respectively. Furthermore, positions were measured relative to the femur width. Finally, radiographic descriptions of an isometric femoral attachment area were developed. RESULTS The mean LFE and KFA positions were found to be 4 ± 4 mm posterior and 4 ± 3 mm anterior to the posterior cortex line, and 6 ± 4 mm distal and 20 ± 5 mm proximal to the perpendicular line intersecting the posterior femoral condyle, respectively. The mean LFE and KFA locations, relative to the femur width, were found at -12% and 11% (anterior-posterior) and -17% and 59% (proximal-distal), respectively. Femoral tunnel placement on or posterior to the femoral cortex line and proximal to the posterior femoral condyle within a 10-mm distance ensures that the tunnel remains safely located in the isometric zone. CONCLUSION Radiographic landmarks for an isometric femoral tunnel placement in LET procedures were described. CLINICAL RELEVANCE These findings may help to intraoperatively guide surgeons for an accurate, reproducible femoral tunnel placement and to reduce the potential risk of tunnel misplacement, as well as to aid in the postoperative evaluation of LET procedures in patients with residual complaints.
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Affiliation(s)
- Vera Jaecker
- Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Thomas R Pfeiffer
- Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Sven Shafizadeh
- Department of Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Sana Medical Centre Cologne, Cologne, Germany
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Naendrup JH, Zlotnicki JP, Murphy CI, Patel NK, Debski RE, Musahl V. Influence of knee position and examiner-induced motion on the kinematics of the pivot shift. J Exp Orthop 2019; 6:11. [PMID: 30888526 PMCID: PMC6424983 DOI: 10.1186/s40634-019-0183-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Grading of the pivot shift test varies significantly depending on the examiner’s technique. Thus, the purpose of this study was to determine the influence of knee starting position and the magnitude of motion during the reduction event on the magnitude of the pivot shift test. Methods Twenty-five clinical providers each performed a total of twenty pivot shift tests on one of two fresh-frozen cadaveric full lower extremity specimens with different grades of rotatory knee laxity. By means of ACL transection and lateral meniscectomy, one specimen was prepared to have a high-grade pivot shift and one to have a low-grade pivot shift. Six-degree-of-freedom kinematics were recorded during each pivot shift test using an electromagnetic-tracking-system. Successful pivot shift tests were defined and selected using an automated, mathematical algorithm based on the exceeding of a threshold value of anterior translation of the lateral knee compartment. The kinematics were correlated with the magnitude of anterior translation of the lateral knee compartment based on varying degrees of rotatory knee laxity using the Pearson correlation coefficient. Results Only mild correlations between anterior translation of the lateral knee compartment and internal tibial rotation at the start of the reduction event were observed in both specimens. The ability to generate a successful reduction event was significantly dependent on the rotatory knee laxity, with a 54% success rate on the high-laxity specimen compared to a 30% success rate on the low-laxity specimen (p < 0.001). Nearly 80% of the variability of the anterior translation of the lateral knee compartment in both specimens was accounted for by external rotation during the reduction event (r = 0.847; p < 0.001). Varus rotation during the reduction event also showed a strong correlation with the anterior translation of the lateral knee compartment in the low-laxity specimen (r = 0.835; p < 0.001). Conclusion Magnitude of motion during the reduction event affected the magnitude of anterior translation of the lateral knee compartment more than the starting position. External rotation during the reduction event accounted for most of the variability in the pivot shift test. More uniform maneuvers and improved teaching are essential to generate repeatable quantitative results of the pivot shift test.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany.,Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jason P Zlotnicki
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Conor I Murphy
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Neel K Patel
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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Jaecker V, Drouven S, Naendrup JH, Kanakamedala AC, Pfeiffer T, Shafizadeh S. Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction. Arch Orthop Trauma Surg 2018; 138:1423-1431. [PMID: 29808437 DOI: 10.1007/s00402-018-2968-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE To analyze the contribution of increased lateral (LTPS) and medial tibial slopes (MTPS) as independent risk factors of graft failure following anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS Fifty-seven patients with graft failure after ACL reconstruction who underwent revision surgery between 2009 and 2014 were enrolled and matched to a control group of 69 patients with primary anatomic successful ACL reconstruction. Patients were matched based on age, sex, date of primary surgery and graft type. LTPS and MTPS were measured on MRI in a blinded fashion. Tibial and femoral tunnel positions were determined on CT scans. Independent t test was used to compare the MTPS and LTPS between subgroups. Risks of graft failure associated with an increasing MTPS and LTPS were analyzed using binary logistic analysis. RESULTS The means of LTPS (7.3°) and MTPS (6.7°) in the graft failure group were found to be significantly greater than in the control group (4.6° and 4.1°, respectively; p = < 0.001). Non-anatomic and anatomic tunnel positions were found in 42 cases (73.7%) and 15 cases (26.3%), respectively. There were no significant differences in MTPS or LTPS between patients with anatomic and non-anatomic tunnel positions within the graft failure group. An increase of the MTPS of 1° was associated with an 1.24 times increased likelihood of exhibiting graft failure [95% CI 1.07-1.43] (p = 0.003) and an increase of the LTPS of 1° was associated with an 1.17 times increased likelihood of exhibiting graft failure [95% CI 1.04-1.31] (p = 0.009). The increased risk was most evident in patients with a lateral tibial posterior slope of ≥ 10°. CONCLUSIONS Increased LTPS and MTPS are independent risk factors for graft failure following ACL reconstruction regardless whether tunnel position is anatomic or non-anatomic. This information may be helpful to clinicians when considering slope correction in selected revision ACL reconstruction procedures.
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Affiliation(s)
- Vera Jaecker
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Sabrina Drouven
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Ajay C Kanakamedala
- University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Thomas Pfeiffer
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Sven Shafizadeh
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
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29
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Jaecker V, Zapf T, Naendrup JH, Kanakamedala AC, Pfeiffer T, Shafizadeh S. Differences between traumatic and non-traumatic causes of ACL revision surgery. Arch Orthop Trauma Surg 2018; 138:1265-1272. [PMID: 29779039 DOI: 10.1007/s00402-018-2954-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and classify causes for anterior cruciate ligament (ACL) reconstruction failure. It was hypothesized that specific technical and biological reconstruction aspects would differ when comparing traumatic and non-traumatic ACL reconstruction failures. MATERIALS AND METHODS One hundred and forty-seven consecutive patients who experienced ACL reconstruction failure and underwent revision between 2009 and 2014 were analyzed. Based on a systematic failure analysis, including evaluation of technical information on primary ACL reconstruction and radiological assessment of tunnel positions, causes were classified into traumatic and non-traumatic mechanisms of failure; non-traumatic mechanisms were further sub-divided into technical and biologic causes. Spearman's rank correlation coefficient and chi-squared tests were performed to determine differences between groups based on various factors including graft choice, fixation technique, technique of femoral tunnel positioning, tunnel malpositioning, and time to revision. RESULTS Non-traumatic, i.e., technical, and traumatic mechanisms of ACL reconstruction failure were found in 64.5 and 29.1% of patients, respectively. Biological failure was found only in 6.4% of patients. Non-anatomical femoral tunnel positioning was found the most common cause (83.1%) for technical reconstruction failure followed by non-anatomical tibial tunnel positioning (45.1%). There were strong correlations between non-traumatic technical failure and femoral tunnel malpositioning, transtibial femoral tunnel drilling techniques, femoral transfixation techniques as well as earlier graft failure (p < 0.05). CONCLUSIONS Technical causes, particularly tunnel malpositioning, were significantly correlated with increased incidence of non-traumatic ACL reconstruction failure. Transtibial femoral tunnel positioning techniques and femoral transfixation techniques, showed an increased incidence of non-traumatic, earlier graft failure.
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Affiliation(s)
- Vera Jaecker
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Tabea Zapf
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Ajay C Kanakamedala
- University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Thomas Pfeiffer
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Sven Shafizadeh
- Department of Sports Traumatology and Trauma Surgery, Witten/Herdecke University, Sana Dreifaltigkeits-Krankenhaus, Aachener Straße 445-449, 50933, Cologne, Germany.
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30
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Pfeiffer TR, Herbst E, Kanakamedala AC, Naendrup JH, Debski RE, Musahl V. The Use of Fluoroscopy Leads to Improved Identification of the Femoral Lateral Collateral Ligament Origin Site When Compared With Traditional Tactile Techniques. Arthroscopy 2018; 34:2487-2493.e1. [PMID: 29859771 DOI: 10.1016/j.arthro.2018.03.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether a fluoroscopic technique can be used to improve the accuracy of the determination of the femoral origin of the lateral collateral ligament (LCL). METHODS A 1-cm incision was made over the lateral epicondyle in 13 fresh-frozen cadaveric knee specimens, and the LCL origin was determined first by palpation and then with a previously described fluoroscopic method. Both points for the LCL origin were marked with 2-mm Kirschner wires. The distances between the center of the anatomic LCL origin and the LCL origin points determined by palpation and fluoroscopic imaging were calculated. An independent t-test was used to compare the distances between the anatomic LCL origin center and the determined LCL origin points. RESULTS The LCL origin points determined by fluoroscopic imaging were significantly (P = .005) closer to the anatomic center of the LCL origin point than the ones determined by palpation (3.2 mm ± 1.6 mm vs 5.0 mm ± 1.6 mm, respectively). A total of 92.7% fluoroscopically determined LCL origin points were within a 5 mm radius surrounding the anatomic LCL origin point. In contrast, only 53.8% LCL origin points determined by palpation were within a 5 mm radius surrounding the anatomic LCL origin point. CONCLUSIONS The use of palpation to identify the LCL origin may not be an accurate method for performing an isometric and anatomic LCL reconstruction. The use of fluoroscopic imaging appears to be a feasible method for identifying the LCL origin in clinical practice and may increase the accuracy of LCL origin identification. Fluoroscopic guidance improves accuracy in determining the anatomic LCL origin, which may help avoiding tunnel malplacement during LCL reconstruction. CLINICAL RELEVANCE: The use of a previously described radiographic method for identifying the LCL origin may be used to achieve a more anatomic LCL reconstruction.
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Affiliation(s)
- Thomas R Pfeiffer
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany; Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Elmar Herbst
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ajay C Kanakamedala
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany; Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Richard E Debski
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Volker Musahl
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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Patel NK, Murphy CI, Nagai K, Canton S, Herbst E, Naendrup JH, Debski RE, Musahl V. Passive teaching is not as effective as active teaching for learning the standard technique of pivot shift test. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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Mellinghoff SC, Hartmann P, Cornely FB, Knauth L, Köhler F, Köhler P, Krause C, Kronenberg C, Kranz SL, Menon V, Müller H, Naendrup JH, Pützfeld S, Ronge A, Rutz J, Seidel D, Wisplinghoff H, Cornely OA. Analyzing candidemia guideline adherence identifies opportunities for antifungal stewardship. Eur J Clin Microbiol Infect Dis 2018; 37:1563-1571. [PMID: 29948362 DOI: 10.1007/s10096-018-3285-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Abstract
Candidemia epidemiology varies significantly by region; thus, local data are essential for evidence-based decision-making in prophylaxis and treatment. Current management strategies are derived from large randomized controlled trials mostly executed in large high-volume tertiary care centers. Results may not be entirely transferable to smaller hospitals. This study investigates epidemiology, diagnosis, and treatment standards in six hospitals in the Cologne metropolitan area (number of inhabitants approx. one million). We assessed adherence to the current guideline of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the Infectious Diseases Society of America (IDSA) using the EQUAL Candida Score of the European Confederation of Medical Mycology (ECMM). Data were documented by trained medical students as part of an integrated research and teaching concept at the University of Cologne. Between January 2014 and June 2017, 77 patients had candidemia, corresponding to an incidence of 0.2 cases/1000 admissions. While 55 patients were enrolled, 22 patients were excluded due to incompletely retrievable health records. Fluconazole monotherapy was the preferred first-line treatment in cases with Candida albicans infection (21/29). A central vascular catheter was present in 40 patients and was removed in 17 (43%) during treatment. Overall mortality at 30 days was 44%. Patients reached a mean EQUAL Candida Score of 9.9 (range 8-14), which was well below the maximum score of 22 for perfect guideline adherence. In summary, management of candidemia differed from current European recommendations. It remains unclear to what extent enhanced adherence would improve patient outcome. Larger prospective studies need to answer that question.
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Affiliation(s)
- Sibylle C Mellinghoff
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, ECMM Diamond Center of Excellence in Medical Mycology, German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany
| | - Pia Hartmann
- German Centre for Infection Research (DZIF), Cologne, Germany.,Institute for Medical Microbiology, Immunology and Hygiene (IMMIH), University of Cologne, Cologne, Germany.,Wisplinghoff Laboratories, Cologne, Germany
| | - Florian B Cornely
- Department I of Internal Medicine, ECMM Diamond Center of Excellence in Medical Mycology, German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany.,University of Varna, Varna, Bulgaria
| | | | - Felix Köhler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, ECMM Diamond Center of Excellence in Medical Mycology, German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany
| | - Philipp Köhler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, ECMM Diamond Center of Excellence in Medical Mycology, German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany
| | | | | | | | - Vidya Menon
- Department of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | | | | | | | - Jule Rutz
- University of Cologne, Cologne, Germany
| | - Danila Seidel
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, ECMM Diamond Center of Excellence in Medical Mycology, German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany
| | - Hilmar Wisplinghoff
- Institute for Medical Microbiology, Immunology and Hygiene (IMMIH), University of Cologne, Cologne, Germany.,Wisplinghoff Laboratories, Cologne, Germany.,Institute for Virology and Clinical Microbiology, Witten/Herdecke University, Witten, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany. .,Department I of Internal Medicine, ECMM Diamond Center of Excellence in Medical Mycology, German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany. .,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany. .,Department I for Internal Medicine, ECMM Excellence Center of Medical Mycology University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.
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Kowalczuk M, Kohut K, Sabzevari S, Naendrup JH, Lin A. Proximal Long Head Biceps Rupture: A Predictor of Rotator Cuff Pathology. Arthroscopy 2018; 34:1166-1170. [PMID: 29373291 DOI: 10.1016/j.arthro.2017.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether acute rupture of the proximal long head biceps is a harbinger of disease of the nearby supraspinatus and subscapularis tendons. METHODS A retrospective chart review from February 1, 2008, to August 31, 2016, was performed at our institution identifying patients who presented with an acute (<12-week) history of "Popeye" deformity of the distal biceps and a magnetic resonance imaging (MRI) of the affected shoulder. MRI images were then reviewed in duplicate to determine supraspinatus and subscapularis tendon tear incidence, size, chronicity, and depth. The association between rotator cuff status and acute long head biceps rupture as well as patient age, sex, smoking status, hand dominance, and history of diabetes mellitus or trauma was then evaluated. RESULTS A total of 116 patients were included in this study (mean age: 61.9 ± 10.9 years). A significant proportion (n = 99; incidence: 85%) were found to have some degree of supraspinatus or subscapularis tendon tearing on MRI (P < .001). These patients were also found to be significantly older compared with those with an intact rotator cuff (mean age 63.3 ± 10.7 vs 54.2 ± 9.2; P = .001). Full thickness rotator cuff tears were significantly more likely to involve the supraspinatus as opposed to the subscapularis (incidence: 44% and 21%; P = .002). CONCLUSIONS Despite the expected association of rotator cuff disease with increasing patient age, the results of this study also affirm the hypothesis that inflammation in the rotator cuff interval signaled by rupture of the long head of biceps is a harbinger of rotator cuff disease. Clinicians should have a high index of suspicion regarding concomitant anterosuperior rotator cuff pathology in patients presenting with acute long head of biceps rupture. Early evaluation with advanced imaging should be strongly considered. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Marcin Kowalczuk
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kevin Kohut
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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Arner JW, Herbst E, Burnham JM, Soni A, Naendrup JH, Popchak A, Fu FH, Musahl V. MRI can accurately detect meniscal ramp lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2017; 25:3955-3960. [PMID: 28343325 DOI: 10.1007/s00167-017-4523-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/10/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Posterior horn meniscal tears are commonly found in conjunction with anterior cruciate ligament (ACL) injury. Some believe tears in the posterior meniscocapsular zone, coined ramp lesions, are important to knee stability. The purpose of this study was to determine whether pre-operative MRI evaluation was able to accurately and reproducibly identify ramp lesions. METHODS Three blinded reviewers assessed MRIs twice for the presence of ramp lesions in patients undergoing ACL reconstruction. Sensitivity, specificity, negative predictive value, and positive predictive value for MRI were calculated based on arthroscopic diagnosis of a ramp lesion. Intra-class correlation coefficient was calculated to assess intra- and interobserver reliability of the MRI assessment between the three examiners. Significance was set at p < 0.05. RESULTS Ninety patients met inclusion criteria (45 males, 45 females, mean age 28.0 years). Thirteen of these patients had arthroscopy-confirmed ramp lesions, while the other 77 had other meniscal pathology. Sensitivity of detecting a ramp lesion on MRI ranged from 53.9 to 84.6%, while specificity was 92.3-98.7%. Negative predictive value was 91.1-97.4%, while positive predictive value was 50.0-90.0%. Inter-rater reliability between three reviewers was moderate at 0.56. The observers had excellent intra-rater reliability ranging from 0.75 to 0.81. CONCLUSIONS This study demonstrates high sensitivity and excellent specificity in detecting meniscal ramp lesions on MRI. Ramp lesions are likely more common and may have greater clinical implications than previously appreciated; the outcomes of untreated lesions must be investigated. Pre-operative identification of ramp lesions may aid clinicians in surgical planning and patient education to improve outcomes by addressing pathology which may have otherwise been missed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Justin W Arner
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Elmar Herbst
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Jeremy M Burnham
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Ashish Soni
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | | | - Adam Popchak
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Freddie H Fu
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA.
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35
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Shaikh H, Herbst E, Rahnemai-Azar AA, Bottene Villa Albers M, Naendrup JH, Musahl V, Irrgang JJ, Fu FH. The Segond Fracture Is an Avulsion of the Anterolateral Complex. Am J Sports Med 2017; 45:2247-2252. [PMID: 28499093 DOI: 10.1177/0363546517704845] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Segond fracture was classically described as an avulsion fracture of the anterolateral capsule of the knee. Recently, some authors have attributed its pathogenesis to the "anterolateral ligament" (ALL). Biomechanical studies that have attempted to reproduce this fracture in vitro have reported conflicting findings. PURPOSE To determine the anatomic characteristics of the Segond fracture on plain radiographs and magnetic resonance imaging (MRI), to compare this location with the location of the ALL described in prior radiographic and anatomic publications, and to determine the fracture's attachments to the soft tissue anterolateral structures of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 36 anterior cruciate ligament-injured patients with Segond fractures (33 male, 3 female; mean age, 23.2 ± 8.4 years) were enrolled. MRI scans were reviewed to determine the anatomic characteristics of the Segond fracture, including the following: proximal-distal (PD) length, anterior-posterior (AP) width, medial-lateral (ML) width, PD distance to the lateral tibial plateau, AP distance to the Gerdy tubercle (GT), and AP distance from the GT to the posterior aspect of the fibular head. The attachment of the anterolateral structures to the Segond fragment was then categorized as the iliotibial band (ITB) or anterolateral capsule. Interrater reliability of the measurements was determined by calculating the Spearman rank correlation coefficient. MEDLINE, Web of Science, and the Cochrane Library were searched from inception to May 2016 for the following keywords: (1) "Segond fracture," (2) "anterolateral ligament," (3) "knee avulsion," (4) "lateral tibia avulsion," and (5) "tibial plateau avulsion." All studies describing the anatomic location of the Segond fracture and the ALL were included in the systematic review. RESULTS On plain radiographs, the mean distance of the midpoint of the fracture to the lateral tibial plateau was 4.6 ± 2.2 mm. The avulsed fracture had a mean PD length of 9.2 ± 2.5 mm and a mean ML width of 2.4 ± 1.4 mm. On MRI, the mean distance of the proximal fracture to the tibial plateau was 3.4 ± 1.6 mm. The mean PD length was 8.7 ± 2.2 mm, while the mean AP width was 11.1 ± 2.2 mm. The mean distance between the GT and the center of the fracture was 26.9 ± 3.3 mm, while the mean distance between the GT and the posterior fibular head was 53.9 ± 4.4 mm. The mean distance of the midpoint of the fracture to the tibial plateau was 7.8 ± 2.7 mm, while the center of the fracture was 49.9% of the distance between the GT and the posterior aspect of the fibular head. Analysis of soft tissue structures attached to the fragment revealed that the ITB attached in 34 of 36 patients and the capsule attached in 34 of 36 patients. One patient had only the capsule attached, another had only the ITB attached, and the last showed neither clearly attached. A literature review of 20 included studies revealed no difference between the previously described Segond fracture location and the tibial insertion of the ALL. CONCLUSION The results of this study confirmed that while the Segond fracture occurs at the location of the tibial insertion of the ALL, as reported in the literature, MRI was unable to identify any distinct ligamentous attachment. MRI analysis revealed that soft tissue attachments to the Segond fracture were the posterior fibers of the ITB and the lateral capsule in 94% of patients.
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Affiliation(s)
- Humza Shaikh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ata Amir Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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36
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Herbst E, Albers M, Burnham JM, Shaikh HS, Naendrup JH, Fu FH, Musahl V. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2017; 25:1009-1014. [PMID: 28233023 DOI: 10.1007/s00167-017-4449-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 01/26/2023]
Abstract
Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Humza S Shaikh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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Abstract
The purpose of this study was to identify the causes and risk factors for hip fractures, a rare but devastating complication, following hip arthroscopy. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant clinical and basic sciences studies and pertinent data was abstracted and analysed in Microsoft Excel. Nineteen studies (12 clinical studies and seven biomechanical studies) with a total of 31 392 patients experiencing 43 hip fractures (0.1% of patients) met the inclusion criteria for this systematic review. Femoral osteochondroplasty was performed in 100% of patients who sustained a hip fracture. Six of the 12 (50%) studies identified early weight bearing (prior to 6 weeks post-operatively) as the cause for the hip fracture. Other causes of this complication included over resection during femoral osteochondroplasty, minor trauma and intensive exercise. The results suggest that early weight bearing is the largest modifiable risk factor for hip fracture after femoral osteochondroplasty. For this reason, an extended period of non-weight bearing or restricted weight bearing should be considered in select patients. Studies report a correlation between risk for post-operative hip fracture and increased age. Increased resection during osteochondroplasty has been correlated with increased risk of fracture in various basic science studies. Resection depth has significantly higher impact on risk of fracture than resection length or width. The reported amounts of resection that depth that can be performed before there is a significantly increased risk of fracture of the femoral neck varies from 10 to 30%.
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Affiliation(s)
- Nolan S Horner
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Room 4E15, Hamilton, ON L8S 4K1, Canada
| | - Khanduja Vikas
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Austin E MacDonald
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Room 4E15, Hamilton, ON L8S 4K1, Canada
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Nicole Simunovic
- Centre for Evidence Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, ON L8N 3Z5, Canada
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38
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Herbst E, Naendrup JH, Pfeiffer T, Debski RE, Musahl V. Neue App zur Quantifizierung des Pivot-shift-Tests. Arthroskopie 2016. [DOI: 10.1007/s00142-016-0096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Abstract
Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a gold standard for objective quantification of injury and subsequent repair, has not been demonstrated. Furthermore, recent studies have suggested that novel anatomic structures may play a significant role in knee stability. The use of biomechanical principles and testing techniques provides essential objective/quantitative information on the function of bone, ligaments, joint capsule, and other contributing soft tissues in response to various loading conditions. This review discusses the principles of biomechanics in relation to knee stability, with a focus on the objective quantification of knee stability, the individual contributions of specific knee structures to stability, and the most recent technological advances in the biomechanical evaluation of the knee joint.
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Affiliation(s)
- Jason P Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Gerald A Ferrer
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
- Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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40
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Abstract
Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm.
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Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Ashish Soni
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Adam Olsen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jason Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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