1
|
Holwein C, Jungmann P, Suchowierski J, Gersing A, Wörtler K, Brucker P, Angele P, Imhoff A, Vogt S. Sandwich Technique for Large Osteochondral Lesions of the Knee. Cartilage 2022; 13:19476035221102571. [PMID: 35906752 PMCID: PMC9340910 DOI: 10.1177/19476035221102571] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. DESIGN Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). RESULTS Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling. CONCLUSION MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.
Collapse
Affiliation(s)
- C. Holwein
- Orthopädisch-Unfallchirurgisches Zentrum, Alb Fils Kliniken GmbH, Göppingen, Germany,Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,C. Holwein, Rohrbachstraße 11, 73337 Bad Überkingen, Germany.
| | - P.M. Jungmann
- Zentrales Röntgeninstitut Kantonsspital Graubünden, Spital Davos AG, Davos, Switzerland
| | - J. Suchowierski
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - A.S. Gersing
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,Institut für Neuroradiologie, Klinikum der Universität München, München, Germany
| | - K. Wörtler
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - P.U. Brucker
- MVZ ATOS Klinik München, München, Germany,Orthopädie in der Ottostraße, München, Germany
| | - P. Angele
- Klinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany,Sporthopaedicum Regensburg, Regensburg, Germany
| | - A.B. Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - S. Vogt
- Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
| |
Collapse
|
2
|
Gassert FT, Hammel J, Hofmann F, Pfeiffer D, Pfeiffer F, Makowski MR, Wörtler K, Gersing AS, Schwaiger BJ. Detection of Perifocal Bone Marrow Edema in Patients with Osteoid Osteoma Using Three-material Decomposition with Dual-layer Spectral CT. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
3
|
Bodden JH, Neumann J, Rasper M, Fingerle AA, Knebel C, Bollwein C, Schwaiger BJ, Gersing AS, Wörtler K. Diagnosis of Joint Invasion in Patients with Malignant Bone Tumors: Value and Reproducibility of Direct and Indirect Signs on MRI. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Feuerriegel GC, Kopp F, Pfeiffer D, Leonhardt Y, Karampinos DC, Schwaiger BJ, Makowski MR, Wörtler K, Gersing AS. Evaluation of MR-derived Simulated CT-like Images and Simulated Radiographs Compared with Conventional Radiography in Patients with Suspected Shoulder Pathology. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
5
|
Wechselberger J, Neumann J, Wörtler K. Bildgebende Diagnostik bei glenohumeralen Knorpelschäden und Schulter-Früharthrose. Arthroskopie 2020. [DOI: 10.1007/s00142-020-00392-0] [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: 11/29/2022]
|
6
|
Abstract
BACKGROUND Osteochondral defects represent a main risk factor for osteoarthritis of the ankle. OBJECTIVES The aim of this article is to provide an overview of current optimal clinical cartilage imaging techniques of the foot and ankle and to show typical osteochondral injuries on imaging. MATERIALS AND METHODS A thorough literature search was performed and was supported by personal experience. RESULTS Cartilage imaging of the foot and ankle remains challenging. However, advanced morphological and quantitative magnetic resonance (MR) imaging techniques may provide useful clinical information, for example, concerning cartilage repair surgery. Compared to MRI, MR arthrography (MR-A) and CT arthrography (CT-A) have higher sensitivity with respect to detection of osteochondral defects. Regarding smaller joints of the foot, mainly advanced osteoarthritic changes are detected on conventional radiography; only in rare cases, MR and CT imaging of these smaller joints is of relevance. CONCLUSIONS While at the smaller joints of the foot cartilage imaging only plays a minor role, at the ankle joint cross-sectional cartilage imaging using CT and MRI becomes more and more important for clinicians due to emerging therapeutic options, such as different osteochondral repair techniques.
Collapse
Affiliation(s)
- A S Gersing
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - B J Schwaiger
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - K Wörtler
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - P M Jungmann
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland. .,Klinik für Neuroradiologie, UniversitätsSpital Zürich, Universität Zürich, Frauenklinikstrasse 10, 8091, Zürich, Schweiz.
| |
Collapse
|
7
|
Thomasius F, Baum E, Bernecker P, Böcker W, Brabant T, Clarenz P, Demary W, Dimai HP, Engelbrecht M, Engelke K, Fratermann U, Grieser T, Gulich M, Hadji P, Henning J, Jehle PM, Kern PM, Ketteler M, Klatt G, Kraenzlin M, Maus U, Meier C, Moser U, Müller D, Peichl P, Pfeifer M, Rintelen B, Rueger JM, Schober HC, Schöffel D, Schwarz H, Siggelkow H, Suhm N, Wiese KG, Wörtler K, Kurth AA. DVO Leitlinie 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1673537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDiese DVO Leitlinien, die in erster Linie für Allgemeinmediziner und Spezialisten für Knochenerkrankungen bestimmt sind, sollten von allen im klinischen und ambulanten Bereich tätigen medizinischen Fachkräften angewendet werden. Ziel der Leitlinie ist die Verbesserung der Diagnose, Prävention und Behandlung von Osteoporose und der Folgen der Erkrankung auf der Grundlage evidenzbasierter Medizin.Klare Empfehlungen, welche Patienten zu diagnostizieren und behandeln sind (basierend auf Risikofaktoren [einschließlich sekundärer Osteoporose]) sowie Primär-, Sekundär- oder Tertiärprävention werden dargestellt, mit dem Schwerpunkt auf der postmenopausalen Osteoporose und der Osteoporose bei Männern.Die Identifizierung von Patienten mit einem hohen Risiko für Frakturen wird hervorgehoben, und spezifische Schwellenwerte für die Intervention sind definiert (20 % Hüftfrakturrisiko innerhalb von 10 Jahren diagnostischer Schwellenwert, 30 % Hüftfrakturrisiko innerhalb von 10 Jahren therapeutische Schwelle). Die Diagnose von Osteoporose basiert auf der Anamnese des Patienten, der körperlichen Untersuchung, dem Funktionstest (z. B. Timed Up and Go Test), konventionellen Röntgenaufnahmen der Brust- und Lendenwirbelsäule und der Bestimmung der Knochenmineraldichte (BMD) durch das DXA Verfahren.Die Anamnese ist entscheidend für die Abschätzung des Frakturrisikos auf der Grundlage von 40 wissenschaftlich überprüften Risikofaktoren, die das Frakturrisiko mindestens verdoppeln (z. B. Begleiterkrankungen, Hüftfrakturen in der Familie, prävalente Frakturen an jedem Ort, Lebensstil, Anwendung von Medikamenten, körperliche Aktivität und Stürze). Röntgenaufnahmen der Brust- und Lendenwirbelsäule sind wichtig, um prävalente Wirbelkörperfrakturen zu erkennen. Beim Fehlen eines großen Traumas kann jede Fraktur bei Erwachsenen über dem Alter von 50 Jahren eine Diagnose von Osteoporose nahelegen, mit dem höchsten Risiko für eine nachfolgende Fraktur innerhalb einer kurzen Zeit nach der ersten Fraktur. BMD-Messungen mit DXA sind wichtig, um das individuelle Frakturrisiko besser abschätzen zu können. Eine grundlegende Laboruntersuchung ist obligatorisch, um verschiedene Formen der sekundären Osteoporose ausschließen zu können.Der DVO-Patientenfindungs-Algorithmus basiert auf dem Geschlecht, Alter, Knochenmineraldichte und vorbestehenden Frakturen als wichtigste Informationen. Die Indikation für eine aktive anti-osteoporotische Therapie kann durch multiple Risikofaktoren modifiziert und verfeinert werden. Dieser Algorithmus wurde seit dem Richtlinien-Update 2006 verwendet und wurde entsprechend der internationalen Literatur zu Risikofaktoren für Osteoporose und osteoporotische Frakturen aktualisiert und angepasst.Die Behandlung der Osteoporose enthält viele Therapiepfeiler. Zusammen mit Empfehlungen für Bewegung, Physiotherapie und Sturzprävention sowie Ernährung (z. B. Calcium, Vit. D), werden pharmakologische Behandlungen basierend auf evidenzbasierter Medizin empfohlen. Die aktiven Anti-Osteoporose-Medikamente müssen für die Indikation postmenopausale Osteoporose und männliche Osteoporose in Deutschland, Österreich und der Schweiz zugelassen sein. Das Management und die Vorbeugung von häufigen oder seltenen Nebenwirkungen aufgrund von Anti-Osteoporose-Behandlungen, die in der klinischen Praxis angewendet werden, werden ebenfalls detailliert behandelt.
Collapse
|
8
|
Mogler C, Boxberg M, Knebel C, Weichert W, Wörtler K, Specht K. [Spindle-cell osteosclerotic bone lesion with MDM2 amplification]. Pathologe 2017; 39:186-190. [PMID: 29209796 DOI: 10.1007/s00292-017-0394-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report presents an osteosclerotic bone lesion in a 49-year-old man with MDM2 amplification. The final diagnosis shows metastasis to the bones from stomach cancer. In primary bone tumours, the MDM2 amplifications observed have been described for many other tumour entities as well, and therefore do not exclude bone metastasis from a carcinoma.
Collapse
Affiliation(s)
- C Mogler
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland.
| | - M Boxberg
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - C Knebel
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, München, Deutschland
| | - W Weichert
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - K Wörtler
- Institut für Radiologie, Klinikum rechts der Isar, München, Deutschland
| | - K Specht
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| |
Collapse
|
9
|
Wörtler K. Primäre Knochentumoren der Wirbelsäule: Falldiskussion. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581684] [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: 10/22/2022]
|
10
|
Wörtler K. Teleradiologische Konsiliardiagnostik eines Referenzzentrums für muskuloskelettale Erkrankungen: Analyse von 322 Einsendungen. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581706] [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: 10/22/2022]
|
11
|
Paul J, Hinterwimmer S, Vavken P, Wörtler K, Imhoff A. Zusammenhang der Rückfußachse mit der Lokalisation von osteochondralen Läsionen am Talus. Z Orthop Unfall 2014; 152:389-92. [DOI: 10.1055/s-0034-1368604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J. Paul
- Orthopädische Universitätsklinik, Universitätsspital Basel, Schweiz
| | | | - P. Vavken
- Orthopädische Universitätsklinik, Universitätsspital Basel, Schweiz
| | - K. Wörtler
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, München
| | - A. Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, München
| |
Collapse
|
12
|
Jungmann P, Baum T, Schäffeler C, Sauerschnig M, Mann A, Ganter C, Bieri O, Rummeny EJ, Wörtler K, Bauer JS. Quantitative MR Bildgebung des Sprunggelenkes: Der Effekt axialer Traktion auf T2 Relaxationszeiten und Diffusionswerte des Gelenkknorpels. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373295] [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: 10/25/2022]
|
13
|
Holzapfel K, Regler J, Rechl H, Specht K, Eisenhart-Rothe RV, Gradinger R, Rummeny EJ, Wörtler K. Lokales Staging von Weichteilsarkomen: Prädiktion der Infiltration neurovaskulärer Strukturen mittels MRT in 174 Fällen. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373328] [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: 10/25/2022]
|
14
|
Wörtler K. Osteochondrale Läsionen. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373309] [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: 10/25/2022]
|
15
|
Wörtler K. Skeletal System. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373380] [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: 10/25/2022]
|
16
|
Wörtler K. Schultergelenk. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1345940] [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: 10/26/2022]
|
17
|
Jungmann PM, Bauer JS, Schäffeler C, Sauerschnig M, Mann A, Baum T, Rummeny EJ, Wörtler K. MR Bildgebung des Gelenkknorpels am OSG: Bessere Beurteilbarkeit durch axiale Traktion? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346223] [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: 10/26/2022]
|
18
|
Jungmann PM, Ganter C, Pohlig F, Schäffeler C, Bauer JS, Nittka M, Rummeny EJ, Wörtler K. View-Angle Tilting (VAT) und Slice-encoding Metal Artifact Correction (SEMAC) zur MR Bildgebung orthopädischer Tumor-Prothesen. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346225] [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: 10/26/2022]
|
19
|
Knier B, Boeckh-Behrens T, Murgan I, Wörtler K, Hemmer B, Winkelmann J. [Crowned dens syndrome: a rare differential diagnosis of acute neck pain]. Nervenarzt 2012; 83:1308-11. [PMID: 22843028 DOI: 10.1007/s00115-012-3599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Vag T, Koch M, Waldt S, Wörtler K. Acute Carpal Tunnel Syndrome from Dissected and Thrombosed Persistent Median Artery Diagnosed at Magnetic Resonance Imaging. ROFO-FORTSCHR RONTG 2012; 184:829-30. [DOI: 10.1055/s-0032-1312732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
Schäffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, Schröder M, Rummeny E, Imhoff AB, Wörtler K. MR-Arthrographie der Schulter bei Pulley-Läsionen: Diagnostische Leistung etablierter und neuer Befundkriterien. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311147] [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: 10/28/2022]
|
22
|
Wörtler K. Benigne Knochentumore 1. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310710] [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: 10/28/2022]
|
23
|
Wörtler K. Spezialisierung in der Radiologie - Wie viel brauchen wir? Was ist realistisch? - Muskuloskelettales System. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310591] [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: 10/28/2022]
|
24
|
Rechl H, Kirchhoff C, Wörtler K, Lenze U, Töpfer A, von Eisenhart-Rothe R. [Diagnosis of malignant bone and soft tissue tumors]. Orthopade 2012; 40:931-41; quiz 942-3. [PMID: 21874363 DOI: 10.1007/s00132-011-1821-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.
Collapse
Affiliation(s)
- H Rechl
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | | | | | | | | | | |
Collapse
|
25
|
Wörtler K, Heuck A. Arbeitsgemeinschaft Muskuloskelettale Radiologie. ROFO-FORTSCHR RONTG 2011; 183:1016-8. [DOI: 10.1055/s-0031-1281779] [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: 10/15/2022]
|
26
|
Wörtler K. Schultergelenkverletzungen bei Überkopfsportarten. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1278758] [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: 10/18/2022]
|
27
|
Meier R, Thürmel K, Moog P, Noel P, Dorn F, Henninger M, Wildgruber M, Rummeny EJ, Wörtler K. Detektion von aktiver Entzündung bei Patienten mit undifferenzierter Arthritis mittels optischer Fluoreszenz-Bildgebung im Vergleich zur MRT. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1268311] [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: 10/18/2022]
|
28
|
Grunewald TGP, Damke L, Maschan M, Petrova U, Surianinova O, Esipenko A, Konovalov D, Behrends U, Schiessl J, Wörtler K, Burdach S, von Luettichau I. First report of effective and feasible treatment of multifocal lymphangiomatosis (Gorham-Stout) with bevacizumab in a child. Ann Oncol 2010; 21:1733-1734. [PMID: 20605931 DOI: 10.1093/annonc/mdq331] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- T G P Grunewald
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München; Laboratory of Functional Genomics and Transplantation Biology, Children's Cancer Research Center, Paediatric Oncology and Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - L Damke
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München
| | - M Maschan
- Department of Haematology, Federal Clinical Research Center for Paediatric Haematology, Oncology and Immunology, Moscow
| | - U Petrova
- Department of Haematology-1, Russian Children's Clinical Hospital, Moscow
| | - O Surianinova
- Department of Haematology, Yaroslavl Regional Children's Hospital, Yaroslavl
| | - A Esipenko
- Department of Haematology, Yaroslavl Regional Children's Hospital, Yaroslavl
| | - D Konovalov
- Department of Pathology, Federal Clinical Research Center for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - U Behrends
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München
| | - J Schiessl
- Department of Pathology, Klinikum Schwabing
| | - K Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Burdach
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München; Laboratory of Functional Genomics and Transplantation Biology, Children's Cancer Research Center, Paediatric Oncology and Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - I von Luettichau
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München.
| |
Collapse
|
29
|
Minzlaff P, Braun S, Haller B, Wörtler K, Imhoff AB. [Autologous transfer of the posterior femoral condyle for large osteochondral lesions of the knee: 5-year results of the Mega-OATS technique]. Orthopade 2010; 39:631-6. [PMID: 20232194 DOI: 10.1007/s00132-010-1608-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Large osteochondral defects of the weight-bearing zones of the femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle. This technique is a salvage procedure and aims at pain-free mobility of patients. MATERIAL AND METHODS Between July 1999 and December 2000, 18 patients were operated on. Sixteen patients were evaluated using the Lysholm score. X-rays were done, and eight individuals underwent magnetic resonance imaging (MRI) analysis. The average age at the date of surgery was 37.4 (15-59) years, and the mean follow-up time was 55.2 (46-62) months. The mean defect size was 5.4 cm(2) (3.1-7.1). Trauma or osteochondrosis dissecans was pathogenetic in 81%. RESULTS The Lysholm score showed a significant (p=0.001) increase from a preoperative median of 65.0 to a postoperative median of 86.0 points. Fifteen patients returned to sport activities. X-rays showed a rounding of the osteotomy edge in 12 patients and a partial bone-dense remodelling of the posterior femoral condyle in 11 patients. All MRI examinations showed vital and congruent grafts. CONCLUSION Thus, the procedure is recommended for treating large and deep focal osteochondral lesions in the weight-bearing zone of the femoral condyle.
Collapse
Affiliation(s)
- P Minzlaff
- Abteilung für Sportorthopädie, KlinikumRechts der Isar, Technische Universität München, Connollystrasse 32, 80809, München, Deutschland.
| | | | | | | | | |
Collapse
|
30
|
Müller D, Brockow K, Baum T, Bauer JS, Schneider S, Rummeny E, Wörtler K. Ganzkörper-MRT bei Patienten mit systemischer Mastozytose. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252578] [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: 10/19/2022]
|
31
|
Schäffeler C, Mueller D, Kirchhoff C, Heinrich P, Rummeny E, Wörtler K. Rupturen am Footprint der Rotatorenmanschette: Prävalenz und Morphologie in 305 MR-Arthrographien der Schulter mit klinischer Korrelation. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252705] [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: 10/19/2022]
|
32
|
Wörtler K. Hüftkopfnekrose des Erwachsenen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252258] [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: 10/19/2022]
|
33
|
Schaeffeler C, Brügel M, Waldt S, Rummeny E, Wörtler K. Ultraschallgesteuerte intraartikuläre Kontrastmittelapplikation für die MR-Arthrografie der Schulter. ROFO-FORTSCHR RONTG 2009; 182:267-73. [DOI: 10.1055/s-0028-1109838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
|
35
|
Wörtler K. Case-Mix mit Falldiskussion (TED). ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221123] [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]
|
36
|
Holzapfel K, Waldt S, Paul J, Brügel M, Rummeny EJ, Wörtler K. Inter- und Intraobserver-Variabilität der MR-Arthrographie in der Detektion und Klassifizierung von SLAP-Läsionen: Evaluation 75 arthroskopisch bestätigter Fälle. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221522] [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]
|
37
|
Bauer JS, Salzmann GM, Landwehr S, Paul J, Imhoff AB, Schöttle PB, Wörtler K, Rummeny EJ. Quantifizierung von T2-Zeit und Morphologie verschiedener Knorpeltransplantate – Osteochondrale Autografts versus Matrix assistierte Knorpelzelltransplantation. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221580] [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]
|
38
|
Müller D, Bauer JS, Walter F, Rechl H, Rummeny EJ, Wörtler K. MRT-Perfusions- und Diffusionsmessungen des proximalen Femurs bei Patienten mit transientem Knochenmarködem, avaskulärer Knochennekrose und subchondraler Insuffizienzfraktur – Erste Ergebnisse. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221618] [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]
|
39
|
Eiber M, Waldt S, Bauer JS, Brügel M, Streng W, Wörtler K, Rummeny EJ. Einfluss von Rasterwahl und Dosis auf die Detektion von Knochenläsionen des Beckens: experimentelle Untersuchung unter Verwendung eine Flachbettdetektorsystems. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221495] [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]
|
40
|
Fischer W, Bohndorf K, Kreitner KF, Schmitt R, Wörtler K, Zentner J. Indikationen der MR- und CT-Arthrografie – Empfehlungen der AG Muskuloskelettale Radiologie der DRG. ROFO-FORTSCHR RONTG 2009; 181:441-6. [DOI: 10.1055/s-0028-1109103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
41
|
|
42
|
|
43
|
Steinborn M, Wörtler K, Nathrath M, Schöniger M, Hahn H, Rummeny EJ. [Whole-body MRI in children with langerhans cell histiocytosis for the evaluation of the skeletal system]. ROFO-FORTSCHR RONTG 2008; 180:646-53. [PMID: 18561067 DOI: 10.1055/s-2008-1027345] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The usefulness of whole-body MRI (WB-MRI) for the detection of skeletal lesions in patients with Langerhans cell histiocytosis should be documented on the basis of case presentations. MATERIALS AND METHODS In six patients with histologically proven Langerhans cell histiocytosis, 14 WB-MRI examinations were performed to evaluate the skeletal system within disease staging (6 primary, 8 follow-up examinations). The examinations were performed on a 1.5 Tesla, 32-channel whole-body scanner. The examination protocol consisted of T 1-weighted and STIR sequences in coronal and sagittal orientation. For comparison, radiographs of the initial skeletal lesions and those that were additionally detected on WB-MRI were available. RESULTS In 4 patients no additional skeletal lesions were found on WB-MRI besides the initial lesion leading to the diagnosis of unifocal single system disease. In 2 patients WB-MRI was able to identify additional skeletal lesions. In a 5 S year-old boy with the primary lesion located in the cervical spine, a second lesion was detected in the lumbar spine on the initial scan and in the skull and proximal femur during follow-up examination. In a 12 year-old girl with a primary lesion of the thoracic spine, WB-MRI diagnosed additional lesions in the pelvic bone and the tibia. In both patients the diagnosis of multifocal skeletal involvement led to chemotherapy. During follow-up examination, the healing response under therapy could be demonstrated. Comparison with conventional imaging showed that especially lesions located in the spine or the pelvis were not detectable on radiographs even when knowing the MR results. CONCLUSION The extent of skeletal involvement in Langerhans cell histiocytosis has crucial impact on therapy and prognosis. Whole-body MRI has been reported to be an established method for the evaluation of disseminated skeletal disease with distinct advantages over conventional radiography and bone scintigraphy. Our results suggest that WB-MRI should also be the imaging modality of choice for the assessment of skeletal involvement in children with Langerhans cell histiocytosis.
Collapse
Affiliation(s)
- M Steinborn
- Institut für Diagnostische und Interventionelle Radiologie, Abteilung Kinderradiologie, Städtisches Klinikum München GmbH, Klinikum Schwabing, Kolner Platz 1, Munich.
| | | | | | | | | | | |
Collapse
|
44
|
Beitzel K, Brucker P, Wörtler K, Imhoff A. Junge Medizinstudentin mit blockiertem Kniegelenk. Arthroskopie 2008. [DOI: 10.1007/s00142-007-0427-x] [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: 10/22/2022]
|
45
|
Brügel M, Gaa J, Waldt S, Holzapfel K, Wörtler K, Rummeny EJ. MR-Diagnostik von Lebermetastasen: Vergleich einer atemgetriggerten diffusionsgewichteten EPI-Sequenz versus Gadolinium. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073657] [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: 10/21/2022]
|
46
|
Wörtler K. Differentialdiagnose der Arthritis: Arthropathien und Gelenktumoren. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073336] [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: 10/21/2022]
|
47
|
|
48
|
Abstract
The treatment of soft tissue sarcoma requires an individually tailored, multimodal therapy due to the high variability in the clinical situation. Resection is the usual treatment for patients with superficial, low grade tumors with a diameter of <5 cm. For intermediate grade, differentiated lesions, resection with negative resection edges combined with radiotherapy attains an almost 80% total survival rate. For patients with high grade sarcoma of >5 cm, local control can be attained by resection and radiotherapy, however every second patient will develop metastases. Patients with a local recurrence should consider a new resection. Radiotherapy is the more effective the lower the remaining postoperative tumor burden.
Collapse
Affiliation(s)
- H Rechl
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität, Ismaninger Strasse 22, 81675 München, Deutschland.
| | | | | | | | | |
Collapse
|
49
|
Sandmann G, Wörtler K, Imhoff A. Rolltreppensturz mit schwerwiegenden Folgen für die Schulter. Arthroskopie 2007. [DOI: 10.1007/s00142-007-0390-6] [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: 10/23/2022]
|
50
|
Aryee S, Lorenz S, Wörtler K, Imhoff AB. Traumatische Schulterluxation. Arthroskopie 2007. [DOI: 10.1007/s00142-006-0378-7] [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: 10/23/2022]
|