1
|
Scheele CB, Pietschmann MF, Wagner TC, Müller PE. [Functional outcomes and return to sports, work, and daily activities after revision UKA compared to primary UKA and TKA]. Orthopadie (Heidelb) 2024; 53:201-208. [PMID: 38349524 PMCID: PMC10896861 DOI: 10.1007/s00132-024-04472-z] [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] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA), in addition to total knee arthroplasty (TKA), has been shown to be effective in the surgical treatment of knee osteoarthritis with appropriate patient selection. In clinical studies, it has demonstrated superior functional results with lower complication rates. In clinical practice, these advantages must be weighed against the disadvantage of an increased revision rate, especially in younger patients with sports and work activities. OBJECTIVES The aim of this study was to compare the functional outcome as well as the time to return to daily activities, work, and sports after revision of UKA to TKA with those of primary UKA and primary TKA using a matched-pair analysis. MATERIALS AND METHODS The study was based on a matched-pair analysis at two defined time points, always comparing 28 patients who underwent either revision of a UKA to a TKA, primary UKA, or primary TKA. Patients completed the Oxford Knee Score, UCLA score, Knee Society score, and WOMAC score during standardized follow-up. In addition, postoperative patient satisfaction and return to activities of daily living, work, and sports were recorded in a standardized manner, and a clinical examination was performed. RESULTS The four functional scores studied showed a common trend in favor of UKA, followed by primary TKA and revision TKA. The differences between converted UKA and primary TKA were not significant. However, at 3.2 years after the last surgery, the results of the converted UKA were significantly lower than those of the primary UKA. Return to work and sports tended to occur the earliest after UKA, followed by TKA and the revision group. All groups showed a tendency to engage in low-impact sports. CONCLUSION The functional results of revised UKA were significantly inferior to those of primary UKA based on a 3-year follow-up. Return to work, sports, and activities of daily living tended to take longer after revision than after primary implantation of either a UKA or a TKA.
Collapse
Affiliation(s)
- Christian B Scheele
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts an der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Matthias F Pietschmann
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Thomas C Wagner
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Peter E Müller
- Klink für Orthopädie und Unfallchirurgie, Muskuloskelettalen Universitätszentrum München (MUM), Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| |
Collapse
|
2
|
Häner M, Stoffels T, Guenther D, Pfeiffer T, Imhoff A, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stöhr A, Mehl J, Niederer D, Jung T, Kittl C, Eberle C, Vernacchia C, Ellermann A, Braun PJ, Krause M, Mengis N, Müller PE, Best R, Achtnich A, Petersen W. Management after acute injury of the anterior cruciate ligament (ACL). Part 3: Recommendation on surgical treatment. Knee Surg Sports Traumatol Arthrosc 2024; 32:223-234. [PMID: 38293720 DOI: 10.1002/ksa.12064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE The aim of this consensus project was to give recommendations regarding surgical treatment of the anterior cruciate ligament (ACL) injured patient. METHODS For this consensus process, an expert, steering and rating group was formed. In an initial online meeting, the steering group, together with the expert group, formed various key topic complexes for which multiple questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS During this consensus process, 30 topics regarding the surgical management and technique of ACL reconstruction were identified. The literature search for each key question resulted in 30 final statements. Of these 30 final statements, all achieved consensus. CONCLUSIONS This consensus process has shown that surgical treatment of ACL injury is a complex process. Various surgical factors influence patient outcomes. The proposed treatment algorithm can be used as a decision aid for the surgeon. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
- Martin Häner
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Berlin, Germany
| | | | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Thomas Pfeiffer
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Andreas Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt am Main, Frankfurt, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | | | | | | | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Daniel Niederer
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, German
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | | | - Cara Vernacchia
- Department of Physical Medicine & Rehabilitation, Shirley Ryan Ability Lab, Chicago, Illinois, USA
- McGaw, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Philipp-Johannes Braun
- Department of Trauma and Orthopaedic Surger, BG Hospital Unfallkrankenhaus, Berlin, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Zofingen, Switzerland
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Tuebingen, Germany
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Wolf Petersen
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Berlin, Germany
| |
Collapse
|
3
|
Müller PE, Konvalin LJ. [Shoulder-clinical introduction]. Radiologie (Heidelb) 2024; 64:93-100. [PMID: 37816804 DOI: 10.1007/s00117-023-01219-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Radiological imaging plays a significant role in the diagnostics of shoulder pathologies. Based on a patient's medical history, physical examination and radiological imaging, it is possible to plan the further conservative or surgical treatment. OBJECTIVES Common pathologies of the shoulder and the correct radiological imaging are presented. CONCLUSIONS A rational and targeted use of radiological imaging, together with the medical history and physical examination allows correct diagnosis of pathologies of the shoulder joint.
Collapse
Affiliation(s)
- Peter E Müller
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Lennart J Konvalin
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| |
Collapse
|
4
|
Niethammer TR, Aurich M, Brucker PU, Faber S, Diemer F, Pietschmann MF, Schoch W, Zinser W, Müller PE. Follow-up Treatment after Cartilage Therapy of the Knee Joint - a Recommendation of the DGOU Clinical Tissue Regeneration Working Group. Z Orthop Unfall 2024. [PMID: 38224697 DOI: 10.1055/a-2206-7242] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The first follow-up treatment recommendation from the DGOU's Clinical Tissue Regeneration working group dates back to 2012. New scientific evidence and changed framework conditions made it necessary to update the follow-up treatment recommendations after cartilage therapy.As part of a multi-stage member survey, a consensus was reached which, together with the scientific evidence, provides the basis for the present follow-up treatment recommendation.The decisive criterion for follow-up treatment is still the defect localisation. A distinction is made between femorotibial and patellofemoral defects. In addition, further criteria regarding cartilage defects are now also taken into account (stable cartilage edge, location outside the main stress zone) and the different methods of cartilage therapy (e. g. osteochondral transplantation, minced cartilage) are discussed.The present updated recommendation includes different aspects of follow-up treatment, starting with early perioperative management through to sports clearance and resumption of contact sports after cartilage therapy has taken place.
Collapse
Affiliation(s)
- Thomas R Niethammer
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Matthias Aurich
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle, Deutschland
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost, Halle (Saale), Deutschland
| | - Peter U Brucker
- ATOS Klinik München, München, Deutschland
- Biomechanik im Sport, Fakultät für Sport- und Gesundheitswissenschaft, Technische Universität München, München
| | - Svea Faber
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | | | - Matthias F Pietschmann
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
- OrthoPraxis Oberhaching, Oberhaching
| | | | - Wolfgang Zinser
- Orthoexpert, Knittelfeld, Österreich
- Metagil Physikalisches Ambulatorium, Knittelfeld, Österreich
| | - Peter E Müller
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| |
Collapse
|
5
|
Walther M, Gottschalk O, Madry H, Müller PE, Steinwachs M, Niemeyer P, Niethammer TR, Tischer T, Petersen J, Feil R, Fickert S, Schewe B, Hörterer H, Ruhnau K, Becher C, Klos K, Plaass C, Rolauffs B, Behrens P, Spahn G, Welsch G, Angele P, Ahrend MD, Kasten P, Erggelet C, Ettinger S, Günther D, Körner D, Aurich M. Etiology, Classification, Diagnostics, and Conservative Management of Osteochondral Lesions of the Talus. 2023 Recommendations of the Working Group "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology. Cartilage 2023; 14:292-304. [PMID: 37082983 PMCID: PMC10601568 DOI: 10.1177/19476035231161806] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 04/22/2023] Open
Abstract
METHODS Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. CONCLUSION In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.
Collapse
Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- König-Ludwig-Haus, Julius Maximilian University of Würzburg, Würzburg, Germany
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Oliver Gottschalk
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Henning Madry
- Institute of Experimental Orthopaedics and Department of Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - Peter E. Müller
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Matthias Steinwachs
- SportClinic Zürich, Klinik Hirslanden, Zürich, Switzerland
- ETH Zürich, Zürich, Switzerland
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- OCM—Hospital for Orthopedic Surgery Munich, Munich, Germany
| | - Thomas R. Niethammer
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Thomas Tischer
- Klinik für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Roman Feil
- Klinik für Unfallchirurgie und Orthopädie, Kath. Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Stefan Fickert
- Sporthopaedicum Straubing, Straubing, Germany
- Sporthopaedicum Regensburg, Regensburg, Germany
| | - Bernhard Schewe
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Germany
| | - Hubert Hörterer
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Christoph Becher
- Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Germany
| | | | - Christian Plaass
- Orthopedic Clinic of Medical School Hannover, DIAKOVERE Annastift, Hannover, Germany
| | - Bernd Rolauffs
- Klinik für Orthopädie und Unfallchirurgie and G.E.R.N. Forschungszentrum, Universitätsklinikum Freiburg, Freiburg, Germany
| | | | - Gunter Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach, Eisenach, Germany
| | | | - Peter Angele
- Sporthopaedicum Straubing, Straubing, Germany
- Sporthopaedicum Regensburg, Regensburg, Germany
- Department of Trauma and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Marc-Daniel Ahrend
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Philip Kasten
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Germany
| | - Christoph Erggelet
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- alphaclinic zürich, Zürich, Switzerland
| | - Sarah Ettinger
- Orthopedic Clinic of Medical School Hannover, DIAKOVERE Annastift, Hannover, Germany
| | - Daniel Günther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Daniel Körner
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Matthias Aurich
- BG Klinikum Bergmannstrost Halle, Halle (Saale), Germany
- Abteilung für Unfall- und Wiederherstellungschirurgie, Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), Halle, Germany
| |
Collapse
|
6
|
Bauer L, Woiczinski M, Thorwächter C, Müller PE, Holzapfel BM, Niethammer TR, Simon JM. Influence of kinematic alignment on femorotibial kinematics in medial stabilized TKA design compared to mechanical alignment. Arch Orthop Trauma Surg 2023; 143:4339-4347. [PMID: 36282314 PMCID: PMC10293425 DOI: 10.1007/s00402-022-04661-5] [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: 05/11/2022] [Accepted: 10/10/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Worldwide more and more primary knee replacements are being performed. Kinematic alignment (KA) as one of many methods of surgical alignment has been shown to have a significant impact on kinematics and function. The aim of the present study was to compare KA and mechanical alignment (MA) with regard to femorotibial kinematics. MATERIALS AND METHODS Eight fresh frozen human specimens were tested on a knee rig during active knee flexion from 30 to 130°. Within the same specimen a medial stabilized (MS) implant design was used first with KA and then with MA. RESULTS The femorotibial kinematics showed more internal rotation of the tibia in KA compared to MA. At the same time, there was a larger medial rotation point in KA. Both alignment methods showed femoral rollback over the knee bend. CONCLUSION Relating to an increased internal rotation and a more precise medial pivot point, it can be concluded that KA combined with a MS implant design may partially support the reproduction of physiological knee joint mechanics.
Collapse
Affiliation(s)
- L Bauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - M Woiczinski
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - P E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - B M Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - T R Niethammer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J-M Simon
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| |
Collapse
|
7
|
Petersen W, Guenther D, Imhoff AB, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stoehr A, Stoffels T, Häner M, Hees T, Mehl J, Ellermann A, Krause M, Mengis N, Eberle C, Müller PE, Best R, Lutz PM, Achtnich A. Management after acute rupture of the anterior cruciate ligament (ACL). Part 1: ACL reconstruction has a protective effect on secondary meniscus and cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2023; 31:1665-1674. [PMID: 35445329 PMCID: PMC10089999 DOI: 10.1007/s00167-022-06960-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/03/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture should be established. METHODS The consensus project was initiated by the Ligament Injuries Committee of the German Knee Society (Deutsche Kniegesellschaft, DKG). A modified Delphi process was used to answer scientific questions. This process was based on key topic complexes previously formed during an initial face-to-face meeting of the steering group with the expert group. For each key topic, a comprehensive review of available literature was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Consensus was defined a-priori as eighty percent agreement. RESULTS Of the 17 final statements, 15 achieved consensus, and 2 have not reached consensus. Results of the consensus were summarized in an algorithm for the management after ACL rupture (infographic/Fig. 2). CONCLUSION This consensus process has shown that the development of post-traumatic osteoarthritis is a complex multifactorial process. Exogenous (primary and secondary meniscus lesions) and endogenous factors (varus deformity) play a decisive role. Due to the complex interplay of these factors, an ACL reconstruction cannot always halt post-traumatic osteoarthritis of the knee. However, there is evidence that ACL reconstruction can prevent secondary joint damage such as meniscus lesions and that the success of meniscus repair is higher with simultaneous ACL reconstruction. Therefore, we recommend ACL reconstruction in case of a combined injury of the ACL and a meniscus lesion which is suitable for repair. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
- Wolf Petersen
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheimer Str. 200, 51109, Köln, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stoehr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Martin Häner
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Tilman Hees
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| |
Collapse
|
8
|
Liu H, Müller PE, Aszódi A, Klar RM. Osteochondrogenesis by TGF-β3, BMP-2 and noggin growth factor combinations in an ex vivo muscle tissue model: Temporal function changes affecting tissue morphogenesis. Front Bioeng Biotechnol 2023; 11:1140118. [PMID: 37008034 PMCID: PMC10060664 DOI: 10.3389/fbioe.2023.1140118] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
In the absence of clear molecular insight, the biological mechanism behind the use of growth factors applied in osteochondral regeneration is still unresolved. The present study aimed to resolve whether multiple growth factors applied to muscle tissue in vitro, such as TGF-β3, BMP-2 and Noggin, can lead to appropriate tissue morphogenesis with a specific osteochondrogenic nature, thereby revealing the underlying molecular interaction mechanisms during the differentiation process. Interestingly, although the results showed the typical modulatory effect of BMP-2 and TGF-β3 on the osteochondral process, and Noggin seemingly downregulated specific signals such as BMP-2 activity, we also discovered a synergistic effect between TGF-β3 and Noggin that positively influenced tissue morphogenesis. Noggin was observed to upregulate BMP-2 and OCN at specific time windows of culture in the presence of TGF-β3, suggesting a temporal time switch causing functional changes in the signaling protein. This implies that signals change their functions throughout the process of new tissue formation, which may depend on the presence or absence of specific singular or multiple signaling cues. If this is the case, the signaling cascade is far more intricate and complex than originally believed, warranting intensive future investigations so that regenerative therapies of a critical clinical nature can function properly.
Collapse
Affiliation(s)
- Heng Liu
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
- *Correspondence: Heng Liu, ; Roland M. Klar,
| | - Peter E. Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Attila Aszódi
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Roland M. Klar
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Department of Oral and Craniofacial Sciences, University of Missouri-Kansas City, Kansas City, MO, United States
- *Correspondence: Heng Liu, ; Roland M. Klar,
| |
Collapse
|
9
|
Müller PE, Niethammer TR. [Sports injuries : What type of imaging is required?]. Radiologie (Heidelb) 2023; 63:235-240. [PMID: 36757482 DOI: 10.1007/s00117-023-01121-y] [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] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Imaging is of great importance in sports injuries, since the indication for conservative and surgical therapy depends on precise knowledge of the extent of the damage. OBJECTIVES Typical sports injuries and their imaging requirements are to be presented as examples. CONCLUSIONS In order to detect the often subtle pathologies, imaging must be adapted to the clinical diagnosis that is specifically suspected.
Collapse
Affiliation(s)
- Peter E Müller
- Schwerpunkt Knie & Sport, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Thomas R Niethammer
- Schwerpunkt Knie & Sport, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| |
Collapse
|
10
|
Santos I, Pichler L, Saller MM, Thorwächter C, Müller JG, Traxler H, Pietschmann MF, Tauber M, Müller PE. Effect of shape and size of supraspinatus tears on rotator cuff strain distribution: an in vitro study. J Shoulder Elbow Surg 2023; 32:e71-e83. [PMID: 36208674 DOI: 10.1016/j.jse.2022.08.023] [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] [Received: 05/27/2022] [Revised: 08/13/2022] [Accepted: 08/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of the size and shape of a supraspinatus tear on the strain of the intact rotator cuff and the kinematics of the shoulder is still unknown. This, however, can be relevant when deciding whether surgical reconstruction is required to prevent an increase in a tendon defect. In this study, the effect of tear width and shape on rotator cuff strain and glenohumeral kinematics was evaluated during active abduction. METHODS Twelve fresh-frozen cadaveric shoulders with intact rotator cuffs were used in this study. We created 50% and 100% wide (full-thickness) crescent-shaped (CS) tears (n = 6) and reverse L-shaped (rLS) tears (n = 6) in the supraspinatus tendon and measured strain and kinematics during active humeral elevation until 30°. RESULTS Both tear shapes and sizes led to an increase in internal rotation, supraspinatus loading force, and superior translation of the humerus. For the 100% wide tear size, anterior translation was observed in the CS tear group, whereas in the rLS tear group, this translation occurred mainly in the posterior direction. Strain was higher in the infraspinatus during the first 25° of abduction in comparison with the supraspinatus tendon in both tear shape groups. An analysis of the anterior and posterior tear borders showed a higher strain concentration on the same side of the tear in the CS tear group with 50% and 100% wide tears. CONCLUSIONS The influence of different tear shapes on translation in the anterior-posterior direction was evident as both CS and rLS tears led to an oppositely directed translation of the humeral head. The strain analysis showed a stress-shielding effect of the infraspinatus at the beginning of abduction. Therefore, special attention must be paid to correctly identify the tear extension and adequately reconstruct the rotator cuff footprint. Moreover, the constant location of maximum strain in the CS tear group may lead to an earlier progression than in the rLS tear group.
Collapse
Affiliation(s)
- Inês Santos
- Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany.
| | - Lieselotte Pichler
- Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Maximilian M Saller
- Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Christoph Thorwächter
- Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Julia Gertrud Müller
- Centre for Anatomy and Cell Biology, Department of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Hannes Traxler
- Centre for Anatomy and Cell Biology, Department of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Matthias F Pietschmann
- Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany; OrthoPaxis Oberhaching, Oberhaching, Germany
| | | | - Peter E Müller
- Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| |
Collapse
|
11
|
Niemeyer P, Albrecht D, Aurich M, Becher C, Behrens P, Bichmann P, Bode G, Brucker P, Erggelet C, Ezechieli M, Faber S, Fickert S, Fritz J, Hoburg A, Kreuz P, Lützner J, Madry H, Marlovits S, Mehl J, Müller PE, Nehrer S, Niethammer T, Pietschmann M, Plaass C, Rössler P, Rhunau K, Schewe B, Spahn G, Steinwachs M, Tischer T, Volz M, Walther M, Zinser W, Zellner J, Angele P. [Correction: Empfehlungen der AG Klinische Geweberegeneration zur Behandlung von Knorpelschäden am Kniegelenk]. Z Orthop Unfall 2023; 161:e2. [PMID: 35345054 DOI: 10.1055/a-1798-7819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Philipp Niemeyer
- OCM Orthopädische Chirurgie München, München, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland
| | - Dirk Albrecht
- Chirurgie, Klinik im Kronprinzenbau, Reutlingen, Deutschland
| | - Matthias Aurich
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.,Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle (Saale, Deutschland
| | - Christoph Becher
- HKF - Internationales Zentrum für Hüft-, Knie- und Fußchirurgie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
| | | | - Peter Bichmann
- Klinik für Unfallchirurgie und Orthopädie, Nordwest Krankenhaus Sanderbusch GmbH, Sande, Deutschland
| | - Gerrit Bode
- Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland
| | | | | | - Marco Ezechieli
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, St. Josefs Krankenhaus Salzkotten, Salzkotten, Deutschland
| | - Svea Faber
- Orthopädische Chirurgie, OCM Klinik München, München, Deutschland
| | - Stefan Fickert
- University Medical Center Mannheim Medical Faculty Mannheim, Heidelberg University, Sportorthopaedicum Regensburg/Straubing, Straubing, Deutschland
| | - Jürgen Fritz
- Orthopädie und Unfallchirurgie, Orthopädisch Chirurgisches Centrum, Tübingen, Deutschland
| | - Arnd Hoburg
- Gelenk- und Wirbelsäulenzentrum, Gelenk- und Wirbelsäulenzentrum Steglitz-Berlin, Berlin, Deutschland
| | - Peter Kreuz
- Zentrum für Orthopädie und Unfallchirurgie, Asklepios Stadtklinik Bad Tolz, Bad Tölz, Deutschland
| | - Jörg Lützner
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Henning Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Stefan Marlovits
- Klinik für Unfallchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Julian Mehl
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TUM, München, Deutschland
| | - Peter E Müller
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, München, Deutschland
| | - Stefan Nehrer
- Fakultät für Gesundheit und Medizin, Donau-Universität Krems, Krems, Österreich
| | - Thomas Niethammer
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität, München, Deutschland
| | - Matthias Pietschmann
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, München, Deutschland
| | - Christian Plaass
- Diakovere Annastift, Klinik für Orthopädie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philip Rössler
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Klaus Rhunau
- Orthopedics, Viktoria Klinik Bochum, Bochum, Deutschland
| | - Bernhard Schewe
- Orthopädisch Chirurgisches Centrum, Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Deutschland
| | - Gunter Spahn
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland.,Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Matthias Steinwachs
- Zentrum für Orthobiologie und Knorpelregeneration, Schulthess Klinik, Zürich, Schweiz
| | - Thomas Tischer
- Orthopaedic Surgery, University Medicine Rostock, Rostock, Deutschland
| | - Martin Volz
- Orthopädie & Unfallchirurgie, Sportklinik Ravensburg, Ravensburg, Deutschland
| | - Markus Walther
- Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Deutschland
| | - Wolfgang Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken, Dinslaken, Deutschland
| | | | - Peter Angele
- sporthopaedicum Regensburg, Regensburg, Deutschland.,Universitätsklinikum Regensburg, Regensburg, Deutschland
| |
Collapse
|
12
|
Niemeyer P, Albrecht D, Aurich M, Becher C, Behrens P, Bichmann P, Bode G, Brucker P, Erggelet C, Ezechieli M, Faber S, Fickert S, Fritz J, Hoburg A, Kreuz P, Lützner J, Madry H, Marlovits S, Mehl J, Müller PE, Nehrer S, Niethammer T, Pietschmann M, Plaass C, Rössler P, Rhunau K, Schewe B, Spahn G, Steinwachs M, Tischer T, Volz M, Walther M, Zinser W, Zellner J, Angele P. Empfehlungen der AG Klinische Geweberegeneration zur Behandlung von Knorpelschäden am Kniegelenk. Z Orthop Unfall 2023; 161:57-64. [PMID: 35189656 DOI: 10.1055/a-1663-6807] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Working Group of the German Orthopedic and Trauma Society (DGOU) on Tissue Regeneration has published recommendations on the indication of different surgical approaches for treatment of full-thickness cartilage defects in the knee joint in 2004, 2013 and 2016. Based upon new scientific knowledge and new developments, this recommendation is an update based upon the best clinical evidence available. In addition to prospective randomised controlled clinical trials, this also includes studies with a lower level of evidence. In the absence of evidence, the decision is based on a consensus process within the members of the working group.The principle of making decision dependent on defect size has not been changed in the new recommendation either. The indication for arthroscopic microfracturing has been reduced up to a defect size of 2 cm2 maximum, while autologous chondrocyte implantation is the method of choice for larger cartilage defects. Additionally, matrix-augmented bone marrow stimulation (mBMS) has been included in the recommendation for defects ranging from 1 to 4.5 cm2. For the treatment of smaller osteochondral defects, in addition to osteochondral transplantation (OCT), mBMS is also recommended. For larger defects, matrix-augmented autologous chondrocyte implantation (mACI/mACT) in combination with augmentation of the subchondral bone is recommended.
Collapse
Affiliation(s)
- Philipp Niemeyer
- OCM Orthopädische Chirurgie München, München, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland
| | - Dirk Albrecht
- Chirurgie, Klinik im Kronprinzenbau, Reutlingen, Deutschland
| | - Matthias Aurich
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.,Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle (Saale, Deutschland
| | - Christoph Becher
- HKF - Internationales Zentrum für Hüft-, Knie- und Fußchirurgie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
| | | | - Peter Bichmann
- Klinik für Unfallchirurgie und Orthopädie, Nordwest Krankenhaus Sanderbusch GmbH, Sande, Deutschland
| | - Gerrit Bode
- Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland
| | | | | | - Marco Ezechieli
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, St. Josefs Krankenhaus Salzkotten, Salzkotten, Deutschland
| | - Svea Faber
- Orthopädische Chirurgie, OCM Klinik München, München, Deutschland
| | - Stefan Fickert
- University Medical Center Mannheim Medical Faculty Mannheim, Heidelberg University, Sportorthopaedicum Regensburg/Straubing, Straubing, Deutschland
| | - Jürgen Fritz
- Orthopädie und Unfallchirurgie, Orthopädisch Chirurgisches Centrum, Tübingen, Deutschland
| | - Arnd Hoburg
- Gelenk- und Wirbelsäulenzentrum, Gelenk- und Wirbelsäulenzentrum Steglitz-Berlin, Berlin, Deutschland
| | - Peter Kreuz
- Zentrum für Orthopädie und Unfallchirurgie, Asklepios Stadtklinik Bad Tolz, Bad Tölz, Deutschland
| | - Jörg Lützner
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Henning Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Stefan Marlovits
- Klinik für Unfallchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Julian Mehl
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TUM, München, Deutschland
| | - Peter E Müller
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, München, Deutschland
| | - Stefan Nehrer
- Fakultät für Gesundheit und Medizin, Donau-Universität Krems, Krems, Österreich
| | - Thomas Niethammer
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität, München, Deutschland
| | - Matthias Pietschmann
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, München, Deutschland
| | - Christian Plaass
- Diakovere Annastift, Klinik für Orthopädie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philip Rössler
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Klaus Rhunau
- Orthopedics, Viktoria Klinik Bochum, Bochum, Deutschland
| | - Bernhard Schewe
- Orthopädisch Chirurgisches Centrum, Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Deutschland
| | - Gunter Spahn
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland.,Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Matthias Steinwachs
- Zentrum für Orthobiologie und Knorpelregeneration, Schulthess Klinik, Zürich, Schweiz
| | - Thomas Tischer
- Orthopaedic Surgery, University Medicine Rostock, Rostock, Deutschland
| | - Martin Volz
- Orthopädie & Unfallchirurgie, Sportklinik Ravensburg, Ravensburg, Deutschland
| | - Markus Walther
- Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Deutschland
| | - Wolfgang Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken, Dinslaken, Deutschland
| | | | - Peter Angele
- sporthopaedicum Regensburg, Regensburg, Deutschland.,Universitätsklinikum Regensburg, Regensburg, Deutschland
| |
Collapse
|
13
|
Betz VM, Holzgruber M, Simon J, Uhlemann F, Niemeyer P, Müller PE, Niethammer TR. The Effect of Smoking on the Outcome of Matrix-Based Autologous Chondrocyte Implantation: Data from the German Cartilage Registry. J Knee Surg 2023; 36:181-187. [PMID: 34237778 DOI: 10.1055/s-0041-1731456] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Smoking is known to have various deleterious effects on health. However, it is not clear whether smoking negatively affects the postoperative outcome following matrix-based autologous cartilage implantation (MACI) in the knee. The purpose of this study was to evaluate the effect of smoking on the outcome of MACI in the knee. A total of 281 patients receiving MACI in the knee between 2015 and 2018 were registered in the German Cartilage Database. The cohort was divided into ex-smokers, smokers, and nonsmokers. Data regarding the Knee Injury and Osteoarthritis Outcome Score (KOOS), the numeric rating scale (NRS) for pain, and satisfaction with the outcome were analyzed and compared. Follow-ups were performed at 6, 12, and 24 months after surgery. Of the 281 patients, 225 (80.1%) were nonsmokers, 43 (15.3%) were smokers, and 13 (4.6%) were ex-smokers. The three groups were comparable with respect to age, sex, body mass index (BMI), height, defect size, the need for additional reconstruction of the subchondral bone defect, number of previous knee surgeries, and defect location. However, nonsmokers had a significantly lower weight as compared with smokers. Besides a significantly lower preoperative NRS of nonsmokers as compared with smokers, there were no significant differences between the three groups with respect to KOOS, NRS, and satisfaction at 6, 12, and 24 months of follow-ups. The present study of data retrieved from the German Cartilage Registry suggests that the smoking status does not influence the outcome of MACI in the knee.
Collapse
Affiliation(s)
- Volker M Betz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin Holzgruber
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johanna Simon
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Felix Uhlemann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philipp Niemeyer
- Department of Orthopaedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.,Department of Orthopaedic Surgery, Orthopädische Chirurgie München Clinic, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas R Niethammer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
14
|
Petersen W, Häner M, Guenther D, Lutz P, Imhoff A, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stöhr A, Stoffels T, Mehl J, Jung T, Eberle C, Vernacchia C, Ellermann A, Krause M, Mengis N, Müller PE, Best R, Achtnich A. Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient. Knee Surg Sports Traumatol Arthrosc 2022; 31:1675-1689. [PMID: 36471029 DOI: 10.1007/s00167-022-07260-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
- Wolf Petersen
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany
| | - Martin Häner
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany.
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Patricia Lutz
- Department of Orthopaedics and Trauma Surgery, State Hospital Feldkirch, Carinagasse 41, 6800, Feldkirch, Austria
| | - Andreas Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt Am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt Am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheiemer Str. 200, 51109, Cologne, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stöhr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Cara Vernacchia
- Department of Physical Medicine and Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL, USA
- McGaw/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Mühlethalstrasse 27, 4800, Zofingen, Schweiz
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| |
Collapse
|
15
|
Dupraz I, Thorwächter C, Grupp TM, Hammerschmid F, Woiczinski M, Jansson V, Müller PE, Steinbrück A. Impact of femoro-tibial size combinations and TKA design on kinematics. Arch Orthop Trauma Surg 2022; 142:1197-1212. [PMID: 34021794 DOI: 10.1007/s00402-021-03923-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/14/2020] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The variability in patients' femoral and tibial anatomy requires to use different tibia component sizes with the same femoral component size. These size combinations are allowed by manufacturers, but the clinical impact remains unclear. Therefore, the goals of our study were to investigate whether combining different sizes has an impact on the kinematics for two well-established knee systems and to compare these systems' kinematics to the native kinematics. MATERIALS AND METHODS Six fresh frozen knee specimens were tested in a force controlled knee rig before and after implantation of a cruciate retaining (CR) and a posterior-stabilized (PS) implant. Femoro-tibial kinematics were recorded using a ultrasonic-based motion analysis system while performing a loaded squat from 30° to 130°. In each knee, the original best fit inlay was then replaced by different inlays simulating a smaller or bigger tibia component. The kinematics obtained with the simulated sizes were compared to the original inlay kinematics using descriptive statistics. RESULTS For all size combinations, the difference to the original kinematics reached an average of 1.3 ± 3.3 mm in translation and - 0.1 ± 1.2° in rotation with the CR implant. With the PS implant, the average differences reached 0.4 ± 2.7 mm and - 0.2 ± 0.8°. Among all knees, no size combination consistently resulted in significantly different kinematics. Each knee showed a singular kinematic pattern. For both knee systems, the rotation was smaller than in the native knee, but the direction of the rotation was preserved. The PS showed more rollback and the CR less rollback than the native knee. CONCLUSION TKA systems designed with a constant tibio-femoral congruency among size combinations should enable to combine different sizes without having substantial impact on the kinematics. The rotational pattern was preserved by both TKA systems, while the rollback could only be maintained by the PS design.
Collapse
Affiliation(s)
- Ingrid Dupraz
- Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany.
| | - Christoph Thorwächter
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Thomas M Grupp
- Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Florian Hammerschmid
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| |
Collapse
|
16
|
Goller SS, Heuck A, Erber B, Fink N, Rückel J, Niethammer TR, Müller PE, Ricke J, Baur-Melnyk A. Magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 for the evaluation of retropatellar autologous chondrocyte transplantation and correlation to clinical outcome. Knee 2022; 34:42-54. [PMID: 34883330 DOI: 10.1016/j.knee.2021.11.003] [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] [Received: 12/28/2020] [Revised: 08/22/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Matrix-associated chondrocyte transplantation (MACT) has become an established treatment option for cartilage defects. OBJECTIVE Three objectives were defined: first, to evaluate retropatellar cartilage grafts using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score; second, to determine whether clinical outcome correlates with specific parameters or overall results; third, to screen those parameters for their ability to predict a clinical outcome of Delta IKDC ≥ 20 as a threshold for good clinical response at 12 months. METHODS 38 patients were included of whom all underwent retropatellar MACT. MRI was performed 3, 6 and 12 months postoperatively. The clinical status was determined using International Knee Documentation Committee Subjective Form (IKDC). Correlations of MOCART 2.0 parameters and Delta IKDC scores were quantified by nonparametric Spearman's R. Those parameters with significant correlations (p < 0.05) were screened for their ability to predict a clinical outcome of Delta IKDC ≥ 20 at 12 months. RESULTS Significant correlations were identified for the parameters MOCART total 6 months (p < 0.05), Surface 6 months (p < 0.05), Surface 12 months (p < 0.05), Structure 6 months (p < 0.01), Structure 12 months (p < 0.05), Subchondral changes 3 months (p < 0.0001), Subchondral changes 6 months (p < 0.05) and Subchondral changes 12 months (p < 0.05). Among all MRI score parameters, Subchondral changes 3 months achieved the highest accuracy of 0.76 (0.62-0.86) in predicting Delta IKDC ≥ 20 after 12 months. CONCLUSION Some of the MOCART 2.0 parameters show significant correlation with Delta IKDC scores in the postoperative course after retropatellar MACT, which seems to depend on the time interval between surgery and MRI acquisition.
Collapse
Affiliation(s)
- Sophia S Goller
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Andreas Heuck
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Bernd Erber
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Nicola Fink
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Johannes Rückel
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Thomas R Niethammer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany.
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany.
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | | |
Collapse
|
17
|
Guenther D, Pfeiffer T, Petersen W, Imhoff A, Herbort M, Achtnich A, Stein T, Kittl C, Schoepp C, Akoto R, Höher J, Scheffler S, Stöhr A, Stoffels T, Mehl J, Jung T, Ellermann A, Eberle C, Vernacchia C, Lutz P, Krause M, Mengis N, Müller PE, Patt T, Best R. Treatment of Combined Injuries to the ACL and the MCL Complex: A Consensus Statement of the Ligament Injury Committee of the German Knee Society (DKG). Orthop J Sports Med 2021; 9:23259671211050929. [PMID: 34888389 PMCID: PMC8649102 DOI: 10.1177/23259671211050929] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Different indications and treatment options for combined injuries to the anterior cruciate ligament (ACL) and medial collateral ligament complex (MCL) are not clearly defined. Purpose: To perform a modified Delphi process with the Committee for Ligament Injuries of the German Knee Society (DKG) in order to structure and optimize the process of treating a combined injury to the ACL and MCL. Study Design: Consensus statement. Methods: Scientific questions and answers were created based on a comprehensive literature review using the central registers for controlled studies of Medline, Scopus, and Cochrane including the terms medial collateral ligament, anterior cruciate ligament, MCL, ACL, and outcome used in various combinations. The obtained statements passed 3 cycles of a modified Delphi process during which each was readjusted and rated according to the available evidence (grades A-E) by the members of the DKG Ligament Injuries Committee and its registered guests. Results: The majority of answers, including several questions with >1 graded answer, were evaluated as grade E (n = 16) or C (n = 10), indicating that a low level of scientific evidence was available for most of the answers. Only 5 answers were graded better than C: 3 answers with a grade of A and 2 answers with a grade of B. Only 1 answer was evaluated as grade D. An agreement of >80% (range, 83%-100%) among committee members was achieved for all statements. Conclusion: The results of this modified Delphi process offer a guideline for standardized patient care in cases of combined injuries to the ACL and MCL.
Collapse
Affiliation(s)
- Daniel Guenther
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Thomas Pfeiffer
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Wolf Petersen
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Andreas Imhoff
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Mirco Herbort
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Andrea Achtnich
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Thomas Stein
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Christoph Kittl
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Christian Schoepp
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Ralph Akoto
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Jürgen Höher
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Sven Scheffler
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Amelie Stöhr
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Thomas Stoffels
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Julian Mehl
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Tobias Jung
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Andree Ellermann
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Christian Eberle
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Cara Vernacchia
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Patricia Lutz
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Matthias Krause
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Natalie Mengis
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Peter E Müller
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Thomas Patt
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Raymond Best
- Investigation performed at Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| |
Collapse
|
18
|
Müller PE, Niethammer TR. Editorial Commentary: Bone Marrow Lesion as a Prognostic Factor for Osteochondral Allograft Transplantation of Cartilage Defects in the Knee Joint. Arthroscopy 2021; 37:3498-3499. [PMID: 34863384 DOI: 10.1016/j.arthro.2021.07.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
Bone marrow lesions (BML) can be categorized as ischemic, mechanical, or reactive. BML are associated with cartilage loss and can be interpreted as a "stress-related bone marrow edema," and are a consequence of subchondral overload due to lack of cartilaginous cushioning and load distribution. The prevalence, depth, and cross-sectional area of BML increase with the degree cartilage defect. There is a risk that bone marrow edema will progress to subchondral cysts, and cysts are a point of no return of a BML. Thus, successful treatment of cartilage damage requires causally addressing the bone marrow edema, and it is also crucial for the therapy of the BML that cartilage damage is completely treated. A postoperative BML is associated with incomplete defect coverage due to incomplete ingrowth of the osteochondral allograft with missing closure of the cartilage surface, or insufficient containment. Ideal treatment for a circumscribed subchondral BML is a single cylinder replacing the damaged cartilage and the entire BML with an osteochondral allograft. In the case of larger defects or larger BML, successful treatment of the cartilage defect is the critical point.
Collapse
|
19
|
Geith T, Stellwag AC, E Müller P, Reiser M, Baur-Melnyk A. Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature. ACTA ACUST UNITED AC 2021; 26:355-362. [PMID: 32558648 DOI: 10.5152/dir.2020.19188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Diagnosis of bone marrow edema syndrome (BMES) can be challenging. There is sometimes uncertainty about the correct diagnosis of BMES on morphologic magnetic resonance imaging (MRI), since subchondral findings like lines and spots can be misinterpreted as "beginning" or "possible" avascular osteonecrosis (AVN). The aim of our study was to systematically assess the temporal course of BMES from first diagnosis on MRI until the end of clinical symptoms and the full disappearance of bone marrow edema (BME) to determine whether subchondral lines and spots detected in these patients can develop into osteonecrosis. METHODS In a combined retrospective and prospective study, we retrieved serial MRI scans of hips and knees with BME from the hospital database. According to clinical and imaging data, all patients with degenerative, infectious/inflammatory, rheumatic, neoplastic conditions and those showing typical osteonecrosis were excluded. We collected all available MRI examinations from first detection of BME until its disappearance. In case edema had not fully resolved in the last available MRI scan, we performed an MRI with an additional dynamic contrast-enhanced (DCE-MRI) sequence. For each MRI scan, we recorded the severity of edema, the presence of subchondral hypointense lines and the presence of subchondral focal hypointense zones on T1-weighted images by two independent readers. The DCE-MRI scans were used to calculate parameter maps to assess the perfusion characteristics. RESULTS The study comprised 49 patients aged 22-71 years. In total, 171 morphologic and 5 DCE-MRI scans were evaluated. In 44 patients (89.8%), the BMES completely healed without remnants. In 18 of 49 patients (36.7%), a subchondral line was present in the first MRI exam. Nine patients (18.4%) developed a subchondral line within 1-5 months after the first MRI. In total, 27 out of 49 patients (55.1%) had subchondral lines (12 knees, 15 hips) during the timeframe of the study. All subchondral lines disappeared in the timeframe of the study. Subchondral focal hypointense zones were present in 14 out of 49 patients (28.6%): in 9 cases, subchondral focal hypointense zones disappeared after a median of 5.5 months (range, 1-85 months), while in 5 cases, subchondral focal lesions persisted until the end of the study (up to more than 85 months) without edema in the surrounding bone. All persisting subchondral focal lesions were hyperperfused. These 5 patients had associated meniscal lesions. CONCLUSION Our study shows that subchondral lines and spots found in patients with BMES do not develop into AVN. Subchondral lines, which resemble subchondral insufficiency fractures, are associated with BMES. Subchondral focal T1-hypointense zones do not represent AVN; most probably these areas represent reparative processes within the subchondral bone, where tensile and shear force overload is present due to altered biomechanics.
Collapse
Affiliation(s)
- Tobias Geith
- Department of Interventional Radiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Ann-Cathrin Stellwag
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
20
|
Betz VM, Ren B, Betz OB, Jansson V, Müller PE. Osteoinduction within adipose tissue fragments by heterodimeric bone morphogenetic Proteins-2/6 and -2/7 versus homodimeric bone morphogenetic protein-2: Therapeutic implications for bone regeneration. J Gene Med 2021; 23:e3311. [PMID: 33527563 DOI: 10.1002/jgm.3311] [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: 11/13/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Fragments of subcutaneous adipose tissue that have been genetically modified to express bone morphogenetic protein-2 (BMP-2) regenerate large segmental osseous lesions in rodents. Gene-activated adipose tissue can be implanted into osseous defects without prior cell extraction and cell culture. The present study aimed to explore whether the heterodimers BMP-2/6 or BMP-2/7 exceed the osteoinductive effect of BMP-2 on adipose tissue. METHODS In an in vitro tissue culture system, freshly harvested rat subcutaneous adipose tissue was cultivated in the presence of either BMP-2 or BMP-2/6 or BMP-2/7 at a high (200 ng/ml) and low (50 ng/ml) concentration. Gene expression analysis as well as histological and immunohistochemical methods were applied to test for osteoinduction. RESULTS A concentration of 200 ng/ml of homodimeric BMP-2 induced osteogenic differentiation most potently, showing more calcification and a higher expression level of bone markers than both concentrations of BMP-2/6 or -2/7. A concentration of 50 ng/ml of BMP-2 was a significantly stronger osteogenic inducer than both concentrations of BMP-2/6 and the low concentration of BMP-2/7. The most potent heterodimeric driver of osteoinduction was BMP-2/7 at a high concentration, demonstrating effects similar to those of BMP-2 at a low concentration. CONCLUSIONS Homodimeric BMP-2 evoked osteoinduction within adipose tissue more potently and at a lower concentration than heterodimeric BMP-2/6 or BMP-2/7. This result agrees well with the fact that it might be easier to translate adipose grafts activated by homodimeric BMP-2 clinically. Preclinical in vivo gene transfer studies are necessary to confirm the results of the present study.
Collapse
Affiliation(s)
- Volker M Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| | - Bin Ren
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| | - Oliver B Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| |
Collapse
|
21
|
Niethammer TR, Gallik D, Chevalier Y, Holzgruber M, Baur-Melnyk A, Müller PE, Pietschmann MF. Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint. Int Orthop 2020. [PMID: 33280063 DOI: 10.1007/s00264-020-04884-4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Femoral and patellar cartilage defects with a defect size > 2.5 cm2 are a potential indication for an autologous chondrocyte implantation (ACI). However, the influence of the localization and the absolute and relative defect size on the clinical outcome has not yet been determined. The purpose of this study is to analyze the influence of the localization and the absolute and relative defect size on the clinical outcome after third-generation autologous chondrocyte implantation. METHODS A total of 50 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D). A match paired analysis was performed of 25 treated femoral and 25 treated patella defects with a follow-up of three years. MRI data was used to do the manual segmentation of the cartilage layer throughout the knee joint. The defect size was determined by taking the defect size measured in the MRI in relation to the whole cartilage area. The clinical outcome was measured by the IKDC score and VAS pre-operatively and after six, 12, 24, and 36 months post-operatively. RESULTS IKDC and VAS scores showed a significant improvement from the baseline in both groups. Femoral cartilage defects showed significantly superior clinical results in the analyzed scores compared to patellar defects. The femoral group improved IKDC from 33.9 (SD 18.1) pre-operatively to 71.5 (SD 17.4) after three years and the VAS from 6.9 (SD 2.9) pre-operatively to 2.4 (SD 2.5) after three years. In the patellar group, IKDC improved from 36.1 (SD 12.6) pre-operatively to 54.7 (SD 20.3) after three years and the VAS improved from 6.7 (SD 2.8) pre-operatively to 3.4 (SD 2.) after three years. Regarding the defect size, results showed that the same absolute defect size at med FC (4.8, range 2-15) and patella (4.6, range 2-12) has a significantly different share of the total cartilaginous size of the joint compartment (med FC: 6.7, range 1.2-13.9; pat: 18.9, range 4.0-47.0). However, there was no significant influence of the relative defect size on the clinical outcome in either patellar or femoral localization. CONCLUSION Third-generation autologous chondrocyte implantation in ACI-treated femoral cartilage defects leads to a superior clinical outcome in a follow-up of three years compared with patellar defects. No significant influence of the defect size was found in either femoral or patellar cartilage defects.
Collapse
Affiliation(s)
- Thomas R Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - David Gallik
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Y Chevalier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Holzgruber
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andrea Baur-Melnyk
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
22
|
Niethammer TR, Gallik D, Chevalier Y, Holzgruber M, Baur-Melnyk A, Müller PE, Pietschmann MF. Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint. Int Orthop 2020; 45:1483-1491. [PMID: 33280063 PMCID: PMC8178140 DOI: 10.1007/s00264-020-04884-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/17/2020] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Femoral and patellar cartilage defects with a defect size > 2.5 cm2 are a potential indication for an autologous chondrocyte implantation (ACI). However, the influence of the localization and the absolute and relative defect size on the clinical outcome has not yet been determined. The purpose of this study is to analyze the influence of the localization and the absolute and relative defect size on the clinical outcome after third-generation autologous chondrocyte implantation. METHODS A total of 50 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D). A match paired analysis was performed of 25 treated femoral and 25 treated patella defects with a follow-up of three years. MRI data was used to do the manual segmentation of the cartilage layer throughout the knee joint. The defect size was determined by taking the defect size measured in the MRI in relation to the whole cartilage area. The clinical outcome was measured by the IKDC score and VAS pre-operatively and after six, 12, 24, and 36 months post-operatively. RESULTS IKDC and VAS scores showed a significant improvement from the baseline in both groups. Femoral cartilage defects showed significantly superior clinical results in the analyzed scores compared to patellar defects. The femoral group improved IKDC from 33.9 (SD 18.1) pre-operatively to 71.5 (SD 17.4) after three years and the VAS from 6.9 (SD 2.9) pre-operatively to 2.4 (SD 2.5) after three years. In the patellar group, IKDC improved from 36.1 (SD 12.6) pre-operatively to 54.7 (SD 20.3) after three years and the VAS improved from 6.7 (SD 2.8) pre-operatively to 3.4 (SD 2.) after three years. Regarding the defect size, results showed that the same absolute defect size at med FC (4.8, range 2-15) and patella (4.6, range 2-12) has a significantly different share of the total cartilaginous size of the joint compartment (med FC: 6.7, range 1.2-13.9; pat: 18.9, range 4.0-47.0). However, there was no significant influence of the relative defect size on the clinical outcome in either patellar or femoral localization. CONCLUSION Third-generation autologous chondrocyte implantation in ACI-treated femoral cartilage defects leads to a superior clinical outcome in a follow-up of three years compared with patellar defects. No significant influence of the defect size was found in either femoral or patellar cartilage defects.
Collapse
Affiliation(s)
- Thomas R Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - David Gallik
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Y Chevalier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Holzgruber
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andrea Baur-Melnyk
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
23
|
Woiczinski M, Maas A, Grupp T, Thorwächter C, Santos I, Müller PE, Jansson V, Steinbrück A. [Realistic preclinical finite element simulation in knee and hip replacements]. Orthopade 2020; 49:1060-1065. [PMID: 33063143 DOI: 10.1007/s00132-020-04025-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the process of developing an implant, computer simulation involving finite element (FE) methods allows the early identification of design-related issues, thus reducing the development process to a minimum. In addition, the FE simulation is used for selecting testing combinations in order to provide the relevant authority with proof of a "worst-case" construct scenario for the subsequent experimental fatigue test. RESULTS Research studies with FE simulations show that implant positioning may affect mechanical loads under certain circumstances and, therefore, influence the preclinical evaluation of the prostheses. DISCUSSION Although the FE simulation currently contributes significantly to preclinical testing, a standardization of the calculation models allowing comparability of results is lacking. Furthermore, the development of new dynamic and realistic models is necessary in order to identify complex damage modes that currently cannot be reproduced experimentally. When considering everyday clinical life in particular, models that can reproduce intraoperative kinematic changes and the resulting incorrect loads of the implant, as well as address these problems by changing the position or design of the prosthesis, are necessary and would help in future.
Collapse
Affiliation(s)
- Matthias Woiczinski
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Allan Maas
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.,Research & Development, Aesculap AG, Tuttlingen, Deutschland
| | - Thomas Grupp
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.,Research & Development, Aesculap AG, Tuttlingen, Deutschland
| | - Christoph Thorwächter
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Ines Santos
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Peter E Müller
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Volkmar Jansson
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Arnd Steinbrück
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| |
Collapse
|
24
|
Woiczinski M, Schröder C, Paulus A, Kistler M, Jansson V, Müller PE, Weber P. Varus or valgus positioning of the tibial component of a unicompartmental fixed-bearing knee arthroplasty does not increase wear. Knee Surg Sports Traumatol Arthrosc 2020; 28:3016-3021. [PMID: 31690992 DOI: 10.1007/s00167-019-05761-3] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Higher revision rates were shown in varus- or valgus-positioned tibias in unicompartmental knee arthroplasty (UKA), but more than 15% of UKA prostheses are implanted with more than 5° of varus or valgus. This study aimed to analyze the wear rate in UKA when implanting the tibial component in either varus or valgus position versus a neutral placement at 90° to the tibial anatomical axis. The study hypothesized that a 5° varus or valgus positioning of the tibial plateau will generate less wear compared to a neutral alignment. METHODS Wear was experimentally analyzed on a medial anatomical fixed-bearing unicompartmental knee prosthesis (Univation, Aesculap, Germany) in vitro with a customized, four-station, servohydraulic knee wear simulator, reproducing the walking cycle. The forces, loading and range of motion were applied as specified in the ISO 14243-1:2002, 5 million cycles were analyzed. The tibial components of the medial prostheses were inserted in a neutral position, with 5° varus, and 5° valgus (n = 3, each group). RESULTS The wear rate decreased significantly with a 5° varus positioning (6.30 ± 1.38 mg/million cycles) and a 5° valgus positioning (4.96 ± 2.47 mg/million cycles) compared to the neutral position (12.16 ± 1.26 mg/million cycles) (p < 0.01 for the varus and the valgus position). The wear area on the inlay was slightly reduced in the varus and valgus group. CONCLUSION A varus or valgus "malpositioning" up to 5° will not lead to an increased wear. Wear was even less because of the reduced articulating contact area between the inlay and the femur. A slight varus positioning of the tibial component (parallel to the anatomical joint line) positioning can be advocated from a point of wear. LEVEL OF EVIDENCE Experimental study.
Collapse
Affiliation(s)
- Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Paulus
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Manuel Kistler
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Patrick Weber
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany. .,ECOM-Excellent Center of Medicine, Arabellastr, 17, 81925, Munich, Germany.
| |
Collapse
|
25
|
Ficklscherer A, Zhang AZ, Beer T, Gülecyüz MF, Klar RM, Safi E, Woiczinski M, Jansson V, Müller PE. The effect of autologous Achilles bursal tissue implants in tendon-to-bone healing of rotator cuff tears in rats. J Shoulder Elbow Surg 2020; 29:1892-1900. [PMID: 32299772 DOI: 10.1016/j.jse.2020.01.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 08/20/2019] [Revised: 12/22/2019] [Accepted: 01/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to investigate the influence of autologous bursal tissue derived from the Achilles bursa on tendon-to-bone healing after rotator cuff tear repair in a rat model. METHODS A total of 136 Sprague-Dawley rats were randomly assigned to either an untreated or a bursal tissue application group or biomechanical testing and histologic testing after rotator cuff repair. After separating the supraspinatus tendon close to the greater tuberosity, the tendon was reattached either unaltered or with a bursal tissue interposition sewn onto the interface. Immunohistologic analysis was performed 1 and 7 weeks after supraspinatus tendon reinsertion. Biomechanical testing of the tendon occurred 6 and 7 weeks after reinsertion. RESULTS Immunohistologic results demonstrated a significantly higher percentage of Type II collagen (P = .04) after 1 and 7 weeks in the tendon-to-bone interface using autologous bursal tissue in comparison to control specimens. The bursa group showed a significantly higher collagen I to III quotient (P = .03) at 1 week after surgery in comparison to the 7-week postsurgery bursa groups and controls. Biomechanical assessment showed that overall tendon stiffness (P = .002) and the tendon viscoelasticity in the bursa group (P = .003) was significantly improved after 6 and 7 weeks. There was no significant difference (P = .55) in force to failure between the bursa group and the control group after 6 and 7 weeks. CONCLUSION Autologous bursal tissue derived from the Achilles bursa and implanted to the tendon-to-bone interface after rotator cuff repair facilitates a faster healing response to re-establish the biologic and biomechanical integrity of the rotator cuff in rats.
Collapse
Affiliation(s)
- Andreas Ficklscherer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Anja Z Zhang
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany.
| | - Thomas Beer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Roland M Klar
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Elem Safi
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| |
Collapse
|
26
|
Huang Y, Seitz D, Chevalier Y, Müller PE, Jansson V, Klar RM. Synergistic interaction of hTGF-β 3 with hBMP-6 promotes articular cartilage formation in chitosan scaffolds with hADSCs: implications for regenerative medicine. BMC Biotechnol 2020; 20:48. [PMID: 32854680 PMCID: PMC7457281 DOI: 10.1186/s12896-020-00641-y] [Citation(s) in RCA: 5] [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: 02/11/2020] [Accepted: 08/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Human TGF-β3 has been used in many studies to induce genes coding for typical cartilage matrix components and accelerate chondrogenic differentiation, making it the standard constituent in most cultivation media used for the assessment of chondrogenesis associated with various stem cell types on carrier matrices. However, in vivo data suggests that TGF-β3 and its other isoforms also induce endochondral and intramembranous osteogenesis in non-primate species to other mammals. Based on previously demonstrated improved articular cartilage induction by a using hTGF-β3 and hBMP-6 together on hADSC cultures and the interaction of TGF- β with matrix in vivo, the present study investigates the interaction of a chitosan scaffold as polyanionic polysaccharide with both growth factors. The study analyzes the difference between chondrogenic differentiation that leads to stable hyaline cartilage and the endochondral ossification route that ends in hypertrophy by extending the usual panel of investigated gene expression and stringent employment of quantitative PCR. Results By assessing the viability, proliferation, matrix formation and gene expression patterns it is shown that hTGF-β3 + hBMP-6 promotes improved hyaline articular cartilage formation in a chitosan scaffold in which ACAN with Col2A1 and not Col1A1 nor Col10A1 where highly expressed both at a transcriptional and translational level. Inversely, hTGF-β3 alone tended towards endochondral bone formation showing according protein and gene expression patterns. Conclusion These findings demonstrate that clinical therapies should consider using hTGF-β3 + hBMP-6 in articular cartilage regeneration therapies as the synergistic interaction of these morphogens seems to ensure and maintain proper hyaline articular cartilage matrix formation counteracting degeneration to fibrous tissue or ossification. These effects are produced by interaction of the growth factors with the polysaccharide matrix.
Collapse
Affiliation(s)
- Yijiang Huang
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital of Munich, 81377, Munich, Germany
| | - Daniel Seitz
- BioMed Center Innovation gGmbh, 95448, Bayreuth, Germany
| | - Yan Chevalier
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital of Munich, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital of Munich, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital of Munich, 81377, Munich, Germany
| | - Roland M Klar
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital of Munich, 81377, Munich, Germany.
| |
Collapse
|
27
|
Niethammer TR, Altmann D, Holzgruber M, Gülecyüz MF, Notohamiprodjo S, Baur-Melnyk A, Müller PE. Patient-Reported and Magnetic Resonance Imaging Outcomes of Third-Generation Autologous Chondrocyte Implantation After 10 Years. Arthroscopy 2020; 36:1928-1938. [PMID: 32200064 DOI: 10.1016/j.arthro.2020.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/18/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the long-term clinical and radiologic outcomes of third-generation autologous chondrocyte implantation (ACI) for the treatment of focal cartilage defects of the knee. METHODS Data capture was carried out between 2004 and 2018. Included were patients with cartilage defects of the knee joint with an International Cartilage Repair Society grade of III or higher treated with third-generation ACI who had a minimum follow-up period of 10 years. International Knee Documentation Committee scores and assessment of pain at rest and on movement using visual analog scale scores were captured preoperatively and at 6 months postoperatively, as well as annually thereafter. In addition, we performed magnetic resonance imaging examinations in 13 cases after 10 years. The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score was used to evaluate the ACI cartilage. RESULTS A total of 54 patients met the inclusion criteria. Of these, 30 reached the 10-year follow-up point and were included in this assessment. At 10 years postoperatively, all clinical outcome parameters showed a statistically significant improvement compared with the preoperative situation, with a responder rate of 70%. The average MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score after 10 years was 59.2 points (range, 20-100 points), and over 60% of the evaluated patients showed good integration of the implant at 10 years postoperatively. CONCLUSIONS The clinical and radiologic findings of this study show that third-generation ACI is a suitable and effective option in the treatment of full-thickness cartilage defects of the knee. At 10 years after surgery, third-generation ACI shows stable results and leads to significant improvement in all clinical outcome parameters. Despite these results, revision surgery after third-generation ACI is common and was needed in 23% of patients in this study. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Thomas R Niethammer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Daniel Altmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Holzgruber
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Susan Notohamiprodjo
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
28
|
Müller PE, Güleçyüz MF. [The shoulder-arm syndrome]. MMW Fortschr Med 2020; 162:44-47. [PMID: 32514957 DOI: 10.1007/s15006-020-0573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Peter E Müller
- Klinik und Poliklinik für Orthopädie Physikalische Medizin und Rehabilitation, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, D-81377, München, Deutschland.
| | - Mehmet F Güleçyüz
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Ludwig-Maximilians-Universität München, Deutschland
| |
Collapse
|
29
|
Scheele CB, Pietschmann MF, Schröder C, Lenze F, Grupp TM, Müller PE. Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty. Knee 2020; 27:587-597. [PMID: 32024609 DOI: 10.1016/j.knee.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/17/2019] [Revised: 10/08/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae. METHODS Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis. RESULTS Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136). CONCLUSIONS Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
Collapse
Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Florian Lenze
- Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Aesculap AG Research & Development, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
30
|
Roßbach BP, Gülecyüz MF, Kempfert L, Pietschmann MF, Ullamann T, Ficklscherer A, Niethammer TR, Zhang A, Klar RM, Müller PE. Rotator Cuff Repair With Autologous Tenocytes and Biodegradable Collagen Scaffold: A Histological and Biomechanical Study in Sheep. Am J Sports Med 2020; 48:450-459. [PMID: 31841352 DOI: 10.1177/0363546519892580] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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 Large rotator cuff tears still represent a challenging problem in orthopaedics. The use of tenocytes on biomaterials/scaffolds for the repair of large rotator cuff defects might be a promising approach in the field of tendon regeneration. HYPOTHESIS Cultivated autologous tenocytes seeded on a collagen scaffold lead to enhanced histological and biomechanical results after rotator cuff repair in a sheep model as compared with unseeded scaffolds in an acute setting. STUDY DESIGN Controlled laboratory study. METHODS At the tendon-bone junction of the infraspinatus tendon of the right foreleg of 24 sheep, a 3.5 × 1.5-cm tendon defect was created. Sheep were randomly allocated to group 1, a defect; group 2, where an unseeded collagen scaffold was implanted; or group 3, which received the implantation of a collagen scaffold seeded with autologous tenocytes. Twelve weeks postoperatively, tendon regeneration was examined histologically and biomechanically. RESULTS The histology of the neotendons of group 3 showed better fiber patterns, a higher production of proteoglycans, and an increased genesis of collagen III in contrast to groups 1 and 2. Immunostaining revealed less tissue dedifferentiation, a more structured cartilage layer, and homogeneous cartilage-bone transition in group 3 in comparison with groups 1 and 2. Biomechanically, the tensile strength of the reconstructed tendons in group 3 (mean load to failure, 2516 N; SD, 407.5 N) was approximately 84% that of the native tendons (mean load to failure, 2995 N; SD, 223.1 N) without statistical significance. A significant difference (P = .0095) was registered between group 1 (66.9% with a mean load to failure of 2004 N; SD, 273.8 N) and the native tendons, as well as between group 2 (69.7% with a mean load to failure of 2088 N; SD, 675.4 N) and the native tendons for mean ultimate tensile strength. In breaking stress, a significant difference (P = .0095) was seen between group 1 (mean breaking stress, 1335 N/mm2; SD, 182.7 N/mm2) and the native tendons, as well as between group 2 (breaking stress, 1392 N/mm2; SD, 450.2 N/mm2) and the native tendons (mean breaking stress, 1996 N/mm2; SD, 148.7 N/mm2). Again, there was no significant difference between group 3 (mean breaking stress, 1677 N/mm2; SD, 271.7 N/mm2) and the native tendons. CONCLUSION Autologous tenocytes seeded on collagen scaffolds yield enhanced biomechanical results after tendon-bone reconstruction as compared with unseeded scaffolds in an acute setting. Biomechanical results and histological outcomes were promising, showing that the use of autologous tenocytes with specific carrier matrices could be a novel approach for repairing rotator cuff tears. CLINICAL RELEVANCE This study supports the use of tenocytes and scaffolds for improving the quality of tendon-bone regeneration.
Collapse
Affiliation(s)
- Björn P Roßbach
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany.,Department of Orthopaedics, Section for Arthroscopy, Joint Surgery and Sports Traumatology, Asklepios Klinik St Georg, Academic Hospital of the University of Hamburg, Hamburg, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany
| | - Lena Kempfert
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany.,Department of Urology and Pediatric Urology, RoMed Klinikum, Rosenheim, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany
| | - Tina Ullamann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany
| | - Andreas Ficklscherer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany.,Orthopädie am Viktualienmarkt, Munich, Germany
| | - Thomas R Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany
| | - Anja Zhang
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany.,Institute for Physical Medicine and Rehabilitation, Klinikum Ingolstadt, Germany
| | - Roland M Klar
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Klinikum Großhadern, Munich, Germany
| |
Collapse
|
31
|
Fottner A, Woiczinski M, Schröder C, Schmidutz F, Weber P, Müller PE, Jansson V, Steinbrück A. Impact of tibial baseplate malposition on kinematics, contact forces and ligament tensions in TKA: A numerical analysis. J Mech Behav Biomed Mater 2019; 103:103564. [PMID: 32090954 DOI: 10.1016/j.jmbbm.2019.103564] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE Malposition of implant components in total knee arthroplasty (TKA) has consequences on tibiofemoral kinematics, contact forces and ligament tensions. To evaluate the impact of tibial baseplate malpositioning in the same knee, we conducted a computer simulation. METHODS An established weight-bearing finite element model of a fixed bearing TKA was used for the computer simulation. To evaluate the influence of tibial baseplate malposition, calculations were consecutively performed in neutral position, at 3° and 6° of internal and external rotation and at 3 mm and 6 mm of medial and lateral translation. RESULTS The highest effect of malposition was observed for ligament tensions, with a tendency of a greater influence for the 6 mm translation compared to 6° of rotation. Changes in contact forces and tibiofemoral kinematics were according to the alterations of ligament tensions. The highest ligament tension, contact force and femoral roll-back were registered for 6 mm medialization of the tibial baseplate. DISCUSSION Tibial baseplate malposition effects ligament tensions, tibiofemoral contact forces and kinematics and has a risk of unfavorable clinical results due to postoperative pain, reduced range of motion, instability and a higher rate of early loosening. Therefore, surgeons should aim for a neutral position of the tibial baseplate.
Collapse
Affiliation(s)
- Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany.
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany; Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Feodor-Lynen-Straße 19, 81377, Munich, Germany
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany; Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Feodor-Lynen-Straße 19, 81377, Munich, Germany
| | - Florian Schmidutz
- BG Trauma Center, University of Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Patrick Weber
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany
| |
Collapse
|
32
|
Scheele CB, Pietschmann MF, Schröder C, Suren C, Grupp TM, Müller PE. Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2019; 20:539. [PMID: 31722711 PMCID: PMC6854632 DOI: 10.1186/s12891-019-2929-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/24/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background The objective of this study was to evaluate the impact of a single- vs. double-layer cementing technique on morphological cementation and the generation of microscopic cement layers or loose cement fragments in unicompartmental knee arthroplasty (UKA). Methods UKAs were implanted in 12 cadaver knees. The specimens were divided into two groups of comparable bone mineral density. Six UKAs were implanted using a single-layer cementing technique (group A) and six UKAs were implanted using a double-layer cementing technique (group B). Morphological cementation was assessed on nine cuts through the implant–cement–bone interface in the frontal plane. Loose bone cement fragments and the microscopically quality of layer formation were evaluated. Results Contact between bone and prosthesis was observed in 45.4% of interfaces in group A and 27.8% in group B (p = 0.126). The significant increase of areas without visible cement interlocking in the anteroposterior direction in group A (p = 0.005) was not evident in group B (p = 0.262). Penetration around the peg tended to occur more frequently in group B (67.5% vs. 90.6% p = 0.091). Scanning electron microscopy identified no evidence of fissure formations within the bilaminar cement mantle. Free bone cement fragments were documented in 66.7% in both groups with no difference concerning mass (p = 1.0). Conclusions This in-vitro study showed a tendency towards a more homogenous cementation of tibial UKAs using a double-layer cementing technique, although most of the differences did not reach the level of significance. However, theoretical downsides of the double-layer cementing technique such as an increased formation of free bone fragments or a microscopically fissure formation within the cement layer could not be detected either.
Collapse
Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Suren
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Aesculap AG Research & Development, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
33
|
Scheele CB, Pietschmann MF, Schröder C, Lazic I, Grupp TM, Müller PE. Influence of bone density on morphologic cement penetration in minimally invasive tibial unicompartmental knee arthroplasty: an in vitro cadaver study. J Orthop Surg Res 2019; 14:331. [PMID: 31640733 PMCID: PMC6805553 DOI: 10.1186/s13018-019-1376-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/13/2019] [Indexed: 11/18/2022] Open
Abstract
Background Unicompartmental knee arthroplasty is an established treatment option for anteromedial osteoarthritis. However, large registry studies report higher rates of aseptic loosening compared to total knee arthroplasty. The objective of this study was to assess the impact of bone density on morphological cement penetration. Moreover, an alternative regional bone density measuring technique was validated against the established bone mineral density assessment. Methods Components were implanted on the medial side of 18 fresh-frozen cadaver knees using a minimally invasive approach. Bone density has been quantified prior to implantation using Hounsfield units and bone mineral density. Morphological cement penetration has been assessed in different areas and was correlated with local bone density. Findings A highly significant correlation between Hounsfield units and trabecular bone mineral density was detected (r = 0.93; P < 0.0001), and local bone density was significantly increased in the anterior and posterior area (P = 0.0003). The mean cement penetration depth was 1.5 (SD 0.5 mm), and cement intrusion into trabecular bone was interrupted in 31.8% (SD 23.7%) of the bone-cement interface. Bone density was correlated significantly negative with penetration depth (r = − 0.31; P = 0.023) and positive with interruptions of horizontal interdigitating (r = + 0.33; P = 0.014). Cement penetration around the anchoring peg was not significantly correlated with bone density. Interpretation Areas with high bone density were characterized by significantly lower penetration depths and significantly higher areas without cement penetration. Anchoring pegs facilitate cement intrusion mechanically. Regional quantification of bone density using Hounsfield units is a simple but valuable extension to the established determination of bone mineral density.
Collapse
Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany. .,Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Igor Lazic
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany.,Aesculap AG Research & Development, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
34
|
Melcher C, Sievers B, Höchsmann N, Düren F, Jansson V, Müller PE. Effect of Hyperbaric Oxygen on Proliferation and Gene Expression of Human Chondrocytes: An In Vitro Study. Cartilage 2019; 10:459-466. [PMID: 29582672 PMCID: PMC6755875 DOI: 10.1177/1947603518764281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/14/2022] Open
Abstract
PURPOSE The present study investigated the effects of hyperbaric oxygen (HBO) on human chondrocyte proliferation and gene expression patterns. METHODS Chondrocyte cultures were transferred to a HBO chamber and exposed to 100% oxygen for 7 consecutive days. Within groups, pressure was varied between 1 and 2 atm and duration of HBO administration was varied among 60, 90, and 120 minutes. Cell counts were performed using the WST-1 assay at 1, 3, 5, and 7 days after initiation of HBO treatment to obtain data to plot a growth curve. Gene expression of apoptosis markers PARP and caspase 3, as well as cartilage specific proteins collagen II and COMP, were detected by reverse transcription polymerase chain reaction. RESULTS The experiments showed that in vitro administration of HBO inhibit chondrocyte growth. When applied compression was increased up to 2 atm, chondrocyte cell count was reduced by half at days 3 and 7 in association with an upregulation of the apoptosis markers PARP and caspase 3 as well as the cartilage specific proteins collagen II and COMP. No significant differences were monitored from varied duration of daily treatment. CONCLUSION Chondrocyte growth was inhibited in vitro by treatment of HBO. This inhibitory effect was even increased by elevating the applied pressure, while molecular testing showed reduced chondrocyte growth. Higher levels of HBO inhibited cell growth even more, but up-regulation of apoptosis specific markers and cartilage specific proteins were seen during administration of high oxygen levels. Thus, it has to be evaluated that there is a critical level of hypo-/hyperoxia required to stimulate or at least maintain chondrocyte cell proliferation.
Collapse
Affiliation(s)
- Carolin Melcher
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University, Munchen Medizinische Fakultat, Munich, Germany,Carolin Melcher, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital Munich, Ludwig-Maximilians-University, Munchen Medizinische Fakultat, Marchioninistraße 15, Munich 81377, Germany.
| | - Birte Sievers
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University, Munchen Medizinische Fakultat, Munich, Germany
| | - Nadine Höchsmann
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University, Munchen Medizinische Fakultat, Munich, Germany
| | | | - Volkmar Jansson
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University, Munchen Medizinische Fakultat, Munich, Germany
| | - Peter E. Müller
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University, Munchen Medizinische Fakultat, Munich, Germany
| |
Collapse
|
35
|
Güleçyüz MF, Macha K, Pietschmann MF, Ficklscherer A, Sievers B, Roßbach BP, Jansson V, Müller PE. Allogenic Myocytes and Mesenchymal Stem Cells Partially Improve Fatty Rotator Cuff Degeneration in a Rat Model. Stem Cell Rev Rep 2019; 14:847-859. [PMID: 29855989 DOI: 10.1007/s12015-018-9829-6] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Rotator cuff (RC) tears result not only in functional impairment but also in RC muscle atrophy, muscle fattening and eventually to muscle fibrosis. We hypothesized that allogenic bone marrow derived mesenchymal stem cells (MSC) and myocytes can be utilized to improve the rotator cuff muscle fattening and increase the atrophied muscle mass in a rat model. METHODS The right supraspinatus (SSP) tendons of 105 inbred rats were detached and muscle fattening was provoked over 4 weeks; the left side remained untouched (control group). The animals (n = 25) of the output group were euthanized after 4 weeks for reference purposes. The SSP-tendon of one group (n = 16) was left unoperated to heal spontaneously. The SSP-tendons of the remaining 64 rats (4 groups with n = 16) were repaired with transosseous sutures. One group received a saline solution injection in the SSP muscle belly, two other groups received 5 × 106 allogenic myocytes and 5 × 106 allogenic MSC injections from donor rats, respectively, and one group received no additional treatment. After 4 weeks of healing, the supraspinatus muscle mass was compared quantitatively and histologically to all the treated groups and to the untreated contralateral side. RESULTS In the end of the experiments at week 8, the myocyte and MCS treated groups showed a significantly higher muscle mass with 0.2322 g and 0.2257 g, respectively, in comparison to the output group (0.1911 g) at week 4 with p < 0.05. There was no statistical difference between the repaired, treated, or spontaneous healing groups at week 8. Supraspinatus muscle mass of all experimental groups of the right side was significantly lower compared to the untreated contralateral muscle mass. CONCLUSION This defect model shows that the injection of allogenic mycocytes and MSC in fatty infiltrated SSP muscles is better than no treatment and can partially improve the SSP muscle belly fattening. Nevertheless, a full restoration of the degenerated and fattened rotator cuff muscle to its original condition is not possible using myocytes and MSC in this model.
Collapse
Affiliation(s)
- Mehmet F Güleçyüz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany.
| | - Konstanze Macha
- Department of Orthopaedics and Traumatology, Klinikum Landsberg am Lech, Bgm.-Dr.-Hartmann-Straße 50, 86899, Landsberg am Lech, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Birte Sievers
- Numares AG, Am Biopark 9, 93053, Regensburg, Germany
| | - Björn P Roßbach
- Department of Orthopaedics and Traumatology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Volkmar Jansson
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
36
|
Scheele CB, Müller PE, Schröder C, Grupp T, Jansson V, Pietschmann MF. Accuracy of a non-invasive CT-based measuring technique for cement penetration depth in human tibial UKA. BMC Med Imaging 2019; 19:9. [PMID: 30665370 PMCID: PMC6341644 DOI: 10.1186/s12880-019-0312-x] [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] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Aseptic loosening of the tibial component remains a major cause of failure in unicompartmental knee arthroplasty (UKA) and may be related to micro-motion at the cement-bone interface due to insufficient cement penetration depth. Cement penetration is therefore taken as an indicator of solid fixation strength and primary stability. However, its non-invasive clinical assessment remains difficult in vivo as conventional x-ray is prone to distortion and CT-scans (computed tomography) are difficult to assess due to metal artifacts. The purpose of this study was to develop and validate a reliable in vivo measuring technique of cement penetration depth in human tibial UKA. Methods In an experimental setting, twelve UKA were implanted in fresh-frozen human cadaver knees using a minimal-invasive medial approach. Cement penetration depth was then measured via 1) virtual 3D-models based on metal artifact reduced CT-scans and 2) histological evaluation of nine serial cross-section cuts through the implant-cement-bone-interface. Subsequently, a concordance analysis between the two measuring techniques was conducted. Results The average cement penetration depth was 1) 2.20 mm (SD 0.30 mm) measured on metal artifact reduced CT-scans and 2) 2.21 mm (SD = 0.42) measured on serial cuts (p = 0.956). The mean difference between both techniques was 0.01 mm (SD 0.31 mm) and the Person correlation coefficient was r = 0.686 (p = 0.014). All differences were within the upper and lower limit of agreement. There was no evidence of any significant proportional bias between both techniques (p = 0.182). Conclusions CT-based non-invasive measurement of cement penetration depth delivers reliable results in measuring the penetration depth in tibial UKA. Thereby, it enables clinicians and researchers to assess the cement penetration for in vivo diagnostics in the clinical setting as well as in vitro biomechanical research with subsequent application of load to failure on the implant-cement-bone-interface.
Collapse
Affiliation(s)
- Christian B Scheele
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Peter E Müller
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Schröder
- Ludwig Maximilians University Laboratory for Biomechanics and Experimental Orthopaedics, Campus Grosshadern, Feodor-Lynen-Straße, 19 81377, Munich, Germany
| | - Thomas Grupp
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.,Aesculap AG Research & Development, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Volkmar Jansson
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias F Pietschmann
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
37
|
Ren B, Betz VM, Thirion C, Salomon M, Klar RM, Jansson V, Müller PE, Betz OB. Gene activated adipose tissue fragments as advanced autologous biomaterials for bone regeneration: osteogenic differentiation within the tissue and implications for clinical translation. Sci Rep 2019; 9:224. [PMID: 30659209 PMCID: PMC6338750 DOI: 10.1038/s41598-018-36283-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023] Open
Abstract
Cost-effective, expedited approaches for bone regeneration are urgently needed in an ageing population. Bone Morphogenetic Proteins (BMPs) stimulate osteogenesis but their efficacy is impeded by their short half-life. Delivery by genetically modified cells can overcome this problem. However, cell isolation and propagation represent significant obstacles for the translation into the clinic. Instead, complete gene activated fragments of adipose tissue hold great potential for bone repair. Here, using an in-vitro culture system, we investigated whether adenoviral transduction with human BMP-2 can promote osteogenic differentiation within adipose tissue fragments. Osteoinduction in adipose tissue fragments was evaluated by quantitative reverse transcriptase polymerase chain reaction, immunohistology and histomorphometry. BMP-2 transduced adipose tissue synthesized BMP-2 protein over 30 days peaking by day six, which significantly promoted osteogenic differentiation as indicated by increased calcium depositions, up-regulation of bone marker genes, and bone-related protein expression. Our results demonstrate that cells within adipose tissue fragments can differentiate osteogenically after BMP-2 transduction of cells on the surface of the adipose tissue. BMP-2 gene activated adipose tissue represents an advanced osteo-regenerative biomaterial that can actively contribute to osteogenesis and potentially enable the development of a novel, cost-effective, one-step surgical approach to bone repair without the need for cell isolation.
Collapse
Affiliation(s)
- Bin Ren
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany.
| | - Volker M Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Christian Thirion
- Sirion Biotech GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | - Michael Salomon
- Sirion Biotech GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | - Roland M Klar
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Oliver B Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| |
Collapse
|
38
|
Chamseddine M, Breden S, Pietschmann MF, Müller PE, Chevalier Y. Periprosthetic bone quality affects the fixation of anatomic glenoids in total shoulder arthroplasty: in vitro study. J Shoulder Elbow Surg 2019; 28:e18-e28. [PMID: 30274689 DOI: 10.1016/j.jse.2018.07.012] [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] [Received: 02/22/2018] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid loosening, a common complication of shoulder arthroplasty, could relate to implant design and bone quality. However, the role of bone density has not been tested experimentally yet. In this study, tests on cadaveric specimens of varying bone density were performed to evaluate the effects of bone quality on loosening of typical anatomic glenoid implants. METHODS Cadaveric scapulae scanned with a quantitative computed tomography scanner to determine bone mineral density (BMD) were implanted with either pegged or keeled cemented glenoid components and tested under constant glenohumeral load while a humeral head component was moved cyclically in the inferior and superior directions. Implant superior and inferior edge lifting, defined as displacement from the underlying bone, was measured with linear variable differential transducers until we reached 23,000 test cycles, and statistical testing was performed for differences in edge lifting due to implant design and related to periprosthetic BMD. RESULTS Edge lifting was statistically significant at all time points, but on average, implant design had no effect. Lifting was highest in specimens in which BMD below the lifting edge was lower, with trends of increased displacement with decreased BMD. CONCLUSIONS Implant lifting was greater in glenoids of lower bone density for both implant designs. This finding suggests that fixation failure will most likely occur in bone of lower density and that the fixation design itself may play a secondary role.
Collapse
Affiliation(s)
- Mohamad Chamseddine
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Sebastian Breden
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany.
| |
Collapse
|
39
|
Kraxenberger M, Schröder C, Geith T, Büttner A, von Schulze-Pellengahr C, Birkenmaier C, Müller PE, Jansson V, Wegener B. Fracture generation in human vertebrae under compression loading: The influence of pedicle preservation and bone mineral density on in vitro fracture behavior. Technol Health Care 2018; 26:155-163. [PMID: 29154300 DOI: 10.3233/thc-171086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fractured vertebral bodies are a common and wide spread health issue. OBJECTIVE The purpose of this study was to develop a standardized method to experimentally generate compression fractures in vertebral bodies. The influence of the pedicles has been investigated with regards to the fracture behavior. The correlation between bone mineral density (BMD), the cause of fractures and the fracture behavior was investigated. METHODS Twenty-one fresh frozen human lumbar spines were examined for bone mineral density (BMD) by means of quantitative computed tomography (qCT). All soft tissue was removed, vertebrae were carefully separated from each other and the exposed cranial and caudal endplates were covered with a thin layer of resin to generate a plane and homogeneous surface. A total of 80 vertebral bodies were tested until fracture. RESULTS A good positive correlation was found between BMD, fracture compression force and stiffness of the vertebral body. No significant differences were found between the fractures generated in vertebral bodies with and without pedicles, respectively. CONCLUSIONS Our model represents a consolidation of already existing testing devices. The comparative measurement of the BMD and the fracture behavior shows validity. In contrast to other authors, the force was applied to the whole vertebral body. Furthermore the upper and lower plates were not parallelized and therefore the natural anatomic shape was imitated. Fracture behavior was not altered by removing the pedicles.
Collapse
Affiliation(s)
- Michael Kraxenberger
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Christian Schröder
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Tobias Geith
- Institute for Clinical Radiology, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Andreas Büttner
- Institute of Forensic Medicine, University Medical Center, Rostock, Germany
| | | | - Christof Birkenmaier
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Peter E Müller
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Bernd Wegener
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| |
Collapse
|
40
|
Niethammer TR, Loitzsch A, Horng A, Baur-Melnyk A, Bendiks M, Gülecyüz MF, Müller PE, Pietschmann MF. Graft Hypertrophy After Third-Generation Autologous Chondrocyte Implantation Has No Correlation With Reduced Cartilage Quality: Matched-Pair Analysis Using T2-Weighted Mapping. Am J Sports Med 2018; 46:2414-2421. [PMID: 30063401 DOI: 10.1177/0363546518784593] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft hypertrophy is common after matrix-based autologous chondrocyte implantation (ACI) in the knee joint. However, it is not clear whether graft hypertrophy is a complication or an adjustment reaction in the cartilage regeneration after ACI. PURPOSE To analyze the cartilage quality of the ACI regeneration with graft hypertrophy using T2-weighted mapping. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 91 patients with isolated cartilage defects (International Cartilage Repair Society [ICRS] grade III-IV) of the knee were treated with Novocart 3D, a third-generation, matrix-based, ACI procedure in the knee joint. All patients were evaluated with a standardized magnetic resonance imaging protocol after 3, 6, 12, 24, 36, and 48 months postoperatively. For morphological and biochemical assessment, the T2-weighted relaxation times of the ACI grafts as well as the healthy surrounding cartilage were determined. The results of the 20 patients with graft hypertrophy (hypertrophic group) were compared with the results of 21 matched patients without graft hypertrophy (nonhypertrophic group) after ACI. Match-paired analysis was performed by comparison of age, defect size, and body mass index. RESULTS The T2-weighted relaxation times of the ACI graft showed significant improvement, with values decreasing from 52.1 milliseconds to 33.3 milliseconds after 48 months. After 12 months, the T2-weighted relaxation times were constant and comparable with the healthy surrounding cartilage. Graft hypertrophy was seen in 22% (n = 20) of the patients who underwent ACI. A significant difference in T2-weighted relaxation times between the hypertrophic and nonhypertrophic ACI grafts could not be found except after 36 months (hypertrophic T2-weighted relaxation time/nonhypertrophic T2-weighted relaxation time: 3 months, 48.0/56.4 ms, P = .666; 6 months, 45.6/42.5 ms, P = .280; 12 months, 39.3/34.7 ms, P = .850; 24 months, 34.8/32.2 ms, P = .742; 36 months, 34.6/38.2 ms, P = .030; 48 months, 34.2/32.3 ms, P = .693). CONCLUSION The T2-weighted relaxation time of the ACI graft cartilage showed significant improvements over the observation period of 4 years postoperatively. After 2 years, graft maturation was completed. Graft hypertrophy after ACI was seen in 22% of the patients. Reduced cartilage quality could not be found in patients with graft hypertrophy after ACI.
Collapse
Affiliation(s)
- Thomas R Niethammer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Ansgar Loitzsch
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Annie Horng
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Bendiks
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
41
|
Gelse K, Angele P, Behrens P, Brucker PU, Fay J, Günther D, Kreuz P, Lützner J, Madry H, Müller PE, Niemeyer P, Pagenstert G, Tischer T, Walther M, Zinser W, Spahn G. [Correction: Debridement in Focal Cartilage Damage of the knee. Systematical review of the literature and recommendations of the working group "clinical tissue regeneration" of the German Society of Orthopaedics and Trauma (DGOU)]. Z Orthop Unfall 2018; 156:e2. [PMID: 29772583 DOI: 10.1055/a-0630-6590] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Kolja Gelse
- Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen
| | - Peter Angele
- Unfallchirurgie, Universitätsklinikum Regensburg
| | | | | | - Jakob Fay
- Unfall- und Arthroskopische Chirurgie, Sporttraumatologie, Lubinus-Clinicum Kiel
| | - Daniel Günther
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH)
| | - Peter Kreuz
- Zentrum für Orthopädie und Unfallchirurgie, Asklepios Stadtklinik Bad Tölz
| | - Jörg Lützner
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden
| | - Henning Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg
| | - Peter E Müller
- Orthopädische Klinik, Ludwig-Maximilians-Universität München
| | - Philipp Niemeyer
- Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg
| | | | - Thomas Tischer
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock
| | - Markus Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München-Harlaching
| | - Wolfgang Zinser
- Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken
| | - Gunter Spahn
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie Eisenach
- Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena
| |
Collapse
|
42
|
Betz VM, Ren B, Messmer C, Jansson V, Betz OB, Müller PE. Bone morphogenetic protein-2 is a stronger inducer of osteogenesis within muscle tissue than heterodimeric bone morphogenetic protein-2/6 and -2/7: Implications for expedited gene-enhanced bone repair. J Gene Med 2018; 20:e3042. [DOI: 10.1002/jgm.3042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Volker M. Betz
- Department of Gene Therapy; University of Ulm; Ulm Germany
- Center for Rehabilitation; RKU - University and Rehabilitation Hospitals Ulm; Ulm Germany
| | - Bin Ren
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation; University Hospital Grosshadern, Ludwig-Maximilians-University Munich; Munich Germany
| | - Carolin Messmer
- Center for Rehabilitation; RKU - University and Rehabilitation Hospitals Ulm; Ulm Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation; University Hospital Grosshadern, Ludwig-Maximilians-University Munich; Munich Germany
| | - Oliver B. Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation; University Hospital Grosshadern, Ludwig-Maximilians-University Munich; Munich Germany
- Department of Chemical Engineering; Massachusetts Institute of Technology; Cambridge MA USA
| | - Peter E. Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation; University Hospital Grosshadern, Ludwig-Maximilians-University Munich; Munich Germany
| |
Collapse
|
43
|
Betz VM, Kochanek S, Rammelt S, Müller PE, Betz OB, Messmer C. Recent advances in gene-enhanced bone tissue engineering. J Gene Med 2018; 20:e3018. [PMID: 29601661 DOI: 10.1002/jgm.3018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/01/2018] [Revised: 03/18/2018] [Accepted: 03/18/2018] [Indexed: 12/13/2022] Open
Abstract
The loss of bone tissue represents a critical clinical condition that is frequently faced by surgeons. Substantial progress has been made in the area of bone research, providing insight into the biology of bone under physiological and pathological conditions, as well as tools for the stimulation of bone regeneration. The present review discusses recent advances in the field of gene-enhanced bone tissue engineering. Gene transfer strategies have emerged as highly effective tissue engineering approaches for supporting the repair of the musculoskeletal system. By contrast to treatment with recombinant proteins, genetically engineered cells can release growth factors at the site of injury over extended periods of time. Of particular interest are the expedited technologies that can be applied during a single surgical procedure in a cost-effective manner, allowing translation from bench to bedside. Several promising methods based on the intra-operative genetic manipulation of autologous cells or tissue fragments have been developed in preclinical studies. Moreover, gene therapy for bone regeneration has entered the clinical stage with clinical trials for the repair of alveolar bone. Current trends in gene-enhanced bone engineering are also discussed with respect to the movement of the field towards expedited, translational approaches. It is possible that gene-enhanced bone tissue engineering will become a clinical reality within the next few years.
Collapse
Affiliation(s)
- Volker M Betz
- Department of Gene Therapy, University of Ulm, Ulm, Germany.,Center for Rehabilitation, RKU - University and Rehabilitation Hospitals Ulm, Ulm, Germany
| | | | - Stefan Rammelt
- University Center of Orthopedics and Traumatology and Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Oliver B Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Carolin Messmer
- Center for Rehabilitation, RKU - University and Rehabilitation Hospitals Ulm, Ulm, Germany
| |
Collapse
|
44
|
Mayer-Wagner S, Hammerschmid F, Blum H, Krebs S, Redeker JI, Holzapfel BM, Jansson V, Müller PE. Effects of single and combined low frequency electromagnetic fields and simulated microgravity on gene expression of human mesenchymal stem cells during chondrogenesis. Arch Med Sci 2018; 14:608-616. [PMID: 29765449 PMCID: PMC5949910 DOI: 10.5114/aoms.2016.59894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/08/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Low frequency electromagnetic fields (LF-EMF) and simulated microgravity (SMG) have been observed to affect chondrogenesis. A controlled bioreactor system was developed to apply LF-EMF and SMG singly or combined during chondrogenic differentiation of human mesenchymal stem cells (hMSCs) in 3D culture. MATERIAL AND METHODS An external motor gear SMG bioreactor was combined with magnetic Helmholtz coils for EMF (5 mT; 15 Hz). Pellets of hMSCs (±TGF-β3) were cultured (P5) under SMG, LF-EMF, LF-EMF/SMG and control (1 g) conditions for 3 weeks. Sections were stained with safranin-O and collagen type II. Gene expression was evaluated by microarray and real-time polymerase chain reaction analysis. RESULTS Simulated microgravity application significantly changed gene expression; specifically, COLXA1 but also COL2A1, which represents the chondrogenic potential, were reduced (p < 0.05). Low frequency electromagnetic fields application showed no gene expression changes on a microarray basis. LF-EMF/SMG application obtained significant different expression values from cultures obtained under SMG conditions with a re-increase of COL2A1, therefore rescuing the chondrogenic potential, which had been lowered by SMG. CONCLUSIONS Simulated microgravity lowered hypertrophy but also the chondrogenic potential of hMSCs. Combined LF-EMF/SMG provided a rescue effect of the chondrogenic potential of hMSCs although no LF-EMF effect was observed under optimal conditions. The study provides new insights into how LF-EMF and SMG affect chondrogenesis of hMSCs and how they generate interdependent effects.
Collapse
Affiliation(s)
- Susanne Mayer-Wagner
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Hammerschmid
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
| | - Helmut Blum
- LAFUGA Genomics, Gene Center Munich, Ludwig-Maximilians University, Munich, Germany
| | - Stefan Krebs
- LAFUGA Genomics, Gene Center Munich, Ludwig-Maximilians University, Munich, Germany
| | - Julia I. Redeker
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
| | - Boris M. Holzapfel
- Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
| | - Peter E. Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
45
|
Safi E, Ficklscherer A, Bondarava M, Betz O, Zhang A, Jansson V, Müller PE. Migration of Mesenchymal Stem Cells of Bursal Tissue after Rotator Cuff Repair in Rats. Joints 2018; 6:4-9. [PMID: 29675500 PMCID: PMC5906115 DOI: 10.1055/s-0038-1636948] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/04/2018] [Indexed: 01/08/2023]
Abstract
Purpose The purpose of this study is to verify migration of mesenchymal stem cells of bursal tissue into the healing site after rotator cuff repair in rats. Methods Fischer rats and green fluorescent protein (GFP)-transgenic rats were used. Bursal tissue from GFP rats was isolated and transplanted into tendon repair sites in Fischer rats. We examined the histology of the rotator cuff and the proportion of GFP-positive cells in the repaired rotator cuff 1, 3, and 6 weeks after surgery. Results Cell migration was observed during the third and sixth week after surgery. We also found mesenchymal stem cells and formed bursal cluster patterns in the repaired rotator cuff tendons. Conclusion Mesenchymal stem cells migrated from bursal tissue and infiltrated the repaired rotator cuff tendons. Clinical Relevance Mesenchymal stem cells from bursal tissue can contribute to the healing progress of the repaired rotator cuff.
Collapse
Affiliation(s)
- Elem Safi
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Andreas Ficklscherer
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Maryna Bondarava
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Oliver Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Anja Zhang
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| |
Collapse
|
46
|
Gelse K, Angele P, Behrens P, Brucker PU, Fay J, Günther D, Kreuz P, Lützner J, Madry H, Müller PE, Niemeyer P, Pagenstert G, Tischer T, Walther M, Zinser W, Spahn G. [Debridement in Focal Cartilage Damage of the knee. Systematical review of the literature and recommendations of the working group "clinical tissue regeneration" of the German Society of Orthopaedics and Trauma (DGOU)]. Z Orthop Unfall 2018. [PMID: 29523016 DOI: 10.1055/s-0044-101470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In clinical practice, there is still no definite treatment algorithm for focal, partial thickness cartilage lesions (grade II - III). It is well-established that debridement (shaving/lavage) of large degenerative cartilage lesions is not recommended, but there is no such recommendation in the case of focal, partial thickness cartilage defects. MATERIALS AND METHODS The scientific rationale of cartilage shaving and joint lavage was investigated and a systematic analysis was performed of the literature on the clinical effect of cartilage debridement. Furthermore, a consensus statement on this issue was developed by the working group on Clinical Tissue Regeneration of the German Society of Orthopaedics and Trauma (DGOU). RESULTS The therapeutic approach is different for asymptomatic lesions with biomechanical stable residual cartilage tissue and clinically symptomatic defects with unstable fragments. The benefit of a joint lavage or surface smoothening of focal partial thickness has not been proved. Even more importantly, the mechanical or thermal resection of cartilage tissue even induces a zone of necrosis in adjacent cartilage, and thus leads to additional injury. Therefore, large scale smoothening (shaving) of clinically asymptomatic, fibrillated or irregular cartilage defects should not be performed. However, if there are clinical symptoms, resection of unstable and delaminated cartilage fragments may be reasonable, as it can reduce harmful shear tension in residual tissue. This can help to brake the progression of the damage and avoid formation of free bodies. CONCLUSION The decision criteria for debridement of partial thickness focal cartilage lesions are multifactorial and include the clinical symptoms, the size and the degree of the defect, the stability of remaining cartilage, localisation of the defect, and individual patient-specific parameters. Debridement is not recommended for asymptomatic lesions, but may be reasonable for symptomatic cases with unstable tissue.
Collapse
Affiliation(s)
- Kolja Gelse
- Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen
| | - Peter Angele
- Unfallchirurgie, Universitätsklinikum Regensburg
| | | | | | - Jakob Fay
- Unfall- und Arthroskopische Chirurgie, Sporttraumatologie, Lubinus-Clinicum Kiel
| | - Daniel Günther
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH)
| | - Peter Kreuz
- Zentrum für Orthopädie und Unfallchirurgie, Asklepios Stadtklinik Bad Tölz
| | - Jörg Lützner
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden
| | - Henning Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg
| | - Peter E Müller
- Orthopädische Klinik, Ludwig-Maximilians-Universität München
| | - Philipp Niemeyer
- Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg
| | | | - Thomas Tischer
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock
| | - Markus Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München-Harlaching
| | - Wolfgang Zinser
- Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken
| | - Gunter Spahn
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie Eisenach.,Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena
| |
Collapse
|
47
|
Güleçyüz MF, Schröder C, Pietschmann MF, Göbel S, Lehmann M, Mayer J, Ficklscherer A, Jansson V, Müller PE. Novel ultrasound assisted suture anchor system using the BoneWelding® technology yields a comparable primary stability in osteopenic and healthy human humeri as a benchmark anchor. Acta Orthop Traumatol Turc 2018; 52:127-133. [PMID: 29290535 PMCID: PMC6136304 DOI: 10.1016/j.aott.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/03/2017] [Accepted: 11/24/2017] [Indexed: 11/25/2022]
Abstract
Introduction The aim of this biomechanical study was to evaluate the primary stability of the SportWelding® Sombrero 3.6 mm suture anchor system in osteopenic and healthy cadaveric humeri. Methods The Sombrero® and BioCorkscrew® anchors were deployed in 8 osteopenic and 4 healthy cadaver humeri after the bone mineral density (BMD) measurements of the 32 specimens. Both anchors were loaded with a USP Nr. 2 FiberWire® suture. An established cyclic testing protocol was performed. The maximum failure load (Fmax), the system displacement and the modes of failure were recorded. Results The Fmax and system displacement of the Sombrero® in osteopenic and healthy humeri was equivalent to the Bio-Corkscrew® benchmark anchor; there were no significant differences in the maximum failure loads and system displacement values. Only anchor and suture dislocations were observed; suture ruptures did not occur. Conclusion This study shows that the Sombrero® yields similar maximum failure loads and system displacement values as the established Bio-Corkscrew® benchmark anchor. The primary stability of the Sombrero® and Bio-Corkscrew® seems to be independent of the bone mineral quality. This relatively small-sized polymer anchor is independent of the BMD and may be an alternative to established suture anchors in rotator cuff repair.
Collapse
Affiliation(s)
- Mehmet F Güleçyüz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Munich, Germany.
| | - Christian Schröder
- Laboratory for Biomechanics and Experimental Orthopaedics of the University of Munich (Ludwig-Maximilians-University), Germany
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Munich, Germany
| | - Stephanie Göbel
- TÜV SÜD Product Service GmbH, Active Medical Products 3, Munich, Germany
| | | | - Jörg Mayer
- SportWelding GmbH, Schlieren, Switzerland
| | | | - Volkmar Jansson
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Munich, Germany
| |
Collapse
|
48
|
Steinbrück A, Schröder C, Woiczinski M, Glogaza A, Müller PE, Jansson V, Fottner A. A lateral retinacular release during total knee arthroplasty changes femorotibial kinematics: an in vitro study. Arch Orthop Trauma Surg 2018; 138:401-407. [PMID: 29188420 DOI: 10.1007/s00402-017-2843-3] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lateral retinacular release (LRR) is a common procedure during total knee arthroplasty (TKA), especially if patellar maltracking is observed intraoperatively. The impact of LRR on patellofemoral kinematics is well-examined, but the influence on femorotibial kinematics requires more elucidation. Therefore, the aim of this study was to evaluate the effects of LRR on femorotibial kinematics in vitro. MATERIALS AND METHODS A fixed bearing TKA was implanted in six human knee specimens. Femorotibial kinematics were measured dynamically through the use of a custom-constructed knee rig which flexes the knee from 20° to 120° under weight bearing conditions. Measurements were performed before and after LRR. LRR was performed completely including transection of synovium, retinaculum and tractus fibers. For the registration of tibiofemoral kinematics a 3-dimensional-ultrasound-based motion analysis system was used. RESULTS LRR revealed a significant reduction of femoral rollback at the lateral compartment (9.4 ± 5.0 vs 7.8 ± 9.4 mm; p < 0.01), whereas the present decrease of femoral rollback at the medial compartment was not significant (3.4 ± 4.7 vs 2.3 ± 5.9 mm; p = 0.34). Accordingly, LRR significantly reduced internal rotation of the tibia (0.8°; p < 0.01). CONCLUSION The results suggest that LRR significantly decreases lateral femoral rollback as well as internal rotation of the tibia, probably by changing the tension of the iliotibial band. When performing a LRR in clinical routine, surgeons should be aware of altering not only patellofemoral kinematics but also the femorotibial kinematics.
Collapse
Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Glogaza
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
49
|
Chevalier Y, Pietschmann MF, Thorwächter C, Chechik O, Adar E, Dekel A, Müller PE. Biodegradable spacer reduces the subacromial pressure: A biomechanical cadaver study. Clin Biomech (Bristol, Avon) 2018; 52:41-48. [PMID: 29353150 DOI: 10.1016/j.clinbiomech.2017.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Received: 07/31/2017] [Revised: 11/09/2017] [Accepted: 12/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Failure after rotator cuff repair remains a major clinical problem and could be related to excessive pressures from the acromion. Previous studies with irreparable tears showed good clinical results of tendon healing with arthroscopic insertion of a protective biodegradable spacer balloon between the repaired tendon and the acromion. One hypothesis is that compression pressures on the repaired tendon will be reduced by the spacer. This cadaver study aimed to investigate the effects of this subacromial spacer on compression pressures over a repaired supraspinatus tendon in passive motion. METHODS Rotator cuff tear and repair were performed in six fresh-frozen cadaveric shoulders, followed by insertion of a biodegradable subacromial spacer. Specimens were tested using a passive shoulder simulator for abduction-adduction, flexion-extension and internal-external rotations. A sensor positioned below the acromion was used to measure compression pressure changes through passive range of motion before and after placement of a subacromial spacer. Peak pressures were measured in adduction-abduction motion, near 90° abduction. FINDINGS Both the mean and peak pressures in abduction-adduction were significantly reduced after insertion of the subacromial spacer (from mean 121.7 (SD 9.5) MPa to 51.5 (SD 1.2) MPa and from peak 1749.6 (SD 80.7) MPa to 535.1 (SD 27.6) MPa) (P<0.0001). INTERPRETATION The reduced peak pressures and wider load distributions over the sensor during both passive abduction-adduction and flexion-extension motions suggest that the use of the spacer will lead to reduced wear of the repair in patients, and potentially prevent rotator cuff re-tear after surgical repair.
Collapse
Affiliation(s)
- Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Germany
| | - Ofir Chechik
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliyahu Adar
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
| | - Assaf Dekel
- Advanced Orthopedic Clinic, Assuta Medical Center, Tel Aviv, Israel
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Germany
| |
Collapse
|
50
|
Scheele C, Pietschmann MF, Schröder C, Grupp T, Holderied M, Jansson V, Müller PE. Effect of minimally-invasive implantation of unicompartmental knee arthroplasty on cement penetration and biomechanical stability. An experimental study in human tibiae. Clin Biomech (Bristol, Avon) 2018; 51:34-39. [PMID: 29175672 DOI: 10.1016/j.clinbiomech.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 02/07/2023]
Affiliation(s)
- C Scheele
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.
| | - M F Pietschmann
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| | - C Schröder
- Ludwig Maximilians University Laboratory for Biomechanics and Experimental Orthopaedics, Campus Grosshadern, Feodor-Lynen-Straße 19, 81377 Munich, Germany
| | - T Grupp
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| | - M Holderied
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - V Jansson
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| | - P E Müller
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|