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Prall WC, Kusmenkov T, Fürmetz J, Haasters F, Mayr HO, Böcker W, Grote S. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Injury 2019; 50:467-475. [PMID: 30580931 DOI: 10.1016/j.injury.2018.12.020] [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: 09/29/2018] [Revised: 11/29/2018] [Accepted: 12/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with widened or misplaced tunnels may require bone grafting prior to revision anterior cruciate ligament (ACL) reconstruction. Utilising reamer-irrigator-aspirator (RIA) harvested bone from the femur showed promising filling rates. Nevertheless, the procedure has neither been validated in a larger population nor been assessed with regards to radiological and clinical outcome of the subsequently conducted revision ACL reconstruction. Therefore, the aim of this study was to evaluate tunnel filling rates, positioning of the revision tunnels and outcome parameters of such two-staged revision ACL reconstructions. MATERIAL AND METHODS A total of 15 consecutive patients were prospectively enrolled in this case series. CT scans were analysed before and after autologous RIA harvested bone grafting. Tunnel volumes and filling rates were calculated based on manual segmentation of axial CT scans. Revision ACL reconstruction was carried out after a mean interval of 6.2 months (±3.7) and positioning of the revision tunnels was assessed by plane radiographs. The mean follow-up was 19.8 months (±8.4) for objective evaluation and 37.1 months (±15.4) for patient reported outcomes. The clinical outcome was assessed by the quantification of the anterior tibial translation, the IKDC objective score, the Tegner activity scale and the Lysholm score. RESULTS Initial CT scans revealed mean tunnel volumes of 3.8cm3 (±2.7) femoral and 6.1cm3 (±2.4) tibial. Filling rates of 76.1% (±12.4) femoral and 87.4% (±5.9) tibial were achieved. Postoperative radiographs revealed significantly improved tunnel positioning with anatomical placement in all but one case at the femur and in all cases at the tibia. At follow up, patients showed significantly improved anterior tibial translations with residual side-to-side differences of 1.7 mm (±0.8) and significantly improved IKDC objective scores. Furthermore, significantly higher values were achieved on the Tegner activity scale (5.3 ± 1.4 vs. 2.8 ± 0.5) and the Lysholm score (85.4 ± 7.9 vs. 62.5 ± 10.5) compared to the preoperative status. CONCLUSION Autologous RIA harvested bone grafting ensures sufficient bone stock consolidation allowing for anatomical tunnel placement of the subsequently conducted revision ACL reconstruction. The two-staged procedure reliably restores stability and provides satisfying subjective and objective outcomes. Thus, RIA harvested bone grafting is an eligible alternative to autologous iliac crest or allogenic bone grafting.
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Affiliation(s)
- W C Prall
- FIFA Medical Center of Excellence, Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany.
| | - T Kusmenkov
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - J Fürmetz
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - F Haasters
- FIFA Medical Center of Excellence, Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - H O Mayr
- FIFA Medical Center of Excellence, Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of Orthopaedics and Trauma Surgery, Freiburg University Hospital, Albert-Ludwigs-University, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - S Grote
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany; Department of Orthopaedics and Trauma Surgery, Brothers of Mercy, Hospital St. Elisabeth Straubing, St.-Elisabeth-Straße 23, 94315 Straubing, Germany
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Helfen T, Lefering R, Moritz M, Böcker W, Grote S. [Characterization of the seriously injured cyclist : An evaluation of the injury and treatment focus areas of 2817 patients]. Unfallchirurg 2016; 120:403-408. [PMID: 27357351 DOI: 10.1007/s00113-016-0208-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transport statistics classify bicyclists in a separate road user collective. For medical reasons, this differentiation is applied as well. Much literature is published in this field. Nevertheless there is a lack of literature regarding the overall injury patterns in a defined injury severity collective. Most literature is about isolated injured regions in combination with a heterogeneous injury severity. Further parameters, such as injury patterns, epidemiological aspects, treatment focal points and characteristic outcomes, have also been studied. The aim of the present study was to evaluate and characterize injury patterns in a standardized and representative collective of severely injured bicyclists. Methods We analysed data from the Traumaregister DGU® from 2002 to 2010. In total, 2817 severely injured (ISS ≥ 9 and additional intensive/intermediate care unit) bicyclists were included. The primary endpoint was evaluation of injury patterns and injury focal points. In addition to that we analysed parameters like epidemiological aspects, circumstances of accident, treatment focal points and outcome. RESULTS The mean age was 50.3 ± 20.9 years. Males accounted for 68.9 % (n = 1940). The mean ISS was 23.7 ± 12.6. The mean AIS regions were the head 71.9 % (n = 2025), the chest with 44.9 % (n = 1264) and the upper extremities 33.6 % (947). In 68.2 % of all cases an ISS ≥ 9 was achieved by a traumatic brain injury; 21.1 % of all cases were mono-injuries. A characteristic distribution of age and a characteristic prevalence of the accidents in relation to the weekday and the month could be shown. CONCLUSION The present study analysed the largest ever published collective of severely injured bicyclists. Traumatic brain injury could clearly be shown as the main injury in this collective. Moreover, one of five cases achieved the state "severely injured" due to mono-injury.
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Affiliation(s)
- T Helfen
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Nußbaumstr. 20, 80336, München, Deutschland.
| | - R Lefering
- IFOM - Institut für Forschung in der Operativen Medizin, Lehrstuhl für Chirurgische Forschung, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Ostmerheimer Str. 200, Haus 38, 51109, Köln, Deutschland
| | - M Moritz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Nußbaumstr. 20, 80336, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Nußbaumstr. 20, 80336, München, Deutschland
| | - S Grote
- Klinik für Orthopädie und Unfallchirurgie, Klinikum St. Elisabeth Straubing GmbH, St.-Elisabeth-Straße 23, 94315, Straubing, Deutschland
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Almstedt HC, Grote S, Perez SE, Shoepe TC, Strand SL, Tarleton HP. Training-related improvements in musculoskeletal health and balance: a 13-week pilot study of female cancer survivors. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26777589 DOI: 10.1111/ecc.12442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
Abstract
Cancer survivors often experience poor post-treatment musculoskeletal health. This study examined the feasibility of combined aerobic and resistant training (CART) for improving strength, skeletal health and balance. Cancer survivors (n = 24) were identified by convenience sampling in Los Angeles County with 11 survivors consenting to 13 weeks of CART. Pre- and post-intervention assessments of bone mineral density (BMD), strength, flexibility and biomarker analysis were performed. Paired t-test analysis suggested increases in lower and upper body strength. The average T-score for BMD at the femoral neck improved from -1.46 to -1.36 and whole body BMD improved from -1.65 to -1.55. From baseline to follow-up, participants also displayed decreases in sway velocity on the eyes open (7%) and eyes closed (27%) conditions. Improvement in lower body strength was associated with increases in lean body mass (LBM) (r = 0.721) and an inverse association was observed between sway velocity and LBM (r = 0.838). Age and time since last treatment were related with biomarkers of anabolic growth (IGF-1, IGFbp-3) and bone (DPD, BAP). In summary, observed physiological changes were consistent with functional improvements, suggesting that isometric and dynamic exercise prescription may reduce the risk for falls and fall-related fractures among survivors.
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Affiliation(s)
- H C Almstedt
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - S Grote
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA.,Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - S E Perez
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - T C Shoepe
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - S L Strand
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - H P Tarleton
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
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Rutkowski SP, Grote S, Flatz W, Haasters F, Böcker W, Ockert B. [Acute posterior dislocation of the sternoclavicular joint: Reduction, fixation by endobutton system and alternative procedures]. Unfallchirurg 2015; 119:346-52. [PMID: 26597194 DOI: 10.1007/s00113-015-0095-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2022]
Abstract
Acute posterior dislocation of the sternoclavicular (SC) joint is rare but can lead to life-threatening vascular injuries of the mediastinum; however, diagnosis is difficult and the injury can be initially overlooked so that surgical treatment is delayed. Although a variety of different treatment modalities have been published, the ideal fixation technique has not yet been identified. We report the case of a patient suffering from a locked posterior SC joint dislocation caused by a skiing accident. The injury was treated by transarticular endobutton fixation. This article describes the technique and highlights its advantages and disadvantages in comparison to previously published treatment options.
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Affiliation(s)
- S P Rutkowski
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - S Grote
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - W Flatz
- Institut für Klinische Radiologie, Klinikum der Universität München, München, Deutschland
| | - F Haasters
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - B Ockert
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Grote S, Prall W. Revision einer VKB-Plastik. Arthroskopie 2014. [DOI: 10.1007/s00142-014-0828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tschöp J, Annecke T, Werner D, Grote S, Ney L. [Tuberculous encephalitis, Landouzy sepsis and Pott's disease: complications after surgery for spinal stenosis]. Anaesthesist 2012; 61:597-600. [PMID: 22699225 DOI: 10.1007/s00101-012-2044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 05/05/2012] [Accepted: 05/07/2012] [Indexed: 11/29/2022]
Abstract
Tuberculosis is an infectious disease with a decreasing incidence in Germany. In particular, the occurrence of reinfections and possible complications associated with this disease, such as tuberculous meningitis/encephalitis and Landouzy sepsis are rare in industrial countries. In this article the intensive care treatment of a patient who initially underwent surgery for spinal stenosis is reported. Due to recurrent appearance of neurological symptoms with increasing severity and abscess formation in the spine, further surgery was performed. Additionally, the patient developed sepsis and meningitis. At this time an infection with Mycobacterium tuberculosis could be detected in both cerebrospinal fluid and abscess material of the spine suggesting a Landouzy sepsis, tuberculous meningitis/encephalitis and the suspicion of an underlying Pott's disease.
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Affiliation(s)
- J Tschöp
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität, Nussbaumstr. 20, 80336, München, Deutschland.
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Ockert B, Haasters F, Polzer H, Grote S, Kessler M, Mutschler W, Kanz KG. Der verletzte Meniskus: Wie sicher ist die klinische Untersuchung? Unfallchirurg 2009; 113:293-9. [DOI: 10.1007/s00113-009-1702-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Polzer H, Ockert B, Grote S, Volkering C, Mutschler W, Kanz KG. [Ankle sprain: which ligaments are injured?]. MMW Fortschr Med 2009; 151:42-43. [PMID: 19927918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Hans Polzer
- Chirurgische Klinik und Poliklinik-Innenstadt Klinikum der Universität München.
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Polzer H, Ockert B, Grote S, Volkering C, Mutschler W, Kanz KG. [Ankle sprain--who needs X-ray?]. MMW Fortschr Med 2009; 151:48-49. [PMID: 19739551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- H Polzer
- Chirurgische Klinik und Poliklinik, Klinikum der Universität München.
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Khalil PN, Ockert B, Huber-Wagner S, Grote S, Kanz KG, Mutschler W. [Broken glass injuries: does every splinter have to be removed?]. MMW Fortschr Med 2009; 151:38-40. [PMID: 19475857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- P N Khalil
- Chirurgische Klinik und Poliklinik, Klinikum Innenstadt der LMU, München.
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Olchev A, Ibrom A, Ross T, Falk U, Rakkibu G, Radler K, Grote S, Kreilein H, Gravenhorst G. A modelling approach for simulation of water and carbon dioxide exchange between multi-species tropical rain forest and the atmosphere. Ecol Modell 2008. [DOI: 10.1016/j.ecolmodel.2007.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Klingler KR, Grote S, Holzem G, Wielckens K. Activated protein C (APC)-resistance: automated detection of the point mutation at position 1691 in the factor V gene. Clin Chem Lab Med 1999; 37:101-7. [PMID: 10219496 DOI: 10.1515/cclm.1999.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Proteolytic cleavage of factor Va, caused by activated protein C, is an important mechanism in limiting clot formation in normal haemostasis. A single point mutation in the factor V gene has been demonstrated to cause resistance of factor Va to proteolytic cleavage by activated protein C. With an 8-fold increased risk of thrombosis and a 2 to 13% prevalence in the Caucasian population for the heterozygous state of this mutation, knowledge of the patient's genetic disposition is of great importance in conditions such as pregnancy, surgery, use of oral contraceptives and immobilization. Therefore we have developed an automated test for the detection of the factor V mutation. This PCR based test makes use of the disappearance of an Mnl 1 restriction site if the mutation is present. The assay has been developed for the widely used ES-systems of Boehringer Mannheim. The test discriminates between the heterozygous and the homozygous state. Because of its low costs and easy handling the assay can be used as a screening test and can be performed in routine clinical laboratories.
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Affiliation(s)
- K R Klingler
- Institut für Klinische Chemie, Universität zu Köln, Germany
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Cochran E, Robins E, Grote S. Regional serotonin levels in brain: a comparison of depressive suicides and alcoholic suicides with controls. Biol Psychiatry 1976; 11:283-94. [PMID: 938697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The levels of 5-hydroxytryptamine have been measured in 33 areas of the human brain and these levels compared in depressed suicides, in alcoholic suicides, and in controls. The values obtained for control brains ranged from 5.3 mumole 5-HT/kg wet weight in substantia nigra to 0.4 mumole 5-HT/kg wet weight in frontal gray. No significant differences were found among diagnostic groups in any of the areas studied.
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