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Lappen S, Siebenlist S, Leschinger T, Kadantsev P, Geyer S, Wegmann K, Müller LP, Hackl M. The importance of interdigitating screw fixation of the trochlea in double plate osteosynthesis of low transcondylar distal humerus fractures: A biomechanical study. Injury 2024; 55:111486. [PMID: 38447478 DOI: 10.1016/j.injury.2024.111486] [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: 01/02/2024] [Revised: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The trochlea is of great importance for the stability of the elbow and its fixation in low transcondylar fractures of the distal humerus is especially challenging. The aim of this study was to determine the optimal trochlea fixation in double plate osteosynthesis of intraarticular distal humerus fractures. METHODS A low transcondylar, C3-type distal humerus fracture was created in 20 fresh-frozen human cadaveric humeri. The samples were then randomly divided into two groups of 10 specimens each. Double plate osteosynthesis was performed in both groups. In group A, the two most distal screws of the lateral plate were inserted into the trochlea fragment. In group B, these screws did not extend into the trochlea. Displacement under cyclic loading and ultimate failure loads were determined for all specimens. RESULTS Group A showed significantly less displacement under cyclic loading in each measurement interval (0.92 mm vs. 1.53 mm after 100 cycles, p = 0 0.006; 1.10 mm vs. 1.84 mm after 1000 cycles, p = 0.007; 1.18 mm vs. 1.98 mm after 2000 cycles, p = 0.008). The ultimate failure load was significantly higher in group A than in group B (345.61 ± 120.389 N vs. 238.42 ± 131.61 N, p = 0.037). CONCLUSIONS Fixation of the trochlea with interdigitating screws in double plate osteosynthesis of low-condylar type C distal humerus fractures results in superior construct stability. LEVEL OF EVIDENCE not applicable (biomechanical).
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Affiliation(s)
- Sebastian Lappen
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
| | - Sebastian Siebenlist
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Tim Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany; Department for Orthopedics, St. Vinzenz Klinik, Pfronten, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany; OCM (Orthopädische Chirurgie München) Clinic, München, Germany
| | - Lars-Peter Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Michael Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
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Thiele K, Unmann A, Geyer S, Siebenlist S, Scheibel M, Seemann R, Lerchbaumer M, Schoch C, Mader K. Evaluation of the efficiency of an ultrasound-supported infiltration technique in patients with tennis elbow applying the ITEC medical device: a multicenter study. JSES Int 2024; 8:361-370. [PMID: 38464435 PMCID: PMC10920118 DOI: 10.1016/j.jseint.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The treatment of lateral epicondylitis remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months. Methods In a prospective, nonrandomized, multicenter study design, 68 patients with chronic lateral epicondylitis and symptoms lasted for at least 6 weeks were included. Each hospital has been assigned for Traumeel (A), autologous whole blood (B), or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient-related outcome parameter, and dorsal wrist extension strength were documented. Preinterventional (obligate) and after 6 months (optional) radiological evaluation (magnetic resonance imaging) was performed. Results The Visual Analog Scale showed a significant reduction after 6 months in all groups (A. 4.8-2.5, B. 6.2-2.3, C. 5.8-2.4). Similar results could be observed with Subjective elbow value, Disabilities of Arm, Shoulder, and Hand Score, Mayo Elbow Performance Score, and Patient Rated Tennis Elbow Evaluation. The loss of strength could be completely compensated after about 6 months. Magnetic resonance imaging did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A = 11, B = 8, C = 4). Switching to surgical intervention was most frequently observed in group C (A = 2, B = 1, C = 5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method. Conclusion The primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.
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Affiliation(s)
- Kathi Thiele
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
| | - Annemarie Unmann
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Trauma Department, LKH Feldbach, Feldbach, Austria
| | - Stephanie Geyer
- Department of Shoulder and Elbow Surgery, St. Vinzenz Klinik Pfronten, Pfronten, Germany
- Sektion Sportorthopädie, Klinikum rechts der Isar, München, Germany
| | | | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Ricarda Seemann
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Zentrum für Orthopädie&Unfallchirurgie Tettnang, Tettnang, Germany
| | | | - Christian Schoch
- Sektion Sportorthopädie, Klinikum rechts der Isar, München, Germany
| | - Konrad Mader
- Zentrum für Orthopädie&Unfallchirurgie Tettnang, Tettnang, Germany
- Division Hand, Forearm and Elbow Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hinz M, Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Irger M, Imhoff AB, Mehl J. Clinical and biomechanical outcomes following patellar tendon repair with suture tape augmentation. Eur J Orthop Surg Traumatol 2023; 33:3569-3576. [PMID: 37233797 PMCID: PMC10651537 DOI: 10.1007/s00590-023-03572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 02/26/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Patellar tendon ruptures (PTR) occur predominantly in middle-aged patients following indirect trauma. The aim of this study was to quantify the short-term results using a suture tape augmentation technique for the repair of PTR. METHODS All consecutive patients with acute (< 6 weeks) PTR who underwent suture tape augmentation between 03/2014 and 11/2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Visual Analog Scale (VAS) for pain, Tegner Activity Scale (TAS) and return to sport rates, Lysholm score, International Knee Documentation Committee subjective knee form (IKDC) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, a standardized clinical examination and an isometric strength evaluation of knee extension and flexion were performed. It was hypothesized that high return to sport rates and good functional outcome would be observed and that the majority of patients would not present with a severe (> 20%) knee extension strength deficit when compared to the contralateral side. RESULTS A total of 7 patients (mean age 37.0 ± SD 13.5 years; 6 male/1 female) were available for final assessment at a median follow-up of 17.0 (25-75% IQR 16.0-77.0) months. Three injuries occurred during ball sports, two injuries occurred during winter sports, and one injury each occurred during a motorcycling and skateboarding accident. The average time between trauma and surgery was 4.7 ± 2.6 days. At follow-up, patients reported little pain (VAS: 0 [0-0.4]). Return to sport was possible for all patients 8.9 ± 4.0 months postoperatively at a high level (TAS: 7.0 [6.0-7.0]). Five patients (71.4%) returned to the preinjury level of play, and 2 (28.6%) did not return to the preinjury level of play. Patient-reported outcome measures were moderate to good (Lysholm score: 80.4 ± 14.5; IKDC: 84.2 ± 10.6; KOOS subscales: pain 95.6 ± 6.0, symptoms 81.1 [64.9-89.1], activities of daily living 98.5 [94.1-100], sport and recreation function 82.9 ± 14.1 and knee-related quality of life 75.9 ± 16.3). All patients were very satisfied (57.1%) or satisfied (42.9%) with the postoperative result. No postoperative complications were reported. Strength measurements revealed a severe knee extension deficit in 3 patients (42.9%), but no significant deficit of isometric knee extension or flexion strength in comparison with the contralateral side was observed overall (p > 0.05). CONCLUSION Suture tape augmentation in acute PTR repair leads to good functional outcome without major complications. Although a severe knee extension strength deficit may occur in some patients postoperatively, an excellent return to sports rate and high patient satisfaction can be expected nonetheless. LEVEL OF EVIDENCE Retrospective cohort study; III.
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Affiliation(s)
- Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Department of Sport and Health Sciences, Prevention Center, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Department of Sport and Health Sciences, Prevention Center, Technical University of Munich, Munich, Germany
| | - Markus Irger
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Julian Mehl
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Geyer S, Kadantsev P, Bohnet D, Marx C, Vieider RP, Braun S, Siebenlist S, Lappen S. Partial ruptures of the distal triceps tendons show only slightly lower ultimate load to failure: a biomechanical study. BMC Musculoskelet Disord 2023; 24:590. [PMID: 37468862 PMCID: PMC10357868 DOI: 10.1186/s12891-023-06720-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE Partial ruptures of the distal triceps tendon are usually treated surgically from a size of > 50% tendon involvement. The aim of this study was to compare the ultimate load to failure of intact triceps tendons with partially ruptured tendons and describe the rupture mechanism. METHODS Eighteen human fresh-frozen cadaveric elbow specimens were randomly assigned to two groups with either an intact distal triceps tendon or with a simulated partial rupture of 50% of the tendon. A continuous traction on the distal triceps tendon was applied to provoke a complete tendon rupture. The maximum required ultimate load to failure of the tendon in N was measured. In addition, video recordings of the ruptures of the intact tendons were performed and analysed by two independent investigators. RESULTS A median ultimate load to failure of 1,390 N (range Q0.25-Q0.75, 954 - 2,360) was measured in intact distal triceps tendons. The median ultimate load to failure of the partially ruptured tendons was 1,330 N (range Q0.25-Q0.75, 1,130 - 1.470 N). The differences were not significant. All recorded ruptures began in the superficial tendon portion, and seven out of nine tendons in the lateral tendon portion. DISCUSSION Partial ruptures of the distal triceps tendon demonstrate a not statistically significant lower ultimate load to failure than intact tendons and typically occur in the superficial, lateral portion of the tendon. This finding can be helpful when deciding between surgical and conservative therapy for partial ruptures of the distal triceps tendon.
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Affiliation(s)
- Stephanie Geyer
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
- St. Vinzenz Kliniken Pfronten Im Allgäu, Pfronten, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Daniel Bohnet
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Christian Marx
- UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Private University Hall, Hall/Tirol, Austria
| | - Romed P Vieider
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Sepp Braun
- UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Private University Hall, Hall/Tirol, Austria
- Gelenkpunkt - Sports and Joint Surgery Innsbruck, Innsbruck, Austria
| | - Sebastian Siebenlist
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany.
| | - Sebastian Lappen
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
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Rödiger T, Geyer S, Odeh T, Siebert C. Data scarce modelling the impact of present and future groundwater development on Jordan multiaquifer groundwater resources. Sci Total Environ 2023; 870:161729. [PMID: 36682544 DOI: 10.1016/j.scitotenv.2023.161729] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Rapidly growing demands and climate change stresses water resources worldwide and leads to highly competitive situations between the environment and socio-economic development of a region, calling for a smart and modelling driven water resources management. However, data scarcity often prevents the realisation of a comprehensive, nation-wide resources model, which provides reliable and spatially discretized results of water resources development. We present a workflow approach to set up a large-scale multi-aquifer model, overcoming data shortage by stepwise calibration and integrating hydrological and numerical groundwater flow modelling into a coupled system. The study aims to develop such a system to assess how groundwater resources react on anthropogenic impacts on the example of the Kingdom of Jordan, one of the water poorest countries on globe. Simulated heads reliably resembled the monitored ones in >70 % of the observation wells. That makes us confident, the model represents all the states well from 1970, prior to the intense development of the country until 2015. The water balance shows an annual deficit of 1.16 million cubic meter (MCM) due to an overdraft. The discharge to the Dead Sea increased from 564 MCM/yr to 696 MCM/yr over the time period. Regional drawdowns of >250 m and groundwater depression with an extension of approx.100 km are observable in both large aquifer complexes. Most severe areas in the upper calcareous aquifer are located in the north of Amman and practically in all urban and agricultural agglomerations across the country. Groundwater tables in the deeper sandstone aquifer are particularly affected in the south as well as in the wider vicinity of the Dead Sea as consequence of its continuous dropping. Simulations of the future development of the groundwater tables indicate a severe deterioration of the situation with further declines in groundwater levels of up to 70 m.
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Affiliation(s)
- T Rödiger
- Helmholtz-Centre for Environmental Research UFZ, Dept. Catchment Hydrology, Theodor-Lieser-Str. 4, 06120 Halle, Germany.
| | - S Geyer
- Helmholtz-Centre for Environmental Research UFZ, Dept. Catchment Hydrology, Theodor-Lieser-Str. 4, 06120 Halle, Germany
| | - T Odeh
- The Hashemite University, Prince Al Hassan bin Talal College for Natural Resources and Environment, Dept. of Water Management and Environment, Zarqa, Jordan
| | - C Siebert
- Helmholtz-Centre for Environmental Research UFZ, Dept. Catchment Hydrology, Theodor-Lieser-Str. 4, 06120 Halle, Germany
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Thiele K, Unmann A, Akgün D, Schoch C, Geyer S, Thiele H, Mader K, Siebenlist S. [Infiltration therapies for lateral epicondylopathy]. Orthopadie (Heidelb) 2023; 52:379-386. [PMID: 37074369 DOI: 10.1007/s00132-023-04371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
The therapy of the lateral epicondylopathy (tennis elbow) includes drug injection into the extensor tendon insertion in chronic cases. The choice of medication and the type of injection is decisive for the success of therapy. Furthermore, accurate application is indispensable for therapy success (e.g. peppering injection technique, ultrasound-supported injection technique). Corticosteroid injection is often associated with short-term success, so that other options have found their way into everyday practice. Objectification of treatment success is usually defined by Patient-Reported Outcome Measurements (PROM). With the introduction of Minimal Clinically Important Differences (MCID), statistically significant results are put into perspective in terms of clinical significance. Therapy for lateral epicondylopathy was considered effective if the mean difference in score results between baseline and follow-up exceeded 1.5 points for the Visual Analogue Scale (VAS), 16 points for Disabilities of Arm, Shoulder and Hand Score (DASH), 11 points for Patient-Rated Tennis Elbow Evaluation (PRTEE), and 15 points for Mayo Elbow Performance Score (MEPS). However, the effectiveness must still be critically questioned according to meta-analytical evaluations, in which healing within 12 months was found in 90% of the cases of untreated chronic tennis elbow in the placebo groups. The use of substances, such as Traumeel (Biologische Heilmittel Heel GmbH, Baden-Baden, Germany), hyaluronic acid, botulinum toxin, platelet rich plasma (PRP), autologous blood or polidocanol, are based on various mechanisms. In particular, the use of PRP or autologous blood for the treatment of musculotendinous and degenerative articular pathologies has become popular, although the studies regarding effectiveness are inconsistent. PRP can be divided into leukocyte-rich (LR-PRP) and leukocyte-poor plasma (LP-PRP) according to its preparation. In contrast to LP-PRP, LR-PRP incorporates the middle and intermediate layers, but there is no standardized preparation described in the literature. Conclusive data regarding effective efficacy are still pending.
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Affiliation(s)
- Kathi Thiele
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
- Auguste Viktoria Krankenhaus, Klinik für Schulterchirurgie, Rubensstrasse 125, Berlin, Deutschland.
| | - Annemarie Unmann
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
- LKH Feldbach, Feldbach, Österreich
| | - Doruk Akgün
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | | | - Stephanie Geyer
- St. Vinzenz Klinik Pfronten, Pfronten, Deutschland
- Klinikum rechts der Isar, München, Deutschland
| | | | - Konrad Mader
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Geyer S, Achtnich AE, Voss A, Berthold DP, Lutz PM, Imhoff AB, Martetschläger F. Iatrogenic instability of the acromioclavicular joint leads to ongoing impairment of shoulder function even following secondary surgical stabilization. Arch Orthop Trauma Surg 2023; 143:1877-1886. [PMID: 35220484 PMCID: PMC10030407 DOI: 10.1007/s00402-022-04387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 02/05/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Iatrogenic instability of the acromioclavicular joint (ACJ) following distal clavicle excision (DCE) represents an infrequent pathology. Revision surgery to restore ACJ stability and alleviate concomitant pain is challenging due to altered anatomic relationships. The purpose of this study was to evaluate the used salvage techniques and postoperative functional and radiological outcomes in retrospectively identify patients with a painful ACJ following DCE. We hypothesized that iatrogenic instability leads to ongoing impairment of shoulder function despite secondary surgical stabilization. METHODS 9 patients with a painful ACJ after DCE (6 men, 3 women, 43.3 ± 9.4 years) were followed up at a minimum of 36 months after revision surgery. Besides range of motion (ROM), strength and function were evaluated with validated evaluation tools including the Constant score and the DASH score (Disability of the Arm, Shoulder and Hand questionnaire), specific AC Score (SACS), Nottingham Clavicle Score (NCS), Taft score and Acromioclavicular Joint Instability Score (AJI). Additionally, postoperative X-rays were compared to the unaffected side, measuring the coracoclavicular (CC) and acromioclavicular (AC) distance. RESULTS At follow-up survey (55.8 ± 18.8 months) all patients but one demonstrated clinical ACJ stability after arthroscopically assisted anatomical ACJ reconstruction with an autologous hamstring graft. Reconstruction techniques were dependent on the direction of instability. The functional results demonstrated moderate shoulder and ACJ scores with a Constant Score of 77.3 ± 15.4, DASH-score of 51.2 ± 23.4, SACS 32.6 ± 23.8, NCS 77.8 ± 14.2, AJI 75 ± 14.7 points and Taft Score 7.6 ± 3.4 points. All patients stated they would undergo the revision surgery again. Mean postoperative CC-distance (8.3 ± 2.8 mm) did not differ significantly from the contralateral side (8.5 ± 1.6 mm) (p > 0,05). However, the mean AC distance was significantly greater with 16.5 ± 5.8 mm compared to the contralateral side (3.5 ± 1.9 mm) (p = 0.012). CONCLUSION Symptomatic iatrogenic ACJ instability following DCE is rare. Arthroscopically assisted revision surgery with an autologous hamstring graft improved ACJ stability in eight out of nine cases (88.9%). However, the functional scores showed ongoing impairment of shoulder function and a relatively high overall complication rate (33.3%). Therefore, this study underlines the importance of precise preoperative indication and planning and, especially, the preservation of ACJ stability when performing AC joint resection procedures. LEVEL OF EVIDENCE Case series, LEVEL IV.
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Affiliation(s)
- Stephanie Geyer
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andrea E Achtnich
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Center, Regensburg, Germany
- Sporthopaedicum, Regensburg, Germany
| | - Daniel P Berthold
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Patricia M Lutz
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Frank Martetschläger
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
- Deutsches Schulterzentrum, ATOS Klinik München, Effnerstr. 38, 81925, Munich, Germany.
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Geyer S, Siebler J, Eggers F, Münch LN, Berthold DP, Imhoff AB, Siebenlist S, Scheiderer B. Influence of sportive activity on functional and radiographic outcomes following reverse total shoulder arthroplasty: a comparative study. Arch Orthop Trauma Surg 2023; 143:1809-1816. [PMID: 35092467 PMCID: PMC10030429 DOI: 10.1007/s00402-022-04344-1] [Citation(s) in RCA: 4] [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: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of the present study was to compare the functional and radiographic outcomes following reverse total shoulder arthroplasty (RTSA) in a senior athletic and non-athletic population. MATERIAL AND METHODS In this retrospective cohort study, patients who underwent RTSA between 06/2013 and 04/2018 at a single institution were included. Minimum follow-up was 2 years. A standardized questionnaire was utilized for assessment of patients' pre- and postoperative physical fitness and sportive activity. Patients who resumed at least one sport were assigned to the athletic group, while patients who ceased participating in sports were assigned to the non-athletic group. Postoperative clinical outcome measures included the Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and visual analog scale (VAS) for pain. Active shoulder range of motion (ROM) and abduction strength were assessed. Radiographic evaluation was based on a standardized core set of parameters for radiographic monitoring of patients following shoulder arthroplasty. RESULTS Sixty-one of 71 patients (85.9%; mean age: 72.1 ± 6.6 years) were available for clinical and radiographic follow-up at a mean of 47.1 ± 18.1 months. Thirty-four patients (55.7%) were assigned to the athletic group and 27 patients (44.3%) to the non-athletic group. The athletic group demonstrated significantly better results for CS (P = 0.002), ASES score (P = 0.001), SST (P = 0.001), VAS (P = 0.022), active external rotation (P = 0.045) and abduction strength (P = 0.016) compared to the non-athletic group. The overall rate of return to sport was 78.0% at an average of 5.3 ± 3.6 months postoperatively. Incomplete radiolucent lines (RLL) around the humeral component were found significantly more frequently in the athletic group compared to the non-athletic group (P = 0.019), whereas the occurrence of complete RLLs around the implant components was similar (P = 0.382). Scapular notching was observed in 18 patients (52.9%) of the athletic group and 12 patients (44.9%) of the non-athletic group (P = 0.51). The overall rate for revision surgery was 8.2%, while postoperative complications were encountered in 3.3% of cases. CONCLUSION At mid-term follow-up, the athletic population demonstrated significantly better clinical results following RTSA without a higher rate of implant loosening and scapular notching when compared to non-athletic patients. However, incomplete radiolucency around the humeral component was observed significantly more often in the athletic group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jakob Siebler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felipe Eggers
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas N Münch
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Geyer S, Lacheta L, Seilern Und Aspang J, Willinger L, Lutz PM, Lappen S, Imhoff AB, Siebenlist S. Patient satisfaction, joint stability and return to sports following simple elbow dislocations: surgical versus non-surgical treatment. Arch Orthop Trauma Surg 2023; 143:1481-1489. [PMID: 35220457 PMCID: PMC9957866 DOI: 10.1007/s00402-022-04383-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE While conservative management is commonly promoted for simple elbow dislocations, the importance of primary surgical treatment in these injuries is still undetermined. The objective of this study was to report patient-reported outcome measures (PROMs), return to sports (RTS) and joint stability using ultrasound in patients following conservative or surgical treatment after simple elbow dislocation. METHODS Patients with a minimum follow-up of 24 months after conservative (CT) or surgical treatment (ST) following simple elbow dislocation were included in this retrospective study. To evaluate patients' postoperative outcome and satisfaction, the Elbow Self-Assessment Score (ESAS) was used, and validated scores such as the Mayo elbow performance score (MEPS), the Quick Disability of Arm and Shoulder Score (Quick-DASH) and RTS were assessed. For objective assessment of residual joint instability, a standardized clinical examination as well as a dynamic ultrasound evaluation of the affected and the contralateral elbow was performed. RESULTS Forty-four patients (26 women, 18 men) with an average age of 41.5 ± 15.3 years were available for follow-up survey (65.5 ± 30.4 months; range 26-123). 21 patients were treated conservatively and twenty-three patients received surgical treatment. CT and ST resulted in similar outcome with regard to ROM, ESAS (CT: 99.4 ± 1.5; ST: 99.8 ± 0.3), MEPS (CT: 97.3 ± 6.8 points; ST: 98.7 ± 3.3) and Quick-DASH (CT: 7.8 ± 10.4; ST: 6.3 ± 7.9) (n.s.). There was no difference in elbow stability and laxity measured by ultrasound between the study groups and compared to the healthy elbow (n.s.). Two patients of the CT group (10%) complained about persistent subjective elbow instability. RTS was faster after surgical compared to conservative treatment (p = 0.036). CONCLUSION Both, conservative and surgical treatment results in high patient satisfaction and good-to-excellent functional outcome after simple elbow dislocation. Even though ultrasound evaluation showed no significant differences in joint gapping between groups, 10% of conservatively treated patients complained about severe subjective instability. Surgically treated patients returned faster to their preoperatively performed sports. Thus, primary surgical treatment may be beneficial for high demanding patients. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Lucca Lacheta
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Lukas Willinger
- Department of Trauma Surgery, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Patricia M Lutz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Lappen
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
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10
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Lutz PM, Geyer S, Winkler PW, Irger M, Berthold DP, Feucht MJ, Imhoff AB, Forkel P. Reliable ligamentous stability and high return-to-sport rates after arthroscopic reduction and internal fixation of tibial eminence fractures. Arch Orthop Trauma Surg 2022; 142:3623-3631. [PMID: 34009463 PMCID: PMC9596592 DOI: 10.1007/s00402-021-03961-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate functional and clinical outcomes, and physical activity after arthroscopic suture fixation of tibial eminence fractures with regard to postoperative stability, range of motion (ROM), complications, and return to sports. METHODS Patients undergoing arthroscopic reduction and internal fixation (ARIF) of tibial eminence fractures using a suture fixation technique were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using KT-1000 arthrometer measurements, clinical examination, outcome scores (Lysholm score, Tegner Activity Scale), and a questionnaire about sport activities. RESULTS A total of 23 patients (44% male, 57% female) with a mean age of 25 ± 15 years were included. Mean follow-up was 57 ± 25 months. KT-1000 arthrometer measurements of anterior tibial translation revealed a mean side-to-side difference of 0.9 ± 1.0 mm. Clinical examination showed 100% normal or nearly normal anterior translation of the tibia. Two patients (9%) received an ACL reconstruction due to traumatic ACL re-instability and were, therefore, considered as failures. An extension deficit concerning hyperextension occurred in 29% of patients postoperatively. Further postoperative complications occurred in 14% of patients and included postoperative stiffness with ROM limitations and secondary dislocation of a fragment. Mean postoperative Lysholm score was 89 ± 14. Comparing pre- and postoperative values, no significant change of the Tegner Activity Scale was observed. All patients (failures excluded) returned to high impact sports activities after ARIF. CONCLUSION Excellent reliable ligamentous stability and high rates of return to high impact sports can be expected after ARIF using a suture fixation technique for type II-IV tibial eminence fractures. Complications, such as limitations in ROM, commonly occur in up to 30% after ARIF. Therefore, regular follow-up examinations remain important in this usually young patient cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp W Winkler
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Markus Irger
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Lappen S, Geyer S, Kadantsev P, Hinz M, Kleim B, Degenhardt H, Imhoff AB, Siebenlist S. All-suture anchors for distal biceps tendon repair: a preliminary outcome study. Arch Orthop Trauma Surg 2022; 143:3271-3278. [PMID: 36416943 DOI: 10.1007/s00402-022-04690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to retrospectively evaluate the clinical outcome of double intramedullary all-suture anchors' fixation for distal biceps tendon ruptures. MATERIALS AND METHODS A retrospective case series of patients who underwent primary distal biceps tendon repair with all-suture anchors was conducted. Functional outcome was assessed at a minimum follow-up of at 12 months based on the assessments of the Mayo Elbow Performance Score (MEPS), Andrews-Carson Score (ACS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Visual Analog Scale (VAS) for pain. Maximum isometric strength test for flexion and supination as well as postoperative range of motion (ROM) were determined for both arms. RESULTS 23 patients treated with all-suture anchors were assessed at follow-up survey (mean age 56.5 ± 11.4 years, 96% male). The follow-up time was 20 months (range Q0.25-Q0.75, 15-23 months). The following outcome results were obtained: MEPS 100 (range Q0.25-Q0.75, 100-100); ACS 200 (range Q0.25-Q0.75, 195-200); QuickDASH 31 (range Q0.25-Q0.75, 30-31); VAS 0 (range Q0.25-Q0.75, 0-0). The mean strength compared to the uninjured side was 95.6% (range Q0.25-Q0.75, 80.9-104%) for flexion and 91.8 ± 11.6% for supination. There was no significant difference in ROM or strength compared to the uninjured side and no complications were observed in any patient. CONCLUSION Distal biceps tendon refixation using all-suture anchors provides good-to-excellent results in terms of patient-reported and functional outcome. This repair technique appears to be a viable surgical option, although further long-term results are needed. LEVEL OF EVIDENCE Level IV (case series).
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Affiliation(s)
- Sebastian Lappen
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Pavel Kadantsev
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin Kleim
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Winkler PW, Geyer S, Walzl D, Woertler K, Paul J, Siebenlist S, Imhoff AB, Achtnich A. Favorable long-term clinical and radiologic outcomes with high survivorship after autologous osteochondral transplantation of the talus. Knee Surg Sports Traumatol Arthrosc 2022; 31:2166-2173. [PMID: 36394584 PMCID: PMC10183420 DOI: 10.1007/s00167-022-07237-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes. METHODS Thirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure. RESULTS Favorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%. CONCLUSION Autologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Philipp W Winkler
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Walzl
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | | | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Abdallah N, Smith A, Geyer S, Binder M, Greipp P, Kapoor P, Dispenzieri A, Gertz M, Baughn L, Lacy M, Hayman S, Buadi F, Dingli D, Hwa Y, Lin Y, Kourelis T, Warsame R, Kyle R, Rajkumar S, Kumar S. 639P Conditional survival in MM and impact of prognostic factors over time. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.765] [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: 11/30/2022] Open
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14
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Tetzlaff J, Luy M, Epping J, Geyer S, Beller J, Stahmeyer J, Sperlich S, Tetzlaff F. Estimating trends in working life expectancy based on health insurance data from Germany – Challenges and advantages. SSM Popul Health 2022; 19:101215. [PMID: 36091300 PMCID: PMC9450162 DOI: 10.1016/j.ssmph.2022.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Abstract
Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8–11 years and 12–13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8–38.3 years in men, 27.5–34.0 years in women) or the older working-age (e.g. at age 50 10.2–11.7 years in men, 7.8–10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Δ3.1 years in women, Δ1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective. Working Life Expectancy has increased substantially since the mid-2000s. The gender gap narrowed over time, but men still spend considerably more years in the labor force than women. Educational inequalities in WLE exist in both sexes, but are larger in women. Measures to increase labor force participation should focus especially on lower-educated women, as WLE is low in this group. Prevention should be strengthened for vulnerable groups to reduce health inequalities and early labor market exits.
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Tetzlaff J, Epping J, Geyer S, Beller J, Sperlich S, Tetzlaff F. Länger leben, länger arbeiten? Zeittrends und
Bildungsungleichheiten in der Working Life Expectancy auf der Basis von
Krankenkassendaten. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- J Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - J Epping
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - J Beller
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - F Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
- Robert Koch-Institut, Fachgebiet Soziale Determinanten der Gesundheit,
Berlin, Deutschland
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16
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Sperlich S, Adler FM, Beller J, Safieddine B, Tetzlaff J, Geyer S. Zeitliche Entwicklung subjektiver Gesundheit von alleinerziehenden
Müttern in Deutschland – eine Dekompositionsanalyse des
Einflusses von Veränderungen der sozioökonomischen
Lebenssituation von 1994 bis 2018. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753619] [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: 12/12/2022]
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17
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Kleim BD, Hinz M, Geyer S, Scheiderer B, Imhoff AB, Siebenlist S. A 3-Dimensional Classification for Degenerative Glenohumeral Arthritis Based on Humeroscapular Alignment. Orthop J Sports Med 2022; 10:23259671221110512. [PMID: 35982830 PMCID: PMC9380229 DOI: 10.1177/23259671221110512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Seminal classifications of degenerative arthritis of the shoulder (DAS) describe either cuff tear arthropathy in the coronal plane or primary osteoarthritis in the cross-sectional plane. None consider a biplanar eccentricity. Purpose/Hypothesis The purpose of this study was to investigate humeroscapular alignment (HSA) of patients with DAS in both the anteroposterior (A-P) and superoinferior (S-I) planes on computed tomography (CT) after 3-dimensional (3D) reconstruction and develop a classification based on biplanar HSA in 9 quadrants. It was hypothesized that biplanar eccentricity would occur frequently. Study Design Cross-sectional study; Level of evidence, 3. Methods The authors analyzed 130 CT scans of patients who had undergone shoulder arthroplasty. The glenoid center, trigonum, and inferior angle of the scapula were aligned in a single plane using 3D reconstruction software. Subluxation of the HSA was measured as the distance from the center of rotation of the humeral head to the scapular axis (line from trigonum through glenoid center) and was expressed as a percentage of the radius of the humeral head in both the A-P and the S-I directions. HSA was described in terms of A-P alignment first (posterior/central/anterior), then S-I alignment (superior/central/inferior), for a total of 9 different alignment combinations. Additionally, glenoid erosion was graded 1-3. Results Subluxation of the HSA was 74.1% posterior to 23.5% anterior in the A-P direction and 17.2% inferior to 68.6% superior in the S-I direction. A central HSA was calculated as between 20% posterior to 5% anterior (A-P) and 5% inferior to 20% superior (S-I), after a graphical analysis. Posterior subluxation >60% of the radius was labeled as extraposterior, and static acetabularization was labeled as extrasuperior. Overall, 21 patients had central-central, 40 centrosuperior, and 1 centroinferior alignment. Of 60 shoulders with posterior subluxation, alignment was posterocentral in 31, posterosuperior in 25, and posteroinferior in 5. There were 3 patients with anterocentral and 4 anterosuperior subluxation; in addition, 4 cases with extraposterior and 17 with extrasuperior subluxation were identified. Conclusion There was a high prevalence of biplanar eccentricity in DAS. The 3D classification system using combined HSA and glenoid erosion can be applied to describe DAS comprehensively.
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Affiliation(s)
- Benjamin D. Kleim
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Maximillian Hinz
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
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Lappen S, Siebenlist S, Kadantsev P, Hinz M, Seilern Und Aspang J, Lutz PM, Imhoff AB, Geyer S. Distal biceps tendon ruptures occur with the almost extended elbow and supinated forearm - an online video analytic study. BMC Musculoskelet Disord 2022; 23:599. [PMID: 35733124 PMCID: PMC9214967 DOI: 10.1186/s12891-022-05546-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Distal biceps tendon ruptures can lead to significant restrictions in affected patients. The mechanisms of injury described in scientific literature are based exclusively on case reports and theoretical models. This study aimed to determine the position of the upper extremities and forces involved in tendon rupture through analyzing video recordings. Methods The public YouTube.com database was queried for videos capturing a clear view of a distal biceps tendon rupture. Two orthopedic surgeons independently assessed the videos for the activity that led to the rupture, the arm position at the time of injury and the forces imposed on the elbow joint. Results Fifty-six video segments of a distal biceps rupture were included (55 male). In 96.4%, the distal biceps tendon ruptured with the forearm supinated and the elbow isometrically extended (non-dynamic muscle engagement) (71.4%) or slightly flexed (24%). The most common shoulder positions were adduction (85.7%) and neutral position with respect to rotation (92.9%). Most frequently a tensile force was enacted on the elbow (92.9%) and the most common activity observed was deadlifting (71.4%). Conclusion Distal biceps tendon ruptures were most commonly observed in weightlifting with a slightly flexed or isometrically extended elbow and forearm supination. These observations may provide useful information for sports specific evidence-based injury prevention, particularly in high performing athletes and individuals engaged in resistance training. Level of evidence Observational study.
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Affiliation(s)
- Sebastian Lappen
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Pavel Kadantsev
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | | | - Patricia M Lutz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Kronsteiner B, Zopf L, Heimel P, Oberoi G, Kramer AM, Slezak P, Reissig L, Geyer S, Weninger WJ, Podesser BK, Kiss A, Moscato F. Topographical Mapping of the cardiac autonomic innervation for selective cardiac neuromodulation in pigs and rabbits using MicroCT. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.156] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020- EU H2020-EU.1.2.2. - FET Proactive
"NeuHeart" Nr. 824071
Background & Introduction
In recent years, Vagus Nerve Stimulation (VNS) has proved to be a potential therapeutic approach for the treatment of cardiovascular diseases, such as Heart Failure or atrial fibrillation [1]. However, the lack of specific anatomical knowledge of the cervical VN [2, 3] and thus, of the cardiac autonomic innervation aggravates the side effects of unselective cervical VNS.
Purpose
The goal of this study was to investigate the cardiac vagus nerve branches for selective cardiac VNS stimulation using micro-computed tomography (µCT) and 3D renderings.
Methods
Vagus nerve specimens (n= 11 pig nerves, n= 5 rabbit nerves) were harvested from the nodose ganglion down to the cardiac branches in domestic pigs and New Zealand White rabbits on both sides, and the cardiac autonomic innervation was mapped µCT and 3D renderings.
Results
Our results provide anatomical and topographical key features on the cervical and cardiac autonomic innervation including course of the cardiac branch, cardiac branching patterns, fascicle number, and size of the autonomic nerves. We also compared these aforementioned anatomical parameters between pigs and rabbits and highlighted key anatomical differences among individuals within pigs. In pigs, the cardiac branches were partly composed of both nerves even when they branched off the VN whereas in rabbits, the two nerves were completely separated and the cardiac branch was solely parasympathetic. Finally, we generated a 3D model of various parts of the VN specimen and compared them to images of the native nerves taken during VN dissection surgery.
Conclusions
Here we present an imaging approach to map the anatomy and topography of the cardiac Vagus Nerve for selective stimulation of cardiac VN branches. We also characterized the morphology of the VN, the sympathetic trunk (ST), and the cardiac branch (CB) at the level of the cardiac branching point to highlight the complex interplay between the nerves. Our data provide one possible reason for unwanted side effects of cervical VNS. However, future studies are required to broaden the knowledge in this specific research field of selective cardiac VNS.
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Affiliation(s)
| | - L Zopf
- Ludwig Boltzmann Cluster for Cardiovascular Research , Vienna , Austria
| | - P Heimel
- Ludwig Boltzmann Cluster for Cardiovascular Research , Vienna , Austria
| | - G Oberoi
- Medical University of Vienna , Vienna , Austria
| | - A-M Kramer
- Medical University of Vienna , Vienna , Austria
| | - P Slezak
- Ludwig Boltzmann Cluster for Cardiovascular Research , Vienna , Austria
| | - L Reissig
- Medical University of Vienna , Vienna , Austria
| | - S Geyer
- Medical University of Vienna , Vienna , Austria
| | - WJ Weninger
- Medical University of Vienna , Vienna , Austria
| | - BK Podesser
- Medical University of Vienna , Vienna , Austria
| | - A Kiss
- Medical University of Vienna , Vienna , Austria
| | - F Moscato
- Medical University of Vienna , Vienna , Austria
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20
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Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Kleim BD, Lappen S, Imhoff AB, Mehl J, Hinz M. Midterm outcome and strength assessment after quadriceps tendon refixation with suture anchors. Eur J Orthop Surg Traumatol 2022; 33:869-875. [PMID: 35137251 PMCID: PMC10125935 DOI: 10.1007/s00590-022-03218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Quadriceps tendon ruptures (QTR) occur predominantly in middle-aged patients through violent eccentric contraction that occurs either when trying to regain balance or during a fall on the hyperflexed knee. The aim of this study was to quantify midterm postoperative results, including strength potential measured via standardized strength tests following acute (< six weeks) quadriceps tendon refixation using suture anchors. METHODS All consecutive patients with QTR who underwent surgical suture anchor refixation between 2012 and 2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Tegner Activity Scale (TAS), Lysholm score, International Knee Documentation Committee subjective knee form (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, return to work rates, and Visual Analog Scale (VAS) for pain. Additionally, a standardized clinical examination and an isometric strength assessment of knee extension and flexion were performed. RESULTS A total of 17 patients (median age 61.0 [25-75% IQR 50.5-72.5]) were available for final assessment at a mean follow-up of 47.1 ± SD 25.4 months. The majority of patients were male (82.4%) and most injuries occurred due to a fall on the hyperflexed knee (76.5%). The average time interval between trauma and surgery was 12.7 ± 7.5 days. Patients achieved a moderate level of activity postoperatively with a median TAS of 4 (3-5.5) and reported good to excellent outcome scores (Lysholm score: 97 (86.5-100); IKDC: 80.7 ± 13.5; KOOS subscales: pain 97.2 (93.1-100), symptoms 92.9 (82.5-100), activities of daily living 97.1 (93.4-100), sport and recreation function 80 (40-97.5) and knee-related quality of life 87.5 (62.5-100). All patients were able to fully return to work and reported little pain [VAS: 0 (0-0)]. No postoperative complications were reported. Strength measurements revealed a significant deficit of knee extension strength in comparison to the contralateral side (p = 0.011). CONCLUSION Suture anchor refixation of acute QTR leads to good functional results and high patient satisfaction without major complications. Isometric knee extension strength, however, may not be fully restored compared to the unaffected side.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Lappen
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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21
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Hinz M, Kleim BD, Berthold DP, Geyer S, Lambert C, Imhoff AB, Mehl J. Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes. Orthop J Sports Med 2022; 9:23259671211062568. [PMID: 34988235 PMCID: PMC8721390 DOI: 10.1177/23259671211062568] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques. Purpose To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities. Study Design Descriptive epidemiology study. Methods Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport. Results Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly (P = .003), older age (P < .001), and higher belt rank (P = .003) were significant risk factors for injury. Conclusion Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.
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Affiliation(s)
- Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christophe Lambert
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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22
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Hinz M, Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Kleim BD, Imhoff AB, Mehl J. Midterm outcome and strength assessment after proximal rectus femoris refixation in athletes. Arch Orthop Trauma Surg 2022; 142:2263-2270. [PMID: 34664130 PMCID: PMC8522542 DOI: 10.1007/s00402-021-04189-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Proximal rectus femoris avulsions (PRFA) are relatively rare injuries that occur predominantly among young soccer players. The aim of this study was to evaluate midterm postoperative results including strength potential via standardized strength measurements after proximal rectus femoris tendon refixation. It was hypothesized that the majority of competitive athletes return to competition (RTC) after refixation of the rectus femoris tendon without significant strength or functional deficits compared to the contralateral side. METHODS Patients with an acute (< 6 weeks) PRFA who underwent surgical refixation between 2012 and 2019 with a minimum follow-up of 12 months were evaluated. The outcome measures compiled were the median Tegner Activity Scale (TAS) and mean RTC time frames, Harris Hip Score (HHS), Hip and Groin Outcome Score (HAGOS) subscales, International Hip Outcome Tool-33 (iHOT-33), and Visual Analog Scale (VAS) for pain. In addition, a standardized isometric strength assessment of knee flexion, knee extension, and hip flexion was performed to evaluate the functional result of the injured limb in comparison to the uninjured side. RESULTS Out of 20 patients, 16 (80%) patients were available for final assessment at a mean follow-up of 44.8 ± SD 28.9 months. All patients were male with 87.5% sustaining injuries while playing soccer. The average time interval between trauma and surgery was 18.4 ± 8.5 days. RTC was possible for 14 out of 15 previously competitive athletes (93.3%) at a mean 10.5 ± 3.4 months after trauma. Patients achieved a high level of activity postoperatively with a median (interquartile range) TAS of 9 (7-9) and reported good to excellent outcome scores (HHS: 100 (96-100); HAGOS: symptoms 94.6 (89.3-100), pain 97.5 (92.5-100), function in daily living 100 (95-100), function in sport and recreation 98.4 (87.5-100), participation in physical activities 100 (87.5-100), quality of life 83.1 ± 15.6; iHot-33: 95.1 (81.6-99.8)). No postoperative complications were reported. Range of motion, isometric knee flexion and extension, as well as hip flexion strength levels were not statistically different between the affected and contralateral legs. The majority of patients were "very satisfied" (56.3%) or "satisfied" (37.5%) with the postoperative result and reported little pain (VAS 0 (0-0.5)). CONCLUSION Surgical treatment of acute PRFA yields excellent postoperative results in a young and highly active cohort. Hip flexion and knee extension strength was restored fully without major surgical complications. LEVEL OF EVIDENCE Retrospective cohort study; III.
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Affiliation(s)
- Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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23
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Lutz PM, Merkle M, Winkler PW, Geyer S, Herbst E, Braun S, Imhoff AB, Feucht MJ. Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries. Knee Surg Sports Traumatol Arthrosc 2021; 29:3846-3853. [PMID: 33483769 PMCID: PMC8514347 DOI: 10.1007/s00167-020-06409-3] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare post-operative physical activity and return to work after combined posterolateral corner (PLC) reconstruction (PLC-R) in anterior cruciate ligament (ACL)- or posterior cruciate ligament (PCL)-based injuries. METHODS Patients aged > 18 years undergoing PLC-R using the Larson technique combined with either ACL or PCL reconstruction were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using Tegner Activity Scale, Activity Rating Scale (ARS), Knee Injury and Osteoarthritis Outcome Score (KOOS), work intensity according to REFA classification, and a questionnaire about type of occupation and time to return to work. RESULTS A total of 32 patients (11 ACL-based injuries and 21 PCL-based injuries) were included. Mean follow-up was 56 ± 26 months in the ACL-based injury group and 59 ± 24 months in the PCL-based injury group. All patients in the ACL-based injury group and 91% of patients in the PCL-based injury group returned to sports activities. Comparing pre- and post-operative values, a significant deterioration of the Tegner Activity Scale and ARS was observed in the PCL-based injury group, whereas no significant change was observed in the ACL-based injury group. KOOS subscales were generally higher in the ACL-based injury with significant differences in the subscale sports and recreational activities. Patients with ACL-based injuries returned to work significantly earlier compared to patients with PCL-based injuries (11 ± 4 weeks vs. 21 ± 10 weeks, p < 0.05). CONCLUSION High rates of return to sports and work can be expected after combined PLC-R in both ACL- and PCL-based injuries. However, deterioration of sports ability must be expected in PCL-based injuries. ACL-based injuries led to superior patient-reported outcomes and an earlier return to work, as compared to PCL-based injuries. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Merkle
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp W Winkler
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Sepp Braun
- Gelenkpunkt - Sports- and Traumasurgery Innsbruck, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Safieddine B, Sperlich S, Epping J, Lange K, Geyer S. Development of Comorbidities in Type 2 Diabetes: Morbidity Expansion or Dynamic Equilibrium? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Different hypotheses have been proposed about the future development of morbidity associated with the temporal improvement in life expectancy. However, many studies have focused on general morbidity while testing these hypotheses. In type 2 diabetes (T2D), one of the most prevalent chronic diseases, research points towards an increasing prevalence over time with a simultaneous increase in life expectancy among this population. While morbidity compression in T2D can thus be ruled out, it remains unclear whether morbidity expansion or dynamic equilibrium applies, which could be the case with a decrease in personal disease burden despite increasing prevalence. Against this background, this study aims to examine how the prevalence of T2D-related comorbidities is developing over time.
Methods
Using claims data of a large statutory insurance provider in the state of Lower-Saxony, Germany, the period prevalence of nine T2D-related comorbidities was examined for the time periods 2005-2007, 2010-2012, and 2015-2017 in 240241, 295868, and 308134 individuals with T2D, respectively. The temporal development of comorbidities was examined by logistic regression analysis. The change in the number of comorbidities over time was examined by ordered logistic regression. Analyses were stratified by gender and three age groups.
Results
Over the three time periods, age-adjusted predicted probabilities for more severe cardiovascular diseases (CVDs) decreased in men and women with T2D while those for less severe CVDs and other vascular diseases such as retinopathy, polyneuropathy any nephropathy increased significantly in all subgroups. Among all subgroups, the predicted probability of having more comorbidities over time also increased significantly.
Conclusions
Despite differences in the way CVDs are developing, the results are in favour of the morbidity expansion hypothesis for this population. Further research is needed to examine the reasons behind the observed trends.
Key messages
The developement of comorbidities in individuals with type 2 diabetes points towards morbidity expansion among this population. Future studies should examine whether the change is socioeconomic status, medication use and lifestyle risk factors are contributing to these trends.
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Affiliation(s)
- B Safieddine
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - S Sperlich
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - J Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - K Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - S Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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25
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Horenkamp-Sonntag D, Bitzer EM, Geyer S. Behandlungsfade in GKV-Routinedaten: Status-Quo der Screening-Inanspruchnahme beim Gebärmutterhalskrebs vor Einführung des HPV-Tests. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - EM Bitzer
- Pädagogische Hochschule Freiburg, Public Health & Health Education
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie
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26
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Schoch C, Dittrich M, Seilern Und Aspang J, Geyer M, Geyer S. Autologous triceps tendon graft for LUCL reconstruction of the elbow: clinical outcome after 7.5 years. Eur J Orthop Surg Traumatol 2021; 32:1111-1118. [PMID: 34363106 DOI: 10.1007/s00590-021-03081-2] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this study was to assess mid- to long-term functional outcomes in patients treated for symptomatic posterolateral instability of the elbow (PLRI) using an autologous ipsilateral triceps tendon as graft. METHODS A total of 196 patients were treated with autologous triceps tendon graft for symptomatic PLRI at single orthopedic institution from 2006 to 2013. The surgical treatment contained arthroscopic instability testing, reconstruction of the lateral ulnar collateral ligament (LUCL) and harvesting autologous ipsilateral triceps tendon as graft. The follow-up outcomes included range of motion (ROM), pain measured on a visual analogue scale (VAS), Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES) and ultrasound to evaluate the integrity of the refixation of the common extensor. RESULTS A total of 178 patients (female: 73; male: 105) were available for follow-up at a mean of 91 months (range 48-144). No patient reported pain at rest; VAS during activity was 1.8 (range 0-5). The ROM decreased slightly compared to preoperative measurements. Flexion decreased significantly from 135.4 to 131.1, though still within the functional arc of motion. All but 13 patients (8.5%) were clinically stable. However, only two patients received a revision of the LUCL reconstruction due to subjective instability. The mean MEPS in the final follow-up was 91.3 (range 73-100). The mean OES was 46.5 (range 39-48). Three patients reported a pain-free clicking of the elbow. No patient complained about donor site morbidity of the ipsilateral triceps tendon. Ultrasound evaluation showed integrity of the common extensors in all patients. CONCLUSIONS LUCL reconstruction using the ipsilateral triceps tendon as graft shows good to excellent mid- to long-term results in the treatment of symptomatic posterolateral elbow joint instability with a low re-instability and complication rate.
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Affiliation(s)
- Christian Schoch
- St. Vinzenz Klinik Pfronten GmbH, Kirchweg 15, 87459, Pfronten, Germany.
| | - Michael Dittrich
- St. Vinzenz Klinik Pfronten GmbH, Kirchweg 15, 87459, Pfronten, Germany
| | | | - Michael Geyer
- St. Vinzenz Klinik Pfronten GmbH, Kirchweg 15, 87459, Pfronten, Germany
| | - Stephanie Geyer
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
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27
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Lutz PM, Knörr M, Geyer S, Imhoff AB, Feucht MJ. Delayed proximal hamstring tendon repair after ischial tuberosity apophyseal fracture in a professional volleyball athlete: a case report. BMC Musculoskelet Disord 2021; 22:578. [PMID: 34167498 PMCID: PMC8223337 DOI: 10.1186/s12891-021-04468-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ischial tuberosity apophyseal fractures are avulsion fractures of the anatomic footprint of the proximal hamstring tendons. Generally, these injuries are rare and frequently occur in skeletally immature, active patients due to incomplete ossification. Depending on the fragment displacement, non-operative or operative treatment approaches are used. Case presentation We report a case of a 29-year-old professional volleyball athlete who has suffered from a nonunion avulsion fracture for 14 years. Isolated suture anchor fixation was performed after open excision of a large bony fragment followed by excellent clinical and functional outcome at 1 year postoperatively. Conclusion In conclusion, avulsion fractures of the ischial tuberosity with large fragments and restrictions to activities of daily living due to pain can, in individualized cases, be treated with an open excision of the fragment followed by repair of the proximal hamstring tendons using suture anchors.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Michel Knörr
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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28
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Berthold DP, Muench LN, Cusano A, Uyeki CL, Slater M, Tamburini LM, Geyer S, Cote MP, Arciero RA, Mazzocca AD. Clinical and Functional Outcomes After Operative and Nonoperative Treatment of Distal Biceps Brachii Tendon Ruptures in a Consecutive Case Series. Orthop J Sports Med 2021; 9:2325967120984841. [PMID: 34179199 PMCID: PMC8193667 DOI: 10.1177/2325967120984841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with ruptures of the distal biceps brachii tendon (DBBT) have traditionally been treated via surgical repair, despite limited patient data on nonoperative management. Purpose/Hypothesis: To determine the clinical and functional outcomes for patients with partial and complete DBBT injuries treated nonoperatively or surgically through an anatomic single-incision technique. We hypothesized that there would be no difference in outcomes in patients treated with nonoperative or operative management. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review identified all patients with a partial or complete DBBT injury sustained between 2003 and 2017. Surgically treated patients underwent DBBT repair using an anatomic single-incision technique. Nonoperative management consisted of formal physical therapy. The following clinical outcome measures were included for analysis: American Shoulder and Elbow Surgeons (ASES) score; the Disabilities of the Arm, Shoulder and Hand (DASH) upper extremity patient questionnaire; the Single Assessment Numeric Evaluation (SANE) score; and the 36-Item Short Form Health Survey. Results: A total of 60 patients (mean ± SD age, 47.8 ± 11.5 years; range, 18-70 years) sustained DBBT ruptures (38 complete and 22 partial) during the study period. Of patients with complete DBBT, 34 were treated operatively and 4 nonoperatively; of those with partial DBBT, 11 were treated operatively and 11 nonoperatively. At a mean follow-up of 5.4 ± 4.0 years (range, 0.5-16.6 years), patients with complete DBBT ruptures achieved overall similar improvements with respect to mean ASES pain, ASES function, SANE, and DASH scores, regardless of whether they were treated operatively or nonoperatively. Subjective satisfaction and functional scores were comparable between the groups. Similarly, at a mean follow-up of 4.1 ± 3.8 years (range, 0.5-11.3 years), patients with partial DBBT injuries had improved mean ASES pain, ASES function, SANE, and DASH scores, regardless of operative or nonoperative treatment. Subjective satisfaction and functional scores were comparable between these groups. For those treated surgically, 5 patients (11.1%) sustained a surgical postoperative complication. Conclusion: In our case series, patients were able to achieve satisfactory outcomes regardless of whether they were treated nonoperatively or with an anatomic single-incision approach for complete or partial DBBT ruptures.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Antonio Cusano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Colin L Uyeki
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Maria Slater
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lisa M Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Geyer S, Seilern Und Aspang J, Geyer M, Schoch C. Hidden instability in posttraumatic stiff elbows. Eur J Orthop Surg Traumatol 2021; 31:1135-1141. [PMID: 33417047 DOI: 10.1007/s00590-020-02846-5] [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] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hidden instability could be one of the reasons for reoccurring stiffness after arthrolysis in posttraumatic elbows. Associated instability in stiff posttraumatic elbows is clinically hard to detect. Surgical treatment for instability and stiffness in the same surgical setting is challenging and has not been evaluated as of yet. HYPOTHESIS The primary hypothesis assumes (1) the existence of a posttraumatic "stiff and unstable elbow" and (2) that coexisting instability can be detected by arthroscopic instability testing. The secondary objective was to report the midterm results after arthrolysis and ligament stabilization in the stiff and unstable elbow. METHODS From 2005 to 2015, 55 patients received arthroscopic arthrolysis of the elbow due to posttraumatic elbow stiffness at our institution. The arthroscopic instability was categorized into three grades with a switching stick: grade I (= stable), grade II (mild instability) and grade III (grossly instable). In cases of persisting instability (grade II-III), a ligament stabilization procedure was performed and all patients were followed up clinically at a minimum of 12 months. Besides ROM and clinical joint stability, PROs (patient reported outcomes) were assessed with the PREE-score (patient-rated elbow evaluation) and the Oxford-Elbow-score (OES). Furthermore, the MEPS (Mayo-elbow-performance-score) was assessed. RESULTS Out of 55 cases presenting for arthrolysis, coexisting elbow instability was detected during arthroscopic instability testing in 22 cases (40%). All 22 patients received additional ligament stabilization. At final follow-up 62.7 ± 35.7 months postoperatively, 20 patients (12 men; 8 women) with a mean age of 42 ± 16.8 were available. PREE, OES and MEPS were 19.8 ± 25.3, 37.5 ± 9.8 and 80 ± 14.5, respectively. ROM improved significantly from 95° ± 29° to 110° ± 24° postoperatively (p = 0.045). Five patients required revision arthrolysis within the follow-up period (20%). One patient demonstrated persisting instability (5%). CONCLUSION Intraoperative instability diagnostics during arthroscopic arthrolysis helps detect persisting posttraumatic instability and may provide a solid indication for a concurrent ligament stabilization procedure. This study is the first to present the postoperative results after arthrolysis with stabilization of the posttraumatic, stiff and unstable elbow. However, the results are heterogenic with 25% requiring revision arthrolysis. Therefore, the stiff but unstable elbow remains a complex clinical presentation in need of further investigations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stephanie Geyer
- Department for Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Jesse Seilern Und Aspang
- Department for Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Michael Geyer
- Department for Orthopedics, St. Vinzenz Klinik, Kirchenweg 15, 87459, Pfronten, Germany
| | - Christian Schoch
- Department for Orthopedics, St. Vinzenz Klinik, Kirchenweg 15, 87459, Pfronten, Germany
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Winkler PW, Rupp MC, Lutz PM, Geyer S, Forkel P, Imhoff AB, Feucht MJ. A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:3382-3391. [PMID: 32833073 PMCID: PMC8458183 DOI: 10.1007/s00167-020-06244-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the incidence and morphology of medial cortical hinge fractures in lateral open wedge distal femoral osteotomy (LOW-DFO) and to determine a safe zone for the position of the osteotomy hinge to minimize the risk of hinge fractures. METHODS Consecutive patients who underwent LOW-DFO for symptomatic valgus malalignment were screened for eligibility for this retrospective observational cohort study. Demographical and surgical data were collected. The incidence and morphology of medial cortical hinge fractures were evaluated on standard postoperative anterior-posterior knee radiographs. Comprehensive measurements evaluating the osteotomy gap and the position of the osteotomy hinge were taken. Additionally, each osteotomy hinge was assigned to a corresponding sector of a proposed five-sector grid of the distal medial femur. RESULTS A total of 100 patients (60% female) with a mean age of 31 ± 13 years were included. The overall incidence of medial cortical hinge fractures was 46% and three distinct fracture types were identified. The most frequently observed fracture type was extension of the osteotomy gap (76%), followed by a proximal (20%) and distal (4%) course of the fracture line in relation to the hinge. Group comparison (hinge fracture vs. no hinge fracture) showed statistically significant higher values for the height of the osteotomy gap (p = 0.001), the wedge angle (p = 0.036), and the vertical distance between the hinge and the proximal margin of the adductor tubercle (AT; p = 0.002) in the hinge fracture group. Furthermore, a significantly lower horizontal distance between the hinge and the medial cortical bone (p = 0.036) was observed in the hinge fracture group. A statistically significant higher incidence of medial cortical hinge fractures was observed when the position of the osteotomy hinge was proximal compared to distal to the proximal margin of the AT (53% vs. 27%; p = 0.023). CONCLUSION Medial cortical hinge fractures in LOW-DFO are a common finding with three distinct fracture types. To minimize the risk of medial cortical hinge fractures, it is recommended to aim for a position of the osteotomy hinge at the level of or distal to the proximal margin of the adductor tubercle. LEVEL OF EVIDENCE Prognostic study; Level III.
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Affiliation(s)
- Philipp W. Winkler
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco C. Rupp
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Patricia M. Lutz
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Lutz PM, Lenz J, Achtnich A, Geyer S. [Female doctors in orthopedics and trauma surgery in Germany: a current status quo]. Orthopade 2020; 50:713-721. [PMID: 33294942 PMCID: PMC8416886 DOI: 10.1007/s00132-020-04048-7] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Gender-specific differences in the workplace in general and in the field of orthopedics and trauma surgery in particular are still clearly identifiable, and are becoming more and more pronounced in the social consciousness. OBJECTIVE Analysis of the gender-specific development in the specialist field of orthopedics and trauma surgery in Germany over the past 15 years and a survey of the status quo. METHODS Assessment of the development of female graduates in the study of human medicine, the proportion of women in accredited and clinical care and the gender-specific acquisition of an additional orthopedic/trauma surgical title. Evaluation of gender-specific numbers of members or participants in the relevant professional associations and the largest German conferences on orthopedics and trauma surgery, as well as the habilitation figures in the field of orthopedics. RESULTS AND DISCUSSION The proportion of female doctors in various fields of orthopedics and trauma surgery in the clinic and in science is increasing. There is still a clear discrepancy in leading positions in clinics, in the acquisition of an additional title, and on the boards of professional associations. In some fields, such as pediatric and hand/foot/ankle surgery, the proportion of women is higher than in other sub-areas of orthopedics and trauma surgery.
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Affiliation(s)
- Patricia M Lutz
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Julia Lenz
- Zentrum für Orthopädie und Unfallchirurgie, Uniklinikum Marburg, Marburg, Deutschland
| | - Andrea Achtnich
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Stephanie Geyer
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
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Eisaman D, Geyer S, McFarland J, Fleming C, Suyama J. 60 The Value of an Integrated Sexual Assault Nurse Examiner Program at Trauma Centers: Comparing the Quality of Documentation. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Safieddine B, Sperlich S, Beller J, Lange K, Epping J, Tetzlaff J, Tetzlaff F, Geyer S. Socioeconomic inequalities in type 2 diabetes among different population subgroups. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic status (SES) groups being more affected. Considering specific population subgroups to examine prevalence and SES inequalities in T2D is rare. In addition, using only one indicator to depict SES inequalities in health has been a common practice despite evidence on differences in what different indicators measure. This study examines the prevalence of and SES (school education, occupation and income) inequalities in T2D in the three population subgroups: employed individuals, nonworking spouses and pensioners. This study also determines the SES indictor with the highest explanatory power.
Methods
This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in 1,345,841 employed individuals, 180,949 nonworking spouses and 773,427 pensioners. Multivariate logistic regression analysis was applied to examine SES inequalities in T2D in the three subgroups. Explanatory power of the three SES indicators was compared by deviance analysis.
Results
T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. Clear gradients in T2D inequalities emerged for all three SES indicators and were observed in the three population subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses.
Conclusions
Nonworking spouses are an important target group in T2D prevention interventions. The three SES indicators differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between education and T2D.
Key messages
The population subgroup “nonworking spouses” is an important target group for type 2 diabetes prevention interventions. The level of school education is a substantial determinant of socioeconomic inequalities in type 2 diabetes.
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Affiliation(s)
- B Safieddine
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - S Sperlich
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - J Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - K Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - J Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - J Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - F Tetzlaff
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - S Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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Geyer S, Imhoff AB, Siebenlist S. Komplikationsmanagement – Ellenbogenarthrolyse. Arthroskopie 2020. [DOI: 10.1007/s00142-020-00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schindler S, Schmidt L, Stroske M, Storch M, Anwander A, Trampel R, Strauß M, Hegerl U, Geyer S, Schönknecht P. Hypothalamus enlargement in mood disorders. Acta Psychiatr Scand 2019; 139:56-67. [PMID: 30229855 DOI: 10.1111/acps.12958] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Accepted: 08/15/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine, in vivo, whether the hypothalamus volume is reduced in patients with mood disorders. METHODS The cross-sectional study included 20 unmedicated (MDDu) and 20 medicated patients with major depressive disorder, 21 patients with bipolar disorder, and 23 controls. Twenty of the controls were matched to the MDDu. Seven Tesla, T1-weighted magnetic resonance images were acquired and processed using methods specifically developed for high-precision volumetry of the hypothalamus. RESULTS An overall group difference was observed for the left hypothalamus volume corrected for intracranial volume. Planned contrasts identified that the left hypothalamus was approximately 5% larger in each patient group compared with the control group. A paired t-test with the 20 matched pairs of MDDu and controls and without correction for covariates confirmed the larger left hypothalamus volume in MDDu. CONCLUSIONS Contrary to our expectations, the hypothalamus volume was increased in patients with uni- and bipolar affective disorders. The effect was left-sided and independent of medication status or statistical correction for covariates. Supported by emerging evidence that the stress response may be related to structural and functional asymmetry in the brain, our finding suggests a crucial role of the hypothalamus in mood disorders.
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Affiliation(s)
- S Schindler
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - L Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - M Stroske
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - M Storch
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - A Anwander
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - R Trampel
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M Strauß
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - U Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - S Geyer
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - P Schönknecht
- Out-patient Department for Sexual-therapeutic Prevention and Forensic Psychiatry, Leipzig, Germany.,Academic State Hospital Arnsdorf, Arnsdorf, Germany
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Tetzlaff J, Epping J, Sperlich S, Geyer S. Wachsende gesundheitliche Ungleichheiten in der Multimorbidität? Eine Analyse der Zeittrends in der erwerbstätigen Bevölkerung auf der Basis von Krankenversicherungsdaten. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
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Geyer S, Tetzlaff J, Sperlich S. Lässt sich der Gesundheitstrend in der älteren Bevölkerung von 1995 bis 2013 durch Veränderungen in der sportlichen Aktivität erklären? Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
| | | | - S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
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Stroske M, Schindler S, Storch M, Geyer S, Schönknecht P. P 40 Correlation between hypothalamus and third ventricle of patients with affective disorders. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.119] [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: 11/28/2022]
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Schindler S, Schmidt L, Stroske M, Storch M, Michaljow A, Hegerl U, Geyer S, Schönknecht P. REMOVED: PB 15 Hypothalamic enlargement in mood disorders – high-resolution in-vivo evidence. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Storch M, Schindler S, Stroske M, Geyer S, Schönknecht P. P 156 Correlation of regional brain volume and affective disorders 7T MRI based structural analysis of human hypothalami with anxiety symptoms. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spreckelsen O, Geyer S. Einflüsse des Vermögens und des sozioökonomischen Status auf die subjektive Gesundheit in Abhängigkeit vom Rentenstatus. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- O Spreckelsen
- Carl von Ossietzky Universität Oldenburg, Abteilung Allgemeinmedizin, Oldenburg
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
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Tetzlaff J, Epping J, Geyer S. Der Zusammenhang von Multimorbidität und Alltagsbeeinträchtigungen im Zeitverlauf – Hinweise auf ein dynamisches Gleichgewicht? Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - J Epping
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
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Sperlich S, Geyer S. Entwicklung subjektiver Gesundheit in Deutschland von 1995 – 2014 – Unterscheidet sich der Trend nach Geschlecht und Lebensphase? Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
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Epping J, Tetzlaff J, Geyer S. Haben besser verdienende Männer höhere Chancen auf eine Spenderniere? Geschlechter- und Einkommensunterschiede in der Nierentransplantation. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Epping
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - J Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
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Blum W, Sanford BL, Klisovic R, DeAngelo DJ, Uy G, Powell BL, Stock W, Baer MR, Kolitz JE, Wang ES, Hoke E, Mrózek K, Kohlschmidt J, Bloomfield CD, Geyer S, Marcucci G, Stone RM, Larson RA. Maintenance therapy with decitabine in younger adults with acute myeloid leukemia in first remission: a phase 2 Cancer and Leukemia Group B Study (CALGB 10503). Leukemia 2016; 31:34-39. [PMID: 27624549 PMCID: PMC5214595 DOI: 10.1038/leu.2016.252] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 04/08/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 12/12/2022]
Abstract
In this prospective phase 2 clinical trial conducted by Cancer and Leukemia Group B (CALGB, now the Alliance), we studied decitabine as maintenance therapy for younger adults with acute myeloid leukemia (AML) who remained in first complete remission (CR1) following intensive induction and consolidation. Given that decitabine is clinically active in AML and with hypomethylating activity distinct from cytotoxic chemotherapy, we hypothesized that one year of maintenance therapy would improve disease-free survival (DFS) for AML patients <60 years who did not receive allogeneic stem cell transplantation (alloHCT) in CR1. After blood count recovery from final consolidation, patients received decitabine at 20mg/m2 IV daily for 4–5 days, every 6 weeks for 8 cycles. One-hundred-thirty-four patients received decitabine, 85 (63%) had favorable risk AML. The median number of cycles received was 7 (range, 1–8), and the primary reason for discontinuation was relapse. DFS at 1-year and 3-years was 79% and 54%, respectively. These results are similar to the outcomes in the historical control comprised of similar patients treated on recent CALGB trials. Thus, maintenance with decitabine provided no benefit overall. Standard use of decitabine maintenance in younger AML patients in CR1 is not warranted. This trial was registered at www.clinicaltrials.gov as NCT00416598.
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Affiliation(s)
- W Blum
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - B L Sanford
- The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - R Klisovic
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - D J DeAngelo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - G Uy
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - B L Powell
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - W Stock
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M R Baer
- Department of Medicine and Greenebaum Cancer Center University of Maryland, Baltimore, MD, USA
| | - J E Kolitz
- Hofstra North Shore-Long Island Jewish School of Medicine, Manhasset, NY, USA
| | - E S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - E Hoke
- The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - K Mrózek
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - J Kohlschmidt
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - C D Bloomfield
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - S Geyer
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - G Marcucci
- Gehr Family Leukemia Center, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - R M Stone
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - R A Larson
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Sperlich S, Geyer S. Familiärer Stress – ein bedeutsamer Mediator des Zusammenhangs von Bildung und Gesundheit bei Frauen? Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jaunzeme J, Geyer S. Reduziert die Psychotherapie die Dauer der Krankschreibungen? Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Geyer S, Schoch C, Nelitz M, Geyer M. [Mid-Term Clinical Results after Open Rotator Cuff Reconstruction in Double-Row Technique with Titanium Anchor Screws]. Z Orthop Unfall 2015; 153:399-407. [PMID: 26274558 DOI: 10.1055/s-0035-1545966] [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: 10/23/2022]
Abstract
BACKGROUND The double-row rotator cuff repair is discussed controversially. Despite improved biomechanical properties, reduced re-tear rates and higher costs, no significant difference compared to single-row fixation in the clinical results is found. Mid-term results of an open double-row fixation with titanium anchor screws are presented. MATERIAL AND METHODS 237 patients (m = 142, f = 95, median age: 56.3 years) were operated in 2007 with this technique by the senior author (M. G.). Preoperatively, 2 years and 4,5 years postoperatively a subjective shoulder score (SSG) with follow-up rates of 86, 87 and 83 %, was evaluated. 5.1 years postoperatively an objective evaluation of 131 patients using the Constant-Murley scores (CS), the simple shoulder tests (SST), Gerber's shoulder value and the evaluation with school grades followed. The integrity of the cuff was checked with ultrasound. The absolute (re-tears and partial re-tears) and the relative (re-tears, partial re-tears, thinning and thickening of the cuff) re-tear rates were evaluated. RESULTS In SSG a highly significant improvement from 51 to 83 points was found (p < 0.001). In CS 80 points (min.: 18; max.: 100), and in SST 11 points (min.: 2; max.: 12) were achieved. The shoulder value of Gerber increased significantly from preoperative 28.1 to 84.5 % 5.1 years postoperative (p < 0.001).The absolute re-tear rate, evaluated in ultrasound was 7.6 %, the relative re-tear rate 17.6 %. For primary rotator cuff reconstructions a higher CS with 82 points and a lower relative re-tear rate with 10.5 % were found. The patient's age had no significant influence on the clinical outcome. The rupture size showed a significant impact on the re-tear rate and the scores (p < 0.05). Between the operated and healthy shoulder neither strength nor mobility were found to be significantly different. Men reached a highly significant better strength than women (p < 0.001) which also resulted in a significantly better outcome in the CS (p < 0.01). The costs for open titanium transfixation technique with 330 € per case are markedly less than for arthroscopic suture bridge technique with 600 to 1000 € per case. CONCLUSION Open double-row cuff repair with titanium screws is a safe and cost effective technique with a low re-tear rate with comparable clinical results regarding open and arthroscopic procedures.
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Affiliation(s)
- S Geyer
- Orthopädie, St. Vinzenz Klinik Pfronten
| | - C Schoch
- Chirurgie/Orthopädie, St. Vinzenz Klinik Pfronten
| | - M Nelitz
- Orthopädie/Unfallchirurgie, MVZ Oberstdorf
| | - M Geyer
- Chirurgie/Orthopädie, St. Vinzenz Klinik Pfronten
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Engelmann C, Grote G, Miemietz B, Vaske B, Geyer S. [Career perspectives of hospital health workers after maternity and paternity leave: survey and observational study in Germany]. Dtsch Med Wochenschr 2015; 140:e28-35. [PMID: 25686461 DOI: 10.1055/s-0041-100305] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVE A term of maternity and paternity (parental) leave becomes frequent on the career paths of medical personnel. Hospitals are highly competitive environments. The question employees universally face is how such a leave will alter their personal work situation and prospects upon return. DESIGN AND PARTICIPANTS We questioned 709 leave-takers and 88 department heads of a German university hospital (2009-12; full data sets: n = 406 and n = 63) about their experiences. This data was validated by epidemiology data extraction and expert interviews, also in a Swiss and in a Norwegian institution. RESULTS Parental leave elicited high emotionality (score: 4.0 +/- 2 out of 5). Superiors' appraisal of employees' parental leave was more positive than negative (p < 0.001, mean + 0.8 +/- 0.9 on a bipolar Likert scale (BLS) from - 2 to + 2). However, the annual labor turnover in leave takers doubled to 39 %; 51 % of leave-takers experienced significant task profile changes. 58 % of doctors thought about changing their employer and 17 % of leave-taking executives lost status after return. Employees' "power" and "influence" dropped significantly (p < 0.05; determined on BLS) whereas the "professional workload" increased (p < 0.001). Consequently, after return career perspectives (measured on a bipolar visual analogue scale from - 5 to + 5) were perceived significantly more negative than positive (p < 0.0001, mean: - 1.3 +/- 2), especially by high-commitment staff (i. e. female executives, mean: - 2.1 +/- 2, pΔ < 0.05 vs. others). These perceptions significantly influenced future choices concerning further terms of leave. The Swiss and Norwegian comparators appeared to have more liberal substitution and part-time schemes than the German institution. DISCUSSION A competitive hospital environment can effectively demote leave-taking medical employees in their jobs. Despite sufficient financial arrangements high-commitment staff will only take parental leave of adequate length when an institutional framework protects their status. Data support four requirements: 1. Formal recognition of the leave taker's status pre-leave. 2. Establishment of a written ("claimable") return policy. 3. Substitution scheme for each individual, preferably by a locum. 4. Redirection of funds to facilitate part-time work schemes temporarily after return.
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Affiliation(s)
- C Engelmann
- Kinderchirurgie, Klinikum Brandenburg, vorm. Medizinische Hochschule Hannover, Deutschland
| | - G Grote
- Institut für Management, Technologie und Ökonomie, ETH Zürich, Schweiz
| | - B Miemietz
- Gleichstellungsbeauftragte, Medizinische Hochschule Hannover, Deutschland
| | - B Vaske
- Institut für Biometrie und Statistik, Medizinische Hochschule Hannover, Deutschland
| | - S Geyer
- Medizinische Soziologie, Medizinische Hochschule Hannover, Deutschland
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Swart E, Gothe H, Geyer S, Jaunzeme J, Maier B, Grobe T, Ihle P. Gute Praxis Sekundärdatenanalyse (GPS): Leitlinien und Empfehlungen. Gesundheitswesen 2015; 77:120-6. [DOI: 10.1055/s-0034-1396815] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E. Swart
- Institut für Sozialmedizin und Gesundheitsökonomie, Med. Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - H. Gothe
- UMIT – Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik GmbH, Department of Public Health & Health Technology Assessment, Hall i.T., Austria; Medizinische Fakultät „Carl Gustav Carus“ der Technischen Universität Dresden, Lehrstuhl für Gesundheitswissenschaften, Dresden
| | - S. Geyer
- Forschungs- und Lehreinheit Medizinische Soziologie, Medizinische Hochschule Hannover, Hannover
| | - J. Jaunzeme
- Forschungs- und Lehreinheit Medizinische Soziologie, Medizinische Hochschule Hannover, Hannover
| | - B. Maier
- Berliner Herzinfarktregister e.V. am Fachgebiet Management im Gesundheitswesen, TU Berlin, Berlin
| | - T. Grobe
- Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, AQUA-Institut, Göttingen
| | - P. Ihle
- PMV forschungsgruppe, Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln, Köln
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