BACKGROUND: A 26-year-old patient presented to a specialised knee clinic in a public hospital with ongoing pain after having sustained a soccer injury six years prior. A large osteochondral defect of the distal medial femoral condyle was diagnosed. Due to resource limitations, fresh allograft or a large osteochondral autograft transplantation system (Mega-OATS) workbench was unavailable. CASE REPORT: A Mega-OATS cartilage transplantation was done, using the patient's posteromedial femoral condyle as donor tissue, and transplanted to the defect in the distal femoral condyle, a technique that has been well documented and followed up. At six weeks postoperatively, an MRI showed early incorporation of the graft tissue. Clinical outcomes were excellent at one year follow-up with the EQ-5D 5L score 11111, the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) 100%, and the Lysholm score also 100%. Radiographs at one year confirmed an unchanged graft position and showed no signs of osteoarthritis. DISCUSSION: Large osteochondral lesions in the knee (> 4 cm2) are challenging to treat, and the most commonly used modalities are fresh osteochondral allograft (OCA) or autologous chondrocyte implantation (ACI). Mega-OATS of the knee has previously been described but is not commonly used due to the requirement of a specialised and expensive workbench, and fear of morbidity at the donor site. CONCLUSION: Mega-OATS of the knee is possible without a specialised workbench or tools and had good clinical outcomes at two-year follow-up of the patient. Level of evidence: Level 5

Wiederherstellung der Valgus- und A-P-Stabilität bei Verletzungen des medialen Kollateralbandes (MCL) und der posteromedialen Gelenkecke.

Zystische ossäre Läsionen entstehen durch verschiedene Pathomechanismen. Sie bleiben in der Regel klinisch asymptomatisch und können in den meisten Fällen anhand ihrer Lokalisation und typischer radiologischer Merkmale unterschieden werden. Im vorgestellten Fall eines 47-jährigen männlichen Patienten wurde eine subchondral gelegene Zyste der lateralen Femurkondyle, die im postoperativen Verlauf nach durchgeführter VKB-Ersatzplastik auftrat, als intraossäres Ganglion identifiziert. Aufgrund der Größenzunahme der Knochenzyste musste das Einbrechen des darüberliegenden Gelenkknorpels befürchtet werden. Durch die Kombination von autologer Spongiosaplastik mit der Transplantation eines osteochondralen Zylinders konnten eine vollständige knöcherne Auffüllung des intraossären Ganglions und eine niveaugerechte Stabilisierung des Gelenkknorpels erreicht werden.

BACKGROUND A questionnaire for patient self-assessment of shoulder function was designed. It was based on the internationally accepted Rowe score. METHOD Explanations and photographs were added to the various parameters to make them easier to understand for the patients. A total of 95 patients completed the assessment form. The validity was tested by a correlation analysis comparing the questionnaire with the original score. RESULTS The questionnaire demonstrated a reproducible and significant (p<0.001), very high correlation (r>0.9) in the overall results and a moderate to very high correlation within single parameters (r>0.68). CONCLUSION Based on these results, it can be concluded that a valid and reproducible assessment of the original score is possible with the new questionnaire. Self-evaluation allows reliable assessment which is not dependent on the examiners or location, resulting in a higher number of patients reachable for follow-up studies.

Auf der Basis des international etablierten Rowe-Scores zur Erhebung der Schulterfunktion wurde ein Fragebogen zur Patientenselbsterfassung entwickelt.

Injuries seen in football players mainly affect the knee and ankle joints and muscles. The causes include chronic overstrain and traumatization usually resulting from physical contact between opponent players. Torsional trauma of the joints results in excessive stressing of the capsular ligaments, potentially leading to rupture of the structures involved. Therapeutic options range from conservative measures to reconstructive or prosthetic surgery. While muscular injuries have a good prognosis with regard to the chances of continuing sports activities, injuries to ligaments often enforce a lengthy pause from sports. Extensive injuries to cartilages can terminate a player's sporting career. However, new procedures that take account of physiological biomechanics, together with the further development of surgical technologies now often allow players to regain their pre-injury level of fitness. Specific rehabilitation is a major therapeutic means of preventing further injury.

Introduction Traumatic shoulder dislocations at a young age result in a significant re-dislocation rates and lead to chronic instability. Conservative treatment fails in 25% to 96% of cases especially in young active patients. The accepted standard treatment is the classical open Bankart repair. Re-dislocation rate could be decreased to 3.5% to 14.9% but almost always results in loss of motion. The development of new techniques and devices has lead to an increase in arthroscopic techniques for shoulder stabilisations. Methods Between September 1996 and October 2000, 262 arthroscopic shoulder stabilisations were performed by one surgeon (ABI). For the refixation of the injured labrum suture anchors were used. In 159 cases FASTak (Arthrex) titanium anchors, in 26 cases Panalok (Mitek) and in 57 cases Suretac (Smith and Nephew) were used. The minimum follow-up was 12 months with a mean follow-up of 24.9 months (12 to 50). Exclusion criteria were SLAP and HAGL lesions, glenoid fractures, the inverted pear sign and hooked or posterior dislocations. Rowe score and a visual analogue scale were used to measure patient satisfaction. Results The Rowe score increased to 83.1 +/− 20.9. The visual analogoue score demonstrated overall patient satisfaction. The redislocation rate was five percent, three percent having a history of adequate trauma. Complaints of subluxations and ongoing instability occured in six percent. Eighty-nine percent of the patients could return to sports with 68% being able to return to their previous sports level. Conclusions This study demonstrates that arthroscopic shoulder stabilisation is comparable to the golden standard of open Bankart repair.

Fragestellung: Können die biochemischen, histologischen und biomechanischen Eigenschaften des Kollagenmeniskus durch Besiedelung mit autologen Fibrochondrozyten verbessert werden?