Background:Thigh muscle atrophy is a consistently reported complication following anterior cruciate ligament (ACL) reconstruction. Poor postoperative muscle status is associated with inferior functional outcomes and an increased risk of re-injury. Methods:This narrative review is based on a systematic literature search in PubMed and Cochrane investigating pre-, intra-/perioperative, and postoperative interventions, as well as adjunctive measures (nutrition, supplementation) aimed at reducing muscle atrophy following ACL reconstruction. Results:Several factors and interventions can reduce post-reconstruction muscle atrophy. Preoperatively, the timing of surgery (21-100 days after injury) and structured prehabilitation are essential. Intraoperatively, tourniquet use increases early postoperative atrophy without affecting long-term outcomes; femoral nerve block should be avoided. Graft choice has a substantial impact on the risk of muscle atrophy (quadriceps tendon > patellar tendon > hamstring tendon). Postoperatively, progressive eccentric resistance training and early neuromuscular electrical stimulation (NMES) are most effective interventions, while blood flow restriction training (BFRT) is a promising adjunctive strategy. Nutritional optimization (≥ 1.6-1.9 g protein/kg/day) and perioperative supplementation with essential amino acids (EAAs) and β-hydroxy-β-methylbutyrate (HMB) have demonstrated beneficial effects, particularly in high-risk patients. Conclusion:Muscle atrophy following ACL reconstruction is unavoidable but can be substantially reduced through a multimodal perioperative approach. In particular, high-risk patients are likely to benefit from the consistent combination of all available preventive strategies.

We describe the case of a 52-year-old patient with recurrent patellar dislocations who was treated with tibial tuberosity transfer and simultaneous reconstruction of the medial patellofemoral ligament (MPFL). A complete lower leg fracture occurred 4 months postoperatively during a single leg hop test to check the functionality on landing. The subsequent treatment was performed using lateral plate osteosynthesis.

Wir beschreiben den Fall eines 52-jährigen Patienten mit rezidivierenden Patellaluxationen, welcher mit Tuberositas-tibiae-Transfer und zeitgleicher MPFL-Plastik behandelt wurde. Vier Monate postoperativ kam es während eines One-leg-hop-Tests zur Überprüfung der Funktionsfähigkeit bei der Landung zu einer kompletten Unterschenkelfraktur. Die anschließende Versorgung erfolgte mittels lateraler Plattenosteosynthese.

Despite the rapid growth of kitesurfing, there is a lack of comprehensive scientific research on injuries associated with the sport. To investigate the incidence and patterns of kitesurfing injuries, as well as their impact on time loss and performance reduction across the different subdisciplines and skill levels. An online survey among kitesurfers assessed major injuries causing more than three weeks of time loss in kitesurfing, medical treatment, or work absence. Injury frequencies were analysed with reference to discipline, sex, and performance level. Severity was determined by time loss and performance reduction. 3138 athletes reporting 3720 injuries were included into the study. The overall injury rate was 4.8 injuries per 1000 h kitesurfing, ranging from 65/1000 h for beginners to 1.1/1000 h for professionals. Besides cuts and abrasion (23

Anterior cruciate ligament (ACL) rupture is the most serious injury in judo. However, little is known about the outcome of treatment and its impact on subsequent athletic development. This study aimed to evaluate (1) ACL re-injury rates, injury-related time loss, and (2) regained level of performance in judoka after conservatively and surgically treated ACL ruptures.Five hundred judoka who had suffered an ACL rupture were included in the study via an online survey. Re-injury rates, persistent symptoms, time loss, and reduction in athletic performance were assessed according to performance level and treatment approach (surgical vs. conservative).Eighty-six percent of athletes underwent surgery. The overall re-injury rate was 27.6%. In the highest performance level group, 41.4% sustained a re-injury. No significant difference was observed with regard to persistent pain, swelling, and episodes of instability (surgical vs. conservative: pain 40.1% vs. 35.2%, p=0.436; swelling 21.7% vs. 12.7%, p=0.081; instability 14.0% vs. 15.5% p=0.736) Among conservatively treated patients, 70.4% returned to sport after 6 months, whereas among surgically treatment patients, 35.9% returned within 6-9 months and 33.6% after more than 9 months . There was no significant difference in post-injury performance level between treatment groups (same performance level: surgical 32% vs. conservative 35%).Judo athletes show high re-injury rates after ACL ruptures, especially in high performance classes. The proportion of persistent symptoms after surgical therapy is high and differs only slightly from those treated conservatively. In rare cases, pre-injury performance levels may be regained even after conservative therapy.

Purpose:The MPP (medial patella plica) has garnered increasing clinical attention due to its potential role in patellofemoral pain syndromes. While often an anatomical relic without pathological significance, inflammation or mechanical irritation of this structure can lead to plica syndrome, causing significant clinical symptoms. The purpose of this study was to analyze the current care situation regarding plica syndrome of the knee among a large number of experienced knee surgeons. Methods:An online survey targeting the current care practices for plica syndrome was conducted among members of the German Knee Society (DKG). The survey was comprised 15 questions regarding diagnostic and treatment approaches. Data were collected anonymously and analyzed using IBM SPSS Statistics Version 26.0. Results:A total of 238 surgeons participated. Most respondents (84 %) agreed that plica syndrome could cause patellofemoral pain. The typical patient profile was predominantly female (77.7 %), aged 21-30 years (57.6 %). The majority of surgeons use magnetic resonance imaging (MRI) combined with clinical examination (58.0 %) to diagnose an MPP, and 54.2 % of surgeons resected the plica upon finding significant intraoperative evidence of impact on the patellofemoral joint. Hemarthrosis and persistent pain were the most reported complications, though 83.2 % of surgeons observed a complication rate below 11 %. Conclusion:This study provides a comprehensive overview of current practices and opinions regarding plica syndrome among experienced German knee surgeons. It emphasizes the need for further research to standardize diagnostic and therapeutic approaches, aiming to optimize patient outcomes in plica-related knee pathologies.

Introduction: Postoperative neuralgias are common complications following orthopedic surgeries, particularly after knee ligament surgeries. This case report presents the treatment of postoperative saphenous nerve neuralgia with Onabotulinumtoxin A in a 45-year-old patient after a complex knee joint surgery. Case Description: The patient suffered a complex injury to the right knee joint, including a tear of the anterior cruciate ligament and the medial collateral ligament, as well as avulsion of the anteromedial joint capsule. In the postoperative course after cruciate ligament replacement with quadriceps tendon and open medial ligament reconstruction with gracilis tendon, the patient developed severe neuropathic pain (allodynia, burning sensations) at the medial ligament scar. Initially, treatment involved local anesthetics, pregabalin, and tramadol. With no therapeutic success, a subcutaneous injection of 30 units of Onabotulinumtoxin A (Xeomin) was administered three weeks postoperatively, resulting in rapid improvement of symptoms and near-complete resolution, particularly of the allodynia. After about six months, there was a resurgence of pain, especially the allodynia. A repeat injection treatment with 30 units of Onabotulinumtoxin A again led to significant improvement in symptoms as described above. Conclusion: The application of Onabotulinumtoxin Type A may serve as an effective therapeutic option for treating postoperative neuropathic pain, especially in cases that do not respond to conventional pharmacological and physical therapies. Further research is needed to verify the reproducibility of treatment success and to determine optimal dosages and potential injection intervals.

Beim „Minced-cartilage-Verfahren“ handelt es sich um eine Methode zur Therapie fokaler Knorpelschäden, bei der Knorpel aus dem Defektbereich oder von anderen Stellen aus dem Gelenk fragmentiert, orthobiologisch aufbereitet und dann einzeitig zur Defektdeckung appliziert wird. Eine spezielle Anwendung dieser Methode ist das Autocart™-Verfahren (Arthrex, Naples, FL, USA), das im Rahmen dieses Artikels vorgestellt werden soll. Die Operation erfolgt in Rückenlage in einem standardisierten aseptischen Setting. Zuerst erfolgt eine arthroskopische Kontrolle der Gelenkstrukturen mit der Defektdokumentation und Defektpräparation (Bilder, Messungen). Bei Bestätigung der Indikation (mittelgradiger fokaler Knorpelschaden ICRS III–IV) erfolgen dann die Defektpräparation (Randstabilisierung und Débridement) sowie eine arthroskopische Knorpelbiopsie mit einem motorgetriebenen Shaver. Dabei werden die Knorpelfragmente in einem speziellen Behälter, dem GraftNet™ (Arthrex), aufgefangen. Parallel oder vorher erfolgt die Abnahme von ca. 30–45 ml autologem Patientenblut zur Herstellung von plättchenreichem Plasma (ACP™, Arthrex) in einer speziellen Zentrifuge. Anschließend wird der zerkleinerte Knorpel in einer Schüssel mit 2–3 Tropfen ACP vermischt, bis eine formbare Substanz (Paste aus Knorpelchips) entsteht. Mithilfe des restlichen ACP erfolgt die Aufbereitung von autologem Thrombin in einem speziellen Gerät (ThrombinatorTM, Arthrex). Im nächsten Schritt wird Thrombin, das zuvor dem ThrombinatorTM entnommen wurde, tropfenweise auf die Paste aus Knorpelchips aufgetragen. Die gesamte Masse wird entweder arthroskopisch oder offen mit einem Applikator im Defekt verteilt, sodass eine Defektfüllung von etwa 80

Das Ziel der fluoroskopisch kontrollierten Bohrkanalanlage beim VKB-Reersatz ist die Vermeidung einer fehlerhaften Anlage des tibialen und femoralen Bohrkanales und der folgenden Reduktion des Rerupturrisikos. Reruptur bzw. Transplantatinsuffizienz nach erfolgtem VKB-Ersatz als einzeitiger Eingriff oder zweizeitig nach vorheriger Bohrkanalauffüllung. Relativ: geringe klinische Instabilität, Kontraindikationen gegen die Anwendung ionisierender Strahlung, fortgeschrittene Arthrose. Absolut: allgemeine Kontraindikationen gegen eine OP. Lagerung in Rückenlage mit anliegender Blutsperre und Seitenstütze. Anlage der Portale analog zur VKB-OP. Positionierung der Bohrdrähte mittels Zielgerät, femoralseitig Ausbohren des Zieldrahtes an die Lateralseite des Femurs, bis das Bohrdrahtende bündig am femoralen Bohrkanaleingang positioniert ist. Zunächst femoral, folgend tibial. Mittels C‑Bogen fluoroskopische Kontrolle der Bohrdrahtposition. Quantitative Analyse der Bohrdrahtposition mittels ACL X‑App, ggf. Korrektur. Bei adäquater Lage in der Quadrantenmethode nach Bernard und Hertel (femoral) bzw. nach Stäubli (tibial) Überbohren bis zur Zielgröße des Bohrkanals. Nachfolgend Einzug und Fixation des Transplantats. Gegebenenfalls ergänzende Eingriffe, z. B. periphere Stabilisation. Hartrahmenorthese für 6 Wochen, davon 2 bis 3 Wochen mit Flexionslimit 90° und Teilbelastung (20 kg) an UAG. 51 durchgeführte Revisionen mit postoperativer Seitendifferenz von 1 mm im Median nach 6 Monaten.

Postoperative Neuralgien sind häufige Komplikationen nach orthopädischen Operationen, insbesondere nach Eingriffen am Kniegelenk. Dieser Fallbericht stellt die Behandlung eines 45-jährigen Patienten mit Onabotulinumtoxin A nach einer komplexen Kniegelenksoperation und postoperativer Nervus Saphenus-Neuralgie dar. Der Patient erlitt eine komplexe Verletzung des rechten Kniegelenkes, einschließlich Riss des vorderen Kreuzbandes und des Innenbandes sowie Avulsion der anteromedialen Gelenkkapsel. Im postoperativen Verlauf nach Kreuzbandersatz mit Quadrizepssehne und offenem Innenbandersatz mit Gracilissehne, entwickelte der Patient starke neuropathische Schmerzen (Allodynie, brennende Missempfindungen) an der Innenbandnarbe. Zunächst wurde mit Lokalanästhetika, Pregabalin und Tramadol behandelt. Bei ausbleibendem Therapieerfolg wurde 3 Wochen postoperativ eine subkutane Injektion mit 30 Einheiten Onabotulinumtoxin A (Xeomin) durchgeführt, was zu einer raschen Verbesserung der Symptome und nahezu vollständigem Rückgang insbesondere der Allodynie führte. Nach ca. 6 Monaten kam es wieder zu einer Schmerzverstärkung insbesondere der Allodynie. Eine erneute Injektionsbehandlung mit 30 Einheiten Onabotulinumtoxin A führte erneut zu oben beschriebener deutlicher Beschwerdebesserung. Die Anwendung von Onabotulinumtoxin Typ A könnte eine effektive Therapieoption zur Behandlung postoperativer neuropathischer Schmerzen sein, insbesondere in Fällen, die auf herkömmliche medikamentöse und physiotherapeutische Behandlungen nicht ansprechen. Weitere Forschung ist nötig, um die Reproduzierbarkeit des Therapieerfolges zu überprüfen und optimale Dosierungen und ggf. auch Injektionsintervalle zu bestimmen.

OBJECTIVE:The goal of the fluoroscopically controlled tunnel positioning in anterior cruciate ligament (ACL) revision surgery is the prevention of malpositioning of femoral and tibial tunnel resulting in a reduced risk of rerupture of the ACL graft. INDICATIONS:Remaining instability of the ACL after performed surgery, either after tunnel filling or as a single-stage surgery. CONTRAINDICATIONS:Relative: minor instability, contraindications against performing intraoperative x‑rays, advanced osteoarthrosis. Absolute: general contraindications against surgery. SURGICAL TECHNIQUE:Supine position with tourniquet in place and lateral thigh support. Creation of the portals analogous to ACL surgery. Positioning of the drill wires using a targeting device, first femoral, then tibial. Now use of the C‑arm to fluoroscopically check the wire position using the ACL X‑app; correct it if necessary. If the position is adequate, use the quadrant method according to Bernard and Hertel (femoral) or according to Stäubli (tibial) to drill over to the target size of the drill channel. Subsequently, the transplant is drawn in and fixed. If necessary, add additional peripheral stabilization. POSTOPERATIVE MANAGEMENT:Knee brace for 6 weeks postoperatively, limited flexion at 90° for 2-3 weeks, partial weight bearing (20 kg) for 2-3 weeks. RESULTS:In the 51 performed ACL revisions performed, there was a postoperative difference of 1 mm in Rolimeter measurement after 6 months.

Wir beschreiben den Fall eines männlichen Zwillingspaares, das gemeinsam aufgrund medialer Knieschmerzen in unserer Sprechstunde vorstellig wurde. In der MRT zeigte sich bilateral bzw. bei nur einfach vorliegender MRT unilateral ein nahezu vollständiger medialer Scheibenmeniskus mit Einwachsen des Vorderhorns in das vordere Kreuzband.

Die Implantation eines funktionellen Meniskusersatzes kann bei medialseitigen Kniegelenksschmerzen infolge Verlustes bzw. Teilverlustes des medialen Meniskus und begrenzter Schädigung des Gelenkknorpels bei gerader Beinachse beim mittelalten Patienten (40–60 Jahre) indiziert sein. Nach externer radiologischer Bestätigung der Indikation und Größenmatching anhand von MRT-Bildern und nach Absolvierung eines Trainingskurses des Operateurs kann die Implantation eines speziellen Meniskusersatzes erfolgen. Die Operation beinhaltet die arthroskopische Entfernung der Meniskusreste medial sowie die Präparation des Interkondylärspaltes mit einer Knochenraspel. Nach Erweiterung zur medialen Arthrotomie kann das selbstzentrierende Implantat unter Valgusstress und Überführen des Gelenks von der Flexion in die Extension in das Gelenk eingebracht werden. Eine Fixation an der Gelenkkapsel erfolgt nicht. Die Nachbehandlung ist funktionell unter Teilbelastung von 1 bis 3 Wochen. In zwei Multicenterstudien fanden sich wechselhafte Ergebnisse zum Outcome bei ca. 20

The accurate positioning of the femoral tunnel is crucial for the success of anterior cruciate ligament reconstruction. Malpositioning of the tunnel is believed to be one of the most important reasons for graft failure. While use of anatomic landmarks and industry-supplied aiming devices aid the surgeon in placing the drill pin in the correct position, fluoroscopic imaging is an additional tool used intraoperatively to verify pin placement. While interpretation of fluoroscopic imaging is frequently based on eyeball measurement, a more accurate analysis of a lateral image uses the quadrant method by Bernard-Hertel. This method has been primarily used for scientific research due to its complexity and has not been integrated into clinical routine yet. We present a digital app-based approach to easily quantify the femoral pin position based on the quadrant method. This approach is mobile and easy to use. Quantification of pin position of femoral bone tunnel on a lateral fluoroscopic image may be used for quality control and teaching purposes or may provide the surgeon with additional information during ACL reconstruction.

BACKGROUND: Recent scientific work shows that the most common injuries in CrossFit (c) occur in the shoulder joint. This paper aims to provide a review of shoulder pathologies in a young CrossFit (c) cohort via MRI and clinical examination. METHODS: A survey was conducted in 13 CrossFit `boxes" in Germany, in which athletes with recurrent shoulder pain could report for a clinical examination and MRI diagnostic. Fifty-one CrossFit athletes with chronic shoulder pain agreed to participate in the study and were then examined physically and by MRI. RESULTS: Fifty-one active CrossFit athletes aged 21-45 years (mean 33.7 years, 35 male and 16 female) were recruited. The most frequently detected pathologies were partial lesions of the supraspinatus tendon (N.=25; 49%) and labral lesions (N.=11; 21.6%). The findings also identified partial lesions of the subscapularis tendon (N.=9; 1 7.6%), pulley lesions (N.=9; 1 7.6%), and partial lesions of the infraspinatus muscle (N.=2; 3.9%). CONCLUSIONS: These data demonstrate the need for a specific focus on particular shoulder injuries in CrossFit. Knowledge about the type of shoulder pathologies caused by CrossFit training allows for training -specific adaptations with regard to prevention, as well as a more targeted, sport -specific therapy. This study is the first in the literature to present on structural changes in the shoulders of active CrossFit athletes.

Knee arthroscopy may be offered as a treatment for mechanical (catching/locking, grinding/clicking) and meniscal (pain with twisting/pivoting) symptoms. Recent studies have found that mechanical symptoms, particularly catching/locking, may be multifactorial in their causes (chondral lesions, meniscal tears, loose bodies) and less responsive to arthroscopic meniscectomy. Surgeons should be aware of this evidence and adjust their surgical indications appropriately.