In 41 patients, an ultrasound guided needle biopsy for histological diagnosis of benign and malignant soft tissue and bone tumors was carried out.In 32 cases following ultrasound guided needle biopsy of the soft tissue component of tumor a final diagnosis could be histopathologically determined; in 5 additional cases, due to the small amount of biopsy, a tumor grouping was able to be ascertained, a further tumor differentiation however could not be made. In 4 cases with cystoid tumors it was not possible to make a diagnosis.The deciding advantage of the new method of ultrasound guided needle biopsy presented here, in comparison to the so called blind tumor biopsy, is that by way of a picture control on the ultrasound screen exact positioning of the biopsy needle is possible. The ultrasound monitor enables one to observe the biopsy procedure, various biopsies from different sites of the soft tissue components of the tumor are possible through one biopsy canal.The new method of the ultrasound guided needle biopsy of benign and malignant soft tissue and bone tumors should however only be carried out in tumor centers.

AIM The present prospective clinical study investigates the value of ultrasonic examination of injuries of the medial collateral ligament of the knee. METHOD The sonographical examination was done in a real-time method with an ultrasound unit Type AI 3200 (Dornier, Neufahrn, Germany) and with a linear transducer (frequency 7.5 Mhz). This functional measurement is being performed in neutral position and in valgus stress on both knee joints to verify the opening of the medial joint space. 42 patients who have been suspicious for a lesion of the medial collateral ligament of the knee were compared with 80 healthy persons. RESULTS The average medial opening of the medial joint space in the patient group using manual dynamic ultrasonic examination was 4.4 mm +/- 1.1 mm (2.5-8.0) applying the force manual and 4.0 mm 1.0 mm (1.3 mm-8.0) using the Telos fixation device to apply the stress force. The control group showed an average medial opening of 2.2 mm +/- 0.5 (0-0.5) as stress was applied manual and 2.5 mm +/- 0.7 mm (0-0.4) with the apparative stress examination using the Telos fixation device. CONCLUSION The ultrasonic verification of the stability of the medial collateral ligament complex in the medial longitudinal view using defined bony landmarks is a very reliable method as a diagnostic tool for acute or older lesions of the medial collateral ligament of the knee. CLINICAL RELEVANCE The advantages of the ultrasonic examination are the immediate availability, the avoidance of radiation and the visualization of movements with dynamic examinations. In contrast to X-ray examination the ultrasonic investigation can provide useful additional information on soft tissue structures.

Treatment of spondylolysis and minor form of spondylolisthesis in childhood is usually conservative and includes physical therapy, a temporary reduction in sport activities or the use of an orthesis. Persisting pain despite conservative therapy, neurological symptoms and progressive sliding on x-ray may indicate surgical treatment. We report about the results in 25 patients operated by direct repair of the isthmus between 1982 and 1990 in the Orthopaedic Hospital in Mannheim. In 75% of the cases the special hook-screw by Morscher was used. The other patients were operated according to the original method described by Buck or by the Scott procedure with wire fixation. The clinical and radiological results were available in all patients by a mean follow-up of 8.9 years (4-12 years). All juvenile patients had good or very good clinical results. Within the adult group half of the patients had fair or worse clinical results. Only in 3 out of 14 cases we found bony consolidation of both arches. In 6 cases the x-ray showed pseudoarthrosis on both sides. In 3 of these patients spondylodesis had to be performed. Because of the bad results of direct repair in adult patients, we looked for further criteria, which are necessary to achieve good clinical and radiological results. In addition of the age, the condition of the disc is important. In adolescent patients (more than 16 years old) we documented a degeneration of the disc by NMR or by intraoperative discography.

The aim of the study was to assess the consistency of the non–image-based navigation system OrthoPilot®, Aesculap, Tuttlingen, Germany, in total knee arthroplasty (TKA) implantation in 5 European centers. Two hundred thirty-five TKAs implanted with this navigation system were matched (according to severity of the preoperative coronal deformation and body mass index) to a historical control group of 235 TKAs implanted with a conventional technique. Consistency of implantation was studied on a 3-month postoperative radiological control with coronal long-leg and sagittal standard x-rays. The use of the OrthoPilot® navigation system allowed a statistically significant improvement in the consistent placement of both tibial and femoral components. In accordance with current literature, survival of the navigated implanted prostheses is expected to be longer.

IntroductionAccuracy of lower limb axial correction is a definite prognostic factor for long term survival of total knee prostheses. Manual instruments do not always allow an optimal prosthetic implantation. Computer guided technique could improve the quality of implantation of a total knee prosthesis. The objective of this study was to assess the effectiveness of a non image based navigation system for total knee prosthesis implantation.Material and methodsThe authors conducted a prospective, comparative study in five European centers. 555 patients were operated on with the same implant (Search© prosthesis, Aesculap, Tuttlingen, FRG) and a non image based navigation system (OrthoPilot©, Aesculap, Tuttlingen, FRG - group 1) and were compared with a historical control of 266 cases operated with the same prosthesis and a conventional, manual instrumentation (group 2). The radiographic results were analysed by an independent observer on hip-knee-ankle X-rays at the 3rd post-operative month.ResultsCoronal mechanical femoro-tibial axis was within the desired range (3° of coronal deformation) in 89% (group 1) and 72% (group 2) of the cases (p < 0.001). Coronal orientation of the femoral component was within the desired range in 89% (group 1) and 77% (group 2) of the cases. Sagittal orientation of the femoral component was within the desired range in 76% (group 1) and 71% (group 2) of the cases. Coronal orientation of the tibial component was within the desired range in 92% (group 1) et 84% (group 2) of the cases. Sagittal orientation of the tibial component was within the desired range in 81% (group 1) and 70% (group 2) of the cases. 275 patients in group 1 (50%) and 82 patients in group 2 (31%) had an optimal implantation for all the studied items (p < 0.001). No significant difference between the different centers was observed.ConclusionThe navigation system allowed a more consistent implantation of the total knee prosthesis within the desired angular range in comparison with the conventional, manual instrumentation. The rate of unacceptable implantations was dramatically decreased. Learning curve was short in all centers. As no significant difference was observed between all centers, this technique should be easily usable on large basis. IntroductionAccuracy of lower limb axial correction is a definite prognostic factor for long term survival of total knee prostheses. Manual instruments do not always allow an optimal prosthetic implantation. Computer guided technique could improve the quality of implantation of a total knee prosthesis. The objective of this study was to assess the effectiveness of a non image based navigation system for total knee prosthesis implantation.

Ultrasound is a noninvasive, immediately available procedure without radiation, which should be performed after exploration and clinical examination. It cannot, however, replace radiographic examination because the cortical substance represents a barrier for the ultrasound waves so that bony lesions (i.e., intraosseous tumors or osteomyelitis) cannot be detected. In the diagnosis of periarticular soft tissue lesions and intra-articular changes, i.e., loose bodies, intra-articular effusion, or synovitis, ultrasound represents an excellent cost-effective method supplying additional information and should be performed before using more costly techniques (magnetic resonance imaging). Ultrasound of the femoral patellar groove is limited because of the higher location of the patella. The area of the dorsal patella is not approachable for ultrasound. The sonographic technique is presented with standard sectional planes according to the directives given by the working group on the musculoskeletal system of the German Society for Ultrasound in Medicine (DEGUM) issued on 20 January 1996.

A diagnostic method is presented for measuring the leg length and the difference in leg lengths with ultrasound. A special device for holding and moving the ultrasound transducer was constructed. The measuring points on the hip, knee, and upper ankle can be visualized with a 5- or 7.5-MHz linear scanner. The measuring device gives the distance of the points in centimeters so that the difference corresponds to the real length of the leg, femur, and tibia. Tests conducted on corpses and clinical examples show that ultrasound in combination with our special device is an ideal method for determining the exact length of the leg. Ultrasound measurement of the leg length offers a reliable, noninvasive, and easily performed method. Because ultrasound is not limited by radiation hazards, our technique can be used for clinical screening.

Sonographic examination can yield additional information free of radiation in the course of corticotomy/callus distraction. The echogenic structures of the cortical structure and the callus between can be scanned at the area of the callus distraction by ultrasound examination. Individual sectional planes are focussed. They are different from the standardized ultrasound examination. Depending on when the corticotomy was performed, the callus between the cortical structures can be visualized sonographically. First it is echo poor, and then it becomes more and more echogenic. The ultrasound examination can give additional information during the first 4 weeks after corticotomy/callus distraction. A deviation of the axis in the area of callus distraction cannot be judged reliably. A sonographically guided division into three stages is possible.

Comparable to the standardized ultrasound screening of newborns and infants according to Graf's method, the standardized ultrasound examination of the locomotor apparatus has become an important feature in the evaluation of many acute and chronic diseases. The standardized ultrasound examination technique according to the guidelines of DEGUM and DGOOC helps the experienced and inexperienced user to avoid diagnostic mistakes by reproducibly displaying anatomical landmarks. Specific individual planes can be necessary in certain indications. The main advantage in comparison to other diagnostic means (i.e., computed tomography and magnetic resonance imaging) lies in the possibility of dynamic examination, which allows excellent imaging especially in rotator cuff affections. In cases without pathological findings, two standardized planes have to be documented. Otherwise, the pathological finding has to be documented in two standardized planes. The standardized procedure is a useful means for assuring and improving the quality of sonographic examinations of articular and periarticular structures.

Sonographic examination can yield additional information free of radiation in the course of corticotomy/callus distraction. The echogenic structures of the cortical structure and the callus between can be scanned at the area of the callus distraction by ultrasound examination. Individual sectional planes are focussed. They are different from the standardized ultrasound examination.Depending on when the corticotomy was performed, the callus between the cortical structures can be visualized sonographically. First it is echo poor, and then it becomes more and more echogenic. The ultrasound examination can give additional information during the first 4 weeks after corticotomy/callus distraction. A deviation of the axis in the area of callus distraction cannot be judged reliably. A sonographically guided division into three stages is possible.

Ultrasound examination of the elbow and hand is invaluable in diagnostics of acute and chronic joint diseases. Ultrasound is a noninvasive, immediately available procedure without radiation, which should be performed after exploration and clinical examination. It cannot, however, replace radiographic examination because the cortical substance represents a barrier for the ultrasound waves so that bony lesions (i.e., intraosseous tumors or osteomyelitis) cannot be detected. In the diagnosis of periarticular soft tissue lesions and intra-articular changes (loose bodies, intra-articular effusion, or synovitis), ultrasound represents an excellent cost-effective method supplying additional information. The sonographic technique is presented with the standard sectional planes according to the directives given by the working group on the musculoskeletal system of the German Society for Ultrasound in Medicine (DEGUM) issued on 20 January 1996.

Eine von den Autoren entwickelte Messapparatur zur sonographischen Beinlängen- und Beinlängendifferenzmessung wird dargestellt. Die Messpunkte im Bereich des Hüft-, Knie- und oberen Sprunggelenks werden sonographisch mit einem 5- oder 7,5-MHz-Schallkopf abgebildet. Der ventrale Pfannenrand, der Hüftkopfscheitelpunkt sowie der laterale Knie- und ventrale obere Sprunggelenkspalt stellen sich als genaue und gut reproduzierbare anatomische Messpunkte dar. Mit Hilfe der Messeinheit können die jeweiligen Abstände der Messpunkte bestimmt werden, die Differenzen entsprechen der Bein-, Oberschenkel- und Unterschenkellänge.

Zusammenfassung Die sonographische Untersuchung kann in der Verlaufskontrolle der Kortikotomie-Kallus-Distraktion wertvolle Zusatzinformationen liefern. Bei der sonographischen Untersuchung werden die echogenen Kortikalisstrukturen der Röhrenknochen auf Höhe der durchgeführten Kortikotomie und der dazwischen gelegene Kallusschlauch eingestellt. Hierfür werden individuelle Schnittebenen, vom standardisierten Untersuchungsablauf abweichend eingestellt. Abhängig vom Zeitpunkt der zurückliegenden Kortikotomie lässt sich der Kallusschlauch zwischen den eingestellten Kortikalisstrukturen abbilden. Zuerst ist er echoarm und wird dann zunehmend echoreich. Die sonographische Untersuchung in der Kortikotomie-Kallus-Distraktion ist – insbesondere während der ersten 4 Wochen nach durchgeführter Kortikotomie – in der Lage, strahlungsfrei Zusatzinformationen zu liefern. Eine Achsenabweichung im Bereich der Kallusdistraktion ist nicht sicher beurteilbar. Eine sonographisch gestützte Stadieneinteilung ist möglich.

Aufgrund der Vorzüge der sonographischen Untersuchung als nichtinvasives, strahlungsfreies und sofort verfügbares, kostengünstiges Verfahren sollte die Sonographie grundsätzlich nach Anamneseerhebung und klinischer Untersuchung, jedoch vor der radiologischen Untersuchung angewendet werden. Da die knöcherne Kortikalis jedoch eine für die Schallwellen unüberwindbare Barriere darstellt, kann die Sonographie die röntgenologische Standarddiagnostik nicht ersetzen, da sonst knöcherne Veränderungen (z. B. inraossärer Tumor, Osteomyelitis) nicht erkannt werden würden.

Zusammenfassung In diesem Beitrag werden die Richtlinien der Kassenärztlichen Vereinigung sowie die Richtlinien des Arbeitskreises “Bildgebende Verfahren” der DGOOC für den/die “Ausbildungsleiter/in und Seminarleiter/in Sonographie” der Allianz der Orthopädie vorgestellt. Die Richtlinien des Arbeitskreises “Stütz- und Bewegungsorgane” der DEGUM (Deutsche Gesellschaft für Ultraschall in der Medizin) zu Standardschnittebenen und Dokumentation, die den Vorgaben des Arbeitskreises “Bildgebende Verfahren” der DGOOC entsprechen, sind ebenfalls in diesem Heft vorgestellt worden (W. Konermann, G. Gruber: Update Sonographie – Standardschnittebenen am Stütz- und Bewegungsorgan. Der Orthopäde 2002: 31: 125–134).

329 Kinder mit Hüftschmerzen, Coxitis fugax (n=161), rheumatoide Koxitis (n=16), tuberkulöse Koxitis (n=3), bakterieller Koxitis (n=16), Morbus Perthes (n=102) und Epiphyseolysis capitis femoris (n=31) wurden sonographisch untersucht. Im Ultraschallbild können in den Standardschnittebenen der DEGUM und der DGOOC die Gelenkkapsel, die Hüftkopfoberfläche sowie die periartikulären Strukturen beurteilt werden.