ZusammenfassungEine frühe Diagnose der atraumatischen Femurkopfnekrose ermöglicht einen frühzeiti... more ZusammenfassungEine frühe Diagnose der atraumatischen Femurkopfnekrose ermöglicht einen frühzeitigen Therapiebeginn und damit verbunden eine bessere Prognose. Die radiologische Abklärung bei Verdacht auf eine atraumatische Femurkopfnekrose ist dabei essenziell. Die bildgebende Diagnostik sollte mit konventionellen Röntgenbildern beider Hüftgelenke beginnen, um Differenzialdiagnosen auszuschließen. Die Magnetresonanztomografie (MRT) ist heute das bildgebende Verfahren der Wahl, mit der höchsten Sensitivität und Spezifität. Mit Hilfe der multiplanaren Computertomografie (CT) kann das Vorliegen einer subchondralen Fraktur am sichersten erfasst werden. Für diese Fragestellung ist die CT der MRT derzeit noch überlegen. Die Skelettszintigrafie sollte nur noch in Ausnahmefällen eingesetzt werden, in denen Kontraindikationen für eine MRT bestehen. Die bildgebende Diagnostik mittels Röntgen, MRT und CT erlaubt eine genaue Stadieneinteilung nach der ARCO-Klassifikation und ermöglicht es, den Patienten frühzeitig einer stadiengerechten Therapie zuzuführen.
Journal of exercise, sports & orthopedics, May 19, 2017
Clinical data suggest that the reconstruction of large osteochondral defects requires application... more Clinical data suggest that the reconstruction of large osteochondral defects requires application of osseous cylinders to augment the bony defect. This prospective case series investigates the clinical outcome after impaction grafting as an alternative to osseous cylinder transplantation to reconstruct the subchondral bone plate. We report on three patients with large osteochondral defects of the femoral condyle (averaging 10.9 cm²) resulting from osteochondritis dissecans or osteonecrosis. Defects were treated with spongiosaplasty followed by matrix-based autologous chondrocyte implantation (MACI) using a collagen-I-hydrogel. The patients were examined at 3, 6, 12, 24, 36, 48, and 60 months after surgery. The follow-up included radiographs, MRI, patient/doctor assessment as well as the IKDC-2000 evaluation package (IKDC score). At final follow-up, all three patients were satisfied with the long-term outcome since free of pain. Their functional and activity levels were back to normal, which was also reflected in the obtained IKDC-scores. Radiographic and MRI imaging showed complete reconsolidation of the subchondral osseus defects and excellent integration of the implanted collagen based matrix with the surrounding hyaline cartilage. Therefore, autologous spongiosaplasty as an alternative to the transplantation of osseous cylinders is a sufficient technique to reconstruct the subchondral bone plate in patients with large osteochondral defects.
Das prästationäre Management ist in der Fast-Track-Endoprothetik von elementarer Bedeutung und um... more Das prästationäre Management ist in der Fast-Track-Endoprothetik von elementarer Bedeutung und umfasst eine umfangreiche Aufklärung des Patienten und eine Risikoevaluation. Fast-Track-Behandlungsprotokolle beinhalten interdisziplinäre Patientenseminare, die die Erkrankung, Operation, schnellstmögliche Mobilisation und jeden einzelnen Teil der Behandlung erklären, wie auch einen „Coach“, einen Angehörigen oder Freund, der den Patienten auf dem Weg der Rehabilitation begleitet, unterstützt und ermutigt. Dadurch können Ängste reduziert werden. Digitale Apps können weitere Informationen und praktische Tipps vermitteln, durch Videos komplexe Abläufe veranschaulichen und dadurch das funktionelle Ergebnis verbessern und die Schmerzintensität reduzieren. Risikofaktoren, die zu einer höheren Morbidität, Mortalität und Komplikationsrate sowie einer längeren Aufenthaltsdauer führen, müssen evaluiert und, wenn möglich, eliminiert werden. Als optimierbare Faktoren gelten Malnutrition und Übergewicht, Alkoholkonsum, Nikotinabusus, der schlecht eingestellte Diabetes, der schlechte Zahnstatus und die Eisenmangelanämie.
Der Name des Autors J. Arnholdt an 7. Stelle des oben genannten Beitrags war fehlerhaft. Wir bitt... more Der Name des Autors J. Arnholdt an 7. Stelle des oben genannten Beitrags war fehlerhaft. Wir bitten, dies zu entschuldigen und den korrigierten Namen (siehe oben) zu berücksichtigen.
BACKGROUND While fast-track arthroplasty has been already established in many European countries ... more BACKGROUND While fast-track arthroplasty has been already established in many European countries and the United States, Germany still struggles to introduce appropriate programs. This is due to a variety of reasons. REASONS From an organizational and medical scope, the fear of alteration, the adherence to restrictions rooted in historical tradition, the reluctance to interdisciplinary cooperation, and the lack of a willingness to implement externally-guided process analysis tools, stand in the foreground. This is system related, and especially the DRG-system with the continuous devaluation of lump compensation rates in primary hip and knee arthroplasty, also in 2020, hinders the implementation. The resulting fears and concerns that an additional reduction of the length-of-stay by fast-track programs is leading to a consistent reduction of the DRG returns, are understandable. On the other hand, the disconnectedness of the ambulatory, inpatient and rehabilitation sector in Germany inhibits the introduction of fast-track programs. SOLUTIONS A well-thought-out change-management is the basic requirement for the successfull establishment of a Fast-Track-Program. Perspectively, a rethinking towards sector-comprehensive care strategies for the implantation of a total hip or knee replacement, including the required rehabilitation procedures, has to be demanded.
Whereas only a few years ago the only expectation of skilful anesthesia was an undisturbed execut... more Whereas only a few years ago the only expectation of skilful anesthesia was an undisturbed execution of surgical procedures, today this has changed to a perioperative responsibility in which all physicians involved in the treatment process try to optimize the existing circumstances and risks of the patient before, during and after surgery. Thus, the tasks for the anesthesiologist have been mainly extended to a rapid recovery strategy with as few side effects as possible, such as nausea and vomiting or postoperative cognitive deficits (POCD). The establishment of evident structures and the introduction of suitable perioperative procedures with the goal of maintaining homeostasis, adequate opioid-sparing pain treatment and rapid postoperative convalescence determine the anesthesiological fast-track concept.
ZusammenfassungHintergrundFast-Track-Endoprothetik gewinnt im deutschsprachigen Raum immer mehr a... more ZusammenfassungHintergrundFast-Track-Endoprothetik gewinnt im deutschsprachigen Raum immer mehr an Akzeptanz. Fast-Track-Programme versprechen durch eine Optimierung der Behandlungsprozesse eine schnellere Genesung, eine höhere Patientenzufriedenheit, eine Verbesserung der Qualität und eine Reduktion der Verweildauer.Ziel der ArbeitEs sollen die Philosophie und Behandlungsprinzipien der Fast-Track-Hüftendoprothetik während der prä-, intra- und postoperativen Phase unter Einbeziehung der derzeitigen Evidenzlage dargestellt werden. Die Herausforderungen im deutschen Gesundheitssystem sollen diskutiert werden.Material und MethodenNeben der Darstellung eigener Daten zum Patientenseminar und zur opioidsparenden Schmerztherapie werden die wesentlichen Arbeiten zum Thema Fast-Track in der Hüftendoprothetik aus einer Pubmed-Literaturrecherche diskutiert.ErgebnisseFast-Track-Konzepte können nur durch eine enge interdisziplinäre Zusammenarbeit erfolgreich umgesetzt werden. Präoperativ kann ein Patientenseminar helfen, den Patienten besser auf die Operation vorzubereiten. Postoperativ nehmen die Frühmobilisation und die Schmerztherapie eine zentrale Rolle ein, wobei eine deutliche Reduktion der Opioide erreicht werden kann.DiskussionFast-Track-Hüftendoprothetik macht ein Umdenken bezüglich traditioneller Behandlungsprinzipien notwendig und fordert ein hohes Maß an interdisziplinärer Zusammenarbeit. Insbesondere aufgrund der Besonderheiten des Gesundheitssystems (DRG-System und stationäre Rehabilitation) hat eine flächendeckende Etablierung in Deutschland bisher nicht stattgefunden.AbstractBackgroundFast track arthroplasty is becoming increasingly accepted in German-speaking countries. By optimizing treatment processes fast track programs promise faster recovery, increased patient satisfaction, quality improvement and reduction in the length of hospital stay.ObjectivesThe philosophy and treatment principles of fast track hip arthroplasty during the pre, intra and postoperative phase are described in the light of the current body of evidence. The challenges concerning fast track arthroplasty within the German health system are discussed.Material and methodsBesides presenting our own data concerning a patient seminar and an opiate saving pain treatment, the most relevant literature related to fast track hip arthroplasty from a pubmed search is discussed.ResultsFast track concepts can only be successfully implemented through close interdisciplinary team work. Preoperatively, a patient seminar can help to prepare patients better for surgery. Postoperatively, early mobilisation and pain treatment play a central role, whereat a clear reduction in opiate application can be achieved.ConclusionFast track hip arthroplasty makes rethinking with respect to traditional treatment principles necessary and demands a high degree of interdisciplinary team work. Particularly, as result of the specifics of the health system (DRG system and stationary rehabilitation), a nationwide establishment in Germany has not taken place so far.
The aim of the study was to evaluate the therapeutic benefit of CaReS®, a type I collagen hydroge... more The aim of the study was to evaluate the therapeutic benefit of CaReS®, a type I collagen hydrogel-based autologous chondrocyte implantation technique, for the treatment of osteochondral defects of the knee (Outerbridge grades III and IV) within a prospective multicenter study. A total of 116 patients in 9 clinical centers were treated with CaReS between 2003 and 2008. The Cartilage Injury Evaluation Package 2000 of the International Cartilage Repair Society (ICRS) was employed for data acquisition and included the subjective International Knee Documentation Committee score (IKDC score), the pain level (visual analog scale, VAS), the physical and mental SF-36 score, the overall treatment satisfaction and the functional IKDC status of the indexed knee. Follow-up evaluation was performed 3, 6 and 12 months after surgery and annually thereafter. The mean defect size treated was 5.4 ± 2.7 cm(2) with 30% of the cartilage defects being ≤4 cm(2) and 70% ≥4 cm(2). The mean follow-up period was 30.2 ± 17.4 months (minimum 12 months and maximum 60 months). The mean IKDC score significantly improved from 42.4 ± 13.8 preoperatively to 70.5 ± 18.7 (p < 0.01) in the mean follow-up period. Global pain level significantly decreased (p < 0.001) from 6.7 ± 2.2 preoperatively to 3.2 ± 3.1 at the latest follow-up. Both the physical and mental components of the SF-36 score significantly increased. At the latest follow-up 80% of the patients rated the overall treatment satisfaction as either good or very good. The functional IKDC knee status clearly improved from preoperative to the latest follow-up when 23.4% of the patients reported having no restriction of knee function (I), 56.3% had mild restriction (II), 17,2% had moderate restriction (III) and 3.1% revealed severe restriction (IV). The CaReS technique is a clinically effective and safe method for the reconstruction of isolated osteochondral defects of the knee joint and reveals promising clinical outcome up to 5 years after surgery. A longer follow-up period and larger patient cohorts are needed to evaluate the sustainability of CaReS treatment.
The last decade has witnessed the development of cell-based therapy as a major biomedical researc... more The last decade has witnessed the development of cell-based therapy as a major biomedical research area, including the treatment of musculoskeletal diseases. Both differentiated and undifferentiated stem cells have been used as starting cell sources. In particular, the use of multipotent adult mesenchymal stem cells holds great promise for future therapeutic strategies. In addition to the cell type used, the cell delivery system is also of critical importance in cell-based therapy. Cell delivery may be achieved by direct cell injection or by grafting engineered constructs derived by cell seeding into natural or synthetic biomaterial scaffolds. While direct injection is the most direct and convenient means of cell delivery, the latter approach is capable of producing three-dimensional engineered tissues with mechanical properties compatible with those of various musculoskeletal tissues. This review will focus on the functional approach of using biomaterial scaffold materials as cell carriers for musculoskeletal applications, as well as the use of cell-based gene therapy for tissue engineering and regeneration.
Rupturen der Patellarsehne nach Kniegelenkersatz Klassifikation und Management Rupturen der Patel... more Rupturen der Patellarsehne nach Kniegelenkersatz Klassifikation und Management Rupturen der Patellarsehne nach Knieprothesenimplantation stellen eine seltene, jedoch sehr schwerwiegende Komplikation dar. Unterschieden werden atraumatische von traumatischen und akute von chronischen Rupturen. Insbesondere chronische Rupturen sind operativ anspruchsvoll, häufig mit Komplikationen behaftet und nehmen nicht selten einen unbefriedigenden Verlauf. Im folgenden Beitrag werden neben der Ätiologie und Diagnostik die unterschiedlichen Operationsverfahren dargestellt und eine Klassifikation mit einem Behandlungsalgorithmus vorgestellt.
ZusammenfassungEine frühe Diagnose der atraumatischen Femurkopfnekrose ermöglicht einen frühzeiti... more ZusammenfassungEine frühe Diagnose der atraumatischen Femurkopfnekrose ermöglicht einen frühzeitigen Therapiebeginn und damit verbunden eine bessere Prognose. Die radiologische Abklärung bei Verdacht auf eine atraumatische Femurkopfnekrose ist dabei essenziell. Die bildgebende Diagnostik sollte mit konventionellen Röntgenbildern beider Hüftgelenke beginnen, um Differenzialdiagnosen auszuschließen. Die Magnetresonanztomografie (MRT) ist heute das bildgebende Verfahren der Wahl, mit der höchsten Sensitivität und Spezifität. Mit Hilfe der multiplanaren Computertomografie (CT) kann das Vorliegen einer subchondralen Fraktur am sichersten erfasst werden. Für diese Fragestellung ist die CT der MRT derzeit noch überlegen. Die Skelettszintigrafie sollte nur noch in Ausnahmefällen eingesetzt werden, in denen Kontraindikationen für eine MRT bestehen. Die bildgebende Diagnostik mittels Röntgen, MRT und CT erlaubt eine genaue Stadieneinteilung nach der ARCO-Klassifikation und ermöglicht es, den Patienten frühzeitig einer stadiengerechten Therapie zuzuführen.
Journal of exercise, sports & orthopedics, May 19, 2017
Clinical data suggest that the reconstruction of large osteochondral defects requires application... more Clinical data suggest that the reconstruction of large osteochondral defects requires application of osseous cylinders to augment the bony defect. This prospective case series investigates the clinical outcome after impaction grafting as an alternative to osseous cylinder transplantation to reconstruct the subchondral bone plate. We report on three patients with large osteochondral defects of the femoral condyle (averaging 10.9 cm²) resulting from osteochondritis dissecans or osteonecrosis. Defects were treated with spongiosaplasty followed by matrix-based autologous chondrocyte implantation (MACI) using a collagen-I-hydrogel. The patients were examined at 3, 6, 12, 24, 36, 48, and 60 months after surgery. The follow-up included radiographs, MRI, patient/doctor assessment as well as the IKDC-2000 evaluation package (IKDC score). At final follow-up, all three patients were satisfied with the long-term outcome since free of pain. Their functional and activity levels were back to normal, which was also reflected in the obtained IKDC-scores. Radiographic and MRI imaging showed complete reconsolidation of the subchondral osseus defects and excellent integration of the implanted collagen based matrix with the surrounding hyaline cartilage. Therefore, autologous spongiosaplasty as an alternative to the transplantation of osseous cylinders is a sufficient technique to reconstruct the subchondral bone plate in patients with large osteochondral defects.
Das prästationäre Management ist in der Fast-Track-Endoprothetik von elementarer Bedeutung und um... more Das prästationäre Management ist in der Fast-Track-Endoprothetik von elementarer Bedeutung und umfasst eine umfangreiche Aufklärung des Patienten und eine Risikoevaluation. Fast-Track-Behandlungsprotokolle beinhalten interdisziplinäre Patientenseminare, die die Erkrankung, Operation, schnellstmögliche Mobilisation und jeden einzelnen Teil der Behandlung erklären, wie auch einen „Coach“, einen Angehörigen oder Freund, der den Patienten auf dem Weg der Rehabilitation begleitet, unterstützt und ermutigt. Dadurch können Ängste reduziert werden. Digitale Apps können weitere Informationen und praktische Tipps vermitteln, durch Videos komplexe Abläufe veranschaulichen und dadurch das funktionelle Ergebnis verbessern und die Schmerzintensität reduzieren. Risikofaktoren, die zu einer höheren Morbidität, Mortalität und Komplikationsrate sowie einer längeren Aufenthaltsdauer führen, müssen evaluiert und, wenn möglich, eliminiert werden. Als optimierbare Faktoren gelten Malnutrition und Übergewicht, Alkoholkonsum, Nikotinabusus, der schlecht eingestellte Diabetes, der schlechte Zahnstatus und die Eisenmangelanämie.
Der Name des Autors J. Arnholdt an 7. Stelle des oben genannten Beitrags war fehlerhaft. Wir bitt... more Der Name des Autors J. Arnholdt an 7. Stelle des oben genannten Beitrags war fehlerhaft. Wir bitten, dies zu entschuldigen und den korrigierten Namen (siehe oben) zu berücksichtigen.
BACKGROUND While fast-track arthroplasty has been already established in many European countries ... more BACKGROUND While fast-track arthroplasty has been already established in many European countries and the United States, Germany still struggles to introduce appropriate programs. This is due to a variety of reasons. REASONS From an organizational and medical scope, the fear of alteration, the adherence to restrictions rooted in historical tradition, the reluctance to interdisciplinary cooperation, and the lack of a willingness to implement externally-guided process analysis tools, stand in the foreground. This is system related, and especially the DRG-system with the continuous devaluation of lump compensation rates in primary hip and knee arthroplasty, also in 2020, hinders the implementation. The resulting fears and concerns that an additional reduction of the length-of-stay by fast-track programs is leading to a consistent reduction of the DRG returns, are understandable. On the other hand, the disconnectedness of the ambulatory, inpatient and rehabilitation sector in Germany inhibits the introduction of fast-track programs. SOLUTIONS A well-thought-out change-management is the basic requirement for the successfull establishment of a Fast-Track-Program. Perspectively, a rethinking towards sector-comprehensive care strategies for the implantation of a total hip or knee replacement, including the required rehabilitation procedures, has to be demanded.
Whereas only a few years ago the only expectation of skilful anesthesia was an undisturbed execut... more Whereas only a few years ago the only expectation of skilful anesthesia was an undisturbed execution of surgical procedures, today this has changed to a perioperative responsibility in which all physicians involved in the treatment process try to optimize the existing circumstances and risks of the patient before, during and after surgery. Thus, the tasks for the anesthesiologist have been mainly extended to a rapid recovery strategy with as few side effects as possible, such as nausea and vomiting or postoperative cognitive deficits (POCD). The establishment of evident structures and the introduction of suitable perioperative procedures with the goal of maintaining homeostasis, adequate opioid-sparing pain treatment and rapid postoperative convalescence determine the anesthesiological fast-track concept.
ZusammenfassungHintergrundFast-Track-Endoprothetik gewinnt im deutschsprachigen Raum immer mehr a... more ZusammenfassungHintergrundFast-Track-Endoprothetik gewinnt im deutschsprachigen Raum immer mehr an Akzeptanz. Fast-Track-Programme versprechen durch eine Optimierung der Behandlungsprozesse eine schnellere Genesung, eine höhere Patientenzufriedenheit, eine Verbesserung der Qualität und eine Reduktion der Verweildauer.Ziel der ArbeitEs sollen die Philosophie und Behandlungsprinzipien der Fast-Track-Hüftendoprothetik während der prä-, intra- und postoperativen Phase unter Einbeziehung der derzeitigen Evidenzlage dargestellt werden. Die Herausforderungen im deutschen Gesundheitssystem sollen diskutiert werden.Material und MethodenNeben der Darstellung eigener Daten zum Patientenseminar und zur opioidsparenden Schmerztherapie werden die wesentlichen Arbeiten zum Thema Fast-Track in der Hüftendoprothetik aus einer Pubmed-Literaturrecherche diskutiert.ErgebnisseFast-Track-Konzepte können nur durch eine enge interdisziplinäre Zusammenarbeit erfolgreich umgesetzt werden. Präoperativ kann ein Patientenseminar helfen, den Patienten besser auf die Operation vorzubereiten. Postoperativ nehmen die Frühmobilisation und die Schmerztherapie eine zentrale Rolle ein, wobei eine deutliche Reduktion der Opioide erreicht werden kann.DiskussionFast-Track-Hüftendoprothetik macht ein Umdenken bezüglich traditioneller Behandlungsprinzipien notwendig und fordert ein hohes Maß an interdisziplinärer Zusammenarbeit. Insbesondere aufgrund der Besonderheiten des Gesundheitssystems (DRG-System und stationäre Rehabilitation) hat eine flächendeckende Etablierung in Deutschland bisher nicht stattgefunden.AbstractBackgroundFast track arthroplasty is becoming increasingly accepted in German-speaking countries. By optimizing treatment processes fast track programs promise faster recovery, increased patient satisfaction, quality improvement and reduction in the length of hospital stay.ObjectivesThe philosophy and treatment principles of fast track hip arthroplasty during the pre, intra and postoperative phase are described in the light of the current body of evidence. The challenges concerning fast track arthroplasty within the German health system are discussed.Material and methodsBesides presenting our own data concerning a patient seminar and an opiate saving pain treatment, the most relevant literature related to fast track hip arthroplasty from a pubmed search is discussed.ResultsFast track concepts can only be successfully implemented through close interdisciplinary team work. Preoperatively, a patient seminar can help to prepare patients better for surgery. Postoperatively, early mobilisation and pain treatment play a central role, whereat a clear reduction in opiate application can be achieved.ConclusionFast track hip arthroplasty makes rethinking with respect to traditional treatment principles necessary and demands a high degree of interdisciplinary team work. Particularly, as result of the specifics of the health system (DRG system and stationary rehabilitation), a nationwide establishment in Germany has not taken place so far.
The aim of the study was to evaluate the therapeutic benefit of CaReS®, a type I collagen hydroge... more The aim of the study was to evaluate the therapeutic benefit of CaReS®, a type I collagen hydrogel-based autologous chondrocyte implantation technique, for the treatment of osteochondral defects of the knee (Outerbridge grades III and IV) within a prospective multicenter study. A total of 116 patients in 9 clinical centers were treated with CaReS between 2003 and 2008. The Cartilage Injury Evaluation Package 2000 of the International Cartilage Repair Society (ICRS) was employed for data acquisition and included the subjective International Knee Documentation Committee score (IKDC score), the pain level (visual analog scale, VAS), the physical and mental SF-36 score, the overall treatment satisfaction and the functional IKDC status of the indexed knee. Follow-up evaluation was performed 3, 6 and 12 months after surgery and annually thereafter. The mean defect size treated was 5.4 ± 2.7 cm(2) with 30% of the cartilage defects being ≤4 cm(2) and 70% ≥4 cm(2). The mean follow-up period was 30.2 ± 17.4 months (minimum 12 months and maximum 60 months). The mean IKDC score significantly improved from 42.4 ± 13.8 preoperatively to 70.5 ± 18.7 (p < 0.01) in the mean follow-up period. Global pain level significantly decreased (p < 0.001) from 6.7 ± 2.2 preoperatively to 3.2 ± 3.1 at the latest follow-up. Both the physical and mental components of the SF-36 score significantly increased. At the latest follow-up 80% of the patients rated the overall treatment satisfaction as either good or very good. The functional IKDC knee status clearly improved from preoperative to the latest follow-up when 23.4% of the patients reported having no restriction of knee function (I), 56.3% had mild restriction (II), 17,2% had moderate restriction (III) and 3.1% revealed severe restriction (IV). The CaReS technique is a clinically effective and safe method for the reconstruction of isolated osteochondral defects of the knee joint and reveals promising clinical outcome up to 5 years after surgery. A longer follow-up period and larger patient cohorts are needed to evaluate the sustainability of CaReS treatment.
The last decade has witnessed the development of cell-based therapy as a major biomedical researc... more The last decade has witnessed the development of cell-based therapy as a major biomedical research area, including the treatment of musculoskeletal diseases. Both differentiated and undifferentiated stem cells have been used as starting cell sources. In particular, the use of multipotent adult mesenchymal stem cells holds great promise for future therapeutic strategies. In addition to the cell type used, the cell delivery system is also of critical importance in cell-based therapy. Cell delivery may be achieved by direct cell injection or by grafting engineered constructs derived by cell seeding into natural or synthetic biomaterial scaffolds. While direct injection is the most direct and convenient means of cell delivery, the latter approach is capable of producing three-dimensional engineered tissues with mechanical properties compatible with those of various musculoskeletal tissues. This review will focus on the functional approach of using biomaterial scaffold materials as cell carriers for musculoskeletal applications, as well as the use of cell-based gene therapy for tissue engineering and regeneration.
Rupturen der Patellarsehne nach Kniegelenkersatz Klassifikation und Management Rupturen der Patel... more Rupturen der Patellarsehne nach Kniegelenkersatz Klassifikation und Management Rupturen der Patellarsehne nach Knieprothesenimplantation stellen eine seltene, jedoch sehr schwerwiegende Komplikation dar. Unterschieden werden atraumatische von traumatischen und akute von chronischen Rupturen. Insbesondere chronische Rupturen sind operativ anspruchsvoll, häufig mit Komplikationen behaftet und nehmen nicht selten einen unbefriedigenden Verlauf. Im folgenden Beitrag werden neben der Ätiologie und Diagnostik die unterschiedlichen Operationsverfahren dargestellt und eine Klassifikation mit einem Behandlungsalgorithmus vorgestellt.
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