Der Orthopäde
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The purpose of this study was to evaluate the effect of tourniquet use with constant pressure until wound closure on perioperative blood loss in total knee arthroplasty (TKA). Sufficient patients were included in the study to produce statistically relevant conclusions. In this retrospective case control study 547 patients who were treated with TKA because of osteoarthritis of the knee joint were included and of these 262 patients were operated with the use of a tourniquet (300 mmHg) and 285 without. ⋯ The average perioperative blood loss without tourniquet use was 1.5±0.6 l (range -0.2 to 4.3 l). In contrast patients treated with the use of a tourniquet lost on average only 1.2±0.5 l (range -0.2 to 3.4 l) (p<0.001). The use of a tourniquet reduces the perioperative blood loss in TKA if it is kept tight during the operation.
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During the past few years arthroscopic and minimal invasive techniques for stabilization of acromioclavicular (AC) joint dislocations have gained increasing interest. Well established procedures for open surgery were modified and implemented to attain an arthroscopic level. Furthermore implants were developed which enable these reconstructive techniques to be performed arthroscopically without the disadvantages of open procedures. The short to mid-term results described so far concerning the clinical and radiological outcome of arthroscopic stabilization techniques show an at least equal outcome to those presented in open surgery.
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Ruptures of the adductor muscles, the M. rectus femoris or the M. biceps femoris are sports injuries which need quick and reliable diagnostic management. Treatment of muscle injuries is mostly conservative; complete tendon ruptures or avulsion fractures of the tendons are treated operatively according to the dislocation and the functional loss.
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Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. ⋯ Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.
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Peroneal tendon injuries are recognized with increasing frequency to be the cause of persistent lateral ankle symptoms. The lesions are frequently found in patients with concomitant anatomical or biomechanical abnormalities, such as chronic lateral instability or cavovarus deformity. The most common mechanism involves a sudden inversion injury or repetitive activities. ⋯ Many of these conditions respond to conservative therapy. However, when left untreated, the disorders can lead to persistent lateral ankle pain and substantial functional deficits. This is particularly true in patients with an underlying anatomical predisposition to lesions.