Wiederkehr zu körperlicher Aktivität und Sport in der Tumororthopädie

Zusammenfassung Einleitung Bei konstant hohen Überlebensraten in der multimodalen Therapie von Knochensarkomen (Osteo- und Ewing-Sarkom) rücken in den letzten Jahren zunehmend die Lebensqualität sowie die Wiederaufnahme von körperlicher Aktivität und Sport in den Fokus. Heutzutage kann ein Großteil der Patienten extremitätenerhaltend mittels modularer Tumorendoprothetik behandelt werden. Es handelt sich vorwiegend um Jugendliche und junge Erwachsene mit präoperativ hohem sportlichen Aktivitätsniveau und entsprechendem Anspruch an die Tumorbehandlung. Ziel dieser Übersichtsarbeit ist die Beantwortung der Frage, welches körperliche Aktivitätsniveau und welche Sportarten Patienten nach Tumorendoprothetik aufgrund von Knochensarkomen realistisch erreichbar sind, des Weiteren der Einfluss von Interventionen auf das funktionelle Ergebnis und den Aktivitätsgrad. Methoden Es handelt sich um ein nicht systematisches Review mit Fokus auf Wiederkehr zu körperlicher Aktivität und Sport nach tumorendoprothetischem Gelenkersatz zur Behandlung von Knochensarkomen der unteren Extremitäten im Jugend- und jungen Erwachsenenalter. Es wurde die elektronische Datenbank PubMed hinsichtlich thematisch relevanter Artikel gescreent. Ergebnisse und Diskussion Das objektive körperliche Aktivitätsniveau (Gangzyklen/Tag, Gangintensitäten) ist nach Tumorendoprothetik der unteren Extremitäten kurzfristig und dauerhaft sowohl im Vergleich zum Gesunden als auch im Vergleich zu anderen Tumorentitäten (Leukämien) reduziert. Auch die sportmotorische Leistungsfähigkeit ist negativ beeinflusst. Generell zeigt sich eine Verbesserung der Ergebnisse mit zunehmender Follow-up-Dauer. Ein funktionelles Assessment ist erst sinnvoll zu erheben nach Beendigung der neoadjuvanten Behandlung, frühestens 12 Monate postoperativ. Im Langzeit-Follow-up erreichen Patienten mit Knochensarkomen nach Tumorendoprothetik der unteren Extremitäten hohe sportliche Aktivitätslevels (Sportart, Frequenz/Woche, UCLA-Score) mit einem Maximum nach 5 Jahren postoperativ, jedoch mit Verschiebung zu Low-Impact-Sportarten. Nur 20% der Patienten nehmen mittelfristig uneingeschränkt am Schulsport teil. Die Tumorlokalisation kann die sportliche Aktivität beeinflussen, nicht so das Auftreten von postoperativen Komplikationen. Individualisierte sporttherapeutische Interventionen während und nach multimodaler Therapie können kurzfristig den körperlichen Aktivitätsgrad (Gangzyklen/Tag, Gangintensitäten) verbessern, „Serious Games“ verbessern motorische Performance und posturale Kontrolle. Langfristig sind hierzu keine Daten vorliegend. Auch High-Impact-Sportarten wie Skifahren können mittels individueller Intervention erlernt und ausgeübt werden. Ein Zusammenhang zwischen hohem Aktivitätsgrad und früher Prothesenlockerung oder Frakturen konnte bislang nicht nachgewiesen werden. Valide Daten zu körperlicher Aktivität und Sport nach Tumorendoprothetik der oberen Extremitäten sind nicht existent. Schlussfolgerung In der tumororthopädischen Behandlung von jungen Patienten mit Knochensarkomen muss dem präoperativ hohen sportlichen Aktivitätsniveau Rechnung getragen werden. Einschränkungen der körperlichen Aktivität beeinflussen die Lebensqualität und Psyche, dementsprechend muss ein Fokus in der Tumororthopädie auf Erhalt und Verbesserung dieser Faktoren liegen. Die Datenlage ist insgesamt schwach, weitere Studien mit Analyse der Sportfähigkeit im Speziellen sowie prospektive Interventionsstudien sind wünschenswert.

Indirect Arthroscopic Distal Clavicle Resection: an Institutional Experience with Midterm Functional Outcome

Background. Acromioclavicular joint arthritis is a relatively common source of shoulder pain. The treatment options consist of conservative management and operative intervention depending on the severity and duration of the disease. Distal clavicle excision is the standard operative treatment and can be performed through either open or arthroscopic techniques. The purpose of this study was to evaluate the functional outcome of arthroscopic resection of the distal clavicle. Material and methods. This was a prospective study, conducted in a group of 50 patients in the Post-Gra­duate Department of Orthopaedics, Govt. Medical College Srinagar, from July 2015 to July 2019 with cases followed for a minimum of 3 years. Results. The mean UCLA score improved from 13.2 preoperatively to 29.56 at final follow-up. An excellent result was seen in 10 patients (20%), good in 34 (68%), fair in 3 (6%) and poor in 3 (6%) patients. Overall 88% of the patients achieved excellent or good results and 94% were satisfied. Persistent pain and excessive intraoperative bleeding were the most common complications in our study. Conclusions. 1. Distal clavicle excision through an indirect or subacromial approach is a safe and effective procedure with very few complications. 2. The subacromial approach gives the added advantage of evaluating any glenohumeral joint and subacromial pathology. 3. This procedure is associated with less pain and improved cosmesis in comparison to open procedures.

Postoperative Outcomes of Single-Stage Versus Staged Bilateral Rotator Cuff Repair in Patients with Bilateral Rotator Cuff Tear: A Retrospective Study

Background: In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair.Methods: From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. There were 24 patients in the single-stage group and 27 patients in the staged group. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, and the range of motion (ROM) of the shoulder were evaluated for comparison between the two groups before and after the operation. Moreover, the hospitalization costs in the two groups were also recorded.Results: All 51 patients were available throughout follow-up. There was no significant difference in the VAS score (P=0.424), ASES score (P=0.325), UCLA score (P=0.170), and Constant score (P=0.275) between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups. The VAS score, ASES score, UCLA score, and Constant score were significantly different between the two groups at 6 months postoperatively (P<0.05). At 12, 18, and 24 months after the operation, the VAS score, UCLA score, Constant score, and ASES score were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. Besides, there was a significant difference in hospitalization costs between the two groups (P<0.05). Furthermore, there was no significant difference in the VAS score, UCLA score, Constant score, ASES score, and ROM between the first surgery and second surgery in the single-stage group postoperatively.Conclusion: Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-up. Moreover, good outcomes were observed on both sides of the single-stage group.

Comparison of Isolated Screw to Plate and Screw Fixation for Tarsometatarsal Arthrodesis Including Clinical Outcome Predictors

Background: The common treatment for end-stage tarsometatarsal (TMT) arthritis is an arthrodesis of the affected joints. This study was performed to examine the clinical and radiographic outcome after TMT arthrodesis and to identify risk factors for postoperative complications. Methods: A total of 101 patients with tarsometatarsal arthritis of at least 2 joints were retrospectively examined. Data were acquired using clinical and radiographic examination, pedobarographic analysis, and standardized questionnaires, including the European Foot and Ankle Society Score, the Foot and Ankle Outcome Score, a pain numeric rating scale (NRS), the 36-Item Short Form Health Survey, and the University of California at Los Angeles Activity (UCLA) Score. The fixation technique, any complications, and revision surgery were recorded. Results: All scores improved significantly, except for the UCLA Score. The mean pain NRS score was significantly reduced from 7.7 preoperative to 3.0 postoperative ( P < .05). The overall nonunion rate was 12.6%. Compared with 2 crossed-screw fixation, locking plate plus compression screw fixation was associated with a decreased nonunion rate (odds ratio [OR] 0.165, 95% confidence interval [CI] 0.032-0.854; P = .017). A body mass index >27 was significantly associated with a higher nonunion rate and wound healing problems (OR 12.05, 95% CI 1.430-101.468; P = .006; OR 5.03, 95% CI 1.273-19.871; P = .013). The overall reoperation rate was 25.2%. Conclusion: TMT arthrodesis of the medial and central column resulted in significant improvement in foot function and pain. A major complication was nonunion. Locking plate plus compression screw fixation was associated with a lower nonunion rate. Level of Evidence: Level III, comparative series.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is an easy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction alongside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities. Methods We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, 19 patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder X-ray initially, immediately postoperatively, and at 1, 3, 6 and 12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up. Results There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90 ± 6.16 versus 94.47 ± 7.26, p = 0.47; UCLA score: 32.84 ± 2.91 versus 34.32 ± 1.16, p = 0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47 ± 27.47 versus 100.75 ± 48.70, p = 0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p = 0.038). Conclusion Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background:Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is a neasy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction a longside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities.Methods: We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, nineteen patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder x-ray initially, immediately postoperatively, and at 1, 3, 6 and12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up.Results: There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90±6.16 versus 94.47±7.26, p=0.47; UCLA score: 32.84±2.91 versus 34.32±1.16, p=0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47±27.47 versus 100.75±48.70, p=0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p=0.038).Conclusion: Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Subacromial Erosion after Hook Plate Fixation in Acute Acromioclavicular Joint Dislocation

Background: This study was to analyze the clinical results of locking hook plate fixation for acute acromioclavicular joint (ACJ) injury and to find out the incidence of subacromial erosion, carry out quantitative analysis and identify risk factors. Methods: The study was conducted on 35 patients who underwent the locking hook plate fixation for acute ACJ joint injury. The clinical outcomes were evaluated measuring the visual analog scale (VAS) for pain, and the University of California at Los Angeles (UCLA) score. The computed tomography (CT) was conducted to measure the subacromial erosion. The acromioclavicular slope (AC slope) of the unaffected side, the acromion-hook angle (AH angle), the acromioclavicular anteroposterior distance (AC-AP distance), and the preoperative acromioclavicular interval (ACI) of the affected side were analyzed to identify the risk factors of subacromial erosion. Results: The mean preoperative VAS score was 7.6 points, which improved by a significant level of 0.3 at the final follow-up (P <0.001). The UCLA score at the last follow-up was 32.3 points, which was higher than the preoperative average of 15.2 points (P = 0.003). According to the computed tomography (CT) findings, subacromial erosion was found in all cases, and the mean value was 5.0mm, which is 53% of the entire acromion thickness. The AC slope (B=-0.159, P<0.001) and AC-AP distance (B=0.233, P=0.004) were found to have a significant influence on postoperative subacromial erosion. The AC slope showed a negative correlation with the amount of erosion, while the AC-AP distance showed a positive correlation with erosion. onclusion: The study was able to obtain satisfactory clinical and radiological results after locking hook plate fixation for acute ACJ injury. The CT findings revealed that subacromial erosion occurred in all cases, and the mean erosion depth was about 50% of the acromial thickness. If the preoperative AC slope of the unaffected side was more acute and the AC-AP distance was larger, the incidence of subacromial erosion was higher. Level of evidence: Therapeutic Level IV Retrospectively registered study: This study was retrospective in nature, and final approval of informed consent exemption by the institutional review board was obtained (KHUH IRB 2019-04-079)

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background: Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is a neasy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction a longside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities.Methods: We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, nineteen patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder x-ray initially, immediately postoperatively, and at 1, 3, 6 and12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up.Results: There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90±6.16 versus 94.47±7.26, p=0.47; UCLA score: 32.84±2.91 versus 34.32±1.16, p=0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47±27.47 versus 100.75±48.70, p=0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p=0.038).Conclusion: Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is an easy-to-master and minimally-invasive approach to surgical intervention. Overstress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction alongside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities. Methods We retrospectively enrolled 38 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, nineteen patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder x-ray initially, immediately postoperatively, and at 1, 3, 6 and 12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up. Results There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90 ± 6.16 versus 94.47 ± 7.26, p = 0.47; UCLA score: 32.84 ± 2.91 versus 34.32 ± 1.16, p = 0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47 ± 27.47 versus 100.75 ± 48.70, p = 0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p = 0.038). Conclusion Concomitant hook plate fixation with loop suspensory reconstruction yielded excellent functional outcomes and superior maintenance of the rCCD with fewer acromion complications than hook plate fixation alone.

The Clinical Results of Arthroscopic Treatment for Calcified Tendinitis of Rotator Cuff—— A Retrospective Study With No Less Than 2 Years Follow Up

Background The treatment of CT remains controversial. The aim of this study was to retrospectively evaluate the pain and functional outcomes of arthroscopic excision with or without rotator cuff repair for treating calcified tendinitis of the rotator cuff.Methods Between Jan 2015 and Apr 2018, a total of 38 patients with 39 shoulders CT of the rotator cuff underwent arthroscopic surgery and were followed for at least two years. The clinical outcomes were evaluated at intervals of 2, 4, and 8 weeks and 3, 6，12 and 24 months after the surgery and annually thereafter. The efficacy measures included the visual analogue scale (VAS) score, University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and radiographic outcomes.Results All patients underwent follow-ups, and the mean follow-up time was 45.38 months. The VAS score significantly decreased from 73.59±11.35 mm before the surgery to 26.41±10.63 mm at 6 months after surgery and continued to decrease to 5.64±5.02 mm at the end of the follow-up period (all p < 0.01). This result was supported by a significant increase in both the UCLA score and ASES score (all p<0.01) after surgery. Plain radiographs after surgery revealed complete calcification removal in all patients. No recurrence was observed during the follow-up period.Conclusions Arthroscopic excision can relieve pain and improve shoulder joint function in patients with CT. Additional randomized controlled studies need to be conducted to confirm our findings.