Maurice Balke

Zusammenfassung: Atrophie der Oberschenkelmuskulatur ist ein regelhaft auftretendes Problem nach vorderer Kreuzbandrekonstruktion. Ein schlechter Muskelstatus postoperativ ist mit schlechterem funktionellem Outcome und einem erhöhten Risiko für erneute Verletzungen assoziiert. Narrative Übersichtsarbeit auf der Grundlage einer Literaturrecherche in PubMed und Cochrane zu prä-, intra-/perioperativen und postoperativen Interventionen sowie begleitenden Maßnahmen (Ernährung, Supplementierung) zur Reduktion der Muskelatrophie nach vorderer Kreuzbandrekonstruktion. Verschiedene Faktoren und Interventionsmöglichkeiten können die Muskelatrophie reduzieren. Präoperativ sind der Operationszeitpunkt (21–100 Tage nach Verletzung) sowie eine strukturierte Prehabilitation bedeutsam. Intraoperativ erhöht die Tourniquet-Anlage die frühe Atrophie ohne langfristigen Effekt; ein Femoralisnervenblock sollte vermieden werden. Die Transplantatwahl beeinflusst das Atrophierisiko maßgeblich (QT>BPTB>HT). Postoperativ sind progressives exzentrisches Krafttraining und frühe NMES die wirksamsten Interventionen; Blood-Flow-Restriction-Training (BFRT) ist eine vielversprechende Ergänzung. Ernährungsoptimierung (mind. 1,6–1,9g Protein/kg KG/Tag) sowie perioperative Supplementierung mit essenziellen Aminosäuren (EAA) und Beta-Hydroxy-Beta-Methylbutyrate (HMB) zeigen positive Effekte, insbesondere bei Risikopatienten. Muskelatrophie nach vorderer Kreuzbandrekonstruktion ist unvermeidbar, aber durch einen multimodalen perioperativen Ansatz deutlich reduzierbar. Insbesondere bei Risikopatienten (weibliches Geschlecht, höheres Alter, schlechter präoperativer Muskelstatus, QT-Transplantat) sollte eine konsequente Kombination aller verfügbaren Maßnahmen angestrebt werden.

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.

Zusammenfassung: Einleitung: 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. Fallbeschreibung: 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. Schlussfolgerung: 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.

Purpose: Wingfoiling is a new popular water sport. Data on the risk of injury or overuse injuries are not yet available. The aim of the study was to analyze the incidence, mechanisms and risk factors for wingfoiling related injuries and the acceptance of safety equipment. Patients and Methods: Data for this retrospective study were collected through an online standardized questionnaire. It was accessible from January 2022 to June 2022. Information on demographics, injury history, overuse complaints, use of (safety)equipment and fitness routines over the past 12 months were asked. Results: A total of 415 completed the questionnaire in full and could be included in the study. Fourteen percent (n = 59) were female, 86% (n = 356) were male. The average age was 43.5 years. Fourteen percent (n = 59) participated in competitions. Thirty-one percent (n = 129) of all participants suffered at least one injury in the past 12 months out of a total of 356 injuries. This corresponds to an injury incidence of 5.7/1000h. Typical mechanism of injury was contact with the own sports equipment. The most frequent cause was individual riding errors due to fatigue with 77.5% (n = 276). The most common acute injury types were contusions, strains, cuts and abrasions of the lower extremities. In the case of chronic complaints (n = 173), the shoulder and knee joint were mainly affected. Seventy-three percent (n = 304) of the participants regularly used a protective equipment, such as a helmet or impactvest. Conclusion: The injury rate of wingfoiling is comparable to windsurfing and kitesurfing. The majority of injuries are minor injuries to the lower extremities. In case of serious injuries, it is mainly the bony thorax that is affected. Most participants already use protective equipment. Overuse complaints mostly affect the large joints.

Background: River surfing (also called “rapid surfing”) involves surfing on stationary waves that are artificially created or placed in rivers and is gaining popularity, especially among surfers in landlocked areas but also among athletes without experience in ocean surfing. Different wave setups, types of boards, and types of fins, as well as the use of safety equipment, can lead to overuse and injuries. Purpose: To analyze the incidence, mechanisms, and risk factors of river surfing–related injuries for different types of waves and to evaluate the usage and appropriateness of safety equipment. Study Design: Descriptive epidemiology study. Methods: An online survey was distributed via social media to river surfers in German-speaking countries to collect information on demographics, injury history for the previous 12 months, wave site attended, use of (safety) equipment, and health issues. The survey was accessible between November 2021 and February 2022. Results: A total of 213 participants completed the survey: 195 participants from Germany, 10 from Austria, 6 from Switzerland, and 2 from other countries. The mean age was 36 years (range, 11-73 years), 72% (n = 153) were male, and 10% (n = 22) took part in competitions. Overall, 60% (n = 128) of surfers experienced 741 surfing-related injuries over the previous 12 months. The most common mechanisms of injury were contact with the bottom of the pool/river (n = 75 [35%]), with the board (n = 65 [30%]), and with the fins (n = 57 [27%]). The most frequent injury types were contusions/bruises (n = 256), cuts/lacerations (n = 159), abrasions (n = 152), and overuse (n = 58). Injuries affected mainly the feet/toes (n = 90), head/face (n = 67), hand/fingers (n = 51), knee (n = 49), lower back (n = 49), and thighs (n = 45). Earplugs were used by 50 (24%) participants, and a helmet was used regularly by 38 (18%) participants and never by 175 (82%) participants. Conclusion: The most frequent types of injury in river surfers were contusions/bruises, cuts/lacerations, and abrasions. The main mechanisms of injury were contact with the bottom of the pool/river, with the board, or with the fins. The feet/toes were more prone to injuries, followed by the head/face and hand/fingers.

Introduction: Acute acromioclavicular joint (ACJ) injuries are among the most common shoulder injuries in active young adults. The most frequently used surgical treatments include the hook plate implantation and arthroscopic treatment using flip-button systems. The aim of this study was to evaluate the results of treating acute ACJ injuries using a new minimally invasive implant based on a flip-button system. Material and methods: From January 2016 to October 2019, a total of 20 patients with acute ACJ injuries (1 × Type III, 3 × Type IV, 16 × Type V) underwent surgery using the Twinbridge implant (Smith & Nephew). It is a prefabricated construct consisting of two Endobuttons connected with an UltraTape. One button is placed under the coracoid using a special aiming device and two buttons are placed on the clavicle. Preoperatively, 1 day postoperatively, 3 months and at least 1 year postoperatively, patients were clinically examined and bilateral stress view and axial radiographs were obtained. At final follow-up, the simple shoulder test (SST), Taft score, Constant score, and ACJ instability (ACJI) score were recorded and a side-to-side ratio of the coracoclavicular (CC) distance was calculated. Results: All 20 patients were contacted at final follow-up at a mean of 28 (min. 13, max 50) months. Six patients were not willing to come for a clinical and radiographic examination and were contacted via telephone. All six patients were free of complaints. Another two patients free of complaints refused radiographs at final follow-up. The patients presented a mean SST of 99.6% (20 patients, min. 91.7, max. 100), Taft score of 11.6/12 points (12 patients, min. 10, max. 12), ACJI of 85.5/90 points (12 patients, min. 78, max. 90), and a Constant score of 97.1 (14 patients, min. 81.0, max. 100) for the affected shoulder. Preoperative stress view images revealed a mean side-to-side difference of the CC distance with a ratio of 1:2.34 (min. 1:1.80, max. 1:3.33). At final follow-up, CC distance was calculated with a mean ratio of 1:1.12 (min. 1.1, max. 1:1.38). Axial images showed a proper position in all cases. A “perfect” radiological result was achieved in six patients (50%) with a side-to-side CC distance of less than 10% (ratio 1:1.1 or less). A Rockwood type II result was achieved in five patients (42%) with a distance of 10 to 25% (ratio 1.11–1.25). One (8%) presented with a Rockwood type III result with a difference of more than 25% (ratio 1:1.38) and was considered a radiological failure. Conclusions: When used correctly, the Twinbridge implant offers good-to-excellent clinical and radiographic results using a minimally invasive surgical technique. Complication rate is comparable to other button-systems.