Alexander Keiler

Background: Ankle sprains and acute Achilles tendon ruptures are common injuries among recreational tennis players. Objectives: This study investigated the specific cause, return to play, and ability to play tennis after an ankle sprain and Achilles tendon rupture. Methods: Patients who sustained an ankle sprain (n=39) or an Achilles tendon rupture (n=7) while playing tennis were retrospectively evaluated, with a mean follow-up of 6.0 and 5.2 years, and follow-up rates of 80% and 78%, respectively. Results: Ankle sprain patients were younger (39 years), smaller and lighter (BMI males 24.3, females 22.5) than Achilles tendon rupture patients (49 years, BMI males 26.8). Ankle sprains occurred more often on clay (56% [CI 40-72%]) and Achilles tendon ruptures on carpet courts (57% [CI 18-90%]). The return-to-play rate for tennis was 90% in patients with ankle sprains after a mean of 3.6 months and 29% in patients with Achilles tendon ruptures (two patients), with returns occurring at 5 and 36 months. The return to any sport was 97% and 100%, respectively. Twenty-nine players (74%) with an ankle sprain reported no complaints while playing tennis, and 6 (15%) had some instability or slight pain. Twenty-one per cent of all ankle sprain patients experienced subsequent events (1-3), with a 10% recurrence rate after a first-time event and a 33% rate in patients with recurrent instability episodes. Conclusion: The return-to-play rate for tennis was high after an ankle sprain and low after an Achilles tendon rupture. The reason for not returning in recreational players was either fear of re-injury or preference for other sports, not because of injury-related disabling factors. Patients after Achilles tendon rupture who returned to play tennis did not have any functional problems, and patients after ankle sprain rarely experienced minor instability or pain.

Background: An active sporting lifestyle is associated with numerous health benefits. In this regard, tennis as a sport that can be practiced by young and old can be a component throughout life. The extent to which play is possible and medically advisable after arthroplasty of the hip, knee, ankle, and shoulder joint is the subject of this narrative review. Purpose: To summarize the current literature and evidence regarding prosthetic treatment of the hip, knee, ankle, and shoulder joints in relation to tennis, both in singles and in doubles, so the clinician can use evidence-based medicine to advise and treat patients who want to return to tennis. Study Design: Narrative review. Methods: An electronic databases search, including PubMed, Google Scholar, ScienceDirect, UpToDate, and Springer, was conducted on articles including tennis and arthroplasty. Results: The return-to-play rate ranged from 7% to 62.5% for total hip arthroplasty, 0% to 62.5% for total knee arthroplasty, 0% to 37.5% for unicondylar knee arthroplasty, 0% to 30% for total ankle arthroplasty, 75% to 100% for anatomic total shoulder arthroplasty, 0% to 50% for reverse total shoulder arthroplasty, and 50% to 100% for shoulder hemiarthroplasty. Tennis play clearance given by surgeons (for singles/doubles) was 80%/89% for total hip, 70%/87% for total knee, 40%/85% for total ankle, 75%/86% for anatomic total shoulder, 30%/43% for reverse total shoulder, and 85/88% for shoulder hemiarthroplasty. The mean period for a return to play was 5-7 months (range, 1-36 months). Existing evidence cannot prove a higher complication rate caused by playing tennis. Conclusion: The current evidence indicated that tennis can be continued even after arthroplasty. The return-to-play rate was higher for total hip arthroplasty, total knee arthroplasty, anatomic shoulder arthroplasty, and shoulder hemiarthroplasty compared with ankle and reverse shoulder arthroplasty. The time frame for a return to sports depended on a variety of intrinsic and extrinsic factors. For players with sufficient experience, tennis doubles and singles could be played after 3 to 6 months. Each patient should therefore be assessed and advised individually and also informed that the practice of high-impact sports (such as tennis) could potentially lead to complications like premature polyethylene wear, implant loosening, dislocations, or periprosthetic fractures, even though no fully conclusive data are available. This article provides information about the outcomes and return-to-play rates for tennis after shoulder, hip, knee, and ankle replacement and will help physicians better advise patients who wish to return to tennis after endoprosthesis surgery.

Zusammenfassung: Hintergrund: Überbelastungsreaktionen sind stark einschränkende sowie belastende Erkrankungen und betreffen in den meisten Fällen den Fuß. Dieser Übersichtsartikel soll die häufigsten spezifischen Krankheitsbilder darstellen sowie Hintergründe und Therapiemaßnahmen erläutern. Er dient als Behandlungspfad und Algorithmus in der klinischen Praxis zur Behandlung von Überbelastungsreaktionen am Fuß. Methoden: Fachspezifische Literatur wurde nach Krankheitsbildern, Grundlagen und Therapiekonzepten systematisch ausgewertet und mit eigenen Erfahrungswerten und Behandlungsmaßnahmen korreliert. Ergebnisse: Plantare Fasciitis, Achillodynie, Ermüdungsfrakturen, Schienbeinkantensyndrom, Überbelastung der Tibialis-posterior-Sehne, Morton-Neurome sowie Apophysitis calcanei stellen die häufigsten Überbelastungsreaktionen am Fuß dar. Die Basis der Diagnostik sollten stets Anamnese sowie klinische Untersuchung in statischer und dynamischer Durchführung darstellen. Bildgebend sollte eine Röntgenaufnahme des Fußes und des Sprunggelenks im Stehen angefertigt werden. Ergänzend empfiehlt sich meist eine Magnetresonanztomographie (MRT), da sie wertvolle Informationen zur Erkrankung liefert und auch zum Ausschluss anderer Differenzialdiagnosen dienen kann. Die primäre Therapie stellen konservative Maßnahmen dar. Für die Eigenbluttherapie mit plättchenreichem Plasma (PRP) findet sich v. a. die Behandlung der plantaren Fasciitis und der Achillodynie zunehmend Evidenz. Nach Ausschöpfung der konservativen Therapie kann in speziellen Fällen mitunter eine operative Therapie angedacht werden. Schlussfolgerung: Überbelastungserkrankungen am Fuß stellen schmerzhafte und belastende Erkrankungen dar. Die primäre Therapie ist konservativ. Zunehmende Evidenz findet sich für die Eigenbluttherapie mit PRP. Dennoch durchlaufen Patienten mitunter einen langen Leidensweg.

Background: Aseptic loosening is one of the leading causes of stem revision. Einzel Bild Röntgen Analyse–Femoral Component Analysis allows for the detection of distal stem migration, which is used as a predictive factor for implant longevity. This study aims to demonstrate the migration behavior of a cemented collared anatomical stem. Methods: This study retrospectively examined all patients who received a cemented Lubinus SP II stem (Waldemar Link, Hamburg, Germany) between 2003 and 2019. We used the EBRA-FCA software (University of Innsbruck, Austria) to determine the migration patterns and thoroughly examined the patients’ medical histories. In addition, the potential influence of femoral configuration and BMI on the migration behavior was assessed. Results: This study included 61 patients (48 females and 13 males) with a total of 61 stems that met our inclusion criteria. The mean age at surgery was 76 years (ranging from 30 to 93 years). According to EBRA-FCA migration analysis, a median subsidence of 0.7 mm was observed at 24 months and at the final follow-up (median 78 months). Distal stem migration was significantly higher at the 6-month time point in patients with Dorr type A femurs compared to Dorr type B femurs (p = 0.016). Body mass index (BMI) had no significant effect on stem migration. Conclusions: The measured subsidence of the Lubinus SP 2 stem using EBRA-FCA was below established thresholds, indicating excellent long-term outcomes. Although there was significantly increased subsidence in Dorr type A femurs during the initial 6 months, thereafter, no statistically significant difference was observed compared to Dorr type B femurs.

Background: Aseptic loosening is one of the most-common causes of the failure of cementless stems. Einzel Bild Röntgen Analyse-Femoral Component Analysis (EBRA-FCA) allows the diagnosis of stem migration, which can be considered a factor in predicting implant survival. The current study aimed to present the migration behavior of a tapered proximally anchored straight stem. Methods: This retrospective study reviewed all consecutive patients who received a cementless CBC straight stem (Mathys AG, Bettlach, Switzerland) between 2005 and 2019. We analyzed the migration pattern using the EBRA-FCA software and reviewed their medical histories. In addition, periprosthetic radiolucency was rated according to the Gruen zones and femoral configuration according to Dorr. Results: A total of 333 stems in 332 patients (female 191; male 141) met our inclusion criteria. The mean age at surgery was 63 (range 21–87) years. Migration analysis by EBRA-FCA showed a mean subsidence of 1.6 mm at final follow-up at 96 months with a maximum noted mean subsidence of 2.0 mm at 72 and 84 months. Dorr Type A showed a tendency of less subsidence than did Dorr Type B and was statistically significant at 6 (p = 0.0396) and 72 months (p = 0.0127). The body mass index (BMI) and increased subsidence were not found to correlate (p > 0.05). For this cohort, the overall femoral revision-free rate was 95.2% and the revision-free rate for aseptic loosening was 99.1%. Conclusions: The results showed migration behavior in cementless stems with initial increased migration and subsequent secondary stabilization, suggesting an excellent long-term outcome. Stem migration of this tapered proximally anchored stem might be lower in Dorr Type A than in Dorr Type B femurs without being statistically significant at all time points.

Introduction: Evidence on the use of brachytherapy in soft-tissue sarcoma (STS) is sparse. Therapy regimens are determined more by local interdisciplinary tumor conferences than by standardized protocols. Patient-specific factors complicate the standardized application of therapy protocols. The individuality of the treatment makes it difficult to compare results. Materials and Methods: A comprehensive literature search was conducted, whereby the literature from a period of almost 44 years (1977–2021) was graded and included in this systematic review. For this purpose, PubMed was used as the primary database. Search string included “soft-tissue sarcoma”, “brachytherapy”, and “extremity.” Four independent researchers reviewed the literature. Only full-text articles written in English or German were included. Results: Of the 175 identified studies, 70 were eligible for analysis based on the inclusion and exclusion criteria. The key points to compare were local complications, recurrence rate and correlation with margins of resection, and the use of brachytherapy regarding tumor grading. Conclusion: Brachytherapy represents an important subset of radiotherapy techniques used in STSs, whose indications and applications are constantly evolving, and for which a local control rate of 50% to 96% has been reported as monotherapy, depending on risk factors. However, the best benefit is seen in the combination of further resection and brachytherapy, and most authors at many other centers agree with this treatment strategy.

Introduction: There is no uniform consensus on the gold standard therapy for acute Achilles tendon rupture. The aim of this pilot study was to compare operative and conservative treatment regarding imaging findings and clinical outcome. Materials and methods: Surgically or conservatively treated patients with acute Achilles tendon rupture were retrospectively evaluated. Differences in tendon length and diameter with and without load were analysed using kinematic MRI, tendon perfusion, structural alterations, movement and scar tissue by means of grey-scale and contrast-enhanced ultrasound (CEUS). Intra- and interobserver agreement were recorded. Results: No significant difference was detected regarding clinical outcome, B mode ultrasonography, contrast-enhanced sonography or MRI findings, although alterations in MRI-based measurements of tendon elasticity were found for both groups. Considerable elongation and thickening of the injured tendon were detected in both groups. Conclusion: Both, conservative and surgical treatment showed comparable outcomes in our preliminary results and may suggest non-inferiority of a conservative approach.

Zusammenfassung: Hintergrund: Die primäre synoviale Chondromatose (SC) ist eine seltene Erkrankung der Synovialmembran unklarer Ätiologie. Der aktuelle Wissensstand zu dieser Erkrankung soll in einer kurzen Übersicht dargestellt werden. Methoden: Übersichtsarbeiten und rezente Fallberichte zur SC wurden systematisch ausgewertet und mit Daten eigener Fälle in Kontext gesetzt. Ergebnisse: Auf Grund neuer genomischer Daten wird die SC als benigne Neoplasie eingestuft. In 60 % der Fälle liegen Mutationen im Fibronektin-1-Gen (FN1) und/oder im Gen für den Activin-A-Typ-II-Rezeptor (ACVR2A) vor. Diagnoseweisend ist die Magnetresonanztomographie (MRT) und die meist arthroskopische Biopsie der Synovia. An einem Fallbeispiel soll gezeigt werden, dass die Knorpelaggregate der SC radiologisch nicht immer schattengebend sein müssen. Differenzialdiagnostisch kommen Monarthritiden anderer Ursachen, andere Gelenk- und Muskelerkrankungen mit Mineralisierung sowie weitere von der Synovialmembran ausgehende Erkrankungen in Betracht. Die Entartungsrate liegt bei 2–4 %. Therapeutisch hat sich in den letzten Jahren das arthroskopische Vorgehen durchgesetzt, das an die Ausdehnung der Erkrankung adaptiert wird. Schlussfolgerung: Genomische Untersuchungen sowie Fallserien und Fallberichte aus jüngerer Zeit werfen ein neues Licht auf die SC. Therapeutisch wird in jüngeren Arbeiten überwiegend arthroskopisch vorgegangen.

Background/Aim: The surgical treatment of patients with bone metastasis of the extremities poses a set of unique challenges. We aimed to highlight common hazards when treating pathological fractures as well as hazards surrounding assumptions on metastatic status and life expectancy. Materials and Methods: This systematic literature review includes studies published from January 1, 1985 to May 7, 2021. Published articles were surveyed using PubMed. Of 99 studies, 32 original articles were found to meet the inclusion criteria. The PRISMA guidelines were used to select articles. Results: Current literature reports a variety of common pitfalls. In order to avoid pitfalls, it is essential to secure the diagnosis. Furthermore, life expectancy must be given consideration when planning surgical therapy. In addition, a well-functioning multidisciplinary team is needed to coordinate further options such as radiation or embolization. Conclusion: Despite the fact that the surgical principles for treating bone metastases of the extremities are often to the point, incorporating all the nuances of treatment is a meticulous procedure.