Eigentlich sind die Mäuse ganz normale Mäuse. Doch eines Tages müssen sie ein neues Haus entern. So ist schnell klar, das sie fortan Piratenmäuse sind. Da Piraten natürlich Schätze suchen müssen, machen sich die Piratenmäuse auf die spannende Reise zu einem echten Drachenschatz.

Abstract: Introduction The treatment of underlying comorbidities is a field of rising interest in cartilage repair surgery. The aim of this study was to analyze the current practice of concomitant surgeries in cartilage repair of the knee especially in the medial or lateral femorotibial compartment. Type, frequency and distribution of additional surgeries for correction of malalignment, knee instability and meniscus deficiency should be evaluated. Methods Baseline data of 4968 patients of the German Cartilage Registry (KnorpelRegister DGOU) were analyzed regarding the distribution of concomitant surgeries in addition to regenerative cartilage treatment. Results Beyond 4968 patients 2445 patients with cartilage defects in the femorotibial compartment of the knee could be identified. Of these patients 1230 (50.3%) received additional surgeries for correction of malalignment, instability and meniscus deficiency. Predominant procedures were leg axis corrections (31.3%), partial meniscectomy (20.9%) and ACL reconstruction (13.4%). The distribution of the concomitant surgeries varied between cartilage defects according to the different defect genesis. Patients with traumatic defects were younger (36y) and received predominantly ACL reconstructions (29.2%) (degenerative: 6.7%), whereas patients with degenerative defects were older (43y) and underwent predominantly leg axis corrections (38.0%; traumatic: 11.0%). Conclusions This study shows the high frequency and distinct distribution of the concomitant surgeries in addition to regenerative cartilage treatment procedures. Understanding of the underlying cause of the cartilage defect and addressing the comorbidities as a whole joint therapy are of utmost importance for a successful regenerative cartilage treatment. These data provide a baseline for further follow up evaluations and long-term outcome analysis. Level of evidence II

Abstract: The working group, "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology (DGOU) issues this paper to update their guidelines. Methods Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. Conclusion In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended

Abstract: High tibial medial open-wedge osteotomy (HTO) is an established treatment option for cartilage lesions in the medial compartment. It was this study's aim to evaluate the effect of asymptomatic single or kissing lesions in the lateral compartment on functional outcome after medial open-wedge osteotomy. A total of 156 patients were enrolled in this retrospective study. All patients underwent HTO due to a varus deformity and a symptomatic cartilage lesion or osteoarthritis in the medial compartment. We acquired preoperative Lysholm and VAS Scores. Each open-wedge osteotomy was preceded by diagnostic arthroscopy to ensure the compartments were thoroughly documented and diagnosed. Cartilage lesions in the lateral compartment were evaluated, and three groups created according to their individual characteristics: group A (no cartilage lesion, n = 119), group B (single cartilage lesion, n = 16) and group C (kissing lesions, n = 21). Cartilage lesions were graded according to the Outerbridge classification, The functional postoperative outcome was determined by relying on several parameters (VAS Score, Lysholm, KOOS, WOMAC Score). Pre- and postoperative long-leg axis views were analyzed via special planning software (mediCAD, Hectec GmbH Germany). Mean follow-up was at 69.0 ± 30.3 months after surgery (range 22 to 121 months). There were no significant differences between the three groups in the correction angle chosen (p = 0.16). Regarding the outcome parameters, group A attained the best results in the WOMACpain Score (p = 0.03) and WOMACfunction Score (p = 0.05). A higher Outerbridge-Score of cartilage lesions in the lateral compartment was associated with a higher (i.e., worse) WOMACpain Score (p = 0.018) and WOMACfunction Score (p = 0.033). In all the groups (A, B, and C), HTO led to a significant improvement in the Lysholm Score (p

Abstract: INTRODUCTION: Patellar instability can be considered as a rapidly increasing musculoskeletal subject of interest. It is now well accepted that multiple factors can produce this pathological condition, isolated,but more often in concert. One major static compound is found to be in trochlear dysplasia. It has been stated that the form of the trochlear surface is primary and genetically bilaterally determined already before use. According to these data, recurrent dislocation of the patella has been described as a hereditary disease with autosomal dominant transmission. Against this assumption, we hypothesize that subjects may devise a flattened trochlea when there is no significant biomechanical interplay and thus input between the patella and the distal femur during developmental growth; according to the assumption form follows function.PRESENTATION OF CASE: In this context, we report the case of a 16-year old male who previously suffered from a traumatic patellar dislocation during sporting activity in his below-knee amputated lower extremity, which occured at age of 18 months. The patient was allocated with a high-grade trochlear dysplasia in his previously amputated limb, while presenting a normal trochlear shape at his healthy contralateral leg.DISCUSSION: This rare case therefore reprents the history of an individuum with identic genetic predisposition and different biomechanical influences during childhood, which makes it of high clinical interest. In presence of trochlear dysplasia the patient suffered reluxation and concurrent subjective instability on the lower limb affected by the amputation which was treated with medial patellofemoral ligament (MPFL) plasty using an autologous gracilis graft.CONCLUSION: One has to consider that a certain biomechanical input may be required for the development of a physiologic trochlear groove

Abstract: Aims and Objectives: Today the selection of the procedures for treatment of focal cartilage lesions is standardized to the defect size. Subject specific parameters like individual cartilage contact mechanisms are not taken into account. Aim of the present study therefore was to investigate inter-individual differences in the patellofemoral cartilage contact mechanisms of healthy subjects and to correlate them to the individual patellar joint surface area and patellar and femoral dimensions. Materials and Methods: 10 knees of 10 healthy subjects with regular shaped patella and trochlea underwent magnetic resonance imaging at rest and during mechanical loading for simulated weight bearing. Imaging was performed at 30° knee flexion. A custom made pneumatic loading device was used to apply 0 and 200 N axial loading to the leg. Manual segmentation of the patella, the trochlear and the patellofemoral cartilage was performed. Patellar volume, joint surface area and cartilage contact areas were calculated for each loading condition. Moreover patellar height, diameter and femoral epicondylar width were determined. Prospective motion correction was performed to reduce motion artifacts during load application. Results: Mean size of the patellar surface area was 16,08 cm2 (range 13,11-18,07 cm2). Mean patellofemoral contact area (PCA) without loading was 6,15 cm2 (range 5,12-7,33 cm2). During axial loading of the leg with 200N PCA significantly increased to 6,77 cm2 (range 6,05-7,55 cm2) (p0,05). Patellar surface area and PCA were not correlated (r=0,01; p0,05). Mean Patella width was 5,4 cm (Range 4,8-6,2 cm) and mean femoral width at the epicondyles was 8,5 cm (Range 7,9-9 cm). The mean patellofemoral cartilage contact area showed poor correlation to patellar geometry (patellar width (r=0,48, p