[Methocarbamol in acute low back pain. A randomized double-blind controlled study].

Background: Muscle relaxants are widely used to treat low back pain (LBP), one of the most frequent health problems in industrialized countries. For this indication, the European Medicines Agency (EMA) recently had imposed restrictions for some muscle relaxants, anti-inflammatories and analgesics; Tetrazepam even had to be withdrawn from the market. Therefore methocarbamol remains the only approved muscle relaxant.

Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament.

The purpose of this study was to determine the objective and subjective long-term outcomes of the first free meniscal allograft transplantations in five patients with complete absence or non-repairable lesion of the medial meniscus after 20 years. Between 1984 and 1986 five patients underwent concomitant medial meniscal transplantation with a deep frozen meniscal allograft, ACL reconstruction and femoral advancement or temporary detachment of the MCL. The clinical outcome of the patients was evaluated 20 years postoperatively using clinical assessment, Lysholm-score, KOOS, IKDC-score, radiographs and magnetic resonance imaging.

A double-blind, multicentre, randomised clinical trial comparing the efficacy and tolerability of aceclofenac with diclofenac resinate in patients with acute low back pain.

The efficacy and tolerability of aceclofenac was compared with diclofenac resinate in a double-blind, multicentre randomised study in patients with acute low back pain suffering from degenerative spinal disorders. The study included 227 patients randomised to receive either aceclofenac 2 x 100 mg daily or diclofenac resinate 2 x 75 mg daily for up to 10 days. The primary objective was to demonstrate the clinical non-inferiority of the analgesic efficacy of aceclofenac compared with diclofenac resinate, as assessed by changes from baseline in the visual analogue scale (0-100 mm) pain score, at rest and at visit 3 (final visit on day's 8-10).

Long-term results of meniscal allograft transplantation.

Between May 1984 and December 1986, 23 patients with a history of medial meniscectomy and anterior knee instability were entered into a long-term prospective study of the results of medial meniscal transplantation combined with reconstruction of the anterior cruciate ligament. In 17 cases a lyophilized meniscal allograft was used and in 6 cases a deep-frozen meniscal allograft was used. The patients' clinical outcomes were evaluated 3 and 14 years postoperatively by clinical assessment, Lysholm score, radiographs, magnetic resonance imaging, arthrography, and, in some cases, arthroscopy.

[Transplantation of allogeneic menisci].

The increase in severe ligament injuries of the knee has led to consideration of the need for meniscal transplantation in reconstructive operations for chronic rotational instability. Transplantation of the medial meniscus was carried out in 30 sheep, which were divided up into 2 groups, each containing 15 sheep. In the first group lyophilized, y-sterilized allogeneic menisci were transplanted and these underwent complete remodelling in 48 weeks.

[Current aspects of meniscus transplantation].

Meniscus transplantation is a common procedure for some orthopaedic surgeons all over the world. Deep frozen as well as freeze-dried meniscal allografts were transplanted. Reconstruction of the knee ligaments after meniscectomy as well as surgical therapy of osteochondral defects of the knee joint after meniscectomy are some of the indications for meniscus transplantation.

[Visualized three-dimensional reconstruction and image analysis in orthopedics and trauma surgery].

Computer tomography is a commonly used technique for detecting pathological alterations in soft tissue and the skeleton. The remote access to image informations as well as the allocation of display and processing tools via networks enables improved diagnostic and therapeutic practice in orthopaedic and traumatologic surgery. The realization of a user friendly image analysis system displays and processes the acquired images in a modality oriented manner.

[Meniscus replacement using Hoffa's infrapatellar fat bodies--initial clinical results].

Between December 1986 and July 1988 a replacement of the absent medial meniscus was taken by means of the infrapatellar adipose body in seven patients. A replacement of the anterior cruciate ligament by means of the middle one third of the patellofemoral ligament was taken too. This operation was done for reconstruction of the synergism between the anterior cruciate ligament and the posterior horn of the medial meniscus.

[Meniscus transplantation and anterior cruciate ligament replacement--results 2-4 years postoperative].

23 transplantations of meniscus combined with replacement of the anterior cruciate ligament were performed from May 1984 to December 1986 at the Department of Orthopaedics of the University of Munich ('Klinikum Grosshadern'). Clinical follow-ups were coupled with arthroscopic follow-ups on the average 10 months postoperatively in 19 patients with transplantation of the medial meniscus of the knee joint. In 17 cases a lyophilised meniscus was transplanted and in 6 cases a deep-freeze allogenous meniscus.

Methods and applications of three-dimensional imaging in orthopedics.

Computed tomography is a commonly used technique for detecting pathological alterations in soft tissues and the skeleton. Three-dimensional images of the skeleton are very useful for planning surgical treatment and monitoring therapy, but unfortunately mental reconstruction of complex three-dimensional anatomical structures from conventional tomography is very difficult. This article describes a process by which automated analysis of the regions of interest in the computed tomographic (CT) images yields the contours of the surfaces which can be presented pseudo-three-dimensionally using Phong's lighting model and Gouraud's shading methods.

Homologous meniscus transplantation. Experimental and clinical results.

The increase in severe ligament injuries of the knee has led to consideration of the need for meniscal transplantation in reconstructive operations for chronic rotational instability. Transplantation of the medial meniscus was carried out in two groups of 15 sheep. In one group lyophilised, gamma-sterilised allogenic menisci were transplanted and these underwent a complete remodelling in 48 weeks.

[Comparative studies on cadmium, chromium, nickel and lead accumulation in coxarthrosis and idiopathic femur head necrosis].

Possible heavy-metal toxicity due to cadmium, chromium, nickel and lead in coxarthrosis and idiopathic necrosis of the head of the femur is reported on for the first time. Studies are made in the diseased head of the femur by means of ICP emission spectroscopy and atom absorption spectrophotometry. Whereas the blood and bone analyses in the own control group and in the coxarthrosis patients show normal values, a statistically significantly elevated element concentration in the head of the femur in the case of idiopathic necrosis of the head of the femur could be demonstrated with regard to the heavy-metal toxicity due to cadmium, nickel and lead.

The results of reconstruction of the lateral ligaments of the ankle.

Eighty-one reconstructions of the lateral ligaments of the ankle were carried out at our clinics between 1967 and 1983. Three methods were used and 53 patients were followed up. The only two poor results followed infection after dural reconstruction.

Investigation of ischaemic necrosis of the femoral head with trace elements.

This preliminary report examines the possible disturbances in mineral and trace element metabolism in idiopathic ischaemic necrosis of the femoral head. Bony specimens from 45 femoral heads removed from patients with this condition were compared with 62 osteoarthritic and 10 normal femoral heads. Blood analysis was also carried out in the first two groups of patients, who were having joint replacement operations.

[Transplantation of the meniscus. Experimental study].

An experimental study has been made of the possibility of meniscus grafting. This was carried out in 30 merino sheep, 15 of which received lyophilised homologous menisci and 15 others deep-frozen homologous menisci. Three sheep had to be excluded because of wound breakdown and sepsis.

[Results of the follow-up of varus osteotomy in Perthes disease with reference to the hip value].

A total of 89 patients with 105 hip joints affected by Perthes' disease at Catterall's stages II to IV, which had been treated by varus osteotomy, were re-examined clinically and radiologically between two and ten years after surgery. The clinical and subjective results of treatment were generally good. The best clinical and radiologic results were found in patients who contracted the disease before the age of seven and in whom necrosis was not yet at an advanced stage.

[Scintigraphic findings in fracture of the vertebral body].

The "region-of-interest technique" was applied for taking 85 quantifying skeleton scintigrams in 60 patients suffering from 75 stable impression fractures of the inferior thoracic spine or the lumbar spine. The skeleton scintigrams were made between 3 days and 6 years after the accident, predominantly between the first and twelfth posttraumatic week. The evaluation curves of the scintigraphic quotients following to fractures of the vertebral bodies show a linear increase of the quotient until the fourth week and afterwards an exponential decrease.

[Meniscus transplantation--animal experiment study].

The possibility of repairing meniscus lesions by transplantation was studied in 30 sheep. Grafting of the meniscus was performed in 15 animals each either with lyophilised homologous menisci that had been sterilised by gamma rays, or with deep frozen homologous menisci. 27 menisci could be evaluated over a period of 48 weeks.

[Long-term results of the tibial head pendulum osteotomy in varus and valgus gonarthrosis in the elderly].

Proximal tibia-head osteotomy is an approved surgical method for the treatment of unilateral knee arthrosis. In a follow-up examination of 44 patients with 56 operated knees the long-term results more than 10 years after surgery are evaluated in older patients with varus and valgus arthrosis. It can be demonstrated that, if the indication is right, excellent long-term results can be expected, also for older patients with unilateral gonarthrosis.

[Meniscus refixation and transplantation].

The knowledge we have about the biomechanical importance of the menisci of the knee joint makes it imperative, where possible, to treat their injuries by means of meniscus-conserving measures. Hence today meniscal suturing is performed successfully not only in fresh injuries but also in old baseline longitudinal tears, whether by means of the arthroscope or arthrotomy. Even after having removed the medial meniscus at a previous operation this can be replaced through homologous lyophilized or deep-frozen meniscal transplants, as would be applicable in cruciate ligament insufficiency of the knee joint.

The ingrowth quota of autologous spongiosa from different points of removal--experimental study in sheep. A preliminary report.

The importance of the point of removal for the ingrowth quota of autologous spongiosa was examined in seven sheep. In six sheep spongiosa was taken from five different regions (proximal radius, olecranon, pelvic crest, trochanter major, and proximal tibia) and was transplanted autologously. Defined corticalis defects of the tibia were the chosen sites for the heterotopic implantations.

[Bone density determination using 125I-densitometry in idiopathic scoliosis].

The aim of the present study was to find out whether idiopathic scoliosis is associated with a general reduction of the calcium salt content of the bones. The study was conducted in a scoliosis patient group of 48 individuals, using 125I densitometry.