nach oben

Current Reviews in Musculoskeletal Medicine

Erschienen in:

15.03.2016 | ACL Update: Objective Measures on Knee Instability (V Musahl, Section Editor)

Knee instability scores for ACL reconstruction

verfasst von: Ata A. Rahnemai-Azar, Jan-Hendrik Naendrup, Ashish Soni, Adam Olsen, Jason Zlotnicki, Volker Musahl

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm.

Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012;40(1):41–8. doi:10.1177/0363546511422999.CrossRefPubMed

Peeler J, Leiter J, MacDonald P. Accuracy and reliability of anterior cruciate ligament clinical examination in a multidisciplinary sports medicine setting. Clin J Sport Med. 2010;20(2):80–5. doi:10.1097/JSM.0b013e3181ceca45.CrossRefPubMed

Torg JS, Conrad W, Kalen V. Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med. 1976;4(2):84–93.CrossRefPubMed

Galway HR, MacIntosh DL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980;147:45–50.PubMed

van Eck CF, van den Bekerom MP, Fu FH, Poolman RW, Kerkhoffs GM. Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1895–903. doi:10.1007/s00167-012-2250-9.CrossRefPubMed

Jakob RP, Staubli HU, Deland JT. Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg. 1987;69(2):294–9.

Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD. Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc. 2010;18(9):1208–13. doi:10.1007/s00167-009-1004-9.CrossRefPubMed

Musahl V, Hoshino Y, Ahlden M, Araujo P, Irrgang JJ, Zaffagnini S, et al. The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):724–31. doi:10.1007/s00167-011-1859-4.CrossRefPubMed

Hefti F, Muller W, Jakob RP, Staubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):226–34.CrossRefPubMed

10.

Irrgang JJ, Bost JE, Fu FH. Re: Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med. 2009;37(2):421–2. doi:10.1177/0363546508327555. author reply 2.

11.

Daniel DM, Stone ML, Sachs R, Malcom L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med. 1985;13(6):401–7.CrossRefPubMed

12.

Ahlden M, Hoshino Y, Samuelsson K, Araujo P, Musahl V, Karlsson J. Dynamic knee laxity measurement devices. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):621–32. doi:10.1007/s00167-011-1848-7.CrossRefPubMed

13.

Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD. Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc. 2010;18(9):1269–76. doi:10.1007/s00167-010-1160-y.CrossRefPubMed

14.

Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M, et al. In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med. 2007;35(7):1098–104. doi:10.1177/0363546507299447.CrossRefPubMed

15.•

Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y et al. Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Computer methods in biomechanics and biomedical engineering. 2015:1-12. doi:10.1080/10255842.2015.1006210. This publication described development of computer tablet software for objective quantification of anterior translation of lateral compartment during pivot shift test. It was demonstrated that this software could provide a reliable method for quantification of pivot shift with acceptable accuracy in clinical practice.

16.

Hoshino Y, Araujo P, Ahlden M, Samuelsson K, Muller B, Hofbauer M, et al. Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc. 2013;21(4):975–80. doi:10.1007/s00167-013-2396-0.CrossRefPubMed

17.

Hoshino Y, Araujo P, Irrgang JJ, Fu FH, Musahl V. An image analysis method to quantify the lateral pivot shift test. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):703–7. doi:10.1007/s00167-011-1845-x.CrossRefPubMed

18.

Arilla F, Rahnemai-Azar A, Scott B, Yacuzzi C, Guenther D, Fu F, et al. Reliability of a 2D simple image analysis method to predict 3D bony motion of the lateral. Las Vegas: Orthopeadic Research Society; 2015.

19.

Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli GM, Visani A, Zaffagnini S. Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):713–7. doi:10.1007/s00167-011-1865-6.CrossRefPubMed

20.

Labbe DR, Li D, Grimard G, de Guise JA, Hagemeister N. Quantitative pivot shift assessment using combined inertial and magnetic sensing. Knee Surg Sports Traumatol Arthrosc. 2015;23(8):2330–8. doi:10.1007/s00167-014-3056-8.CrossRefPubMed

21.

Borgstrom PH, Markolf KL, Wang Y, Xu X, Yang PR, Joshi NB, et al. Use of inertial sensors to predict pivot-shift grade and diagnose an ACL injury during preoperative testing. Am J Sports Med. 2015;43(4):857–64. doi:10.1177/0363546514565090.CrossRefPubMed

22.

Zaffagnini S, Lopomo N, Signorelli C, Marcheggiani Muccioli GM, Bonanzinga T, Grassi A, et al. Inertial sensors to quantify the pivot shift test in the treatment of anterior cruciate ligament injury. Joints. 2014;2(3):124–9.PubMedPubMedCentral

23.•

Lopomo N, Zaffagnini S, Signorelli C, Bignozzi S, Giordano G, Marcheggiani Muccioli GM, et al. An original clinical methodology for non-invasive assessment of pivot-shift test. Comput Methods Biomech Biomed Engin. 2012;15(12):1323–8. doi:10.1080/10255842.2011.591788. This recent work reported application of inertial sensors for objective measurement of tibial acceleration during pivot shift test. The inertial sensors are non-invasively mounted on the tibia and wirelessly transferred information to a computer tablet for analysis.CrossRefPubMed

24.

Berruto M, Uboldi F, Gala L, Marelli B, Albisetti W. Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon? Knee Surg Sports Traumatol Arthrosc. 2013;21(4):981–5. doi:10.1007/s00167-013-2436-9.CrossRefPubMed

25.

Araujo PH, Ahlden M, Hoshino Y, Muller B, Moloney G, Fu FH, et al. Comparison of three non-invasive quantitative measurement systems for the pivot shift test. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):692–7. doi:10.1007/s00167-011-1862-9.CrossRefPubMed

26.

Bull AM, Earnshaw PH, Smith A, Katchburian MV, Hassan AN, Amis AA. Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Joint Surg. 2002;84(7):1075–81.CrossRef

27.

Chalmers PN, Mall NA, Moric M, Sherman SL, Paletta GP, Cole BJ, et al. Does ACL reconstruction alter natural history?: A systematic literature review of long-term outcomes. J Bone Joint Surg Am. 2014;96(4):292–300. doi:10.2106/JBJS.L.01713.CrossRefPubMed

28.

Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331–42. doi:10.1056/NEJMoa0907797.CrossRefPubMed

29.

Swart E, Redler L, Fabricant PD, Mandelbaum BR, Ahmad CS, Wang YC. Prevention and screening programs for anterior cruciate ligament injuries in young athletes: a cost-effectiveness analysis. J Bone Joint Surg Am. 2014;96(9):705–11. doi:10.2106/JBJS.M.00560.CrossRefPubMedPubMedCentral

30.

Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W. The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med. 2007;35(2):223–7. doi:10.1177/0363546506294571.CrossRefPubMed

31.

Petersen W, Zantop T. Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res. 2007;454:35–47. doi:10.1097/BLO.0b013e31802b4a59.CrossRefPubMed

32.

Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE. Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res. 2004;22(1):85–9. doi:10.1016/S0736-0266(03)00133-5.CrossRefPubMed

33.

Adachi N, Ochi M, Uchio Y, Sumen Y. Anterior cruciate ligament augmentation under arthroscopy. A minimum 2-year follow-up in 40 patients. Arch Orthop Trauma Surg. 2000;120(3-4):128–33.CrossRefPubMed

34.

Ochi M, Adachi N, Uchio Y, Deie M, Kumahashi N, Ishikawa M, et al. A minimum 2-year follow-up after selective anteromedial or posterolateral bundle anterior cruciate ligament reconstruction. Arthroscopy. 2009;25(2):117–22. doi:10.1016/j.arthro.2008.10.011.CrossRefPubMed

35.

Araki D, Kuroda R, Matsushita T, Matsumoto T, Kubo S, Nagamune K, et al. Biomechanical analysis of the knee with partial anterior cruciate ligament disruption: quantitative evaluation using an electromagnetic measurement system. Arthroscopy. 2013;29(6):1053–62. doi:10.1016/j.arthro.2013.02.012.CrossRefPubMed

36.

Yoon KH, Lee SH, Park SY, Kang DG, Chung KY. Can physical examination predict the intraarticular tear pattern of the anterior cruciate ligament? Arch Orthop Trauma Surg. 2014;134(10):1451–7. doi:10.1007/s00402-014-2048-y.CrossRefPubMed

37.

Hu J, Qu J, Xu D, Zhang T, Zhou J, Lu H. Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports traumatol Arthrosc. 2014;22(9):1976–85. doi:10.1007/s00167-013-2749-8.CrossRefPubMed

38.

Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH. Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med. 2011;39(1):108–13. doi:10.1177/0363546510377399.CrossRefPubMed

39.

Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy. 2012;28(4):526–31. doi:10.1016/j.arthro.2011.11.024.CrossRefPubMed

40.

Middleton KK, Muller B, Araujo PH, Fujimaki Y, Rabuck SJ, Irrgang JJ, et al. Is the native ACL insertion site “completely restored” using an individualized approach to single-bundle ACL-R? Knee Surg Sports traumatol Arthrosc. 2015;23(8):2145–50. doi:10.1007/s00167-014-3043-0.CrossRefPubMed

41.

Zelle BA, Vidal AF, Brucker PU, Fu FH. Double-bundle reconstruction of the anterior cruciate ligament: anatomic and biomechanical rationale. J Am Acad Orthop Surg. 2007;15(2):87–96.CrossRefPubMed

42.

Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med. 2002;30(5):660–6.PubMed

43.

Morimoto Y, Ferretti M, Ekdahl M, Smolinski P, Fu FH. Tibiofemoral joint contact area and pressure after single- and double-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2009;25(1):62–9. doi:10.1016/j.arthro.2008.08.014.CrossRefPubMed

44.

Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. 2012.

45.

Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. 2012.

46.

Desai N, Bjornsson H, Musahl V, Bhandari M, Petzold M, Fu FH, et al. Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):1009–23. doi:10.1007/s00167-013-2811-6.CrossRefPubMed

47.

Chen G, Wang S. Comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction after a minimum of 3-year follow-up: a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2015;8(9):14604–14.PubMedPubMedCentral

48.

Lipke JM, Janecki CJ, Nelson CL, McLeod P, Thompson C, Thompson J, et al. The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees. J Bone Joint Surg Am. 1981;63(6):954–60.PubMed

49.

Kilcoyne KG, Dickens JF, Haniuk E, Cameron KL, Owens BD. Epidemiology of meniscal injury associated with ACL tears in young athletes. Orthopedics. 2012;35(3):208–12. doi:10.3928/01477447-20120222-07.CrossRefPubMed

50.

Sharifah MI, Lee CL, Suraya A, Johan A, Syed AF, Tan SP. Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):826–30. doi:10.1007/s00167-013-2766-7.CrossRefPubMed

51.

Krinsky MB, Abdenour TE, Starkey C, Albo RA, Chu DA. Incidence of lateral meniscus injury in professional basketball players. Am J Sports Med. 1992;20(1):17–9.CrossRefPubMed

52.

Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2010;38(8):1591–7. doi:10.1177/0363546510364402.CrossRefPubMed

53.

Musahl V, Rahnemai-Azar A, Costello J, Arner J, Fu F, Hoshino Y, et al. The influence of anterolateral capsular injury on knee laxity of anterior cruciate ligament injured patients. Orlando: Orthopaedic Research Society; 2016.

54.

Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H. Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. The American journal of sports medicine. 2015. doi:10.1177/0363546515613069.

55.

Arilla F, Guenther D, Yacuzzi C, Rahnemai-Azar A, Fu F, Debski R, et al. Effects of anterolateral capsular injury and extra-articular tenodesis on knee kinematics during physical examination. American Orthopaedic Society for Sports Medicine. Orlando: Orthopaedic Journal of Sports Medicine; 2015. p. 2325967115S00032.

56.

Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, et al. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):870–7. doi:10.1007/s00167-011-1640-8.CrossRefPubMed

57.

Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ et al. An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. The American journal of sports medicine. 2015. doi:10.1177/0363546515618387.

58.

Kittl C, El-Daou H, Athwal KK, Gupte CM, Weiler A, Williams A, et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med. 2016;44(2):345–54. doi:10.1177/0363546515614312.CrossRefPubMed

59.

Cavaignac E, Carpentier K, Pailhe R, Luyckx T, Bellemans J. The role of the deep medial collateral ligament in controlling rotational stability of the knee. Knee Surg Sports Traumatol Arthrosc. 2014. doi:10.1007/s00167-014-3095-1.

60.

LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med. 1999;27(4):469–75.PubMed

61.

Lemaire M, Combelles F. Plastic repair with fascia lata for old tears of the anterior cruciate ligament (author’s transl). Rev Chir Orthop Reparatrice Appar Mot. 1980;66(8):523–5.PubMed

62.

Marcacci M, Zaffagnini S, Iacono F, Neri MP, Loreti I, Petitto A. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sports Traumatol Arthrosc. 1998;6(2):68–75. doi:10.1007/s001670050075.CrossRefPubMed

63.

Ireland J, Trickey EL. Macintosh tenodesis for anterolateral instability of the knee. J Bone Joint Surg. 1980;62(3):340–5.

64.

Spencer L, Burkhart TA, Tran MN, Rezansoff AJ, Deo S, Caterine S, et al. Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med. 2015;43(9):2189–97. doi:10.1177/0363546515589166.CrossRefPubMed

65.•

Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM. Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy. 2015;31(10):2022–34. doi:10.1016/j.arthro.2015.04.089. This publication systematically reviews the current literature regarding benefits of performing an additional extra-articular tenodesis in patients with ACL injury. This paper reveals that published studies lack sufficient internal validity, sample size, methodologic consistency, and standardization of protocols and outcomes.CrossRefPubMed

66.

Rezende FC, de Moraes VY, Martimbianco AL, Luzo MV, da Silveira Franciozi CE, Belloti JC. Does combined intra- and extraarticular ACL reconstruction improve function and stability? A meta-analysis. Clin Orthop Relat Res. 2015;473(8):2609–18. doi:10.1007/s11999-015-4285-y.CrossRefPubMed

67.

Trojani C, Beaufils P, Burdin G, Bussiere C, Chassaing V, Djian P, et al. Revision ACL reconstruction: influence of a lateral tenodesis. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1565–70. doi:10.1007/s00167-011-1765-9.CrossRefPubMed

68.

Engebretsen L, Lew WD, Lewis JL, Hunter RE. Knee mechanics after repair of the anterior cruciate ligament. A cadaver study of ligament augmentation. Acta Orthop Scand. 1989;60(6):703–9.CrossRefPubMed

69.

Rahnemai-Azar AA, Miller RM, Guenther D, Fu FH, Lesniak BP, Musahl V et al. Structural properties of the anterolateral capsule and iliotibial band of the knee. The American journal of sports medicine. 2016. doi:10.1177/0363546515623500.

70.•

Branch T, Lavoie F, Guier C, Branch E, Lording T, Stinton S, et al. Single-bundle ACL reconstruction with and without extra-articular reconstruction: evaluation with robotic lower leg rotation testing and patient satisfaction scores. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2882–91. doi:10.1007/s00167-015-3772-8. This publication compared the biomechanical characteristics of combined extra articular tenodesis and ACL reconstruction and isolated ACL reconstruction by utilizing a robotic technology. This study demonstrated that combined extra articular tenodesis reduces internal rotation of the tibia with respect to femur.CrossRefPubMedPubMedCentral

71.

Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, et al. Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):732–6. doi:10.1007/s00167-011-1850-0.CrossRefPubMed

Titel: Knee instability scores for ACL reconstruction
verfasst von: Ata A. Rahnemai-Azar
Jan-Hendrik Naendrup
Ashish Soni
Adam Olsen
Jason Zlotnicki
Volker Musahl
Publikationsdatum: 15.03.2016
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 2/2016
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-016-9339-6

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2016

Elbow rheumatoid elbow: surgical treatment options

Treatment of complex elbow fracture-dislocations

Posterolateral rotatory instability of the elbow

Osteochondritis dissecans of the elbow

Distal biceps ruptures: open and endoscopic techniques