Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle. ß

Zusammenfassung Hintergrund Die tatsächliche Anzahl verunglückter E‑Scooter-Fahrer in Deutschland scheint deutlich höher zu sein, als es die aktuellen Zahlen des Statistischen Bundesamtes vermuten lassen. Diese epidemiologische Studie untersucht E‑Scooter-Verletzungen und vergleicht diese mit E‑Bike- und Fahrradverletzungen. Fragestellung Zur Schaffung einer vergleichbaren Datenlage über die Gefahren von E‑Scootern, E‑Bikes und Fahrrädern wurden die typischen Verletzungsmuster analysiert und daraus Präventionsmöglichkeiten abgeleitet. Material und Methode Es wurden alle Patienten, die sich nach Unfällen mit Beteiligung von E‑Scootern, E‑Bikes und Fahrrädern über die universitäre Notaufnahme eines Level-1-Traumazentrums im Zeitraum vom 15. Juni 2019 bis 31. Oktober 2020 vorstellten, prospektiv untersucht. Ergebnisse Es wurden 68 verunglückte E‑Scooter-Fahrer erfasst. Davon waren signifikant mehr männlich als weiblich (p = 0,032). Das mittlere Alter betrug 31,1 (±13) Jahre, und lediglich 11,8 % (n = 8) der Unfälle wurden polizeilich registriert. Im gleichen Zeitraum wurden 34 verunglückte E‑Bike- und 356 Fahrradfahrer erfasst. In allen 3 Gruppen waren die meisten Verletzungen im Kopfbereich, gefolgt von Verletzungen an den oberen Extremitäten. Signifikant mehr E‑Scooter-Fahrer hatten einen ISS ≥ 16 als in der Gruppe der verunglückten Fahrradfahrer (p = 0,016). Verunglückte E‑Scooter-Fahrer hatten eine signifikant längere Krankenhausverweildauer (KHVD) als E‑Bike-Fahrer (p = 0,003) und als Fahrradfahrer (p = 0,001). Einen Helm trugen 52,9 % (n = 18) der E‑Bike- und 53,3 % (n = 113) der Fahrradfahrer, dagegen nur 1,5 % (n = 1) der E‑Scooter-Fahrer. Die häufigste Unfallursache bei E‑Bike- (17,7 %; n = 6) und Fahrradfahrern (10,4 %; n = 37) war das Wegrutschen auf Straßenbahnschienen, bei E‑Scooter-Fahrern die Kollision mit einem Bordstein (7,4 %; n = 5). Diskussion Die 3 untersuchten Patientenkollektive zeigten differierende Verletzungsursachen und -profile. Als Ursachen für einen erhöhten Anteil von Schwerverletzten im Vergleich zu Fahrradfahrern sind die Elektromobilität, Fahren unter Alkoholeinfluss und das unzureichende Tragen eines Helms bei E‑Scootern bei Dominanz von Kopfverletzungen zu nennen. Da 73,5 % (n = 50) der erfassten E‑Scooter-Unfälle nicht polizeilich registriert wurden, ist von einer sehr viel höheren Anzahl von E‑Scooter-Unfällen auszugehen als bisher angenommen. Präventive Maßnahmen könnten die Einführung einer Helmpflicht, eine höhere Anzahl von Verkehrskontrollen, Fahrsicherheitstrainings und der Ausbau von Fahrradwegen sein.

(1) Background: The COVID-19 pandemic has led to a significant change in the utilization of trauma surgery and tumor orthopedic hospital facilities. (2) Methods: In a monocentric retrospective analysis, the weekly numbers of cases requiring intra-clinical treatment in the first four months of 2020 were compared with those of 2019. Patients’ visits to the emergency department and shock room, consultation hours, work-related accidents, case numbers in the normal and intensive care units, ventilation hours, the “Simplified Acute Physiology Score/ Therapeutic Intervention Scoring System” (SAPS/TISS), the average length of stay in hospital, the number of operations and their degree of urgency, as well as deaths, were analyzed in a study based on the data from 7606 outpatient consultations in 2019 and 6755 in 2020, as well as 993 inpatient cases in 2019 and 950 in 2020. (3) Results: There was a significant reduction in the number of treatments per week in the emergency department (261 ± 29 vs. 165 ± 25; p < 0.001) with the same number of shock room treatments and fewer consultation hour contacts (226 ± 29 vs. 119 ± 65; p = 0.012). There were fewer inpatient cases (66 ± 7 vs. 42 ± 11; p = 0.001), resulting in a fall in the days of hospitalization (492 ± 63 vs. 308 ± 78; p < 0.001) and number of operations (73 ± 7 vs. 55 ± 10; p = 0.012), especially elective procedures (20 ± 3 vs. 7 ± 7; p = 0.008). The SAPS/TISS score was lower (1351 ± 1213 vs. 399 ± 281; p = 0.023). Fewer fracture treatments and septic surgeries were performed, while the number of procedures to treat orthopedic malignancies remained constant. (4) Conclusions: During the first phase of the COVID-19 pandemic, we observed a significant reduction in the number of cases treated in orthopedics. While the number of multiple-injured patients was unchanged, fewer patients presented for primary and regular care. Treatment of acute injuries and malignant tumor diseases was not at risk. There was no effect on in-house mortality. We see a potential for the recruitment of medical staff from the outpatient department, operating room, and the ward. In the event of a future second wave, our results may allow for early planning, particularly of the all-important human resources. Reorganization by hospitals and decreased patient numbers in trauma surgery can enable the reallocation of medical staff, equipment, and beds to increase capacity for COVID-19 patients.

Background: The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. Methods: n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. Results: 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6–7)/7 (5–7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). Conclusions: DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended.

Introduction: Underwater rugby (UWR) is a team sport which combines swimming sprints, apnoea diving, a good overview of the three-dimensional underwater space and wrestling for the ball.This was the first epidemiological study of UWR injuries in a large international collective. Methods: A questionnaire containing 124 questions was distributed to 198 active UWR players and completed under the supervision of medical staff. Demographic data and information about injuries in ten different body regions were collected. Results: Of the 198 respondents, 106 (53.5%) were male and 92 (46.5%) were female. On average, each UWR player suffered a median of 19.5 (IQR 44) injuries. Based on the exposure time, means of 37.7 (SD 90.0) injuries per 1000 playing hours per player and 9.9 (20.1) injuries per year were found. Significant injuries mainly occurred to the head region (45.7%). Bruises and sprains were observed more often than fractures and dislocations. Male athletes had a longer total injury break time (median 4.8 [IQR 10.5] days), than female athletes (4 [8.6] days). Female athletes had more injuries (median 20 [IQR 26.8]) than male athletes (18.5 [63]). The length of the injury-related break time increased with the rise in body mass index. Conclusions: The risk of severe injury in UWR is low compared to other ball sports like water polo and rugby. UWR is played under water and the impact of tackles is lessened by the water. Further studies should record chronic injuries in UWR and establish measures to prevent injury.