Der Unfallchirurg
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The patellofemoral joint is stressed strongly during weight training. There are different individual preconditions that influence the stress distribution. Forces on tendons and cartilage are a function of angle and exercise. ⋯ Patellofemoral malalignment, high loads and overuse, uncontrolled exercises and steroids represent risk factors for injuries. Individual training concepts with controlled exercises that reduce peak loads are desirable. There is a wide scope of therapeutic options ranging from antiphlogistic therapy to the reconstruction of tendons and cartilage.
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Chronic relapsing exertional compartment syndrome is not only found in young athletic subjects. Non-athletic patients can also suffer from exercise dependent pain in the lower limb. The syndrome is defined by increased tissue pressure in between a closed osteo-fibrous space resulting in disturbed microcirculation and finally irreversible neuroischemic damage. ⋯ Duplex ultrasound also provides pathogenetic factors like popliteal and anterior entrapment, stenosis or hypoplasia of the anterior tibial artery or thrombosis of the deep muscle veins. Many patients are reporting a pain history over years, resulting in complete reduction of their sporting activity. The knowledge about pathogenesis, symptoms, diagnosis and therapy should help shorten the negative impact of the syndrome on their quality of life.
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Vascularized pedicled bone grafts are known since the beginning of the last century. Microvascular bone grafts (free vascularized bone transfer) are known since the beginning of the seventies. ⋯ Because of those properties, it became possible to successfully treat a large segmental bone defect by only few operations. As the treatment of complicated combined soft tissue/bone defects led to high complication rate up to 40 to 60% the indications of this method were altered.
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Hyaline articular cartilage consists mainly of water, which is reversibly transferred to the joint space under compression to reduce friction between the cartilage surfaces. This water content is regulated by proteoglycanes, which are produced by chondrocytes. ⋯ Power training should lead to a submaximal loading of cartilage below the rupture limit as the capacity of cartilage tissue to adapt to higher loads is limited. When the cartilage tissue shows osteoarthritic changes the loading capacity of the cartilage matrix is significantly reduced, which should be taken into consideration during power training.