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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 69 (1998), S. 1153-1160 
    ISSN: 1433-0385
    Keywords: Key words: Proximal femur ; Necrosis of femoral head ; Non-unions ; Post-traumatic deformities ; Corrective osteotomy. ; Schlüsselwörter: Proximaler Femur ; Femurkopfnekrosen ; Pseudarthrosen ; posttraumatische Deformitäten ; Korrekturosteotomie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Grundsätzlich sind 4 posttraumatische Zustände des proximalen Femur durch Osteotomien beeinflußbar: Rezidivierende Hüftluxationen und -subluxationen, Femurkopfnekrosen, Pseudarthrosen, Deformitäten. Unter Berücksichtigung der individuellen Situation ist dabei in allen Fällen ein diagnostisches, indikatorisches und therapeutisches Raster zu respektieren, das sich im wesentlichen aus folgenden Schritten aufbaut: 1. Analyse des Problems unter Berücksichtigung von Vorgeschichte, Klinik und bildgebender Diagnostik; 2. Indikation zur Osteotomie; 3. zeichnerische Planung; 4. Operationstechnik. Spezifische diagnostische, indikatorische und operationstechnische Besonderheiten dieser posttraumatischen Veränderungen werden beschrieben. Auf Korrekturen von Deformitäten in der Frontal- und Sagittalebene, von Translationen, von Längen- und Torsionsdifferenzen wird speziell eingegangen. Der klinischen, übersichtsradiographischen und computertomographischen/sonographischen Analyse der Beingeometrie kommt hierbei ein zentraler Stellenwert zu. Bei der Vielfalt und Komplexität posttraumatischer Zustände des proximalen Femur kann nur eine perfekte maßgeschneiderte Lösung die Antwort auf ein ganz individuelles Problem sein.
    Notes: Summary. Basically, four post-traumatic conditions of the proximal femur can be improved by corrective osteotomies: recurring luxations and subluxations of the hip joint; necrosis of the femoral head; non-unions; deformities. Dependent on the individual situation, the following procedure can be recommended, including diagnosis of deformities and indication and therapy of corrective osteotomies: analysis of the problem from the viewpoint of history, clinical findings and imaging techniques; indication for corrective osteotomy; graphic planning; operation technique. Particularities of post-traumatic conditions with regard to diagnosis, indication and surgical technique are indicated. Only with perfectly tailored concepts can we respond to the individual situation of an individual patient and reflect the variety and complexity of post-traumatic conditions of the proximal femur.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Unfallchirurg 100 (1997), S. 124-132 
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Beinverkürzung ; Femur ; Verlängerungsosteotomie ; Treppe ; Key words Leg shortening ; Femur ; Prolongation osteotomy ; One-stage ; Step
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Intraindividual length differences up to 1.2 cm in femora, up to 1.0 cm in tibiae and up to 1.4 cm in whole leg length can be regarded as physiological. Length differences in childhood are frequently compensated for by functional adaptation in the chain of adjacent limbs. In adults, however, that adaptability is diminished and correction osteotomy after post-traumatic shortening may therefore be indicated more generously dependent on local and general criteria of operability. A conscientious analysis of bone geometry by clinical means, radiology and computed tomography is mandatory for the indication and planning of any correction osteotomy. Intraindividual leg length differences of more than 4 cm are preferentially treated by continuous callus distraction techniques. Shortening by less than 4 cm, however, is suitable for a one-stage stepwise prolongation osteotomy in the metaphysis of the femur, i.e. in the subtrochanteric or supracondylar region. These osteotomies are than stabilized by long condylar plates; the bony defects are filled up by auto- or allogenous corticospongeous bone. Simple modifications of the stepwise prolongation osteotomy permit additional corrections of torsional deviations up to 20° or of axial deviations in the frontal or sagittal plane up to 5°. The results of 24 one-stage stepwise prolongation osteotomies of the subtrochanteric and supracondylar femur after congenital or post-traumatic shortening are presented as well as the reason and respective therapies for three important complications.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Der Unfallchirurg 101 (1998), S. 440-445 
    ISSN: 1433-044X
    Keywords: Key words Knee joint • Plica • Arthroscopy • Surgery • Treatment outcome ; Schlüsselwörter Kniegelenk • Plicasyndrom • Arthroskopie • Therapie • Ergebnis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 1850 zwischen 1991–1995 durchgeführten Kniegelenkarthroskopien wurde in 102 Fällen (5,5 %) die Diagnose „Plica-Syndrom“ gestellt und eine arthroskopische Resektion vorgenommen. In 54 Fällen handelte es sich um ein isoliertes Plicasyndrom; 38 von 54 Patienten konnten im Mittel nach 31 (8–78) Monaten anhand eines modifizierten Fragebogens nach Lysholm nachkontrolliert werden. Von 21 Patienten ohne plicainduzierte Knorpelläsion (Gruppe 1) zeigten 90 % subjektiv ein sehr gutes und gutes und 10 % ein unbefriedigendes Ergebnis. Schlechtere Ergebnisse fanden sich bei den 17 Patienten mit plicainduzierter Knorpelläsion (Gruppe 2) mit 64 % subjektiv sehr guten und guten Resultaten. In beiden Gruppen konnte durch die Operation eine präoperativ bestehende Bewegungsstörung oder Schwellneigung verbessert werden. Die durchschnittliche Nachbehandlungszeit dauerte bei Patienten ohne Knorpelläsion mit durchschnittlich 1,7 Monaten gegenüber 3,2 Monaten bei Vorliegen einer Knorpelläsion nur halb so lang.
    Notes: Summary In a series of 1850 consecutive knee arthroscopies between 1991 and 1995, plicasyndrome was diagnosed and resected by arthroscopy in 102 patients (5.5 %). Clinical response was evaluated for 38 of 54 patients with an isolated plicasyndrome by use of a modified Lysholm questionnaire at an average follow-up of 31 months (range, 8–78 months). Excellent or good results were obtained in 90 % of 21 patients without plica-induced lesions of the cartilage (group 1) and poor results in 10 %. Only 64 % of 17 patients with plica-induced lesions of the cartilage (group 2) had excellent or good results. Both groups showed an improvement for range of motion and swelling postoperatively. The mean time for rehabilitation was 3.2. and 1.7 months for patients with and without cartilage lesions, respectively.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Unfallchirurg 102 (1999), S. 632-637 
    ISSN: 1433-044X
    Keywords: Key words Patella dislocation • Arthroscopy • Medial tightening • Lateral release ; Schlüsselwörter Patellaluxation • Arthroskopie • Mediale Raffung • Laterales Release
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zwischen Januar 1986 und August 1995 waren 86 Patienten mit Patellaluxation mit einer arthroskopischen medialen Kapselraffung und lateralem Release versorgt worden, davon standen 49 Patienten für ein Follow-up zur Verfügung. 29 Patienten waren nach Erstluxation und 20 Patienten nach mehrfachen Luxationen (2–20) operativ versorgt worden. Bei 28 Patienten erfolgte das laterale Release arthroskopisch, bei 21 Patienten offen. Die Nachuntersuchung erfolgte nach durchschnittlich 47,3 Monaten. Die Reluxationsrate betrug 8 %. Das Ergebnis war von 44 (90 % der nachuntersuchten) Patienten als gut bis sehr gut beurteilt worden, der Lysholm-Score betrug 87,3 ± 13,9. Beeinflußt wurde das Ergebnis vom Zeitpunkt der Indikationsstellung. Patienten mit Monoluxation (n = 29) wiesen eine niedrigere Reluxationsrate (3 vs. 15 %) und ein besseres funktionelles und subjektives Ergebnis auf, als Patienten mit rezidivierenden Luxationen (n = 20). Zwischen dem offenen und dem geschlossenen durchgeführten lateralen Release konnten wir keine signifikanten Unterschied feststellen. Die vorgestellte Methode stellt ein geeignetes, minimal-invasives Verfahren zur Therapie insbesondere der Monoluxation dar.
    Notes: Summary Between January 1986 and August 1995, we treated 86 patients suffering from lateral displacement of the patella with arthroscopic medial tightening and lateral release after a conservative functional treatment remained unsuccessful. 49 patients were available for follow-up studies. 29 patients were treated after primary dislocation of the patella, and 20 patients after recurrent dislocations (2–20). The lateral release was performed by arthroscopy in 28 patients and in 21 patients in an open procedure. The mean follow-up time was 47.3 months. The rate of reluxation was 8 %. In the opinion of the patients, 44 (90 % of the follow-up) operations were evaluated as good/very good, the average Lysholm score was 87.3 ± 13.9. The clinical results were influenced by the point of time of the operation. Patients with monoluxation showed a lower rate of reluxation (3 % vs. 15 %) and superior functional and subjective results than those with recurrent dislocation. However, there were no significant differences between the open and closed performed lateral release. We recommend the technique presented here as a minimal-invasive method especially for patients with monoluxation of the patella.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Retrograde Femurmarknagelung ; Minimalinvasive Implantatentfernung ; Korrekturosteotomie ; Marknagel ; Keywords Retrograde femoral nailing ; Arthroscopic assisted implant removal ; Femoral fractures ; Supracondylar osteotomies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Recently, the retrograde femoral nailing has become a procedure with increasing acceptance. Indications for the retrograde femur nail are distal femoral fractures including dia- and transcondylar fractures, supracondylar osteotomies and distal periprosthetic femur fractures after total knee joint replacement. Controversial discussion is carried on about the implant removal, which is potentially afflicted with further damage to the knee joint. To minimise the operative damage due to the implant removal, an arthroscopic assisted procedure has been selected. The arthroscopic assisted implant removal was possible in all of our patients. Intraoperatively, 2/3 of the patients showed normal age-related findings of the chondral and meniscal structures. The arthroscopic assisted implant removal is a gentle procedure, which allows minimal invasive extraction of retrograde femur nails and prevents secondary damage to the knee joint due to the otherwise difficult localisation of the implant. The advantages of this procedure concerning gentleness and diagnostic capabilities are as convincing, that we indicate implant removal of retrograde femur nails in all younger patients (〈60 years), except in periprosthetic fractures.
    Notes: Zusammenfassung Die distale Femurmarknagelung ist in den letzten Jahren ein zunehmend gängiges Verfahren geworden. Die Hauptindikationsgebiete der retrograden Femurmarknagelung sind die distalen Femurfrakturen einschließlich der dia- und perkondylären Gelenkfrakturen des distalen Femur, Korrekturosteotomien und periprothetische distale Femurfrakturen nach Kniegelenkimplantation. In der Diskussion ist die Implantatentfernung, welche zu einem erneuten Schaden im Bereich des Kniegelenkes führt. Um den operativen Schaden der Implantatentfernung zu minimieren, wurde eine arthroskopisch gestützte Vorgehensweise gewählt. Die arthroskopisch unterstützte Metallentfernung war bei allen Patienten möglich. Intraoperativ konnten arthroskopisch bei 2/3 der Fälle unauffällige Gelenkverhältnisse gefunden werden. Die arthroskopisch gestützte Entfernung retrograder Marknägel ist eine schonende Vorgehensweise, welche die minimal-invasive Entfernung retrograder Marknägel ermöglicht und dabei mit Hilfe der arthroskopischen Sicht sekundäre Schäden im Bereich des Knies durch schwieriges Aufsuchen des Nageleintritts verhindert. Dieses Verfahren ist so schonend bei der Entfernung retrograder Marknägel des distalen Femur, dass wir die Metallentfernung – mit Ausnahme von periprothetischen Frakturen – bei jüngeren Patienten (〈60 Jahre) für indiziert halten.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 68 (1997), S. 1119-1125 
    ISSN: 1433-0385
    Keywords: Key words: Knee ; Ligaments ; Carbon fiber ; Instability ; Alloplastic prostheses. ; Schlüsselwörter: Knie ; Instabilität ; Bänder ; Kohlefaser ; alloplastische Bandprothese.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. 120 Patienten nach Ersatz des vorderen Kreuzbandes (VKB) mit La-Fil-Kohlefaserprothese wurden retrospektiv mittels Fragebogen und 80 Patienten klinisch nach im Mittel 10 ± 2 Jahren untersucht. Die subjektive Beurteilung ergab 60 % zufriedene Patienten bei deutlich vermindertem Aktivitätsniveau. Als objektive Komplikationen waren bei 72,5 % der Patienten die C-Faser rupturiert und bei 68 % der Patienten synoviale Reaktionen zu beobachten. Röntgenologisch zeigten sich in bis zu 59 % der Fälle arthrotische Veränderungen. Die mit C-Faser rekonstruierten Collateralbänder (85 % medial, 5,8 % lateral) waren zu 75 % stabil. Für das Versagen der Kohlefaserprothesen scheinen weniger die Aktivität oder die Zeit als vielmehr das Einwachsverhalten der Prothesen eine Rolle zu spielen. Im Langzeitverlauf führt die reaktive Synovitis über katabole Enzymreaktionen zur Gelenkdestruktion. Klinische Zeichen sind rezidivierende Gelenkergüsse und Schmerzen. Zur Unterbrechung des Circulus vitiosus ist die (arthroskopische) Synovektomie indiziert.
    Notes: Summary. The retrospective results of carbon prostheses for knee ligament reconstruction in 120 patients, as established by questionnaire, are reported at 10 ± 2 years follow-up. Eighty patients could also be reviewed clinically. Some 60 % of the patients showed good subjective function at reduced activity level. Complications were seen in 72.5 % of the patients with rupture of the carbon prosthesis and in 68 % of those with synovitis. X-ray showed osteoarthritis in up to 59 % of the patients. Carbon prostheses for collateral ligament reconstruction (85 % medial, 5.8 % lateral) were successful in 75 % of cases. Activity and time seem to be less responsible for failure of the carbon prostheses than the features of growing in. Destruction of the knee joint over time is due to reactive synovitis and catabolic enzyme reaction and correlates with joint effusion and pain. If these problems appear, (arthroscopic) resection of the synovia is indicated to interrupt the circulus vitiosus.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Arthroskopische Kapsel-Labrum-Refixation ; Akute und chronische Schulterluxationen ; Isokinetik ; Key words Acute and chronic shoulder instability ; Arthrosopic suture repair ; Isokinetic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: We examined 30 patients with an arthroscopic suture repair for anterior shoulder instability in a retrospective evaluation. The follow-up period ranged from 12 to 58 months with an average of 22 months. Arthroscopic suture repairs were done on 14 patients (acute group, average age 26.1 years) with acute detached glenoid labrum, confirmed on arthro-CT, within 10 days after the injury and on 16 patients (secondary group, average age 25 years) with chronic should dislocation. The evaluation according to the Rowe scale resulted in a mean score of 97.1 for the acute group, compared with 92.7 for the secondary group. In each group we found one recurrent dislocation, which in the acute group was due to an adequate trauma. Two of the 14 acute group patients showed a reduction in external rotation of up to 20°, compared with 6 patients in the secondary group. The external rotation of one patient in the secondary group was reduced to 40°. The isokinetic muscle strength was decreased in both groups, both for 60°/s and for 120°/s, to 85% compared with the healthy side. The primary surgical therapy of young patients (below 25 years) with an acute shoulder dislocation and a detached glenoid labrum is recommended owing to the lower redislocation rate, an overall shortened course of treatment and a trend to better postsurgical range of motion.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Der Unfallchirurg 101 (1998), S. 537-542 
    ISSN: 1433-044X
    Keywords: Key words Shoulder instability • Arthroscopic repair • Implants bioabsorbable • Surgical technique ; Schlüsselwörter Schulterinstabilität • Arthroskopie • Resorbierbares Implantat • Operationstechnik
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Nach arthroskopisch, mit resorbierbaren Dübeln, versorgter vorderer Schulterluxation wurden 38 Patienten prospektiv durchschnittlich nach 22 (12–33) Monaten nachuntersucht. Das Durchschnittsalter zum Zeitpunkt der Operation betrug 28,4 (15–57) Jahre, das Intervall zwischen Erstluxation und Operation im Mittel 50 (3–244) Monate; 33 Patienten erreichten im Rowe-Score ein ausgezeichnetes Ergebnis, 3 ein gutes und je einer ein mäßiges oder schlechtes Ergebnis. Eine freie Beweglichkeit zeigten 26 Patienten, bei 11 war die Außenrotation 〈 10 ° und bei 1 〈 20 ° eingeschränkt. Die Gesamtreluxationsrate betrug 8 % (je 1 Patient mit 2 maliger Voroperation, habitueller und multidirektionaler Instabilität). Die arthroskopische Versorgung der vorderen Schulterluxation mit resorbierbaren Dübeln führt bei richtiger Indikation und Beachtung operationstechnischer Details zu sehr guten, den offenen Verfahren gleichwertigen Resultaten. Insbesondere Patienten mit unidirektionaler, rezidivierender Schulterinstabilität mit in der Regel gut erhaltenem Kapsel-Band-Gewebe eignen sich für die beschriebene Technik.
    Notes: Summary We examined 38 patients with an arthroscopic bioabsorbable tack repair for anterior shoulder instability in a prospective evaluation. The mean follow-up was 22 months (range 12 to 33). The average age was 28.4 years (range 15 to 57), the operation was performed at average of 50 months (3 to 244 months) after injury. Assessment using the Rowe score revealed excellent results in 33 and good results in 3 patients. 1 patient had a fair result and 1 had a poor result. 26 shoulders obtained full range of motion, 11 had minor (〈 10 °) loss of external rotation, 1 experienced greater (〈 20 °) loss of external rotation. 3 of the 38 patients (8 %) had recurrent instability, 1 patient with 2 preceding operations and atraumatic and voluntary dislocation, respectively. The recurrence rate of arthroscopic Bankart repair with bioabsorbable tacks are comparable to open Bankart procedures. Success of the procedure depends on appropriate surgical technique and suitable selection of patients with unidirectional, posttraumatic, anterior instability who are found to have well-developed ligamentous tissue.
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  • 9
    ISSN: 1433-7347
    Keywords: Key words Anterior cruciate ; ligament refixation ; Modified ; Marshall technique ; PDS II
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The results of prospective anterior cruciate ligament (ACL) refixation in 33 patients with high proximal rupture is reported at 20– 28 months’ follow-up: mean age was 31.1 ± 12.5 years. The surgical technique was a specially developed refixation of the ACL using a multiple suture loop (modified Marshall technique) augmented with intra-articular PDS II (polydioxanon, resorbable, Ethicon, Hamburg, Germany) to avoid derangement of blood circulation and to guarantee early functional rehabilitation. All patients were operated on within 7.3 ± 4.5 days after injury. According to the IKDC evaluation score, 22 patients showed excellent and 10 patients good subjective function. Twenty regained their pre-injury level of activity. Anterior stability was tested manually and by KT-1000 max (Medmetric, San Diego). Twenty-eight patients had a firm end-point, although there was a positive Lachman test in 16 patients. Maximal joint laxity as measured by KT-1000 showed a 1–2 mm, 3–5 mm, 6–10 mm and 〉 10 mm anterior drawer for 16, 14, 2 and 1 patients, respectively. Twenty-five of the evaluated knee joints had a negative pivot shift test. Three patients had a limited range of motion. The potential advantages of PDS II-augmented refixation of acute proximal ACL ruptures are anatomic reconstruction without destruction of other anatomic structures used as grafts, early functional rehabilitation and possibly better proprioception.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Knee surgery, sports traumatology, arthroscopy 7 (1999), S. 166-172 
    ISSN: 1433-7347
    Keywords: Key words Clinical study ; Knee instability ; Anterior cruciate ; ligament ; Ultrasound evaluation ; KT 1000 arthrometer ; Prone evaluation of the knee
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL) lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees was to compare the diagnostic accuracy of prone ultrasonographic Lachman testing with KT-1000 measurements in the same study population. Our technique is based on a prone position of the patient. The thigh lies on the table surface such that the patella has no contact. The lower leg is placed on a roll in the ankle area and flexed to 30 °. The transducer (5 MHz) is positioned over the medial aspect of the popliteal fossa to visualize the femoral condyle as well as the tibial head. Under ultrasound control the lower leg is manually lifted as far the thigh stays in contact with the surface defining the startposition. The lower leg is then released and drawn by gravity into the anterior drawer position, the final position. The distance between the posterior tangent from the medial femoral condyle to the medial tibial plateau was registered by three independent ultrasound measurements of the injured knee. The uninvolved opposite knee served as an internal control. The same procedure was done using a KT-1000 device (89 and 133 Newton and manual maximum force). The patients were split into two groups: acute injury (A), and (B) 6 months following ACL repair with a patellar tendon graft. All patients then underwent arthroscopy. In group A with acute ACL lesions the anterior drawer resulted in 14.1 mm (± 3.5) and was significantly (P 〈 0.001) different from the contralateral knee (7.7 mm ± 2.9). The KT 1000 showed a comparable difference with 14.4 mm (± 3.9) for the injured knee and 8.3 mm (± 3.4) for the uninjured (P 〈 0.001). Sonometrically, group B patients showed no clear difference between the repaired (9.9 mm ± 2.7) knee and its control (8.1 mm ± 2.5). This was found for the KT-1000 results as well. The results derived from the ultrasound evaluation of the anterior drawer correlated well with those from the KT-1000 (r = 0.46). Based on a minimum intra-individual difference of 5 mm in the ultrasound measured anterior drawer, the sensitivity of the test in group A resulted in 0.96, and the specificity in 0.98. The described technique is reproducible, painless and easy to perform in order to evaluate acute ACL tears using any commercially available ultrasound device. The reproducibility is similar to the KT-1000 device. We recommend this technique for use in cases of acute ACL tears as well as in the follow-up of ACL repair.
    Type of Medium: Electronic Resource
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