PURPOSE OF THE STUDY: The study describes changes in gait parameters (temporal-spatial parameters, kinematic parameters represented by the global Gait Deviation Index) of individuals with Adolescent Idiopathic Scoliosis (AIS) compared to the healthy population. The hypothesis assumed a difference in the observed parameters between the two mentioned groups. MATERIAL AND METHODS: In a retrospective study, the temporal-spatial parameters and Gait Deviation Index (GDI) of a cohort of 45 AIS patients (36 girls and 9 boys with the mean age of 15.2 years, the mean Cobb angle of the thoracic curve of 47.3° and the lumbar curve of 51.8°) were compared to a typically developing population of 12 healthy individuals with no musculoskeletal pathology. The difference of followed-up parameters in patients with AIS compared to normal values was assessed by one-sample Student's T-test at the significance level of p = 0.05. RESULTS: The gait analysis shows significant deviations in the gait stereotype of patients with AIS compared to the healthy population. Statistically significant differences within temporal-spatial parameters were confirmed for cadence, walking speed, step time, stride time for left leg, step length, stride length and step width. The mean GDI of the cohort reached the value of 91.07 that indicates a slight alteration of gait, however, even this change is statistically significant. DISCUSSION: In our cohort of patients with AIS, we identified a significantly reduced walking speed (on average 15.4% compared to normal values. At the same time, a reduction in cadence (by an average of 7.5%) and an increase of the stride time (by an average of 12%) were recorded. Our mean GDI values were 91.07, which is consistent with the results reported in the literature for comparable groups of AIS patients. CONCLUSIONS: Our study demonstrated that AIS significantly affects gait stereotype. The differences compared to the group of healthy individuals within temporal-spatial parameters were confirmed for cadence, walking speed, duration and length of step and stride, and step width. The kinematic analysis of gait using the global (GDI) index in patients with AIS demonstrated its slight alteration. A better understanding of the change in movement stereotypes and gait in patients with AIS can bring wider possibilities for individualizing conservative treatment and also can help prevent secondary changes in the locomotor system. KEY WORDS: adolescent idiopathic scoliosis, AIS, gait analysis, Gait Deviation Index, GDI.
- MeSH
- analýza chůze * metody MeSH
- biomechanika MeSH
- chůze (způsob) fyziologie MeSH
- lidé MeSH
- mladiství MeSH
- retrospektivní studie MeSH
- skolióza * patofyziologie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
BACKGROUND: Idiopathic scoliosis does not only cause structural changes in the spine, but also functional changes of the musculoskeletal system. RESEARCH QUESTION: Does idiopathic scoliosis lead to asymmetric hip loading in severe Lenke type 1 deformity? METHODS: 23 patients (18 girls, 5 boys) aged 15 ± 2.8 years with an adolescent idiopathic main thoracic curve (Cobb angle 48.8°+/- 9.2°) were included. Measured X-ray parameters were: Cobb angle of primary thoracic and secondary lumbar curve, translation of the C7- plumb line, apical thoracic vertebra and apical lumbar vertebra from the central sacral vertical line. Subjects were examined by means of kinematic and kinetic gait analysis. The symmetry index (SI) was calculated as a ratio of hip frontal moments during a single stance for both sides when the symmetrical load was considered SI = 0 + /- 29.36 (0 +/- 1 SD of the mean SI of the healthy population). The Pearson correlation coefficient was used to show the relation between hip loading and radiologic measures of spinal deformity. RESULTS: Only 34.8% of subjects with Lenke type 1 deformity showed symmetrical hip loading. Significant negative correlation was proved between SI and apical thoracic vertebra translation (R = - 0541; p < 0,05) as well as between SI and coronal imbalance (R = -0,5197; p < 0,05). There was no correlation between SI and the magnitude of the primary thoracic curve (R = -0.19; p = 0.385). Coronal imbalance correlates positively with translation of apical thoracic vertebra (R = 0,7255; p < 0,05). SIGNIFICANCE: Two-thirds of subjects with Lenke type 1 deformity showed asymmetrical hip loading. This asymmetry is related to the translation of the apical thoracic vertebra and coronal imbalance and is not related to the magnitude of the main thoracic curve. On the contrary, the secondary lumbar curve plays role in the compensatory mechanism of the trunk.
- MeSH
- bederní obratle diagnostické zobrazování MeSH
- fúze páteře * MeSH
- hrudní obratle MeSH
- lidé MeSH
- mladiství MeSH
- radiografie MeSH
- retrospektivní studie MeSH
- skolióza * diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY A retrospective evaluation of the success rate of revision ACL reconstruction performed using BTB allograft in terms of the life expectancy of the procedure up to and over five years from surgery. MATERIAL AND METHODS Over a ten-year period, from 2003 to 2013, we performed 47 revision ACL reconstruction surgeries. The majority of the primary ACL reconstructions using BTB autografts were not performed at our site. The group observed included 16 women (34%) and 31 men (66%). The women were aged between 25 and 48 years, the median age being 32.5, and the men were aged between 25 and 46 years with the median age of 35. We were able to make a full pre- and post-operative evaluation of 22 out of 47 patients who underwent secondary ACL reconstruction surgery using a cadaverous BTB graft. This evaluation included an objective clinical testing and a subjective evaluation of the function and stability of the knee joint using the Tegner activity score, Lysholm score, and a modified Cincinatti score. The set of 22 patients was split into two groups: up to five years from revision surgery and over five years from the procedure. RESULTS In the group of patients who were fully evaluated within five years of revision reconstruction there was an average improvement of 16.4 points on the Cincinatti score, 19.9 points on the Lysholm score, and an upward movement averaging 1.5 levels on the Tegner activity score. In the over five years from surgery category the average improvement was 15.5, 15.9, and 1.2 levels upward movement, respectively. We were unable to prove a significantly increased level of failure in BTB allografts after five and more years from revision ACL reconstruction. DISCUSSION The two strongest factors affecting the life expectancy of ACL replacements are the age of the patient and the type of the graft used, allograft or autograft. The most at risk, in terms of how long the graft will last, is the age group of 10 - 19 years old. With each ten-year increase in age the risk of rupture is reduced more-or-less by half. Patients with ACL allograft replacement show a fourfold increased risk of the graft rupturing. The younger and more active the patient requiring revision ACL reconstruction is, the greater the need for an autograft. If an allograft has been used in revision reconstruction on an athlete, a great emphasis must be placed on the necessity of delaying the return to previous sporting activities for at least nine months. CONCLUSIONS The mid-term results of revision ACL reconstruction show that, subject to reasonable levels of stress, a correctly performed procedure using cadaverous BTB grafts is a good option to restore the stability of the knee joint over a period of five years and more from surgery. An increased incidence of reruptures or greater insufficiency of the cadaverous graft were not evident in our group after five and more years. The risk of cadaverous grafts failure is just like in the autologous replacement directly linked to the return to sport interval, frequency and intensity of stress to which the graft is subjected over a long period of time. The risk of rerupture is always higher in allograft reconstructions that have already stood in need of restructuring for a longer period of time. For this reason, a delay in returning to sports activity must be emphasized. As a rule, we recommend a return to full athletic training only after nine months to a year after surgery. Key words: anterior cruciate ligament, revision ACL reconstruction, tendon graft insufficiency, BTB autograft insufficiency, BTB allograft of the ACL, cadaverous BTB graft, ACL graft rerupture.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- neúspěšná terapie MeSH
- reoperace statistika a číselné údaje MeSH
- spokojenost pacientů * MeSH
- štěp kost-čéškový vaz-kost škodlivé účinky metody psychologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
