- MeSH
- artroskopie metody MeSH
- bolest ramene diagnóza etiologie MeSH
- burzitida chirurgie diagnóza farmakoterapie MeSH
- diferenciální diagnóza MeSH
- luxace ramenního kloubu chirurgie diagnóza etiologie MeSH
- pooperační péče metody rehabilitace MeSH
- poranění ramene chirurgie etiologie MeSH
- poranění rotátorové manžety chirurgie diagnóza MeSH
- ramenní kloub * chirurgie patofyziologie MeSH
- syndrom zhmožděného ramene chirurgie diagnóza farmakoterapie MeSH
- techniky fyzikální terapie * MeSH
- věkové faktory MeSH
- Publikační typ
- přehledy MeSH
Úvod: Frekvence artroskopií kolene zahrnujících zadní kompartmenty roste se zlepšováním a rozšiřováním artroskopického instrumentária a chirurgických technik. Cílem této práce je prezentovat naše zkušenosti se zadními artroskopickými přístupy do kolenního kloubu. Materiál a metoda: Od roku 2003 do roku 2013 jsme provedli artroskopii kolene s využitím zadních přístupů u 67 pacientů (41 mužů a 26 žen). Průměrný věk v době operace byl 31 let. Indikacemi k chirurgickému výkonu byly ošetření trhlin zadních rohů menisků, rekonstrukce zadního zkříženého vazu (PCL), artroskopicky asistované fixace tibiálních avulzních zlomenin zadního zkříženého vazu a odstranění volných nitrokloubních tělísek. Diagnóza byla stanovena na základě klinického vyšetření, prostého rtg vyšetření a u některých pacientů magnetické rezonance (MRI). Po artroskopické vizualizaci kolene ze standardních předních přístupů byly vytvořeny posteromediální a posterolaterální přístupy a zadní kompartmenty kolene byly ošetřeny. Pooperační sledování probíhalo v rozmezí od několika týdnů po několik let v závislosti na typu operace. Výsledky: U žádného ze 67 pacientů našeho souboru se nevyskytly perioperační ani pooperační komplikace po artroskopii kolene. Tito pacienti udávali subjektivní zlepšení po operaci. Diskuze: V dnešní době se artroskopické operace upřednostňují před konzervativní léčbou či klasickými otevřenými chirurgickými postupy. Ačkoliv artroskopie zadních kompartmentů kolene je pro zkušeného operatéra relativně bezpečná, přetrvávají určité obavy z iatrogenního poranění okolních nervově-cévních struktur během artroskopické operace. Různými autory bylo popsáno několik odlišných způsobů vytvoření zadních přístupů.
Introduction: The frequency of knee arthroscopy involving the posterior compartments has increased with recent improvements in surgical techniques and arthroscopic equipment. The aim of this study is to present our experience with posterior arthroscopic portals. Material and Methods: From 2003 till 2013 knee arthroscopy with use of posterior portals was carried out in 67 patients (41 men and 26 women). Their average age at the time of surgery was 31 years. The indications for surgery were repair of tears in the posterior horn of the menisci, posterior cruciate ligament (PCL) reconstructions, arthroscopic fixations of tibial avulsion fractures of the PCL and removal of loose intraarticular bodies. The diagnosis was based on clinical examinations, plain X-ray and MRI results in some patients. After arthroscopic visualization of the knee from standard anterior portals, the posteromedial and posterolateral portals were created and the posterior compartments of the knee were treated. The follow-up ranged from several weeks to a few years depending on character of surgery. Results: There were not any intra-operative or post-operative complications in 67 patients after the knee arthroscopy. Those patients reported subjective relief after the surgery. Discussion: Arthroscopic operations are preferred to conservative treatment or classic open surgery nowadays. Although arthroscopy in the posterior region of the knee is relatively uncomplicated for well-trained arthroscopist, there remains significant concern about iatrogenic injury to the surrounding neurovascular structures during arthroscopic procedures. Several authors reported different creation of posterior portals.
- MeSH
- artroskopie * metody trendy využití MeSH
- hodnotící studie jako téma MeSH
- kolenní kloub * chirurgie MeSH
- lidé MeSH
- ortopedické výkony * metody MeSH
- pooperační komplikace ošetřování prevence a kontrola terapie MeSH
- pooperační péče metody využití MeSH
- radiografie metody využití MeSH
- statistika jako téma MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
UNLABELLED: This study describes a diagnostic and therapeutic algorithm in a 53-year-old male patient who was diagnosed with a synovial chondromatosis of the knee joint extending to the popliteal fossa and soft tissues around the knee. Because of the presence of massive nodules, the patient was indicated for total synovectomy, with removal of pathologically changed cartilaginous tissue, performed by combined anterior and posterior approaches to the knee joint. Despite complete removal of the synovium and loose cartilage bodies and the patient's pain relief in the post-operative time, three years after the operation new problems appeared. Magnetic resonance imaging (MRI) confirmed a relapse of synovial chondromatosis and the patient was indicated for revision surgery of the knee joint. The results of physical examination and MRI scans, and intra-operative findings in the patient are reported. KEY WORDS: synovial chondromatosis, total synovectomy, direct anterior and posterior approaches to the knee joint.
- MeSH
- chondromatóza synoviální chirurgie MeSH
- kolenní kloub chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- poranění kolena chirurgie MeSH
- recidiva MeSH
- reoperace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY: The aim of this retrospective study was to present a comprehensive overview of the causes of bone-tendon-bone (BTB) autograft failure after primary anterior cruciate ligament (ACL) reconstruction. MATERIAL AnD METHODS: Between 2003 and 2013, we performed revision ACL replacement in 47 patients who had undergone primary BTB autograft ACL reconstruction in other hospitals. The group consisted of 16 women (aged 25 to 48 years) and 31 men (25 to 46 years). Surgery was performed on the right knee in 26 and on the left knee in 21 patients. In each of the 47 patients, two different assessments were made: 1. Analysis of causes of failure based on surgical protocols and/or intra-operative video records taken during most of the procedures. 2. Evaluation of bone tunnel location on lateral knee radiograms, using the method described by Harner for femoral tunnels and that reported by Stäubli and Rauschning for tibial tunnels. RESULTS: The most frequent cause of knee instability, occurring in 51.1% of the patients, was new trauma to the knee. nontraumatic instability in the remaining 48.9% was due to insuffiiency of the graft, and resulted from an incorrect surgical technique (42.5%) or biological causes (6.4%). The most common surgical mistake found was incorrect bone tunnel placement in the tibia or femur, with a malpositioned femoral tunnel being most frequent. This was diagnosed in 32 patients (68.1% of all patients) and, in 17, was the main or major cause of BTB graft failure. DISCUSSION: Based on relevant literature data and our experience, principles for prevention of graft failure after ACL reconstruction can be summarised as follows: 1. harvest of a suffiiently strong BTB autograft 2. accurate anatomical bone tunnel placement 3. appropriate tension of the BTB autograft 4. preventing graft impingement 5. secure graft fiation 6. early functional rehabilitation with an accent on delaying full weight-bearing on the knee (6 to 9 months post-operatively) CONCLUSIONS: New trauma to the knee is the most frequent cause of BTB autograft failure after ACL reconstruction. This can be avoided by participating in a professionally guided rehabilitation programme and not returning to sports activities earlier than 9 months after ACL reconstruction. The most common technical error in ACL reconstruction is non-anatomical tunnel placement in the tibia and femur. Femoral tunnel malposition is most frequent while incorrect tibial tunnel placement, which does not inflence graft failure so much, is less common.
- MeSH
- dospělí MeSH
- femur radiografie MeSH
- kolenní kloub patologie radiografie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum cruciatum anterius patologie radiografie chirurgie MeSH
- nestabilita kloubu radiografie MeSH
- neúspěšná terapie MeSH
- reoperace metody MeSH
- retrospektivní studie MeSH
- štěp kost-čéškový vaz-kost metody MeSH
- tibie radiografie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The authors present the case of aseptic necrosis of the humeral capitulum in a top female gymnast. She was referred to our department with the diagnosis of aseptic necrosis already made and after repeated arthroscopic treatment of the elbow including removal of a loose body in another institution. Exercise-related pain and swelling of the elbow became permanent and did not allow her to pursue her sports activities. After thorough examination, the treatment by implantation of autologous cultured chondrocytes, as a solid chondrograft, was chosen. At the first stage of arthroscopic surgery, a loose body was removed and a sample of healthy cartilage from an articular region not subject to strain was collected. The sample was sent to the Tissue Bank for cultivation and chondrocyte formation into a solid chondrograft, a procedure taking 4 to 5 weeks. At the second stage, the chondrograft was implanted into the lesion site and fixed with tissue glue (Tissucol). The arm was immobilised in a plaster cast for 4 weeks. The patient was followed up clinically and examined with magnetic resonance imaging at 6 month after implantation. The examination showed full graft integration and the arm's return to full mobility without pain at exercise. Even with this rare lesion site within the elbow joint, the implantation of a solid chondrograft proved to be a method achieving very good outcomes.
- MeSH
- artroskopie MeSH
- autologní transplantace MeSH
- gymnastika zranění MeSH
- humerus chirurgie zranění MeSH
- kloubní chrupavka chirurgie MeSH
- kultivované buňky MeSH
- lidé MeSH
- loketní kloub MeSH
- mladiství MeSH
- osteonekróza chirurgie MeSH
- poranění lokte MeSH
- poranění z opakovaného přetěžování MeSH
- tkáňové inženýrství MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY Injury to the posterior cruciate ligament (PCL) is relatively rare and, if combined with avulsion fracture of the PCL insertion site, it accounts for only a small number of knee injuries. This is why PCL avulsion fracture is an easily missed diagnosis resulting in knee instability and arthritis development. The aim of this study was to show the necessity of surgical treatment of these injuries. MATERIAL Between January 2004 and September 2005, four patients with PCL injury underwent surgery. Three had avulsion fracture at the PCL insertion site, and in one the avulsion fracture involved also the intercondylar eminence. The average follow-up was 15 months, with a range of 5 to 20 months. METHODS The diagnosis was based on clinical examination, plain X-ray and MRI results. After arthroscopic treatment of the anterior compartment, the posterior compartment was treated from the posteromedial and the posterolateral approach. Using a K-wire for guidance, a tunnel was drilled and the fragment was fixed with an absorbable cannulated screw. Postoperatively, the limb was immobilized in a rigid brace at a 20° flexion for weeks followed by passive exercise rehabilitation. Within weeks of surgery full weight-bearing was possible in all patients. Outcome evaluation was based on clinical, radiographic and MRI examination shortly after surgery and at 3-month follow-up. RESULTS None of the four treated knee joints had any post-operative instability. The PCL was in a correct position and showed appropriate tension on MRI scans. DISCUSION Today arthroscopically-assisted operations are preferred to conservative treatment or open osteosynthesis. An exact diagnosis is best made on the basis MRI examination. To fix the bony fragment, various techniques can be used, such as hooked nail, screw, K-wire or traction suture through the proximal tibia. The method used usually depends on the size of a bony fragment. CONCLUSIONS The advantages of arthroscopic surgery include faster healing and rehabilitation and less pain and trauma associated with the operative procedure. A readily performed arthroscopic procedure prevents knee joint instability and arthritis development, the outcomes achieved in our patients give support to the indication for surgical treatment in this kind of knee injury. Key words: posterior cruciate ligament, avulsion fracture of the tibia, arthroscopy, osteosynthesis.
