PURPOSE OF THE STUDY The authors present the clinical use of the new instrumentation set for the anterior cruciate ligament (ACL) reconstruction using the hamstring tendons (HS). The positionning of the femoral tunnel and the fixation of the graft play an important role for the results of the surgery. The aim of the study was to confirm the proposed surgical technique and the methods of the graft fixation, especially from the point of view of the clinical midterm results at the evaluation up to eight years after the surgery. MATERIAL AND METHODS The clinical evaluation comprises 58 patients operated from 2007 to 2014 using the new instrumentation set. There were 9 men and 49 women included in the sample. The mean age was 34.6 years (range 18 - 58 yrs), namely 36.7 in women and 32.4 years in men. The evaluation was performed pre-opeatively and at 3 and 6 months, 1, 3, 5 and 8 years post-operatively. All the patients were followed based on the same criteria - clinical range of motion (ROM), stability of the knee - instrumentation Lachman test utilizing Rolimeter, subjective IKDC score and pain VAS scale for the harvesting site. The ocurrence and the rate of post-operative complications were monitored. RESULTS The integration and the ingrowth of the graft were achieved in all cases, the full ROM was gained as well, no pathological instability was observed. The fixation of the HS graft in the bone was confirmed by post-op X ray at 3 months after the surgery. The clinical evaluation showed the following mean differences in the pre-op and final post-op findings. The average preoperative laxity using the Lachmann test was 9.7 mm (range 6-12 mm), at 3 months 1.8 mm (1.4-2.1 mm), at 6 months 1.6 mm (1.2 - 2.2 mm), at 1 year 1.6 mm (1.1-2.3 mm), at 3 years the stability was 1.7 mm (1.2 mm-2.4 mm), at 5 years 2.3 mm (1.2-3.6 mm) and at 8 years after surgery it was 2.5 mm (1.2-3.9 mm). None of the patitents included in the study showed pathological instability that would be considered an indication for revision. In the evaluation of the subjective IKDC score, the pre-operative average was 56, with the range of 42-66, at 3 months post-operatively 79 (69-85), at 6 months 88 (74-92), at 1 year 95 (88-100), at 3 years 96 (89-100), at 5 years 94 (87-100), and at 8 years 92 (84-98). No severe complications were observed. CONCLUSIONS The method provided sufficient post-operative stability of the knee joint. Fixation of the femoral screw satisfied the demands laid on it. Regarding the pain perception, the method was considered positive, the level of pain involved in the procedure was low. No severe complications or technical mistakes occurred during the surgical procedures. The new instrumentation set developed for the ACL reconstruction offers an easy technique and comfortof use. Key words:anterior cruciate ligament, reconstruction, hamstrings, knee arthroscopy, instrumentation set.
- MeSH
- dospělí MeSH
- kolenní kloub MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum cruciatum anterius MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nestabilita kloubu * MeSH
- poranění předního zkříženého vazu * MeSH
- rekonstrukce předního zkříženého vazu * MeSH
- šlachy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The success rate of the anterior cruciate ligament (ACL) reconstruction depends on the fixation of the graft, the surgical technique and, of course, on the experience of the operating surgeon. The authors present the development of the construction of the new instrumentation set designed to manage the ACL lesions using the hamstring (HS) tendons. The study is divided into two parts, of which part one focuses on construction, methods and work with new instruments, while part two presents the outcomes of the surgery. MATERIAL AND METHODS Fixation of hamstring grafts depends, contrary to the union of bone blocks in the Bone-Tendon-Bone (BTB) graft and the bone tunnel, on the method of tendon graft fixation and compression inside the bone tunnel. The instrumentation set for ACL reconstruction is designed to be used for hamstring tendons (semitendon and gracilis) forming four strands of the prepared graft. The system was designed as the fixation of the graft using the femoral screw with eyelet and a press-fit fixation using a metal interference screw in tibia. The easiest and fastest option has proven to be the pulling of the screw with eyelet through the tibial tunnel and intra-articular space to the femoral canal, where fixation by screwing in is done. The exact position of the inserted screw is verified by the measuring gauge. The screw is pulled in by the long version of the femoral screwdriver and Kirschner wire passing through the middle of the screw with eyelet. The advantage of this system consists in the subsequent insertion of the interference screw by the same wire, which guarantees its exact positioning in the centre between the individual strands of the graft (thanks to the specific way of ligament preparation). The possibility of later tensioning of the graft by tightening the femoral screw is another advantage. DISCUSSION Compared to other methods using the HS tendons, the advantages of the described operative technique consist in the simplicity of the used instrumentation procedure. The technique of graft fixation inside the femoral canal is not suitable for bioabsorbable materials. It is offset by the fixation stability and the possibility of final graft tensioning. CONCLUSIONS The newly developed instrumentation set for ACL reconstruction is fit for purpose, easy as to the surgical technique, and it guarantees the logical sequence of surgical steps reducing surgical errors to minimum. The instrumentation set is user-friendly, easy to handle and, once the operating surgeon masters the surgical procedure, it allows to reduce the duration of the surgery to approximately 30 minutes. There were no major complications or technical errors reported during the surgical procedures using these instrumentation set.
Small hydrophobic gold nanoparticles with diameter lower than the membrane thickness can form clusters or uniformly distribute within the hydrophobic core of the bilayer. The coexistence of two stable phases (clustered and dispersed) indicates the energy barrier between nanoparticles. We calculated the distance dependence of the membrane-mediated interaction between two adjacent nanoparticles. In our model we consider two deformation modes: the monolayer bending and the hydroxycarbon chain stretching. Existence of an energy barrier between the clustered and the separated state of nanoparticles was predicted. Variation analysis of the membrane mechanical parameters revealed that the energy barrier between two membrane embedded nanoparticles is mainly the consequence of the bending deformation and not change of the thickness of the bilayer in the vicinity of nanoparticles. It is shown, that the forces between the nanoparticles embedded in the biological membrane could be either attractive or repulsive, depending on the mutual distance between them.
PURPOSE OF THE STUDY Hamstring grafts are commonly used for ACL reconstruction. The purpose of our study is to determine the effects of the suspension fixation compared to graft cross-pinning transfixation, and the effect(s) of structural damage during the preparation of the graft on biomechanical properties of the graft. MATERIAL AND METHODS The design of the study is a cadaveric biomechanical laboratory study. 38 fresh-frozen human hamstring specimens from 19 cadaveric donors were used. The grafts were tested for their loading properties. One half of each specimen was suspended over a 3.3mm pin, the other half was cross-pinned by a 3.3mm pin to simulate the graft cross-pinning technique. Single impact testing was performed and the failure force, elongation and acceleration/deceleration of each graft was recorded and the loading force vs. elongation of the graft specimens was calculated. Results for suspended and cross-pinned grafts were analysed using ANOVA method, comparing the grafts from each donor. RESULTS The ultimate strength of a double-strand gracilis graft was 1287 ± 134 N when suspended over a pin, the strength of a cross-pinned graft was 833 ± 111 N. For double-strand semitendinosus grafts the strengths were 1883 ± 198 and 997 ± 234 N, respectively. Thus, the failure load for the cross-pinning method is only 64.7% or 52.9% for the suspension method. DISCUSSION Structural damage to the graft significantly reduces the graft strength. Also, extensive suturing during preparation of the graft reduces its strength. CONCLUSIONS Fixation methods that do not interfere with the graft's structure should be used to reduce the risk of graft failure. Key words: ACL reconstruction, hamstring graft, biomechanical testing.
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
For biodegradable porous scaffolds to have a potential application in cartilage regeneration, they should enable cell growth and differentiation and should have adequate mechanical properties. In this study, our aim was to prepare biocompatible scaffolds with improved biomechanical properties. To this end, we have developed foam scaffolds from poly-epsilon-caprolactone (PCL) with incorporated chitosan microparticles. The scaffolds were prepared by a salt leaching technique from either 10 or 15 wt% PCL solutions containing 0, 10 and 20 wt% chitosan microparticles, where the same amount and size of NaCl was used as a porogen in all the cases. PCL scaffolds without and with low amounts of chitosan (0 and 10 wt% chitosan) showed higher DNA content than scaffolds with high amounts of chitosan during a 22-day experiment. 10 wt% PCL with 10 and 20 wt% chitosan showed significantly increased viscoelastic properties compared to 15 wt% PCL scaffolds with 0 and 10 wt% chitosan. Thus, 10 wt% PCL scaffolds with 0 wt% and 10 wt% chitosan are potential scaffolds for cartilage regeneration.
- MeSH
- biokompatibilní materiály aplikace a dávkování chemie MeSH
- chrupavka cytologie fyziologie MeSH
- kultivované buňky MeSH
- lidé MeSH
- mikrosféry * MeSH
- polyestery aplikace a dávkování chemie MeSH
- proliferace buněk účinky léků fyziologie MeSH
- řízená tkáňová regenerace metody MeSH
- tkáňové podpůrné struktury * MeSH
- viabilita buněk účinky léků fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Our study compares the histological and immunohistochemical cellular composition of two different chondrocyte-seeded biomaterials and the results of their transplantation. Our study cohort included 21 patients, comprising 19 men and two women with a mean age of 32 years, who were affected by single chondral lesions of the femoral condyles. These patients were enrolled in our study and treated with arthroscopic implantation of the tissue Hyalograft C and/or Brno culture. Brno culture bioengineered with a fibrin-based scaffold contains round cells showing features of differentiated chondrocytes expressing S-100 protein and α-smooth muscle actin. In contrast, in the case of Hyalograft C, the scaffold was made up of a fibrillar network composed of biomaterial fibres of the esters of hyaluronic acid and cells resembling fibroblasts and myofibroblasts and expressing only α-smooth muscle actin. The average size of the defects was 2.5 cm2. Patients were evaluated using the standardized guidelines of the International Knee Documentation Committee. During the comparison of bioptic samples obtained from both patient cohorts, we did not observe any important differences in the histological makeup of the newly formed cartilage. The histological analysis of these two groups of homogeneous patients shows that this bioengineered approach, under proper indications, may offer favourable and stable clinical results over time, in spite of the different matrix and cellular composition of the two transplants used.
- MeSH
- aktiny metabolismus MeSH
- artroskopie MeSH
- biokompatibilní materiály chemie MeSH
- biopsie MeSH
- buněčná diferenciace MeSH
- chondrocyty cytologie transplantace MeSH
- chrupavka patologie MeSH
- dospělí MeSH
- femur patologie MeSH
- fibroblasty cytologie MeSH
- kohortové studie MeSH
- koleno patologie MeSH
- kyselina hyaluronová analogy a deriváty chemie MeSH
- lidé MeSH
- proteiny S100 metabolismus MeSH
- tkáňové inženýrství metody MeSH
- transplantace buněk metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
PURPOSE: The aim of the present study was to introduce a novel oblong revision cup type TC for use in revision total hip arthroplasty (THA), and to evaluate mid-term results in terms of bone tissue remodelling in the immediate area of the implant. METHODS: The results of 31 patients that underwent revision THA between 2004 and 2008 are presented. The mean follow-up interval was 7.1 years (range 5.3-9.3 years, minimum of five years following revision). Osteointegration of the implant and bone tissue remodelling around the implant and ribs were assessed by X-ray and computed tomography (CT). RESULTS: The average Harris hip score increased from 39.8 to 85.3. Excellent results were achieved in nine patients, good in 16, fair in three and poor in three. According to X-ray results, 25 hips had a well-fixed, bone-ingrown cup and five had a stable fibrous union in the middle and the distal third of the implant. Proximal migration of the cup was noted in one case. Pelvic CT was additionally performed in ten patients. In all cases, we detected bone remodelling in the space between the implant ribs. Kaplan-Maier survivorship of the acetabular components was 94.2 % at 7.1 years. CONCLUSIONS: Our results show that the novel oblong revision cup type TC is relatively simple to implant, and is associated with reliable primary fixation and documented osteointegration and bone remodelling in the immediate area.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- kyčelní protézy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * MeSH
- protézy - design MeSH
- reoperace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Mnohočetný myelom (MM) svou manifestací na skeletu ohrožuje postiženého jedince vznikem patologických zlomenin. Nejčastějším klinickým projevem progredující infiltrace kostní dřeně nádorovými buňkami je bolest v oblasti postižené kostní tkáně, další příznaky jsou spojeny s poruchou funkce ledvin a útlumem krvetvorby. Část zaměřená na diagnostiku objasňuje výtěžnost jednotlivých metod ke stanovení správné diagnózy, z nichž rozhodující význam má probatorní biopsie. Z velmi pestré symptomatologie onemocnění jasně vyplývá nutnost komplexního přístupu lékařů k pacientovi s posouzením celkového a lokálního nálezu, rizik následných intervenčních výkonů a s nimi souvisejících případných komplikací. Mirelsovo skóre popisující pravděpodobnost vzniku patologické zlomeniny je současně směrnicí indikačně-terapeutickou. Vedle radioterapie lze včasnou operací úspěšně předejít porušení kostní kontinuity u hrozící patologické zlomeniny. V části zaměřené na léčbu autoři popisují načasování jednotlivých terapeutických metod vzhledem k objektivnímu nálezu na skeletu. Při vlastní operační léčbě je důležitá volba vhodného typu výkonu a implantátu ve vztahu k prognóze přežití s hlavním cílem eliminovat bolesti, zlepšit funkci postižené končetiny a tím zvýšit kvalitu života nemocného.
A multiple myeloma (MM) manifested on the skeleton poses a risk of pathological fractures for the concerned patient. The most frequent clinical manifestation of progressing tumour-cell infiltration into the bone marrow is pain in the region of the affected bone tissue. Other symptoms are associated with kidney function disorder and the inhibition of haematopoiesis. The diagnostics section of the article explains the yield of individual methods for the determination of the correct diagnosis, explorative biopsy being of crucial significance. The highly manifold symptomatology requires a complex approach of the doctor to the patient, assessment of the total as well as local findings, of the risks associated with subsequent intervention procedures and potential complications related thereto. Mirel’s score, describing the possible risk of pathological fractures, serves also as an indicative and therapeutic guideline. In addition to radiotherapy, an early surgery may successfully prevent a break in bone continuity where a risk of pathological fracture exists. In the section on treatment, the authors describe the timing of individual therapeutic methods with a view to the objective finding on the skeleton. In terms of the surgical treatment proper, the choice of a suitable type of the surgical procedure and a suitable implant is important in respect of the survival prognosis, the primary objective being the elimination of pain and improved function of the involved extremity, which may improve the quality of life of the patient.
- Klíčová slova
- Mirelsovo skóre, osteolytické ložisko, patologická zlomenina, osteosyntéza,
- MeSH
- akutní poškození ledvin komplikace MeSH
- anemie komplikace MeSH
- bisfosfonáty terapeutické užití MeSH
- denzitometrie MeSH
- dospělí MeSH
- fraktury spontánní etiologie chirurgie komplikace MeSH
- krevní obraz MeSH
- kvalita života MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mnohočetný myelom diagnóza komplikace terapie MeSH
- nádory kostí komplikace sekundární terapie MeSH
- nádory kostní dřeně patologie MeSH
- nezvladatelná bolest MeSH
- ortopedické výkony metody MeSH
- osteolýza diagnóza epidemiologie terapie MeSH
- paliativní péče metody MeSH
- počítačová rentgenová tomografie MeSH
- prognóza MeSH
- progrese nemoci MeSH
- radiografie MeSH
- radioisotopová scintigrafie MeSH
- radioterapie metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tomografie emisní počítačová MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- přehledy MeSH
