PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.
- MeSH
- bolest MeSH
- dolní končetina MeSH
- kolenní kloub * MeSH
- lidé MeSH
- mladiství MeSH
- osteochondróza * diagnóza MeSH
- sportovci MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Differential diagnosis of tumor processes in orthopedics is a relatively broad and inherently very serious issue, especially if the patients are pediatric patients. A number of examination procedures is used in diagnostics, together with a wide range of complementary laboratory and imaging methods. However, the clinical examination, including the collected anamnestic data, remains to be the cornerstone. In pediatric patients, of major importance is the cooperation with parents, but not always necessary information is provided to make the final diagnosis. In younger children, it is very often impossible to obtain relevant anamnestic data due to a number of factors that are typical for pediatric patients, namely fear, noncooperation, misunderstanding of questions, mainly as a result of mental immaturity. Therefore, diagnosis in these cases is based primarily on clinical and complementary findings. This work presents a complex issue of this diagnosis, with a surprising and unexpected finding of a foreign body in the knee joint of a pediatric patient, which completely changed the subsequent treatment strategy. It concerned a 10-year-old boy referred to our clinic from another workplace for suspected tumor process in the knee joint. The whole process of examination and final diagnosis depends on a number of detailed information that we have tried to obtain throughout the process. Key words: tumor, knee, foreign body, diagnostics, imaging methods.
- MeSH
- cizí tělesa * diagnostické zobrazování chirurgie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- kolenní kloub * diagnostické zobrazování MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Patelofemorální kloub u dítěte může být postižen onemocněním vrozeným, traumatem, nebo získanou vývojovou patologií. Vrozené poruchy patelofemorálního kloubu vznikají na podkladě vrozené vady, abnormality nebo anatomické variace. Získané poruchy postihují často děti předškolního věku a dospívající. Jedná se zejména o traumata nebo jejich následky. Volba nejvhodnější terapie dané patologie se odvíjí od klinického projevu postižení. Uplatňuje se jak léčba chirurgická, tak konzervativní. Podobnost příznaků jednotlivých patologických stavů může vést k nesprávné diagnostice. Významné postavení v léčbě zastává v současné době miniinvazivní operativa. Problematika patelofemorálního kloubu u dítěte by měla být vždy řešena ve specializovaném centru zaměřeném na dětskou ortopedii a traumatologii.
Patello-femoral joint in paediatric patients can be affected by various inherited, traumatic or acquired conditions. Congenital pathologies usually relate to inherited abnormality or anatomic variations. The acquired or pathology usually develops in early school age and later in adolescence. The optimal treatment options depends on the clinical presentation and type of pathology and involves both conservative and surgical therapy. The main role in surgical management represents mini- invasive approach to treatment. The patella-femoral problems should be addressed in specialized centers dealing with paediatric orthopaedics and traumatology.
- MeSH
- dědičná osteoonychodysplazie diagnóza patologie terapie MeSH
- dítě * MeSH
- fraktury kostí diagnóza etiologie terapie MeSH
- kolenní kloub diagnostické zobrazování patologie MeSH
- lidé MeSH
- luxace pately diagnóza etiologie terapie MeSH
- patela diagnostické zobrazování patologie MeSH
- patelofemorální kloub * diagnostické zobrazování patologie MeSH
- poranění z opakovaného přetěžování diagnóza etiologie terapie MeSH
- syndrom MeSH
- synoviální membrána patologie MeSH
- vrozené vady MeSH
- Check Tag
- dítě * MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Our paper presents a unique case of a 64-year-old patient after a fall, treated with oral antidiabetic drugs for type II diabetes mellitus. Following a series of examinations, a bilateral injury was diagnosed - patellar ligament tear on the right side and rupture of quadriceps femoris muscle on the left side. It is a rare injury, complicated by simultaneous involvement of both knee joints. The used therapy consisted of a bilateral surgery followed by gradual verticalisation, first with the support of a walking frame and later with the use of forearm crutches. During the final examination, the patient demonstrated full flexion at both knees, while an extension deficit of approx. 5 degrees was still present on the left side. The right knee X-ray showed a proper position of the patella after the removal of temporary tension band wire. Although the clinical results of operative treatment of both the patellar ligament rupture and rupture of quadriceps femoris muscle are in most cases good, early operative treatment, proper technique and post-operative rehabilitation are a prerequisite for success. Key words: knee injuries, patellar ligament, quadriceps muscle, rupture.
- MeSH
- čtyřhlavý sval stehenní diagnostické zobrazování zranění chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum patellae diagnostické zobrazování zranění chirurgie MeSH
- management nemoci MeSH
- ruptura chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY: Treatment for tears of the anterior cruciate ligament (ACL) in paediatric patients has been a long-discussed issue because of complications associated with ligament reconstruction in the presence of growth plates. Various fixation materials and their efficiency as well as ACL techniques are still under investigation. The aim of our study was to find an optimal strategy of treating acute intra-articular ACL injury in childhood. MATERIAL AND METHODS: The paediatric patients treated for primary traumatic ACL injury between 2003 and 2013 were retrospectively evaluated. Only patients with a healthy contralateral knee (with no signs of instability or previous injury) and no record of previous ACL repair were included. A total of 78 patients were assessed; there were 39 girls and 39 boys with an average age of 15.4 years (11 - 16). The physical development of the patients was assessed on the Tanner scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner-Lysholm scoring system. The instrumented Lachman test using a rollimeter was performed to assess knee stability at 12 and 24 months of follow-up. In addition, the range of knee motion in comparison with the other side, complications and the re-rupture rate of reconstructed ACLs were recorded. Four patients with open growth plates were operated on using the transepiphyseal technique, the remaining 74 underwent reconstruction by the standard transphyseal method. RESULTS: The average Tegner-Lysholm scores were 54 (41-62) pre-operatively and 86.1 (74-96) at 24 months post-operatively. The average IKDC score increased from 48 (42-56) points to 91 (73-97) points. The Lachman test was positive in all patients before ACL reconstruction and negative in 96% of them at 12 and 24 months after surgery. The full range of joint motion was restored after ACL surgery, with minimal motion restriction in flexion and extension, in 70 (89.7%) patients. Motion restriction by 15° or less in flexion and 5° or less in extension was recorded in seven (9%) patients and a significant restriction in extension exceeding 10° was found in one (1.3%) patient. No differences in results were found between the two scoring systems. Five patients (6.4 %) sustained a re-tear in the reconstructed ACL due to a trauma. Non-traumatic subjective instability after the primary repair was not recorded. Revision ACL surgery was carried out due to fixation materials protruding from the bone surface in two patients and because of a Cyclops lesion with extension deficit in one patient. No development of deformity or instability was observed at 24 months in the patients in whom the transepiphyseal technique was used. DISCUSSION In the current literature ACL reconstruction by the transphyseal technique has been described in patients older than 15 years of age but no optimal age has been suggested. Animal experiments have shown that tunnels taking up more that 7-9% of the growth plate surface can result in growth restriction or angular deformity. ACL reconstruction in patients with distinct bone immaturity carries a high risk. The effect of growth on the biomechanical properties of a graft and a long-term consequence of surgical intervention in the growth plate is not yet understood. CONSLUSIONS: Although indications for surgical ACL repair and its timing are bound to be different in each patient, we consider the age of over 15 years to be ideal for ACL reconstruction. In patients younger than 15 years, the necessity of surgical treatment is questionable and conservative therapy can give good outcomes. No adverse effect of an applied graft on the post-operative results was demonstrated. The features of an immature skeleton are specific and complicated therefore, in our view, the relevant health care for paediatric patients should be concentrated into specialised institutions.
- MeSH
- dítě MeSH
- lidé MeSH
- ligamentum cruciatum anterius patofyziologie chirurgie MeSH
- mladiství MeSH
- poranění kolena patofyziologie chirurgie MeSH
- poranění předního zkříženého vazu MeSH
- recidiva MeSH
- rekonstrukce předního zkříženého vazu metody MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- růstová ploténka chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
Úvod: Traumatická luxace čéšky je častým úrazem kolenního kloubu v dětském věku, postihujícím pacienty ve věkové skupině nejčastěji 10–18 let s převahou dívek. V současné době není jasně daný nejvhodnější způsob terapie. Cílem této práce je na základě zhodnocení výsledků léčby pacientů určit optimální postup při řešení traumatické luxace čéšky. Soubor pacientů: Do retrospektivního sledování bylo zařazeno 323 pacientů ošetřených v letech 2006–2011, průměrný věk 15 let (9–18 let). Převaha dívek oproti chlapcům byla 2 : 1. Konzervativní terapie byla zvolena u 288 pacientů a 35 pacientů bylo léčeno operačně na základě rtg a klinického nálezu. Následně byly zhodnoceny klinické výsledky léčby a byl určen počet reluxací a dalších komplikací u jednotlivých metod v rozmezí 2 let od úrazu. Výsledky: Ve skupině konzervativně léčených pacientů byla zjištěna reluxace u 64 z 288 pacientů (22 %), a to významněji ve skupině pacientů nad 15let ve 28 % (55 ze 197), zatímco ve skupině operačně řešených pacientů nedošlo k žádné reluxaci. U operačně řešených pacientů jsme rovněž nezaznamenali žádné významné pooperační komplikace. Diskuze: U pacientů léčených konzervativně je vyšší riziko reluxace než u operačně řešených pacientů. Na rozvoj chronické nestability kolenního kloubu má vliv mechanika PF kloubu, zejména pak Q-úhel stehenního svalu, dále pak dysplazie čéšky a distálního femuru. Závěr: Z našich výsledků vyplývá, že konzervativní postup je vhodný u pacientů bez výrazné dysplazie patellofemorálního skloubení a zajišťuje dobré klinické výsledky u těchto pacientů. Konzervativní terapie rovněž nepřináší výraznější rizika léčby. Operační řešení akutní traumatické luxace je metodou volby pro pacienty s osteochondrální zlomeninou a je vhodné pro pacienty adolescentního věku, přičemž zajišťuje nižší riziko reluxace čéšky.
Introduction: An acute patellar dislocation is a common injury in childhood, involving mainly adolescent patients, with the majority of them being female. Currently, there is no set algorithm for treatment and no “gold standard” procedure. The aim of our study is to determine the optimal treatment plan for an acute patellar dislocation, based on retrospective clinical review study. Patient group: There were 323 patients enlisted in this retrospective study. These were treated in years 2006-2011 for an acute patellar dislocation. Their mean age was 15 years (9-18 years). Girls-to-boys ratio was 2:1. Conservative treatment was advocated in 288 patients and 35 patients were treated surgically on the basis of clinical and X-ray findings. Clinical results of the treatment methods were evaluated at 2 years after the trauma. Re-dislocation and complication rates were recorded. Results: In the conservatively treated group, the re-dislocation rate was 22% (64 of 288 patients), with the rate being higher in the 15 and older age group - 28% (55 of 197). In the surgically treated group no re-dislocation was recorded. No severe complications were recorded in either group. Discussion: There is a higher incidence of re-dislocation in the conservatively treated patients. The chronic instability of the patella is greatly influenced by biomechanics of the patello-femoral joint, especially Q-angle and patellar dysplasia. Conclusion: Our results support the use of conservative treatment for patients under 15years of age with mild or no patellar dysplasia and produce good results in these patients with minimal risks. Surgical treatment is more suitable for patients over 15 years of age or with severe patello-femoral dysplasia and is a method of choice in osteochondral fractures. Primary surgical treatment ensures lower rate of re-dislocation.
- Klíčová slova
- nestabilita čéšky, patellofemorální dysplazie,
- MeSH
- algoritmy MeSH
- artroskopie MeSH
- dítě MeSH
- hojení ran MeSH
- imobilizace MeSH
- lidé MeSH
- luxace pately * chirurgie radiografie terapie MeSH
- manipulace ortopedická metody MeSH
- mladiství MeSH
- nestabilita kloubu komplikace prevence a kontrola MeSH
- patela chirurgie radiografie zranění MeSH
- patelofemorální kloub patofyziologie MeSH
- protetické prostředky * MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- sekundární prevence MeSH
- věkové rozložení MeSH
- vnitřní fixace fraktury * metody statistika a číselné údaje MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
