PURPOSE: Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. METHODS: Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. RESULTS: Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. CONCLUSIONS: Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.
- MeSH
- dítě MeSH
- kyčelní kloub MeSH
- lidé MeSH
- osteotomie metody MeSH
- Perthesova nemoc * diagnostické zobrazování chirurgie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Suprakondylické zlomeniny humeru jsou jedny z nejčastějších zlomenin dětského věku na horní končetině. Vzhledem ke specifické anatomii distálního humeru a intimnímu vztahu nervů a cév je u tohoto typu zlomeniny vyšší riziko závažných komplikací. Základem úspěšné léčby je znalost anatomie a patofyziologie tohoto poranění. Klinická i radiologická diagnostika byly v průběhu let již dobře vypracovány. Názory na terapeutické postupy se však liší s ohledem na zkušenosti jednotlivých pracovišť. Zejména se liší postupy operační repozice a fixace dle typu zlomeniny. Klíčovým aspektem léčby je důsledná repozice rotačních dislokací, aby se předešlo poruše růstu a omezené funkci lokte. Následné řešení reziduálních deformit je velmi komplikované, má svá přesná pravidla a indikace, a proto náleží pracovištím s velkou zkušeností v této oblasti. Předkládaný text je přehledem poznání v oblasti ošetřování suprakondylických zlomenin humeru u dětí.
Supracondylar humeral fractures are one of the most common fractures of childhood in the upper limb. Due to the specific anatomy of the distal humerus and the intimate relationship between nerves and blood vessels, this type of fracture has a higher risk of serious complications. The basis of successful treatment is knowledge of the anatomy and pathophysiology of this injury. Clinical and radiological diagnostics have been well developed over the years. However, opinions on therapeutic approach differ with regard to the experience of individual centres. In particular, the methods of surgical reduction and fixation differ according to the type of fracture. A key aspect of treatment is the precise reduction of rotational dislocations to prevent growth disturbance and elbow function impairment. Subsequent treatment of residual deformities is very complicated, has its own rules and indications, and therefore belongs to centres with extensive experience in this field. The presented text is an overview of knowledge in the field of treatment of supracondylar humeral fractures in children.
PURPOSE: To establish recommendations for diagnosis, classification, treatment, and rehabilitation of posteromedial corner (PMC) knee injuries using a modified Delphi technique. METHODS: A list of statements concerning the diagnosis, classification, treatment and rehabilitation of PMC injuries was created by a working group of four individuals. Using a modified Delphi technique, a group of 35 surgeons with expertise in PMC injuries was surveyed, on three occasions, to establish consensus on the inclusion or exclusion of each statement. Experts were encouraged to propose further suggestions or modifications following each round. Pre-defined criteria were used to refine item lists after each survey. The final document included statements reaching consensus in round three. RESULTS: Thirty-five experts had a 100% response rate for all three rounds. A total of 53 items achieved over 75% consensus. The overall rate of consensus was 82.8%. Statements pertaining to PMC reconstruction and those regarding the treatment of combined cruciate and PMC injuries reached 100% consensus. Consensus was reached for 85.7% of the statements on anatomy of the PMC, 90% for those relating to diagnosis, 70% relating to classification, 64.3% relating to the treatment of isolated PMC injuries, and 83.3% relating to rehabilitation after PMC reconstruction. CONCLUSION: A modified Delphi technique was applied to generate an expert consensus statement concerning the diagnosis, classification, treatment, and rehabilitation practices for PMC injuries of the knee with high levels of expert agreement. Though the majority of statements pertaining to anatomy, diagnosis, and rehabilitation reached consensus, there remains inconsistency as to the optimal approach to treating isolated PMC injuries. Additionally, there is a need for improved PMC injury classification. LEVEL OF EVIDENCE: Level V.
- MeSH
- kolenní kloub * chirurgie MeSH
- konsensus MeSH
- lidé MeSH
- poranění kolena * diagnóza chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY We present the results of the retrospective study comparing the clinical outcomes of outside-in versus all-inside suture techniques of unstable RAMP lesions (RL) of the medial meniscus in patients with simultaneous ACL lesion with a minimum two-year follow-up. MATERIAL AND METHODS The retrospective evaluation covered two groups of patients who underwent the arthroscopic repair of unstable RL in combination with anterior cruciate ligament reconstruction (ACLR). Group 1 included 42 patients (28 men/24 women). Group 2 consisted of 36 patients (21 men/15 women). In Group 1, RL suture repair using the outside-in technique by posteromedial approach with absorbable PDS suture was performed, while in Group 2 the all-inside technique of RL suture via the standard anteromedial portal was applied using the Fast-Fix system (Smith Nephew, USA). The evaluation was done preoperatively and postoperatively with the mean follow-up of 27.9 months in Group 1 and 30.1 months in Group 2. The patients were assessed using the subjective IKDC score and the side-to-side difference (SSD) in ventral laxity was measured by Genourob (GNRB) laximeter at the applied pressure of 134 N and 250 N. Moreover, the failure rate of RAMP lesion repair, ACL graft, necessity of secondary partial meniscectomy and return to pre-injury level of sport were analysed. RESULTS The median IKDC score increased in Group 1 from 56 points preoperatively to 92 points postoperatively and in Group 2 from 58 points preoperatively to 90 points postoperatively (p>0.05). The median value of SSD in ventral laxity of the knee measured by the GNRB laximeter at the applied pressure of 134 N in Group 1 was 5.6 mm preoperatively and 1.9 mm postoperatively and in Group 2 it was 5.9 mm preoperatively and 2.3 mm postoperatively. At the pressure of 250 N, the median value in Group 1 was 7.9 mm preoperatively and 2.7 mm postoperatively and in Group 2 it was 8.1 mm preoperatively and 3.2 mm postoperatively. When comparing the SSD of the groups postoperatively, no statistically significant difference was found (p>0.05). Revision arthroscopy was performed in 8 patients. In 1 patient (2.4 %) in Group 1 and in 4 patients (11.1%) in Group 2 a rerupture of the RL of the meniscus occurred and partial meniscectomy was performed. In Group 2, statistically significant higher occurrence of the RL suture failure (p<0.05) was reported and there was a need to perform partial medial meniscectomy (p<0.05). The ACL graft failure was observed in 2 patients (4.7%) in Group 1 and in 3 patients (8.3%) in Group 2 (p>0.05). 31 evaluated patients (73.8%) from Group 1 and 24 patients (66.7%) from Group 2 (p>0.05) returned to the pre-injury level of sports activities. DISCUSSION When comparing the outcomes of individual techniques of the RL repair published in recent literature with our conclusions, we may state that the results of subjective as well as objective criteria achieved were similar to those reported by other authors worldwide. No study has so far been published which would compare the outcomes of the by us presented two surgical techniques of the RL suture in an ACL-deficient knee with a minimum follow-up of 24 months. CONCLUSIONS Both the surgical techniques of unstable RL repair in combination with the ACLR using a tendon graft result in a statistically significant improvement of clinical outcomes postoperatively. In Group 2, with the all-inside RL repair, a statistically significant higher failure rate of RL repair was confirmed as well as the need to perform secondary partial meniscectomy compared to Group 1. Key words: RAMP lesion, ACL-deficient knee, unstable medial meniscus lesion, repair of meniscus, all-inside technique, posteromedial technique, ACL reconstruction.
INTRODUCTION: Hip arthroscopy is a common procedure in hip preservation surgery. Its complication rate is relatively low. This prospective multicentric study evaluates complication rate in patients undergoing primary hip arthroscopy. MATERIALS AND METHODS: The study cohort consisted of 908 patients mean age of 37 years (14-67 years). Patients were prospectively included in the study in the years 2009-2017. All complications were recorded and evaluated. The minimum follow-up was 36 months. Results were statistically evaluated and risk factors for complications were identified. RESULTS: The overall complication rate was 7.3% (67/908 cases), the minor complication rate of 4.9% (45/908 cases) and the major complication rate 2.4% (22/908 cases). The most common severe complications were iatrogenic cartilage damage and instrument breakage, while the most common minor complications were perineal hypoaesthesia and heterotopic ossifications. The conversion rate to total hip replacement was 4.2% (39/908 patients). CONCLUSION: Hip arthroscopy is a safe procedure with low complication rates. Surgeon training and experience greatly influence the complication rates.
- MeSH
- artroskopie * škodlivé účinky MeSH
- dospělí MeSH
- kyčelní kloub chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- následné studie MeSH
- prospektivní studie MeSH
- reoperace MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
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PURPOSE OF THE STUDY Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoro - acetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. MATERIAL AND METHODS The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In Group 1 (31 patients), microfractures for chondral defects was performed, while in Group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in Group 1 and 31.1 in Group 2. Preoperatively and 6, 12 and 24 months postoperatively the modified Harris Hip Score (mHHS) parameters and VAS score were evaluated and also revision surgeries, conversion to endoprosthesis, and occurrence of complications were recorded. RESULTS Preoperatively, no statistical difference between the two groups was found in the studied parameters (mHHS and VAS). Postoperatively (after 6, 12 and 24 months), in both groups a statistically significant increase in mHHS and VAS score was reported. When comparing the mHHS parameter at individual evaluated times in Group 1 and Group 2, a statistically significant difference was confirmed at 12 and 24 months after surgery (P < 0.001), namely in favour of Group 1. At 6 months postoperatively, no statistically significant difference in this parameter between the two groups was confirmed (P = 0.068). When comparing the VAS score parameter in these two groups at individual times, no statistically significant difference was confirmed at 6 and 12 months after surgery (P= 0.83 / P= 0.39). A statistically significant difference in the VAS score parameter was observed only at 24 months after surgery, namely in favour of Group 1 (P< 0.037). In the course of the follow-up period, altogether 3 patients (2 patients from Group 1) were indicated for revision hip arthroscopy and in 1 female patient an endoprosthesis was implanted. No severe intraoperative or postoperative complications were observed. DISCUSSION In agreement with other authors worldwide, the arthroscopic treatment of FAI syndrome, if indicated and performed correctly, was confirmed to improve the clinical condition of patients postoperatively, regardless of the technique used in treating the chondral defect. Based on our results as well as conclusions of other world authors, in treating the grade IV defects of smaller size it is appropriate, in treating the cartilage, to prefer the microfracture surgery, which is less demanding both technically and financially and contrary to mere debridement allows to fill the original defect by fibrocartilage tissue. CONCLUSIONS The benefits of the acetabular microfracture in patients with the FAI syndrome treated arthroscopically were confirmed. A statistically significant difference between the two studied groups was reported in the mHHS parameter at 12 and 24 months after surgery and also in the VAS parameter at 24 months in favour of the group with performed microfracture. In both the studied groups, the arthroscopy resulted in a statistically significant improvement of the assessed quality of life parameters. Key words: hip arthroscopy, femoroacetabular impingement syndrome, chondral defect, microfracture, abrasive chondroplasty.
- MeSH
- acetabulum chirurgie MeSH
- artroskopie MeSH
- femoroacetabulární impingement * chirurgie MeSH
- kvalita života MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- následné studie MeSH
- prospektivní studie MeSH
- stresové fraktury * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
