URPOSE OF THE STUDY The aim of this study was to summarise the current approaches to diagnostics and therapy of the medial meniscus tear, and to evaluate the short-term results of meniscus repair by outside-in and all-inside techniques. MATERIALS AND METHODS The study included 24 patients who underwent medial meniscus repair for vertical longitudinal tear 10 mm or longer in length localised in the rear two-thirds of meniscus in the red-red or red-white zone at the author's workplace between June 2012 and December 2014. As regards the method, either outside-in or all-inside techniques were used, or the combination of both. The Steadman technique was used in cases of LCA ruptures. Before the surgery standard radiographs of the knee joint of each patient were taken. The Lysholm Knee Score was used to evaluate the function of the knee pre- and postoperatively. The Barrett's criteria were used to evaluate the healing of repaired meniscus. The clinical success was defined as an absence of any of such criteria. The satisfaction of the patients was evaluated by the visual analogue scale (VAS). The patients were followed up for 13.5 (6-36) months. RESULTS The functional results presented by Lysholm Knee Score demonstrate the improvement of all patients. When comparing the score measured before and after the surgery, this score increased from 67.1 ± 11.4 (24-81) preoperatively to 90.4 ± 13.0 (34-100) postoperatively. The outcome was excellent in 11 patients (45.8 per cent), good in 12 patients (50.0 per cent), and poor in one patient (4.2 per cent). According to the Barrett's criteria, 19 repaired menisci were healed (79.2 per cent) = success rate. In five patients at least one of the monitored criteria was positive. In these cases, the result was considered a failure. Patient satisfaction averaged at 8.0 ± 1.5 (3-10). Only one patient with the concurrent anterior cruciate ligament (ACL) tear with poor functional result, positive Barrett's criteria and VAS 3 agrees with the proposed revision surgery. Regarding possible complications, no neurovascular injury, deep vein thrombosis (DVT) or deep infection were reported. DISCUSSION The results presented in this research correspond to the outcomes of other authors, in particular as regards the shortterm follow-up. Other authors state that even the long-term results of Lysholm Knee Score related to meniscus repair are considerably better than the results after meniscectomy. When assessing the Barrett's criteria, the success rate of 79.2 per cent (19 patients) was reached; therefore, the failure rate was 20.8 per cent (5 patients). These results are comparable with the results of other authors whose success rate of meniscus repair ranges between 60 and 90 per cent. Based on the assessment of the VAS patient's satisfaction, the average rate of 8.0 points (3-10) was reached. A similar average rate of the patient's satisfaction amounting to 8.35 ± 1 (6-10) was reached in a similar designated study of Keyhani et al. carried out in 2015. Regarding possible complications, no neurovascular injury, deep vein thrombosis (DVT) or deep infection were reported. Similar observation of the low complication rate can be seen in the research studies of other authors. CONCLUSIONS Our short-term follow-up revealed that the postoperative results of Lysholm Knee Score considerably improved, the satisfaction rate of the patients was high and the failure rate is entirely in line with the values stated in literature. The results of our study confirm that in the indicated cases the meniscus repair is an effective method of treatment of vertical longitudinal tears located in both RR and RW zones. The preserved meniscus is considerably supportive to ensure stability of the knee joint, in particular in the event of concurrent rupture of anterior cruciate ligament, and to prevent early osteoarthritic changes. Nevertheless, it is necessary to carry out further randomized clinical studies with a larger number of patients and a longerterm follow-up to confirm our results. Key words:meniscus tear, meniscus repair, outside-in and all-inside technique, evaluation of results.
- MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče MeSH
- kolenní kloub diagnostické zobrazování patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- menisky tibiální chirurgie MeSH
- mladiství MeSH
- obnova funkce MeSH
- poranění menisku diagnóza terapie MeSH
- rentgendiagnostika metody MeSH
- reoperace * metody statistika a číselné údaje MeSH
- šicí techniky * MeSH
- spokojenost pacientů MeSH
- totální endoprotéza kolene * škodlivé účinky metody MeSH
- vizuální analogová stupnice MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
I přes výrazné zdokonalení artroskopické operační techniky a zlepšení znalostí v problematice rekonstrukce předního zkříženého vazu zůstává výběr štěpu stále diskutovanou otázkou. Po mnoho let bylo patelární ligamentum (BTB) považováno za zlatý standard pro rekonstrukci předního zkříženého vazu. Během posledního desetiletí dramaticky narostl počet rekonstrukcí pomocí hamstringů. Hamstringy a patelární ligamentum jsou nejvíce užívané autoštěpy k plastice LCA. Aloštěpy nachází své místo především v revizní operativě. Mnoho literárních prací porovnávalo výsledky při užití hamstringů i BTB štěpu. Prokázaly jen malé rozdíly ve výsledcích. Při užití hamstringů je udávána větší subjektivní spokojenost pacientů. Patelární ligamentum je široce užíváno, ale v porovnání s hamstringy je referována větší asociace s bolestivostí předního kolena. Některé práce udávají u BTB štěpu lepší návrat k náročnějším sportovním aktivitám. Kontraindikací užití patelárního ligamenta by měl být předešlý chirurgický výkon v oblasti patelárního ligamenta, Osgood-Schlatterova choroba, významná femoropatelární artróza a poúrazové stavy pately. Hamstringy by neměly být užívány vzhledem ke své funkci dynamických mediálních stabilizátorů kolena u pacientů s valgózním kolenem, při mediální nestabilitě a u sportů s převahou rotace. Výběr štěpu závisí zejména na zkušenostech chirurga, dostupnosti štěpů a také na aktivitě pacienta. Výsledek rekonstrukce LCA nezávisí jen na výběru štěpu, ale také na typu fixace štěpu, precizní operační technice, pooperační rehabilitaci a komplianci pacienta.
In the last decade there has been an improvement in surgical techniques and new knowledge in issue of the anterior cruciate ligament reconstruction, however the selection of graft is still a matter of discussion. The patellar tendon (bone-tendon-bone) has been reported to be a gold standard for ACL reconstruction. The number of patients who underwent ACL reconstruction using hamstrings has been dramatically increased during the period of the last ten years. Hamstring and patellar tendon are the most commonly used autografts for ACL reconstruction. Allografts are used especially for re-operating. The outcomes of the techniques using hamstrings and patellar tendon have been compared in many published studies. The results were slightly different. The techniques using hamstrings are associated with more patient satisfaction. Patellar tendon is widely used, however, it is associated with more knee pain, compared to the harmstrings. Some of the studies present evidence that it is easier to come back to difficult sport performances when using BTB graft. Contraindications for using patellar tendon should be a previous surgery performed in the area of patellar tendon, Osgood – Schlatter disease, severe femoropatellar arthrosis and recent patellar injury. Whereas the hamstrings work as dynamic stabilizators of the knee, they should not be used in patients with knee valgosity, in medial instability and in athletes who rotate their knee. Selection of the graft depends mainly on the surgeon’s experience, availability of the graft and the patient’s activity. Final result of ACL reconstruction depends not only on the type of the graft, but also on the type of graft fixation, precise operating technique, rehabilitation after surgery and the patient’s compliance.
- MeSH
- artroskopie metody využití MeSH
- diferenciální diagnóza MeSH
- koleno patologie MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie patologie MeSH
- mrtvola MeSH
- ortopedické výkony dějiny MeSH
- štěp kost-čéškový vaz-kost využití MeSH
- transplantáty dějiny trendy využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Developmental dysplasia of the hip (DDH) is a serious anatomical abnormality. The aims of the study were to compare the current views on general screening for DDH and, in a group of patients diagnosed for DDH both clinically and ultrasonographically, to analyse the results of their treatment with Wagner stockings. MATERIAL AND METHODS: In the years 2000 to 2001, a total of 3,221 children were examined at birth clinically and by ultrasonography using Graf's method. DDH was diagnosed in 137, and Wagner stockings were used for treatment in 127 patients. This Wagner abduction device consists of linen stockings buttoned to a linen baby shirt. It is based on the Pavlik harness treatment of DDH, and enables us to start therapy at neonatal age. The group was followed up, with checkups including clinical examination and AP radiography to evaluate position of the femoral head in relation to avascular necrosis (AVN) by the Salter method. The data obtained was statistically analysed by the SPSS software, version 14 (SPSS Inc., Chicago, USA). RESULTS: Out of the 127 children, 106 (95 girls and 11 boys) completed the treatment. In 87 (82%) children with Wagner stockings only, the treatment took place for an average of 82 days (range, 28 to 167), with abduction therapy starting on average at 13 days (range, 1 to 76 days). In 19 (18%) children it was necessary to continue abduction therapy and Wagner stockings were replaced by a Pavlik's harness. The total abduction treatment then lasted on average for 152 days (range, 81 to 289). After January 1, 2005, 75 children (follow-up rate, 70.7%) were examined, 33 at regular checkups and the rest at invitation. The average follow-up was 5.9 (3.8-7.5) years. On two early radiograms with left-side findings, proximal femoral lesions met the Salter criteria of AVN diagnosis. The AVN rate was 2.6% or 1.8% when related to either the patients or the affected hips. At the latest follow-up even in these cases the radiographic findings were resolved. DISCUSSION: At present there is no consensus concerning either screening of newborns for DDH or its early therapy. In the Czech Republic the general screening known as three-step examination of infant hips attained a legal frame by the Regulation issued by the Ministry of Health in 1977 and its amendment in 1996. In Austria the general clinical and ultrasonographic screening is regarded as the gold standard. On the other hand, some official bodies such as the U.S. Preventive Services Task Force, American Academy of Pediatrics or Canadian Task Force do not recommend any general screening.The results of this retrospective study were compared with those of treatment with the Pavlik harness or Frejka pillow, which are both based on a passive mechanical mode of therapy. The comparison has shown that the treatment with Wagner stockings is highly effective and has a low AVN rate. CONCLUSION: This retrospective study has shown that, in DDH, therapy with Wagner stockings is sufficient to provide for physiological development of the hip, while the AVN rate is very low. Early diagnosis and treatment related to general screening are both beneficial. Based on these results we recommend Wagner stockings as a useful aid in the treatment which is initiated early in infancy and is in agreement with the Pavlik method of functional DDH therapy.
PURPOSE OF THE STUDY The reconstructions of Bankart lesions, carried out according to the procedure recommended by the Mitek company, showed a high rate of recurrent dislocation. Therefore, based on operative experience, anatomical studies and reconstructive surgery on cadaver shoulders, we developed a new surgical technique that provided good shoulder stability and better operative outcomes. The results are reported here. MATERIAL Between 1997 and 2005, arthroscopic Bankart repair with use of Mitek anchors was performed on 368 shoulders at the Department of Orthopedics, Faculty of Medicine, Palacky University in Olomouc. The average age of the patients was 22 years (range, 16 to 56 years). The patients were allocated to two groups according to the surgical technique used. Group 1, which comprised 100 shoulders, was treated by the Bankart repair procedure recommended by the Mitek Company. Group 2, which included 268 shoulders, underwent Bankart reconstruction by the technique developed at our department. METHODS In group 1, anchors were inserted in the anterior glenoid rim, as recommended by the Mitek company. In group 2, implants were inserted into the superior region, with surface reduced to spongious bone, of the anterior glenoid rim. This allowed for creation of a more robust capsulolabral complex preventing the humeral head from dislocation. The results were assessed by the UCLA (University of California at Los Angeles) shoulder score system and statistical evaluation was performed at the Department of Medical Biophysics, Faculty of Medicine, Palacky University in Olomouc. RESULTS In group 1 (Mitek procedure), the UCLA shoulder score evaluation was as follows: 22 (22 %) excellent, 28 (28 %) good, 22 (22 %) satisfactory, and 28 (28 %) poor outcomes. In group 2 (our technique), the results included 199 (74 %) excellent, 66 (24.6 %) good, two (0.8 %) satisfactory and one (0.6 %) poor outcomes. The difference between the groups was statistically significant (Chi-square, p<0.0001). DISCUSSION The method of Bankart lesion repair has been a much discussed issue for a long time. At our department Mitek implants have been used. Although the operative procedures were faultlessly done, the results of the first 100 operations were not satisfactory. In some patients, the labrum reinserted by Mitek anchors failed to heal; it either remained loose or was attached to the scapular neck distally and thus did not provide sufficient stability that would prevent recurrent dislocation of the shoulder. In view of this, we conducted reconstructive operations on cadaver limbs, after a thorough topographic and anatomic study of the glenohumeral joint, and developed a modified method; after the labrum and capsule were freed, implants were inserted into the superior part of the anterior glenoid rim. This created a sufficient capsulolabral complex that prevented recurrent dislocation. CONCLUSION Arthroscopic Bankart lesion repair, with the insertion of anchors by our method, markedly improved surgical outcomes and provided good shoulder stability. We believe that, in the future, this method will be more widely used in arthroscopic treatment of Bankart lesions.
Cílem studie bylo porovnat výsledky léčby u 22 pacientů se zlomeninou člunkové kosti
Purpose of the study: Results of reconstruction of the anterior cruciate ligament using hamstrings with Endobutton position were evaluated 5 years after surgery and compared to results of other operating techniques. Material: 313 reconstructions of the anterior cruciate ligament using Endobutton position were performed from 1. 1. 2000 to 31. 12. 2000. 74 patients arrived for check-up 5 years after the surgery. Methods: Objective parameters recomended in the IKDC 2000 (International Knee Documentation Committee) examination form were evaluated in the set of patients. Measurement of the thigh circumference in the operated and non-operated extremity was added to the objective evaluation. For subjective evaluation, we used the IKDC 2000 subjective examination form, the Lysholm score and the Tegner activity score. Results: Based on the IKDC objective form results of the group of 74 patients, 5 years after the surgery, 31 % of the patients were placed in group A (normal function), 54 % of patients in group B (nearly normal function) and 15 % of patients in group C (slightly abnormal function). Group D (very abnormal function ) was not represented. The Lysholm score was 83,53 +9,06, on average. The average value of the IKDC subjective evaluation was 85,62+10,11 points. According to the Tegner activity score, 27 % of patients returned to the same activity level as prior to injury, in 53 % of patients the activity level was 1 degree lower, in 14 % of patients 2 degrees lower and in 1 % of patients 3 degrees lower than prior to injury. An increase in activity level was not reported. Conclusion: The evaluation of the investigated group documented satisfactory results of ACL reconstruction with Endobutton position five years after the surgery, which are comparable to published results and to the results of other operating techniques.
- MeSH
- artroskopie metody využití MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie MeSH
- přenos šlachy metody využití MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) metody využití MeSH
- zákroky plastické chirurgie metody využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
Cíl práce: Cílem práce je prezentovat operační techniku rekonstrukce předního zkříženého vazu (LCA) pomocí hamstringů s fixací endobutton position, dále upozornit na úskalí jednotlivých kroků operační techniky, shrnout výhody a nevýhody této techniky a diskutovat o problematice výběru štěpu a výběru fixace při rekonstrukci LCA. Materiál a metody: Na Ortopedické klinice FN Olomouc bylo od ledna 1999 do září 2005 operováno 1464 pacientů technikou Endobutton position. Diskuze: Nevýhodou Endobutton techniky je extraartikulární nepřímá fixace a s ní související nepříznivé efekty {"bungee a windshieldwiper (stěračový) effect"}. Výběr štěpu při plastice LCA závisí na zkušenostech chirurga, dostupnosti štěpu a aktivitě pacienta. Patelární ligamentum je obecně užíváno u aktivních a profesionálních sportovců. Hamstringy jsou používány u starších lidí, žen a rekreačních sportovců. Každá fixace štěpu má své výhody a nevýhody. Ideálním řešením je tzv. hybridní fixace, která zvyšuje biologické hojení štěpu a současně poskytuje dostatečnou primární mechanickou sílu. Závěr: Technika Endobutton patří mezi náročnější operační techniky plastiky LCA. Stěžejními zásadami úspěchu je správná indikace, precizní operační technika se zaměřením na centraci kanálů a presfit štěpu, kompliance pacienta a správná rehabilitace.
Purpose of the study: The purpose of the study is to present the operating technique of the reconstruction of the anterior cruciate ligament using hamstrings with Endobutton position, to emphasise the difficulties of particular steps, to summarise the advantages and disadvantages of this technique and to discuss the issue of graft and fixation type selection in ACL reconstruction. Materials and methods: At the Department of Orthopedic Surgery of the Faculty Hospital Olomouc, 1464 patients underwent reconstruction of the ACL with Endobutton position between January 1999 and September 2005. Discussion: The disadvantage of the Endobutton technique is the extraarticular indirect fixation and its negative effects ("bungee and windshield - wiper effect"). The selection of graft in ACL reconstruction depends on the surgeon's experince, accessibility of the graft and on the patient's activity. The patellar ligament is generaly used in active and professional athletes. Hamstrings are used in older people, women and recreational athletes. Every type of graft fixation has its advantages and disadvantages. An ideal solution is hybrid fixation, which supports the biological healing of the graft and also provides sufficient primary mechanical strength. Conclusion: Endobutton technique belongs to the more difficult operating techniques of ACL reconstruction. Most important for its success are correct indication, precise performance of the technique with focus on canal centration and graft presfit, patient's compliance and correct rehabilitation.
- MeSH
- artroskopie metody využití MeSH
- femur MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie transplantace MeSH
- obnova funkce MeSH
- poranění předního zkříženého vazu MeSH
- přenos šlachy MeSH
- svaly chirurgie MeSH
- tibie MeSH
- transplantáty využití MeSH
- zákroky plastické chirurgie metody využití MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie transplantace MeSH
- nemocniční záznamy klasifikace statistika a číselné údaje MeSH
- poranění předního zkříženého vazu MeSH
- zákroky plastické chirurgie metody statistika a číselné údaje využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
