PURPOSE: The authors present clinical results in patients following transplantation of deep-frozen menisci within ten years following the surgery. METHODS: A cohort of 46 patients who were transplanted altogether 49 menisci was subject to prospective study following six months, two, five and ten years after meniscus transplantation. For subjective assessment, we used KOOS, IKDC and Lysholm scores; objective assessment was based on load X-ray examination of the operated knee at two, five and ten years after the surgery, MRI examination of 34 patients in the interval of two and ten years after the operation, control arthroscopy was performed in 23 patients eight of whom suffered a new injury. RESULTS: All 38 patients who have completed ten year follow-up without any new injury of the operated joint demonstrated statistically significant improvement of mobility in the period of six months and two, five and ten years following the meniscal transplantation. Further follow-up demonstrated different results in patients with a new injury and without a new injury of the operated knee joint. In eight patients (17.3%), the follow-up was disturbed by a new injury of the operated joint within three to eight years after the meniscal transplantation. In three patients with the damaged meniscal transplant, a cartilage deterioration from degree II to degree IIIa was found. In second-look arthroscopy, the patients with no injury showed signs of the improved condition of cartilage by one degree according to ICRS classification on average. The MRI imaging showed relatively frequent (47%) extrusion of the anterior and medial part of meniscus (2.5-3.8 mms) without the followed-up dynamics of changes at two and ten years after the surgery. CONCLUSION: All patients in the selected cohort proved the positive benefit of meniscus transplant when it comes to the improvement of clinical symptoms and improvement of mobility of the operated knee joint. The higher mobility following the transplantation compared to the activity prior to the surgery could have contributed to a new injury of the operated joint in 17% of the patients in the cohort.
- MeSH
- artroskopie MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- meniskus * diagnostické zobrazování chirurgie MeSH
- menisky tibiální diagnostické zobrazování chirurgie MeSH
- následné studie MeSH
- poranění menisku * diagnostické zobrazování epidemiologie chirurgie MeSH
- prospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION The authors evaluate the results of endoscopic treatment and analyse the causes of persisting difficulties in retrocalcaneal bursitis unresponsive to conservative treatment. Stated as one of the causes is the possible chronic irritation of minor/partial tears of anterior parts of the distal portion of the Achilles tendon, which have no chance to heal due to continued overload and impingement syndrome of the superior prominence of the calcaneal tubercle. MATERIAL AND METHODS The authors evaluate the group of 24 patients (10 women and 14 men) diagnosed with retrocalcaneal bursitis, who reported more than 12 months of difficulties and in whom the conservative therapy options have already been exhausted. The decision to perform a revision arthroscopy was made by the authors based on chronic long-lasting difficulties, clinical examination, calcaneus radiograph, ultrasound examination and negative response to the performed conservative treatment. The MRI scan was obtained in 4 patients. In 11 patients during arthroscopy the Achilles tendon was intact, in 13 patients (54.2%) minor tears were detected on the anterior aspect of the distal Achilles tendon, not diagnosed preoperatively (by ultrasound examination). In all the patients, resection of the prominence of the calcaneal tubercle was performed, whereas in patients with affected Achilles tendon also the loose tendon fragments were resected. RESULTS A total of 23 patients reported an improvement of their condition, the pain subsided at 21-43 days. Altogether 21 patients returned to activities carried out before the onset of pain. The AOFAS score values measured preoperatively in patients with an intact tendon were 59.5 ± 15.0, in patients with an injured tendon it was 45.57 ± 9.6, while 6 months after the surgery the values were 95.7 ± 6.2, or 88.71 ± 7.8 respectively. In 1 female patient, with one prior surgery, diagnosed with a partial tear of the Achilles tendon, the effect of the surgery was unsatisfactory. After six months the patient underwent an open revision surgery and the Achilles tendon reinsertion. No intraoperative or postoperative complications were observed. DISCUSSION The endoscopic technique facilitates a more visible bone resection, with better control of resection, which is less invasive than the open technique. The source of irritation can be removed, which is not always only the prominence of the calcaneal tubercle, but another cause of persisting problems can also be a microtrauma affecting the anterior portion of the Achilles tendon, with a reactive hyperaemia in bursal tissue. Compared to literature and also based on the results of the authors of this retrospective study, the endoscopic calcaneoplasty is less invasive than the open surgery. It is always necessary to properly diagnose the causes of difficulties and to timely respond to persisting symptoms in patients, not responding satisfactorily to conservative therapy. CONCLUSIONS The findings presented by the authors provide a new perspective on the causes of chronic problems such as the "posterior heel pain" and tend to give preference to the active endoscopic approach in patients with persisting problems, not responding to conservative treatment, predisposed based on the radiological examination and with a positive finding on ultrasound or MRI scan. Key words:retrocalcaneal bursitis, endoscopic calcaneoplasty, arthroscopy.
- MeSH
- Achillova šlacha zranění MeSH
- artroskopie * škodlivé účinky metody MeSH
- burzitida diagnóza patofyziologie chirurgie MeSH
- hodnocení výsledků zdravotní péče MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- patní kost diagnostické zobrazování patologie MeSH
- pooperační bolest diagnóza etiologie chirurgie MeSH
- rentgendiagnostika metody MeSH
- reoperace metody statistika a číselné údaje MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Intraartikulární zlomeniny distální tibie (pilonu) jsou častými a komplikovanými zlomeninami, které pacienty imobilizují na dlouhou dobu a snižují jejich společenské a sociální uplatnění. Optimální metodou léčby je operační stabilizace dlahou nebo zevním fixátorem. Cíl: Cílem této práce je retrospektivní srovnání léčby zlomenin pilonu tibie zevním fixátorem a dlahovou osteosyntézou v Úrazové nemocnici v Brně na Klinice traumatologie Lékařské fakulty Masarykovy Univerzity v Brně. Práce se zaměřuje na počet a charakter komplikací obou metod léčby, srovnává je a koreluje je s pracemi publikovanými v zahraničí. Metodika: Retrospektivně byly zhodnoceny dvě stejně početné skupiny pacientů se zlomeninou pilonu typu B3, C1 – 3 dle AO klasifikace, které byly léčeny dle indikace operatéra dlahovou osteosyntézou nebo přemosťujícím zevním fixátorem. Práce sleduje dobu hojení, klinické hodnocení dle Weberova protokolu, komplikace v průběhu hojení a vzájemně je srovnává. Výsledky: Soubor tvořilo 32 pacientů léčených dlahovou osteosyntézou a 35 pacientů léčených zevním fixátorem. V průběhu 18měsíčního sledování se všechny zlomeniny zhojily a pacienti byli schopni zatěžovat končetinu vlastní váhou těla. U skupiny léčené zevním fixátorem se vyskytlo častěji opožděné kostní hojení – 4 resp. 1. Při dlahové stabilizaci byly častější hluboké infekce 4 resp. 2. Závěr: Námi sledovaný soubor prokázal zvýšený výskyt infekcí měkkých tkání při léčbě dlahovou osteosyntézou a vyšší výskyt pakloubů při léčbě zevním fixátorem. Nicméně klinické výsledky v horizontu sledování 18 měsíců nenacházejí rozdíl mezi oběma skupinami. Studie se tímto shoduje s dalšími autory, kteří z dlouhodobého hlediska nenacházejí signifikantního rozdílu mezi způsoby léčby.
Background: Pilon fractures (Tibial plafond) are frequent and serious injuries. Pacients are treated long time and it causes them both medical and social complications. Goal of pilon fracture treatment is to restore the joint surface either by external fixator or plate. Study goals: Comparison of treatment methods of pilon fracture and review of their complications is the principal goal of this study. Results of this study were compared with other recent articles. Methods: A retrospective study took place in Emergency Hospital Brno, Department of trauma surgery, Masaryk University. Patients with tibial plafond AO B3, C1 – C3 fractures were involved in the study. They were diveded into two comparable groups. One group was treated by external frame, whereas the other one was treated by LCP plate system. Division was made upon the choice of surgeon in coordinance with type of fracture, soft tissue quality and other external factors. Treatment follow up, Webber clinical evaluation and treatment complications were compared between these two groups. Results: Together 67 patients were included in the study, 32 of them treated by LCP plate and 35 with external fixator. All fractures has healed and all patients were able to bear full weight during the 18 month follow-up period. 4 cases of delayed union were seen in the fixator group. Where as in LCP plate group were 4 patients with skin infection. Conclusion: Higher incidence of delayed union in the fixator group and tissue infection in the LCP plate group were observed. Despite these results there was no l difference in the clinica outcome between both groups at the end of the 18 month follow-up period. Our results are consistent with conclusions of other authors.
- MeSH
- externí fixátory statistika a číselné údaje škodlivé účinky MeSH
- fraktury tibie * chirurgie komplikace MeSH
- infekce měkkých tkání epidemiologie MeSH
- lidé MeSH
- ortopedické fixační pomůcky MeSH
- ortopedické výkony metody MeSH
- pooperační komplikace epidemiologie MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
Vyd. 1 206 s. : il. ; 18 cm
- MeSH
- chování mladistvých MeSH
- mladiství MeSH
- Check Tag
- mladiství MeSH
- Publikační typ
- beletrie MeSH
- eseje MeSH
- Konspekt
- Psychologie
- NLK Obory
- humanitní vědy a umění
- psychologie, klinická psychologie
2. vyd. 216 s. ; 17 cm
- MeSH
- nemoc MeSH
- první pomoc MeSH
- terapie náhlých příhod MeSH
- terapie MeSH
- Publikační typ
- příručky MeSH
- Konspekt
- Lékařské vědy. Lékařství
- NLK Obory
- terapie
- lékařství
