Genu recurvatum congenitum je vzácná vrozená vada, jejíž podstatou je nadměrná hyperextenze kolene s omezením jeho flexe, případně v kombinaci se subluxací nebo dislokací femorálního kondylu vůči tibii. Etiologie není jednoznačně objasněna, uvádí se vrozené polohové deformity a vrozené poruchy pojiva. Častý je i současný výskyt s dalšími vrozenými vadami pohybového aparátu (dysplazie kyčelního kloubu, postavení nohy pod kotníkem). Diagnostika je založena na somatickém nálezu, doplňuje se zobrazení pomocí UZ (především kontraktura a/nebo fibróza kvadricepsu) a RTG (vyloučení luxace v kloubu nebo traumatismu). V těžších případech jsou přítomny i komplexnější muskuloskeletální odchylky, vhodné je pátrat minimálně klinicky po dalších vrozených vadách, mohou být přítomny syndromologické jednotky. V managementu převažuje konzervativní přístup – redresní sádrování kolene v neutrálním postavení zahajujeme v den porodu. Podle dosažené flexe pokračujeme konzervativně, nebo zvážíme indikaci operačního řešení. To je dále vyhrazeno i pro primárně těžší případy vady a také pokud byla vada zachycena až v pozdějším věku. U lehčích forem vady a brzkého zaléčení je prognóza výborná, v ostatních případech jsou výsledky individuální, mohou přetrvávat rezidua v poruše motoriky. Většina pacientů vyžaduje pravidelnou dispenzarizaci. V kazuistice budeme mluvit o novorozenci z naší nemocnice, který je typickým příkladem lehké formy této vady.
Genu recurvatum congenitum is a rare congenital disease. Its essence is excessive hyperextension of knee with limited flexion, optionally in combination with subluxation or dislocation of the femoral condyle to the tibia. The aetiology is not clearly clarified, congenital positional deformities and congenital connective tissue disorders are reported. The co-occurrence with other congenital malformations of the musculoskeletal system (dysplasia of hip joint, abnormities of foot under the ankle) is also common. The diagnosis is based on a somatic finding, ultrasound imaging (especially contracture and / or quadriceps fibrosis) and X-ray (exclusion of dislocation in joint or traumatism) are made. In more severe cases, more complex musculoskeletal abnormalities are present, it is advisable to look at least clinically for other congenital defects, syndromological units may be present. A conservative approach prevails in management – we start splinting and casting of the knee in a neutral position on the day of delivery. Depending on the flexion achieved, we continue conservatively or consider an indication for surgical solution. That is also reserved for primarily more severe cases of defects and also if the defect was detected at a later age. For milder forms of defect and early healing, the prognosis is excellent, in other cases the results are individual, walking mechanism impairment may persist. Most patients require regular dispensarization. In the case report, we will talk about a newborn from our hospital, that is a typical example of a mild form of this defect.
- Klíčová slova
- genu recurvatum congenitum,
- MeSH
- časná diagnóza MeSH
- diferenciální diagnóza MeSH
- kolenní kloub abnormality MeSH
- lidé MeSH
- nemoci kloubů * terapie vrozené MeSH
- novorozenec MeSH
- sádrové obvazy MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky 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
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
Úvod: Zápěstní blok patří mezi periferní nervové blokády. Zájem o tyto metody vyvolaly především nežádoucí účinky celkových anestetik. Indikací zápěstního bloku jsou výkony na ruce plánované i akutní. Z hlediska obtížnosti patří zápěstní blok mezi jednoduché metody s nízkými riziky komplikací. Materiál a metody: Soubor pacientů operovaných v zápěstním bloku v období 6/2015-3/2016 na ortopedicko-traumatologickém oddělení Nemocnice Přerov. Hodnotili jsme retrospektivně úspěšnost aplikace zápěstního bloku. Výsledky: Do souboru bylo zařazeno celkem 24 pacientů, u nichž byl proveden operační výkon v zápěstním bloku. U 33,3 % pacientů byl zápěstní blok doplněn další lokální aplikací anestetika, žádný z pacientů nebyl konvertován na celkovou anestezii. Nezaznamenali jsme prozatím žádné komplikace. Diskuze: Z naší zkušenosti je využití zápěstního bloku optimální u plánovaných operačních výkonů, u traumatologických pacientů je ve většině případů nutné doplnění další lokální aplikace anestetika.
Introduction: Wrist block belongs among peripheral nerve blockades. Interest in these methods was caused mainly by unwanted effects of general anaesthesia. Indications of wrist block are elective and acute hand surgery. In terms of difficulty, wrist blocks are simple methods with low risks of complications. Material and methods: Evaluation of the results of successful wrist block application in patients treated at the Department of Orthopaedics and Traumatology at the Přerov City Hospital in the period between 06/2015 - 03/2016. Results: The group consisted of 24 patients indicated for a hand surgery using wrist block. In a third of the patients it was necessary to complete the wrist block by an additional dose of local anaesthesia; none of the patients required general anaesthesia. We recorded no known complications at this time. Discussion: In our experience, using wrist block is optimal in cases of elective hand surgery, in cases of trauma patients it is usually necessary to complete the wrist block by an additional dose of local anaesthesia.
- Klíčová slova
- chirurgie ruky, zápěstní blok,
- MeSH
- anestetika lokální terapeutické užití MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nervová blokáda * kontraindikace metody škodlivé účinky MeSH
- ortopedické výkony MeSH
- periferní nervy MeSH
- retrospektivní studie MeSH
- ruka * chirurgie MeSH
- senioři MeSH
- traumatologie MeSH
- výsledek terapie MeSH
- zápěstí * inervace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (p<0.05) was achieved postoperatively. The mean duration of surgical procedure was 68 minutes. Moreover, in peritrochanteric space apart from chronic bursitis also another pathology was found in a total of 14 cases (74%). In six cases (32%) it was a mild degeneration of m. gluteus medius (treated only with debridement) and in eight patients who underwent surgery (42%) the dorsal third of tractus iliotibialis was hypertrophic and protruding into bursa (treated with an incision of the hypertrophied part of the band). No serious neurovascular or thromboembolic complications were recorded. Only minor postoperative complications in a total of 7 patients who underwent surgery (37%) occurred. DISCUSSION There are lots of studies in literature presenting the results of endoscopic treatment of GTPS either using an independent trochanteric bursectomy or its combination with iliotibial band release. In our study we succeeded in achieving similar clinical results as those achieved by the other authors engaged in this area. CONCLUSIONS It has been proven in this retrospective study that the technique of endoscopic trochanteric bursectomy in patients with greater trochanteric pain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of postoperative complications. Key words: greater trochanteric pain syndrome, peritrochanteric space, recalcitrant trochanteric bursitis, hip arthroscopy, endoscopic trochanteric bursectomy, iliotibial band release.
- MeSH
- artralgie etiologie chirurgie MeSH
- burzitida komplikace chirurgie MeSH
- dospělí MeSH
- endoskopie * MeSH
- kyčelní kloub * MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- syndrom MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- artroskopie kyčelního kloubu,
- MeSH
- artroskopie * metody MeSH
- artróza kyčelních kloubů * chirurgie klasifikace MeSH
- kyčelní kloub chirurgie patologie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- artroskopie kyčelního kloubu,
- MeSH
- artroskopie * škodlivé účinky MeSH
- kyčelní kloub chirurgie patologie MeSH
- lidé MeSH
- peroperační komplikace * MeSH
- pooperační komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
