BACKGROUND: This study aimed to assess the mid-term effects of focused extracorporeal shockwave therapy (ESWT) on clinical symptoms and tendon structure in patellar tendinopathy. Ultrasound (US) evaluation and an innovative in vivo analysis of intra-tendinous morphology using validated spatial frequency analysis (SFA) software were employed to quantify the organization and density of collagen fascicles. METHODS: This prospective cohort study included 21 recreational athletes (mean age 29.9 ± 9.3 years) with chronic unilateral symptomatic patellar tendinopathy. ESWT was applied as monotherapy over four weekly sessions. Pain was assessed using the Numeric Rating Scale (NRS) and disease severity with the Victorian Institute of Sports Assessment - Patella (VISA-P) questionnaire. Morphological parameters, such as tendon diameter (TD), were assessed with US and analyzed using SFA software. The asymptomatic tendons served as controls. Follow-up assessments were conducted at the end of the treatment period and 3 months posttreatment. RESULTS: Baseline evaluations revealed increased TD in proximal part of the tendon ( P = 0.001) and decreased organization of collagen fascicles ( P = 0.013) in symptomatic tendons compared to asymptomatic controls. At the 3-month follow-up, symptomatic tendons showed significant reductions in TD ( P < 0.001) and improvements in both organization and density of collagen fascicles throughout various parameters - peak spatial frequency radius (PSFR) ( P = 0.024), P6 ( P = 0.05), Q6 ( P = 0.016), PPP ( P = 0.003). No significant morphological changes were observed in asymptomatic tendons. Clinical evaluations demonstrated significant reductions in NRS ( P < 0.001) and increases in Victorian Institute of Sports Assessment - Patella (VISA-P) scores ( P < 0.001) at all time points. CONCLUSION: The study suggests that ESWT may have the potential to induce positive structural changes in patellar tendinopathy, including improved organization and density of collagen fascicles. These findings indicate that ESWT could be a promising noninvasive approach to managing patellar tendinopathy, with observed improvements in clinical symptoms and tendon structure. However, further high-quality research is needed to confirm these results and establish their long-term efficacy.

• MeSH
• dospělí MeSH
• léčba mimotělní rázovou vlnou * metody   MeSH
• lidé MeSH
• ligamentum patellae * diagnostické zobrazování   patologie   MeSH
• mladý dospělý MeSH
• prospektivní studie MeSH
• tendinopatie * terapie   diagnostické zobrazování   patologie   MeSH
• ultrasonografie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice. MATERIALS AND METHODS: A literature search of original publications and historical sources was performed. RESULTS: The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance. CONCLUSION: The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.

• MeSH
• dějiny 18. století MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• dějiny 21. století MeSH
• fibula * anatomie a histologie   MeSH
• hlezenní kloub * anatomie a histologie   MeSH
• klinická relevance MeSH
• kloubní ligamenta * anatomie a histologie   MeSH
• lidé MeSH
• terminologie jako téma MeSH
• tibie anatomie a histologie   MeSH
• Check Tag
• dějiny 18. století MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• dějiny 21. století MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• přehledy MeSH

AIM: To propose a standardized, high-resolution ultrasound (US) protocol to assess the patellar tendon-Hoffa fat pad interface (PTHFPI) in patients with (proximal) patellar tendinopathy (PPT). METHODS: Using a high-frequency transducer and a high-level machine, we matched the cadaveric and histological microarchitecture of the PTHFPI with multiple sonographic patterns of patients with PPT. Likewise, high-sensitive color/power Doppler assessments were also performed to evaluate the microcirculation of the soft tissues beneath the patellar tendon. RESULTS: Modern US equipment allows for detailed assessment of the potential pain generators located inside the PTHFPI in patients with PPT. They include anterosuperior portion of the Hoffa body and the loose connective tissue of the deep paratenon with its microvascular plexus. CONCLUSIONS: In patients with PPT, accurate sonographic assessment of the PTHFPI can be performed using adequate technological equipment. Accordingly, tailored ultrasound-guided interventions can also be planned if/when clinically indicated.

• MeSH
• kolenní kloub diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligamentum patellae * diagnostické zobrazování   MeSH
• mrtvola MeSH
• senioři MeSH
• tendinopatie * diagnostické zobrazování   patologie   MeSH
• tuková tkáň * diagnostické zobrazování   MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

This study aimed to characterize the mechanical properties of native human ligamentum flavum (LF) and correlate them with histopathological changes. Mechanical property gradients across the cranial, medial, and caudal regions of LF were mapped and compared with histological sections. We also compared lumbar spinal stenosis (LSS) samples with disc herniation (DH) samples as reference material to identify differences in mechanical properties and histopathological features. Our results revealed significant heterogeneity in LF mechanical properties, with local variations correlating with specific histopathological changes such as chondroid metaplasia and loss of elastic fibers. These findings underscore the importance of considering LF heterogeneity in mechanical characterization and provide insights into its behavior under pathological conditions.

• MeSH
• bederní obratle * patologie   MeSH
• biomechanika MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligamentum flavum * patologie   MeSH
• mechanický stres MeSH
• senioři MeSH
• spinální stenóza * patologie   MeSH
• výhřez meziobratlové ploténky * patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Precise positioning of the acetabular component during total hip replacement is the key to achieving optimal implant function and ensuring long-term patient comfort. However, different anatomical variations, degenerative changes, dysplasia, and other diseases make it difficult. In this study, we discuss a method based on the three-dimensional direction of the transverse ligament, predicting native acetabular anteversion with higher accuracy. METHODS: Angular positions of the acetabulum and direction of the transverse ligament were automatically calculated from routine computed tomography data of 270 patients using a registration algorithm. The relationship between acetabular angles and ligament direction and their relationship with sex, age, and pelvic tilt were sought. These relationships were then modelled using multilinear regression. RESULTS: Including the direction of the transverse ligament in the sagittal and transverse planes as a regressor in the multilinear model explained the variation in acetabular anteversion (R2 = 0.76 for men, R2 = 0.63 for women; standard deviation in prediction: men, 3.92° and women, 4.00°). CONCLUSIONS: The results indicate that the ligament was suitable as a guidance structure almost insensitive to the ligament in the sagittal and transverse planes must be considered. Estimation based on the direction in only 1 plane was not sufficiently accurate. The operative acetabular inclination was not correlated with the direction of the ligament. The correlations were higher in men than in women.

• MeSH
• acetabulum * diagnostické zobrazování   chirurgie   MeSH
• anteverze kosti diagnostické zobrazování   MeSH
• dospělí MeSH
• kloubní ligamenta * diagnostické zobrazování   anatomie a histologie   MeSH
• kyčelní kloub diagnostické zobrazování   anatomie a histologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * metody   MeSH
• počítačová rentgenová tomografie * MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgická rána ošetřování   MeSH
• Filipendula účinky léků   MeSH
• fytoterapie MeSH
• hojení ran účinky léků   MeSH
• kloubní ligamenta chirurgie   zranění   MeSH
• kolenní kloub u koně, psa chirurgie   zranění   MeSH
• masti terapeutické užití   MeSH
• pooperační péče MeSH
• roztoky pro parenterální výživu terapeutické užití   MeSH
• roztoky terapeutické užití   MeSH
• výsledek terapie MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• fixace fraktury MeSH
• fraktury vřetenní kosti * diagnóza   komplikace   terapie   MeSH
• kloubní ligamenta zranění   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nestabilita kloubu diagnóza   etiologie   terapie   MeSH
• poranění zápěstí diagnóza   terapie   MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• zápěstí patologie   MeSH
• Check Tag
• lidé MeSH

PURPOSE: The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2-S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. METHODS: Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. RESULTS: Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. CONCLUSION: Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.

• MeSH
• disekce MeSH
• iatrogenní nemoci MeSH
• kloubní ligamenta MeSH
• lidé MeSH
• mrtvola MeSH
• pánev MeSH
• pudendální nerv * anatomie a histologie   MeSH
• pudendální neuralgie * chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

After anterior cruciate ligament (ACL) injury, a decrease in muscle strength associated with muscle atrophy is frequently observed. The temporal and spatial effects of reconstructive surgery on muscle atrophy have not been examined in detail. This study aimed to 1) reveal the short and mid-term effects of reconstructive surgery on muscle atrophy, and 2) investigate the differences in the degree of atrophy after ACL reconstruction in the hindlimb muscles. ACL transection with or without reconstructive surgery was performed unilaterally on the knees of rats. Untreated rats were used as controls. At one or four weeks post-surgery, the relative muscle wet weights (wet weight/body weight) of the hindlimb muscles were calculated to assess atrophy. At one week post-surgery, muscle atrophy was induced by ACL transection and further aggravated by reconstructive surgery. Reconstructive surgery facilitated recovery from muscle atrophy in some muscles compared with those without reconstructive surgery (ACL transection alone) at four weeks post-surgery. Muscle atrophy after ACL reconstruction was greater in the rectus femoris and plantar flexors than in the semitendinosus and plantar extensors at one week post-surgery. These results indicate that reconstructive surgery exacerbates muscle atrophy in the first week post-surgery, while facilitating recovery between the first and fourth week post-surgery. After reconstructive surgery, muscle atrophy was observed not only in the quadriceps and hamstrings, but also in the lower leg muscles, suggesting the need for muscle strengthening interventions for the lower leg muscles as well as the quadriceps and hamstrings.

• MeSH
• čtyřhlavý sval stehenní patologie   fyziologie   MeSH
• krysa rodu rattus MeSH
• ligamentum cruciatum anterius chirurgie   MeSH
• plastická chirurgie * MeSH
• poranění předního zkříženého vazu * chirurgie   patologie   MeSH
• svalová atrofie etiologie   patologie   MeSH
• svalová síla fyziologie   MeSH
• zadní končetina MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The competence of the anterior translation of tibia (ATT), posterior cruciate ligament angle (PCLA), and femorotibial rotation angle (FTRA) measured on MR images in predicting anterior cruciate ligament (ACL) injury was evaluated in this study. MATERIAL AND METHODS 266 patients who underwent diagnostic arthroscopy between 2015-2020 were included in this study. Age, gender, radiological fi ndings included ATT, PCLA, and FTRA were measured on preoperative MR images of all patients. RESULTS ACL tear was detected in 143 of patients and most of them were younger males. In ACL-R group, the ATT was 7 mm (-4-17 mm), PCLA value was 110o (52o-157o), and FTRA value was 5.8o (-5o-18o), while in ACL-I group, the ATT was approximately 5 mm (-4-12 mm), PCLA value was 122o (82o-162o) and FTRA value was 1.6o (-10.9o-10o) (p<0.001). ROCCurve test results showed that if ATT value was >6.05 mm (63% sensitivity, 65% specifi city) if PCLA value was <116.5o (65% sensitivity, 70% specifi city) and if FTRA value was >3.45o (73% sensitivity, 72% specifi city), these parameters could predict the probability of ACL tear, preoperatively. The Logistic Regression test results revealed that the PCLA and FTRA values could be the best markers to predict the probability of ACL tear, preoperatively. CONCLUSIONS This study results showed that the ATT, PCLA, and FTRA values could be used as predictive markers in diagnosis of ACL tear, preoperatively. Among these three values, it was concluded that the FTRA could have the highest sensitivity and specifi city ratios and the best predictive value. Key words: anterior cruciate ligament tear, magnetic resonance imaging, arthroscopy, rotational instability, femorotibial rotation angle, anterior translation of the tibia, posterior cruciate ligament angle.

• MeSH
• biologické markery MeSH
• izotopy kyslíku MeSH
• kolenní kloub MeSH
• lidé MeSH
• ligamentum cruciatum anterius diagnostické zobrazování   MeSH
• magnetická rezonanční tomografie MeSH
• poranění předního zkříženého vazu * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH