1. vydání 127 stran : barevné ilustrace ; 20 cm
Příručka, která se zaměřuje na léčbu zranění a bolesti kloubů (zejména kolenního a menisku) pomocí rehabilitačních cvičení. Určeno široké veřejnosti.; Za 35 let rozvoje a terapeutické praxe Roland Liebscher-Bracht a Dr. Med Petra Brachtová vyvinuli jedinečnou, účinnou metodu proti bolesti kolenou. V této knize se dozvíte, jak bolesti kolenou v mnoha případech vznikají a proč běžné terapie často trvale nepomáhají, jak je možné, že díky metodě Liebschera a Brachtové máte opravdovou šanci se bolestí konečně zbavit, jak se pomocí speciálně vymyšlených cviků Liebschera a Brachtové, vhodnými fasciálními masážemi a léčebnou osteopresurou můžete sami úspěšně léčit, jak časté bolesti kolenou účinně omezíte a zůstanete bez bolesti až do vysokého věku. 10 KROKŮ K OPTIMÁLNÍMU CVIČEBNÍMU PROGRAMU Vyzkoušejte postupně všechny uvedené techniky. Zaznamenejte si, jak se během každé z nich a po ní cítíte. Začněte svůj program cviky a aplikacemi, které jsou pro vás snadné a uleví vám od bolesti hned na začátku. Pravidelně cvičit šest dní v týdnu. Nejlepší je používat všechny tři techniky denně. Doporučujeme cvičit ráno a večer provádět masáž a osteopresuru. Propojte terapii s ranní (vstávání, koupání...) a večerní rutinou (sledování televize, povídání...). Pokud to budete dodržovat čtrnáct dní, stane se i cvičení rutinou a bude pro vás stále snazší. Začněte se spíše kratším programem, který určitě dodržíte. Pokud jej nedokážete plnit pravidelně, okamžitě jej snižte. Omezte svůj ranní program na 15, maximálně 20 minut. Je to pro vás příliš dlouhá doba? Začněte s pěti minutami! Lepší je cvičit kratší dobu a pravidelně než dlouho a nepravidelně. Pokud vám čas nestačí na celý program, cvičte polovinu z něj vždy tři dny nebo třetinu ve dvou dnech. Experimentujte s různými denními postupy (přestávka na oběd, změna místa atd.). S rostoucí flexibilitou zkoušejte náročnější varianty – a těšte se ze svých pokroků. Samoléčba bolestí kolenou METODOU LIEBSCHER & BRACHT: Poznejte skutečné příčiny bolestí kolenou Skoncujte s pocitem bezmoci Rozvíjejte důvěru v zacházení s vlastním tělem. Ulevte si od bolesti kolenou sami a natrvalo Vraťte se do formy a rozhýbejte se Získejte novou chuť do života a kvalitu života Vybudujte sílu a pružnost nohou Najděte konečně opět zálibu ve sportu Zůstaňte bez bolesti kolenou až do vysokého věku
- MeSH
- injekce intraartikulární MeSH
- kolagen * aplikace a dávkování farmakologie terapeutické užití MeSH
- kolenní kloub * patologie účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- menisky tibiální patologie účinky léků MeSH
- poranění kolena farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Medial knee pain is commonplace in clinical practice and ultrasound assessment of the tibial collateral ligament-medial meniscus complex is increasingly becoming a valuable examination tool in the outpatient setting. In the pertinent literature, basic sonographic protocols have been proposed to evaluate the medial compartment of the knee joint. Using high-frequency ultrasound probes and high-level ultrasound machines; we matched the histo-anatomical features of the tibial collateral ligament-medial meniscus complex and its different sonographic patterns in physiological/pathological conditions to define a standardized (layer-by-layer) sonographic approach. Moreover, high-sensitive power Doppler assessments have also been performed to evaluate the nearby microcirculation. Modern ultrasound equipment appears to provide optimal "sonographic dissection" of the tibial collateral ligament-medial meniscus complex for its various physiological/pathological patterns. Likewise, high-sensitive power Doppler allows clear visualization of the microcirculation as regards the local ligamentous and capsular structures. In clinical practice, using adequate technological equipment, a detailed sonographic assessment of the tibial collateral ligament-medial meniscus complex can be performed. High-frequency B-mode ultrasound imaging and high-sensitive power Doppler perfusion patterns can be matched/integrated with the clinical findings to optimize the management of patients with medial knee pain.
- MeSH
- bolest patologie MeSH
- kolenní kloub diagnostické zobrazování MeSH
- lidé MeSH
- ligamentum collaterale tibiale * MeSH
- menisky tibiální patologie MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy 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.
Cíl: Cílem práce bylo určit vliv artroskopické parciální meniskektomie (APM) na kolenní kloub z hlediska rozvoje osteoartrózy (OA) v dlouhodobém horizontu od operace. Soubor a metodika: Systematicky jsme prohledali medicínské databáze – PubMed, MEDLINE, Embase, Web of Science s použitím klíčových slov: "partial meniscectomy“, "osteoarthritis“, "outcome“. Vyhledávání jsme zúžili na období let 2000–2020 a zařadili jsme pouze studie s minimální dobou sledování 60 měsíců. Extrahovali jsme radiologické – primární výsledky, a subjektivní hodnocení pacientů – sekundární výsledky. Výsledky: Zařazovacím, resp. vylučovacím, kritériím vyhovovalo nakonec pouze osm kvalitních klinických studií. Průměrná délka sledování byla 88 měsíců. Všechny zařazené studie prezentují u pacientů podstupujících APM pro lézi menisku zhoršení OA o jeden i více stupňů. Z celkového počtu posouzených pacientů tvoří podíl s progresí OA 36,3 %. K uvedenému zjištění je kontrastní subjektivní hodnocení výsledku operace, kdy došlo ke zlepšení ve všech hodnocených parametrech výsledku operace. Závěr: Indikace k APM musí obsahovat parametr budoucího zhoršení OA postiženého kolena, protože APM může být u pacientů ve středním/vyšším věku stimulem k progresi OA. Na druhé straně je nepochybné, že APM dosahuje poměrně spolehlivě dobré klinické výsledky, včetně sebehodnocení (PROMIS). Racionálním řešením bude nepochybně vytvoření mnohem jemnějšího algoritmu pro vedení léčby u kolen s OA a symptomatickou meniskeální lézí, jenž umožní odlišit pacienty, kteří mohou z operační léčby dlouhodobě profitovat. U ostatních je indikovaná kvalitně vedená rehabilitace s navazujícím tréninkem po dostatečně dlouhou dobu. Vzhledem k heterogenitě studií zařazených do tohoto přehledového článku bude nutné provést další prospektivní a moderně vedené studie na toto téma.
Objective: Our aim was to identify the effect of arthroscopic partial meniscectomy (APM) on the knee joint during longterm follow-up in terms of osteoarthritis (OA) progression. Methods: We systematically searched medical databases – PubMed, MEDLINE, Embase, Web of Science, using key words: "partial meniscectomy“, "osteoarthritis“, outcome“. The search was limited to the period from 2000 to 2020
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
Meniscus is a semilunar fibrocartilaginous tissue, serving important roles in load buffering, stability, lubrication, proprioception, and nutrition of the knee joint. The degeneration and damage of meniscus has been proved to be a risk factor of knee osteoarthritis. Mechanical stimulus is a critical factor of the development, maintenance and repair of the meniscus fibrochondrocytes. However, the mechanism of the mechano-transduction process remains elusive. Here we reported that cyclic hydrostatic compress force (CHCF) treatment promotes proliferation and inhibits apoptosis of the isolated primary meniscus fibrochondrocytes (PMFs), via upregulating the expression level of integrin ?5ß1. Consequently, increased phosphorylated-ERK1/2 and phosphorylated-PI3K, and decreased caspase-3 were detected. These effects of CHCF treatment can be abolished by integrin ?5ß1 inhibitor or specific siRNA transfection. These data indicate that CHCF regulates apoptosis of PMFs via integrin ?5ß1-FAK-PI3K/ERK pathway, which may be an important candidate approach during meniscus degeneration.
- MeSH
- apoptóza fyziologie účinky léků MeSH
- buněčný převod mechanických signálů fyziologie MeSH
- chondrocyty metabolismus účinky léků MeSH
- fibroblasty metabolismus účinky léků MeSH
- hydrostatický tlak MeSH
- integrin alfa5beta1 antagonisté a inhibitory metabolismus MeSH
- krysa rodu rattus MeSH
- kultivované buňky MeSH
- malá interferující RNA aplikace a dávkování MeSH
- meniskus cytologie metabolismus MeSH
- pevnost v tlaku fyziologie MeSH
- potkani Sprague-Dawley MeSH
- proliferace buněk fyziologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Due to the internal structure of the knee joint, the ability to characterize and quantify the dynamic response of the meniscal tissue directly in vivo is highly problematic. The main purpose of this study was to investigate the behaviour of the meniscus under loading conditions. Four healthy young females were included. To obtain T2* values in the meniscus, the vTE sequence was used with 10 echoes ranging from 0.8 to 10.1 ms. Submilisecond first echo time is a great advantage of vTE sequence allowing for precise mapping of relatively short T2*. The two-parametric least squares fitting procedure was used to calculate T2* pixel-wise. A custom-made diamagnetic apparatus was developed to simulate stress conditions on the lower limb in a conventional MR scanner. vTE T2* was performed in five consecutive scans, 6:10 min apart. Three different compartments of the medial and lateral meniscus were segmented. The differences at the different time-points were calculated. A constant increase of T2* times after compression was statistically significant in the anterior horn of the medial meniscus. T2* mapping with variable echo time sequence might be a satisfactorily sensitive technique to detect the changes of meniscus physiology under loading conditions in vivo.
- MeSH
- dospělí MeSH
- kloubní chrupavka * diagnostické zobrazování MeSH
- kolenní kloub MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- menisky tibiální * diagnostické zobrazování fyziologie MeSH
- zátěžový test * MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
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
- radiografie 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
