PURPOSE: To establish recommendations for diagnosis, classification, treatment, and rehabilitation of posteromedial corner (PMC) knee injuries using a modified Delphi technique. METHODS: A list of statements concerning the diagnosis, classification, treatment and rehabilitation of PMC injuries was created by a working group of four individuals. Using a modified Delphi technique, a group of 35 surgeons with expertise in PMC injuries was surveyed, on three occasions, to establish consensus on the inclusion or exclusion of each statement. Experts were encouraged to propose further suggestions or modifications following each round. Pre-defined criteria were used to refine item lists after each survey. The final document included statements reaching consensus in round three. RESULTS: Thirty-five experts had a 100% response rate for all three rounds. A total of 53 items achieved over 75% consensus. The overall rate of consensus was 82.8%. Statements pertaining to PMC reconstruction and those regarding the treatment of combined cruciate and PMC injuries reached 100% consensus. Consensus was reached for 85.7% of the statements on anatomy of the PMC, 90% for those relating to diagnosis, 70% relating to classification, 64.3% relating to the treatment of isolated PMC injuries, and 83.3% relating to rehabilitation after PMC reconstruction. CONCLUSION: A modified Delphi technique was applied to generate an expert consensus statement concerning the diagnosis, classification, treatment, and rehabilitation practices for PMC injuries of the knee with high levels of expert agreement. Though the majority of statements pertaining to anatomy, diagnosis, and rehabilitation reached consensus, there remains inconsistency as to the optimal approach to treating isolated PMC injuries. Additionally, there is a need for improved PMC injury classification. LEVEL OF EVIDENCE: Level V.

• MeSH
• kolenní kloub * chirurgie   MeSH
• konsensus MeSH
• lidé MeSH
• poranění kolena * diagnóza   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Patellar sleeve fracture is a form of injury in which small osseous fragments avulsed with periosteum and cartilage. 15-year-old male patient, playing in school football team, apllied to our clinic with a history of previously missed patellar superior pole sleeve avulsion fracture. Care must be taken in order not to miss the patellar superior pole sleeve fractures, which are very rare in children. Extra care must be taken in patients, whose X-ray imaging is clean but there is a problem in the extensor mechanism of the knee. INTRODUCTION Since the patella has high mobility and large cartilage surfaces, it's fracture is very rare in children (9). Growing patella is more prone to osteochondral or avulsion fractures (8). Patellar sleeve fracture is a form of injury in which small osseous fragments fractured with periosteum and cartilage (5). Avulsion or sleeve fractures of patella can be seen in inferior and superior patellar poles. Fractures in superior pole is very rare and only a few cases have been described in the literature (2).

• MeSH
• avulzní fraktury diagnóza   chirurgie   MeSH
• fraktury kostí diagnóza   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• nepoznaná diagnóza MeSH
• patela zranění   chirurgie   MeSH
• poranění kolena diagnóza   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Předkládaná kazuistika ukazuje případ 47letého pacienta, který byl předoperačně (plastika vazu LCA kolene levé dolní končetiny [LDK]) hodnocen z hlediska rizika tromboembolické nemoci (TEN) jako nízkorizikový a u kterého došlo k pooperační manifestaci hluboké žilní trombózy (HŽT) (pooperačně nebyl zajištěn žádnou tromboprofylaxí). Byla u něho prokázána FV leidenská mutace v heterozygotní konstituci. Pacient byl od počátku léčen apixabanem (Eliquis), v souladu s doporučovanými dávkovacími standardy dle SPC. Po redukci dávky přípravku Eliquis po šesti měsících terapie byla zjištěna recidiva HŽT ve formě ileofemorální flebotrombózy LDK současně s bilaterální plicní embolizací. Kalibrovaná monitorace antiXa (IU/ml) pro apixaban ukázala nedostatečný efekt léčby. Důvodem recidivy TEN z našeho pohledu byla tedy nedostatečně účinná antikoagulační terapie s apixabanem v redukované dávce 2,5 mg 2× denně. Byla dále zvolena terapie přípravkem Pradaxa v dávce 2× 150 mg denně v indikaci prevence rekurence TEN. Terapie je monitorována pomocí kalibrovaných testů (Hemoclot). Léčba je efektivní, bez krvácivých komplikací a je volena jako terapie dlouhodobá.

The present report shows a case of 47-year-old patient who was preoperatively (LCA ligament of LDK ligament sculpture) assessed as “low-risk” for thrombosis and who had postoperative manifestation of DVT (no thromboprophylaxis postoperatively). FVLeiden mutation in heterozygous constitution has been demonstrated. The patient was treated with apixaban (Eliquis) from the beginning, in accordance with the recommended SPC dosage standards. After reducing the dose of Eliquis after 6 months of therapy, recurrence of DVT was found (ileofemoral phlebothrombosis and pulmonary embolism). Calibrated anti Xa monitoring (IU/ml) for apixaban showed insufficient effect in treatment. The reason for the recurrence of thromboembolism, from our point of view, was inadequate anticoagulant therapy with apixaban at a reduced dose of 2.5 mg twice daily. Further, Pradaxa therapy was selected at 2×150 mg daily in the indication of prevention of recurrence of thromboembolism. The therapy is monitored by calibrated tests (Hemoclot). Treatment is effective without bleeding complications and is chosen as a long-term therapy.

• Klíčová slova
• apixaban,
• MeSH
• antikoagulancia * analýza   aplikace a dávkování   ekonomika   MeSH
• dabigatran analýza   aplikace a dávkování   ekonomika   MeSH
• fibrin-fibrinogen - produkty degradace analýza   účinky léků   MeSH
• inhibitory faktoru Xa aplikace a dávkování   MeSH
• klinické rozhodování MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutace MeSH
• ortopedické výkony škodlivé účinky   MeSH
• plicní embolie diagnóza   etiologie   komplikace   MeSH
• pooperační komplikace diagnóza   farmakoterapie   prevence a kontrola   MeSH
• poranění kolena chirurgie   MeSH
• recidiva MeSH
• rezistence k aktivovanému proteinu C MeSH
• riziko MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• sportovní úrazy chirurgie   MeSH
• terapie neúspěšná MeSH
• ultrasonografie MeSH
• výsledek terapie MeSH
• žilní tromboembolie * diagnóza   etiologie   farmakoterapie   komplikace   prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

A handbook that focuses on surgical treatment of periprosthetic fractures of the hip and knee. Written for professional public, especially orthopaedic surgeons.

• MeSH
• fraktury kyčle chirurgie   MeSH
• kolenní kloub chirurgie   MeSH
• náhrada kyčelního kloubu metody   MeSH
• periprotetické fraktury chirurgie   MeSH
• poranění kolena chirurgie   MeSH
• reoperace metody   MeSH
• selhání protézy MeSH
• totální endoprotéza kolene metody   MeSH
• Publikační typ
• příručky MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• chirurgie
• NLK Publikační typ
• kolektivní monografie

PURPOSE OF THE STUDY There is limited evidence on survival and complication rates in patients after total knee arthroplasty for posttraumatic osteoarthritis. The failure mechanisms leading to revision remain an issue of constant debate. The purpose of this study was to analyze the mid-term survival of primary total knee arthroplasties as well as to evaluate complications and failure mechanisms in patients with posttraumatic knee osteoarthritis. MATERIAL AND METHODS This retrospective study included 79 patients with an average age of 59 years at the time of primary total knee arthroplasty. A functional and radiographic assessment was obtained during outpatient clinical follow-up at 3 and 12 months postoperatively and yearly intervals after that. Survival rates were calculated using Kaplan-Meier analyses. The mean postoperative follow-up was 69 months. RESULTS At 69 month the revision-free survival rate was 88.6%. In nine cases (11.4%) a revision procedure was performed. The leading cause of revision was a periprosthetic infection (n = 6, 66.6%). An age of fewer than 55 years at the time of total knee arthroplasty had a significant influence on implant survival (p = 0.018) with superior survival in favor of the older patient population. At most recent follow-up, a mean Knee Society Score of 82 points and an average Function Score of 77 points were observed. CONCLUSIONS Periprosthetic joint infection is the primary failure mechanism leading to a revision in patients with total knee arthroplasty for posttraumatic osteoarthritis. Apart from the increased infection rate, total knee arthroplasties in patients with posttraumatic osteoarthritis revealed results that were comparable to patients with primary osteoarthritis. Key words:posttraumatic knee osteoarthritis, total knee replacement, survival, complications, revision, outcome.

• MeSH
• artróza kolenních kloubů chirurgie   MeSH
• infekční artritida komplikace   MeSH
• kolenní kloub diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• následná péče MeSH
• pooperační komplikace epidemiologie   MeSH
• poranění kolena chirurgie   MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• totální endoprotéza kolene škodlivé účinky   mortalita   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgie operační metody   MeSH
• fraktury kostí * chirurgie   komplikace   patofyziologie   terapie   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• kosti dolní končetiny patofyziologie   zranění   MeSH
• ortopedické výkony metody   škodlivé účinky   MeSH
• patela * patofyziologie   zranění   MeSH
• poranění dolní končetiny chirurgie   komplikace   patofyziologie   terapie   MeSH
• poranění kolena chirurgie   komplikace   patofyziologie   terapie   MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH

V našej práci prezentujeme kazuistiku 44ročného pacienta so spontánnou bilaterálnou ruptúrou proximálnej časti ligamentum patellae. U pacienta neboli zistené systémové ochorenia ako rizikové faktory šľachových ruptúr. Diagnóza bilaterálnej ruptúry bola potvrdená fyzikálnym vyšetrením a RTG nálezom (patella alta). Druhý deň po úraze bola u pacienta realizovaná bilaterálna reinzercia ruptúr transoseálnymi stehmi cez tunely v patele spolu s odľahčením sutúry serklážnymi slučkami. Vzhľadom k re-ruptúre na pravom kolene po dvoch týždňoch od sutúry bola realizovaná revízna operácia - reinzercia šľachy pôvodnou metódou a augmentáciou šľachami musculus semitendinosus a musculus gracilis. Pooperačne boli obidve kolená fixované v ortézach po dobu 12 týždňov, flexia do 60° bola pacientovi povolená po 6 týždňoch a flexia nad 90° po 9 týždňoch. Po jednom roku od úrazu mal pacient aktívne bilaterálne plnú extenziu. Rozsah flexie v pravom kolene bol 125° a vľavo 130°. Subjektívne pociťoval pacient pravé koleno ako stabilnejšie. Klinický výsledok operačnej liečby bilaterálnej ruptúry ligamentum patellae závisí od skorej operačnej intervencie a pooperačnej rehabilitácie. V prípade re-ruptúr, sutúr s časovým odstupom a v prípadoch nedostatočnej kvality šľachy je indikovaná augmentácia šľachy autológnym štepom, alogénnym štepom alebo syntetickými materiálmi. Podobný prípad sme v slovenskej ani českej literatúre zatiaľ popísaný nenašli.

We present the case of a 44-year-old patient with spontaneous bilateral ruptures of the proximal part of the patellar ligament. There were no identified specific risk factors for tendon ruptures. The diagnosis of bilateral patellar tendon rupture was confirmed in the initial physical examination with unambiguous x-ray diagnosis of patella alta. The second day after the injury, the patient underwent bilateral reinsertion of the rupture with transosseous suture (FiberWire) through tunnels in patella, together with the protection of the primary repairs using cerclage wires. Due to re-rupture of the patella ligament of the right knee two weeks later, revision procedure was carried out. That consisted of resuture of the tendon by the original method and augmentation using the semitendinosus and gracilis tendons. Postoperatively, both knees were fixed in orthoses for 12 weeks, flexion to 60° was allowed after 6 weeks, and flexion beyond 90° after 9 weeks. After one year from injury, the patient had an active bilateral full extension. The range of the right knee flexion was 125° and 130° on the left. The range of the right knee flexion was 125° and 130° on the left. The patient subjectively felt his right knee to be more stable. The clinical results of surgical treatment of the bilateral rupture ligamentum patellae tendons depend on early surgical intervention and post-operative rehabilitation. Augmentation of the tendon with autograft, allograft, or synthetic materials is indicated in the case of re-ruptures, late sutures and in cases of deficient quality of the tendon. We found no similar case described either in the Slovak or Czech literature.

• MeSH
• autologní transplantace metody   MeSH
• dospělí MeSH
• lidé MeSH
• ligamentum patellae * chirurgie   patofyziologie   zranění   MeSH
• ortopedické výkony metody   MeSH
• poranění kolena * diagnostické zobrazování   chirurgie   rehabilitace   MeSH
• šlachy chirurgie   transplantace   MeSH
• výsledek terapie MeSH
• zadní stehenní svaly chirurgie   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

UNLABELLED: This study describes a diagnostic and therapeutic algorithm in a 53-year-old male patient who was diagnosed with a synovial chondromatosis of the knee joint extending to the popliteal fossa and soft tissues around the knee. Because of the presence of massive nodules, the patient was indicated for total synovectomy, with removal of pathologically changed cartilaginous tissue, performed by combined anterior and posterior approaches to the knee joint. Despite complete removal of the synovium and loose cartilage bodies and the patient's pain relief in the post-operative time, three years after the operation new problems appeared. Magnetic resonance imaging (MRI) confirmed a relapse of synovial chondromatosis and the patient was indicated for revision surgery of the knee joint. The results of physical examination and MRI scans, and intra-operative findings in the patient are reported. KEY WORDS: synovial chondromatosis, total synovectomy, direct anterior and posterior approaches to the knee joint.

• MeSH
• chondromatóza synoviální chirurgie   MeSH
• kolenní kloub chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ortopedické výkony metody   MeSH
• poranění kolena chirurgie   MeSH
• recidiva MeSH
• reoperace MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: The objective of this study is to evaluate the effect of posterior tibial slope after fracture healing on antero-posterior knee laxity, functional outcome and patient satisfaction. MATERIAL AND METHODS: 126 patients who were treated for tibial plateau fractures between 2008-2013 in the orthopedics and traumatology department of our institution were evaluated for the study. Patients were treated with open reduction and internal fixation, arthroscopy assisted minimally invasive osteosynthesis or conservative treatment. RESULTS: Mean posterior tibial slope after the treatment was 6.91 ± 5.11 and there was no significant difference when compared to the uninvolved side 6.42 ± 4,21 (p = 0.794). Knee laxity in anterior-posterior plane was 6.14 ± 2.11 and 5.95 ± 2.25 respectively on healthy and injured side. The difference of mean laxity in anterior-posterior plane between two sides was statistically significant. DISCUSSION: In this study we found no difference in laxity between the injured and healthy knees. However Tegner score decreased significantly in patients who had greater laxity difference between the knees. We did not find significant difference between fracture type and laxity, IKDC functional scores independent of the ligamentous injury. CONCLUSION: In conclusion despite coronal alignment is taken into consideration in treatment of tibial plateau fractures, sagittal alignment is reasonably important for stability and should not be ignored.

• MeSH
• artroskopie metody   MeSH
• dospělí MeSH
• fraktury tibie patofyziologie   chirurgie   MeSH
• kolenní kloub patofyziologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nestabilita kloubu chirurgie   MeSH
• poranění kolena chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• spokojenost pacientů MeSH
• tibie anatomie a histologie   diagnostické zobrazování   MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Treatment for tears of the anterior cruciate ligament (ACL) in paediatric patients has been a long-discussed issue because of complications associated with ligament reconstruction in the presence of growth plates. Various fixation materials and their efficiency as well as ACL techniques are still under investigation. The aim of our study was to find an optimal strategy of treating acute intra-articular ACL injury in childhood. MATERIAL AND METHODS: The paediatric patients treated for primary traumatic ACL injury between 2003 and 2013 were retrospectively evaluated. Only patients with a healthy contralateral knee (with no signs of instability or previous injury) and no record of previous ACL repair were included. A total of 78 patients were assessed; there were 39 girls and 39 boys with an average age of 15.4 years (11 - 16). The physical development of the patients was assessed on the Tanner scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner-Lysholm scoring system. The instrumented Lachman test using a rollimeter was performed to assess knee stability at 12 and 24 months of follow-up. In addition, the range of knee motion in comparison with the other side, complications and the re-rupture rate of reconstructed ACLs were recorded. Four patients with open growth plates were operated on using the transepiphyseal technique, the remaining 74 underwent reconstruction by the standard transphyseal method. RESULTS: The average Tegner-Lysholm scores were 54 (41-62) pre-operatively and 86.1 (74-96) at 24 months post-operatively. The average IKDC score increased from 48 (42-56) points to 91 (73-97) points. The Lachman test was positive in all patients before ACL reconstruction and negative in 96% of them at 12 and 24 months after surgery. The full range of joint motion was restored after ACL surgery, with minimal motion restriction in flexion and extension, in 70 (89.7%) patients. Motion restriction by 15° or less in flexion and 5° or less in extension was recorded in seven (9%) patients and a significant restriction in extension exceeding 10° was found in one (1.3%) patient. No differences in results were found between the two scoring systems. Five patients (6.4 %) sustained a re-tear in the reconstructed ACL due to a trauma. Non-traumatic subjective instability after the primary repair was not recorded. Revision ACL surgery was carried out due to fixation materials protruding from the bone surface in two patients and because of a Cyclops lesion with extension deficit in one patient. No development of deformity or instability was observed at 24 months in the patients in whom the transepiphyseal technique was used. DISCUSSION In the current literature ACL reconstruction by the transphyseal technique has been described in patients older than 15 years of age but no optimal age has been suggested. Animal experiments have shown that tunnels taking up more that 7-9% of the growth plate surface can result in growth restriction or angular deformity. ACL reconstruction in patients with distinct bone immaturity carries a high risk. The effect of growth on the biomechanical properties of a graft and a long-term consequence of surgical intervention in the growth plate is not yet understood. CONSLUSIONS: Although indications for surgical ACL repair and its timing are bound to be different in each patient, we consider the age of over 15 years to be ideal for ACL reconstruction. In patients younger than 15 years, the necessity of surgical treatment is questionable and conservative therapy can give good outcomes. No adverse effect of an applied graft on the post-operative results was demonstrated. The features of an immature skeleton are specific and complicated therefore, in our view, the relevant health care for paediatric patients should be concentrated into specialised institutions.

• MeSH
• dítě MeSH
• lidé MeSH
• ligamentum cruciatum anterius zranění   patofyziologie   chirurgie   MeSH
• mladiství MeSH
• poranění kolena patofyziologie   chirurgie   MeSH
• recidiva MeSH
• rekonstrukce předního zkříženého vazu metody   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• růstová ploténka chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH