Hamstrings Dotaz Zobrazit nápovědu
PURPOSE OF THE STUDY The success rate of the anterior cruciate ligament (ACL) reconstruction depends on the fixation of the graft, the surgical technique and, of course, on the experience of the operating surgeon. The authors present the development of the construction of the new instrumentation set designed to manage the ACL lesions using the hamstring (HS) tendons. The study is divided into two parts, of which part one focuses on construction, methods and work with new instruments, while part two presents the outcomes of the surgery. MATERIAL AND METHODS Fixation of hamstring grafts depends, contrary to the union of bone blocks in the Bone-Tendon-Bone (BTB) graft and the bone tunnel, on the method of tendon graft fixation and compression inside the bone tunnel. The instrumentation set for ACL reconstruction is designed to be used for hamstring tendons (semitendon and gracilis) forming four strands of the prepared graft. The system was designed as the fixation of the graft using the femoral screw with eyelet and a press-fit fixation using a metal interference screw in tibia. The easiest and fastest option has proven to be the pulling of the screw with eyelet through the tibial tunnel and intra-articular space to the femoral canal, where fixation by screwing in is done. The exact position of the inserted screw is verified by the measuring gauge. The screw is pulled in by the long version of the femoral screwdriver and Kirschner wire passing through the middle of the screw with eyelet. The advantage of this system consists in the subsequent insertion of the interference screw by the same wire, which guarantees its exact positioning in the centre between the individual strands of the graft (thanks to the specific way of ligament preparation). The possibility of later tensioning of the graft by tightening the femoral screw is another advantage. DISCUSSION Compared to other methods using the HS tendons, the advantages of the described operative technique consist in the simplicity of the used instrumentation procedure. The technique of graft fixation inside the femoral canal is not suitable for bioabsorbable materials. It is offset by the fixation stability and the possibility of final graft tensioning. CONCLUSIONS The newly developed instrumentation set for ACL reconstruction is fit for purpose, easy as to the surgical technique, and it guarantees the logical sequence of surgical steps reducing surgical errors to minimum. The instrumentation set is user-friendly, easy to handle and, once the operating surgeon masters the surgical procedure, it allows to reduce the duration of the surgery to approximately 30 minutes. There were no major complications or technical errors reported during the surgical procedures using these instrumentation set.
The relationship between the muscular strength of hamstrings and quadriceps and their possible muscular imbalance is considered by many authors as one of the causes of knee joint injury. The aim of this work is to assess the exercise program including squat modifications both in terms of progression of lower limb strength and in terms of possible change of H: Q ratio. Probands were divided into five groups (one control, four experimental). The experimental groups practiced the intervention program twice a week for eight weeks (EX1: Barbell squat, EX2: Barbell half squat, EX3: Barbell half squat with countermovement). In one training session participants repeated the exercise five times in six series. All experimental groups exhibited significant differences in mean values (p < 0.01), indicating the progression of lower limb strength measured by 1RM for barbell squat. The differences in the mean values of the H: Q ratio measured on an isokinetic dynamometer in the isokinetic test mode at angular velocities of 60 and 300 degrees per second do not show statistically significant differences (p = 0.99338). The established strength intervention program is suitable for the development of lower limb strength and does not show any changes in the H: Q ratio.
- MeSH
- biomechanika MeSH
- čtyřhlavý sval stehenní MeSH
- kolenní kloub * patologie MeSH
- lidé MeSH
- sportovní úrazy MeSH
- svalová síla MeSH
- techniky cvičení a pohybu MeSH
- zadní stehenní svaly MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Anterior cruciate ligament reconstruction is one of the most common reconstruction surgeries. The unintended consequences of the surgery are hemarthrosis, blood loss, knee swelling and postoperative pain. The purpose of the study was to evaluate the effect of a single dose of intravenous tranexamic acid (TXA) on the postoperative parameters and functional status of the knee joint 3 months after surgery. MATERIAL AND METHODS It is a prospective randomised clinical study. An intravenous injection of TXA equivalent to 15 mg/kg in 100 ml of saline solution was administered to the test group during the surgery (20 minutes before the end of the surgery). The control group was administered 100 ml of saline solution without TXA. In both groups, the following parameters were evaluated preoperatively and postoperatively (on Day 1 and Day 10 and at 1 month and 3 months): thigh circumference at 1 cm above the patella, Coupens and Yates (CY) score for swelling, and pain score (VAS). At 24 hours after the surgery, the blood loss (secretion into the drain) and decrease in hemoglobin (Hb) and hematocrit (HCT) levels compared to the preoperative levels were assessed. The functional status of the knee joint was assessed based on the Lysholm knee scoring scale and the IKDC subjective knee evaluation form preoperatively, or at 1 and 3 months postoperatively. RESULTS In the test group, a significantly lower blood loss was detected 24 hours after the surgery. The mean difference of 128 ml compared to the control group was both statistically and practically significant (p < 0.001, d =1.42). The test group showed a lower decrease in Hb and HCT levels postoperatively compared to the control group, although with no statistical significance. On the first postoperative day, slightly better results of the thigh circumference at 1 cm above the patella and of the CY score were observed in the test group. However, during the follow-up check performed postoperatively on Day 10, the differences in the thigh circumference at 1 cm above the patella, CY score and pain VAS score were negligible. The differences in the functional status of the knee joint between the two groups ascertained during the check performed 1 month and 3 months after the surgery were insignificant. DISCUSSION Our study, just like other studies, confirms a significant effect of a single dose of intravenous TXA on the volume of blood loss and early postoperative swelling, which are the parameters affecting the early postoperative course. Even though the intervention does not affect the subsequent result of surgery, it can undoubtedly be of benefit perioperatively. There is a fairly limited number of randomised clinical studies on this topic in literature, with most of them published in the last 7 years. Further research should, among other things, optimise the protocol and identify a suitable candidate for TXA administration in patients undergoing an ACL reconstruction. CONCLUSIONS Our study confirmed the positive effect of a single dose of intravenous TXA during the reconstruction of anterior cruciate ligament using hamstrings on early postoperative blood loss and early postoperative swelling, which can have a positive effect on wound healing and prevent postoperative complications. Therefore, in agreement with available literature, we recom mend administering a single dose of intravenous TXA in ACL reconstruction, unless there is a contraindication to this therapy. Key words: anterior cruciate ligament reconstruction, hamstrings tranexamic acid, single intravenous administration, clinical evaluation.
- MeSH
- kolenní kloub chirurgie MeSH
- kyselina tranexamová * MeSH
- lidé MeSH
- Lysholmovo skóre MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- prospektivní studie MeSH
- rekonstrukce předního zkříženého vazu * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s-1. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.
Proximal hamstring avulsion is an uncommon muscle injury with a lack of consensus on indications and the timing and technique of surgery. Poor clinical symptoms and difficulties in the diagnostic process can lead to a false diagnosis. The authors present three cases of proximal hamstring avulsion, two complete and one partial ruptures of the biceps femoris muscle. MRI and ultrasound scans were used for optimal treatment alignment. Acute surgery reconstruction (< 4 weeks) was done in two patients. Re-attachment of the full thickness ruptures was performed to the original place and secured by suture anchors, the partial rupture was fixed by a simple suture. Two patients were free of any symptoms at 6 months after surgery, the last one had pain in the subgluteal area and a mild deficit in hamstring strength. Two interesting systematic reviews published on the treatment of proximal hamstring avulsion are discussed in the final part of the paper. Key words: hamstring, rupture, avulsion.
- MeSH
- avulzní fraktury diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- šicí techniky MeSH
- ultrasonografie metody MeSH
- výsledek terapie MeSH
- zadní stehenní svaly diagnostické zobrazování zranění MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Valdes, O, Inzulza, S, Collao, N, Garcia-Vicencio, S, Tufano, JJ, Earp, J, Venegas, M, and Peñailillo, L. Eccentric cycling is an alternative to Nordic hamstring exercise to increase the neuromuscular function of knee flexors in untrained men. J Strength Cond Res 37(11): 2158-2166, 2023-Nordic hamstring exercise (NHE) has been proposed to reduce knee flexor (KF) injuries. However, submaximal alternatives to NHE are necessary for the clinical or weaker population. The aim of this study was to compare the effects of Nordic hamstring training (NHT) and eccentric cycling (ECC) training on the neuromuscular function of the KF. Twenty healthy men (27.7 ± 3.5 years) were randomly assigned into 2 groups that performed 10 training sessions (2-3 sessions·week-1) of either NHT (n = 10) or ECC (n = 10). Maximal voluntary isometric contraction of the KF and knee extensor (KE) muscles (MVICKF and MVICKE) was measured, and the hamstring/quadriceps strength (H/Q) ratio was calculated. Furthermore, changes in NHE maximum reaction force (NHE-MRFKF), NHE break-point angle (NHE-BPA), and muscle activity of the semitendinosus (STEMG) and biceps femoris (BFEMG) during the NHE after the interventions were compared. Although no group × time effects were observed (p = 0.09-0.70), but time effects were found for all variables. Pairwise comparisons revealed that MVICKF (+16.9%; p = 0.02), H/Q ratio (+11.8%; p = 0.01), NHE-MRFKF (+19.8%; p = 0.005), and NHE-BPA (+30.8%; p = 0.001) increased after ECC, whereas NHE-MRFKF (+9.7%; p = 0.003), NHE-BPA (+35.5%; p = 0.0002), and STEMG (+33.7%; p = 0.02) increased after NHT. A group × time effect was observed (p = 0.003) in BFEMG, revealing an increase only after ECC (+41.1%; p < 0.0001). Similar neuromuscular adaptations were found after both training modalities. Therefore, ECC provides similar adaptations as NHT and may serve as an alternative form of KF training for those unable to perform NHE.
Many hamstring injuries that occur during physical activity occur while the muscles are lengthening, during eccentric hamstring muscle actions. Opposite of these eccentric hamstring actions are concentric quadriceps actions, where the larger and likely stronger quadriceps straighten the knee. Therefore, to stabilize the lower limbs during movement, the hamstrings must eccentrically combat against the strong knee-straightening torque of the quadriceps. As such, eccentric hamstring strength expressed relative to concentric quadricep strength is commonly referred to as the "functional ratio" as most movements in sports require simultaneous concentric knee extension and eccentric knee flexion. To increase the strength, resiliency, and functional performance of the hamstrings, it is necessary to test and train the hamstrings at different eccentric speeds. The main purpose of this work is to provide instructions for measuring and interpreting eccentric hamstring strength. Techniques for measuring the functional ratio using isokinetic dynamometry are provided and sample data will be compared. Additionally, we briefly describe how to address hamstring strength deficiencies or unilateral strength differences using exercises that specifically focus on increasing eccentric hamstring strength.
- MeSH
- čtyřhlavý sval stehenní fyziologie MeSH
- dospělí MeSH
- kosterní svaly fyziologie MeSH
- lidé MeSH
- odporový trénink metody MeSH
- sporty fyziologie MeSH
- terapie cvičením metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- audiovizuální média MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
The aim of the study was to present the results of video-assisted fractional lengthening of the triceps surae muscle and the hamstrings in children with spastic cerebral palsy. In the period from September 2003 to December 2004, triceps surae muscle contractures were treated in 35 lower extremities (22 patients) and hamstring lengthening was performed in 12 knees (eight patients). The patients were between 4 and 10 years of age. Lengthening of the gastrocnemius-soleus was sufficient for achieving 10 degrees dorsiflexion of the foot in 31 of the 35 extremities. The short-term follow-up, at least 1 year after operation, did not reveal any complications. The hamstring lengthening resulted in full correction in nine knees; one endoscopic procedure required conversion to open surgery owing to bleeding. In one case, incomplete sciatic nerve palsy developed. Video-assisted gastrocnemius-soleus recession as well as video-assisted lengthening of the hamstrings proved to be fully efficient in the group reported here.
- MeSH
- Achillova šlacha chirurgie MeSH
- dítě MeSH
- dolní končetina chirurgie patofyziologie MeSH
- endoskopie MeSH
- kontraktura chirurgie patofyziologie MeSH
- kosterní svaly chirurgie patofyziologie MeSH
- lidé MeSH
- mozková obrna patofyziologie MeSH
- následné studie MeSH
- nemoci sedacího nervu etiologie MeSH
- pooperační komplikace MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- video-asistovaná chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- práce podpořená grantem MeSH
Jedním z nejčastějších úrazů u sportovců je poranění svalů zadní skupiny stehna, tzv. hamstringů. Toto zranění vyžaduje dlouhou rekonvalescenci a je zatíženo velkým rizikem opětovného zranění po návratu ke sportu. V posledních letech mnoho studií ukázalo, že současným včasným cvičením svalu na zvýšení jeho pevnosti a současně cvičeními na stabilizaci trupu a odstranění svalové nerovnováhy se výrazně zkracuje doba léčby a minimalizuje nebezpečí obnovení zranění. Cílem tohoto článku je ukázat přesný plán léčby a jednotlivé cviky. Cvičení je rozvrženo do několika fází, sportovec se do další fáze přesunuje až po splnění přísných kritérií a díky tomu se minimalizuje nebezpečí obnovení zranění. Současně je v cvičeních zahrnuto i cvičení ke zlepšení stabilizace trupu a cvičení k odstranění svalových dysbalancí, které má největší vliv na to, že se úrazy svalů nevracejí. Při dodržení těchto doporučení se výrazně snižuje riziko obnovení zranění a doba nutná ke zhojení svalu se zkracuje. Tato cvičení se dají použít i jako prevence poranění svalů zadní skupiny stehna.
Of the most common injuries to athletes are injuries to the hamstring muscles. This injury requires a long reconvalescence and has a high risk of re-injury after returning to the sport. Many studies have recently shown that the current early exercise strengthens the muscle and at the same time the stabilization body and elimination muscle imbalance exercise significantly reduces treatment time and minimizes the risk of repeated injury of the hamstring. This article aims to show the exact treatment plan and individual exercises. This type of conditioning is scheduled in several phases, the athlete moves to the next stage after meeting stringent criteria and thus minimizes the risk of getting hurt again. It also includes the practice to stabilize the body and the drill to eliminate muscle imbalances that have the greatest influence on the fact that the muscle injury does not return. In following the above mentioned recommendations the risk of getting injured again is being substantially reduced and recovery time necessary for healing of the muscle shortens. These exercises can be used as a prevention of hamstrings injury.
- Klíčová slova
- poranění svalů, hamstringy, léčba,
- MeSH
- diagnostické techniky a postupy MeSH
- diferenciální diagnóza MeSH
- kosterní svaly zranění MeSH
- kritické cesty MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- primární prevence MeSH
- radiografie MeSH
- rehabilitace metody MeSH
- sportovní úrazy diagnóza patofyziologie terapie MeSH
- sporty MeSH
- stehno zranění MeSH
- techniky cvičení a pohybu metody MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
