PURPOSE OF THE STUDY: The study describes changes in gait parameters (temporal-spatial parameters, kinematic parameters represented by the global Gait Deviation Index) of individuals with Adolescent Idiopathic Scoliosis (AIS) compared to the healthy population. The hypothesis assumed a difference in the observed parameters between the two mentioned groups. MATERIAL AND METHODS: In a retrospective study, the temporal-spatial parameters and Gait Deviation Index (GDI) of a cohort of 45 AIS patients (36 girls and 9 boys with the mean age of 15.2 years, the mean Cobb angle of the thoracic curve of 47.3° and the lumbar curve of 51.8°) were compared to a typically developing population of 12 healthy individuals with no musculoskeletal pathology. The difference of followed-up parameters in patients with AIS compared to normal values was assessed by one-sample Student's T-test at the significance level of p = 0.05. RESULTS: The gait analysis shows significant deviations in the gait stereotype of patients with AIS compared to the healthy population. Statistically significant differences within temporal-spatial parameters were confirmed for cadence, walking speed, step time, stride time for left leg, step length, stride length and step width. The mean GDI of the cohort reached the value of 91.07 that indicates a slight alteration of gait, however, even this change is statistically significant. DISCUSSION: In our cohort of patients with AIS, we identified a significantly reduced walking speed (on average 15.4% compared to normal values. At the same time, a reduction in cadence (by an average of 7.5%) and an increase of the stride time (by an average of 12%) were recorded. Our mean GDI values were 91.07, which is consistent with the results reported in the literature for comparable groups of AIS patients. CONCLUSIONS: Our study demonstrated that AIS significantly affects gait stereotype. The differences compared to the group of healthy individuals within temporal-spatial parameters were confirmed for cadence, walking speed, duration and length of step and stride, and step width. The kinematic analysis of gait using the global (GDI) index in patients with AIS demonstrated its slight alteration. A better understanding of the change in movement stereotypes and gait in patients with AIS can bring wider possibilities for individualizing conservative treatment and also can help prevent secondary changes in the locomotor system. KEY WORDS: adolescent idiopathic scoliosis, AIS, gait analysis, Gait Deviation Index, GDI.

• MeSH
• analýza chůze * metody   MeSH
• biomechanika MeSH
• chůze (způsob) fyziologie   MeSH
• lidé MeSH
• mladiství MeSH
• retrospektivní studie MeSH
• skolióza * patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE OF THE STUDY Evaluation of the success rate of revision ACL reconstruction using the cadaverous BTB allogeneic graft and comparison of the outcomes achieved with the data of patients after the primary ACL reconstruction using the autologous BTB graft with filtering out the potential effect of diversity of the groups of patients as concerns sex and age. MATERIAL AND METHODS The evaluated outcomes of 34 patients operated in the period 2004-2017, i.e. with the minimum follow-up period of three years, were compared with the outcomes of 34 patients selected individually so that in pairs the age and sex are identical - 10 women and 24 men in the range of age from 20 to 44 years, with the median of 29 years at the time of surgery. The assessment and comparison of the outcomes achieved are done according to the Lysholm and Tegner scores. RESULTS The mean Lysholm score of the patients after the revision ACL reconstruction using the cadaverous BTB allograft achieved 54.7 points preoperatively, 72.3 points at the 1-year follow-up and 77.4 points at the 3-year follow-up. The Tegner score at the time of full performance before the injury was 7.7 points, whereas it was 5.8 points after the injury and 6.5 points three years after the surgery. In the group of patients after the primary ACL reconstruction using the autologous BTB graft, the Lysholm score was 64.4 points preoperatively, 85.1 points one year postoperatively and 88.2 points three years postoperatively. The results according to the Tegner score achieved by the primary control group at respective follow-up periods were 6.7 points, 5.1 points and 6.2 points respectively. DISCUSSION The increase in the number of performed ACL reconstructions leads also to an increase in the number of revision surgeries. This trend is also fuelled by the change in the lifestyle, the shift in age-related indication criteria for surgery, and other factors. The realistic expectations regarding the outcome of the revision ACL reconstruction shall take into account the effect of multiple insults that the knee must withstand. Even though subjective improvement of the knee condition is usually experienced postoperatively, the achieved outcomes tend to be less positive than in primary reconstructions. The return to the original pre-injury level of sports activities is achieved less frequently after revision surgeries. CONCLUSIONS The revision surgery of ACL rupture using the cadaverous BTB graft is a safe and reliable technique. It has a potential to improve the subjective satisfaction of the patient, nonetheless the mean postoperative Lysholm score is not so high as that achieved in patients after primary ACL reconstruction. Key words: anterior cruciate ligament, revision ACL reconstruction, cadaverous BTB graft, ACL graft rerupture.

• MeSH
• dospělí MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• ligamentum cruciatum anterius chirurgie   MeSH
• mladý dospělý MeSH
• poranění předního zkříženého vazu * chirurgie   MeSH
• rekonstrukce předního zkříženého vazu * MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Spondylolistéza či olistéza je definována jako patologický stav páteře, při kterém dochází nejčastěji k ventrálnímu až ventrokaudálnímu posunu kraniálního obratle vůči kaudálněji uloženému obratli. Specifickým typem v problematice spondylolistéz je tzv. "high dysplastic" spondylolistéza (dále HDDS), vznikající na podkladě dysplastických změn v oblasti lumbosakrálního přechodu. Možnosti terapie HDDS: Konzervativní terapie spočívající v imobilizaci v sádrovém korzetu, k nápravě spinopelvických parametrů nevede ani rehabilitace. Na našem pracovišti proto jako léčbu HDDS preferujeme terapii chirurgickou, a to 360° fúzi s repozicí a stabilizací postiženého segmentu. Materiál a metody: Na naší klinice jsme v období 2004-2016 operovali pro HDDS celkem 32 pacientů. U operovaných pacientů jsme hodnotili velikost skluzu předoperačně, v časném pooperačním období a rok od operace, společně s komplikacemi spojenými s operačním řešením. Výsledky chirurgické léčby: Operačním řešením došlo ve srovnání s předoperačním velikostí skluzu k redukci skluzu o 50 %. Hodnocení retence repozice rok od operace neukázalo signifikantní změnu oproti stavu v časném pooperačním období. Četnost neurologických komplikací dosahovala 13 %. Diskuse a závěr: Chirurgická léčba, která spočívá v repozici a stabilizaci obratlových těl, se nám jeví jako nejvhodnější terapeutická možnost řešící patologicko-anatomickou podstatu HDDS. Podle výsledků měření na našem souboru pacientů vedlo chirurgické řešení oproti původní velikosti skluzu ke zlepšení postavení obratle L5 o více než 50 %.

Introduction: Spondylolisthesis is defined as the patological situation of the spine in which the slippage of the upper vertebral body against the lower vertebral body occurs. The specific type of Spondylolisthesis is called High Dysplastic Spondylolisthesis (further referred to as HDDS) and it is based on dysplastic changes of the lumbosacral part of the spine. Possibilities of the treatment of HDDS: Neither conservative treatment, that means imobilisation in the plaster cast, nor rehabilitation does not improve spino-pelvic parametres. At our department we prefer 360° fusion with reposition and stabilisation of the affected vertebral segment as the treatment of HDDS surgical method. Matherial and Methods: We operated 32 patients for HDDS between years 2004-2016. We have evaluated the slippage of the vertebrae prior the operation, postoperatively and one year after the surgery. We have also evaulated complications associated with the operation. Results of the surgical therapy: Surgical therapy has improved the slippage by 50% compared to pre-operative condition. The retention of the reposition hasn´t been changed significantlly one year after the surgery. The incidence of neurological compliactions has reached 13%. Discussion and conclusion: The surgical treatment, involving reposition and stabilisation of the affected vertebral segment, seems to be the best possible treatment option for HDDS, which solves the pathological-anatomical principle of HDDS. The evaluation of the surgical method has shown the improvment of the slippage by 50% compared to original position.

• Klíčová slova
• retence repozice,
• MeSH
• dospělí MeSH
• fúze páteře * metody   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ortopedické výkony MeSH
• páteř chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• spondylolistéza * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY A retrospective evaluation of the success rate of revision ACL reconstruction performed using BTB allograft in terms of the life expectancy of the procedure up to and over five years from surgery. MATERIAL AND METHODS Over a ten-year period, from 2003 to 2013, we performed 47 revision ACL reconstruction surgeries. The majority of the primary ACL reconstructions using BTB autografts were not performed at our site. The group observed included 16 women (34%) and 31 men (66%). The women were aged between 25 and 48 years, the median age being 32.5, and the men were aged between 25 and 46 years with the median age of 35. We were able to make a full pre- and post-operative evaluation of 22 out of 47 patients who underwent secondary ACL reconstruction surgery using a cadaverous BTB graft. This evaluation included an objective clinical testing and a subjective evaluation of the function and stability of the knee joint using the Tegner activity score, Lysholm score, and a modified Cincinatti score. The set of 22 patients was split into two groups: up to five years from revision surgery and over five years from the procedure. RESULTS In the group of patients who were fully evaluated within five years of revision reconstruction there was an average improvement of 16.4 points on the Cincinatti score, 19.9 points on the Lysholm score, and an upward movement averaging 1.5 levels on the Tegner activity score. In the over five years from surgery category the average improvement was 15.5, 15.9, and 1.2 levels upward movement, respectively. We were unable to prove a significantly increased level of failure in BTB allografts after five and more years from revision ACL reconstruction. DISCUSSION The two strongest factors affecting the life expectancy of ACL replacements are the age of the patient and the type of the graft used, allograft or autograft. The most at risk, in terms of how long the graft will last, is the age group of 10 - 19 years old. With each ten-year increase in age the risk of rupture is reduced more-or-less by half. Patients with ACL allograft replacement show a fourfold increased risk of the graft rupturing. The younger and more active the patient requiring revision ACL reconstruction is, the greater the need for an autograft. If an allograft has been used in revision reconstruction on an athlete, a great emphasis must be placed on the necessity of delaying the return to previous sporting activities for at least nine months. CONCLUSIONS The mid-term results of revision ACL reconstruction show that, subject to reasonable levels of stress, a correctly performed procedure using cadaverous BTB grafts is a good option to restore the stability of the knee joint over a period of five years and more from surgery. An increased incidence of reruptures or greater insufficiency of the cadaverous graft were not evident in our group after five and more years. The risk of cadaverous grafts failure is just like in the autologous replacement directly linked to the return to sport interval, frequency and intensity of stress to which the graft is subjected over a long period of time. The risk of rerupture is always higher in allograft reconstructions that have already stood in need of restructuring for a longer period of time. For this reason, a delay in returning to sports activity must be emphasized. As a rule, we recommend a return to full athletic training only after nine months to a year after surgery. Key words: anterior cruciate ligament, revision ACL reconstruction, tendon graft insufficiency, BTB autograft insufficiency, BTB allograft of the ACL, cadaverous BTB graft, ACL graft rerupture.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• neúspěšná terapie MeSH
• reoperace statistika a číselné údaje   MeSH
• spokojenost pacientů * MeSH
• štěp kost-čéškový vaz-kost škodlivé účinky   metody   psychologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: The aim of this retrospective study was to present a comprehensive overview of the causes of bone-tendon-bone (BTB) autograft failure after primary anterior cruciate ligament (ACL) reconstruction. MATERIAL AnD METHODS: Between 2003 and 2013, we performed revision ACL replacement in 47 patients who had undergone primary BTB autograft ACL reconstruction in other hospitals. The group consisted of 16 women (aged 25 to 48 years) and 31 men (25 to 46 years). Surgery was performed on the right knee in 26 and on the left knee in 21 patients. In each of the 47 patients, two different assessments were made: 1. Analysis of causes of failure based on surgical protocols and/or intra-operative video records taken during most of the procedures. 2. Evaluation of bone tunnel location on lateral knee radiograms, using the method described by Harner for femoral tunnels and that reported by Stäubli and Rauschning for tibial tunnels. RESULTS: The most frequent cause of knee instability, occurring in 51.1% of the patients, was new trauma to the knee. nontraumatic instability in the remaining 48.9% was due to insuffiiency of the graft, and resulted from an incorrect surgical technique (42.5%) or biological causes (6.4%). The most common surgical mistake found was incorrect bone tunnel placement in the tibia or femur, with a malpositioned femoral tunnel being most frequent. This was diagnosed in 32 patients (68.1% of all patients) and, in 17, was the main or major cause of BTB graft failure. DISCUSSION: Based on relevant literature data and our experience, principles for prevention of graft failure after ACL reconstruction can be summarised as follows: 1. harvest of a suffiiently strong BTB autograft 2. accurate anatomical bone tunnel placement 3. appropriate tension of the BTB autograft 4. preventing graft impingement 5. secure graft fiation 6. early functional rehabilitation with an accent on delaying full weight-bearing on the knee (6 to 9 months post-operatively) CONCLUSIONS: New trauma to the knee is the most frequent cause of BTB autograft failure after ACL reconstruction. This can be avoided by participating in a professionally guided rehabilitation programme and not returning to sports activities earlier than 9 months after ACL reconstruction. The most common technical error in ACL reconstruction is non-anatomical tunnel placement in the tibia and femur. Femoral tunnel malposition is most frequent while incorrect tibial tunnel placement, which does not inflence graft failure so much, is less common.

• MeSH
• dospělí MeSH
• femur radiografie   MeSH
• kolenní kloub patologie   radiografie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligamentum cruciatum anterius patologie   radiografie   chirurgie   MeSH
• nestabilita kloubu radiografie   MeSH
• neúspěšná terapie MeSH
• reoperace metody   MeSH
• retrospektivní studie MeSH
• štěp kost-čéškový vaz-kost metody   MeSH
• tibie radiografie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakty MeSH

• Publikační typ
• abstrakt z konference MeSH