Q95400484
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PURPOSE OF THE STUDY: Our study aims to compare the results of preoperative radiography and intraoperative visual assessment of the cartilage with histological assessment of joint surfaces of the medial and lateral compartments resected in patients during the total knee replacement. MATERIAL AND METHODS: The cohort included 20 patients (9 men and 11 women) with the mean age of 66.6 (±7.0) years who met the inclusion criteria of the study. Degenerative changes of the knee joint seen on a preoperative weight-bearing anteroposterior X-ray were evaluated according to the Kellgren-Lawrence grading system separately for the medial and lateral compartment. Based on the visual appearance, the condition of articular surfaces was assessed using the International Cartilage Repair Society Score (ICRS Grade). The histological assessment of degenerative changes was conducted by a pathologist with the use of the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment System based on six grades of articular cartilage degeneration. RESULTS: The mean degree of degenerative changes based on the radiological classification was assessed as 3.5 (±0.6) for the medial compartment and 2.1 (±0.4) for the lateral compartment. The visually assessed chondropathy according to the ICRS Grade was 3.7 (±0.6) for the medial femoral condyle and 1.8 (±1.0) for the lateral femoral condyle. The histological score obtained using the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment was 4.9 (±1.1) for the medial femoral condyle and 2.4 (±0.7) for the lateral femoral condyle. In respect of the medial compartment, there was no statistically significant parametric correlation between the intraoperative visual assessment of the cartilage degeneration and the preoperative radiological grade r = 0.45. The histological assessment showed a statistically significant concordance both with the degree of chondropathy r = 0.76 and the radiological grade r = 0.64. In the lateral compartment, the parametric test showed a statistically significant concordance only between the radiological grade and the histological score r = 0.72. The correlation between the visual assessment of chondropathy and the radiological grade r = 0.27 as well as the histological score r = 0.24 was very low. DISCUSSION: In our cohort assessing the early degenerative changes of the lateral compartment as well as the more advanced degenerative changes of the medial compartment, the correlation between the intraoperative assessment of cartilage degeneration as a diagnostic method to examine the lateral compartment and the preoperative radiological grade was not confirmed. Our results failed to confirm a better reporting value of the visual cartilage degeneration assessment of the lateral compartment as against the preoperative X-ray. The space width without narrowing on an X-ray has no reporting value for this compartment in case of varus deformity. CONCLUSIONS: The results clearly indicate that the assessment of macroscopic appearance of the cartilage degeneration during arthroscopy does not necessarily guarantee good long-term clinical outcomes after high tibial osteotomy. The respective degrees of cartilage degeneration identified during the intraoperative visual assessment and the radiological grading of osteoarthritic changes did not correlate in either compartment. In the lateral compartment, the initial radiological and histological findings preceded the visually detectable cartilage changes. KEY WORDS: knee, cartilage, osteoarthritis, radiology, histology, arthroscopy, osteotomy.
- MeSH
- artróza kolenních kloubů * chirurgie diagnostické zobrazování patologie MeSH
- kloubní chrupavka * patologie diagnostické zobrazování MeSH
- kolenní kloub diagnostické zobrazování patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- radiografie * metody MeSH
- senioři MeSH
- totální endoprotéza kolene * metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of the study was to evaluate the long-term results in a group of patients treated by proximal tibial valgus osteotomy. MATERIAL: A group of 92 high tibial osteotomies performed in the 1985/1994 period were evaluated. All were indicated for primary osteoarthritis. Closing wedge osteotomy was the technique used. Staple-fixed osteotomy was immobilised in a plaster cast for 6 weeks in 44 cases. Osteotomy fixed with a plate in 35 or with a cerclage in 13 cases was immobilised for two weeks. METHODS: Recurrent intensive pain and walking problems were regarded as a termination of the favourable effect of osteotomy. This was evaluated by the Kaplan-Meier survival analysis. The tibio-femoral angle 5 to 10 degrees of valgus was considered as an optimal deformity correction. The results were compared in relation to complications, correction, duration of immobilisation and patient age. RESULTS: The mean age of the patients was 59.8 ± 8.7 years (range, 42 to 78). During surgery, medial unicompartmental arthritis, grade II or higher, was recorded in 59 patients (64.1%) and multicompartmental knee arthritis was found in 66 patients (71.7%). The absence of noticeable problems was reported by 80.4% of the patients at 10 years and by 30.4 % at 15 years after osteotomy. Surgery decreased the range of motion from 100 ± 6.9 to 94.5 ± 17.7 degrees flexion (p = 0.04). Poor correction and post-operative complications were found in 21 patients (22.8 %) who also experienced significantly worse outcomes (p = 0.003). Good results after 10 and 15 years were reported by 47.6% and 14.3% of the patients, respectively. Of 71 patients (77.2%) who had good correction and surgery without complications, the osteotomy showed a good effect in 90.1% at 10 post-operative years and in 35.2% at 15 years. A longer immobilisation resulted in significantly worse results (p = 0.04) and a restricted range of motion (p = 0.02). The patients younger than 60 years achieved better results than the elderly patients (p = 0.38), but the difference was not significant. DISCUSSION: Good results were recorded up to 10 years after osteotomy, although some patients had had worse arthritis than recommended for this procedure. Inadequate correction and complications deteriorated the effect of osteotomy. With the opening wedge technique it is easier to achieve good correction, and stable fixation allows for active physical therapy. Better long-lasting results are achieved with total knee arthroplasty (TKA). However, in young active adults TKA can fail prematurely. Osteotomy can postpone the necessity of this implantation. If TKA is performed after osteotomy, functional outcomes are similar to those after primary implantation. CONCLUSIONS: Corrective osteotomy is an effective method in patients below 60 years who have an early-stage osteoarthritis of the knee with axial mal-alignment. If the tibio-femoral angle is over-corrected to more than 10 degrees valgus, patelo-femoral pain will ensue. Post-operative active physical therapy is necessary. After bone healing, implants must be removed. Corrective osteotomy has not been overcome by the development of joint replacement techniques, but both methods are complementary in the treatment of osteoarthritis.
The physical activity of the population is decreasing due to an increase in sedentary lifestyles. The aim of the study was to analyze midterm results of total knee arthroplasty according to the lifelong physical activity of the patients. We evaluated 37 patients (23 women, 14 men), with age average 70.0 years (range 53-87). We divided the patients according to lifelong physical activity. The active group included 11 patients with any history of physical activity and the passive included 26 patients with a sedentary lifestyle. No intergroup differences existed in age, gender or preoperative Knee Score. The active group had a higher postoperative Knee Score 90.5 (+/- 5.0) compared to the passive 87.4 (+/- 5.0). Pain after arthroplasty was experienced significantly more in the active group. Between the active 87.3 (+/- 9.3) and passive 67.5 (+/- 16.7) groups we measured a statistically significant difference in the improvement of Functional Score - ability to walk and climb stairs. Sedentary lifestyle affects the clinical outcomes of total knee arthroplasty. This data is demonstrating that physical activity ameliorate functional postoperative results.
- MeSH
- činnosti denního života MeSH
- cvičení MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene MeSH
- výsledek terapie MeSH
- životní styl MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
Ve vrcholovém sportu je pohybový aparát přetěžovaný. Často se setkáváme se sportovci, kteří sportu zanechali z důvodu poškození pohybového aparátu. Jiní mají po ukončení sportovní kariéry zdravotní problémy. Tréninkové přetížení a opakované úrazy vedou k předčasným degenerativním změnám kloubů. Nejčastěji je artrózou postižen kolenní kloub. Rekreační pohybová aktivita je esenciální pro trofiku tkání a funkci kloubu. Ale při velkých tréninkových dávkách není možná dostatečná reparace a regenerace tkání. Úrazy mění biomechaniku kloubů. Opakované úrazy urychlují degenerativní změny. U sportovce je důležitá diagnostika a úplné doléčení všech úrazů. Avšak léčba se přizpůsobuje nutnosti rychlého návratu ke sportu. Operačním výkonem nejsme schopni zabránit rozvoji degenerativních změn. Preventivně působíme nácvikem správné centrace kolenního kloubu. Cvičením snižujeme riziko úrazů a optimalizujeme rozložení zátěže na kloubních plochách. Důležitá je genetická dispozice a odolnost pohybového aparátu. Při léčbě vrcholových sportovců můžeme pouze snížit budoucí rozvoj degenerativních změn. Předčasné opotřebení kloubů je daní vrcholovému sportu.
Musculoskeletal apparatus is overloaded in top level sport. We meet sportsmen dropped from sport due to disorder of locomotor system often. Others have health problem after sport carrier. Training doses and multiple injuries are leading to the premature degenerative changes. Knee joint is affected with arthritis most common. Recreational movement activity is essential for tissue trofic and joint function. But in high dose training is reparation and regeneration of joint tissue impossible. There are changes of joint biomechanics after injuries. Multiple injuries accelerate degenerative changes. Important is to diagnose and correct principle treatment of every sportsman injury. Treatment of top level sportsmen conform fast return to sport activity. Operation can not avoid development of degenerative changes. Prevention is training of the knee dynamic stability. Exercise decrease risk of injury and optimize joint surface loading. Important is genetic disposal and resistibility of musculoskeletal system. In top level sport health care we can only decrease degenerative changes. Osteoarthritis of the joints is tax of top level sport.
- Klíčová slova
- předčasné degenerativní změny, přetěžování,
- MeSH
- artróza kolenních kloubů patofyziologie prevence a kontrola MeSH
- biologické markery MeSH
- biomechanika MeSH
- diferenciální diagnóza MeSH
- extracelulární matrix - proteiny diagnostické užití krev MeSH
- hyalinní chrupavka patofyziologie zranění MeSH
- kloubní chrupavka fyziologie patofyziologie MeSH
- kolenní kloub patofyziologie patologie MeSH
- kosti a kostní tkáň patofyziologie MeSH
- kostní dřeň patofyziologie MeSH
- lidé MeSH
- menisky tibiální patofyziologie MeSH
- osteoartróza MeSH
- sportovní úrazy patofyziologie MeSH
- sporty MeSH
- Check Tag
- lidé MeSH
Ve vrcholovém sportu je pohybový aparát přetěžovaný. Úrazy a svalové dysbalance mohou předčasně ukončit sportovní kariéru mladého sportovce. Cílem studie bylo vyšetřit zdravotní stav a dynamickou stabilitu kolen hráčů českého národního juniorského hokejového týmu. Vyšetřeno bylo 25 hokejistů narozených v roce 1994. Hráči měli průměrnou výšku 179,7 (± 5,3) cm a průměrnou hmotnost 72,6 (± 7,4) kg. Deset hráčů (40 %) mělo infekci horních cest dýchacích. Dvanáct hokejistů (48 %) mělo v minulosti úraz, 4 (16 %) mělo úraz opakovaně. Devět hráčů (36%) mělo chronické obtíže s pohybovým aparátem. Při vyšetření výpadu mělo dynamickou nestabilitu levého kolena 9 (36 %) a pravého 12 (48 %) hráčů. Při testu na balanční podušce to bylo 12 (48 %) hráčů u levého kolena a 16 (64 %) pravého. Nebyl statistický rozdíl mezi útočníky a obránci. Mladí hokejisté měli opakované úrazy nebo chronické obtíže v kom- binaci se svalovými dysbalancemi. U těchto hráčů je velké riziko ukončení sportovní kariéry ze zdravotních důvodů. Při dlouhodobém nekontrolování funkčního stavu pohybového ústrojí je sportovní kariéra mladých sportovců ohrožena.
High level sport activity is overloading for musculoskeletal system. Injuries and muscle dysbalance can stop sport career of young sportsman. Aim of this study was to examine health status and dynamic stability of the knee in Czech national junior ice hockey team. We examined 25 ice hockey players born in 1994 with high 179,7 (± 5,3) cm and weight 72,6 (± 7,4) kg. Ten players (40 %) had an upper respiration tract infection. Twelve players (48 %) had an injury in the history, 4 (16 %) had multiple injury. Nine players (36 %) had chronic problems with locomotor system. In step drive had dynamic instability 9 (36 %) players of the left and 12 (48 %) of the right knee. In test on balance disc had dynamic instability 12 (48 %) of the left and 16 (64 %) of the right knee. There were no statistic differences between forwards and defenders. Young ice hockey players had multiple injury and chronic problems in combination with muscle dysbalance. Their sporting career is in high risk due to health problems. Long-term infringement of the regulations for sport examination screening is injurious for young sportsmen.
- Klíčová slova
- dynamická stabilita, lední hokej,
- MeSH
- biomechanika MeSH
- hokej MeSH
- kolenní kloub MeSH
- koleno MeSH
- lidé MeSH
- mladiství MeSH
- nestabilita kloubu diagnóza MeSH
- prevence úrazů MeSH
- statistika jako téma MeSH
- zdravotní stav MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
Účinnou metodou omezení rozvoje předčasných degenerativních změn v oblasti kolene vrcholových sportovců je snížení rizika úrazů. Cílem studie bylo popsat vliv tréninku propriocepce ve sportovní přípravě na vnímání pohybu kolene, a tím snížit riziko poranění. Principem neuromuskulárního tréninku je získat senzomotorickou kontrolu a dosáhnout dobrou funkční stabilitu pro snížení rizika úrazu vazivového aparátu kolene, jehož následky se mohou podílet na rozvoji posttraumatické artrózy. V hodnoceném souboru bylo 21 mužů a věkový průměr činil 32,7 roku (rozmezí 23–35 let). Sportovci prodělali artroskopickou parciální mediální meniskektomii. Neměli poškození vazivového aparátu kolene. Tegnerovo skóre aktivity bylo průměrně 9,4 (rozsah hodnot 8–10). Po dobu dvou měsíců 2–3x týdně zařadili do své tréninkové jednotky nácvik dynamické stability kolene. Vyšetřeni byli na počátku sledování na nestabilní podušce a dále každý měsíc. Výsledek byl porovnáván s jejich subjektivním hodnocením kontroly pohybu kolene v tréninku. V úvodním vyšetření mělo 18 sportovců dynamickou nestabilitu kolene, po 2 měsících cvičení zůstali pouze dva. Subjektivně hodnotilo pozitivní efekt cvičení 19 sportovců. Pouze jeden sportovec nedokončil sledování z důvodu zranění. Naše studie ukázala možnost nácviku propriocepce ve sportovním tréninku jako jednu z metod vedoucí k omezení rizika úrazů vazivového aparátu kolene.
A reduction in the risk of injuries has been an effective method of restricting premature degenerative diseases of the knee in top-level sportsmen. The aim of this study was to describe the influence of dynamic stability training on the perception of movement in the training activities of sportsmen and hence to reduce the risk of injuries. The purpose of neuromuscular training is to improve the sensor-motor control and to achieve good functional stability to reduce the risk of knee ligament injury, the consequences of which may be involved in the development of posttraumatic osteoarthritis. A group of 21 sportsmen (mean age 32.7y) with a history of knee arthroscopic partial medial meniscectomy was tested. The average Tegner activity score was 9.4. The sportsmen included the dynamic stability control exercise in their training two or three times a week for the period of two months. They were examined at baseline and then every month. The results were compared with the sportsman’s subjective assessment of the knee movement control in training. Eighteen sportsmen had a dynamic instability at baseline and after two months of neuromuscular training this number dropped down to two. Nineteen sportsmen subjectively evaluated the result of their neuromuscular training as positive. Only one sportsman did not complete the follow-up due to injury. Our study has demonstrated the possibility to use dynamic stability control of the knee as a method reducing the risk of ligament injury.
- MeSH
- cvičení fyziologie MeSH
- kolenní kloub fyziologie patofyziologie MeSH
- lidé MeSH
- poranění kolena patofyziologie prevence a kontrola rehabilitace MeSH
- posturální rovnováha MeSH
- propriocepce fyziologie MeSH
- prospektivní studie MeSH
- sportovní úrazy patofyziologie prevence a kontrola rehabilitace MeSH
- Check Tag
- lidé MeSH
