Therapeutic approaches to treat joint contracture after anterior cruciate ligament (ACL) reconstruction have not been established. Arthrofibrosis accompanied by joint inflammation following ACL reconstruction is a major cause of arthrogenic contracture. In this study, we examined whether anti-inflammatory treatment using low-level laser therapy (LLLT) can prevent ACL reconstruction-induced arthrogenic contracture. Rats underwent ACL transection and reconstruction surgery in their right knees. Unoperated left knees were used as controls. After surgery, rats were reared with or without daily LLLT (wavelength: 830 nm; power output: 150 mW; power density: 5 W/cm2; for 120 s/day). We assessed the passive extension range of motion (ROM) after myotomy at one and two weeks post-surgery; the reduction in ROM represents the severity of arthrogenic contracture. ROM was markedly decreased by ACL reconstruction at both time points; however, LLLT partially attenuated the decrease in ROM. One week after ACL reconstruction, the gene expression of the proinflammatory cytokine interleukin-1beta in the joint capsule was significantly upregulated, and this upregulation was significantly attenuated by LLLT. Fibrotic changes in the joint capsule, including upregulation of collagen type I and III genes, shortening of the synovium, and thickening were caused by ACL reconstruction and seen at both time points. LLLT attenuated these fibrotic changes as well. Our results indicate that LLLT after ACL reconstruction could attenuate the formation of arthrogenic contracture through inhibition of inflammation and fibrosis in the joint capsule. Thus, LLLT may become a novel therapeutic approach for ACL reconstruction-induced joint contracture.
- MeSH
- fibróza MeSH
- kolenní kloub chirurgie MeSH
- kontraktura * etiologie prevence a kontrola MeSH
- krysa rodu Rattus MeSH
- laserová terapie s nízkou intenzitou světla * škodlivé účinky MeSH
- poranění předního zkříženého vazu * komplikace chirurgie MeSH
- rekonstrukce předního zkříženého vazu * škodlivé účinky MeSH
- rozsah kloubních pohybů MeSH
- zánět patologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The effects of exercise on mechanical hyperalgesia, joint contracture, and muscle injury resulting from immobilization are not completely understood. This study aimed to investigate the effects of cyclic stretching on these parameters in a rat model of chronic post-cast pain (CPCP). Seventeen 8-week-old Wistar rats were randomly assigned to (1) control group, (2) immobilization (CPCP) group, or (3) immobilization and stretching exercise (CPCP+STR) group. In the CPCP and CPCP+STR groups, both hindlimbs of each rat were immobilized in full plantar flexion with a plaster cast for a 4-week period. In the CPCP+STR group, cyclic stretching exercise was performed 6 days/week for 2 weeks, beginning immediately after cast removal prior to reloading. Although mechanical hyperalgesia in the plantar skin and calf muscle, ankle joint contracture, and gastrocnemius muscle injury were observed in both immobilized groups, these changes were significantly less severe in the CPCP+STR group than in the CPCP group. These results clearly demonstrate the beneficial effect of cyclic stretching exercises on widespread mechanical hyperalgesia, joint contracture, and muscle injury in a rat model of CPCP.
- MeSH
- chronická bolest etiologie patologie rehabilitace MeSH
- hyperalgezie etiologie patologie rehabilitace MeSH
- imobilizace MeSH
- kondiční příprava zvířat metody MeSH
- kontraktura etiologie patologie rehabilitace MeSH
- kosterní svaly fyziologie MeSH
- krysa rodu Rattus MeSH
- lidé MeSH
- modely nemocí na zvířatech MeSH
- potkani Wistar MeSH
- sádrové obvazy MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
This study tested whether cell cycle inhibitor mitomycin C (MMC) prevents arthrogenic contracture progression during remobilization by inhibiting fibroblast proliferation and fibrosis in the joint capsule. Rat knees were immobilized in a flexed position to generate flexion contracture. After three weeks, the fixation device was removed and rat knees were allowed to freely move for one week. Immediately after and three days after fixator removal, rats received intra-articular injections of MMC or saline. The passive extension range of motion (ROM) was measured before and after myotomy of the knee flexors to distinguish myogenic and arthrogenic contractures. In addition, both cellularity and fibrosis in the posterior joint capsule were assessed histologically. Joint immobilization significantly decreased ROMs both before and after myotomy compared with untreated controls. In saline-injected knees, remobilization increased ROM before myotomy, but further decreased that after myotomy compared with that of knees immediately after three weeks of immobilization. Histological analysis revealed that hypercellularity, mainly due to fibroblast proliferation, and fibrosis characterized by increases in collagen density and joint capsule thickness occurred after remobilization in saline-injected knees. Conversely, MMC injections were able to prevent the remobilization-enhanced reduction of ROM after myotomy by inhibiting both hypercellularity and joint capsule fibrosis. Our results suggest that joint capsule fibrosis accompanied by fibroblast proliferation is a potential cause of arthrogenic contracture progression during remobilization, and that inhibiting fibroblast proliferation may constitute an effective remedy.
- MeSH
- fibroblasty účinky léků MeSH
- imobilizace škodlivé účinky MeSH
- injekce intraartikulární MeSH
- kloubní pouzdro účinky léků MeSH
- kontraktura farmakoterapie etiologie MeSH
- mitomycin aplikace a dávkování MeSH
- potkani Wistar MeSH
- preklinické hodnocení léčiv MeSH
- proliferace buněk účinky léků MeSH
- protinádorová antibiotika aplikace a dávkování MeSH
- rozsah kloubních pohybů účinky léků MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- mitomycin MeSH
- protinádorová antibiotika MeSH
UNLABELLED: The aim of article was to describe two possibilities of reconstruction of contracted and deformed conjunctival socket at the patient undergoing enucleation of the eye many years ago. METHOD: The free full-thickness mucosa graft was used in local anaesthetic for reconstruction conjunctival socket at the first patient. The amnion membrane was used in the second case with correction of ectropion of lower eyelid. RESULTS: The good cosmetic and stabile effect was obtained in both cases.
- MeSH
- amnion transplantace MeSH
- chirurgické laloky MeSH
- enukleace oka * MeSH
- kontraktura etiologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- oftalmologické chirurgické výkony metody MeSH
- senioři MeSH
- ústní sliznice transplantace MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Isolated or combined surgical procedures on muscles around the hip joint are currently indicated by many authors. In cerebral palsy patients they are regarded as essential intervention. MATERIAL In the years 2005-2007, surgery in the hip joint region was essential for 150 children between 3 and 18 years of age. At the time of surgery, the patients' locomotion ranged from stage 1 to stage 7 of the Vojta system. METHODS The outcome was evaluated by clinical and radiographic examination at 2 and 6 months post-operatively and hip migration percentage and Wiberg's CE angle were measured. RESULTS The best clinical and radiographic outcomes were achieved in children younger than 6 years of age. On the other hand, isolated transfer of the distal rectus femoris muscle significantly affected pelvis anteflexion in adolescent patients. The most marked decrease in migration percentage was found after adductor tenotomy combined with surgery on the iliopsoas muscle (55.6 %) or when the two procedures were combined with distal rectus femoris transfer. DISCUSSION Combined surigical procedures, i.e., adductor tenotomy, surgery on the iliopsoas muscle or rectus femoris muscle and medial hamstrings, with fixation using an abduction modified Atlanta brace, are effective in patients with marked lateral hip migration who are younger that 6 years. Isolated adductor tenotomy and distal transfer of the rectus femoris muscle markedly improve standing position in walking patients. CONCLUSION An appropriate combination of surgical procedures on muscles in the hip region and on medial hamstrings can significantly improve the patient's locomotion and, if lateral migration is present, help to avoid surgery on bones.
- MeSH
- bederní svaly chirurgie MeSH
- čtyřhlavý sval stehenní chirurgie MeSH
- dítě MeSH
- kontraktura diagnostické zobrazování etiologie chirurgie MeSH
- kosterní svaly chirurgie MeSH
- kyčelní kloub diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- mozková obrna komplikace diagnostické zobrazování chirurgie MeSH
- předškolní dítě MeSH
- radiografie MeSH
- šlachy chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of the study was to demonstrate the outcomes of video-assisted tenotomy of the gastrocnemius and soleus muscles in children with the spastic form of cerebral palsy. MATERIAL: In the period from September 2003 to March 2004, 18 lower extremities in 14 patients were operated on.A set for endoscopic plastic surgery with a 4-mm trocar was used. Aponeurotomy was carried out with a scalpel no. 11 or arthroscopic scissors. The treated limb was immobilized in plaster cast for 6 weeks. METHODS The inclusion criteria were: an equinus gait free from a valgus or a varus deviation, preferably unilateral, and the age range between 4 and 10 years. The patients were examined before surgery and followed up at 3-month intervals. RESULTS: In 16 out of 18 treated extremities, simple aponeurotomy of the gastrocnemius and soleus muscles was sufficient to achieve 20 degrees dorsiflexion. In two cases it was necessary to complete the procedure at the same stage by video-assisted sliding double-point tenotomy of the Achilles tendon. The short-term follow-up did not reveal complications such as failure of wound healing or neurological or vascular disturbance. DISCUSSION: The international literature data show that this method has largely been developed on cadavers. Much attention has been given to potential injury to the sural nerve. However, the ultimate goal of this operation, i. e., sufficient correction, should be regarded as a much more important factor. In older children, simple aponeurotomy may not achieve this objective and therefore the authors developed a procedure combining video-assisted aponeurotomy with sliding double-point tenotomy of the Achilles tendon. CONCLUSIONS: Video-assisted tenotomy of the gastrocnemius and soleus muscles proved a fully effective method in our group evaluated at short-term follow-up.
- MeSH
- bérec * MeSH
- dítě MeSH
- endoskopie MeSH
- kontraktura etiologie chirurgie MeSH
- kosterní svaly chirurgie MeSH
- lidé MeSH
- mozková obrna komplikace MeSH
- předškolní dítě MeSH
- šlachy chirurgie MeSH
- video-asistovaná chirurgie * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Numerous appliances or methods have been used to manage perioral deep burns and resultant contractures, however, until now, no particular technique is considered to be the "ideal technique". In this article, a new modified design of an extraoral appliance, composed of polymethylmetacrylate and silicon sheet is introduced. Two female and one male patient of a mean age of 33 were included in the study. They had a common history of facial thermal injury and hypertrophic scar formation. All three had a history of failed preceding operations to release commissure contractures. The appliance was placed within 14 days following the operation and stretched continuously for 6 months. During 14 months of follow-up period, no recurrence was encountered and a relatively symmetrical and satisfactory mouth opening was obtained. Owing to the effect of the silicon sheet, a more smooth, flattened scar surface and pliable commissure was achieved. No ulcerations, or tissue breakdown was observed. Extraoral appliances composed of polymethylmetacrylate silicon sheet were considered to be practical, convenient and efficient for the postsurgical treatment of the oral commissure contractures complicated with hypertrophic scar formation.
- MeSH
- design vybavení MeSH
- dlahy * MeSH
- dospělí MeSH
- jizva hypertrofická etiologie chirurgie MeSH
- kontraktura etiologie chirurgie MeSH
- lidé MeSH
- polymethylmethakrylát MeSH
- popálení komplikace chirurgie MeSH
- silikonové elastomery terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- polymethylmethakrylát MeSH
- silikonové elastomery MeSH
The authors' aim is to summarize and generalize the knowledge acquired in the course of the last eight years of work with children with extensive burns. Reconstructive surgeries show a certain specific feature consisting in the considerable extent of the scarred area often exceeding 50% of the body surface, and with the gradual increase in number of operations they are gaining importance.
- MeSH
- dítě MeSH
- expanze tkáně metody MeSH
- jizva etiologie chirurgie MeSH
- kontraktura etiologie chirurgie MeSH
- lidé MeSH
- popálení komplikace chirurgie MeSH
- reoperace MeSH
- transplantace kůže metody MeSH
- umělá kůže MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF THE STUDY: To evaluate the contribution of different surgical techniques of lengthening of distal hamstrings on the development of hyperextension deformity of the knee in spastics. MATERIAL: Totally 51 patients of age 7.6 + 3.7 years at operation. Follow-up after surgical release for 4-10 years. Basically two surgical techniques were used: 1. Simple division of gracilis and semitendinosus, fractional lengthening of semimembranosus and biceps femoris. 2. Gracilis and semitendinosus were anchored after its transverse division to fractionally lengthened semimembranosus. METHODS: Pre-operative and post-operative Bleck popliteal angles were estimated. Hyperextension was tested in lying and standing positions. RESULTS: Type of surgery (1 or 2) did not influence the development of hyperextension deformity of the knee (tested by Fisher exact test). Nevertheless the relation between type of surgery (1 or 2) and the stratified value of Bleck popliteal angle was statistically significant. In the subgroup 2, in which the superficial tendons were anchored to semimebraneous, the occurrence of values of Bleck angle less than 20 degrees, was lower than in the subgroup 1. DISCUSSION: It seems, that the type of described two different surgical techniques is not so much decisive for development of hyperextension deformity. CONCLUSION: Authors surmise, that principal role play stronger deep knee flexors (semimembranosus and biceps femoris). Its fractional lengthening must be very careful.
- MeSH
- bérec chirurgie MeSH
- dítě MeSH
- kloubní deformity získané etiologie MeSH
- kolenní kloub chirurgie MeSH
- kontraktura etiologie chirurgie MeSH
- kosterní svaly chirurgie MeSH
- lidé MeSH
- mozková obrna komplikace chirurgie MeSH
- následné studie MeSH
- pooperační komplikace * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Although permanent sequelae of deep burns always persist, they can be very favourably influenced if we start soon after the injury. There are several possibilities: very early rehabilitation by positioning and supports prevents the shortening of tendons and ligaments surrounding the large joints and thus reduces post-traumatic oedema. By selecting the correct surgical technique at the right moment, we achieve an optimal course of healing and scar formation. Great attention must be paid to infection and its prevention. After healing it is important to apply compressive aids soon, preferably in combination with silicone and similar materials. For lubrication it is better to use creams with a high water content. Ensure the optimal mental well-being of affected patients. If the patient communicates well, do not hesitate to use psychoanalytic methods to reduce emotional and verbal blocks related to the injury.
