Arthroscopic partial medial meniscectomy

Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62%) vertical complete bucket handle lesions, 19 (8.92%) vertical incomplete lesions, 18 (8.45%) longitudinal tears, 35 (16.43%) oblique tears, 18 (8.45%) complex degenerative lesions, 17 (7.98%) radial lesions and 28 (13.14%) horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC) score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49%) of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57%) patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93%) patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation

Liječenje ozljeda medijalnog meniskusa parcijalnom meniscektomijom

Partial meniscectomy involves partial removal of the meniscus. This can vary from minor trimming of the damaged part of the meniscus to the removal of the rip from the meniscocapsular junction. Meniscus tears are the most common knee injury. They may occur in acute knee injuries in younger patients, or as part of a degenerative process in older individuals. The aim of the study was to demonstrate the method of choice for treatment of medial meniscus injuries that, in well selected cases, resulted in a small rate of complications and fast rehabilitation. The study analyzed the results of arthroscopic partial medial meniscectomy in 99 patients, in the period from 2005 to 2013, with follow up of 12-14 months. In our series of arthroscopically treated medial meniscus, tears were found in 29 patients with vertical complete bucket handle lesions, 14 with vertical incomplete lesions, 9 with longitudinal tears, 13 with oblique tears, 11 with complex, flap and degenerative lesions, 10 with radial lesions and 13 with horizontal lesions. The mean preoperative International Knee Documentation Committee score was 52.52%, then 81.81% at one month and 92.92% at six months of arthroscopic partial medial meniscectomy. Arthroscopic partial medial meniscectomy is a minimally invasive diagnostic and therapeutic procedure. This procedure is an acceptable and effective long-term treatment, particularly in patients without significant articular cartilage damage, and is associated with minimal morbidity.Parcijalna meniscektomija podrazumijeva djelomično uklanjanje meniskusa. Ovo može varirati od manje ekstirpacije oštećenog dijela meniskusa do uklanjanja rascjepa s meniskokapsularnog hvatišta. Ozljede meniskusa su najčešće ozljede koljena. One se mogu javiti kao akutne ozljede koljena kod mlađih bolesnika ili kao dio degenerativnog procesa u starijih osoba. Cilj studije bio je pokazati metodu izbora u liječenju ozljeda medijalnog meniskusa koja u dobro odabranim slučajevima dovodi do malog postotka komplikacija i brze rehabilitacije. U studiji su analizirani rezultati artroskopske parcijalne medijalne meniscektomije kod 99 bolesnika u razdoblju od 2005. do 2013. godine s praćenjem kroz 12-14 mjeseci. U našoj seriji bolesnika liječenih ovom metodom utvrđen je rascjep poput drške košarice (bucket handle) u 29, vertikalni nepotpuni rascjep u 14, uzdužni rascjep u 9, kosi rascjep u 13, degenerativna lezija u 11, radijalni rascjep u 10 i horizontalni rascjep u 13 bolesnika. Prosječni prijeoperacijski zbir IKDC (International Knee Documentation Committee) bio je 52,52%, jedan mjesec nakon parcijalne artroskopske medijalne meniscektomije IKDC je bio 81,81%, a šest mjeseci nakon parcijalne meniscektomije 92,92%. Artroskopska parcijalna medijalna meniscektomija je minimalno invazivan dijagnostički i terapijski zahvat. Ona je prihvatljiva i učinkovita kao liječenje, naročito kod bolesnika bez značajnog oštećenja zglobne hrskavice, a praćena je minimalnim pobolom

POVREDE TIBIOFIBULARNE SINDESMOZE - UZROK NESTABILNOSTI SKOČNOG ZGLOBA KOD SPORTISTA

Analyzing a group of 11 sportsmen who had fracture of ankle joint with injury of TF syndesmosis, we concluded that these sportsmen who have been treated operatively had better final result of treatment and much more stable ankle jont which enabled them to return to sport activities, and where the non-operative treatment had been undertaken (4), in one patient the result of treatment was bad, and it meant the end of active playing of football. The analysis showed that the result of treatment depended on the type of ankle joint fracture at pronation – eversion procedures with injury of TF syndesmosis – final result was worse than at supination – eversion fractures. Opearive treatment at these injuries should be applied always when active sportsmen are concerned, because only this way the ideal anatomic reduction is achieved, congruence of joint surfaces of ankle joint, adequate recovery of ligaments of TF syndesmosis and absolute stability of ankle joint in sportsmen, which enables them to continue their sport caree

PREVENCIJA SKAKAČKOG KOLJENA KOD ODBOJKAŠA

One of the most frequent injuries occurring in volleyball is evidently yumper’s knee, which could separate player from practice and playing for several months. Becau- se occurrence of this syndrome of overstressing are common despite the modern techni- ques of medical treatments, it is therefore crucial to find the real source of this problem as wel as developing new preventive measures. Examples of what could be done as a prevention of this syndrome is given in the summary of this pape

Total hip arthroplasty for femoral neck fractures as an urgent procedure

Background/Aim. Total hip arthroplasty (THA) is one of the most widely accepted operative methods for femoral neck fracture (FNF) in elderly. However, the data on the early THA for FNF are very limited. The aim of this study to determine if there were differences in postoperative complications and functional outcomes between an urgent and delayed THA following FNF. Methods. This prospective study included a total of 244 patients who had THA following FNF from January 2010 to January 2013. In the first group 41 FNF patients were treated with THA within less than 12 hours of admission. A total of 203 FNF patients were operated in delayed settings, of whom 162 required prolonged preoperative processing and comorbidities correction. The group II consisted of 41 FNF patients who were fit for the early surgery at admission, but the operation was delayed due to institution related reasons. Main outcome measurements included mortality, functional outcome assessement, cardiological and pulmonary complications, pressure ulcers, dislocations, infections, length of hospitalization and revisions. Results. There were no differences in terms of age, gender, type of implants, neither in mortality, nor complications. There were differences in hospital length of stay [t (51.72) = -10.25, p < 0.001)]. The patients operated within less than 12 hours of admission, had significantly better scores at all three time points of functional outcome assessment: at discharge t (80) = 2.556, p < 0.012; one month t (80) = 4.731, p < 0.001; three months t (80) = 5.908, p < 0.001. Conclusion. THA for FNF as an urgent procedure is not a widely accepted concept. Our findings indicate that the early operative treatment, does not worsen clinical outcomes, and our results give an advantage to the policy of the early THA for FNF

Importance of Herrings classification in predicting the outcome of aseptic necrosis of the femoral head

Aim To highlight the importance of values of the Herring’s classification in the treatment planning of Legg-Calve-Perthes disease (LCPD). Method The charts of 14 patients in a period of 4 years (2004-2008) were retrospectively reviewed. Inclusion criteria was unilateral LCPD and contralateral healthy hip. The patients were divided into three Herring groups according to radiographic images (A, B and C). For all patients the acetabulum/head index (AHI) was determined. Results The youngest patient was 4.9 years and the oldest 9.11 years; male patients were dominant (male:female 11:3). The right hip side was more affected comparing to the left one (8:6). The distribution of patients in Herring groups was three in the Group A, six in the Group B and five patients in the Group C. The AHI index was lowest in the group C. Patients in the group C were treated surgically. Conclusion Herrings classification predicts patients with extensive changes and suggests what kind of treatment should be applied

Does diabetes affect stability in people with unilateral transtibial amputation?

Introduction/Objective. Currently, analysis of the stability of amputees with diabetes is lacking. The aim of this case study was to examine the effects of unilateral transtibial amputation on the stability and balance confidence of patients with below-knee amputation caused by trauma and diabetes. Methods. Seventeen subjects, 12 males and five females, with the average age of 51.47 ± 12.12 years, who use a unilateral transtibial prosthesis, were examined. The balance of 10 traumatic amputees (TTA) and seven diabetic amputees (TDA) was assessed by Activities-Specific Balance Confidence (ABC) scale, Timed Up and Go (TUG) test, and One-Legged Stance Test (OLST). Plantar pressure distribution was recorded using Gaitview AFA-50. Results. For 10 TTA and one TDA, ABC scores were > 80%, the mean value of the TUG test was 11 (range: 8.08–23 seconds). All the subjects could stand on the healthy leg, two women with diabetes were unable to stand on the prosthetic leg. The distribution of load between the healthy and the prosthetic leg showed higher overload on the healthy leg (average: 56.62%). Conclusion. The data from this case series describe stability problems of people with transtibial amputation. Plantar pressure distribution has the potential to provide information about the properties of stability in the amputees who use prosthesis