Ganglijske ciste koljena – retrospektivni prikaz niza uzastopnih slučajeva

The aim of this study was to describe relevant medical history, clinical symptoms and outcomes in 12 patients having undergone surgical treatment of intra-articular ganglion cysts of the knee at our Department from January 2010 to June 2016. Patient demographics, medical history, knee manifestations, management and outcome were evaluated. The mean patient age was 26.4 (range, 16-46) years. Th ere were seven female and five male patients. Duration of symptoms prior to the operation varied from 2 months to 3 years (mean, 17.1 months). All patients had preoperative magnetic resonance imaging work-up of the knee. Pain was the most common clinical presentation. All patients were surgically treated arthroscopically, and an additional open approach was used in only one of the patients. There were no complications during surgery and the postoperative period was uneventful in all patients. The mean follow up period was 43.5 (range, 9-83) months and no recurrence was observed. All patients remained symptom-free with full range of motion at final follow up. Despite a wide range of intra-articular ganglion cyst presentations and symptoms, our cohort demonstrated an excellent remission rate and functional prognosis following surgical treatment of the ganglion cysts of the knee.Cilj ovoga istraživanja bio je prikazati rezultate kirurškog liječenja simptomatskih ganglijskih cista smještenih unutar koljena. U razdoblju od siječnja 2010. do lipnja 2016. godine 12 je bolesnika (7 žena i 5 muškaraca) operirano u Klinici za ortopediju KBC-a Zagreb i Medicinskog fakulteta Sveučilišta u Zagrebu. Srednja životna dob u trenutku kirurškog zahvata bila je 26,4 (raspon, 16-46) godine. Srednje trajanje simptoma prije zahvata bilo je 17,1 (raspon, 2-36) mjeseci. Bol je bila vodeći simptom u bolesnika, a prije zahvata u svih je bolesnika načinjena i magnetska rezonanca koljena koja je uz dijagnostičko značenje pomogla i u planiranju artroskopskog zahvata. Kod svih je bolesnika nakon detaljnog artroskopskog pregleda koljena standardnim artroskopskim pristupima locirana ganglijska cista te je nakon uzimanja komadića tkiva za patohistološku analizu u 11 bolesnika u potpunosti resecirana uz pomoć motoriziranog instrumenta, dok je u jednog bolesnika zbog lokalizacije i veličine ciste bilo potrebno načiniti otvorenu eksciziju. Svi su kirurški zahvati, kao i rano poslijeoperacijsko razdoblje, protekli bez komplikacija. Srednje vrijeme praćenja bolesnika bilo je 43,5 (raspon, 9-83) mjeseci, a u tom se razdoblju nije pojavio recidiv niti kod jednog bolesnika. Na posljednjem kontrolnom pregledu svi su bolesnici bili bez simptoma uz pun opseg kretnja operiranog koljena. Ovo je istraživanje pokazalo da se, usprkos različitim prezentacijama simptomatskih intraartikularnih ganglijskih cista koljena, kirurškim liječenjem postižu odlični rezultati i potpun funkcionalni oporavak koljena u bolesnika

Osteochondritis dissecans of the elbow: excellent mid-term follow-up results in teenage athletes treated by arthroscopic debridement and microfracture

AIM: To evaluate the outcome of patients who underwent microfracture procedure on osteochondritis dissecans (OCD) lesions in the elbow, which had already been proven successful on OCD lesions in the knee and ankle. ----- METHODS: Nine young patients who were previously treated by arthroscopic debridement and microfracture by a single surgeon were included in the study. The median age at operation was 15 years (range 12-19). The median time between the procedure and evaluation was 5 years (range 2-9). The evaluation included physical examination and patient interview with elbow function scoring. Success of treatment was determined according evaluation Mayo Elbow Performance Index scores and the patients' return to sports. ----- RESULTS: Eight patients scored excellent results and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. ----- CONCLUSIONS: We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum

Articular cartilage repair techniques exploiting intrinsic healing capacity – which one is the best?

In this review article articular cartilage structure and organization is explained, followed by brief discussion on articular cartilage focal lesion development and subsequent endogenous regeneration, which mainly relies on presence of intrinsic healing capacity. In case of full thickness focal chondral defects intrinsic healing ability is insufficient and full spontaneous repair is almost never achieved. In those cases, cartilage repair techniques are indicated. Currently, the most commonly used articular cartilage repair techniques include three groups of techniques such as: bone marrow stimulation, osteochondral allografting/autografting and autologous chondrocyte implantation. These groups are further divided to specific cartilage repair techniques, discussed in detail and compared to other approaches. The information provided is intended to allow proper critical judgment and to answer the question “Which articular cartilage repair technique is the best for the particular patient?”

Indikacija za artroskopiju stražnjeg dijela gležnja ima puno više od samog stražnjeg sindroma sraza

ankle impingement syndrome. However, other indications of the posterior part of the ankle/hindfoot remain mostly uninvestigated. The aim of this study is to investigate the indications for posterior ankle/hindfoot arthroscopy performed as a solitary procedure and to report the outcomes. A total of 71 patients, who had undergone this procedure in our department over a period of nine years, were analysed. In all cases, the van Dijk et al. technique was followed. The most prevalent indication for posterior/hindfoot arthroscopy remains posterior ankle impingement syndrome in 59.15% of cases. Other indications included ten various posterior ankle/hindfoot pathologies, with the subtalar joint contracture being the most common one (15.49%). During the mean follow-up period of 79 (range, 24 - 127) months, there were 2 minor complications noted, both pertaining to transitory sensory deficits. The total median AOFAS Ankle-Hindfoot score significantly improved from 69 to 98, with the improvement noted regardless of the indication. The satisfaction rate with the procedure was 98.59%. This study has shown that posterior ankle/hindfoot arthroscopy is an efficient and safe orthopaedic tool for the treatment of various posterior ankle and hindfoot articular and periarticular pathologies.Artroskopija stražnjeg dijela gležnja postala je uobičajena operacijska tehnika za liječenje stražnjeg sindroma sraza gležnja. S druge strane, korištenje te tehnike za druge indikacije u području stražnjeg dijela gležnja i dalje se istražuje. Cilj ovog istraživanja bio je analizirati indikacije za artroskopiju stražnjeg dijela gležnja kod bolesnika kod kojih je taj zahvat načinjen kao samostalan zahvat te prikazati rezultate i komplikacije provedenog liječenja. Istraživanje obuhvaća 71 bolesnika kod kojih je tijekom devetogodišnjeg razdoblja načinjen taj zahvat i koji su pristali sudjelovati u njemu. U svim je slučajevima zahvat načinjen prema tehnici koju su opisali van Dijk i sur. Najčešća indikacija za taj zahvat i u našem je istraživanju bila stražnji sindrom sraza gležnja i to u 59,15% slučajeva. Od drugih indikacija najčešća je bila kontraktura subtalarnog zgloba u 15,49%, a sveukupno je bilo 10 različitih indikacija zbog kojih je načinjen taj zahvat. Tijekom praćenja od 79 mjeseci (raspon, 24-127) primijećene su dvije manje komplikacije i to prolazni gubitak osjeta s lateralne strane gležnja i stopala. Ukupni zbroj bodova dobiven AOFAS upitnikom porastao je sa 69 prije zahvata na 98 na pregledu provedenom u svrhu istraživanja uz napomenu da je poboljšanje zabilježeno kod svih indikacija. Gotovo svi su bolesnici (98,59%) bili zadovoljni s načinjenim zahvatom. Rezultati istraživanja ukazuju da je artroskopija stražnjeg dijela gležnja sigurna i učinkovita metoda u liječenju različitih ozljeda i oštećenja u stražnjem dijelu gležnja

Synovial Chondromatosis of the Elbow

Synovial chondromatosis (SC) is a rare, mostly benign proliferation of the synovium of the joint, tendon or bursa which results in the formation of loose bodies. It can appear in one of 33 described localisations, but it is most common in the knee. In our study we gathered a group of 7 patients (6 male and 1 female) with SC of the elbow, which underwent arthroscopic surgery of the elbow, performing both removal of the loose bodies and complete synovectomy. Mayo Elbow Performance Score (MEPS) was used to evaluate and compare the patients’ condition before the operation and at the final follow-up, 31 months, on average, after the operation (range 18–56 months). All patients had poor MEPS before the operation, with an average of 40.7 (range 15–50 points). At the final follow-up, 6 patients had a good or excellent MEPS, while a poor MEPS was present in a single patient. The average MEPS was 85 (range 45–100 points). The one patient who’s MEPS remained poor developed heterotopic ossification in the same elbow shortly after arthroscopic surgery. This patient was reoperated 8 months later using an open technique. No other complications occurred in the rest of the operated patients and no recurrence of SC occurred in any of the operated patients. Our results confirm that arthroscopic removal of loose bodies and complete synovectomy should be the treatment of choice for SC of the elbow

Sindrom kubitalnog kanala

Sindrom kubitalnog kanala susrećemo relativno često te on predstavlja značajan javnozdravstveni problem. Specifičnost tijeka ulnarnog živca niz ruku, a napose anatomski međuodnosi s koštanim i mekotkivnim strukturama u području lakta čine ga vrlo podložnim vanjskim utjecajima, ponajviše silama kompresije. Progresija parestezija na ulnarnoj strani četvrtog prsta i na čitavom petom prstu zahvaćene šake uz pojavu motoričke slabosti i atrofije mišića šake uvelike ograničava bolesnike, najčešće one koji se bave aktivnostima koje zahtijevaju da im je lakat duže vremena u fleksiji, da neometano obavljaju svakodnevne aktivnosti. Stoga je iznimno važno pravovremeno dijagnosticiranje sindroma koje se zasniva na iscrpnoj anamnezi i detaljnom kliničkom pregledu uz pomoć niza specifičnih testova koji su detaljno opisani u radu. Elektromioneurografijom možemo utvrditi stupanj kompresije ulnarnog živca te pratiti uspješnost daljnjeg liječenja. Blaži oblici sindroma kubitalnog kanala uspješno se liječe konzervativnim načinom, dok teže oblike sindroma te one koji su neosjetljivi na provedeno konzervativno liječenje treba liječiti kirurški. Metode kirurškog liječenja sindroma možemo podijeliti na one koje ostavljaju živac u ležištu u kubitalnom kanalu poput in situ dekompresije i medijalne epikondilektomije te na one tijekom kojih se živac premješta u novo ležište ispred i iznad medijalnog epikondila, što nazivamo antepozicijom ulnarnog živca. Sve opisane metode pokazale su se gotovo jednako uspješnima, no usprkos tomu istraživanja pokazuju da se u današnje vrijeme kao metoda izbora kirurškog liječenja sindroma kubitalnog kanala najčešće koristi in situ dekompresija

Rib stress fracture in a male adaptive rower from the arms and shoulders sport class: case report

Adaptive rowing is rowing or sculling for rowers with a physical disability. It debuted at the Paralympic Games in 2008. In order to ensure an equitable playing field, rowers with similar levels of physical function and disability are classified into different sport classes for competition. Rowers with an inability to use a sliding seat and impaired trunk function resulting in an inability to perform trunk forward and backward lean via hip flexion/extension are assigned to the Arms and Shoulders (AS) class. AS rowers have to use a chest strap set immediately below the chest in order to localize any trunk movement in AS class. Conditions created by adaptations of rowing equipment and technique within the AS class create unique stresses on the upper thoracic region. The following case report demonstrates how etiology and management of a rib stress fracture in an AS rower differs in comparison to able-body rowers. Of significant importance were the limitations imposed on the rower’s ability to maintain rowing-specific fitness, due to the nature of the rib stress fracture and requirement to decrease force transmission through the ribs for several weeks. The rower’s gradual return to full training was further impacted by obligatory use of the chest strap, which directly applied pressure over the injured area. Protective orthosis for the chest was designed and applied in order to dissipate pressure of the chest strap over the thorax during rowing (most importantly at the catch position) both on the ergometer and in the boat

Stress Fractures

Prijelomi zamora čest su problem, a ovisno o medicinskoj ustanovi ti prijelomi čine između 1,1 i 3,7% svih ozljeda u sportaša. Brojni su čimbenici koji pogoduju nastanku prijeloma zamora. U žena se vrlo često ističe kao uzrok nastanka prijeloma zamora i hormonalni disbalans (trijas sportašica). Za postavljanje dijagnoze najvažnije je pomisliti na mogućnost postojanja prijeloma zamora. Stoga i jest klinički pregled osnovni postupak na koji se potom nadovezuju druge dijagnostičke metode: radiološka, scintigrafska, a u posljednje doba i magnetska rezonancija. Za najveći broj prijeloma zamora dovoljno liječenje jest prekid sportske aktivnosti u trajanju od 4 do 6 tjedana. Postoje i prijelomi zamora visokoga rizika u koje ubrajamo prijelome vrata i trupa bedrene kosti, prijelom prednjeg dijela srednje trećine tibije, prijelom navikularne kosti, prijelom baze pete metatarzalne kosti (Jonesov prijelom) te prijelom zamora sezamske kosti nožnoga palca. Ti prijelomi zahtijevaju posebno dugotrajnije liječenje, a katkad i kirurško.Stress fractures are common overuse injuries, ranging between 1.1% and 3.7% of all athletic injuries. Causes are many and usually involve repetitive submaximal stress. There is a wide research evidence showing that training errors cause stress fractures in as many as 22% to 75% of cases. Intrinsic factors such as hormonal imbalance may also contribute to the onset of stress fractures, especially in women. During medical examination, it is essential always to bear in mind the possibility of stress fracture. Clinical diagnosis is therefore the basic procedure, followed by other diagnostic methods in the following order: radiology, scintigraphy, and MRI. Most stress fractures are uncomplicated and can be managed through rest and restriction from precipitating activities for 4-6 weeks. A subset of stress fractures can present a high risk for progression to complete fracture, delayed union, or nonunion. Specific sites for this type of stress fracture are the femoral neck, the anterior cortex of the tibia, the tarsal navicular, the fifth metatarsal (Jones fracture), and the great toe sesamoids. Therefore, high-risk stress fractures require aggressive treatment, and in some cases even surgical intervention is appropriate