Artroskopsko liječenje ozljeda meniska u adolescenata: usporedba tehnike šivanja izvana-unutra i meniskealnih strelica

The aim of this study was to evaluate clinical and subjective outcomes of the meniscal dart technique in patients having undergone arthroscopic meniscal repair by comparing it with the outside-in suturing technique. From January 2006 until June 2017, case records of 37 patients having undergone arthroscopic meniscal repair were retrospectively reviewed. The patients were divided into two groups based on the technique used for meniscal repair, as follows: 18 patients in suture technique group and 19 patients in meniscal dart group. Each patient was analyzed for the following parameters: age, gender, mechanism of injury, side of injury and injured meniscus, injury localization regarding anatomic position, injury type and associated injuries. The patients that underwent meniscal repair were analyzed for type of repair technique, operating results and results of follow-up (Lysholm and International Knee Documentation Committee (IKDC) score). There were no statistically significant differences between the groups according to clinical outcomes except for anatomic injury localization (p=0.035). Median of operation time was 62.5 min in suture technique group and 70 min in meniscal dart group (p=0.184); median of hospital stay was 2 days for both groups (p=0.951); median of Lysholm score was 86.5 and 84.5 (p=0.651); and median of IKDC score was 81.05 and 81.6, respectively (p=0.986). Understanding the harmful impact of meniscectomy, arthroscopic meniscal repair should be attempted whenever possible. Our data support arthroscopic repair of meniscal tears, since both the suture technique and the meniscal dart technique are safe and successful in meniscal repair in children, with good long-term results and without important complications.Cilj ovoga istraživanja je bio analizirati kliničke i subjektivne ishode liječenja u bolesnika operiranih zbog ozljeda meniska te usporediti dvije skupine bolesnika operiranih različitim tehnikama popravka meniska. Od siječnja 2006. do lipnja 2017. godine u studiju je uključeno 37 bolesnika koji su liječeni artroskopski zbog rupture meniska. Bolesnici su podijeljeni u dvije skupine ovisno o vrsti kirurškog zahvata: jednu skupinu skupinu činilo je 18 bolesnika u kojih je meniskus šivan tehnikom postavljanja šavova, a drugu 19 bolesnika u kojih su upotrebljene strelice za fiksaciju meniska. Svakom ispitaniku analizirani su sljedeći parametri: dob, spol, mehanizam nastanka ozljede, lateralizacija ozljede i meniska, anatomska lokalizacija ozljede i pridružene ozljede. Ispitanicima koji su podvrgnuti tehnikama popravka meniska analizirani su još i vrsta kirurške tehnike popravka meniska, rezultati subjektivne evaluacije 4 tjedna nakon operacije putem upitnika Lysholm i IKDC (International Knee Documentation Committee) te komplikacije nakon operacije. Između skupina bolesnika operiranih tehnikom postavljanja šavova i tehnikom fiksacije meniska strelicama nije bilo značajne razlike u promatranim ishodima liječenja, osim za anatomsku lokalizaciju ozljede (p=0,035). Medijani operacijskog vremena u skupini bolesnika operiranih tehnikom postavljanja šavova iznosio je 62,5 min, dok je u skupini fiksacije meniska strelicama medijan operacijskog vremena iznosio 70 minuta (p=0,184). Medijan duljine hospitalizacije bio je 2 dana za obje skupine (p=0,951). Medijan vrijednosti ljestvice Lysholm za promatrane skupine bio je 86,5 i 84,5 (p=0,651), a ljestvice IKDC 81,05 i 81,6 (p=0,986). Poznavajući štetne učinke meniskektomije, tehnika popravka meniska je dugoročnije bolji odabir i trebala bi se provoditi kadgod je to moguće. Obje tehnike (tehnika postavljanja šavova i tehnika fiksacije meniska strelicama) su sigurne i uspješne u liječenju ruptura meniska u djece, bez značajnijih komplikacija te s dobrim dugoročnim rezultatima

AutoCart – minimally invasive method of treatment osteochondral lesions in children and adolescents

Uvod: AutoCart je novija metoda liječenja osteohondralnih lezija lokomotornog sustava. Cilj ovoga preglednog članka jest prikazati indikacije i rezultate ishoda liječenja ovom metodom kod pedijatrijske populacije. Ispitanici i metode: U ovom članku prikazano je šest pacijenata liječenih AutoCart metodom u razdoblju od ožujka 2022. do siječnja 2023. godine. Svi pacijenti su imali simptomatske lezije koljena i talusa trećeg i četvrtog stupnja. Lezije na koljenu su operirane artroskopskim putem, a lezije talusa klasičnim, otvorenim načinom. Rezultat liječenja je procijenjen putem upitnika kojim se ocjenjivala kvaliteta života prije i nakon operacije. Također je procijenjena skala boli prije i nakon operacije kao važan pokazatelj uspješnosti ove metode liječenja. Rezultati: Prosječna dob bolesnika je bila 13,6 godina. Trojica bolesnika (50%) bila su muškog spola, a tri (50%) ženskog. Kod troje bolesnika (50%) bila je lezija talusa kao i kod lezije koljena (50%). Kod četvoro pacijenta postojao je jasan mehanizam ozljede (66%), a kod dvoje bez jasnog mehanizma (33%). Medijan vremena od simptoma do operacijskog zahvata je bio 6,6 mjeseci za koljeno, a 7,3 mjeseca za talus. Kvaliteta života kod pacijenata prije operacije bila je 7,67, a nakon operacije 1,00. Zaključci: Ova metoda liječenja kod pravilno postavljene indikacije pokazuje značajno kliničko i subjektivno poboljšanje. Također daje odličan cost benefit u odnosu na metodu transplantacije uzgojene hrskavice, jer se provodi u jednom aktu. Budući da je riječ o novoj metodi liječenja, ipak treba vremena za detaljniju evaluaciju ove kirurške metode.Introduction: AutoCart is a new method of treating osteochondral lesions of the musculosceletal system. The purpose of this review article is to present the indications and results of this method in treatment of the pediatric population. Materials and methods: This article presents six patients treated with the AutoCart in the period from March 2022. to January 2023. All patients had symptomatic lesions of the third and fourth degree of the knee and talus. Lesions on the knee were treated arthroscopically, and lesions on the talus were operated with open method. The results of the treatment were evaluated by a questionnaire that assessed the quality of life before and after the operation. The pain scale before and after surgery was also evaluated as an important indicator of the success of this treatment method. Results: The average age of the patients was 13.6. year. Three patients (50%) were male, and three (50%) were female. Three patients (50%) had a talus lesion as well as a knee lesion (50%). In four patients there was a clear mechanism of injury (66%), and two patients were without a clear mechanism (33%). The median time from symptoms to surgery was 6.6 months for the knee and 7.3 months for the talus. The quality of life in patients before surgery was 7.67, and after surgery was 1.00. Conclusions: This treatment method with a properly set indication shows significant clinical and subjective improvement. It also provides an excellent cost benefit compared to the transplant of cultured cartilage because it is performed in one act. Considering this being new treatment method, more time is needed for a more detailed evaluation of this surgical method

Akutni učinci nifedipina na torzijsko detorzijsku ozljedu testisa štakora

Pozadina/svrha:Torzija testisa je stanje koje zahtijeva žurnu dijagnostiku i liječenje kako bi se sačuvala vitalnost testisa i eventualna plodnost. Objavljenje su mnoge studije o utjecaju različitih lijekova i supstanci koje imaju zaštitnu ulogu na testis prilikom jednostrane T/D ozljede, ali niti jedna nije zaživjela u svakodnevnoj praksi. Cilj ovog rada bio je ispitati akutni utjecaj nifedipina na jednostranu T/D ozljedu testisa u štakora. Metode: Dvadeset četiri mužjaka štakora soja Sprague Dawley u dobi od 9 tjedana (odrasli štakori) je podijeljeno u tri skupine, svaka po 8 štakora. Prva skupina je bila kontrolna ili lažno operirana, druga skupina je bila skupina kojoj smo učinili jednostranu torziju testisa za 720 stupnjeva u trajanju od 3 sata, a treća skupina su bili štakori kojima smo također učinili jednostranu torziju testisa za 720 stupnjeva u trajanju od 3 sata, ali 30 minuta prije detorzije smo im dali intraperitonealno nifedipin. Nakon dodatnih 3 sata reperfuzije učinili smo obostranu orhidektomiju. Odstranjene testise smo analizirali na oksidacijski stres (aktivnost enzima glutation peroksidaze i superoksid dizmutaze i koncentraciju malondialdehida u tkivu testisa). Učinjena je histološka analiza po Johnsen kriterijima te je mjerena apoptoza. Rezultati: U skupini štakora kod jednostrane T/D ozljede koja je primila nifedipin, ipsilateralni testis je pokazao manje oštećenje u odnosu na skupinu koja nije dobila nifedipin (Manji oksidacijski stres, manji apoptotski index). Nakon jednostrane T/D ozljede (3 sata torzije i 3 sata detorzije) nema značajnih akutnih promjena sjemenskog epitela po Johnsenovim kriterijima. Jednostrana T/D ozljeda testisa dovodi do povećanog oksidacijskog stresa u suprotnom testisu. Zaključak: Nifedipin djeluje zaštitno na ipsilatealni testis kod jednostrane akutne T/D ozljede testisa u štakora.Background/aims: Testicular torsion is a condition that requires immediate diagnosis and treatment in order to preserve the vitality of the testicles and possible fertility. Many studies about the effect of various drugs and substances that have a protective effect on the testicle in T/D injury has been published but none become entrenched in everyday practice. The aim of this study was to investigate the effect of nifedipine on the unilateral testicular T/D injury in rats. Methods: Twenty-four adult male Sprague-Dawley rats, aged 9 weeks (adult rats) were randomly divided into 3 groups, each containing 8 rats. Rats in the control group underwent a sham operation of the left testis. In the T/D group, the left testis was twisted at 720° for 3 hours. After 3 hours of reperfusion, at the end of the experiment, the testes were removed. Rats in the treatment group received the same surgical procedure as the T/D group, but nifedipine was administered intraperitoneally 30 minutes before the time of detorsion. After an additional 3 hours of reperfusion bilateral orchiectomy was performed. Removed testes were analyzed for oxidative stress (activity of the enzyme glutathione peroxidase, superoxide dismutase and malondialdehyde in testicular tissue). Histological analysis by Johnsen’s criteria was performed and apoptosis was measured. Results: In the group of rats with unilateral T/D injury, treated with nifedipine, ipsilateral testis showed less damage compared to the group that did not receive nifedipine (lower oxidative stress and apoptotic index). There were no significant differences in Johnsen’s criteria after a unilateral I/R injury (3 hours torsion and 3 hours detorsion). Also no significant differences in contra lateral testis after unilateral I/R injury were recorded except in oxidative stress. Conclusion: Nifedipine has protective effect on ipsilateral testicle after unilateral acute T/D injury of the rat’s testicle

Akutni učinci nifedipina na torzijsko detorzijsku ozljedu testisa štakora

Pozadina/svrha:Torzija testisa je stanje koje zahtijeva žurnu dijagnostiku i liječenje kako bi se sačuvala vitalnost testisa i eventualna plodnost. Objavljenje su mnoge studije o utjecaju različitih lijekova i supstanci koje imaju zaštitnu ulogu na testis prilikom jednostrane T/D ozljede, ali niti jedna nije zaživjela u svakodnevnoj praksi. Cilj ovog rada bio je ispitati akutni utjecaj nifedipina na jednostranu T/D ozljedu testisa u štakora. Metode: Dvadeset četiri mužjaka štakora soja Sprague Dawley u dobi od 9 tjedana (odrasli štakori) je podijeljeno u tri skupine, svaka po 8 štakora. Prva skupina je bila kontrolna ili lažno operirana, druga skupina je bila skupina kojoj smo učinili jednostranu torziju testisa za 720 stupnjeva u trajanju od 3 sata, a treća skupina su bili štakori kojima smo također učinili jednostranu torziju testisa za 720 stupnjeva u trajanju od 3 sata, ali 30 minuta prije detorzije smo im dali intraperitonealno nifedipin. Nakon dodatnih 3 sata reperfuzije učinili smo obostranu orhidektomiju. Odstranjene testise smo analizirali na oksidacijski stres (aktivnost enzima glutation peroksidaze i superoksid dizmutaze i koncentraciju malondialdehida u tkivu testisa). Učinjena je histološka analiza po Johnsen kriterijima te je mjerena apoptoza. Rezultati: U skupini štakora kod jednostrane T/D ozljede koja je primila nifedipin, ipsilateralni testis je pokazao manje oštećenje u odnosu na skupinu koja nije dobila nifedipin (Manji oksidacijski stres, manji apoptotski index). Nakon jednostrane T/D ozljede (3 sata torzije i 3 sata detorzije) nema značajnih akutnih promjena sjemenskog epitela po Johnsenovim kriterijima. Jednostrana T/D ozljeda testisa dovodi do povećanog oksidacijskog stresa u suprotnom testisu. Zaključak: Nifedipin djeluje zaštitno na ipsilatealni testis kod jednostrane akutne T/D ozljede testisa u štakora.Background/aims: Testicular torsion is a condition that requires immediate diagnosis and treatment in order to preserve the vitality of the testicles and possible fertility. Many studies about the effect of various drugs and substances that have a protective effect on the testicle in T/D injury has been published but none become entrenched in everyday practice. The aim of this study was to investigate the effect of nifedipine on the unilateral testicular T/D injury in rats. Methods: Twenty-four adult male Sprague-Dawley rats, aged 9 weeks (adult rats) were randomly divided into 3 groups, each containing 8 rats. Rats in the control group underwent a sham operation of the left testis. In the T/D group, the left testis was twisted at 720° for 3 hours. After 3 hours of reperfusion, at the end of the experiment, the testes were removed. Rats in the treatment group received the same surgical procedure as the T/D group, but nifedipine was administered intraperitoneally 30 minutes before the time of detorsion. After an additional 3 hours of reperfusion bilateral orchiectomy was performed. Removed testes were analyzed for oxidative stress (activity of the enzyme glutathione peroxidase, superoxide dismutase and malondialdehyde in testicular tissue). Histological analysis by Johnsen’s criteria was performed and apoptosis was measured. Results: In the group of rats with unilateral T/D injury, treated with nifedipine, ipsilateral testis showed less damage compared to the group that did not receive nifedipine (lower oxidative stress and apoptotic index). There were no significant differences in Johnsen’s criteria after a unilateral I/R injury (3 hours torsion and 3 hours detorsion). Also no significant differences in contra lateral testis after unilateral I/R injury were recorded except in oxidative stress. Conclusion: Nifedipine has protective effect on ipsilateral testicle after unilateral acute T/D injury of the rat’s testicle

Akutni učinci nifedipina na torzijsko detorzijsku ozljedu testisa štakora

Pozadina/svrha:Torzija testisa je stanje koje zahtijeva žurnu dijagnostiku i liječenje kako bi se sačuvala vitalnost testisa i eventualna plodnost. Objavljenje su mnoge studije o utjecaju različitih lijekova i supstanci koje imaju zaštitnu ulogu na testis prilikom jednostrane T/D ozljede, ali niti jedna nije zaživjela u svakodnevnoj praksi. Cilj ovog rada bio je ispitati akutni utjecaj nifedipina na jednostranu T/D ozljedu testisa u štakora. Metode: Dvadeset četiri mužjaka štakora soja Sprague Dawley u dobi od 9 tjedana (odrasli štakori) je podijeljeno u tri skupine, svaka po 8 štakora. Prva skupina je bila kontrolna ili lažno operirana, druga skupina je bila skupina kojoj smo učinili jednostranu torziju testisa za 720 stupnjeva u trajanju od 3 sata, a treća skupina su bili štakori kojima smo također učinili jednostranu torziju testisa za 720 stupnjeva u trajanju od 3 sata, ali 30 minuta prije detorzije smo im dali intraperitonealno nifedipin. Nakon dodatnih 3 sata reperfuzije učinili smo obostranu orhidektomiju. Odstranjene testise smo analizirali na oksidacijski stres (aktivnost enzima glutation peroksidaze i superoksid dizmutaze i koncentraciju malondialdehida u tkivu testisa). Učinjena je histološka analiza po Johnsen kriterijima te je mjerena apoptoza. Rezultati: U skupini štakora kod jednostrane T/D ozljede koja je primila nifedipin, ipsilateralni testis je pokazao manje oštećenje u odnosu na skupinu koja nije dobila nifedipin (Manji oksidacijski stres, manji apoptotski index). Nakon jednostrane T/D ozljede (3 sata torzije i 3 sata detorzije) nema značajnih akutnih promjena sjemenskog epitela po Johnsenovim kriterijima. Jednostrana T/D ozljeda testisa dovodi do povećanog oksidacijskog stresa u suprotnom testisu. Zaključak: Nifedipin djeluje zaštitno na ipsilatealni testis kod jednostrane akutne T/D ozljede testisa u štakora.Background/aims: Testicular torsion is a condition that requires immediate diagnosis and treatment in order to preserve the vitality of the testicles and possible fertility. Many studies about the effect of various drugs and substances that have a protective effect on the testicle in T/D injury has been published but none become entrenched in everyday practice. The aim of this study was to investigate the effect of nifedipine on the unilateral testicular T/D injury in rats. Methods: Twenty-four adult male Sprague-Dawley rats, aged 9 weeks (adult rats) were randomly divided into 3 groups, each containing 8 rats. Rats in the control group underwent a sham operation of the left testis. In the T/D group, the left testis was twisted at 720° for 3 hours. After 3 hours of reperfusion, at the end of the experiment, the testes were removed. Rats in the treatment group received the same surgical procedure as the T/D group, but nifedipine was administered intraperitoneally 30 minutes before the time of detorsion. After an additional 3 hours of reperfusion bilateral orchiectomy was performed. Removed testes were analyzed for oxidative stress (activity of the enzyme glutathione peroxidase, superoxide dismutase and malondialdehyde in testicular tissue). Histological analysis by Johnsen’s criteria was performed and apoptosis was measured. Results: In the group of rats with unilateral T/D injury, treated with nifedipine, ipsilateral testis showed less damage compared to the group that did not receive nifedipine (lower oxidative stress and apoptotic index). There were no significant differences in Johnsen’s criteria after a unilateral I/R injury (3 hours torsion and 3 hours detorsion). Also no significant differences in contra lateral testis after unilateral I/R injury were recorded except in oxidative stress. Conclusion: Nifedipine has protective effect on ipsilateral testicle after unilateral acute T/D injury of the rat’s testicle