Õlavarre kakspealihase distaalse kõõluse kroonilise rebendi rekonstruktsioon m. semitendinosus’e autotransplantaadiga

Õlavarre kakspealihase distaalse kõõluse rebendid on haruldased vigastused. Vigastus tekib olukorras, kus kõõlusele rakendub ootamatu suur füüsiline jõud. Kõõluse täielik rebend tekib enamikul juhtudel kõõluse ja luu piiril ning haarab kõõluse kinnituskohta kogu ulatuses, osalisi kõõluse rebendeid esineb väga harva. Rebendiga kaasnevad kaebused on valu küünarliigese eespinnal ja küünarliigese fleksioonijõu vähenemine. Kõõluse rebendi diagnoosimise ja ravi hilinemisel võib kujuneda välja krooniline kõõluse rebend. Krooniliste täielike rebendite korral ei ole kõõluse anatoomiline taastamine kinnituskohale enamasti võimalik. Õlavarre biitsepsi funktsiooni ja käe jõu taastamiseksning valu lahendamiseks tehakse erinevate kõõluste auto- või allotransplantaatidega biitsepsi distaalse kõõluse rekonstruktsioon. Postoperatiivses faasis järgneb pikaajaline rehabilitatsiooniprogramm. Tartu Ülikooli Kliinikumi sporditraumatoloogia keskuses on 10 aasta jooksul tehtud kolm õlavarre biitsepsi distaalse kõõluse kroonilise rebendi rekonstruktsiooni m. semitendinosus’e kõõluse autotransplantaadiga. Kõigil patsientidel on taastunud käe funktsioon ja fleksioonijõud rahuldavale tasemele

Põlveliigese funktsionaalne võimekus ja subjektiivne seisund 20 aastat pärast eesmise ristatisideme rekonstruktsiooni põlvekerdakõõluse autotransplantaadiga endistel tippsportlastel

Eesmise ristatisideme (ERS) vigastust peetakse üheks põlveliigese sidemete enam levinud vigastuseks. ERSi rekonstruktsiooni järgseid kaugtulemusi on patsientide subjektiivse hinnangu ning objektiivsete näitajate põhjal Eestis vähe uuritud. Töö eesmärk oli hinnata retrospektiivselt subjektiivseid ja objektiivseid kaugtulemusi 20 aastat pärast ERSi taastamist. Uuriti 15 meessoost patsienti, kellel taastati ERS, kasutades põlvekedra kõõluse autosiirikut. Kaugtulemustes esines kõikides KOOSi alakategooriates opereeritud ja terve jala võrdluses statistiliselt oluline erinevus, neist suurim elukvaliteedi alakategoorias (p ≤ 0,005). Sääre sirutajalihaste (reie nelipealihase) isokineetilise jõumomendi näitajates esines statistiliselt oluline erinevus opereeritud ja opereerimata jala võrdluses nurkkiirusel 60°/s (p ≤ 0,008) ja nurkkiirusel 180°/s (p ≤ 0,005). Sääre painutajalihaste (nn hamstring-lihaste) jõumomendi näitajate tulemustes statistiliselt olulised erinevused puudusid. 20 aastat pärast ERSi taastamist on opereeritud jalal reie nelipealihase jõunäitajad väiksemad ning kaebusi on rohkem võrreldes opereerimata jalaga. &nbsp

Alumise hüppeliigese ehk subtalaarliigese artroskoopiliselt assisteeritud artrodees

Alumise hüppeliigese ehk subtalaarliigese osteoartoos on suhteliselt harva esinev probleem, kuid see mõjutab patsiendi elukvaliteeti oluliselt. Subtalaarliigese osteoartroosist põhjustatud probleeme ravitakse nii konservatiivsete kui ka operatiivsete meetoditega. Sageli on kirurgiline ravilahendus ainuvõimalik hea või väga hea lõpptulemuse saavutamiseks. Lahtine operatsioon on osteoartroosiga patsientidel alumise hüppeliigese artrodeesi valikmeetod olnud aastakümneid. Miniinvasiivse kirurgia kiire arengu käigus on leitud, et artroskoopiliselt assisteeritud subtalaarliigese artrodees on kujunemas tõhusaks valikmeetodiks subtalaarliigese artroosi ravis. Tartu Ülikooli Kliinikumis on aastatel 2016–2017 ravitud artroskoopiliselt assisteeritud artrodeesiga kokku 4 subtalaarliigese osteoartroosiga patsienti. Kõikides opereeritud liigestes toimus radioloogilise uuringu alusel luustumine 8–10 nädala jooksul. Kirurgilise raviga seotud tüsistusi ei esinenud. Kõik patsiendid pöördusid tagasi aktiivse füüsilise tegevuse juurde. Tuginedes positiivsetele tulemustele mujal maailmas, võime ka meie väikese rühma puhul kinnitada selle metoodika efektiivsust

Põlveliigese eesmise ristatisideme taastamise operatsioon – mitte alati õnnestumine

Põlveliigese eesmise ristatisideme (ERS) rebendite esinemissagedus on eri andmetel 37–61 juhtu 100 000 inimese kohta aastas. Eestis esineb see vigastus 300–400 isikul aastas ja järjest sagedamini rakendatakse sel korral operatiivset ravi. Sõltumata rakendatud operatiivse ravi meetodist on eri autorid hinnanud ERSi vigastuse operatiivse ravi tulemusi edukaks 75–97%-l ravitutest. Operatiivse ravi komplikatsioonideks võivad olla liigese süvainfektsiooni kujunemine, operatsioonjärgne artrofibroos ning liigese ebastabiilsus ja operatsioonijärgne valu. Oluline on ka operatsioonitehnika, eelkõige tunneli õige positsiooni valik. Komplikatsioonide ennetamisel on oluline osa patsientide õigel valikul ning kirurgi oskuste õigel hindamisel

Musculoskeletal Injury Risk in a Military Cadet Population Participating in an Injury-Prevention Program

Background and Objectives: Musculoskeletal injuries are a major health hazard among military personnel. Previous research has proposed several exercise-based strategies for prevention. The purpose of this study was to investigate the effect of an exercise-based injury-prevention program on the incidence of musculoskeletal injury, motor performance and psychosocial status. Materials and Methods: Thirty-six Estonian Military Academy cadets were randomly assigned into either an intervention or control group. The intervention group followed a neuromuscular exercise-based injury-prevention warm-up program, three times per week for 6 months. The control group continued with the usual warm-up. The main outcome measure was injury incidence during the study period. Additionally, evaluation of isokinetic lower-extremity strength, postural sway, physical fitness and psychosocial status was included pre- and post-intervention. Results: During the 6-month study period, the musculoskeletal injury incidence was 43% in the intervention group and 54% in the control group (RR = 0.8; 95% CI = 0.41 to 1.99). The noted 20% risk reduction was not statistically significant (p = 0.59). Furthermore, there were no statistically significant differences between the intervention and control group in motor performance or psychosocial status measures. Conclusions: In conclusion, no effect of the exercise-based injury-prevention program on injury risk, motor performance or psychosocial status could be detected

Men have higher risk of kinesiophobia after anterior cruciate ligament reconstruction in long term follow up.

Background Psychological and physiological factors could negatively affect patients' recovery and increase re-injury rate after anterior cruciate ligament reconstruction (ACLR). In daily practice surgeons and physiotherapists see athletes struggling to improve muscle strength and complaining of lack of self-confidence during the progress of return to sport. The Tampa Scale for Kinesiophobia is a valid questionnaire to measure a patient's psychological status and isokinetic test is widely used to measure muscle recovery. Hypothesis Patients with kinesiophobia have inferior self reported and functional outcomes after ACLR. Methods 140 patients, 100 (71%) men and 40 (29%) women, mean age 32.5 (±8.3), were included in the study 5.5 (±1.25) years after ACLR. All patients were operated by two senior surgeons. Preoperative and postoperative assessments were performed by two sports specialized physical therapists. Patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee score and Tampa Scale of Kinesiophobia (TSK-17). Quadriceps and hamstring muscle isokinetic strength was assessed at 60°/sec and 180°/sec using the HumacNorm dynamometer. Functional performance was tested with the single-leg-hop test for distance and the Y-balance test for anterior reach. Variables of the study were described by means and standard deviations. Shapiro-Wilk test was conducted to test for normality of the variables and unpaired t-tests were used to test for differences between subgroups. After tests were conducted, simple Bonferroni adjustment was applied to account for the number of tests made. Results 68/140 patients (48.6%) reported a Tampa kinesiophobia score equal or higher than 37 points, above which is the cut off score for kinesiophobia. Patients with kinesiophobia had statistically significant lower scores in the KOOS Symptoms (p=0.001) and Quality of Life subscores (p=0.001), Total score (p=0.001) and the Oxford Knee Score (p=0.024). Isokinetic peak torque muscle strength mean deficits at 60°/sec and 180°/sec for knee flexion and extension were between 6% and 7% for patients with kinesiophobia and between 2% to 4% for patients without kinesiophobia compared with the contralateral side, with no significant differences between groups. There was no statistically significant difference in the Single-leg-hop test for distance leg ratio (0.98 (±0.19) and 1.00 (±0.26)) and the Y-balance test for anterior reach leg ratio (0.99 (±0.08) and 1.01 (±0.07)) respectively between the groups. Conclusion At 5 years after ACLR operated leg functional performance is equal to nonoperated leg. However kinesiophobia is present in nearly half of patients. Strength and functional tests alone are not good enough instruments for assessing complete recovery, on the other hand self-reported questionnaires have high correlation to kinesiophobia after ALCR. Further studies are needed to avoid development of kinesiophobia as well how to recognize phobia at early stages of rehabilitation

Seven-month wintertime supplementation of 1200 IU vitamin D has no effect on hand grip strength in young, physically active males: a randomized, controlled study.

Background: There has been a growing interest in the role of vitamin D for the well-being and physical performance of humans; however, there is a lack of long-term supplementation studies performed on members of the young, physically active, male population. Hypothesis: The hypothesis of the study was that vitamin D supplementation during wintertime will decrease the prevalence of critically low vitamin D blood serum levels and increase hand grip strength during the winter season among young male conscripts. Study Design: Longitudinal, triple-blinded, randomized, placebo-controlled trial. Methods: Fifty-three male conscripts from the Estonian Army were randomized into two groups: 27 to an intervention group and 26 to a placebo group. The groups were comparable in terms of their demographics. The intervention group received 1200 IU (30 µg) capsules of vitamin D3 and the control group received placebo oil capsules once per day. The length of the follow-up was seven months, from October 2016 until April 2017. Blood serum vitamin D (25(OH)D), parathyroid hormone (PTH), calcium (Ca), ionized calcium (Ca-i), testosterone and cortisol values and hand grip strength were measured four times during the study period. Results: The mean 25(OH)D level decreased significantly in the control group to a critically low level during the study, with the lowest mean value of 22 nmol/l found in March 2017. At that time point, 65% in the control group vs 11% in the intervention group (p < 0.0001) had 25(OH)D values of less than 25 nmol/l (p < 0.001). In the intervention group the levels of 25(OH)D did not change significantly during the study period. All other blood tests revealed no significant differences at any time point. The corresponding result was found for hand grip strength at all time points. Conclusion: Long-term vitamin D supplementation during wintertime results in fewer conscripts in the Estonian Army with critically low serum vitamin D (25(OH)D) levels during the winter season. However, this did not influence their physical performance in the form of the hand grip strength test

10 months 4000IU vitamin D supplementation decreases the risk of vitamin D deficiency but has no effect to physical performance during active military training in high-latitudes – a randomized controlled trial

Embargoed til publishedBackground: Vitamin D deficiency with related consequences to human health has growing interest to military specific researchers worldwide. Many specific conditions could put soldiers in to the higher risk of vitamin D deficiency. Under high level of physical pressure during military training might increase the need of vitamin D in human body and therefore supplementation with vitamin D could be crucial for general health and physical fitness. Study Design: Longitudinal, triple-blinded, randomized, controlled trial. Methods: 113 men conscripts from the Estonian Army were randomized into two vitamin D supplementation groups: 58 to an 4000 IU and 58 to an 600 IU group. The length of the follow-up was ten months, from July 2021 until May 2022. Physical fitness and hand grip tests were performed 3 times and blood serum (25(OH)D), parathyroid hormone, calcium, ionized calcium values were measured 4 times during the study period. Results: The 600IU group had a significantly lower mean value of 25(OH)D in all time points during the study compared to 4000IU group (p<0.001) except baseline. Non of the study subjects in the Group A 600IU reached sufficient level of 25(OH)D in January and May. 61.3% in the 600IU and 30.6% 4000IU group had 25(OH)D levels under 50 nmol/L in May. No statistically significant differences found in the body weight and vitamin D correlation analysis in any time point on between study groups. No statistically significant differences in PTH, i-Ca were found between study groups at any time point except Ca results. No significant differences at any time points were revealed in the physical fitness test and hand grip strength tests except in non-dominant hand grip test in October. Conclusion: Ten months vitamin D3 4000IU supplementation decreased risk of vitamin D deficiency but had no effect to physical fitness compared to low dosage vitamin D supplementation. Trial registration: ClinicalTrials.gov Identifier: NCT04939636. Prospectively registered 13 October 2020

Severe deficiency of Vitamin D has no negative effect on physical performance during military training

Introduction Decreased physical fitness and inferior physical performance are risk factors and potentially life threatening in the combat situation. To examine the effect of Vitamin D on physical performance a prospective longitudinal 10-month study of young male conscripts in the Estonian Army was designed. The hypothesis of the study was, that severe deficiency of Vitamin D has a negative effect on physical performance. Materials All conscripts (n = 410) entering the 10-month military service in July 2015 at the Kuperjanov Battalion were asked to participate. A total of 98 male conscripts volunteered to participate initially. Study design and data collection A prospective longitudinal study with a 10-month follow-up period was performed. The Army Physical Fitness Test (APFT) test was performed three times, the hand grip strength and blood serum values of 25(OH)D, parathyroid hormone (PTH) and calcium (Ca) were measured four times. Results A significant decrease in the levels of 25(OH)D compared with the baseline values were found, with a lowest mean value of 31.9 nmol/l in March 2016 (p 25nmol/L. Discussion The main finding of the present study was that severe deficiency of 25(OH)D were common among male conscripts during the winter season, but had no negative effect on physical performance in terms of the APFT test and hand grip strength test. Conclusion Severe deficiency of Vitamin D during the winter season are common but have no negative effect on physical performance in young physically active men in military service