Morphometric parameters as risk factors for anterior cruciate ligament injuries: A MRI case-control study

Background/Aim. The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee, representing 50% of all knee injuries. The aim of this study was to determine the differences in the morphometry of knee injury patients with an intact and a ruptured anterior cruciate ligament. Methods. The study included 33 matched pairs of patients divided into two groups: the study group with the diagnosis of anterior cruciate ligament rupture, and the control group with the diagnosis of patellofemoral pain but no anterior cruciate ligament lesion. The patients were matched on the basis of 4 attributes: age, sex, type of lesion (whether it was profession- related), and whether the lesion was left- or right-sided. Measurements were carried out using magnetic resonance imaging (MRI). Results. The anterior and posterior edges of the anterior cruciate ligament in the control group were highly significantly smaller (p < 0.01; in both cases). The control group showed a statistically significantly larger width of the anterior cruciate ligament (p < 0.05). A significant correlation between the width of the anterior cruciate ligament and the width (p < 0.01) and height (p < 0.05) of the intercondylar notch was found to exist in the control group, but not in the study group (p > 0.05). The patients in the control group showed a shorter but wider anterior cruciate ligament in comparison to their matched pairs. The control group of patients was also characterized by the correlation between the width of the intercondylar notch and the width of the anterior cruciate ligament, which was not the case in the study group. Conclusions. According to the results of our study we can say that a narrow intercondylar notch contains a proportionally thin anterior cruciate ligament, but we cannot say that this factor necessarily leads to rupture of the anterior cruciate ligament

Jačine i odnosi jačina mišića ekstenzora i fleksora kolena kod sportista nakon rekonstrukcije prednjeg ukrštenog ligamenta

Introduction Maximal strength ratios such as the limb symmetry index (LSI) and hamstring-to-quadriceps ratio (HQ) may be considered the main outcome measures in the monitoring of recovery after anterior cruciate ligament (ACL) reconstruction. Although explosive strength is much more important than maximal strength, it is generally disregarded in the follow-up of muscle function recovery. Objective The purpose of this study was to compare ratios between maximal (Fmax) and explosive strength (rate of force development - RFD) in individuals with ACL reconstruction. Methods Fifteen male athletes were enrolled and had maximum voluntary isometric quadriceps and hamstring contractions tested (4.0 ± 0.1 months post reconstruction). In addition to Fmax, RFD was estimated (RFDmax as well as RFD at 50, 100, and 200 ms from onset of contraction) and LS gt I and HQ ratios were calculated. Results The involved leg demonstrated significant hamstring and quadriceps deficits compared to uninvolved leg (p lt 0.01). Deficits were particularly significant in the involved quadriceps, causing higher HQ ratios (average 0.63), compared to the uninvolved leg (0.44). LSI was significantly lower for RFD variables (average 55%) than for Fmax (66%). Conclusion The assessment of RFD may be considered an objective recovery parameter for one's readiness to return to sports and should be an integral part of standard follow-up protocol for athletes after ACL reconstruction. Moreover, the combination of indices derived from maximal and explosive strength may provide better insight in muscle strength balance, as well as a clear picture of functional implications.Uvod Maksimalne jačine ekstenzora i fleksora kolena, njihov međusobni odnos (eng. hamstrings-to-quadriceps ratio; HQ), kao i indeks simetrije operisane i neoperisane noge (eng. limb symmetry index; LSI) važni su pokazatelji pomoću kojih se prati oporavak nakon rekonstrukcije LCA. Iako je za izvođenje brojnih funkcionalnih zadataka eksplozivna jačina važnija od maksimalne, ova sposobnost generalno je zanemarena u praćenju oporavka mišićne funkcije. Cilj rada bio je da se uporede odnosi (maksimalne jačine (Fmax) i odnosi eksplozivne jačine (eng. Rate of Force Development - RFD) kod sportista sa rekonstrukcijom LCA. Metode rada U studiju je uključeno 15 sportista, kojima je testirana maksimalna voljna izometrijska kontrakcija (MBK) ekstenzora i fleksora kolena (4,0 ± 0,1 meseca postoperativno). Pored Fmax, procenjivan je i RFD (RFDmax, kao i RFD na 50, 100 i 200 ms od početka kontrakcije) i računati odnosi jačine (LSI i HQ odnos). Rezultati Maksimalna jačina i ekstenzora i fleksora operisane noge bila je značajno niža nego kod neoperisane noge (p lt 0,01). Deficiti su bili posebno izraženi kod ekstenzora operisane noge, usled čega su i HQ odnosi na toj strani (prosečno 0,63) bili veći nego kod neoperisane noge (0,44). Indeks simetrije je bio značajno niži za varijable RFD (prosečno 55%) nego za Fmax (66%). Zaključak Procena eksplozivne jačine može biti još jedan objektivni pokazatelj oporavka i spremnosti za izlaganje specifičnim opterećenjima i kretnjama, zbor čega bi trebalo da bude deo standardnog protokola za praćenje sportista nakon rekonstpukcije LCA. Štaviše, kombinacija indeksa izvedenih iz maksimalne i eksplozivne jačine morala bi dati kompletniji uvid u balans jačine mišića za kretnje koje zahtevaju maksimalne i eksplozivne akcije, kao i jasnu sliku o funkcionalnim implikacijama

Alternating Consecutive Maximum Contraction as a Test of Muscle Function in Athletes Following ACL Reconstruction

The novel test based on isometric alternating consecutive maximal contractions performed by two antagonistic muscles has been recently proposed as a test of muscle function in healthy subjects. The aim of this study was to evaluate reliability and sensitivity of a novel test as a test of knee muscles function in athletes recovering from anterior cruciate ligament reconstruction. Fifteen male athletes with recent ligament reconstruction (4.0 +/- 0.1 months following the surgery) and 15 sport and physical education students participated in the study. Peak torques of the quadriceps and hamstring muscles assessed both through the alternating consecutive maximal contractions and standard isokinetic test performed at 60 ((degrees) under bar)/s and 180 ((degrees) under bar)/s served for calculation of the hamstrings-to-quadriceps ratio and the bilateral difference in strength. When applied on individuals recovering from anterior cruciate ligament reconstruction, the novel test revealed a high within-day reliability and sensitivity for detecting imbalances both between antagonistic and between contralateral muscles. The present findings suggest that alternating consecutive maximal contractions could be used as a test of muscle function that is either complementary or alternative to the isokinetic test, particularly in the laboratories where the isokinetic devices are not available. Potential advantages of the novel test could be both a brief testing procedure and a possibility to conduct it using relatively inexpensive devices such as custom made kits containing a single one-axis force transducer

Possible factors for ankle fractures

Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI), height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p &lt; 0.001) with a significantly higher age (59.9 years, SD ± 14.2) in relation to males (45.1 years, SD ± 12.8) (p &lt; 0.0001). Type A fracture was most frequent in the younger patients (34.2 years, SD ± 8.6), and those with increased physical exercises (p = 0.020). In type B fracture, the risk factor was osteoporosis (p = 0.0180), while in type C fracture, body weight (p = 0.017) and osteoporosis (p = 0.004) were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures

The role-share-influence of the posterior tibial slope on rupture of the anterior cruciate ligament

Background/Aim. Posterior tibial slope is one of the most citated factors wich cause rupture of the anterior cruciate ligament (ACL). The aim of this study was to determine the association of a greather posterior tibial slope on the lateral condyle, that is a lesser posterior tibial slope on the medial condyle, with ACL rupture. Methods. The patients were divided into two groups. The study group included the patients with chronic instability of the knee besause of a previous rupture of ACL. The control group included the patients with knee lesion, but without ACL rupture. Posterior tibial slope measuring was performed by sagittal MR slices supported by lateral radiograph of the knee. We measured posterior tibial slope on lateral and medial condyles of the tibia. Using these values we calculated an average posterior tibial slope as well as the difference between slopes on lateral and medial condyles. Results. Patients with ACL rupture have highly statistically significantly greather posterior tibial slope (p &lt; 0.01) on lateral tibial condyle (7.1° : 4.5°) as well as statistically significantly lesser posterior tibial slope (p &lt; 0.05) on medial tibial condyle (5.0° : 6.6°) than patients with intact ACL. Conclusion. Great posterior tibial slope on lateral tibial condyle associated with the small posterior tibial slope on the medial tibial condyle, that is a positive differentce between lateral and medial tibial condyles are factors wich may cause ACL rupture

Optimization of the “Perth CT” Protocol for Preoperative Planning and Postoperative Evaluation in Total Knee Arthroplasty

Background and Objectives: Total knee arthroplasty (TKA) has become the treatment of choice for advanced osteoarthritis. The aim of this paper was to show the possibilities of optimizing the Perth CT protocol, which is highly effective for preoperative planning and postoperative assessment of alignment. Materials and Methods: The cross-sectional study comprised 16 patients for preoperative planning or postoperative evaluation of TKA. All patients were examined with the standard and optimized Perth CT protocol using advance techniques, including automatic exposure control (AEC), iterative image reconstruction (IR), as well as a single-energy projection-based metal artifact reduction algorithm for eliminating prosthesis artifacts. The effective radiation dose (E) was determined based on the dose report. Imaging quality is determined according to subjective and objective (values of signal to noise ratio (SdNR) and figure of merit (FOM)) criteria. Results: The effective radiation dose with the optimized protocol was significantly lower compared to the standard protocol (p 0.05). Analyzing the objective criteria for image quality optimized protocols resulted in lower SdNR values and higher FOM values. No significant difference of image quality was determined using the SdNR and FOM as per the specified protocols and parts of extremities, and for the presence of prothesis. Conclusions: Retrospecting the ALARA (‘As Low As Reasonably Achievable’) principles, it is possible to optimize the Perth CT protocol by reducing the kV and mAs values and by changing the collimation and increasing the pitch factor. Advanced IR techniques were used in both protocols, and AEC was used in the optimized protocol. The effective dose of radiation can be reduced five times, and the image quality will be satisfactory

Intramedular fixation after breaking of the femoral plate

Any fracture of the femoral shaft presents a challenge to the orthopedic surgeon. Femoral fractures most often occur within polytrauma, by forces of high intensity as is the case with traffic accidents. There are two methods to treat with internal fracture fixation, intra and extra medullary fixation. Both treatments have their advantages and disadvantages and it is necessary to make a good preoperative plan. We present the case of a 23-year-old man who suffered a femoral shaft fracture as a driver in a car accident. He was initially surgically treated with orthopedic repositioning and internal, extramedullary fixation. After 18 months, bending of the osteosynthetic material and dislocation of the fragments with varus and recurvatum were verified. Oligotrophic pseudoarthrosis was also present. Reintervention and fixation with interlocking nail was performed. The weight bearing is allowed after two weeks. After 3 months, patient has full range of motion and there is no palpatory painful sensitivity. Intramedullary fixation is the method of choice for fractures of the femur, especially when there is no comminution and in cases of open fractures of the first and second degree. Rotation of fragments is locked, physical rehabilitation is faster and there is less risk of mal union

Piriformis: Sparing approach, is it better?

Hip fractures as well as coxarthrosis are conditions that are becoming more common in everyday orthopedic practice. With the aging of the world's population, there is an increasing need for partial (HA) or total hip arthroplasty (THA). No elective procedure is as important to quality of life as total hip arthroplasty, and partial hip arthroplasty is a method of treatment in elder population who suffered fracture of the femoral neck. There are several hip approaches that can be used for arthroplasty. Hip dislocation is a serious complication after hip arthroplasty and occurs somewhat more frequently when the posterior hip approach is used. The aim of this study is to show that the piriformis sparing technique gives better results in terms of reducing the frequency of dislocations in the early postoperative period (one year). We operated od 249 patients, and after follow-up that lasted from 13 to 22 months we had four dislocations, three in patient with THA(0.021) and one after HA(0.009). Preservation of the piriformis tendon is a minor modification in the operative technique that can lead to a great benefit in the quality of treatment and a reduced risk of complications