Measurement of parameters of proprioception after dislocation of patella in adolescent women

Iščašenje, luksacija ili dislokacija čašice (patele), predstavlja povredu kolena prilikom koje dolazi do pomeranja patele iz patelofemoralnog dela zgloba kolena. Pri ovoj povredi dolazi do oštećenja medijalnih mekotkivnih struktura kolena koje su zadužene za pravilno pomeranje čašice unutar patelofemoralnog zgloba. Nakon prve povrede kod velikog borja pacijenata razvije se hronična nestabilnost patelofemoralnog zgloba sa posledičnim recidivantnim luksacijama patele. Mehanizam nastanka hronične nestabilnosti nije u potpunosti razjašnjen i smatra se multifaktorijalnim, a za jedan od faktora smatra se narušavanje neurološke regulacije pokreta kolena. Propriocepcija je složen neurološki mehanizam koji nam omogućava mentalno mapiranje delova tela, sprečavajući prekomerne i nepravilne pokrete koji mogu dovesti do povređivanja. Za njegovu procenu u zglobu kolena najčešće se procenjuje osećaj pozicije zgloba (JPS – eng. „Joint Position Sense“) kao jedne od komponenti propriocepcije. Nerazjašnjeno je koji je najbolji način za njegovu procenu u pogledu izbora različitih uglova fleksije kolena i pozicija ispitanika, ali i kakav je uticaj povreda struktura kolena na njega. U istraživanju su učestvovale isključivo osobe ženskog pola (15-17 godina), svrstane u tri kategorije od po 30 ispitanika. Prvu, kontrolnu grupu, činile su zdrave ne sportistkinje; drugu, grupu sportistkinja, činile su ispitanice koje su se takmičarski bavile košarkom; treću, grupu pacijentkinja, činile su osobe sa luksacijom čašice kolena. Za merenje JPS korišten je VICON optički sistem (©Vicon Motion Systems Ltd. UK registered no. 1801446) za analizu pokreta. Za svaku grupu meren je JPS metodom pasivnog pozicioniranja-aktivne reprodukcije sa kolenom u različitim nivoima fleksije (30°, 45° i 60°), u uspravnom, ležećem i sedećem položaju, nakon čega su rezultati bili poređeni između grupa. Naši rezultati su pokazali da odabir pozicije ispitanika i ugla merenja ne utiče na JPS u zdravim populacijama, kontrolnoj grupi i grupi sportiskinja, niti postoji statistički značajna razlika odgovarajućih pozicija i uglova između ovih grupa. Za grupu pacijentkinja dobili smo da postoji deficit propriocepcije, i da je sedeći stav najosetljivijim za procenu deficita osećaja pozicija zgloba kolena. U odnosu na odgovarajuće uglove kontrolne grupe i grupe sportistkinja, kod pacijentkinja postoji statistički značajno veća greška traženih uglova u sedećem stavu, zbog čega je ovaj stav karakterističan za ovu grupu. Takođe smo uočili da je najveća razlika pri uglu od 45°, čineći ga kritičnim uglom za grupu pacijentkinja. Ono što je ključni zaključak je da nakon povrede kolena po tipu luksacije čašice postoji neurološki deficit kontrole pokreta kolena, koji potencijalno može dovesti do daljeg povređivanja. Obzirom da je JPS metod kumulativne procene proprioceptivnog sistema, dalja istraživanja bi trebala da budu usmerena na određivanje mesta oštećenja istog, čime bi se postiglo bolje razumevanje funkcionisanja sistema regulacije pokreta kao i mogućnost sprovođenja efikasnijeg lečenja nakon povrede kolena.Patellar dislocation represents a knee injury during in which patella moves outside patellofemoral joint. The injury causes damage to the medial soft tissues of the knee, who act as a lateral patella restraint. After the first patella dislocation, large number of patients develop chronic instability of patellofemoral joint with recurrent patella luxation as a result. Etiology of chronic instability of patellofemoral joint is not fully understood, and is considered multifactorial, with one of the factors being the impairment of the neurological regulation of the knee movement. Proprioception is a complex neurological mechanism that allows us to mentally map parts of the body, preventing us from excessive and irregular movements that can lead to injuries. Measuring joint position sense (JPS) is the most commonly used method for evaluating proprioception of the knee. It is unclear what is the best way to evaluate JPS in terms of choosing different angles of knee flexion and the position of subjects, as well as the impact of different knee injuries on it. This study included only female participants (15-17 years old), who were classified into three groups of 30 subjects. The first, control group, included healthy non-athletes; second, a group of athletes, included subjects who actively participated in basketball; third, group of patients, consisted of people with a luxation patella. For measuring JPS, a VICON optical system (© Vicon Motion Systems Ltd. UK registered No. 1801446) was used for motion analysis. For each group, JPS was analysed using passive positioning-active reproduction method with knee at different angles of flexion (30°, 45° and 60°), in an upright, lying and seated position, after which the results were compared between the groups. Our results had shown that the choice of position and angle of measurement did not affect JPS in healthy populations, control group and group of athletes, nor there is a statistically significant difference in the respective positions and angles between these groups. For patients group, we observed a deficit in proprioception, and that the sitting position was the most sensitive for assessing this deficit of JPS. In relation to the corresponding angles of the control group and the athletes' group, there were statistically significant errors of the reproduction angles in the sitting position, which is why this position is characteristic for patients with patella dislocation. We also noted that the biggest difference was for 45° angle, making it the critical angle for the patient group. The key conclusion is that after knee injury, such as patella dislocation, neurological deficit of knee movement control can be observed, and which can potentially play a role in further injuries. Since measuring off knee JPS is a method of cumulative assessment of the proprioceptive system, further research should focus on determining the exact site of damage, which would allow for better understanding and more efficient treatment of knee injuries

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth’s method through a systematic review and meta-analysis. Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: “Schroth exercise”, “idiopathic scoliosis”, “Cobb angle”, “angle of trunk rotation”, and “quality of life”. Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = −0.492, p ˂ 0.005); ATR (ES = −0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis

Complication after the reconstruction of the old patellar tendon rupture

Introduction. Chronic patellar tendon rupture (PTR) occurs rarely; its frequency and prevalence are unknown. There are very little data on the late patellar tendon reconstruction in rheumatoid arthritis and its complications. Case report. We presented a surgical repair of a PTR with early postoperative rupture of the contralateral patellar tendon for a 21-year-old woman with a past medical history of juvenile rheumatoid arthritis (treated with corticosteroids) who sustained initial injury 11 months prior to the presentation. The contralateral side was used for autograft harvesting. We used bone-tendon-bone (BTB) autograft and allografts followed by double-wire loop reinforcement and immediate postoperative mobilization. The patient was followed for 2 years, and the function of both knees was re-stored completely, with a full active range of motion. In this case, reconstruction of an 11-month-old chronic PTR (with complete resorption of the tendon and completely separated infrapatellar pads, complicated by the contralateral PTR) with BTB autograft and allografts and double wire loop reinforcement gave an excellent functional result. Two years after the surgical treatment, the extensor function of both knees was completely restored with a full range of movements. The patient reported satisfying outcomes and was able to return to all pre-injury activities without the assistance of orthopedic devices. Conclusion. This case report highlights the importance of the early diagnosis and describes operative techniques used in chronic PTR repair and treatments of the early postoperative complications such as rupture of the contralateral tendon