Drukčiji pristup liječenju oštećenog meniska – sačuvajmo menisk

Menisci su vezivno-hrskavične strukture koje imaju važnu ulogu u zaštiti zglobne hrskavice i stabilnosti koljena. Puknuće meniska predstavlja najčešću intraartikularnu patologiju koljenskog zgloba te je najčešći razlog izvođenja operacijskih zahvata na koljenu. Razvojem artroskopskih tehnika, artroskopska djelomična meniscektomija postala je metodom izbora u liječenju puknuća meniska. Iako je minimalno invazivan zahvat kojim se odstranjuje samo dio meniska, a nakon kojeg se bolesnici brzo vraćaju svakodnevnim aktivnostima, artroskopska djelomična meniscektomija dugoročno ima nepovoljan utjecaj na hrskavicu koljena, što rezultira ubrzanim razvojem osteoartritisa. Stoga se od devedesetih godina prošlog stoljeća sve više promovira metoda artroskopskog šivanja meniska kojom se nastoji sačuvati anatomska cjelovitost, a time i funkcionalnost meniska. Premda kliničke studije pokazuju zadovoljavajuće dugoročne rezultate nakon takvih zahvata, nažalost, i dalje se šivanje meniska ne izvodi dovoljno često. Cilj ovoga preglednog rada jest naglasiti važnost meniska u očuvanju hrskavice i stabilnosti koljena te na temelju podataka iz literature prikazati suvremene spoznaje o etiologiji, klasifikaciji, dijagnostici i liječenju puknuća meniska

Veća učestalost revizijskih zahvata i aseptičkog razlabavljenja totalnih endoproteza koljena sa stražnjom stabilizacijom u usporedbi s totalnom endoprotezom koljena s očuvanim stražnjim križnim ligamentom istog tipa endoproteze – retrospektivna studija jednog centra na 580 koljena

The purpose of this study was to evaluate the 4-year survivorship of total knee arthroplasty (TKA) of a single manufacturer and determine whether failure rates differ between the cruciate-retaining (CR) and the posterior-stabilised (PS) type of implant. In addition, possible causes of revision were analysed as well. A retrospective analysis of 580 TKAs, with either the CR or the PS type of the Biotech Future Knee endoprosthesis (BIOTECH GmbH, Garbsen-Berenbostel, Germany) was performed. The 4-year survivorship for revision of any cause in all cases was 89.14%, with aseptic loosening being the most common cause of revision (53.9%). Regarding the type of implant model, the revision rate was higher in the PS group compared to the CR group (13.7% to 8.0%, respectively, p=0.027). The Cox regression models suggested that the type of prosthesis was a significant predictor of the need for revision (HR, 0.442; 95% CI, 0.234-0.833). In conclusion, our study has shown higher revision rates with the PS implant type when compared to the CR implant type with a higher rate of aseptic loosening in the PS group. Further studies are needed to determine the cause of these results and to investigate whether the problem is specific to the implant.Primarne endoproteze koljena razlikuju se u dizajnu s obzirom je li stražnja ukrižena sveza održana (CR) ili žrtvovana (PS). Cilj istraživanja bio je ispitati 4-godišnje preživljenje totalne endoproteze koljena jednog proizvođača te utvrditi postoje li razlike s obzirom na CR ili PS dizajn endoproteze. Također, analizirani su mogući uzroci revizijskih zahvata. Retrospektivno je analizirano 580 koljenskih (PS i CR) endoproteza Biotech Future Knee (BIOTECH GmbH, Garbsen-Berenbostel, Germany). Ukupno 4-godišnje preživljenje ispitivanih endoproteza je 89.14%, a kao najčešći uzrok revizijskog zahvata zabilježeno je aseptičko razlabavljenje endoproteze (53.9%). S obzirom na dizajn endoproteze, postotak revizijskih zahvata je bio viši u PS nego u CR grupi(13.7% i 8.0%, p=0.027). Coxov regresijski model upućuje na dizajn endoproteze kao značajan prediktor potrebe za revizijskim zahvatom (HR, 0.442; 95% CI, 0.234-0.833). U zaključku, ovo istraživanje utvrdilo je viši postotak revizijskih zahvata kod PS dizajna u usporedbi s CR dizajnom endoproteze. Potrebne su dodatne studije kako bi se utvrdilo je li opažena razlika specifična za dizajn endoproteze ili ispitivani implantat

The role of anterolateral ligament in anterior cruciate ligament reconstruction – plantaris tendon graft technique

Anterior cruciate ligament (ACL) reconstruction is the principal treatment option in symptomatic patients with ACL rupture. Regardless of the technique utilised, ACL reconstruction alone could not always restore normal knee kinematics, especially rotational stability. Moreover, present techniques mostly use autografts such as hamstring tendons and additionally disrupt the knee bio- mechanics. The anterolateral ligament (ALL) of the knee has been recognised as an important structure in providing rotational knee stability. Concurrent reconstruction of ACL and ALL ligaments has proven superior in both clinical stability tests and subjective outcome scores. Using plantaris tendon as ALL graft, detrimental effects of harvesting two hamstring tendons are avoided

Rekonstrukcija prednjeg križnog ligamenta i anterolateralnog ligamenta koljena tetivama kvadricepsa i plantarisa

Anterior cruciate ligament (ACL) reconstructions with quadriceps tendon (QT) grafts are gaining popularity, both in primary and revision procedures. Recently, the role of the anterolateral ligament (ALL) of the knee in improving rotational knee stability has been emphasised and concurrent ACL and ALL reconstruction is advocated. In this paper, a new technique utilising the QT and the plantaris tendon (PLT) for combined ACL and ALL reconstruction is analysed. Patients that underwent combined ACL and ALL reconstruction using QT and PLT grafts in a 3-years period were prospectively analysed. A total of 9 patients with 6 months minimum follow-up were assessed with Lachman and Pivot shift clinical tests, International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner activity scale. One patient had reconstructed ACL re-rupture at the final follow-up visit, leaving 8 patients with a mean follow-up of 19±8 months. There was a significant improvement in anteroposterior and rotational stability in all the patients. The IKDC, KOOS, and Lysholm scores improved as well. The Tegner activity scale increased postoperatively, however, it did not reach preinjury values. QT and PLT grafts are valuable alternatives for currently used grafts in combined ACL and ALL reconstructive procedures. This new technique is a reasonable option in ACL revision surgery and a good alternative in primary ACL and ALL reconstruction, especially when hamstring grafts are not advised or they are missing.Rekonstrukcija prednjeg križnog ligamenta (ACL) presatkom tetive kvadricepsa (QT) kod primarnih i revizijskih zahvata postaje sve učestalija. Nedavno je istaknuta uloga anterolateralnog ligamenta (ALL) u poboljšanju rotacijske stabilnosti koljena te se zagovara istodobna rekonstrukcija ACL-a i ALL-a. U ovom radu analizirana je nova kirurška tehnika kombinirane rekonstrukcije ACL-a i ALL-a koja koristi QT i tetivu plantarisa (PLT). Prospektivno su praćeni pacijenti kojima je učinjena udružena rekonstrukcija ACL-a i ALL-a presadcima QT i PLT u razdoblju od 3 godine. Ukupno je analizirano 9 pacijenata s minimalno 6 mjeseci praćenja. Koristili su se klinički testovi Lachman i Pivot shift te upitnici procjene ishoda: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm i Tegnerova ljestvica aktivnosti. Kod svih pacijenata je došlo do značajnog poboljšanja u anteroposteriornoj i rotacijskoj stabilnosti. Rezultati IKDC, KOOS i Lysholm upitnika također su se poboljšali. Tegnerova ljestvica aktivnosti se postoperativno poboljšala, ali nije dosegla vrijednosti prije ozljede. Jedan je pacijent zadobio rerupturu ACL-a u vrijeme posljednjeg pregleda, ostavljajući 8 pacijenata s prosječnim praćenjem od 19±8 mjeseci. Presadci QT i PLT vrijedna su alternativa za trenutno korištene presatke u zahvatima udružene rekonstrukcije ACL-a i ALL-a. Ova nova tehnika razumna je opcija u revizijskim zahvatima rekonstrukcije ACL-a i dobra alternativa u primarnoj rekonstrukciji ACL-a i ALL-a, osobito kada se ne preporuča koristiti tetive fleksora koljena ili one nedostaju

Plantaris muscle tendon – a novel graft in new operation technique for combined anterior cruciate and anterolateral ligament reconstruction of the knee

Mišić plantaris je mali mišić površnog stražnjeg odjeljka noge karakteriziran najdužom tetivom u ljudskom tijelu. Istraživanja ukazuju da je plantaris rudimentarni mišić sa zanemarivom biomehaničkom funkcijom. Tetiva mišića plantarisa odavno je prepoznata kao lako dostupan presadak kod raznih rekonstruktivnih zahvata u ortopediji. Anterolateralni ligament koljena predstavlja važan čimbenik uspostave rotacijske stabilnosti kod koljena kojem nedostaje funkcija prednjeg križnog ligamenta. Tetiva mišića plantarisa ima odlična biomehanička svojstva za rekonstrukciju anterolateralnog ligamenta. U ovom kratkom preglednom radu prikazana je nova operacijska tehnika zajedničke rekonstrukcije prednjeg križnog ligamenta i anterolateralnog ligamenta koljena uz presatke tetiva mišića semitendinozusa i plantarisa.Plantaris muscle is a fusiform muscle of the superficial posterior leg compartment. It is characterized by the longest tendon in humans. Reports suggest that plantaris muscle is rudimentary with a minor biomechanical function. Plantaris tendon is a well known and accessible graft for various reconstructive procedures. The anterolateral ligament has recently been recognized as an important structure in restoring the rotational stability of the anterior cruciate ligament deficient knee. Plantaris tendon has excellent biomechanical properties for anterolateral ligament reconstruction. The present study describes a new combined anterior cruciate ligament and anterolateral ligament reconstruction technique using plantaris tendon and semitendinosus tendo

The Conceptual Design of a Smart Wrist Orthosis and Functional Performance - Project Overview

The idea of the project was to find a conceptual design of a multi-functional smart orthosis for wrist fixation. The application of additive technologies presents the potential in designing a customised orthosis for every patient individually. By using pre-generated 3d models of various hand shapes it is possible to prepare models for several shapes and sizes of forearms and hands. The conceptual design provides a possible solution for a two-part orthosis bound around the forearm and a modular extension to stabilize the wrist without additional compression. The multi-functionality occurs with the development of a small pre-defined electronic plate located in the bottom part of the orthosis. The temperature and heart rate are constantly monitored and displayed wirelessly on a smartphone. The target group are the patients active in sports or patients with minor injuries. Moreover, the orthosis can be used for body temperature and heart function monitoring during recovery period