We treated 49 patients with recurrent patellar dislocations or persistent patellar subluxations. Chondral defects were graded according to the International Cartilage Repair Society (ICRS). Thirty patients (group I) had chondral defects grade I or II, and 19 patients (group II) had chondral defects grade III or IV. All patients were treated with proximal and distal realignment of the knee extensor mechanism, but group II also had a simultaneous autologous osteochondral grafting of the chondral defect. Patients were followed for 2 years and clinically assessed using the Marshall score comparing the two groups. Apart from a slower recovery in group II, the clinical and functional results were almost the same at the final follow-up.
The techniques of fascial relaxation significantly reduced recovery time and liminated muscle tensing in the operated hip joint, thus contributing to improving the range of motion.
There is continuous ageing in world population. Although life expectancy still increases there is no similar trend in maintaining quality of life. The number of disabilities due to
age is expected to double in 2060. Muscle mass is one of the most important factors of health and nutrition in old age and it constant loss is characteristic for process of ageing. Muscle mass is controlled by number of different factors. The most important of which is balance between muscle protein synthesis and degradation. Ageing has no influence on muscle protein degradation so for maintaining muscle mass it is better to target muscle protein synthesis. Optimal protein dose in the meal is the minimal amount of protein effecting in maximal anabolic response. Threshold for anabolic response increase with age. This process, named anabolic resistance can be overwhelmed with high amount of protein in diet. Experts in the field of ageing and nutrition recommend 1,2−1,5 g/kg/d protein for the maintaining of muscle mass, 1,2−1,5 g/kg/d for older with additional risk factors, 2,0 g/kg/d for seriously ill and malnourished. Physical training has synergistic influence with diet protein. Physical training improves muscle performance, muscle strength and prevents muscle wasting. Physical training combined with increased amount of protein in diet results with increased muscle mass.
Physical activity is one of the most important element of a healthy lifestyle and determinant of the physical and mental health. According to the WHO, limited physical activity is the fourth most common premature deaths risk factor in the world. Regular sport and active recreation is very important for our health. Physical exercise is the most effective method used by physiotherapists to prevent and slow down the aging process of the body, and consequently, diseases of elderly, such as: osteoporosis, injuries caused by falls, diabetes or hypertension. Physical activity has a positive effect on the quality of life and cognitive functions of elderly. People over 65 years constitute about 40-50% of people who require specialist medical care in the world. Therefore, health and medical professionals dealing with preventive healthcare and treatment of elderly people should have basic knowledge in geriatric rehabilitation, as well as to be able to plan suitable physiotherapy program adequate to the needs of older people. To assess the functional status of the patient, as well as the effectiveness of the training, various types of functional tests are used, specially designed for the elderly. These tests are based on the Comprehensive Geriatric Assessment (COG) considering the state of health, physical and mental fitness as well as socio-environmental conditions. The physiotherapeutic program should be based on functional training involving the entire human body, i.e. nervous, muscular, skeletal, sensory and balance systems.
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