No abstract

The anterolateral ligament (ALL) is a rotational stabilizer of the knee joint widely investigated the last 13 years as the possible cause of some anterior cruciate ligament (ACL) reconstructions failure. ALL injuries accompany 64% of ACL ruptures. Nevertheless, there are still no publications concerning changes in the ACL rehabilitation process due to the ALL concomitant rupture. We evaluated rotational stability in 12 athletes with the ACL rupture and concomitant ALL injury or Segond fracture treated conservatively before the treatment and 3 months later. The physical therapy comprised the range of motions and strengthening exercises during the immobilization period and thereafter. As only the knee joint was immobilized the physical therapy was conducted to the adjacent joints and muscles at the very beginning. A total of 83.33% of patients became pivot-shift negative in three months. In 16.67% pivot-shift test was questionable. Lachman test remained positive in 91.67%. The ACL is a more important structure than the ALL. So, our treatment strategy focuses mainly on it. Most changes in physical therapy are the immobilization and postponed axial loading with internal rotation. But even these minor changes may influence greatly the overall stability of the knee, particularly rotational stability. It seems to be the single case series as- sessing the rotational stability recovery after the ALL rupture conservative treatment we found in the scientific literature. Immobilization and non-weightbearing for up to 6 weeks may decrease the rotational instability in con- servatively treated ALL injuries concomitant to the ACL ruptures. Further investigations of the physical therapy and rehabilitation of the anterolateral ligament injuries and Segond fractures are necessary.

Актуальність. Синдром пахвинного болю в спортсменів (СПБС) є четвертою за частотою патологією в структурі спортивного травматизму. Дані щодо вибору оптимальних способів та методів лікування СПБС обмежені. Мета дослідження: на підставі аналізу клінічних та ультрасонографічних результатів лікування хворих зі СПБС обгрунтувати вибір оптимального способу хірургічного лікування. Матеріали та методи. Основу дослідження становили 114 хворих зі СПБС, яким було проведено хірургічне лікування. Результати. Артроскопічне лікування внутрішньосуглобової форми СПБС вірогідно високоефективне (р < 0,05) на всіх термінах спостереження. Ефективність лікування хворих із комбінацією ушкодження суглобової губи та суглобового хряща становила 90,5 % на 90-ту добу спостереження, тоді як у пацієнтів з іншими внутрішньосуглобовими ушкодженнями було відмічено повну відсутність клінічних та сонографічних симптомів. Хірургічне лікування навколосуглобової форми СПБС (синдром внутрішнього та зовнішнього клацаючого стегна) також вірогідно високоефективне (р < 0,05) (як артроскопічний реліз сухожилка m. iliopsoas, так і мініінвазивна фасціотомія m. tensor fasciaе lataе) на всіх термінах спостереження. Патогномонічні симптоми зникали вже на 21-шу добу. Оперативне лікування позасуглобової форми СПБС (ARS-синдром) за стандартною та новою методиками (реліз із рефіксацією сухожилка привідного м’яза стегна та інтраопераційним введенням автологічної плазми, багатої факторами росту), встановило більшу ефективність нової методики, що проявлялось клінічно та ультрасонографічно. Результати двобічної тенотомії m. adductor longus дозволяють вірогідно рекомендувати дану методику спортсменам старшої вікової групи з двобічним ARS-синдромом ІІІ–ІV стадії. Ця процедура дозволяє швидко усунути больовий синдром на 21-шу добу до 0,6 бала за візуально-аналоговою шкалою. Висновки. Доведено ефективність хірургічного лікування синдрому пахового болю спортсменів. Додавання автологічної плазми, багатої факторами росту, дозволяє швидко та дешево покращити результати хірургічного лікування інгвінальної форми та ARS-синдрому. Двобічна тенотомія m. adductor longus ефективна та раціональна в спортсменів старшої вікової групи. Диференційовані підходи до лікування синдрому пахового болю з використанням нових способів оперативного лікування прискорюють повернення пацієнтів до спортивної діяльності.

Summary. Relevance. Negative results of the anterior cruciate ligament (ACL) reconstruction occur in 10-20% of cases. The incidence of infectious arthritis can reach up to 1.7% and even up to 7.1%, according to the literature. However, ACL reconstruction can be complicated not only by infectious but also by reactive arthritis. Differential diagnosis between infectious and reactive arthritis is often hard to be done, but it is necessary for effective treatment. Objective: to determine the possible causes of the development of reactive and infectious arthritis after ACL reconstruction, peculiarities of their diagnostics and differential diagnostics. Materials and Methods. The literature data regarding the frequency of reactive and infectious arthritis after various methods of surgical treatment of ACL injury and the use of different types of implants, as well as laboratory indicators of the activity of the inflammatory process in the postoperative period and such indicators in reactive and infectious arthritis, were analyzed. We also analyzed literature data on the sensitivity and specificity of various methods of microbiological studies in patients with infectious synovitis or arthritis. Results. Numerous probable causes of a higher incidence of infectious arthritis in ACL reconstruction are suspected. Synthetic implants may be the cause of the development of reactive arthritis, according to a number of studies. Our experience in using different biodegradable fixators from various manufacturers suggest that the percentage of complications depends not only on the fact of the biodegradability of the implant, but on its composition, and even on the percentage of tricalcium phosphate or the manufacturer. Therefore, it is impossible to unambiguously state that biodegradable fixators are worse or better then metallic or non-biodegradable polymeric ones. However, on average, if we consider all existing fixators from various manufacturers, the number of complications when using biodegradable implants is higher. Diagnosis of reactive arthritis is often based on negative bacteriological findings. Given the not always high sensitivity of bacteriological inoculation of synovial fluid and the duration of the investigation, we cannot rely only on its results. Conclusions. The most difficult for differential diagnosis between infectious and reactive arthritis (synovitis) is acute synovitis after ACL reconstruction with normal results of bacteriological studies, but high biochemical parameters of inflammation. We suggest to suspect infectious arthritis after ACL reconstruction in the following hemogram values: 1) CRP >40-50 mg/l, 2) ESR >30-50 mm/h, 3) fibrinogen >800 mg/ml, 4) procalcitonin in blood plasma >0.5 ng/ml, 5) leukocytosis and left shift of the leukocyte formula, with the following synovial fluid test parameters: a) CRP >40-50 mg/l, b) leukocytosis with an increase in the percentage of polymorphonuclear leukocytes >75%.

Background. The purpose of the study was to evaluate the efficacy and safety of the combination use of Flextra® and extracorporeal shock wave therapy (ESWT) or ESWT alone from the standpoint of clinical and structural evolution of tendinopathies (Achilles and lateral elbow tendinopathy). Materials and methods. The study was conducted at the premises of the Medical Center “European Orthopedics” in Kyiv for 2020–2021. Seventy-four patients (39 women and 35 men, mean age of 42.7 ± 5.4 years) were examined, they were randomly divided into four groups. The first group included patients with Achilles tendinopathy and the second one — those with lateral elbow tendinopathy. Both groups received two Flextra capsules a day for 90 days and underwent a course of ESWT. The third group included individuals with Achilles tendinopathy and the fourth group — patients with lateral epicondylitis, who underwent the same course of ESWT (7 procedures). Results. The study showed that taking Flextra® in combination with ESWT has a statistically significant effect on the structure and clinical symptoms of various tendinopathies. In patients with t.calcaneus tendinopathy and epicondylitis, the drug plays an important role in the healing of tendons, which is reflected in the results of ultrasound examinations. Conclusions. Flextra® is an effective and safe drug in the treatment of Achilles tendinopathy and epicondylitis, and the additional use of ESWT provides high efficiency, especially in the initial stages of the disease.

No abstract

Summary. Relevance. Ultrasonographic parameters of the anterolateral ligament (ALL), a recently described anatomical structure, are essential to have a starting point in its injury diagnostics. Objective: to determine the ultrasonographic parameters of the normal ALL. Materials and Methods. We studied 47 volunteers (94 joints) without a history of injuries of the knee joints with a multi-frequency linear sensor Philips HD-11 XE #USD0874946. Results. The ALL was visualized in all 94 knee joints. The ALL looked like an anisotropic fibrillar structure and seemed to be symmetrical in 93.62% of patients. We were able to assess the integrity of the ALL in only 82.98% of the knee joints. The minimum thickness of the ALL was always in its meniscal part (1.43±0.54 mm). The thickest part was the area of attachment to the tibia (3.26±0.47 mm); the width of the tibial ALL attachment was 12.83±2.64 mm. The thickness of the ALL femoral attachment was difficult to estimate in most cases due to the braiding of the ALL and fibular collateral ligament fibers together. We could visualize the tibial and meniscal portion in 100%, femoral – in 95.74%, and menisco-tibial – in only 4.26%. There is a violation of the cortical layer integrity at the site of the tibial ALL attachment in at least one knee joint in 25.53% of patients without a history of injuries. Conclusions. The contralateral knee joint ALL may be a valid reference for ultrasonographic comparison for the injured ALL. Ultrasonographic signs of the cortical layer discontinuity at the tibial ALL attachment are not indisputable symptoms of Segond fracture.

the purpose was to specify the lower extremity joint angles in different squats for the future development of adequate computational models of the joints. Methods. We investigated joint angles in the lower extremity joints in 103 athletes in different types of squats with and without added weight (barbell) 75% of 1 repetition maximum. results. the mean knee and hip flexion and ankle dorsiflexion angles in horizontal squats are respectively 113.