Management of intraoperative contamination of anterior cruciate ligament graft.

The options after the intraoperative graft contamination include sterilizing and implanting the graft, rejecting the graft and isolating another one from the other knee, rejecting the graft and using an allograft. The survey was prepared in Google Forms®. Only fully and correctly completed survey questionnaires were considered and included in this study. In total, 41 questionnaires in the study reported contamination. For the surgeon, the risk of contaminating the graft during the surgery is 0.2%. The mean contamination rate is 1.2 accidents per whole career. The statistical significance was observed in correlation between years of specialization and several accidents (p<0.05). The graft contamination may be experienced by almost 30% of surgeons performing ACL reconstructions. Neither knowledge, nor experience and training can prevent an operating team from that situation. The only solution is to follow a strict protocol of graft preparation. According to the data gathered in this study, there is still no ideal protocol after the incident occurs.

Sport injuries in professional volleyball players.

Recently there has been a considerable surge in interest in volleyball by both physiotherapists and orthopaedic surgeons. Only few previous studies specified the nature, frequency, and demographics of volleyball injuries. The study was conducted during two league seasons. After the approvals of local bioethics committee and clubs` authorities, contact with the club's doctors was established. A special survey was designed to standardize the process of acquiring data on a weekly basis. One-hundred-and-ninety-eight women and 301 men were under supervision of the research group. On average, 45% of all players (56% males and 26% females) suffered from injuries and musculoskeletal disorders over two seasons. Relatively high incidence of injuries during matches was between 17.3 and 33.8 injuries per each 1000 hours of playing. Almost 50% of musculoskeletal problems occurred in the first phase of the season. Over 50% of musculoskeletal problems were reported during trainings. The blockers are the most affected players in both sex groups. Acute injuries mainly involved knee and ankle joints, while chronic problems affected knee, shoulder, spine and abdominal muscles. Professional volleyball is not a safe sport, especially during a league season. Attention should be especially paid to ankle, shoulder and knee joints, which are the most commonly injured structures. The study revealed that blockers were the most susceptible to injuries and should be protected by special training regime. These findings can help to prepare sports medicine personnel and to guide further related research to prevent injuries among volleyball professionals.

Anatomical variations of knee ligaments in magnetic resonance imaging: pictorial essay.

Evaluation with magnetic resonance imaging (MRI) is currently a gold standard for comprehensive posttraumatic assessment of the knee joint. Increasing availability of MR systems with stronger magnetic fields and new sequences results in higher resolution of images and thus allows imaging smaller and finer anatomical details, including different anatomical variations. This article focuses on anatomical variations of knee ligaments, which can mimics pathological structures. Well-known and less common ligaments that are sporadically observed and may raise the most doubt will be discussed. Familiarity with those variations of ligaments is indispensable for precise MRI reporting to avoid misinterpretation as meniscal tears, loose bodies or mass lesions especially in cases. This paper is addressed to both radiology and orthopaedics specialists. Illustrations show discussed ligaments in standard planes while, for less known ligaments, we add information on how to adjust planes to properly visualise a particular structure, which will hopefully facilitate finding and differentiating those structures in clinical practice.

Athletes do better after FAI arthroscopic treatment in male population.

BACKGROUND: Arthroscopic surgery is becoming popular in the management of hip pathologies. There are numerous studies describing the outcomes of the treatment of athletes with this method. These outcomes are generally found to be excellent. Yet there are little data in the literature with respect to the arthroscopic treatment of nonathletes. The objective of our study is to compare the outcomes of the femoroacetabular impingement (FAI) treatment between athletes and nonathletes using arthroscopy, using two popular scales. METHODS: The study involved a total of 129 male patients operated at our departments between 2009 and 2013. The subjects were divided into two groups: athletes and nonathletes. The results were assessed using the Nonarthritic Hip Score (NAHS) and Modified Harris Hip Score (MHHS). In addition, the length of postoperative hospitalization was evaluated. RESULTS: Analyses revealed that athletes performed better in NAHS over each period under analysis (prior to the operation, 12 and 24 months after the operation). As regards MHHS in these periods, the results in both groups were comparable. In addition, it was found that the length of postoperative hospitalization was similar in athletes and nonathletes. CONCLUSIONS: Arthroscopic treatment of FAI is an effective method producing visible effects in athletes as well as nonathletes but quicker recovery in male athletic population. In the examined population, NAHS was a better measurement tool than MMHS, showing differences between the athlete and nonathlete population.

Lower limb equalization with percutaneus epiphysiodesis of the knee joint area.

INTRODUCTION: Epiphysiodesis has become one of the most popular methods in the treatment of leg length discrepancy (LLD) due to its surgical simplicity, short hospitalization time, and a low risk of complications. PATIENTS AND METHODS: A retrospective analysis was performed on 34 patients treated for LDD with percutaneus epiphisiodesis of the distal femur and/or the proximal tibia. The mean discrepancy was 2.8 cm. The outcome evaluation method was based on Kemnitz et al. RESULTS: Based on the Kemnitz criteria, 23 (67.6%) patients experienced good results, while 2 (5.9%) satisfactory and 9 (26.5%) poor results. In 47% of patients, swellings of the knee joint were observed in the postoperative period. One serious complication - varus deformity of 10 degrees in femur occurred in the follow-up period. CONCLUSIONS: Percutaneous epiphysiodesis is a simple method of the LLD correction, with a low rate of complications and applicable in cases of late LDD diagnosis.

Patellar ligament hypertrophy evaluated by magnetic resonance imaging in a group of professional weightlifters.

The aim of this research was to investigate if perennial, professional weightlifting training, started at puberty, leads to hypertrophy of the patellar ligament (PL). The knee examinations were performed with a 1.5 T magnetic resonance imaging system. The area of the cross-sectional area (CSA) of the PL midsubstance was evaluated in T1-weighted images. A control group of 19 participants was also examined with the same protocol. A significant increase of the PL midregion CSA was observed in a group of weightlifters. The area of the PL midsubstance and the onset of training were very strongly, reversely correlated. This paper presents the first description of PL midregion hypertrophy due to professional weightlifting training initialised and continued from a pubertal spurt. The described overgrowth is more intensified than has been reported for other parts of the PL. Moreover, it has been observed in the region that is the least susceptible for injuries, which in another situation could also have led to increased volume of the PL. The described phenomenon should be considered by orthopaedic surgeons because it can influence the choice of the surgical technique for cruciate ligament reconstruction as the PL is one of the structures for harvesting autografts.

[Corrective surgical procedures as repeated treatment of residual clubfoot]. / Zabiegi poprawcze jako uzupelnienie leczenia operacyjnego wrodzonej stopy konsko-szpotawej.

The authors present an analysis of failed surgery in 139 patients with congenital clubfeet. There were 72 feet, which required repeated surgical procedures after primary treatment. Twelve feet were treated by posterior release, and 65 by postero-medial release. The repeated reconstruction was performed at a mean age of 3.6 years. No very good results were found in either group at final follow-up, done according to the Magone et al. classification. In the first group treated by posterior release god results were noted in 53.3% of the cases, sufficient in 43.1% and poor in 38.5%. The authors underline that the final results depend on early consequent conservative treatment, use of adequate operating techniques and cooperation between child, parents, physician and orthotic specialist.

[The comparison of the results of treatment of displaced supracondylar humeral fractures by skeletal traction and percutaneous K-wire fixation in children]. / Porównanie wyników leczenia zlamania nadklykciowego kosci ramiennej u dzieci z pelnym przemieszczeniem odlamów wyciagiem i przeskórna stabilizacja.

The aim of the study was to compare of the results of treatment of displaced supracondylar humeral fractures by skeletal traction and percutaneous K-wire fixation in children. We assessed retrospectively the type and result of treatment of 23 children. We obtained very good results in all cases treated by closed reposition secured by percutaneous K-wire fixation. In the group treated by skeletal traction, in 5 cases reposition was inadequate with subsequent limitation of range of motion in the elbow joint. According to our results closed reposition and percutaneous fixation should be the method of choice in displaced supracondylar humeral fractures in children.

[The use of Bicontact hip prosthesis in treatment of coxarthrosis]. / Zastosowanie endoprotezy Bicontact w leczeniu zmian zwyrodnieniowych stawu biodrowego.

The issue of a stabile, long lasting bone-implant interface is still very valid. One of the new models of uncemented hip prosthesis is the Bicontact prosthesis made by Aesculap. This four-part endoprosthesis offers two types of cups: threaded München type and spherical Plasmacup type. The prosthesis stem is a wedged type stem, porous in the proximal type. The aim of this paper was to evaluate the value of Bicontact prosthesis in treatment of coxarthrosis. Our material consisted of 69 patients (38 female and 31 male) with 72 operated hips. Average age of the patients was 50.8 years. The mean follow-up was 24.5 months. Clinical and radiological evaluation according to Merle d'Aubine-Postel classification with Charnley's modification yielded 88% very good and good results. In 11 hips a similar complication was noted--fracture of the femur during final hammering of the prosthesis stem into the medullary canal. This was immediately repaired by circular wire fixation without any influence on the final result. This complication was observed during the first procedures. The learning curve of surgical technique allowed us to avoid this complication during subsequent procedures. We concluded that type of hip prosthesis was is very useful in in treatment of coxarthrosis.

[Intervate dislocation of the distal interphalangeal joint of the annular finger in a child]. / Zastarzale zwichniecie stawu miedzypaliczkowego dalszego palca serdecznego u dziecka.

The paper presents a good cosmetic and functional result of surgical treatment of distal interphalangeal joint dislocation of the annular finger in a 14 year old boy. The mechanism and pathology of this rare lesion of the hand are discussed. Factors affecting final outcome are: preserved joint cartilage, careful surgical approach and proper post-op treatment.

[Long term results of the treatment of clubfoot with postero-medial fibular graft]. / Odlegle wyniki leczenia wrodzonej stopy konsko-szpotawej metoda uwolnienia okoloskokowego.

The authors present long term results of treatment of congenital clubfoot by postero-medial release. Our material consisted of 82 patients, with 103 clubfeet, 5 months to 9 years old (mean age 22 months) at the time of surgery. The age at the time of the final follow-up ranged from 6.3 to 27 years. Final results were evaluated according to the Magone classification. Basing on this classification we achieved very good results in 9 feet, good results in 20, sufficient results in 28 and poor results in 46 feet. In the analyzed group most of the results were either sufficient or poor--71.84% of the cases. These feet required further surgical procedures. The authors stress that incorrect classification for this type of surgery and inadequate surgical technique caused a high percentage of poor and sufficient results.