Gait abnormalities in patients with chronic ankle instability can improve following a non-invasive biomechanical therapy: a retrospective analysis.

[Purpose] The purpose of this study was to evaluate the changes in gait patterns and clinical outcomes of patients with chronic ankle instability (CAI) following treatment with a home-based non-invasive biomechanical device. [Subjects and Methods] Thirty-three patients with CAI were compared with 43 healthy controls. Patients underwent a spatiotemporal gait assessment before and three months following treatment. Clinical evaluation was recorded with SF-36 Health Survey and the Foot and Ankle Outcome Score (FAOS). [Results] Significant baseline differences were found between groups. Patients with CAI showed a statistically significant improvement in velocity, cadence, symptomatic limb step length and single limb support over time. Significant improvements in SF-36 PCS and FAOS outcome scores were found in patients with CAI. [Conclusion] Patients with CAI have baseline spatiotemporal gait abnormalities as compared with healthy controls. However, clinical and gait metrics improvement can be expected after 12 weeks of perturbation training using a non-invasive biomechanical device.

[THE EVOLUTION IN TREATING MENISCAL TEARS--FROM RESECTION TO SUTURING].

The meniscus has an important biomechanical role in the normal function of the knee including load bearing, shock absorption and joint stability. Tears of the meniscus are one of the common sports injuries. The knowledge that total meniscectomy causes early development of degenerative changes has raised the prevalence of meniscal tear repair in order to preserve as much as possible of the meniscal tissue. The type of tear (degenerative of traumatic), shape and location have a critical effect on healing ability after suture of the tear and thus will determine the treatment plan.

Surgical treatment of residual osgood-schlatter disease in young adults: role of the mobile osseous fragment.

Osgood-Schlatter disease is a well-known condition in late childhood characterized by pain over the tibial tubercle. This condition usually resolves spontaneously at skeletal maturity. Few patients develop pain over the tibial tubercle. Radiological examination demonstrates a round regular ossification over the tubercle. Treatment is usually symptomatic, but occasionally surgical treatment is necessary, usually due to the development of a painful ossicle. This article reports our experience with refractory Osgood-Schlatter disease in 22 patients. Most patients were operated under local anesthesia. A midline longitudinal skin incision was used, followed by subperiosteal dissection of the osseous fragment. The knee was put in soft dressing. Patients were encouraged to resume daily activity immediately postoperatively. No wound complications were noted. All patients returned to their previous level of physical activity within 12 weeks postoperatively. All but 1 were free of pain on kneeling or direct pressure over the knee joint. Based on our experience, we devised a treatment algorithm. We believe that the key factors for successful surgical treatment are clear visualization of separation on lateral knee radiographic view and a clinical mobility positive test (firm grasping of the prominent part of the tubercle and its sliding movement). Our results are uniformly good; the only failure related to mistaken inclusion criteria where the lateral radiograph did not show a distinctly separated fragment.

Treatment of articular cartilage lesions of the knee.

Treatment of articular cartilage lesions in the knee remains a challenge for the practising orthopaedic surgeon. A wide range of options are currently practised, ranging from conservative measures through various types of operations and, recently, use of growth factors and emerging gene therapy techniques. The end result of these methods is usually a fibrous repair tissue (fibrocartilage), which lacks the biomechanical characteristics of hyaline cartilage that are necessary to withstand the compressive forces distributed across the knee. The fibrocartilage generally deteriorates over time, resulting in a return of the original symptoms and occasionally reported progression to osteoarthritis. Our purpose in this study was to review the aetiology, pathogenesis and treatment options for articular cartilage lesions of the knee. At present, autologous cell therapies, growth factor techniques and biomaterials offer more promising avenues of research to find clinical answers.

[Knee injury in cyclers].

Cycling is currently one of the most popular recreational activities. Hence, there are increases in the numbers of injuries resulting from cycling. Most of the injuries are to the knee and are of non-contact nature and therefore, preventable. The majority of pain syndromes are non-traumatic and caused by overuse, inadequate preparation, inappropriate equipment, poor technique and lack of training. The treatment of non-traumatic knee injuries is regularly conservative, including: rest, ice, NSAID's training programs modification and adequate equipment. Delayed treatment can cause chronic injuries.

[The treatment of meniscal tear with bio-absorbable arrow--3 years follow-up].

BACKGROUND: The introduction of bio-absorbable materials has improved the ability to offer a simple fast and friendly solution to meniscal tears. The technique of meniscal suture with bio-absorbable arrows is associated with lower morbidity and complication rates. AIM: The clinical evaluation of treatment of meniscal tear by suture with bio-absorbable arrows. METHODS: During the period 1997-2004, 14 patients underwent arthroscopic all-inside meniscus repair. The "Biofix" bio-absorbable arrows fixation technique was used. Fourteen patients were followed--11 males and 3 females. Their mean age was 23 years (range 16-34 years). Follow-up period was an average of 34 months (range 6-72 months). Sport injuries were the main cause of meniscal tear (60%). Other causes included: work accidents (20%) and military accidents (20%). All the tears were located in an area suitable for suture in the "red-red" or "red-white" zone. RESULTS: One patient had a tear of the lateral meniscus. Four patients had anterior cruciate ligament (ACL) tear. The mean length of the tear was 9.6 mm. Tears were fixed with 2.5 arrows in average. The clinical evaluation was by the Lysholm Score. Excellent results were reported in 10 patients, good in one patient, fair in 2 patients and poor in 1 patient. One patient suffered from a transient tender point on the medial joint line due to protruded arrow tip, one patient needed a menisectomy due to unresolved symptoms and one patient underwent ACL reconstruction. CONCLUSION: Meniscal suture with bio-absorbable arrows is an easy and reliable suture technique compared to the classical methods and it seems to have a lower complication rate. Further studies are needed to establish the quality of the repair and the associated morbidity.