Uncommon Bone Injuries in Soccer Players.

Soccer is the most common team sport in the world. A significant number of players are associated with a large number of injuries. Injuries occur in a variety of contexts regardless of the age or performance level of players. The vast majority of injuries involve soft tissues. Bone injuries are less common, but usually result in long-term exclusion from the game. Three different types of fractures related to soccer are classified as acute types, stress fractures and avulsion. This manuscript outlines the diagnostic procedures and treatments for stress fractures, avulsion fractures and bone cyst. The common feature of the described injuries includes frequent difficulties associated with the correct diagnosis and treatment direction. In therapeutic treatment, the doctor and the patient often have to choose between conservative treatment and surgical treatment, which in many cases is not simple. We suggest that in the event of injuries to soccer players, surgical treatment should be used, shortening the time to return to full sports activity. A very important element of the therapeutic process is proper rehabilitation, which should be individually tailored to the patient in order to optimize the treatment process. Some of the rehabilitation protocols should be permanently incorporated into the warm-up protocols for training. Such a procedure has a preventive effect.

The electromyographic activity characteristics of the gluteus medius muscle before and after total hip arthroplasty.

PURPOSE: The clinical outcomes of total hip arthroplasty are influenced by the correct muscle function that determines good, longterm and proper function of the artificial joint. The aim of the study was to analyze the electromyographic activity of the gluteus medius muscle in patients with hip osteoarthritis and after arthroplasty in various static weight bearing conditions, both on the affected and contralateral side. METHODS: The prospective study involved 70 patients qualified for hip replacement. Patients underwent a surface electromyography of the gluteus medius muscle which involved the Trendelenburg test. The normalized results were obtained for both hips, preoperatively and 6 months after arthroplasty. RESULTS: The only muscle activity differences were found at a full load condition of lower limb. In the preoperative assessment, the activity of the gluteus medius muscle was greater on the side qualified for surgery. After arthroplasty and the rehabilitation period, the muscle activity on the operated side decreased and significantly increased on the contralateral side. Detailed analysis of the contralateral side revealed relationship with osteoarthritis. Previous hip arthroplasty of that side resulted in lower muscle activity, similar to fully functional joints. CONCLUSION: The activity characteristics of the gluteus medius muscle vary depending on the condition of the joint, and the characteristics change as a result of the surgical procedure performed on both the operated and contralateral sides. These dependencies should be taken into account in the rehabilitation process, especially at the side opposite to the operated one.

Analysis of intercondylar notch size and shape in patients with cyclops syndrome after anterior cruciate ligament reconstruction.

BACKGROUND: Cyclops lesion is the second most common cause of extension loss after anterior cruciate ligament reconstruction. This study focused on the correlation between the anatomy of the intercondylar notch and the incidence of cyclops lesion. To determine whether the size and shape of the intercondylar notch are related to cyclops lesion formation following anterior cruciate ligament reconstruction according to magnetic resonance imaging (MRI) findings. METHODS: One hundred twenty-five (125) patients were retrospectively evaluated. The notch width index (NWI) and notch shape index (NSI) were measured based on coronal and axial MRI sections in patients diagnosed with cyclops syndrome (n = 25), diagnosed with complete anterior cruciate ligament (ACL) tears (n = 50), and without cyclops lesions or ACL ruptures (n = 50). RESULTS: Imaging analysis results showed that the cyclops and ACL groups had lower mean NWI and NSI values than the control group. Significant between-group differences were found in NSI (p = 0.0140) based on coronal cross-sections and in NWI (p = 0.0026) and NSI (p < 0.0001) based on axial sections. CONCLUSIONS: The geometry of the intercondylar notch was found to be associated with the risk of cyclops lesion formation and ACL rupture.

The Fifth Metatarsal Bone Fracture in Athletes - Modalities of Treatment Related to Agility in Soccer Players.

The 5th metatarsal fracture is a common foot fracture which could exclude a player from competition for several months and significantly affect his or her career. This manuscript presents the treatment and rehabilitation of professional soccer players who had acute fractures of the 5th metatarsal bone and a cannulated screw fixation. The main purpose of the analysis was to determine the minimum time necessary for a permanent return to the sport after a 5th metatarsal fracture among professional soccer players. We followed the surgical and rehabilitation path of 21 professional soccer players from the Polish League (Ist and IInd divisions) who suffered from the 5th metatarsal bone fracture. All players underwent standard percutaneous internal fixation with the use of cannulated screws. The total inability to play lasted for 9.2 (± 1.86) weeks among players treated only surgically (n = 10), 17.5 (± 2.5) weeks in the conservative and later surgery group, excluding players with nonunion (n = 6), and 24.5 (± 10.5) weeks for nonunion and switch treatment (n = 4) players. Prompt fracture stabilization surgery is recommended for athletes, enabling the implementation of an aggressive rehabilitation protocol as soon as possible. Early limb loading after surgery (from week 2) does not delay fracture healing or hinder the bone union, thus rehabilitation plays a crucial role in shortening the time of RTP (return to play) and is obligatory for each athlete who undergoes surgical treatment.

Stress fractures in uncommon location: Six case reports and review of the literature.

BACKGROUND: Individuals' interest in sports activities has been increasing, contributing to more stress fracture occurrences in uncommon locations on the skeleton. In this study, several cases of stress fractures in atypical locations are presented, and the possibility of combining diagnostic methods to make accurate and quick diagnoses is explored. Additionally, different causes of stress fractures, as well as various modalities of treatment, are highlighted. Other potential factors of stress fractures were identified by a literature review. CASE SUMMARY: Six cases of stress fractures in the calcaneus, intermediate cuneiform bone, sacrum, tibia (bilateral), navicular bone and femoral neck are presented, with different types of diagnostic imaging and treatments. All of the cases were associated with an aspect of mobility because all of the patients were physically active in various sport disciplines. CONCLUSION: The type of therapeutic procedure selected should depend on the specific clinical case, i.e., the patient's condition and level of physical activity.

Impact of Duration of Eccentric Movement in the One-Repetition Maximum Test Result in the Bench Press among Women.

Scientific studies related to resistance training have considered many variables; however, the tempo of movement of particular repetitions is often neglected or not reported in resistance training practice and research. The aim of the study was to determine the effect of different duration of the eccentric (ECC) phase of movement on one-repetition maximum test (1RM) results during the bench press exercise (BP). Twenty-one strength trained females (age = 23.4 ± 2.2 years, body mass = 52.3 ± 6.7 kg), with a minimum one year of strength training experience took part in the study. The experiment was conducted following a randomized crossover design, where each participant completed the 1RM test in the BP with three different duration times of the ECC movement: 2/0/X, 4/0/X, 6/0/X. Concentric (CON) movement was performed with maximal velocity (X). The ANOVA with repeated measures were used to compare the differences between the analyzed variables. The results of the study indicated the maximal load in the 1RM test was significantly higher during the BP with the 2/0/X tempo compared to 6/0/X (p < 0.01) and 4/0/X tempos (p < 0.01). Therefore, the results indicated that the longer the duration of the ECC phase of movement, the greater the decrease in the result of the 1RM test. The 1RM test procedure should include information about the movement tempo used during the test protocol.

Kinematic gait parameters changes in patients after total knee arthroplasty. Comparison between cruciate-retaining and posterior-substituting design.

PURPOSE: The patients expect optimal knee function after Total Knee Arthroplasty. It is necessary to apply appropriate surgical technique and supervised physical therapy. The optimal management of posterior cruciate ligament remains controversial. Both implant designs, i.e., cruciate retaining and posterior substituting, allow the orthopedic surgeon to achieve excellent clinical outcomes, as measured by commonly used questionnaires. Such methods of assessment may poorly reflect the functional status of patients. Therefore, three-dimensional gait analysis is recommended to evaluate the outcomes of surgical intervention. This study sought to determine differences in kinematic gait parameters and Knee Society Score between cruciate-retaining and posterior-substituting patients. METHODS: 23 individuals after cruciate-retaining total knee arthroplasty and 19 individuals after posterior-substituting total knee arthroplasty were subjected to gait analysis using three-dimensional motion capture system BTS Smart DX 7000. In addition, gait was assessed in 21 patients with knee osteoarthritis and in 30 healthy individuals. RESULTS: The study did not reveal differences between cruciate-retaining and posterior-substituting groups, both in terms of Knee Society Score and kinematic gait parameters. There were also no differences in kinematic gait parameters between patients from the knee osteoarthritis group and total knee arthroplasty groups. The analyzed parameters in all of the groups differed significantly from those found in healthy individuals. CONCLUSIONS: Surgical technique and implant design do not affect values of kinematic gait parameters evaluated under natural walking speed. Several months after surgery the patients still demonstrated alterations in gait pattern, similar to those recorded in patients with knee osteoarthritis.

The dependence between clinical condition and value of the maximum force in the quadriceps femoris muscle during MVC test in patients with knee osteoarthritis.

The aim of this study was to check whether there was a correlation between the value of the maximum developed torque of the quadriceps femoris muscle and subjective evaluation of a patient's pain which is measured by the VAS. Also evaluated were changes in the muscle torque value and KSS scale over time. For examining patient's condition use was made of a KSS scale (knee score: pain, range of motion, stability of joint and limb axis) before the surgery and in weeks 6 and 12, as well as 6 months after surgery. It was found to be constantly improving in comparison with the condition before the surgery. This is confirmed by a significant statistical value difference of KSS scale. The surgery substantially increases the quality of live and function recurrence.

CXCL8 and CCL5 expression in synovial fluid and blood serum in patients with osteoarthritis of the knee.

Chemokines proved able to induce release of enzymes relevant in cartilage damage. The present study addressed the levels of CXCL8 and CCL5 and the potential role of these chemokines in predicting the morphological changes in the course of osteoarthritis (OA). Synovial fluid (SF) and blood serum were obtained from 20 patients undergoing knee replacement surgery because of OA. For comparison, samples were also obtained from another 20 patients during diagnostic or therapeutic arthroscopy performed because of knee injury. The samples were analyzed for CXCL8 and CCL5 using enzyme-linked immunosorbent assay. SF from the group with OA showed significantly (p = 0.024) increased levels of CXCL8 when compared with the group after knee injury. We have not demonstrated any significant correlation between chemokine expression and clinical or radiological signs of OA. Mediators of inflammation are the potential predicting factors of OA, however, with respect to examined chemokines development of a diagnostic test can be limited by the low serum concentration and lack of correlation with clinical and radiological signs of the disease.

Retransfusion of shed blood collected in drains after Total Knee Replacement.

BACKGROUND: Total knee arthroplasty is associated with a perioperative blood loss, which is usually addressed with transfusion of allogenic blood. The possible risks of such treatment include viral infection, immunologic complications and occasional lack of blood products. Recently, retransfusion of blood recovered from the operative field or drains has become an effective treatment for blood loss. The purpose of this study was to evaluate the clinical usefulness of autologous transfusion of blood recovered from drains and to determine if the retransfusion alone is sufficient for treatment of the perioperative blood loss. MATERIALS AND METHODS: A retrospective evaluation of 214 patients (240 knees) was performed. Standard suction drains were used in 127 cases, whereas in 113 cases we used the HandyVac retransfusion system. The comparative analysis included the preoperative haemoglobin level, surgery time, length of hospitalisation, incidence of fever and demand for allogenic blood transfusion. RESULTS: Retransfusion of blood from drains decreased the incidence of allogenic transfusion from 69.3% to 43.4%. The global demand for blood products was reduced by 42%. The use of retransfusion kits did not increase surgery time. In the retransfusion group, the incidence of elevated body temperature and number of days with fever per one patient were higher than in the allogenic transfusion group. CONCLUSIONS: Retransfusion of shed blood from drains decreases the demand for allogenic blood. However, it does not eliminate the need for transfusion. The method is simple and relatively safe. It does not increase surgery time. No serious adverse effects were noted apart from elevated body temperature. A low preoperative haemoglobin level was a risk factor for additional allogenic transfusions in patients who have received retransfusion.

Bilateral neurogenic hip arthropathy. A case report.

Neurogenic arthropathy is a rare joint disorder, characterized by rapid progression and marked destruction of articular surfaces (known as Charcot's joint) with only mild to moderate pain. Most cases are related to diabetic neuropathy, but they may complicate the course of other neurogenic clinical conditions such as neurosyphilis (tabes dorsalis), syringomyelia, myelomeningocele, Peroneal Muscular Atrophy, spine or peripheral nerve injury, alcoholism and avitaminosis. Loss of superficial sensation and proprioception plays a pivotal role in development of arthropathy because it affects the joint's normal protective reflexes and leads to joint instability, degeneration and destruction. The authors describe an unusual case of bilateral neurogenic hip arthropathy in a 61-year old women who developed this condition in the course of multilevel lumbar spondylosis with spinal and nerve root compression. The patient underwent a successful bilateral hip replacement and remains almost asymptomatic contrary to literature reports that suggest high risk of complications after the operative treatment of Charcot's joints.

Cost analysis and sociomedical aspects of the conservative and surgical treatment of hip osteoarthritis.

INTRODUCTION: Hip osteoarthritis (OA) is one of the most common causes of pain, physical disability and marked impairment of patients' physical fitness and mobility. Insufficient funding for health care contributes to prolonged waiting times for total hip replacement (THR) surgery, which has been proven to be the only effective treatment for OA. Average waiting time in Poland is estimated at 2-2.5 years. Objective. To carry out a retrospective comparative analysis of the cost of THR surgery vs. conservative treatment for OA in a variety of sociomedical aspects while patients are awaiting THR. MATERIAL AND METHODS: Two groups of patients were compared. Group I consisted of 77 patients awaiting THR and treated with physical therapy and drugs. Group II consisted of 91 patients who underwent THR. Evaluations and comparisons were based on a modified WOMAC index, the SF-8 survey and estimates of pharmacological, procedural and orthopaedic equipment expenditures. RESULTS: Prolonged waiting times and the associated conservative treatment costs, including drugs, physical therapy, sanatorium, orthopaedic equipment, transport, sickness benefits and costs of pharmacological treatment of complications, were shown to be approximately twice higher compared to the cost of surgical treatment. Apart from financial costs, other significant aspects should also be noted, such as deterioration of the patient's life quality and psychosocial health, and prolonged anguish. CONCLUSIONS: Pharmacological treatment, rehabilitation, physical therapy and other methods appear to be inefficient in patients with hip OA awaiting THR and their costs are twice as high. Additionally, NSAID drugs produce GI ulcers in 25% of the patients. Psychosocial problems are also common for these patients. Surgical treatment produces a radical improvement of the quality of life and ameliorates psychosocial problems. Therefore, hip OA costs can only be reduced by shorter waiting times, which can be accomplished through an increase in funding resulting in wider access to the procedure.