Assessing long-term return to play after hip arthroscopy in football players evaluating risk factors for good prognosis.

PURPOSE: Groin pain is the third most common disease in football players and has often been associated with hip pathology such as femoroacetabular impingement and labral lesions. Hip arthroscopy offers possibilities of function restoration via minimally invasive procedures. The aim of this study is to evaluate professional football player's injuries and their return to play after hip arthroscopy for FAI and labral injuries. METHODS: Patients that underwent hip arthroscopy between 2009 and 2014 were selected retrospectively. From this population, only professional soccer players competing at national level were included (Tegner 10). Arthroscopic surgery was proposed in patients with persistent pain. All patients were assessed for VAS score preoperatively and at 3, 6, 12 and 24 months post-op. HOS (sport and DLA) and mHHS tests were performed at the same time periods. RESULTS: All patients were men with a mean age of 26.5 ± 7.1 years old. Preoperative VAS (7.4 ± 1.3), HOS ADL (67.7 ± 5.5), HOS sport (37.6 ± 18.7) and mHHS (72.5 ± 8.8) showed improved scores during long-term follow-up. Time to return to play was 10.8 months (SD ± 4.3), with range between 4 and 20 months. Mean follow-up was 45.4 ± 15.6 months (range from 26 to 72 months). No differences were observed between non-active and active patients at final follow-up with respect to chondral lesions, but significant differences were observed with reference to management of the labrum (p = 0.031), where a higher rate of labrectomies existed among inactive patients and a higher rate of suture among active patients. CONCLUSIONS: Hip arthroscopy is a safe procedure with very good return to play results, but for optimized return to football one should consider patient age at the time of surgery, the condition of the labrum and low scores on the Harris Hip Score (mHHS) and HOS (sport version) as predictive factors for poor prognosis. Level of evidence IV.

Osteocartilaginous lesions of the talus in soccer players.

OBJECTIVE: The objective of this study is to describe the results of arthroscopic debridement for talar lesions in a population of soccer players. PATIENTS: Patients were sixteen soccer players with osteochondral talar lesions, treated surgically between 1999 and 2004. INTERVENTIONS: All patients were diagnosed clinically. Complementary imaging studies included X-ray, scintigraphy, and magnetic resonance imaging. All patients underwent arthroscopic debridement. MAIN OUTCOME MEASUREMENTS: At 3.56 years of follow up, patient status was assessed using a visual analog scale (VAS) and the Ogilvie-Harris scale. The mean time to return to sports at the same level as that before the start of symptoms was evaluated. RESULTS: The Ogilvie-Harris score showed 81.75% excellent results and 18.25% good results. The VAS score was 0.26 (0-2.2). Among the total, 93.75% of patients resumed sports activities at the same level as that before surgery. CONCLUSIONS: Arthroscopic debridement of talar osteochondral lesions in soccer players provides excellent results. We consider this option the treatment of choice in this population.

Alpine infrastructure in Central Europe: integral evaluation of wastewater treatment systems at mountain refuges.

Planning, construction and operation of onsite wastewater treatment systems at mountain refuges is a challenge. Energy supply, costly transport, limited water resources, unfavourable climate and load variations are only some of the problems that have to be faced. Additionally, legal regulations are different between and even within countries of the Alps. To ensure sustainability, integrated management of the alpine infrastructure management is needed. The energy and water supply and the wastewater and waste disposal systems and the cross-relations between them were analysed for 100 mountain refuges. Wastewater treatment is a main part of the overall 'mountain refuge' system. The data survey and first analyses showed the complex interaction of the wastewater treatment with the other infrastructure. Main criteria for reliable and efficient operation are training, technical support, user friendly control and a relatively simple system set up. Wastewater temperature, alkalinity consumption and high peak loads have to be considered in the planning process. The availability of power in terms of duration and connexion is decisive for the choice of the system. Further, frequency fluctuations may lead to damages to the installed aerators. The type of water source and the type of sanitary equipment influence the wastewater quantity and quality. Biosolids are treated and disposed separately or together with primary or secondary sludge from wastewater treatment dependent on the legal requirements.

Fracaso de la cirugía del LCA / Failure of anterior cruciate ligament surgery

El objetivo es clasificar y describir la etiología multifactorial para considerar como fallo la cirugía del ligamento cruzado anterior (LCA), ayudar a prevenirlo y a resolverlo, centrándonos sobre todo en aquellas etiologías que obligan al recambio del LCA por inestabilidad recurrente, sin olvidarnos de las que afectan a la función o son motivo de dolor persistente. A menudo se puede identificar una causa primaria o secundaria del fracaso de una cirugía de LCA e incluso con el plan más meticuloso, podemos encontrar hallazgos no anticipados durante la intervención por lo que nuestro protocolo debe ser lo suficientemente flexible para acomodarse al desarrollo de la cirugía. Es crucial aconsejar al paciente preoperatoriamente y limitar sus expectativas acerca de los resultados sobre la cirugía dada la complejidad de este procedimiento. Con una planificación preoperatoria apropiada, intensa atención a los detalles y ajuste apropiado de las expectativas del paciente, la cirugía de revisión del LCA puede suponer un beneficioso y satisfactorio resultado para el paciente (AU)

The present study classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, with a view to preventing and resolving such situations. The study particularly focuses on those causes that require ACL replacement due to recurrent instability, without neglecting those that affect function or produce persistent pain. It is often possible to identify a primary or secondary cause of ACL surgery failure, and even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol therefore should be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential, limiting his or her expectations as to the results of surgery, in view of the complexity of this kind of procedure. With adequate preoperative planning, close attention to details, and appropriate definition of the patient expectations ACL revision surgery may offer beneficial and satisfactory results for the patient (AU)

Operative treatment of combined anterior and posterior cruciate ligament injuries in complex knee trauma: can the cruciate ligaments be preserved?

A retrospective study was performed focusing on operative treatment after combined anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) injuries. The operative treatment included the preservation of one or both cruciate ligaments. Twenty-eight patients, average age 30 years (range: 12-55 years), were evaluated 5.4 years (range: 1-14 years) postoperatively. Twenty-two operations were performed in patients with acute injuries (<30 days after trauma) and 6 operations in patients with chronic instabilities (>30 days after trauma). Both cruciate ligaments were preserved by suture or refixation in 16 patients. Suture of one and reconstruction of the other cruciate ligament with autologous tendon graft was performed in 12 cases. In addition, 61 procedures (meniscal suture/resection, medial/lateral reconstruction, tendon suture, and open reduction and internal fixation were performed. Postoperative treatment included continuous passive motion and protected weight bearing. Eleven (27% acute, 83% chronic) patients required revision (ACL/PCL reconstruction, osteotomy, and meniscal repair). At follow-up, 43% of the patients were very satisfied and 46% were satisfied. Seventy-one percent (89% preinjury) of the patients were able to maintain intensive and moderate International Knee Documentation Committee (IKDC) activity levels. The IKDC evaluation of the patients (acute %/chronic cases %) was graded for symptoms: A 39% (45/17), B 35% (27/67), C 15% (18/0), and D 11% (9/17); for range of motion: A 42% (36/67), B 42% (50/17), C 16% (14/17), and D 0%; and for ligaments: A 21% (18/17), B 33% (45/0), C 42% (32/83), and D 4% (5/0). Radiographic findings were A 18%, B 41%, and C 41%. Primary repair of acute injuries was superior to the delayed repair of chronic instabilities. Preservation of cruciate ligaments in acute combined ACL/PCL tears results in a satisfying knee function despite distinct residual ligament instability. Although suture of the cruciate ligaments in open technique is a therapeutic option in acute multiligamentous knee injuries, it is not recommended for the treatment of chronic instabilities.

Renal tolerance of fleroxacin in healthy volunteers.

In order to evaluate kidney tolerance of fleroxacin, a new fluoroquinolone, we performed a volunteer study with 16 healthy males, 20-27 years old. On three consecutive days 800 mg of fleroxacin was administered orally. Alanine-aminopeptidase and distal- and pan-tubular antigens were determined in 24 h urine collections with specific monoclonal antibodies. Routine haematological and biochemical parameters were determined daily and were in the normal range during the follow-up. No significant changes in excretion of alanine-aminopeptidase and of the urinary antigens were observed during the three days of fleroxacin administration and on the following three days. The results obtained in this volunteer study indicate that fleroxacin has no nephrotoxic side effects.