The Coronal Alignment of Lower Limbs in the Adolescent Football and Ice Hockey Players.

Background: To investigate the influence of sport-specific activities on coronal axial alignment of the lower limbs in adolescent football and ice hockey players. Methods: This cross-sectional study targeted healthy adolescent male football and ice hockey players with at least 3 years of sports participation. 90 football and 38 ice hockey players aged 12-16 years were divided into five age-matched subgroups. Coronal alignment of the lower limbs was determined by measuring the players' intercondylar or intermalleolar (ICD-IMD) distance with a custom-made calliper. In addition, their sports history was recorded. An age-matched comparison between the two sports groups was performed using the two-way model ANOVA and a multiple regression model for ICD-IMD was constructed. Results were additionally compared with age-matched data from the general population published in recent literature. Results: A statistically significant increase in ICD-IMD values (p < 0.05) was found between 12 (football 0 mm; ice hockey - 64 mm) and 16 years (football 340 mm; ice hockey 310 mm) in both sports groups. Results of regression analysis of pooled group data showed that ICD-IMD has low positive correlation (r = 0.407; r2 = 0.168; p < 0.05) with time of participation in sport, but no association with age of athletes at the start of their sport participation (r = - 0.018; r2 = 0.000; p > 0.05). There were no statistically significant differences between the two groups at any time point. Both sports groups showed a significant increase in ICD-IMD values (mean 198 mm) after the age of 14 compared to the general population. Conclusions: Participation in football and ice hockey is associated with a similar increase in ICD-IMD in the adolescent years in male athletes. The observed increase was higher in both groups of athletes than in their peers who do not regularly participate in sports. Level of Evidence: Level 4 (case series).

Knee osteoarthritis in the former elite football players and the ordinary population: a comparative cross-sectional study.

A cross-sectional case-control study compared subjective knee function, quality of life and radiographic knee osteoarthritis (OA) between 45 former elite football players and an age-matched general male population. Participants completed the Knee OA Outcome Score (KOOS), a quality-of-life assessment (EQ-5D-3 L) and standing knee radiographs. Among the players, 24 (53%) sustained at least one moderate or severe knee injury, while 21 (47%) did not recall any injury. Players with previous knee injuries reported significantly lower knee-specific and general quality-of-life scores (KOOS 69; EQ-5D-3 L 0.69 (0.2)) compared to the non-injured players (KOOS 92; EQ-5D-3 L 0.81 (0.2)) or the control population (KOOS 90; EQ-5D-3 L 0.83 (0.2)). The injured knees had higher radiographic OA Kellgren-Lawrence (KL) scale grades 1.7 (1.3) than the knees of the non-injured players 0.8 (1.0) or the control knees 0.8 (1.0)Former elite football players who had previously sustained a moderate or severe knee injury reported inferior knee function and lower quality of life. Injured knees had higher levels of radiographic OA. Non-injured players reported similar knee and general function and their knees had similar grades of OA to those in the control group. The defining moment for long-term knee preservation in football should be injury prevention protocols.

Bilateral neck fracture in bimodular femoral stem after primary total hip arthroplasty: a case report.

BACKGROUND: Bi-modular stems were introduced in primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. Despite numerous reports on modular femoral neck fractures, some designs are still marketed worldwide. While the risk factors for the sudden failure are multifactorial and mostly known, the timing of this new THA complication is not predictable by any means. CASE PRESENTATION: In this report, the literature regarding one of the most popular bi-modular stems with specific neck-stem coupling (oval Morse taper) is reviewed and illustrated with a case of bilateral modular neck fracture in a patient with idiopathic aseptic necrosis of femoral heads treated with primary bi-modular THA. Because of bilateral modular femoral neck fracture, which occurred 3 years on the left side and 20 years after implantation on the right side, the patient required a total of 6 revisions and 208 days of hospitalized care. CONCLUSION: To our knowledge, this is the first report of bilateral modular neck fracture in a single patient. Even though the same surgeon performed both operations and used the same neck length and orientation, fractures occurred with a 17-year time difference after implantation. This shows that we cannot predict with certainty when a fracture might occur. Orthopaedic surgeons should use bi-modular stem designs for primary THA very cautiously.

Radiographic analysis of lower limb alignment in professional football players.

INTRODUCTION: To radiographically analyze lower limb alignment in adult asymptomatic professional football players and to correlate these values to clinical measurements. MATERIALS AND METHODS: Twenty-four asymptomatic players [24.2 (3.6) years] were enrolled. Standard bilateral lower limb anteroposterior weight-bearing radiographs were acquired and clinical measurement of intercondylar/intermalleolar (ICD/IMD) distance was performed. Coronal plane mechanical alignment was assessed by five angles: leg mechanical axis (LMA), lateral proximal femoral angle (LPFA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and lateral distal tibial angle (LDTA). Their values were compared to the reference values for adult population. An inter-individual comparison between right/left and dominant/non-dominant leg was added. The sum of bilateral LMA was correlated against ICD/IMD and against ICD/IMD adjusted for body height. RESULTS: Football players presented with ICD/IMD of 46.5 (19.8) mm. Two, out of five, lower leg coronal angles showed significant differences (p < 0.001) compared to reference data from literature: LMA 5.8 (3.0)º vs.1.2 (2.2)º and MPTA 83.5 (2.6)º vs. 87.2 (1.5)º. No significant differences between left/right leg and dominant/non-dominant leg were established. Summed up bilateral LMA showed a high correlation to IMD/ICD (r = 0.8395; R2 = 0.7048), and even higher to ICD/IMD adjusted for body height (r = 0.8543; R2 = 0.7298). CONCLUSIONS: This study was radiographically confirming increased varus of elite football players toward general population. Apex of the varus deformity was located in the proximal tibia. Clinical measurement of ICD/IMD adjusted for body height highly correlated with the radiographic values of coronal alignment; therefore, it may be used in population studies.

Lumbar and sacral pedicle screw placement using a template does not improve the midterm pain and disability outcome in comparison with free-hand method.

BACKGROUND: The free-hand technique carries a higher risk of pedicle weakening and neurovascular injuries in comparison with pedicle screw placement using a drill guide. Due to this evidence and because of some variances in the surgical method, different outcome can be expected. The objective of the study was to evaluate the disability, the back and leg pain before and at least 3 years after the surgery between examined groups. MATERIALS AND METHODS: Eleven patients in drill guide and 13 in control group were randomly assigned for vertebral fusion in the lumbar and first sacral regions. Pre- and post-operative CT scans, Oswestry disability index (ODI) and visual analogue scale (VAS) for back and leg pain were taken. Post-operative evaluations of cortex perforation and statistical analysis between studied groups have been performed. RESULTS: Seventy-two screws were inserted in each group. All patients completed a 3-year follow-up. Comparing groups, there was no statistical significant difference in VAS and ODI before or after surgery. Cortex perforation incidence in drill guide group was 6 and in free-hand group 29 (p < 0.05). In each group, pain and disability were significantly lower as before the procedure. CONCLUSIONS: The application of a drill guide template for pedicle screw placement is not more effective in reducing pain and disability after midterm follow-up in comparison with the free-hand technique. However, it reduces the cortex perforation incidence. Concerning this evidence, a drill guide is still an additional tool that could in the future potentially compete with other screw placement techniques.

Quantitative Evaluation of Growth Plates around the Knees of Adolescent Soccer Players by Diffusion-Weighted Magnetic Resonance Imaging.

PURPOSE: To quantitatively evaluate growth plates around the knees in adolescent soccer players utilizing the diffusion-weighted MR imaging (DWI). METHODS: The knees and adjacent growth plates of eleven 14-year-old male soccer players were evaluated by MRI before (end of season's summer break) and after two months of intense soccer training. MRI evaluation was conducted in coronal plane by PD-FSE and DWI. All images were screened for any major pathological changes. Later, central growth plate surface area (CGPSA) was measured and the apparent diffusion coefficient (ADC) values were calculated in two most central coronal slices divided into four regions: distal femur medial (DFM), distal femur lateral (DFL), proximal tibia medial (PTM), and proximal tibia lateral (PTL). RESULTS: No gross pathology was diagnosed on MRI. CGPSA was not significantly reduced: DFM 278 versus 272, DFL 265 versus 261, PTM 193 versus 192, and PTL 214 versus 210. ADC decrease was statistically significant only for PTM: DFM 1.27 versus 1.22, DFL 1.37 versus 1.34, PTM 1.13 versus 1.03 (p = 0.003), and PTL 1.28 versus 1.22. CONCLUSIONS: DWI measurements indicate increased cellularity in growth plates around knees in footballers most prominent in PTM after intense training. No detectable differences on a standard PD-FSE sequence were observed.

Porous tantalum shells and augments for acetabular cup revisions.

PURPOSE: The purpose of this study was to evaluate early functional results of revision hip arthroplasty with pelvic bone loss revised with porous tantalum (PT) acetabular components. METHODS: Twenty-five consecutive patients (25 hips) with loose acetabular components after total hip arthroplasty with a minimum of Paprosky IIa pelvic bone loss treated with PT cups with and without modular augments were retrospectively reviewed. Clinical outcomes were assessed using Harris hip score, and Western Ontario and McMaster Universities scores. Mean follow-up was 20.5 months and no patient was lost during follow-up. RESULTS: The average Harris hip score, and Western Ontario and McMaster Universities scores improved from 40 and 36 preoperatively to 79 and 73 postoperatively, respectively. No statistically significant differences in functional outcome scores were found between the group with moderate (Paprosky IIa, b) and severe (Paprosky IIc or more) acetabular bone loss. At the most recent radiographic evaluation, 24 cups demonstrated no lucent lines and 1 cup had lucent lines but remained well fixed. One cup was revised for traumatic dislocation but was found well fixed at open reduction. There were no septic or aseptic failures in this series. CONCLUSION: While awaiting longer-term follow-up studies, trabecular metal components show sufficient primary stability and appear suitable for revision hip arthroplasty with acetabular bone loss.

Increased risk of knee injuries and osteoarthritis in the non-dominant leg of former professional football players.

The aim of the study was to evaluate differences in knee injuries and osteoarthritis between the dominant and non-dominant legs of former professional football players. The study cohort comprised 40 retired professional players with an average age of 49.2 years. Participants completed a questionnaire about their sports and personal history with special emphasis on knee injuries/operations of the dominant and non-dominant leg. Bilateral standing knee radiographs were taken. Overall, 29 footballers (73%) had experienced at least one moderate or severe knee injury and 18 (40%) had undergone at least one knee operation during their career. Among those injured, 14 (35%) players had suffered a dominant knee injury and 22 (55%) a non-dominant knee injury. Evidence of osteoarthritis (Kellgren-Lawrence scale > or = 2) was found in 17 (43%) dominant and 23 (58%) non-dominant knees. Professional football players have a significant risk of knee injuries and early osteoarthritis with preponderance in the non-dominant leg.

The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study.

BACKGROUND: Arthroscopic reconstruction is a standard surgical procedure in cases of symptomatic knee instability due to rupture of the anterior cruciate ligament. Bone-tendon-bone and hamstring tendon grafts are both in use for anterior cruciate ligament reconstruction. There are no significant differences between the two types of graft in relation to function scores, but there is a difference in anteroposterior stability when measured on the KT-2000 arthrometer: knee joints after reconstruction with bone-tendon-bone autografts are more stable than those reconstructed with hamstring tendon autografts. PURPOSE: To improve knee stability after anterior cruciate ligament reconstruction with a hamstring graft and use of platelet-derived growth factors. BASIC PROCEDURE: Platelet-leukocyte gel was produced from platelet-leukocyte-rich plasma prepared from a unit of whole blood in an autologous platelet separator. The gel was applied locally, after hamstring graft placement. Fifty patients were included in the study: 25 in the platelet gel group, 25 in a control group. We evaluated anteroposterior knee stability with the KT-2000 arthrometer before surgery and at 3 and 6 months after surgery. MAIN FINDINGS: Patients treated with the gel demonstrated significantly better anteroposterior knee stability than patients in the control group. The calculated improvements in knee stability at 6 months were 1.3 +/- 1.8 mm in the control group and 3.1 +/- 2.5 mm in the platelet gel group (P = 0.011). PRINCIPAL CONCLUSION: Platelet-leukocyte gel, applied locally, can improve knee stability in surgery for reconstruction of the anterior cruciate ligament.