A 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries.

OBJECTIVE: The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. DESIGN: A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms' duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). RESULTS: The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients' age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. CONCLUSIONS: Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.

Biceps Tenodesis versus Tenotomy with Fast Rehabilitation Protocol-A Functional Perspective in Chronic Tendinopathy.

The study aimed to evaluate the results after arthroscopic tenodesis and tenotomy of the biceps tendon (LHBT), coupled in tenotomy modality with a personalized postoperative rehabilitation protocol. The study included patients who underwent arthroscopic biceps tenotomy or tenodesis due to chronic biceps tendinopathy. Postoperatively, a standard rehabilitation program was prescribed to the tenodesis group and personalized was introduced in the tenotomy group, respectively. The outcomes were assessed using the American Shoulder and Elbow Surgeons scale (ASES), clinical tests that are dedicated to biceps tendinopathy, the occurrence of a Popeye deformity, night pain, and return to previous sporting activities. A cohort of 67 patients was enrolled in the final follow-up examination (mean 27 months) of which 40 patients underwent tenotomy (60%), and 27 patients (40%) underwent tenodesis. The mean ASES score improved from 48.1 to 87.8 in the tenotomy group and from 44 to 72.7 in the tenodesis group during the follow-up (p < 0.0001). The tenotomy group had better mean postoperative ASES scores than the tenodesis group (p < 0.0001). Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128). Moreover, the frequency of night pain decreased in the tenotomy group (p = 0.0059). Return to previous sporting activities was more frequent in the tenotomy group (p = 0.0090). Arthroscopic biceps tenotomy is a reproducible, simple procedure, and augmented by a rapid rehabilitation protocol that provides promising clinical outcomes, reduces shoulder pain, and allows the patient to return to previous sporting activities, even in population older than 50 years.

The effectiveness of lumbar extensor training: local stabilization or dynamic strengthening exercises. A review of literature.

BACKGROUND: Deconditioning of the lumbar extensor musculature (lumbar erector spinae and multifidus) is a risk factor for low back injury and pain. The article presents various aspects of scientific reports which confirm the effectiveness of lumbar extensor exercises. MATERIAL AND METHODS: The articles to be reviewed were extracted from the MedLine and PubMed data - bases. The following key words were used as search terms: lumbar multifidus muscle exercises, low back global exercise, motor control exercise in chronic low back pain, low back stabilization exercise. RESULTS: A number of prior investigations have described lumbar multifidus atrophy and replacement by fat after low back injury. Restoration of the tonic activity of the multifidus muscle is an essential condition in regaining health and spine functions. On the other hand, conditioning and strengthening exercises are considered valuable in effectively 'pre-habilitating' and reducing injury risk for athletes. CONCLUSIONS: 1. The lumbar low load specific stabilization exercises would be more efficient than muscle strengthening in the improvement of chronic low back pain. 2. Conditioning and strengthening exercises are considered valuable in effectively 'pre-habilitating' and reducing injury risk for athletes.