Patellar tendon rupture--treatment results.

INTRODUCTION: Patellar tendon rupture is a rare injury which, if missed, leads to delayed surgical treatment and may result in the loss of the knee joint function. The aim of this study was to report our results of operative treatment of the patellar tendon rupture and point out the significance of timely diagnosis and surgical procedure. MATERIAL AND METHODS: This retrospective ten-year study included 20 patients, 15 males and 5 females, their mean age being 42 (20-84) years. Seven participants had an injury on the right side and 13 had an injury on the left side. Thirteen participants had the diagnosis set in the first seven days after the injury. The applied techniques were surgical suture of the tendon, bone-tendon-bone ligamentoplasty using allograft from a bone bank and bone-tendon-bone ligamentoplasty using contralateral autograft, and they were performed in 12, 5 and 3 patients, respectively. The treatment results were assessed by using the Lysholm score, measuring the range of movement in the knee joint and measuring the girth of the thigh 10 cm above the patella. RESULTS: The follow-up period after the surgery was 4 years on average (1-10 years) and the average value of the Lysholm score was 83 (27-100). The result was found to be excellent in 11 cases, satisfactory in 5 cases and unsatisfactory in 4. A statistically significant difference (p=0.0197 p<0.05) was found in the average values of the Lysholm score between the group of patients with risk factors (71.78) and the subjects without risk factors (92.18). A statistically significant difference (p=0.008 p<0.01) was found in the Lysholm score between the patients with timely diagnosis (91.62) and cases of chronic tendon tear (67). CONCLUSION: Timely diagnosis and early surgical reparation are the basic imperatives in the treatment of this injury. Comorbidity and risk factors are related to a poorer postoperative Lysholm score. The method of choice is early surgical treatment.

Magnetic resonance imaging comparison of lateral collateral ligament and patellar tendon length.

INTRODUCTION: The problem of using patellar tendon auto or allografts for lateral collateral ligament reconstruction results in the occurrence of ligaments mismatch. The length of patellar tendon does not match the lateral collateral ligament. MATERIAL AND METHODS: Out of 151 patients, who formed the study, 102 were men with the mean age of 30 years (18-54) and 49 women, with the mean age of 34 (18-55), and they all underwent magnetic resonance imaging of the knee. Both patellar tendon and lateral collateral ligament were measured using a three-dimensional isovoxel true-fast-imaging with steady-state precession sequence with water excitation and secondary multiplanar reformations. In order to visualize the lateral collateral ligament insertions precisely, sagittal images were reformatted according to the anatomical, oblique ligament position, in anteriorly tilted, paracoronal plane. The length of the patellar tendon was measured from the patellar apex to the tibial tuberosity insertion site. RESULTS: The mean patellar tendon length was 52.88 +/- 7.56 mm (37-75) with a significant difference between men and women. The mean lateral collateral ligament length was 61.21 +/- 5.77 mm (46-80) with a significant difference between genders. The average differences between lateral collateral ligament and patellar tendon length was 8.38 +/- 7.23 mm (-9 to 26) without a significant difference between the genders. In 18 (11.92%) patients, the patellar tendon was longer than the lateral collateral ligament; in 7 patients (4.63%) they were equal; and in 126 patients (83.44%) the patellar tendon was shorter than the lateral collateral ligament. CONCLUSION: The length of patellar tendon does not match the length of lateral collateral ligament. If patellar tendon auto or allograft is used for lateral collateral ligament reconstruction, the lengths of both ligaments must be determined preoperatively in order to avoid intraoperative complications.

Surgical treatment of shoulder rotator cuff injuries.

INTRODUCTION: The rotator cuff is the most important functional structure of the shoulder. The aim of this study was to determine which factors contribute to a rotator cuff injury and to evaluate the results of the surgical treatment at the Department of Orthopedic Surgery and Traumatology in Novi Sad since December 2009 until May 2012. MATERIAL AND METHODS: The study sample consisted of 20 patients who had been operated for a shoulder rotator cuff injury. Their mean age was 56.8 +/- 9.1. RESULTS: According to the Constant Shoulder Score, 75% of the patients had excellent and good results. A statistically significant difference (p < 0.05) was found between Constant Shoulder Score of the operated should and the opposite shoulder as well as between the range of external and internal rotation and abduction. After the surgical treatment, 95% of the patients have no limitations in the activities of daily living and they are satisfied with the results of treatment. CONCLUSION: Surgical treatment of a shoulder rotator cuff injury is reliable, time-tested and provides good clinical results especially in patients who were operated within the first three weeks after the injury.

Fracture of the patella after the anterior cruciate ligament reconstruction.

INTRODUCTION: Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. MATERIAL AND METHODS: We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. RESULTS: The patients were invited for the check-up 5 years (2-8 years) after surgery on average. The mean Lysholm score was 92 (85-100). All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months). In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. DISCUSSION AND CONCLUSION: The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.

[Hormone replacement therapy and cardiovascular risk in postmenopausal women].

Five years after the menopause, we can see the increase in cardiovascular risk due to prolonged deficiency of ovarian hormones. These risks are the same or even more severe than those in men within the same age group. The basic influence of normalizes those disturbances. In 2002. published data from a WHI study show an increase in cardiovascular risk during the first year of hormone replacement therapy with no protective effect. The most recent published data from WHI study show positive effects of hormone replacement therapy, within postmenopausal women younger than 65 years. Those women had significantly reduced calcifications on coronary vessels The American Association of Clinical Endocrinologists and the estrogens can be genomic and non genomic. Estrogens influence endothelia and smooth muscle wall of arterial blood vessels, metabolism of lipoproteins and induce the metabolic syndrome. Hormone replacement therapy partially or completely International Menopause Society proclaim that the hormone replacement therapy can prevent cardiovascular diseases and slow down the progress of atherosclerosis. The aim of ongoing KEEPS is to investigate the preventive effect of the hormone replacement therapy on blood vessels, in early postmenopausal period (women younger than 60 year). This study should be valid enough to define new clinical knowledge about the hormone replacement therapy and cardiovascular risk.