Functional and magnetic resonance imaging outcome after polyurethane meniscal scaffold implantation following partial meniscectomy.

PURPOSE: Prevention of the knee osteoarthritis following meniscectomy is implantation of an allotransplant or an artificial meniscus. We present retrospective study of our early results of the treatment using polyurethane meniscal scaffold. METHODS: From 2016 to 2020, we implanted nine polyurethane scaffolds (Actifit) after partial meniscectomy, five males and four females, age 36 (16-47), BMI 26.7 (17.2-35.9) kg/m2. Functional status, activity, pain, and MRI were assessed. RESULTS: FU 20.8 (6-48.5) months, 35.2 (0-68) months from the meniscectomy to the implantation. The average implant length was 46.1 (35-60) mm, average number of sutures was 7.6 (5-10). Lysholm score before surgery was 61.7 (49-85), after the surgery 86.4 (62-95) with p 0.0045, Tegner activity score before meniscectomy was 5.8 (4-7), after 3.8 (2-5), and after the scaffold implantation 4.6 (3-7) with p 0.0488. Before surgery, VAS score was 3.1 (2-4), and after 7.7 (5-9) with p 0.0042. Pursuant to the Genovese classification, the last follow-up MRI showed a type 2 meniscal morphology in four cases and a type 3 in five cases. Seven patients had type 1 and two had type 2 signal intensity. On average, the absolute extrusion of a transplanted meniscus was 3.67 mm, and the relative extrusion was 0.58 mm. Extrusion progress was not detected. CONCLUSION: Significantly improved knee functionality, increased level of physical activity, and reduced pain. MRI analysis revealed the meniscal transplant morphology and volume loss, as well as its extrusion without progression.

TIBIAL TUBERCLE AVULSION FRACTURE IN A MALE ADOLESCENT.

Tibial tuberosity fractures are rare in childhood, most frequently due to excessive quadriceps muscle contraction. On performing long jump, a 15-year-old boy sustained tibial tuberosity avulsion fracture type II according to Watson-Jones. The patient was treated operatively with fragment repositioning and screw fixation. Ten months after the injury and rehabilitation, he resumed his sports activities with full range knee motion.

[Pelvic discontinuity in revision total hip arthroplasty--case report]. / Zdjelicni diskontinuitet u revizijskoj artroplastici kuka--prikaz bolesnika.

Revision total hip arthroplasty with massive bone loss and pelivic discontinuity has no standardized treatment up until now. This report presents a case of a female patient with a diagnosed pelvic discontinuity 4 years after the previous hip arthroplasty. The patient is suffering from rheumatoid arthritis, and was admitted to hospital treatment for hip pain, leg shortening, limitated range of motion and the inability to walk. Pelvic discontinuity was identified in preoperative radiographs of the pelvic and hip region, and intraoperatively it was determined that it was a type IV b discontinuity according classifications for acetabular defects defined by AAOS, and subclassification of type IV according Berry et al., that is discontinuity associated with cavitary and segmental acetatabular bone loss. In the goal of achieveing a stable construction, as a vital prerequisite for achieving bone consolidation, an osteosynthesis of the posterior column was done with a reconstructive plate by A.O. method, and afterwards the defect was filed with bone transplants from the bone transplant bank. An adequate revision cementless cup was installed, and screws were used to achieve a good fixation of the bigger modeled bone transplants and the fixation of the cup for the remainder of the pelvis. By that method a good inicial stability of construction was achieved. In the goal of achieving bone ingrowth and avoidance of mechanical failure it was advised an avoidance of weight bearing in the period of 3-6 months after the operation. With the method of reconstruction we applied after 2 years of follow-up the cinical result was satisfactory, and radiologicaly there are no signs of construction loosening so it can be claimed that the discontinuity was cured.

Arthroscopic decompression of suprapatellar cyst: case report.

Bursae around the knee reduce friction between moving structures. When involution of suprapatellar septum fails to occur ("complete septum"), then suprapatellar bursa may stay completely separated from the knee joint cavity to form a cystic cavity. In the case of the increased volume, suprapatellar bursitis can cause painful suprapatellar swelling. The aim is to point to the possibility of arthroscopic decompression of suprapatellar cyst. In the case presented, the indication for knee arthroscopy was based on clinical examination, ultrasonography and magnetic resonance studies. The preoperative diagnosis was verified intra-operatively, and intra-articular cyst decompression was performed by arthroscopy. At the final examination 8 months postoperatively, the patient still had no pain, swelling and had full range of motion. This minimally invasive operative procedure resulted in a satisfactory anatomic and functional outcome. In this case report, we present a patient with suprapatellar cyst submitted to arthroscopic cyst decompression.

[Osteochondral fracture of the patella after acute dislocation]. / Kostano-hrskavicni prijelom ivera kao posljedica akutne luksacije.

Acute patellar dislocation is a common injury in young athletes, which occurs due to inappropriate biomechanical relations and anatomic deviations in the area of knee joint. In these unfavorable conditions, abrupt and vigorous strain of the quadriceps muscle of the thigh may result in lateral patellar dislocation. A case is presented of a young male athlete with acute patellar dislocation and consequential osteochondral fracture. Although x-ray showed normal knee finding, typical history, clinical examination and magnetic resonance image of the knee indicated arthroscopy, which confirmed the diagnosis ofpatellar dislocation. The osteochondral fragment was found and fastened by screws, thus reconstructing the articular surface of the patella. Medial patellar stabilizers were strengthened and lateral stabilizers loosened, thus re-establishing its anatomic slide way. On second-look operation, the screws were removed. In this case, good anatomic and functional outcome was achieved by timely operative treatment, joint surface reconstruction and rehabilitation.

Value of ß2-microglobulin in the serum of healthy subjects older than 40 years.

The aim of this research was to determine if the age of healthy subjects older than 40 years of age has an influence on the concentration of ß(2) -microglobulin in the serum of subjects of different populations. We examined the values of ß(2) -microglobulin in the serum of 51 healthy subjects aged 40-86 years using the microparticle enzyme immunoassay AxSYM ß(2) -microglobulin test. The reference values of ß(2) -microglobulin according to the nonparametric statistical method is 0.95-2.73 mg/L. A correlation was found between ß(2) -microglobulin and age: 40-50 years (0.94-1.54 mg/L), 51-65 years (0.96-2.62 mg/L), and >65 years (1.13-2.84 mg/L). There was no significant statistical difference of ß(2) -microglobulin between genders (P > 0.05); however, there was a statistically significant difference between the concentration of ß(2) -microglobulin and the subjects' age. (Spearman's rank correlation coefficient ρ = 0.66; P < 0.01). A direct correlation between age and the concentration of ß(2) -microglobulin was observed. This research is a contribution to determining reference values of ß(2) -microglobulin in subjects of different populations.

A case report of spontaneous concurrent bilateral rupture of the quadriceps tendons in a patient with chronic renal failure.

In patients with chronic renal failure, many complications may develop that involve all organ systems, especially the locomotor system. Spontaneous concurrent bilateral rupture of the quadriceps tendons is a very rare complication in patients with chronic renal failure, usually occurring in patients under 50 years of age. Although there are numerous causes that lead to tendon weakness and rupture, most authors agree that secondary hyperparathyroidism plays a major role in the pathogenesis of tendon rupture. Soft tissue and perivascular calcifications, diminished local circulation, reduced tendon elasticity, impaired collagen metabolism, nerve lesions, repeated trauma, and articular swelling contribute to tendon weakness and rupture. A patient is presented in whom spontaneous concurrent bilateral quadriceps tendon rupture occurred at the age of 34, after seven years of hemodialysis therapy. Timely diagnosis and operative management with primary tendon suturing followed by physiotherapy produced a good anatomical and functional result.

Large suprapatellar synovial cyst in a 12-year-old girl: arthroscopic decompression.

In this study, we present a case of a very rare and large suprapatellar synovial cyst of the knee, which was successfully treated with an arthroscopic intra-articular decompression. Suprapatellar bursa is located between the femur and quadriceps tendon, proximal to the knee joint, and it normally communicates with a joint cavity. However, very rarely bursa can remain completely separated from the knee joint, which can result in the formation of a separated compartment inside which, in special circumstances, fluids can be accumulated and with time can lead to the formation of suprapatellar cyst. Although certain authors use ultrasound, arthrography and computerized tomography, MRI is recognized as the 'gold standard' in diagnostics of knee cysts. When considering ways of treatment, according to the available literature, suprapatellar cysts are treated mostly by an open excision, whereas in our case we managed to show that cysts could also be effectively and safely treated by arthroscopic decompression, with no recurrence and followed by fast and functional recovery.

[Posterior horn cyst of the medial meniscus]. / Cista straznjeg roga medijalnog meniskusa.

We will present a rare case of a large symptomatic cyst of the medial meniscus, conjoined with a horizontal tear of a posterior meniscal horn. After clinical, radiological and ultrasound examination, a diagnosis was confirmed with MRI examination of the knee. Literature supports surgical therapy, which includes complete arthroscopic technique, meniscectomy and decompression of the cyst. In our case, it showed that arthroscopic partial meniscectomy and opened cystectomy were the efficient way of treatment.