Relationship between the hip range of motion and functional motor system movement patterns in football players.

BACKGROUND: The aim of this study was to determine the hip range of motion and the movement patterns of football players assessed with an aid of a Functional Motor Systems test, and to find an association between these parameters and the risk for hip joint injury. METHODS: The study included 50 men aged between 16 and 20 years: 25 footballers and 25 age- and body mass index-matched controls. The hip ranges of motion (flexion, extension, internal and external rotation, adduction and abduction) were determined, and the movement patterns were evaluated with the tests from the Functional Motor Systems battery. RESULTS: Football players presented with significantly higher ranges of the hip flexion, extension, internal and external rotation than the controls. Moreover, footballers and controls differed significantly in terms of their mean overall Functional Motor Systems scores (15.77 points ±2.44 vs. 13.79±3.02 points, P=0.019). Football players scored best on the shoulder mobility test for the right side and worst on the rotary stability test for the left side. The scores on the trunk stability test and rotary stability test for the left side were significantly higher in footballers than in the controls. Nevertheless, the overall Functional Motor Systems scores of 14 points or less were recorded in the case of as many as 10/25 footballers. CONCLUSIONS: Altogether, these findings suggest that some football players present with a strain which may predispose them to future injuries. Future research should center around the etiology of reduced hip ROM observed in footballers. Furthermore, football training seems to result in a considerable motor asymmetry of the trunk which also predisposes to injury.

Activity and Quality of Life after Total Hip Arthroplasty.

BACKGROUND: Coxarthrosis is a chronic musculoskeletal condition that causes severe pain and considerable limi-tation of the patient's motor performance. Total hip arthroplasty is one of the most common and effective methods used in the treatment of advanced degenerative changes. The aim of the present study was to evaluate the activity and quality of life of patients after unilateral total hip arthroplasty. MATERIAL AND METHODS: The study was conducted in a group of 189 patients who had undergone unilateral total hip arthroplasty. Goniometry was used to determine the range of motion of both hip joints. Patients' physical ability and pain severity were assessed based on the Harris Hip Score (HHS) questionnaire. RESULTS: The examination of the range of motion in the lower extremities revealed statistically significant diffe-rences in flexion (p<0.01), abduction (p=<0.01), adduction (p<0.01) and external rotation (p<0.01) between the operated and the healthy extremity. The greatest limitation of motion was demonstrated for external rotation (<14°). Approximately 14% of the patients were not able to perform this motion in their healthy hip joint, while 17.5% of them could not do so in the affected hip joint. Analysis of HHS results (mean = 79 pts) revealed that more than 50% of the patients described their functional ability and quality of life as good and excellent. It was demonstrated that 54% of patients did not suffer from pain, whereas minor or mild pain was noted in 35%. CONCLUSIONS: 1. A subjective clinical assessment of patients after total hip arthroplasty showed that their quality of life had improved. 2. It is necessary to perform physiotherapy after total hip arthroplasty, on both the operated and healthy side. 3. Exacerbation of pain and impaired activity in patients after total hip arthroplasty were associated with the female sex to a considerable extent.

The role of vasculature in bone development, regeneration and proper systemic functioning.

Bone is a richly vascularized connective tissue. As the main source of oxygen, nutrients, hormones, neurotransmitters and growth factors delivered to the bone cells, vasculature is indispensable for appropriate bone development, regeneration and remodeling. Bone vasculature also orchestrates the process of hematopoiesis. Blood supply to the skeletal system is provided by the networks of arteries and arterioles, having distinct molecular characteristics and localizations within the bone structures. Blood vessels of the bone develop through the process of angiogenesis, taking place through different, bone-specific mechanisms. Impaired functioning of the bone blood vessels may be associated with the occurrence of some skeletal and systemic diseases, i.e., osteonecrosis, osteoporosis, atherosclerosis or diabetes mellitus. When a disease or trauma-related large bone defects appear, bone grafting or bone tissue engineering-based strategies are required. However, a successful bone regeneration in both approaches largely depends on a proper blood supply. In this paper, we review the most recent data on the functions, molecular characteristics and significance of the bone blood vessels, with a particular emphasis on the role of angiogenesis and blood vessel functioning in bone development and regeneration, as well as the consequences of its impairment in the course of different skeletal and systemic diseases.

Bone remodeling in the context of cellular and systemic regulation: the role of osteocytes and the nervous system.

Bone is a dynamic tissue that undergoes constant remodeling. The appropriate course of this process determines development and regeneration of the skeleton. Tight molecular control of bone remodeling is vital for the maintenance of appropriate physiology and microarchitecture of the bone, providing homeostasis, also at the systemic level. The process of remodeling is regulated by a rich innervation of the skeleton, being the source of various growth factors, neurotransmitters, and hormones regulating function of the bone. Although the course of bone remodeling at the cellular level is mainly associated with the activity of osteoclasts and osteoblasts, recently also osteocytes have gained a growing interest as the principal regulators of bone turnover. Osteocytes play a significant role in the regulation of osteogenesis, releasing sclerostin (SOST), an inhibitor of bone formation. The process of bone turnover, especially osteogenesis, is also modulated by extra-skeletal molecules. Proliferation and differentiation of osteoblasts are promoted by the brain-derived serotonin and hypothetically inhibited by its intestinal equivalent. The activity of SOST and serotonin is either directly or indirectly associated with the canonical Wnt/ß-catenin signaling pathway, the main regulatory pathway of osteoblasts function. The impairment of bone remodeling may lead to many skeletal diseases, such as high bone mass syndrome or osteoporosis. In this paper, we review the most recent data on the cellular and molecular mechanisms of bone remodeling control, with particular emphasis on the role of osteocytes and the nervous system in this process.

Kinetic and kinematic characteristics of natural velocity gait in anterior cruciate ligament-deficient patients.

This study evaluates changes in the knee following anterior cruciate ligament (ACL) injuries by presenting the kinematic characteristics of the ankle and hip joints and the pelvis, and assessing the dynamic forces applied by knee joint muscles under isokinetic conditions to identify compensatory mechanisms. Seventeen ACL-deficient males, 16-47 years of age, participated in the study, and measurements were taken an average of 24.4 months after their injuries occurred. Vicon, a three-dimensional motion analysis system, was used to examine the participants' locomotive characteristics. Isokinetic tests were carried out using Easytech Genu 3 at two velocities 60 and 180°/s. We found that deviations from normal gait were most common in the ACL-deficient knee, and that there was also a noticeable impact on the functioning of other joints in the same limb. However, even chronic knee joint laxity did not result in a considerable change in a participant's gait stereotype. Measurements showed a reduction in muscular strength in knee joint extensors and flexors in isokinetic contraction in the developed joint moments of the muscle groups under research compared with the healthy limb.

Treatment of reverse obliquity intertrochanteric fractures.

BACKGROUND: Unstable intertrochanteric fractures of the hip, especially reverse oblique fractures are a serious problem in traumatology, as there is no standard method of treatment and inadequate treatment carries a significant complication rate. To assess the surgical treatment results of reverse oblique trochanteric fractures. MATERIAL/METHODS: Between 1997-2010, 389 patients with intertrochanteric fractures were treated. 28 (7.1%) of these fractures classified as reverse oblique. This group of patients consisted of 10 men and 18 women, aged 24 to 98 years. All patients underwent surgery. Following treatment options were used; dynamic hip screw (DHS)--10 patients, proximal femoral nail (PFN)--13 patients, dynamic condylar screw (DCS)--2 patients, angular plate--4 patients, UFN spiral blade--1 patient, bone plate--1 patient. Since 2000, all patients with reverse oblique fractures were treated with a PFN. RESULTS: Seventeen (60.7%) hips healed without complications. In three patients fixation was unsuccessful. The first patient, who was unhealed because of non-union, underwent three types of fixation (DHS, DCS and PFN) before finally receiving a total revision cement prosthesis. The second patient suffered a re-fracture following angular plate procedure and fixation was changed into a DHS. The third patient, treated with DCS, healed with a varus deformity. Twelve out of thirteen PFN-treated hips healed without complications. Six patients died a few years after surgery due to unrelated causes. CONCLUSIONS: The operative treatment of reverse oblique fractures using intramedullary fixation carries fewer complications than internal extramedullary fixation.

Evaluation of the kinematic parameters of normal-paced gait in subjects with gonarthrosis and the influence of gonarthrosis on the function of the ankle joint and hip joint.

The aim of the study was to assess the variability of parameters characterising the gait of persons suffering from degenerative changes of the knee joint and their influence on the ankle and hip joints. The values of the angular changes in the knee, ankle and hip joints in the three planes of motion were assessed. Locomotion tests were performed on 27 persons, aged between 60 and 74, using Vicon 250, the three-dimensional analysis system. The sharpest deviations from the results of the control group were revealed in the transverse and frontal planes. Degenerative knee joint disease has changed the gait stereotype causing a reduction in the economy of gonarthrosis patients' locomotion, the influence of the disease on the function of the neighbouring joints is also distinctly marked.

Ectopic bone formation after treatment with colchicine.

We followed changes occurring within bone tissue and marrow cells during the process of colchicine-induced ectopic bone development and its resorption inside the marrow cavity of the rat tibia. To stimulate ectopic bone formation male Wistar rats were i.p injected with 0.5 or 1 mg/kg b.w. of colchicine or with a 100 microg intra-bone injection. Not all subjects responded to colchicine with ectopic bone formation in the marrow cavity, even among individuals belonging to the same strain. The kind ofresponse in a given animal depended on the dose and site of colchicine administration. During 10 days of the experiment an increase in the occurrence of micronuclei in the polychromatic erythrocytes residing in the bone marrow (even 40-fold) was observed, indicating high genotoxicity of colchicine (at a dose of 1 mg/kg b.w. i.p. or 100 microg intra-bone injection). An increase in the frequency of emperipolesis in megakaryocytes between the 4th and 8th days of the experiment was caused by the toxic action of colchicine and may indicate the labilisation of cell membranes and microtubule depolymerisation.

[Analysis of kinematic parameters of normal-paced gait in subject after posterior cruciate retention and substitution total knee replacement--leading article]. / Analiza parametrów kinematycznych chodu z naturalna predkoscia w grupie osób po zabiegu endoprotezoplastyki stawu kolanowego z zachowaniem i po usunieciu wiezadla krzyzowego tylnego --doniesienia wstepne.

The main goal of this study was to estimate the variability of gait parameters (angular changes) in patients after cruciate-retaining and cruciate-substituting total knee arthroplasties. Angular changes of the knee joint in three planes were taken into consideration. The three-dimensional analysis of locomotion pattern was carried out on 18 patients aged 60-74, using the Vicon system. 8 patients were after posterior cruciate-retaining (CR) total knee arthroplasty and 10 after posterior-stabilized (PS) arthroplasty. The control group consisted of 30 healthy subjects 50-70 years old. The results showed, that CR patients walked on flexed knees and the varus alignment in stance phase was observed. Increased internal rotation was also visible. The movement analysis of PS knee joints was similar to CR group but the angular changes in frontal and transversal planes were more increased compared to the norm.

Treatment of femoral shaft union disturbances with intramedullary nailing. Treatment failure.

BACKGROUND: The paper contains an analysis of the treatment outcomes of intramedullary nailing for femoral shaft non-union. MATERIALS AND METHODS: Twenty-two patients were treated between 1999 and 2005 with locked intramedullary nailing for femoral shaft non-union. The average age was 38.2 years (range 17-79). The study group comprised 20 males and 2 females. The right femur was affected in 12 patients, and the left in 10 patients. All patients had undergone multiple operations to treat the non-union. At the time of the study, non-union had been present for a period ranging from 9 months to as much as 10 years. Stabilisation with an intramedullary nail was preceded by reaming of the medullary cavity. Nails of different diameter were used (11-16 mm, usually 11 or 13 mm). Both static and dynamic locking was used. Surgery was confined to stabilization with an intramedullary nail in 13 patients, and 9 patients additionally underwent the Judet-Forbes decortication procedure, bone grafting or internal plate fixation and osteomuscular decortication. RESULTS: The non-union healed in 19 patients and was not achieved in the remaining 3. A detailed analysis was performed in 9 cases in which the bone union was not achieved despite reaming the medullary cavity, nailing and additional procedures, which did not lead to bone healing in 3 patients. CONCLUSIONS: Despite being an acknowledged method of treatment for delayed union of long-bone shafts, intramedullary nailing following reaming of the medullary cavity did not result in bone healing in all of our patients and additional procedures were often required. Therefore, the use of this procedure for femoral shaft pseudoarthroses should be decided on a case-by-case basis.

Incorrect osteosynthesis as a cause of bone union disturbances.

BACKGROUND: Treatment of bone union disturbances is one of the most difficult therapeutic challenges in any orthopaedic and trauma department. MATERIAL AND METHODS: An analysis of causes of bone union disturbances in a series of 136 patients treated between 1999 and 2005 at the Orthopaedics and Traumatology Department of Jagiellonian University's Collegium Medicum is presented with particular regard to the type of primary stabilisation. RESULTS: An inappropriate primary stabilisation technique was the cause of bone union disturbances in nearly all of the patients. All errors identified in the series, such as wrong classification of fracture, failure to account for fracture biomechanics, wrong implant choice, incorrect reduction of bone fragments, wrong implant positioning and brutal surgery technique, were associated with primary stabilisation of the fractures. CONCLUSIONS: 1. Operator errors committed during primary fracture stabilization are the most common cause of bone union disturbances. 2. Elimination of errors committed during primary stabilization is the most effective prophylaxis of bone union disturbances.

[The three-dimensional pattern of the pelvis movement in standarized gait cycle in patients before and after knee arthroplasty--leading article]. / Trójwymiarowy schemat pracy miednicy w znormalizowanym cyklu chodu w grupie osób przed i po endoprotezoplastyce stawu kolanowego--doniesienie wstepne.

The main goal of this study was to estimate the influence of knee arthroplasty on angular changes of pelvis movement in three planes. The three-dimensional analysis of locomotion was carried out with 13 patients afer total knee replacement aged 47-74, using Vicon system. The first examination took place before knee operation and the second examination 6 months after arthroplasty. The results were represented at the background of biomechanical gait parameters of 30 healthy people aged 50-70. The angular changes of pelvis movement in each gait phase were taken into consideration. After knee arthroplasty the results of patients examinations were similar to the biomechanical norm in sagittal and transversal plane. In the sagittal plane the difference between the results of the first and the second research was 15 degrees. The first examination of pelvis movement in transversal plane showed that the distinction between patients results and biomechanical norm was 17 degrees in initial contact and terminal swing; after total knee replacement the movement amplitude was similar to the biomechanical norm. The biggest change of the hip joint movement after knee replacement was noticeable in transversal plane but there was only slight improvement in sagittal and frontal plane. There was also noticeable change in the knee movement in frontal plane and the results of the two research sessions in sagittal and transversal plane was similar to the biomechanical norm.

Three-dimensional pattern of knee movement in patients with gonarthrosis.

BACKGROUND: The main goal of this study was to estimate the variability of gait parameters in patients diagnosed with arthroplasty of the knee joint. Angular changes of the knee joint in three planes, and spatio-temporal parameters of gait were analysed. MATERIALS AND METHODS: A three-dimensional analysis of locomotion patterns was carried out using the Vicon 250 system in 33 patients aged 48-74. RESULTS: The most significant biomechanical deviations from the norm were revealed in the transverse and horizontal planes. Walking speed was visibly decreased, leading to noticeable changes in other spatio-temporal parameters. CONCLUSION: 1. Degenerative disease of the knee joints markedly affects the normal gait pattern, resulting in deviations from the biomechanical norm with regard to angular change in the knee joints in the three planes of movement. 2. The abnormal locomotion pattern was most evident in the frontal and transverse planes. 3. Gonarthrosis also changed the values of particular spatio-temporal parameters. 4. Statistical analysis revealed significant (p<0.05) differences from the biomechanical norm in variables determined in the frontal and transverse planes, and in the sagittal plane in the group with a varus knee deformity.

Three-dimensional model of bone marrow stromal cell culture.

In a hematopoietic microenvironment in vivo, spatial organisation of hematopoiesis is possible due to the existence of a three-dimensional framework, the main part of which is formed by a branching population of stromal cells. Most of the previous in vitro studies, concerning long-term bone marrow cultures, were based on a previously prepared, flat adherent layer of stromal cells. There are only few reports concerning the three-dimensional growth pattern of the bone marrow stroma. In the present study we used a new three-dimensional model of the stromal cell culture. The framework for the cultured stromal cells was a structure of a nonliving trabecular bone (Unilab Surgibone). After a period of about four weeks the stromal cells created a spatial network which filled the intertrabecular spaces of the spongy bone.

[Monitoring of the early stages of bone healing process based on serum osteocalcin level changes]. / Monitorowanie wczesnych faz zrostu kostnego na podstawie zmian poziomu osteokalcyny w surowicy krwi.

The aim of this paper was assessment of utility of serum osteocalcin levels in monitoring early stages of bone healing and early detection of bone healing disorders. Serum osteocalcin level and alkaline phosphatase activity was assessed with acute long bone fractures and with delayed bone union and pseudoarthroses. 25 patients underwent the trial. The analysis of the results confirmed the utility of serum osteocalcin level as a prognostic factor in early detecting of union disorders and its correlation to radiological examination.

[Interlocking intramedullary nail with reaming of bone marrow cavity in treatment of tibia and femur pseudarthrosis]. / Blokowany gwózdz sródszpikowy z rozwiercaniem jamy szpikowej w leczeniu stawów rzekomych kosci udowej i piszczelowej.

The aim of this paper was to assess the results of treatment of pesudoarthrosis of the tibia and femur with reamed interlocked intramedullary nailing. A group of 17 patients with pseudoarthrosis of long bones were treated. Pseudoarthrosis were located in 10 cases in the tibia and in 7 cases in the femur. In the analysed group there were 14 male and 3 female patients (average age: 48 years). All patients were treated by locked intramedullary nailing. Complete bone union was observed in 15 cases, 1 case is still under observation (radiological signs of bone union are already evident) and in 1 case treatment failed to resolve the pseudoarthrosis. Intramedullary interlocking nailing in the treatment of long bone pseudoarthrosis give very good stability and creates very good conditions for blood vessel penetration between the bone fragments. The reaming procedure yields biologically active material that accelerates the bone union process.