Chirurgia narzadow ruchu i ortopedia polska

Publications in this journal

• Article: Organization and activity of the Replantation Service for amputated hands in Poland.

  Andrzej Zyluk
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  ABSTRACT: A permanent on-call service for hand amputations (Replantation Service) was established in 2010 of the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. Organization of this system, rules of activity and spectrum of cases admitted to replantation units was presented. A scheme of referral of amputations was shown and the main problems that appeared during almost three-year activity of the Service were discussed. Medico-legal and ethical implications arising from these problems were shown and organization of replantation service in other European countries was outlined. Establishing of the Replantation Service constituted a significant progress in the organization of the management of upper limb amputations. Thanks to that, over the period of three years, more than 200 patients were saved from severe disability, receiving a chance to regain an amputated limb.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:71-6.
• Article: The use of flexor digitorum superficialis tendon in anterior cruciate ligament reconstruction. Operative technique.

  Leszek Romanowski, Klaudiusz Kosowski, Wiesław Wiśniewski
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  ABSTRACT: This paper presents the technique used in anterior cruciate ligament(ACL) reconstruction using the ring finger flexor digitorum superficialis tendon (FDS IV). The biologic material used in autografts and allografts is subject of controversy. Due to this some authors suggest using synthetic materials. All the authors agree that the use of biological material harvested from the vicinity of the knee joint can cause further dysfunction of this joint(weakening) It would seem that use of a biological material harvested from another part of body would be the optimal solution for ACL reconstruction. In our opinion the ring finger flexor digitorum superficialis tendon meets this criteria. Its parameters (length, strength, shape) are comparable to currently used biological materials. From experience in hand surgery we know that the harvesting of FDS IV(loss of FDS IV function) does not cause significant loss of function in the hand. It seems that the FDS IV is very well suited for ACL reconstruction. This paper presents the technique used in ACL reconstruction using FDS IV augmented with a synthetic material.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:105-7.
• Article: Proprioception exercises in medical rehabilitation.

  Wanda Stryła, Adam M Pogorzała, Justyna Stępień
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  ABSTRACT: Proprioception, or kinesthesia, is the sense of orientation responsible for perception of body and relative position of its parts. Kinaesthesia is received by receptors located in muscles and tendons. In this study a set of proprioception developing exercises was presented. Proprioception should be restored in case of musculoskeletal and neurological disorders. Proprioception training can also be used as a prophylaxis before starting various sporting activities. Proprioception developing exercises have significant meaning for the elderly, who are at risk of balance disorders. These exercises help developing motor memory and at the same time protect from falls.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:5-27.
• Article: Wpływ wieku na wynik rehabilitacji po endoprotezoplastyce biodra.

  Joanna Dolata, Krzysztof Pietrzak, Wojciech Manikowski, Jacek Kaczmarczyk, Ewa Gajewska, Wiesław Kaczmarek
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  ABSTRACT: Background This publication compares the results of physiotherapy after total hip replacement in two groups, each consisting of 50 subjects, differing in age by 10 years Material and Methods A group of 100 patients after total hip replacement was divided into two subgroups consisting of 50 subjects each, with mean age difference of 10 years. The first group included patients aged 47-60 years, the other 61-69 years. Patients were assessed at 6 weeks and reevaluated at 10 weeks after surgery during a 4-week in-hospital rehabilitation program. The study was based on a questionnaire, physical examination, 6-minute walking test and a test on stabilometric platform. Results In the younger group we observed easier and faster resolution of pain in the operated joint. In group II, which included patients aged 61 to 69 years, improvement in hip joint mobility was less pronounced than in the younger group. Six-minute walking test showed less improvement in walking distance in group II than group I. Among group II patients we noted less pronounced increase in weight bearing on the operated limb (by 2%, while 4% improvement was noted in group I), while final degree of weight-bearing was greater in group II than in group I and amounted to 48%. Conclusions Younger patients recover faster, hip pain subsides easier, hip function returns more readily and to a greater extent. During a 4-week course of in-hospital rehabilitation older patients may regain hip function in a manner that brings them closer to the younger group.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:109-13.
• Article: Vitamin D concentration in patients with normal and impaired bone union.

  Andrzej M Boszczyk, Piotr Zakrzewski, Stanisław Pomianowski
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  ABSTRACT: Background: The aim of the study was to compare vitamin D concentration in patients treated due to delayed bone union and non-union (pseudoarthrosis) and patients with normal fracture healing. Material/Methods: A retrospective case-control study was conducted. We enrolled 35 patients with inexplicable (standard and correct surgery, closed fracture, no comorbid metabolic diseases) fracture healing impairment, and 35 patients assigned by age and measurement season. Vitamin D (as 25OHD) concentration was measured in all patients. Results: Vitamin D deficiency was reported in 86% of examined patients. No difference was shown between groups in deficiency prevalence. Conclusions: Previous studies indicated decreased vitamin D concentration in patients with impaired fracture healing. However, these studies did not include control groups. No difference was demonstrated between patients with normal fracture healing and those with impaired bone union in terms of vitamin D deficiency prevalence.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:1-3.
• Article: Clinical assessment of the efficacy of SpineCor brace in the correction of postural deformities in the course of idiopathic scoliosis.

  Barbara Plewka, Marcin Sibiński, Marek Synder, Dariusz Witoński, Katarzyna Kołodziejczyk-Klimek, Michał Plewka
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  ABSTRACT: Background The objective of the study was to perform a clinical, comparative assessment of the degree of postural deformities before and after the treatment of idiopathic scoliosis in patients treated with SpineCor brace compared to the control group. Material and Methods A group of 90 children with idiopathic scoliosis (including 74 girls) at the average age of 12.2 was subject to prospective observation. Average pre-treatment Cobb angle was 24.9° in the thoracic spine and 25.8° in the lumbar spine. The group actively treated with the SpineCor brace consisted of 45 children, while the control group consisted of the remaining 45 children with the natural course of the disease. Results Both groups did not differ significantly in terms of age, gender, height, body weight, Risser sign of skeletal maturity and baseline clinical and radiological parameters of scoliosis. Significant reduction of rib hump was observed upon 2-year SpineCor brace treatment (P=0.04) compared to the group treated by physiotherapy only (P=0.91). Similarly, improvement in lumbar prominence was observed in the actively treated group (P=0.009), with a trend towards worse results in the control group (P=0.07) In the group treated with the SpineCor brace, significant reduction in pectoral and hamstring muscle contractures as well as reduction in shoulder asymmetry and reduction in anterior and posterior vertical deviation were observed. Conclusions Treatment using the SpineCor dynamic brace leads to a clinical improvement in posture, particularly to reduction in rib hump, lumbar prominence and muscular contractures.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:85-89.
• Article: Distal radioulnar joint instability: A review of literature.

  Andrzej Zyluk, Bernard Piotuch
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  ABSTRACT: Distal radioulnar joint instability most commonly accompanies fractures of the distal radius and is directly caused by lesion of the triangular fibrocartilage complex, which is the major structure responsible for congruity of the distal radioulnar joint. Acute instability accompanying fractures of the distal radius usually does not require separate management, if the fracture itself is firmly fixated. Chronic instabilites causing persistent pain and wrist dysfunction are treated by arthroscopic reinsertion of the torn attachments of the triangular fibrocartilage. If not possible, radioulnar functional tenodesis is performed using palmaris longus tendon graft, thus restoring joint stability.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:77-84.
• Article: Clinical examination vs. MRI: Evaluation of diagnostic accuracy in detecting ACL and meniscal injuries in comparison to arthroscopy.

  Mohammed Azfar Siddiqui, Ibne Ahmad, Aamir Bin Sabir, Ekram Ullah, Syed Amjad Ali Rizvi, Syed Wajahat Ali Rizvi
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  ABSTRACT: Background: To compare the diagnostic accuracy of clinical examination and MRI in evaluation of meniscal and ACL injuries using arthroscopic findings as reference standard. Material/Methods: A total of 51 patients with traumatic knee injuries were identified and prospectively followed up with clinical examination, MRI and arthroscopy. Clinical examination and MRI findings were compared with arthroscopic findings. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated with statistical analysis. Results: Out of 24 patients with arthroscopic evidence of medial meniscal injury, clinical examination and MRI correctly identified 20 and 18 patients, respectively. Clinical examination was characterized by better sensitivity and specificity with regard to diagnosis of medial meniscal tear. On arthroscopy, lateral meniscal tear was present in 13 patients; clinical examination and MRI both identified 8 of them correctly. Similarly, out of 9 patients with arthroscopic evidence of ACL tear, clinical examination and MRI correctly identified 7 and 8 patients, respectively. There were only marginal differences in sensitivity and specificity of clinical examination and MRI in diagnosis of lateral meniscal and ACL injury. Conclusions: Careful clinical examination is much better than MRI with regard to the diagnosis of medial meniscus injury and is as reliable as MRI with regard to diagnosis of lateral meniscus injury and ACL tears. MRI should be used to rule out such injuries rather than to diagnose them.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:59-63.
• Article: Mortality as an indicator of treatment quality after pertrochanteric fractures in the elderly.

  Bogdan Koczy, Jacek Semenowicz, Jacek Majewski, Jakub Wąsik
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  ABSTRACT: Background: Fractures in people over the age of 65, especially pertrochanteric fractures of the femur, present a growing medical problem. Surgical treatment of such fractures should be performed in the shortest possible time after the accident. Efforts were made to answer the question what contributes to the reduction in mortality after pertrochanteric fractures. Material/Methods: This work presents a comparative analysis of two populations treated surgically due to pertrochanteric fractures at the District Hospital of Orthopedic and Trauma Surgery in Piekary Slaskie during years 1988-1992 and 2005-2008. Patient mortality was used as an indicator of treatment quality. In the first group of 118 patients hospitalized in years 1988-1992, there were 48 deaths reported during 12 months after the surgery. In the second studied population of 244 patients (operated in years 2005-2008), 54 deaths were noted in the 12-month period after the surgery. There was a reduction in mortality from 40.6% to 22.3% over those 15 years. Conclusions: Introducing mortality as an indicator in the comprehensive assessment of treatment quality will intensify its monitoring in both the hospital as well as the out-of-hospital period of care. It will also reveal the individuality and social importance of geriatric fractures.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:65-9.
• Article: The impact of aerobic exercises on bone mineral density in breast cancer women during endocrine therapy.

  Katarzyna Hojan, Piotr Milecki, Piotr Leszczyński
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  ABSTRACT: Background: The assessment of the impact aerobic exercises on bone mineral density in breast cancer women during endocrine therapy (ET). Material/Methods: The study included 53 women (mean 44.3 ±SD 4.9) during breast cancer treatment. This was a nonrandomized, prospective clinical study. The following examinations of the assessment of bone in the DEXA were measured: the bone mineral density of the neck of a femur (FN), lumbar region L1-L4, and total body (TB) as well as defining of T-score and Z-score. The examinations were conducted for all the patients according to the schedule: before the beginning of ET, after 6 months of ET and after 12 months of ET (after 6 month aerobic training). Results: After the first 6 months of ET without regular physical exercise the following results were noted: the BMD mean value of FN, in the L1-L4 spine region and in TB were significant lower than the initial value. After 6 month aerobic training, in the 12th month of the follow up, the BMD mean value of FN was 1.1% (p>0.05) lower, while in the L1-L4 spine region it was 5.6% (p<0.05) lower, and in TB 2.7% (p<0.05) lower in comparison to the values in the sixth month of the observation. Conclusions: That even short course of ET is related to changes in bone mineral density. The introduction of aerobic exercises caused a slowdown in negative changes in bones.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:47-51.
• Article: Algorithm of physical therapy exercises following total hip arthroplasty.

  Wanda Stryła, Adam M Pogorzała, Piotr Rogala, Andrzej Nowakowski
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  ABSTRACT: Authors present a set of exercises for patients after total hip replacement (THR) treated due to idiopathic hip joint osteoarthritis. Outcome of surgical treatment depends largely on physical therapy conducted after the procedure. Physical therapy following total hip arthroplasty involves restoration of proper physical function. Exercises increase the strength of hip girdle muscles and stabilize the involved hip joint. Total postoperative rehabilitation improves the gait esthetics. Restoring patient's full independence in everyday and professional life after total hip arthroplasty is the best test for properly conducted rehabilitation. A rehabilitation algorithm following hip arthroplasty was established based on the data acquired from literature and authors' own studies. Methods of rehabilitation following total arthroplasty was unified with regard to the type of endoprosthesis (cemented and non-cemented). Rehabilitation after revision and cancer arthroplasties were not taken into consideration. Exercises were divided into those performed in supine and standing positions as well as resistance training (using an elastic TheraBand® tape). At a later stage of rehabilitation, marching and walking as well as cycloergometer training were included. Patient's position during the day and in the sleep for two months following THR was taken into account, including some types of exercises that are contraindicated and pose a threat of endoprosthesis luxation.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:33-9.
• Article: Outcome of treatment of complex, perilunate fracture-dislocation of the wrist: A case report.

  Andrzej Zyluk, Bernard Piotuch, Piotr Puchalski
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  ABSTRACT: Complex, perilunate fracture-dislocations of the wrist comprise severe and challenging injuries, characterised by a total loss of contact between the lunate bone and the head of the capitate as well as fracture of one, or more bones surrounding lunate bone. The principle of treatment of such injuries involves stable fixation of fractures, anatomical reduction of the displaced carpal bones with temporary arthrodesis wit K-wires to maintain their position. We present a patient who sustained a complex, perilunate fracture-dislocation of the wrist with fractures of the scaphoid, hamate and base of the IV metacarpal bone, as a result of a blast. A ssessment at one year after the surgery showed satisfactory result: mean range of motion in the wrist was 50-60% of the healthy side, grip strength was 55%, DASH score of 36 and Mayo score of 65.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:41-5.
• Article: [Long-term preservation of Bone Morphogenetic Activity in stored demineralized murine incisors.]

  Krzysztof H Włodarski, Grzegorz Szczęsny, Bolesław Kuzaka, Paweł K Włodarski
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  ABSTRACT: Demineralizowana macierz kości lub zębiny, wszczepione domięśniowo wywołują powstawanie kości w miejscu implantacji. Zjawisko to, zwane "indukcją osteogenezy" wywołane jest uwalnianiem z nich niekolagenowych białek, zwanych Białkami Morfogenetycznymi Kości (BMP). Demineralizacja ułatwia ich uwalnianie z macierzy a osiągnąwszy odpowiednie stężenie, te sygnałowe białka pobudzają różnicowanie się komórek mezenchymatycznych biorcy w kierunku osteo- i/lub chondrogennym. Macierze zmineralizowane w podobnych warunkach przeszczepiania uwalniają białka BMP zbyt wolno, by osiągnęły stężenie progowe, wyzwalające różnicowanie, przeto nie indukują osteogenezy. Na rynku dostępne są czyste postacie białek morfogenetycznych, lecz w wielu przypadkach stosowanie kości demineralizowanych ma przewagę nad izolowanymi białkami BMP, gdyż łączą w sobie własności osteoindukcyjne z walorami mechanicznymi, tak pożądanymi w osteosyntezach i wypełnianiu ubytków kostnych. W niniejszej pracy wykazano, że przechowywanie dmineralizowanych i liofilizowanych siekaczy myszy przez okres co najmniej 30 miesięcy nie zmienia ich potencjału kościotwórczego i zdolności do kolonizowania indukowanej kości szpikiem. Liofilizowaną zębinę, przechowywaną przez 0-30 miesięcy w temperaturze lodówki przeszczepiano do mięśni udowych myszy i miejsce implantacji oceniano histologicznie po 10-450 dniach. Tkankę kostną, ściśle połączona z implantowaną zębiną stwierdzono w ok. 87% przypadków a czas przechowywania matryc w przedziale czasowym 0-30 miesięcy nie wpływał na ich zdolności osteoindukcyjne.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:97-100.
• Article: Total elbow arthroplasty in complicated distal humerus fracture - a case report.

  Maciej Kaźmierczak, Krystian Stanisław Pyszel, Paweł Henryk Surdziel
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  ABSTRACT: Background:Total elbow arthroplasty is still a rarely performed surgical procedure in distal humerus fractures. Reconstruction and osteosynthesis using Locking Compression Plates remains the gold standard for treatment of such types of fractures. Case Report: We report a case of 51-year-old man with distal humerus fracture and early destabilization of primary osteosynthesis, successfully treated with total elbow arthroplasty, resulting in excellent physical function of the operated elbow. Results: Several studies performed over the last decades demonstrated that total elbow arthroplasty in many cases may be a beneficial method of treatment. Osteoporosis, comminuted fractures, older age and early destabilization of primary osteosynthesis are the most common indications for considering elbow arthroplasty.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:91-6.
• Article: Clinical and functional evaluation of patients after total elbow arthroplasty.

  Przemysław Lubiatowski, Izabela Olczak, Ewa Lisiewicz, Maciej Bręborowicz, Jan Długosz, Marcin Redman, Piotr Ogrodowicz, Leszek Romanowski
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  ABSTRACT: Background: The operation of the total elbow arthroplasty (TEA) is recommended in case of advanced joint destruction. At present both in our country and abroad, the number of elbow arthroplasties performed per year is increasing. Surgical procedures are difficult, and postoperative complications may arise. The aim of this study is to evaluate the function of the elbow and the clinical status of patients after having undergone TEA. Material/Methods: Our research is based on 18 patients who had undergone total elbow arthroplasty. The average patient age was 60. The follow-up time varied from 8-108 months. Postoperative assessment included the evaluation of the range of motion and grip strength using a dynamometer. Functional evaluation was carried out using Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) and the SECEC Elbow Score (SES). We had also assessed the pain level (VAS), postoperative complications and patient satisfaction. The study included X-rays of the elbow for the evaluation of prosthesis integrity and possible signs of implant loosening. Results: The increase of the range of motion was seen among all patients. The amplitude of flexion and extension increased by an average of 25.3° (p<0.02). The results of all questionnaires of functional assessment showed a significant improvement comparing to results before surgery: DASH - 82.6 (±24.6) vs. 116.7 (±24.2), SECEC - 39.3 (±8.5) vs. 27.9 (±9.2), MEPS - 65 (±23.3) vs. 35.8 (±16.9). The VAS pain decreased from 10.9 (±3) to 5.3 (±4). In the postoperative period, 4 patients experienced inflammation, 2 patients had a loosening of prosthesis, and 6 needed a revision of the prosthesis. 94.4% patients were satisfied with the treatment. Conclusions: Total elbow arthroplasty effectively improves the clinical status of the patient by reducing pain, increasing range of motion and improving many activities of daily life.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:53-8.
• Article: A modified technique of placing transpedicular screws into the S1 vertebrae - surgical technique note.

  Lukasz Kubaszewski, Jacek Kaczmarczyk, Andrzej Nowakowski
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  ABSTRACT: Anatomical variability of sacral bone as well as its diverse interpretations a surgical field prompted the authors to modify surgical technique in such manner to allow unequivocal identification of a starting point for introduction of transpedicular screws into the first sacral vertebra. The starting point is not located, as described in previous publications, inferiorly and laterally to the S1 articular process, but goes through a precisely defined place in the dorsal ridge of superior articular process following its partial resection.
  Chirurgia narzadow ruchu i ortopedia polska 01/2013; 78:101-4.
• Article: Evaluation of hyaluronic acid intra-articular injections in the treatment of primary and secondary osteoarthritis of the knee.

  Sławomir Swięchowicz, Alina Ostałowska, Aleksandra Kasperczyk, Dariusz Nowak, Ewa Birkner, Sławomir Kasperczyk
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  ABSTRACT: Background: Osteoarthritis is one of the most common locomotor conditions and the knee is the second most frequently affected articulation. One of therapeutic methods is viscosupplementation involving intra-articular injections of hyaluronic acid preparations. The aim of the study was to evaluate the clinical status and analyse selected biochemical blood parameters in patients with knee osteoarthritis after intra-articular injections of a hyaluronic acid preparation. Material/Methods: Blood was taken from 113 patients, 60 patients with primary and 53 patients with secondary osteoarthritis, who were administered intra-articular injections of a hyaluronic acid preparation into the affected knee, according to the schedule established in the study protocol. Concentration of lipid hydroperoxides in blood plasma was determined, along with that of malondialdehyde in erythrocytes. Plasma concentrations of ceruloplasmin, TAC, albumin, total bilirubin, and uric acid were also determined. Clinical assessment was performed using a modified HHS scale and the WOMAC questionnaire. Results: Intra-articular administration of a hyaluronic acid preparation significantly reduced pain in the knee and improved its functioning, regardless of the form of osteoarthritis. Not only clinical improvement was observed, but also beneficial changes in the blood antioxidant system. Conclusions: Comparable clinical improvement was observed in both forms of osteoarthritis of the knee. It was also beneficial changes in blood antioxidant system, especially in the group with secondary osteoarthritis.
  Chirurgia narzadow ruchu i ortopedia polska 01/2012; 77:105-9.
• Article: Linguistic and cultural adaptation into Polish of the IKDC 2000 subjective knee evaluation form and the Lysholm scale.

  Tomasz Piontek, Kinga Ciemniewska-Gorzela, Jakub Naczk, Kamil Cichy, Andrzej Szulc
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  ABSTRACT: Purpose: The aim of the following paper was Polish cultural and linguistic adaptation including adaptation of particular questions, instructions and possible answers to 2000 IKDC knee form and Lysholm's scale. Material/Methods: The cultural adaptation process of this questionnaire was made according to indicators of International Quality of Life Assessment (IQOLA) project, placed in Journal of Clinical Epidemiology. Testing version (pre-final test) was carried out on 30 patients suffering from instability of a knee. Patients underwent arthroscopic reconstruction of the anterior cruciate ligament. The period from operation to filling in the questionnaires took 2 years. The questionnaire was filled up twice, at intervals from 2 days to 2 weeks. Results: We received cultural and linguistic adapted knee evaluation scales which are similar to the original version according to the psychometric proprieties such as accuracy of a single question and whole scales. Conclusions: We were able to develop a reliable, ISAKOS/ESSKA-compliant instrument for subjective knee function evaluation to be used in the population of Polish patients following arthroscopic reconstruction of anterior cruciate ligament. Polish version of IKDC 2000 questionnaire is more reliable - i.e. more useful in clinical evaluation of patients with ACL damage - than the Polish rendition of Lysholm scale.
  Chirurgia narzadow ruchu i ortopedia polska 01/2012; 77:115-9.