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ABSTRACT: To evaluate the outcome of patients who underwent microfracture procedure on osteochondritis dissecans (OCD) lesions in the elbow, which had already been proven successful on OCD lesions in the knee and ankle.
Nine young patients who were previously treated by arthroscopic debridement and microfracture by a single surgeon were included in the study. The median age at operation was 15 years (range 12-19). The median time between the procedure and evaluation was 5 years (range 2-9). The evaluation included physical examination and patient interview with elbow function scoring. Success of treatment was determined according evaluation Mayo Elbow Performance Index scores and the patients' return to sports.
Eight patients scored excellent results and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether.
We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum.
Croatian Medical Journal 02/2012; 53(1):40-7. · 1.80 Impact Factor
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ABSTRACT: The case of a 30-year-old male with a history of pain in his left ankle is presented. The pain was described as predominantly nocturnal and frequently relieved by the use of nonsteroidal anti-inflammatory drugs. Computed tomography indicated a diagnosis of an osteoid osteoma in the posteromedial portion of the tibia. The patient underwent excision of the tumor using 2-portal posterior ankle arthroscopy. A clearly visualized nidus was removed using a combination of a cochlea and shaver. Histopathologic analysis of the resected tissue confirmed the diagnosis of an osteoid osteoma. The patient reported immediate relief of the pain and was rapidly allowed to bear weight on the foot. During regular follow-up, he had no pain recurrence and his joint mobility was normal. To our knowledge, this is the first report of the removal of an osteoid osteoma of the ankle using 2-portal posterior ankle arthroscopy.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 11/2011; 51(1):103-5.
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ABSTRACT: Osteochondritis dissecans (OCD) is a localized disorder of the joint surface by which a segment of subchondral bone and its overlying cartilage become fragmented. Arthroscopic treatment of OCD of the first metatarsophalangeal joint consisted mainly of debridement and loose body removal. The microfracture technique for the treatment of OCD of the first metatarsophalangeal joint is presented for the first time. The technique has been shown to be a safe and technically uncomplicated first-line treatment.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 05/2011; 50(5):623-5.
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ABSTRACT: The aim of this study was to determine whether elite international junior rowers in 2007 were heavier and taller than those evaluated in 1997, and to compare this change among finalists and non-finalists, and sweep rowers and scullers. Body weight and height data obtained by a questionnaire from a total of 398 rowers (42% female, 58% male) at the Junior World Rowing Championships in Beijing, People's Republic of China, in 2007 (65.9% of all competitors), were compared with data from 603 rowers measured at the Junior World Rowing Championships in Hazewinkel, Belgium in 1997 (36.5% female, 63.5% male, representing 90% and 89% of all competitors, respectively, by gender). Male and female rowers in 2007 were significantly taller compared to those in 1997 (1.0 cm, p = 0.009 and 2.1 cm, p < 0.001, respectively; one-sample t-test). No statistically significant difference was found for body mass. The finalists and sweep rowers were taller and heavier compared to nonfinalists and scullers at both Championships respectively. The heights of elite level junior rowers increased significantly over the decade. The finalists at World Junior Rowing Championships were again taller and heavier compared to the nonfinalists.
Collegium antropologicum 03/2011; 35(1):127-31. · 0.61 Impact Factor
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ABSTRACT: Discoid meniscus is the most common morphological anomaly of the meniscus. The frequency of this anomaly varies depending on geographic location and is highest in eastern Asia (Japan, China, and Korea). Although discoid meniscus was described more than a hundred years ago it is still a challenge both in the diagnostic and therapeutical sense. Since the incidence of this anomaly is relatively high and clinical presentation heterogenous, differential diagnosis of any nonspecific symptom and pain without obvious trauma of the knee in children should include the discoid meniscus. Most authors recommend only observation
for an asymptomatic discoid meniscus determined incidentally during arthroscopy because the knee might have adapted to the discoid anatomy and may continue to function well. Surgical intervention is indicated only for symptomatic discoid menisci. Currently, most authors recommend meniscal preservation using arthroscopic saucerization. The goal of saucerization is to create a stable and functionally remaining meniscus which will provide adequate shock absorption without re-tearing. In this review we present the latest findings regarding etiology, anatomical features, classification, accompanying conditions, clinical manifestations, diagnostic modalities and practical management considerations of discoid meniscus.
Medicina fluminensis. 01/2011; Vol.47.:224-232.
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ABSTRACT: Pigmented villonodular synovitis (PVNS) is a rare proliferative synovial disorder of uncertain etiology. Two forms of this disorder, a localized (LPVNS) and diffuse (DPVNS) form, are well differentiated. The therapy of choice for LPVNS is arthroscopic partial synovectomy with excision of the lesion. Total synovectomy, whether done arthroscopically or through an open arthrotomy, is the recommended treatment for DPVNS. During an eight-year period 13 patients, six male and seven female, average age 28 years (range, 16 to 60 years) were treated for PVNS of the knee with arthroscopic synovectomy. Average follow-up was 84 months (range, 28 to 127 months). Four patients were affected by localized PVNS and were subjected to partial arthroscopic synovectomy (two to three portals) with a complete lesion excision. The remaining nine patients presented with the diffuse form of PVNS and all of them underwent total arthroscopic synovectomy (five portals). The diagnosis was confirmed by synovial biopsy. Each patient was evaluated before treatment and at final follow-up. Results were assessed clinically, radiographically and subjectively and were rated as excellent, good, fair, or poor. No complications or recurrences were noted in the LPVNS group, and all four patients were rated as excellent. In the DPVNS group, eight patients were rated as excellent and one patient was rated as fair and it was the patient who suffered the only recurrence in our case series. No relevant complications were encountered. No cases of infection, joint stiffness or neurovascular lesions were seen. Arthroscopy has become the golden standard in treatment of LPVNS, and can undoubtedly give results that are as good as with open synovectomy when treating DPVNS, if performed by an experienced arthroscopic surgeon.
Collegium antropologicum 12/2010; 34(4):1467-72. · 0.61 Impact Factor
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ABSTRACT: In this report, we present a rare case of an initially unrecognized fracture of the posteromedial process of the talus sustained in a seldom reported position of dorsiflexion and supination of the foot. Fractures of the posteromedial process of the talus are very rare and represent an important diagnostic problem. Difficult x-ray visualization makes these fractures often misdiagnosed as ankle sprains. Complications due to this kind of fractures can include serious consequences such as avascular osteonecrosis, tarsal tunnel syndrome, post-traumatic osteoarthritis, or chronic pain. Timely diagnosis represents an important factor in the development of these conditions. A heightened awareness in examining ankle traumas with specific patient history details is of great importance. The most common mechanism of injury includes dorsiflexion and pronation of the foot. However, in an increasing number of cases alternative mechanisms have been described, all including high-energy impacts. Our patient sustained a fracture of the posteromedial process of the talus in dorsiflexion and supination with high-energy impact due to a 3-m fall. The patient was treated with excision of the fragment six months after the injury, and 18 months after the surgery the patient returned to his normal daily activities with significantly less pain in the posteromedial part of the ankle.
Acta clinica Croatica 09/2010; 49(3):315-20. · 0.25 Impact Factor
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The Journal of Bone and Joint Surgery 09/2009; 91(8):2045-6; author reply 2046-7. · 3.27 Impact Factor
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ABSTRACT: In this study, we evaluated the extent to which 2000-m rowing ergometer performance times predicted final rankings at the World Rowing Championships in a sample of 638 rowers of both sexes and body-mass classifications (i.e., open-category and lightweight rowers). Rowing ergometer performance times were examined using a questionnaire, and in 17 of 23 events they were positively correlated (P < or = 0.049) with the final rankings at the Championships. The highest correlations were for the ergometer performance times achieved by rowers in lightweight men's single sculls (r = 0.78; P = 0.005), women's single sculls (r = 0.75; P = 0.002), men's single sculls (r = 0.72; P = 0.004), and lightweight men's double sculls (r = 0.72; P < 0.001). We used linear regression to establish regression equations to predict final rankings based on 2000-m rowing ergometer performance times for each event in which there was a correlation greater than r = 0.50. Although correlations in 12 events met this criterion, the large standard errors of the estimate hindered ranking predictions in all of the studied events. Regression equations could be used to determine the most probable 2000-m ergometer performance time for a rower to achieve specific rankings at the World Rowing Championships.
Journal of Sports Sciences 08/2009; 27(9):907-13. · 1.93 Impact Factor
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ABSTRACT: The last three decades have witnessed a tremendous increase in female sports participation at all levels. However, increased sports participation of female athletes has also increased the incidence of sport-related injuries, which can be either acute trauma or overuse injuries. Overuse injuries may be defined as an imbalance caused by overly intensive training and inadequate recovery, which subsequently leads to a breakdown in tissue reparative mechanisms. This article will review the most frequent overuse injuries in female athletes in the context of anatomical, physiological, and psychological differences between genders.
Croatian Medical Journal 01/2008; 48(6):767-78. · 1.80 Impact Factor
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ABSTRACT: Arthroscopic surgery of the ankle has become indispensable method in the armamentarium of the modern orthopaedic surgeon. Technological advancement and thorough understanding of the anatomy have resulted in improved ability to perform arthroscopy of the ankle. The method is minimally invasive and it allows the direct visualization of intra-articular structures without arthrotomy or malleolar osteotomy. Anterior or posterior approach may be used, and various indications have become generally accepted: anterior soft tissue or bony impingement, loose bodies, osteochondral defects, synovitis (rheumatoid arthritis, infective arthritis, and hemophilic arthropathy), posterior impingement syndrome, posttraumatic conditions, osteoarthritis (arthrosis), ankle arthrodesis, tumor-like lesions (synovial osteochondromatosis, pigmented villonodular synovitis) and many combinations of these pathological entities. In this paper we will discuss technique, indications, complications and future perspective of the ankle arthroscopy. In addition we will review the most recent literature data regarding this appealing technique.
Lijec̆nic̆ki vjesnik 06/2007; 129(5):152-7.
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ABSTRACT: The aim of this paper is to report on three cases of symptomatic osteochondritis dissecans of the humeral capitellum in adolescent gymnasts, two females and one male. In all the cases arthroscopic surgery was performed. During arthroscopy, loose osteochondral fragments were removed, the defect was debrided and microfractures were performed. All the three patients regained the full range of motion of the affected elbow, and returned to the high-level gymnastics within a period of 5 months. At 12 months follow-up, all the three patients remained symptomless and were participating in high-level gymnastics. A combination of arthroscopy and the microfracture technique is a reliable method with excellent short-term results in the treatment of the osteochondritis dissecans of the elbow.
Knee Surgery Sports Traumatology Arthroscopy 06/2006; 14(5):491-6. · 2.21 Impact Factor
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ABSTRACT: To compare the quality and diagnostic reliability of conventional spin-echo and fast spin-echo with fat suppression magnetic resonance (MR) imaging in the evaluation of cruciate ligament injury.
Thirty-five patients with internal knee injury and positive clinical signs of cruciate ligament injury were examined by using an Elscint Prestige 2T MR scanner. Findings of conventional and fast spin-echo with fat suppression MR sequences were evaluated and compared with each other and with arthroscopic findings. In all patients, arthroscopy was performed within 2 months after the MR examination.
Analysis of anterior cruciate ligament injury with conventional spin-echo sequence showed 81.8% sensitivity. The sensitivity of fast spin-echo sequences with fat suppression was 96.9%. According to the type of the anterior cruciate ligament injury, the sensitivity of fast spin-echo sequences with fat suppression was higher than that of conventional spin-echo sequence (85.7% and 66.7%, respectively) for partial rupture, but the sensitivity of both sequences for complete rupture was the same (100% both).
Fast spin-echo with fat suppression sequence can be used routinely in clinical practice for the assessment of acutely injured knees as the substitute for conventional spin-echo sequence without decreased diagnostic reliability.
Croatian Medical Journal 05/2004; 45(2):195-201. · 1.80 Impact Factor
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ABSTRACT: The authors report a case of a 21-year-old woman with osteoid osteoma of the talar neck that was treated with arthroscopic resection. The nidus was removed in one piece with grasping forceps, and histopathologic findings confirmed the preoperative diagnosis of osteoid osteoma. Postoperatively, the patient was immediately relieved of ankle pain and there was no recurrence at the 1-year follow-up. If possible, the nidus should be removed without the use of a motorized instrument to ensure the correct histolologic diagnosis.
The Journal of Foot and Ankle Surgery 42(6):359-62. · 0.52 Impact Factor
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ABSTRACT: The aim of this study was to determine the efficacy of the microfracture method in the treatment of symptomatic osteochondral lesion of the talus.
24 patients operated by the mentioned method were prospectively followed-up. Standard radiological treatment was performed in all patients, ankle CT was performed in 10 patients, and MR was performed in 8 patients. Patients' subjective satisfaction with operation was assessed by SANE and Martin's score, while the objective function was assessed by AOFAS and Freiburg's score.
The mean preoperative AOFAS score was 53 (from 31 to 61), while the mean postoperative AOFAS score was 87.5 (from 81 to 100). Postoperative Freiburg's score was 89.5 (from 76 to 100). The distribution of treatment outcomes was evaluated by the Martin's score and it revealed excellent, good and satisfying results in 94.5% patients, while the distribution of outcomes by the SANE questionnaire revealed excellent and good result in 91.8% patients.
The arthroscopy of the ankle with microfractures is safe, cheap and effective method in the treatment of osteochondral lesions.
Lijec̆nic̆ki vjesnik 129(6-7):191-9.
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ABSTRACT: Rib stress fractures with an occurrence rate of between 2 and 12% of all other overuse injuries of rowers are the cause of the most time lost from on-water training and competition. As the rib stress fractures are very infrequent in the general population, of otmost importance is to think about such possibility in case of rib cage pain in athlete without a history of trauma. That is why we present our three cases of rowers in whom we suspected the existence of rib stress fractures. The review of the literature related to rib stress fractures in rowers with the newest knowledge of etiology, clinical picture, diagnostics, differential diagnosis and treatment of stress fractures is reported.
Lijec̆nic̆ki vjesnik 129(10-11):327-32.
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ABSTRACT: Stress fractures, which are classified among overuse injuries of bone, may be defined as partial or complete bone fracture that results from repeated application of stress of less strength than the stress required to fracture bone in a single loading. They are common problem in sports medicine comprising between 1.1 to 10% of all athletic injuries. Causes are many, but training errors, i.e. „too soon, too much“, are the most frequently encountered cause of stress fractures, causing stress fractures in as many as 22 to 75% cases. To diagnose a stress fracture, it is essential to have the possibility of such a condition constantly in mind. Clinical examination represents basic diagnostic procedure followed later on by other diagnostic methods: radiography, scintigraphy, computed tomography and magnetic resonance imaging. For the most of stress fractures sufficient treatment is rest from offending athletic activity during 4 to 6 weeks leading to disappearance of pain and gradual return to sport activities. Stress fractures in some localizations, femoral neck (tension side), anterior cortex of the tibia, tarsal navicular, fifth metatarsal, etc., have higher number of complications during the treatment and require additional treatment, and in some cases even surgical intervention is appropriate. Finally, as in the most of the injuries belonging to the overuse group, prevention is the key word.
Croatian Sports Medicine Journal (hsmv@kif.hr); Vol.20 No.1.
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ABSTRACT: There has been increasing interest in investigating the medial patellofemoral ligament (MPFL) during the last fifteen years. This is due to the recognition of the MPFL as the primary static soft-tissue restraint to lateral patellar displacement and the association of MPFL injury with primary traumatic patellar dislocation. The MPFL often heals poorly and thus rarely regains its full function. Numerous surgical techniques have been described for reconstruction of this important structure. This paper reviews the relevant anatomy and biomechanics, published reconstruction options, and describes the surgical technique performed at our institution--that of using a quadriceps autograft to reconstruct the MPFL.
Lijec̆nic̆ki vjesnik 134(7-8):224-32.
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ABSTRACT: Overuse injuries of the musculoskeletal system are a common problem in both general population and among athletes. Researches made in the last decade have shown that overuse injuries are mainly caused by degenerative changes and not inflammation, as was thought before. Although they can be present everywhere in musculoskeletal system, overuse injuries are most often seen on tendons. The main goal of this article is to refer to latest guidelines in the treatment of overuse injuries, with special attention to eccentric exercise treatment program for most common tendinopathies (patellar tendinopathy, Achilles tendinopathy and lateral epicondylitis). The main reason is the fact that very good results are accomplished after eccentric exercises in the treatment of tendinopathies and are thus suggested as the first treatment option.
Lijec̆nic̆ki vjesnik 134(1-2):29-41.
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ABSTRACT: Elbow arthroscopy has become an indispensable method of surgical care of injuries and their consequences and damages that affect the elbow. The advantages of elbow arthroscopy in comparison to classical open surgery are multiple. Primarily, arthroscopy allows an excellent view of intra-articular structures and thus a detailed overview of the entire joint which enables us to perform complete surgery without opening the joint. Furthermore, morbidity is significantly smaller, rehabilitation is faster, and return to daily activities is also faster. Basic requirements for successful application of elbow arthroscopy are careful planning of the procedure, very good knowledge of regional anatomy of the elbow, strictly following the rules of performing the procedure, good technique and an experienced surgeon. Pathologies that can currently be addressed arthroscopically include osteochondritis dissecans of elbow, lateral epicondylitis, synovial plica syndrome, elbow osteoarthritis, elbow contracture, as well as the diseases where the synovectomy is needed, such as rheumatoid arthritis, pigmented villonodular synovitis, synovial chondromatosis and hemophiliac synovitis.
Lijecnicki vjesnik; Vol.132 No.7-8.
