Anton Tudor

Long-term results of anterior cruciate ligament reconstruction: a comparison with non-operative treatment with a follow-up of 17–20 years

PurposeThe aim of our study was to review the clinical and radiological outcome of patients who had undergone anterior cruciate ligament (ACL) reconstruction in comparison to a group of non-operatively treated patients.MethodsIn a retrospective study we compared ACL reconstruction using a bone-patellar tendon-bone graft with a non-operatively treated group of patients 17–20 years later. Fifty-four patients that met the inclusion criteria, with arthroscopically proven ACL rupture, were treated between 1989 and 1991. Thirty-three patients underwent ACL reconstruction, forming group one. Eighteen non-reconstructed patients continued with rehabilitation and modification of activities (group two). The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms and the Lysholm and Tegner scale were used to assess the knees at follow-up. Radiographic assessment was performed using the IKDC grading scale.ResultsFollow-up results showed that 83% of reconstructed patients had stable knees and normal or nearly normal IKDC grade. Patients in the non-reconstructed group had unstable knees with 84% having abnormal or severe laxity. The subjective IKDC score was significantly in favour of group one: 83.15 compared to 64.6 in group two. The Lysholm and Tegner score was also significantly better in group one. Conservatively treated patients all had unstable knees and worse scores. The rate of osteoarthritis showed more severe changes in non-reconstructed patients with additional meniscus injury.ConclusionsWe can conclude that 94% of patients who underwent ACL reconstruction had stable knees after 15–20 years and there was a significantly lower percentage of osteoarthritis in comparison to conservatively treated patients.

Minimally invasive calcaneo-stop method for idiopathic, flexible pes planovalgus in children.

Background: The aim of this study was to correct heel valgus in children and to lift the longitudinal arch of the foot using a temporary cancellous screw placed percutaneously across the talocalcaneal articulation. Methods: From April, 1997, to June, 2003, 94 procedures were done on 48 children between the ages of 8 and 14 years. The Meary angle to determine the degree of collapse of the medial longitudinal arch was 170 degrees or less, and the weightbearing hindfoot was in valgus. Presumably, the screw achieves correction by stimulating the proprioceptive foot receptors allowing active inversion of the foot. Results: At 5 years followup, no serious complications occurred. The correction of the Meary angle on average was 17.10 ± 5.51 degrees. In every foot, heel valgus and the longitudinal arch of the foot were improved radiographically and clinically without the loss of function. We removed the screws in all patients. In 91 feet, the arch of the foot and heel valgus remained in the corrected position. Conclusions: The ‘calcaneo-stop’ method is a simple, effective, minimally invasive technique for the treatment of idiopathic, flexible pes planus in carefully selected pediatric patients.

Flat-Footedness Is Not a Disadvantage for Athletic Performance in Children Aged 11 to 15 Years

OBJECTIVE. Because the controversy about the relation of foot morphology and foot function is still present, we find it surprising that there are no studies published dealing with motor skills and athletic performance in flat-footed school children. Our aim in this study was to determine if there is an association between the degree of foot flatness and several motor skills that are necessary for sport performance. METHODS. The feet of 218 children aged 11 to 15 years were scanned, and the arch index was determined. The value of the arch index was corrected for the influence of age, and then the entire sample was categorized into 4 groups according to the flatness of their feet. The children were tested for eccentric-concentric contraction and hopping on a Kistler force platform, speed-coordination polygon (Newtest system), balance (3 tests), toe flexion (textile crunching), tiptoe standing angle, and repetitive leg movements. Altogether, 17 measures of athletic performance were measured. RESULTS. No significant correlations between the arch height and 17 motor skills were found. Categorizing the sample into 4 groups did not reveal any differences between the groups in athletic performance. Also, several multivariate analysis of variance sets of multiple independent variables referring to a particular motor ability were not found to be significant. The differences were not found even after comparing only the 2 extreme groups, meaning children with very low and children with very high arches. CONCLUSIONS. No disadvantages in sport performance originating from flat-footedness were confirmed. Children with flat and children with “normal” feet were equally successful at accomplishing all motor tests; thus, we suggest that there is no need for treatment of flexible flat feet with the sole purpose of improving athletic performance, as traditionally advised by many.

Risk-taking behavior in skiing among helmet wearers and nonwearers.

OBJECTIVE To examine differences in on-the-snow ski behavior between helmet wearers and nonwearers. METHODS The data were collected using a survey. Several tourist agencies helped in administrating the survey to the skiers during the 2008-2009 and 2009-2010 seasons. The survey consisted of multiple-choice questions. The subjects were asked to choose answers most suitable for their skiing style and preferred skiing technique, volume of off-piste skiing, readiness to use time measuring systems on the slopes, and group-skiing preferences, such as leading the group, beside the group, away from the group, etc. The Risk Index was then calculated for each subject. RESULTS The answers of 710 skiers (mean age 35.5, range 16-81 years) were analyzed. The predictive power for risk-taking behavior was tested for gender, age, educational level, level of skiing, years of skiing, and helmet usage. Younger age, male gender, higher skiing level, and helmet usage were used as independent predictors for the overall Risk Index (Power [1-β err prob] = 0.942). Significantly higher risk was assessed for the male helmet wearers while the results were not significant for the female helmet wearers. The male occasional helmet wearers were found to be the most prone to risky behavior. In female nonhelmet wearers, there was a significant decrease in risk-taking behavior with age but this was not true for female helmet wearers. CONCLUSIONS For males under 35 years of age, helmet use is one of the factors influencing risk-taking on the slopes. This is demonstrated for occasional helmet wearers in particular.

Postoperative blood loss management in total knee arthroplasty: a comparison of four different methods

PurposeAs the blood loss after the total knee arthroplasty (TKA) is not only a potentially serious medical problem but also an economical concern, the purpose of the study was to investigate the effectiveness of different combinations of knee positioning and the applied wound dressings on blood saving after TKA.MethodsA randomized controlled trial including 147 TKA-operated patients was conducted. The subjects were assigned to one of the four groups; Group 1—controls, Group 2—flexion, Group 3—flexion and compression, Group 4—compression. The main outcome measures of the study were the blood loss volumes during the procedure and in the intensive care rooms and the decreases in haemoglobin, haemotocrit and red blood cells on the first and the second postoperative day.ResultsThe MANOVA results showed no differences between the groups in any of the observed parameters. The post-hoc comparisons of the each group to the control group also revealed no influence of any of the proposed blood saving techniques on the actual blood loss.ConclusionNo significant differences among the four proposed blood saving methods were determined.

Bilateral fibular stress fracture in young female basketball player.

This report is a unique case of three stress fractures in a 14-year-old active female basketball player and we emphasize the importance of triple-phase bone scanning in differential diagnosis of the stress fracture. According to radiographic examination and laboratory tests, which were normal, the stress fracture of the right fibula was strongly suspected while making the diagnosis. Despite the treatment applied, recurrence, and deterioration of the symptoms were presented. Repeated laboratory test results were again normal, but the presence of an abundant periosteal reaction on the plain radiographs was confusing, so osteomyelitis or Ewing sarcoma of the fibula was suspected. We decided to perform a three-phase bone scanning; its findings were critical for the judgment and we diagnosed three stress fractures involving both fibulae. Final confirmation of the diagnosis of the bilateral fibular stress fractures in our case, however, was done by computed tomography examination.

The influence of ski helmets on sound perception and sound localisation on the ski slope

OBJECTIVES The aim of the study was to investigate whether a ski helmet interferes with the sound localization and the time of sound perception in the frontal plane. MATERIAL AND METHODS Twenty-three participants (age 30.7±10.2) were tested on the slope in 2 conditions, with and without wearing the ski helmet, by 6 different spatially distributed sound stimuli per each condition. Each of the subjects had to react when hearing the sound as soon as possible and to signalize the correct side of the sound arrival. RESULTS The results showed a significant difference in the ability to localize the specific ski sounds; 72.5±15.6% of correct answers without a helmet vs. 61.3±16.2% with a helmet (p < 0.01). However, the performance on this test did not depend on whether they were used to wearing a helmet (p = 0.89). In identifying the timing, at which the sound was firstly perceived, the results were also in favor of the subjects not wearing a helmet. The subjects reported hearing the ski sound clues at 73.4±5.56 m without a helmet vs. 60.29±6.34 m with a helmet (p < 0.001). In that case the results did depend on previously used helmets (p < 0.05), meaning that that regular usage of helmets might help to diminish the attenuation of the sound identification that occurs because of the helmets. CONCLUSIONS Ski helmets might limit the ability of a skier to localize the direction of the sounds of danger and might interfere with the moment, in which the sound is firstly heard.