Damjan Dimnjaković

Current practice variations in the management of anterior cruciate ligament injuries in Croatia.

AIM To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. METHODS The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.

Peroneal tendoscopy – more than just a solitary procedure: case-series

This study presents a series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure at our department in 2013. Patients were clinically diagnosed with peroneal tendons disorders and underwent an additional radiological assessment. Peroneal tendoscopy was carried out in a standard manner before any other arthroscopic or open procedure. Postoperative management depended on the type of pathology. We found 3 peroneus brevis tendon partial tears, 4 cases of a low-lying peroneus brevis muscle belly, 5 cases of tenosynovitis, and 1 case of an intrasheath peroneal tendon subluxation. In 5 patients peroneal tendoscopy was performed as a solitary procedure and in 8 patients as an accessory procedure – together with anterior or posterior ankle arthroscopy, combined posterior and anterior ankle arthroscopy, or open surgery. Both as a solitary and accessory procedure, peroneal tendoscopy was safe and successful, ie, all patients were without any symptoms at one-year follow-up. Our series of patients showed that peroneal tendoscopy can be used both as an independent procedure as well as a valuable accessory procedure.

Clinical and MRI Outcomes After Surgical Treatment of Osteochondral Lesions of the Talus in Skeletally Immature Children.

Background:The literature on the osteochondral lesion of the talus (OLT) in skeletally immature children is scarce and little is known about the clinical outcomes and the radiologic appearance of these lesions after surgical treatment. The aim of this study was to assess mid-term clinical and magnetic resonance imaging (MRI) outcomes after arthroscopic microfracture (AM) of OLT in skeletally immature children. Methods:Thirteen patients with OLT treated by AM before skeletal maturity were included in the study. The Berndt and Harty outcome question, the Single Assessment Numeric Evaluation question, and the Martin questionnaire were used to obtain patients’ subjective satisfaction with their operated ankle. Functional outcomes preoperatively and postoperatively were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. MRI scans were performed postoperatively using a magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for 11 ankles. Results:The median age was 15 years (range, 13 to 16 y) and the median follow-up period was 5.6 years (range, 3.8 to 13.6 y). According to the Berndt and Harty outcome question, good clinical results were reported in 10 (76.9%) and fair in 3 (23.1%) patients. The postoperative AOFAS score was significantly improved when compared with the preoperative AOFAS score, with a mean increase of 35 points (P<0.001). The overall MOCART score was 65 (range, 10 to 75). MRI variables of the MOCART scoring system showed no association with clinical outcomes. Conclusions:AM seems to be an effective surgical method for the treatment of OLT in skeletally immature children. Level of Evidence:Level IV—therapeutic studies, case series.

Removal of Osteoid Osteoma of the Calcaneus Using Subtalar Arthroscopy.

Intra-articular calcaneal osteoid osteoma is a very rare condition and the diagnosis as well as the treatment is extremely challenging. We report a case of a 19-year-old male with intra-articular osteoid osteoma of the calcaneus, initially treated for peroneal tenosynovitis with unsatisfactory results. Thorough diagnostic procedure revealed the superolateral location of a calcaneal osteoid osteoma, near the sinus tarsi. A cherry-red elevated lesion typical of an osteoid osteoma nidus was completely removed arthroscopically using the anterolateral portal and the middle portal for subtalar arthroscopy. Histopathology confirmed the suspected diagnosis. The postoperative clinical course was uneventful with immediate pain relief and full weightbearing and movement allowed soon. The patient had no recurrent pain and normal joint mobility 8 months postoperatively. Considering the accessibility of the lesion, intra-articular osteoid osteoma of the calcaneus can be successfully treated arthroscopically using lateral approach for subtalar arthroscopy. Levels of Evidence: Therapeutic, Level IV: Retrospective, Case report

INFLUENCE OF FONDAPARINUX VERSUS NADROPARIN CALCIUM THROMBOPROPHYLAXIS ON CLINICAL PARAMETERS FOLLOWING TOTAL KNEE ARTHROPLASTY

Fondaparinux has been shown to be as effective as low molecular weight heparin in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The main goal of this prospective randomized controlled trial was to define whether thromboprophylaxis in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences clinical parameters in the same manner in patients receiving fondaparinux as in those receiving nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent unilateral TKA performed by the same surgeon and were randomized into two groups of 30 patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation of the edema during the early postoperative period. No differences were found between the groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. The level of urea was significantly lower in the nadroparin group on the first and second postoperative day. No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were noted during the study. Study results showed both fondaparinux and nadroparin to have the same influence on clinical parameters during the first 7 postoperative days in patients undergoing TKA.

Ganglion Cyst of the Knee: A Retrospective Review of a Consecutive Case Series

The aim of this study was to describe relevant medical history, clinical symptoms and outcomes in 12 patients having undergone surgical treatment of intra-articular ganglion cysts of the knee at our Department from January 2010 to June 2016. Patient demographics, medical history, knee manifestations, management and outcome were evaluated. The mean patient age was 26.4 (range, 16-46) years. Th ere were seven female and five male patients. Duration of symptoms prior to the operation varied from 2 months to 3 years (mean, 17.1 months). All patients had preoperative magnetic resonance imaging work-up of the knee. Pain was the most common clinical presentation. All patients were surgically treated arthroscopically, and an additional open approach was used in only one of the patients. There were no complications during surgery and the postoperative period was uneventful in all patients. The mean follow up period was 43.5 (range, 9-83) months and no recurrence was observed. All patients remained symptom-free with full range of motion at final follow up. Despite a wide range of intra-articular ganglion cyst presentations and symptoms, our cohort demonstrated an excellent remission rate and functional prognosis following surgical treatment of the ganglion cysts of the knee.

Operacijsko liječenje koštanohrskavičnih oštećenja talusa u djece

U medicinskoj literaturi malo je dostupnih podataka o operacijskom lijecenju kostanohrskavicnih ostecenja talusa (engl. Osteochondral Lesion of the Talus, OLT) u djece. Cilj ovog istraživanja bio je evaluirati srednjorocne rezultate lijecenja OLT-a artroskopskom stimulacijom kostane srži (engl. Bone Marrow Stimulation, BMS) tehnikom mikrofraktura u djece kod koje u trenutku operacijskog zahvata nije bila dostignuta kostana zrelost. U istraživanju je sudjelovalo 13-ero djece s dijagnosticiranim OLT-om koja su lijecena artroskopskom BMS tehnikom mikrofraktura, a kod koje su u trenutku operacijskog zahvata epifi zne pukotine rasta bile otvorene. Na zadnjem kontrolnom pregledu ispitanici su procijenili stanje operiranog gležnja pomocu Berndt and Harty (BH), Single Assessment Numeric Evaluation (SANE) i Martin upitnika. Funkcionalno stanje gležnja evaluirano je American Orthopaedic Foot and Ankle Society (AOFAS) upitnikom. Upitnik Short Form 36 (SF 36) primjenjen je za procjenu kakvoce života povezane sa zdravljem. Medijan životne dobi ispitanika u trenutku zahvata iznosio je 15 (13-16) godina, a medijan pracenja u poslijeoperacijskom razdoblju 5,6 (3,8-13,6) godina. Prema BH upitniku ishod lijecenja je u 10-ero bolesnika ocijenjen kao dobar, a kod troje zadovoljavajuci. Kod 11-ero ispitanika rezultati su prema SANE upitniku ocijenjeni kao izvrsni ili dobri. Utvrđeno je znacajno poboljsanje poslijeperacijskog AOFAS skora u odnosu na prijeoperacijski AOFAS skor, a prosjecna razlika je iznosila 35 bodova. Medijan zbirne komponente tjelesnog i mentalnog zdravlja SF 36 upitnika nalazio se u normalnim granicama za hrvatsku populaciju. Artroskopska BMS tehnika mikrofraktura pouzdana je i ucinkovita operacijska metoda za lijecenje OLT-a u djece kod koje nije dostignuta kostana zrelost.