Tomasz Piontek

All-arthroscopic AMIC procedure for repair of cartilage defects of the knee.

PurposeBone marrow mesenchymal stem cells were introduced into clinical practice due to their ability to differentiate into many types of cells. Autologous matrix-induced chondrogenesis (AMIC) combines the microfracture method with matrix-based techniques that utilizes a collagen membrane to serve as a scaffold for new bone marrow mesenchymal stem cells, allowing effective reconstruction of even large fragments of a damaged cartilage surface.MethodsAll-arthroscopic technique to repair knee cartilage defects using the AMIC technique, which includes the use of a collagen matrix (porcine collagen type I and III) and fibrin glue—technique presentation.ConclusionThis technical note introduces an all-arthroscopic AMIC technique to reconstruct extensive cartilage defects (without bone defects). The technique may be used for treatment of all location of knee cartilage lesions.Level of evidenceV.

Abdominal compartment syndrome - the prevention and treatment of possible lethal complications following hip arthroscopy: a case report

IntroductionIntra-abdominal hypertension and abdominal compartment syndrome have been increasingly recognized as a hip arthroscopy complication over the past decade. In the absence of consensus definitions and treatment guidelines, the diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome remains variable from institution to institution.Case presentationWe report the occurrence of the extravasation of fluid into the abdomen during arthroscopic treatment of femoroacetabular impingement combined with resection of trochanteric bursa and our management of the condition in a 55-year old Caucasian woman.ConclusionsWe present an algorithm of treatment of abdominal compartment syndrome, as a hip arthroscopy complication, according to the consensus definitions and recommendations of the World Society of the Abdominal Compartment Syndrome. In the algorithm options, we have included paracentesis and percutaneous catheter decompression as the main point of treatment. Our algorithm will have a broader clinical impact on orthopedic surgery, anesthesiology and emergency medicine.

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with autologous hamstring grafts-isokinetic assessment with control group.

Objective The aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group. Design Controlled Laboratory Study. Materials and Methods Results of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and “drawer” test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises. Results After arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065) and extensors (p = 0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044) and Lysholm (p = 0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm). Conclusions Although harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function.

EVALUATION OF FUNCTIONAL LIMITATIONS IN FEMALE SOCCER PLAYERS AND THEIR RELATIONSHIP WITH SPORTS LEVEL – A CROSS SECTIONAL STUDY

The main objective(s) of the study The aim of this study was to analyze: a) abnormalities in the length of lower limb muscles, b) the correctness of movement patterns, and c) the impact of functional limitations of muscles on the correctness of fundamental movement patterns in a group of female soccer players, in relation to their skill level. Materials and Methods 21 female soccer players from Polish Ekstraklasa and 22 players from the 1st Division were tested for lower limb muscle length restrictions and level of fundamental movement skills (with the Fundamental Movement Screen™ test concept by Gray Cook). Chi-square test was used for categorical unrelated variables. Differences between groups in absolute point values were analyzed using the non-parametric Mann-Whitney U test. Statistical significance was set at p<0.05. Results Statistically significant higher number of measurements indicating an abnormal length of rectus femoris was observed in the 1st Division group (p = 0.0433). In the group of Ekstraklasa the authors obtained a significantly higher number of abnormal hamstring test results (p = 0.0006). Ekstraklasa players scored higher in the rotational stability test of the trunk (p = 0.0008), whereas the 1st Division players scored higher in the following tests: deep squat (p = 0.0220), in-line lunge (p = 0.0042) and active straight leg raise (p = 0.0125). The results suggest that there are different functional reasons affecting point values obtained in the FMS™ tests in both analyzed groups. Conclusions The differences in the flexibility of rectus femoris and hamstring muscle observed between female soccer players with different levels of training, may result from a long-term impact of soccer training on the muscle-tendon system and articular structures. Different causes of abnormalities in fundamental movement patterns in both analyzed groups suggest the need for tailoring prevention programs to the level of sport skills represented by the players.

Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection A 2-Year Clinical Follow-Up

Objective To collect and analyze the 2-year follow-up clinical and MRI results of patients treated with an arthroscopic technique of collagen membrane-based meniscus repair. Design 53 consecutive patients with combined (horizontal and radial or longitudinal component) and complex meniscal tears (tear extended through avascular zones or/and composed with two or more morphological tear pattern) were treated with an “all-inside” arthroscopic suture of meniscus and wrapping with a collagen membrane (Chondro-Gide) technique with bone marrow blood injection. The IKDC 2000 subjective score, IKDC 2000 clinical evaluation score, Lysholm score and Barret clinical criteria of meniscal healing were recorded. All patients were examinated by MRI 2 years postoperatively, using modified WORMS criteria for meniscal integrity. Results The 2 year follow-up was achieved in 50 cases. Of these, 2 patients were excluded from the evaluation due to incomplete data and 2 patients underwent partial meniscectomy and were classified as failures. In 46 patients (86.8% of the intended to treat cases), a statistically significant improvement in IKDC 2000 subjective, Lysholm scores and IKDC 2000 clinical assessment between preoperative and the 2-year follow-up time points were obsereved. Barret criteria demonstrated an improved clinical outcome between pre- and post-operative values. MRI revealed a non-homogeneous signal without meniscal tear (WORMS grade 1) in 76% of the operated menisci (13% WORMS grade 2). Conclusions The 2-year follow-up data demonstrate that this technique is safe and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. Level of evidence IV

STRATEGY OF VISUAL PROPRIOCEPTIVE CONTROL IN PATIENTS WITH INJURY TO THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE AND HEALTHY INDIVIDUALS (SOCCER PLAYERS)

Objective: Knee joint dysfunction resulting from injury to the anterior crucial ligament (ACL) is associated not only with mechanical joint instability but also with damage of ligamentous receptors responsible for the joint proprioception. It was found that disturbances of signals from the damaged joint produce disorders in movement perception and position of the analogous joint in the normal limb. This study is aimed at evaluating the control strategy in patients with an injury to the anterior crucial ligament.Design: Cohort study; Level of evidence, 3. Subjects/Patients84 men, aged 15 to 55 years (mean age 27 years) were included in this study. MethodsPatients were divided into two groups: those with unilateral injury to the ACL (33 patients) and a control group of healthy volunteers (soccer players; 51 men). Anterior crucial ligament damage was confirmed with arthroscopic knee joint examination in every patient. The way of visual proprioceptive control was assessed with both dynamic (DRT) and static (SRT) Riva tests standing on one leg. Tests were performed with the Delos Postural Proprioceptive System (Delos s.r.l., Corso Lecce, Torino, Italy) in the biomechanical evaluation laboratory at Rehasport Clinic in Poznań. Results: A statistically significant difference for deviations from the averaged axis in SRT (static Riva test) with closed eyes was found between the limb with a damaged ACL and the normal limb in the group of patients with injury to the ACL (p=0.006) and between the limb with a damaged ACL and normal limbs in healthy volunteers (p=0.022). A statistically significant difference for deviations from the averaged axis in SRT with closed eyes was also found between the dominant and non-dominant limb in healthy volunteers (p=0.013). No significant differences in the results of tests with open eyes were noted. Conclusions: The results of systems and their contribution to the visual proprioceptive control suggest an important role of the visual system in compensation of archeproprioceptive system disorders resulting from injury to the ACL. Clinical Relevance: Neurological deficits of proprioceptive perception, associated with injury to the ACL and affecting the balance, may be noted only in the results of tests performed with closed eyes.

Arthroscopic Treatment of Chondral and Osteochondral Defects in the Ankle Using the Autologous Matrix-Induced Chondrogenesis Technique.

One of the greatest challenges nowadays facing orthopaedic surgeons around the world is the problem of articular cartilage defects and their treatment. The autologous matrix-induced chondrogenesis technique is based on 2 elements-drilling into bones and matrix application. The purpose of this article is to present the surgical technique of arthroscopic treatment of chondral or osteochondral defects in the ankle using the autologous matrix-induced chondrogenesis technique.

HAMSTRING/QUADRICEPS RATIO IN ACL INJURY PREDICTION IN ELITE FOOTBALL PLAYERS

Background Hamstring/quadriceps conventional ratio (H/Q) has been widely used in the prediction of anterior cruciate ligament (ACL) injury; however there is still no consensus on the values that are really predictive for ACL injury in elite male football players. Objective To verify the value of H/Q predictive for ACL injury in elite male footballers. Design Retrospective study, analysing ACL injury occurrence in footballers and H/Q value from isokinetic tests. Setting Male football elite division. Patients (or Participants) Records of 74 professional male footballers who played at least one season between 2010–2016 have been analysed. Interventions (or Assessment of Risk Factors) All players were monitored and treated by one clinic, thus medical history of each player was documented. ACL injury was confirmed in USG examination. Players were dichotomously categorized as injured or uninjured for data analysis. The same clinic was responsible for conducting isokinetic assessment using Biodex System 3 Pro. Retrospective footballers records were reviewed between May 2006 and April 2016. Receiver operating characteristic (ROC) curves were used to evaluate the possibility of using the H/Q value to predict ACL injury. Level of significance was set at p<0.05 and Statistica v.12.5 software was used. Main Outcome Measurements Area under the curve (AUC); number of ACL injuries and values of H/Q were also analysed. Results Total 331 knee isokinetic tests of 74 elite male football players were reviewed, and data of 8 ACL injuries were analysed. Cut-off value of H/Q ratio was calculated at 0.63±0.11. The ROC analyses showed an area under the curve of 0.67 (95% CI 0.49–0.84; p=0.0598). Conclusions Although it occurred to be insignificant we observed a tendency towards H/Q values at 0.63±0.11, that may be useful in future studies in multifactorial analysis of ACL injury prediction. However, studies on bigger sample should be performed to verify these results.

APPRAISAL OF THE FUNCTIONAL MOVEMENT SCREEN IN FOOTBALL INJURY PREDICTION

Background Functional Movement Screen (FMS) has been used in the prediction of football injuries. However, the discussion continues on how sensitive and specific the test is. Lately, systematic review [McCall et al. 2014] enrolling studies published up to September 2014 and clinical commentary [Wright et al. 2016] were published underlying caution prior to implementation of the FMS into clinical practice as an injury prediction tool. Thus, it seems necessary to up-date the debate. Objective To provide up-to-date evidence-based summary of available evidence regarding the predictive value of FMS in football players. Design Critically Appraised Topic. Setting Amateur, collegiate Division I and II. Patients (or Participants) Male and female footballers. Interventions (or Assessment of Risk Factors) Medline, SPORTDiscuss/with/Full Text, Academic Search Complete, Nursing/Academic Edition, MasterFILE Premier databases were searched (on August 31st 2016) using “football”, “soccer”, “functional movement screen” keywords. Only prospective cohort studies published as full article in reviewed journals were included. Main Outcome Measurements Between samples – injured vs. uninjured analysis, odd ratio (OR), likelihood ratio (LR), receiver operating curve (ROC). Results Our search yielded 18 studies, after abstract revision 3 articles met the criteria. The first [Warren et al. 2015] did not confirm the validity of FMS in injury prediction (OR=1.01, 95% CI 0.53–1.91). The second [Schroeder et al. 2016] showed no difference between injured/uninjured players in FMS score (Z=−0.890, p=0.373), concluding FMS to be a poor predictor of injury in football players. The third [Mokha et al. 2016] found that asymmetry was a better predictor of injury than the composite FMS score. None of the studies used LR ratio or ROC curve analyses in statistical analysis. Conclusions Caution is required when applying FMS in football injury prediction. It is necessary to conduct a well-designed prospective study with sufficient statistical analysis used for predictive parameters to justify the use of FMS test in injury prediction in football players.

Acute Adductor Muscle Injury

The main sign of the adductor muscle injury is intense pain in the groin area. The diagnosis of adductor syndromes is sometimes difficult to determine, as numerous patients may experience symptoms similar to those of adductor muscle injury.