Publications by authors named "Andrzej Grzegorzewski"

64 Publications

Pediatric Monteggia Fracture Outcome Assessment - Preliminary Report.

Ortop Traumatol Rehabil 2022 Apr;24(2):79-86

Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland.

Background: The term Monteggia fracture refers to a class of injuries encompassing the fracture of the proximal end of the ulna with subluxation or dislocation of the radial head. These injuries account for 0.4-1% of all forearm fractures in children. Despite its low incidence, Monteggia fractures require particular attention, since as much as 30-50% of the cases may be unrecognized, which subsequently leads to complications. The purpose of this paper is to evaluate treatment outcomes of Monteggia fractures in children. Both conservative treatment and surgery were analyzed.

Material And Methods: 15 children (7 boys and 8 girls) between the ages of 4-16.3 years (mean age 8.3 years) with Monteggia fractures were hospitalized at our center in the years 2015-2020. Closed reduction and immobilization in a cast were performed in 12 patients, while three children underwent surgical treatment with internal fixation of the ulna. The radial head dislocation was reduced successfully in every patient.

Results: Every child from the study group who received conservative treatment regained full elbow mobility as well as normal forearm supination and pronation. Only one of the patients who underwent the surgery demonstrated a 20° deficit in elbow flexion that did not affect limb function.

Conclusions: 1. Our experience shows that closed reduction together with immobilization in a cast is usually a sufficient treatment in Monteggia fractures. 2. However, the dislocated radial head should be properly reduced in all patients. 3. Correct diagnosis and treatment followed by appropriate rehabilitation result in full recovery and no mobility limitations in children and teenagers.
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http://dx.doi.org/10.5604/01.3001.0015.8265DOI Listing
April 2022

Effectiveness of conservative treatment of multidirectional instability of the shoulder joint. Literature review and meta-analysis.

Pol Przegl Chir 2021 Aug;94(1):6-11

Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland.

<br><b>Introduction:</b> Multidirectional shoulder instability (MDI) occurs when the shoulder is dislocating in at least two directions. The patient usually experiences pain with apprehension and a clicking sensation inside the joint. So far, a few classification scales of shoulder instability have been made. Despite this fact, MDI is highly problematic for clinicians in diagnosis and treating.</br> <br><b>Aim:</b> This article presents the current trends in the conservative treatment of multidirectional instability, assess effectiveness of rehabilitation and indicates the directions of MDI research.</br> <br><b>Material and methods:</b> In order to find current literature and conduct a critical analysis, the following scientific database was used: Cochrane Library, Physiotherapy Evidence Database (PEDro), MEDLINE and PubMed. We chose four articles which included a comparison of conservative and operative treatment, and four which evaluate the effectiveness of rehabilitation.</br> <br><b>Results:</b> Low quality evidence shows priority of surgical treatment over conservative treatment. The protocol developed by Watson obtains a statistically significant advantage over the Burkhead and Rockwood protocol. Discussion: The effectiveness of rehabilitation reaches different levels. Rehabilitation should last from 3 to 12 months. If rehabilitation does not achieve a sufficient effect, arthroscopic methods of reducing the volume of the articular capsule should be considered. Due to the small number of scientific reports and their quality, the obtained data should be interpreted with caution. Much further research is required to create a precise and most effective algorithm.</br> <br><b>Conclusion:</b> Rehabilitation exercises play an important role in the treatment of multidirectional instability of the shoulder joint, especially when the patient has not had an injury. Exercise types and load should be dosed individually. At present, the protocol described by Watson is the most effective.</br>.
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http://dx.doi.org/10.5604/01.3001.0015.2415DOI Listing
August 2021

Analysis of Outcomes of Total Cementless Hip Joint Arthroplasty in the Treatment of Advanced Hip Osteoarthritis Following Childhood Perthes' Disease.

Ortop Traumatol Rehabil 2020 Oct;22(5):327-337

Klinice Ortopedii i Ortopedii Dziecięcej Uniwersytetu Medycznego w Łodzi, Łódź, Polska / Department of Orthopaedics and Paediatric Orthopaedics of the Medical University of Lodz, Poland.

Background: The aim of this study is to analyse the outcomes of total cementless hip joint arthroplasty in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood.

Material And Methods: The study enrolled 56 patients (15 women and 41 men) who underwent a total of 61 hip joint arthroplasties for coxarthrosis following Perthes' disease. The mean age of the patients at surgery was 46.7 years (range 21-67 years). The mean follow-up period was 13.7 years.

Results: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 25 cases, good in 16, satisfactory in 16 and poor in 9 cases. Poor results were always related to loosening of the acetabular cup. Heterotopic ossification was noted in 7 cases. According to the Kaplan-Meier estimator, 10 years' survival probability was 85.24% for the whole implant and 100% for the stem.

Conclusions: 1. Total cementless hip joint arthroplasty is an effective method in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the patients' young age, there may be more cases of loosening over time, requiring regular long-term follow-up.
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http://dx.doi.org/10.5604/01.3001.0014.4216DOI Listing
October 2020

Acetabular shape and orientation of the spastic hip in children with cerebral palsy.

Dev Med Child Neurol 2021 05 7;63(5):608-613. Epub 2021 Jan 7.

Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland.

Aim: To see if three-dimensional (3D) methods could bring new understanding to acetabular changes in shape and orientation in the spastic hip and in which direction(s) acetabular orientation might change, which is crucial for planning appropriate hip correction surgery.

Method: We performed a retrospective study of pelvic computed tomography (CT) examinations in 20 consecutive patients (10 females, 10 males). The mean age of patients was 12 years 9 months (SD 2y; range: 9-16y) at the time of the CT examination. The control group consisted of 18 consecutive pelvic CT examinations (36 acetabula) of deceased individuals (six females, 12 males) aged 4 to 17 years (mean age: 10y 6mo; SD 5y 2mo) whose whole-body CT scans were taken shortly after their death. We compared 3D CT reconstructions of 28 unstable and dislocated hips in children with bilateral cerebral palsy (Gross Motor Function Classification System levels IV and V) with the unaffected side and typically developing controls to assess spatial orientation (inclination, anteversion, and tilt), acetabular volume, and surface area. Additionally, we analysed the multiple factors that may lead to structural and spatial changes of the acetabulum.

Results: Patients with dislocated and spastic hips had significantly lower anteversion (-3.2° and -1.4° respectively, p<0.001), increased inclination (85.2° and 85.3° respectively, p<0.001), and decreased tilt (24.6° [p=0.014] and 20.7° [p=0.013] respectively) compared with typically developing individuals. Regarding acetabular volume and surface area, dislocated and unstable hips had significantly lower volume (17.6ml vs 31.5ml respectively, p<0.001) and surface area (28.9cm vs 36.2cm respectively, p<0.001) than unaffected hips. Among several factors, only Reimer's migration index had an influence on acetabular orientation (i.e. anteversion, p=0.01), volume (p<0.001), and surface (p=0.004).

Interpretation: Acetabula in patients with spastic hip disease were severely retroverted with increased steepness; acetabular orientation was distorted superoposteriorly. In rare cases, acetabular orientation was distorted only superiorly or superoanteriorly.

What This Paper Adds: Acetabular orientation was distorted superoposteriorly in most patients with severe bilateral cerebral palsy. More pronounced acetabular changes were found in hips with a higher Reimer's migration index.
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http://dx.doi.org/10.1111/dmcn.14793DOI Listing
May 2021

CORR Insights®: Isolated Trochanteric Descent and Greater Trochanteric Apophyseodesis Are Not Effective in the Treatment of Post-Perthes Deformity.

Clin Orthop Relat Res 2020 01;478(1):176-178

A. Grzegorzewski, Medical University of Lodz, Department of Orthopaedics and Pediatric Orthopaedics, Lodz, Poland.

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http://dx.doi.org/10.1097/CORR.0000000000001057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000067PMC
January 2020

Variation in pelvic shape and size in Eastern European males: a computed tomography comparative study.

PeerJ 2019 20;7:e6433. Epub 2019 Feb 20.

Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland.

Background: The significantly accelerated development of human society in the last millennium has brought about changes in human behavior and body mass that may have influenced human bone morphology. Our objective was to analyze the variation in pelvic shape and size in males from modern and medieval populations.

Methods: We obtained 22 pelvic girdles of adult males from a medieval cemetery located in Cedynia, Poland. The control group comprised 31 contemporary male pelves from individuals inhabiting the same region. The analyzed parameters were: interspinous distance (ISD), intercristal distance (ICD), intertuberous distance (ITD), anatomic conjugate of the pelvis, height of the pelvis (HP), iliac opening angle (IOA), iliac tilt angle (ITA), and ISD/ITD/HP ratio. Geometric morphometrics was used to analyze differences in shape in the pelves. All analyses were carried out on three-dimensional CT reconstructions of pelves.

Results: ISD, ICD, and IOA were significantly greater in modern pelves than in those from Cedynia, but no significant differences were seen between the two groups in ITD, anatomical conjugate, HP, or ITA. ISD/ITD/HP ratios were significantly lower in the Cedynia group. Geometric morphometrics revealed significant differences in pelvic shape between the analyzed groups.

Discussion: The pelves of modern males are larger, wider, and flatter than those of medieval males. Changes in the set of daily activities that produce mechanical loading and estimated body mass may constitute the main factors explaining pelvic variability. However, differences in ontogenesis should also be taken into consideration, especially since growth in past populations is often found to be reduced relative to modern populations.
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http://dx.doi.org/10.7717/peerj.6433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387581PMC
February 2019

Radial Extracorporeal Shockwave Therapy and Ultrasound Therapy in the Treatment of Tennis Elbow Syndrome.

Ortop Traumatol Rehabil 2017 Oct;19(5):415-426

Uniwersytet Medyczny w Łodzi / Medical University of Lodz Klinika Ortopedii i Ortopedii Dziecięcej / Department of Orthopaedics and Paediatric Orthopaedics.

Background: Both ultrasound and radial shockwave therapies are used to treat tennis elbow syndrome. The aim of this study was to compare the therapeutic efficacy of both therapies by assessing the reduction in pain intensity and frequency, restoration of mobility, and reduction in the need for pain medication.

Material And Methods: The study enrolled 60 people, who were randomly divided into two groups of 30 patients: those treated by radial shockwave therapy and those treated by ultrasound therapy. Radial shockwave therapy consisted of 3 sessions at weekly intervals. Ultrasound therapy consisted of 10 treatments performed daily. The clinical status of the patients before treatment, just after treatment, and after 8 weeks was assessed with the Leitinen questionnaire and a visual analogue scale (VAS).

Results: Pain reduction, as assessed by VAS scores, was observed in both groups, who were not different at baseline (p=0.807). While both therapies were effective (p<0.005), mean pain intensity assessed by VAS scores in patients treated by radial shockwave therapy was significantly lower compared to those treated by ultrasound therapy; this relationship was present just after treatment completion (p=0.001) and at 8 weeks after treatment completion (p=0.002).

Conclusions: 1. Both radial shockwave and ultrasound therapies cause a reduction in the intensity and frequency of pain that persists for at least 8 weeks, reducing the need for pain medication and improving the function of the treated upper limb. 2. Ultrasound therapy is less effective than radial shockwave therapy.
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http://dx.doi.org/10.5604/01.3001.0010.5821DOI Listing
October 2017

Comparison Analysis of Autologous Conditioned Plasma.

Ortop Traumatol Rehabil 2016 11;18(6):563-568

Department of Orthopaedics and Paediatric Orthopaedics, Medical University in Łódź, Poland.

Background: Autologous Conditioned Plasma (ACP) has a wide range of potential uses in modern orthopaedics. The aim of this study was to examine the characteristics of proprietary ACP and compare them with those of ACP produced using a commercially available kit.

Material And Methods: In the hospital laboratory, 20 samples of ACP taken from patients and prepared according to the commercially available kit protocol with a double syringe system were compared with 40 ACP preparations made using disposable sterile equipment available in the hospital.

Results: The mean platelet concentration in the ACP samples prepared according to the Arthrex protocol was 2.02 (range 1.16 to 2.64) times greater than in peripheral blood, while the concentration in the proprietary preparation was 1.61 (range 0.82 to 2.52) times higher. However, the mean platelet density in the proprietary preparation (n = 24) was 1.98 (range 1.48 to 2.52) times that of peripheral blood within 20 minutes of collection, and 1.41 (range 0.84 - 1.87) times after 20 minutes (n = 16). Therefore, the proprietary method of producing ACP is comparable to that of the commercial kit with regard to platelet density (p>0.05).

Conclusion: Using disposable hospital equipment and with a relatively short time between ACP preparation and testing, it is possible to obtain a suitable proprietary platelet-rich preparation comparable to one produced using a commercial system.
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http://dx.doi.org/10.5604/15093492.1230542DOI Listing
November 2016

Bilateral hypermobility of ulnar nerves at the elbow joint with unilateral left ulnar neuropathy in a computer user: A case study.

Int J Occup Med Environ Health 2016 ;29(3):517-22

Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Occupational Diseases and Toxicology).

Occupational ulnar neuropathy at the elbow joint develops in the course of long term direct pressure on the nerve and a persistently flexed elbow posture, but first of all, it is strongly associated with "holding a tool in a certain position" repetitively. Therefore, computer work only in exceptional cases can be considered as a risk factor for the neuropathy. Ulnar hypermobility at the elbow might be one of the risk factors in the development of occupational ulnar neuropathy; however, this issue still remains disputable. As this condition is mostly of congenital origin, an additional factor, such as a direct acute or chronic professional or non-professional trauma, is needed for clinical manifestations. We describe a patient - a computer user with a right ulnar nerve complete dislocation and left ulnar nerve hypermobility, unaware of her anomaly until symptoms of left ulnar neuropathy occurred in the course of job exposure. The patient was exposed to repetitive long lasting pressure of the left elbow and forearm on the hard support on the cupboard and desk because of a non-ergonomically designed workplace. The additional coexistent congenital abnormal displacement of the ulnar nerve from the postcondylar groove during flexion at the elbow increased the possibility of its mechanical injury. We recognized left ulnar neuropathy at the ulnar groove as an occupational disease. An early and accurate diagnosis of any form of hypermobility of ulnar nerve, informing patients about it, prevention of an ulnar nerve injury as well as compliance with ergonomic rules are essential to avoid development of occupational and non-occupational neuropathy.
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http://dx.doi.org/10.13075/ijomeh.1896.00398DOI Listing
January 2017

Does hemipelvis structure and position influence acetabulum orientation?

BMC Musculoskelet Disord 2016 Mar 16;17:131. Epub 2016 Mar 16.

Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Kościuszki 4, Łódź, Poland.

Background: Although acetabulum orientation is well established anatomically and radiographically, its relation to the innominate bone has rarely been addressed. If explored, it could open the discussion on patomechanisms of such complex disorders as femoroacetabular impingement (FAI). We therefore evaluated the influence of pelvic bone position and structure on acetabular spatial orientation. We describe this relation and its clinical implications.

Methods: This retrospective study was based on computed tomography scanning of three-dimensional models of 31 consecutive male pelvises (62 acetabulums). All measurements were based on CT spatial reconstruction with the use of highly specialized software (Rhinoceros). Relations between acetabular orientation (inclination, tilt, anteversion angles) and pelvic structure were evaluated. The following parameters were evaluated to assess the pelvic structure: iliac opening angle, iliac tilt angle, interspinous distance (ISD), intertuberous distance (ITD), height of the pelvis (HP), and the ISD/ITD/HP ratio. The linear and nonlinear dependence of the acetabular angles and hemipelvic measurements were examined with Pearson's product - moment correlation and Spearman's rank correlation coefficient. Correlations different from 0 with p < 0.05 were considered statistically significant.

Results: Comparison of the axis position with pelvis structure with orientation in the horizontal plane revealed a significant positive correlation between the acetabular anteversion angle and the iliac opening angle (p = 0.041 and 0.008, respectively). In the frontal plane, there was a positive correlation between the acetabular inclination angle and the iliac tilt angle (p = 0.025 and 0.014, respectively) and the acetabular inclination angle and the ISD/ITD/HP ratio (both p = 0.048).

Conclusions: There is a significant correlation of the hemipelvic structure and acetabular orientation under anatomic conditions, especially in the frontal and horizontal planes. In the anteroposterior view, the more tilted-down innominate bone causes a more caudally oriented acetabulum axis, whereas in the horizontal view this relation is reversed. This study may serve as a basis for the discussion on the role of the pelvis in common disorders of the hip.
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http://dx.doi.org/10.1186/s12891-016-0982-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794903PMC
March 2016

NERVE ENDINGS AND VASCULAR SUPPLY IN SEMITENDINOSUS TENDON OF CEREBRAL PALSY CHILDREN.

Acta Ortop Bras 2015 Sep-Oct;23(5):259-62

Medical University of Lodz, Orthopedics and Pediatric Orthopedics Clinic, Lodz, Poland.

Objective: To evaluate the distribution of SP (substance P) and S-100 peptide immunoreactivity, as well as the vascular supply of tissues commonly used as grafts for anterior cruciate ligament (ACL) reconstruction. A second aim was to compare the above mentioned distribution in the semitendinosus muscle tendons of cerebral palsy (CP) patients with the semitendinosus muscle tendons and patellar tendons of patients without CP.

Methods: The first group consisted of 14 children with cerebral palsy with a mean age of 11.7 years old. At the time of hamstring lengthening operation, a sample of semitendinosus muscle was taken for analysis. The second group comprised 20 patients treated for isolated ACL rupture of the knee (mean age 32 years old). Group three comprised ten patients in the mean age of 14.3 years old treated for recurrent lateral patellar dislocation, and from whom a sample of patellar tendon was obtained.

Results: No statistically significant differences were demonstrated with regard to the amount of immunopositive nerve fibers expressing SP or S-100 in all 3 groups of patients. A significant difference was noted in the number of blood vessels between the adult and child semitendinosus muscles, but not between the semitendinosus muscles and patellar tendon of children.

Conclusion: The number of nociceptors as well as proprioceptive fibers is similar in patients with CP and patients from a neurologically healthy population. Level of Evidence IV, Cases Series.
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http://dx.doi.org/10.1590/1413-785220152305142813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775478PMC
March 2016

Anterior Cruciate Ligament Reconstruction Using the Transphyseal Technique in Prepubescent Athletes: Midterm, Prospective Evaluation of Results.

Arthroscopy 2016 06 9;32(6):1141-6. Epub 2016 Mar 9.

Department of Orthopaedics and Pediatric Orthopaedics, Medical University of Lodz, Lodz, Poland.

Purpose: To evaluate the efficacy, results, and complications of transphyseal technique of anterior cruciate ligament (ACL) reconstruction in prepubertal patients and to assess a possible influence of children's growth on the outcome.

Methods: Between 2005 and 2009, 22 (16 boys and 6 girls) prepubescent patients, Tanner stage 1 and 2, underwent ACL reconstruction and the follow-up 6, 12, and 24 months after surgery and after growth plate closure. The average age of the girls was 11.2 years, and of the boys, 12.3 years. The average follow-up period was 77.2 months. Clinical outcome was evaluated by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) objective and subjective knee scores. Standard radiograms were performed for potential axial growing disturbance.

Results: The average follow-up period was 77.2 months (range, 54 to 102 months), and IKDC subjective scores changed from 58 (range, 44 to 69) before surgery to 87 (range, 86 to 87; P = .00) at 6 months, 93 (range, 88 to 97; P = .00) at 12 months, and 95 (range, 92 to -98; P = .5) at final examination. Lysholm score increased from 58 (range, 53 to 64) before surgery to 89 (range, 85 to 92; P = .00) at 6 months and 96 (range, 94 to 100; P = .00) at 12 months, 24 months (P = .9), and final examination (P = .8). Before injury, all patients were graded 7 on the Tegner scale. Nineteen athletes reached at least grade 7 and returned to the level of activity a mean of 9 months after the surgery. No patient had deformity or growth disturbances observed clinically.

Conclusions: Arthroscopic-assisted transphyseal ACL reconstruction in prepubescent patient is a promising technique, provided that all technical details are respected. It gives excellent subjective and objective knee scores and provides a very good function of the knee joint in the midterm period with no or only minor effect on the leg length. The rate of growth after surgery did not influence the results.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2015.11.045DOI Listing
June 2016

Social Attitudes toward Cerebral Palsy and Potential Uses in Medical Education Based on the Analysis of Motion Pictures.

Behav Neurol 2015 14;2015:341023. Epub 2015 Jul 14.

Department of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, 91-002 Łódź, Poland.

This study presents how motion pictures illustrate a person with cerebral palsy (CP), the social impact from the media, and the possibility of cerebral palsy education by using motion pictures. 937 motion pictures were reviewed in this study. With the criteria of nondocumentary movies, possibility of disability classification, and availability, the total number of motion pictures about CP was reduced to 34. The geographical distribution of movie number ever produced is as follows: North America 12, Europe 11, India 2, East Asia 6, and Australia 3. The CP incidences of different motor types in real world and in movies, respectively, are 78-86%, 65% (Spastic); 1.5-6%, 9% (Dyskinetic); 6.5-9%, 26% (Mixed); 3%, 0% (Ataxic); 3-4%, 0% (Hypotonic). The CP incidences of different Gross Motor Function Classification System (GMFCS) levels in real world and in movies, respectively, are 40-51%, 47% (Level I + II); 14-19%, 12% (Level III); 34-41%, 41% (Level IV + V). Comparisons of incidence between the real world and the movies are surprisingly matching. Motion pictures honestly reflect the general public's point of view to CP patients in our real world. With precise selection and medical professional explanations, motion pictures can play the suitable role making CP understood more clearly.
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http://dx.doi.org/10.1155/2015/341023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516815PMC
April 2016

A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis.

Int Orthop 2015 Nov 30;39(11):2199-203. Epub 2015 Jul 30.

Clinic of Orthopaedics and Paediatric Orthopaedics Medical University of Łódź, Pomorska 251, 92-213, Łodź, Poland.

Purpose: Chronic tendinopathy of lateral epicondyle of the humerus, commonly known as "tennis elbow" is one of the most frequent tendinopathies caused by recurrent overload of the muscle origins. The aim of the study was to assess the effectiveness of treating lateral epicondylitis (LE) with autologous conditioned plasma (ACP) and betamethasone injections, and to compare these methods over the course of a one year follow-up.

Methods: Patients were randomly placed into one of into two groups: 53 were treated with ACP, and 46 with 1 ml betamethasone injections and 2 ml of 1 % lignocaine. Both those groups were comparable in terms of initial DASH score.

Results: After six weeks and six months, the mean DASH score was significantly better in the betamethasone group, but was better in ACP group after one year. Full recovery (patients with no symptoms) at all time points was more common in the betamethasone group. A comparison of grouped DASH scores revealed more very good and good results in the ACP group after one year. More patients had pain symptoms related to injection in the ACP group than the betamethasone group.

Conclusions: ACP therapy of LE allows better results to be obtained at 12 months. Betamethasone injections give more rapid improvement, but the therapeutic effect is longer lasting in the ACP group.
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http://dx.doi.org/10.1007/s00264-015-2861-0DOI Listing
November 2015

Early results of revision acetabular cup using antiprotrusio reconstruction rings and allografts.

Indian J Orthop 2015 May-Jun;49(3):317-22

Department of Orthopedics, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland.

Background: Hip arthroplasty is one of the most frequently performed orthopedic procedures with high scores of success while its most common complication is aseptic loosening of the acetabular component, which may result from host bone loss or even from pelvis discontinuity. The purpose of the study was to evaluate results in patients after revision acetabular arthroplasty with reconstruction rings and allografts.

Materials And Methods: Retrospective data was collected from 69 revisions of acetabular components, performed in a group of 69 treated patients (the mean age 65.1 years). Before surgery, the patients had bone defects of type IIb (n = 5), IIc (n = 20), IIIa (n = 27) or IIIb (n = 17), according to Paprosky et al.

Results: The mean followup period of the patients was 7.2 years (range 3-19 years). A Kaplan-Meier analysis showed that a 3- and 10 year survival rate was 92.8% and 84.8% respectively, using further revision for any reason of the acetabular device as an end point. Eight patients revealed implant related complications. Four patients presented with ring loosening, one with a loose acetabular polyethylene cup, two hips demonstrated recurrent dislocations and one patient was with deep infection. Regarding the remaining 61 patients without re-revision surgery, the mean Harris hip score improved from 30.5 to 73.8 points.

Conclusion: A modified, antiprotrusion cage provides an acceptable survival rate and radiological results, but complications could still be expected. It seems that the observed massive bone loss with pelvic discontinuity and an insufficient fixation of the cage to the ischium may result in implant loosening. Stable fixation of the ischial ring flange with screws is an essential condition to expect a good outcome.
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http://dx.doi.org/10.4103/0019-5413.156205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443414PMC
May 2015

An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction.

BMC Musculoskelet Disord 2015 Feb 25;16:42. Epub 2015 Feb 25.

Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, ul. Kościuszki 4, Łódź, Poland.

Background: Two-dimensional (2D) measurements of acetabular morphology and orientation are well known; there is less information on these acetabular characteristics in three dimensions. One important reason is the lack of standardized reference planes for the pelvis, especially in relation to the spinopelvic unit; another is that no method precisely assesses the acetabulum in three-dimensional (3D) orientation based on its axis rather than on the directions of the edges of the acetabular rim. We present an objective, highly reliable and accurate, axis-based approach to acetabular anthropometry in the measurement of acetabular volume and spatial orientation in both normal and pathologic hips. This was done using reference planes based on the sacral base (SB) and true acetabular axis in 3D computed tomography (CT) pelvic reconstruction.

Methods: Radiological examinations of 30 physiologic pelves (60 acetabula) were included in the study. Reliability and accuracy of the method were verified by comparing acetabular angles in 2D pelvic scans with 3D reconstructions. We also applied the method to two pathologic acetabula.

Results: Comparison of axis position in the horizontal plane revealed significant positive correlations between 2D angle measurements (acetabular anteversion angle [AAA] and anterior acetabular index [AAI]) and 3D measurement of anteversion angle (p < 0.001 and p = 0.012, respectively). In the frontal plane, there was no difference between abduction angle, measured on topogram, and inclination angle, obtained from a 3D model (p = 0.517). In the sagittal plane, there was a significant negative correlation between AAA and acetabular tilt (p < 0.001). Inter- and intra-observer reproducibility was excellent for determination of the sacral-base plane and assessment of volume, with Fleiss κ coefficients of 0.850 and 0.783, respectively, and intraclass correlation coefficients of 0.900 and 0.950, respectively. Inter-observer reproducibility for evaluation of acetabular axis ranged from 0.783 to 0.883, and intra-rater reliability ranged from 0.850 to 0.900 for all 3D angles.

Conclusions: Our method is a new, reliable diagnostic tool for assessing the acetabula in both normal and pathologic hip joints. The sacral-base plane can be used as a stable reference that takes the relationship of the acetabulum to the spinopelvic unit into consideration.
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http://dx.doi.org/10.1186/s12891-015-0503-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351831PMC
February 2015

Phenomenon of painless knee in recurrent patellar dislocation in children.

Arch Med Sci 2014 Jun 27;10(3):531-6. Epub 2014 Jun 27.

Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Poland.

Introduction: Cartilage lesion with patellar malalignment may be correlated with pain. Situations in which patients with recurrent patellar dislocation are painless between episodes of luxation can be approached with considerable curiosity. We evaluated the distribution of substance-P and S-100 protein expression in soft tissue of the knee in children with recurrent patellar dislocation, in order to evaluate the distribution of nociceptors and determine tissue origins of this situation.

Material And Methods: Samples were collected from the medial and lateral synovial membrane, medial and lateral patellar retinaculum, Hoffa's body, patellar ligament, and quadriceps' aponeurosis in 10 children during the Blauth procedure and 10 adults with idiopathic osteoarthritis during total joint alloplasty. The density of nociceptive fibres was compared in the children and adults using S-100 and substance-P monoclonal antibodies.

Results: Statistical differences between groups were demonstrated for S-100 expression in synovial membrane of the medial knee compartment (p < 0.05) and for substance-P expression in the medial patellar retinaculum (p < 0.05) and synovial membrane of the lateral (p < 0.05) and medial (p < 0.05) knee compartment in favour of children.

Conclusions: Lack of pain sensations in patients with recurrent patellar dislocation may be associated with non-increased expression of nerve endings in Hoffa's body. Increased expression of either S-100 protein or substance-P in synovial membrane and the medial retinaculum did not induce pain development in the knee joints of that group of patients.
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http://dx.doi.org/10.5114/aoms.2014.43747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107259PMC
June 2014

Suprascapular Notch asymmetry: a study on 311 patients.

Biomed Res Int 2014 12;2014:196896. Epub 2014 May 12.

Department of Normal and Clinical Anatomy, Medical University of Łódź, Ulica Narutowicza 60, 90-136 Łódź, Poland.

The most important risk factor of suprascapular nerve entrapment is probably the shape of the suprascapular notch (SSN). The aim of the study was to perform a radiological study of the symmetry of SSN. Included in the study were 311 patients (137 women and 174 men) who underwent standard computed tomography investigation of the chest. A total of 622 computed tomography scans of scapulae were retrospectively analyzed to classify suprascapular notches into five types. Suprascapular notch was recognized as a symmetrical feature in 53.45% of the patients. Symmetry was more frequently seen in females (54.0% versus 52.9%), but not to any significant degree (P = 0.8413). Type III was the most commonly noted symmetrical feature (66.9%) and type II was less common (0.6%). Type III was the most symmetrical type of suprascapular notch, occurring significantly more often as a symmetrical feature in comparison with type I (P < 0.0001), type II (P = 0.00137), or type IV (P = 0.001). Our investigation did not show that the suprascapular notch is a symmetrical feature. However, symmetry was recognized more frequently in the case of type III SSN. No significant differences in symmetry were found with regard to sex.
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http://dx.doi.org/10.1155/2014/196896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4044447PMC
February 2015

Morphological and radiological study of ossified superior transverse scapular ligament as potential risk factor of suprascapular nerve entrapment.

Biomed Res Int 2014 3;2014:613601. Epub 2014 Apr 3.

Department of Normal and Clinical Anatomy, Medical University of Łódź, Ulica Narutowicza 60, 90-136 Łódź, Poland.

The suprascapular notch is covered superiorly by the superior transverse scapular ligament. This region is the most common place of suprascapular nerve entrapment formation. The study was performed on 812 specimens: 86 dry scapulae, 104 formalin-fixed cadaveric shoulders, and 622 computer topography scans of scapulae. In the cases with completely ossified superior transverse scapular ligament, the following measurements were performed: proximal and distal width of the bony bridge, middle transverse and vertical diameter of the suprascapular foramen, and area of the suprascapular foramen. An ossified superior transverse scapular ligament was observed more often in men and in the right scapula. The mean age of the subjects with a completely ossified superior transverse scapular ligament was found to be similar than in those without ossification. The ossified band-shaped type of superior transverse scapular ligament was more common than the fan-shaped type and reduced the space below the ligament to a significantly greater degree. The ossified band-shaped type should be taken into consideration as a potential risk factor in the formation of suprascapular nerve entrapment. It could explain the comparable frequency of neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified superior transverse scapular ligament.
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http://dx.doi.org/10.1155/2014/613601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996327PMC
February 2015

Hip joint pain in children with cerebral palsy and developmental dysplasia of the hip: why are the differences so huge?

BMC Musculoskelet Disord 2014 Mar 21;15:96. Epub 2014 Mar 21.

DAFO, Individual Medical Practice ul, Poselska 10 m, 26, 95-070 Aleksandrow Lodzki, Poland.

Backgrounds: Non-traumatic hip dislocation in children is most often observed in the course of developmental dysplasia of the hip (DDH) and infantile cerebral palsy. The risk of pain sensations from dislocated hip joint differentiates the discussed groups of patients. Will every painless hip joint in children with cerebral palsy painful in the future?

Methods: Material included 34 samples of joint capsule and 34 femoral head ligaments, collected during open hip joint reduction from 19 children with CP, GMFCS level V and from 15 children with DDH and unilateral hip dislocation. All the children were surgically treated.The density of nociceptive fibres was compared between the children with CP and DDH, using S-100 and substance P monoclonal antibodies.

Results: More frequent positive immunohistochemical reaction to S-100 protein concerned structures of the femoral head ligaments in children with CP and cartilage losses on the femoral head, when compared to the same structures in children with DDH (p = 0.010). More frequent were found positive immunohistochemical reactions for S-100 protein in the joint capsules of children with cartilage losses (p = 0.031) and pain ailments vs. the children with DDH (p = 0.027). More frequent positive reaction to substance P concerned in femoral head ligaments in CP children and cartilage lesions (p = 0.002) or with pain ailments (p = 0.001) vs. the DDH children.

Conclusions: Surgical treatment of hip joint dislocation should be regarded as a prophylactics of pain sensations, induced by tissue sensitisation, inflammatory process development or articular cartilage defects.
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http://dx.doi.org/10.1186/1471-2474-15-96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004466PMC
March 2014

The variable morphology of suprascapular nerve and vessels at suprascapular notch: a proposal for classification and its potential clinical implications.

Knee Surg Sports Traumatol Arthrosc 2015 May 18;23(5):1542-8. Epub 2014 Mar 18.

Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136, Łódź, Poland,

Purpose: The most common place for suprascapular nerve entrapment is the suprascapular notch. The aim of the study was to determine the morphological variation of the location of the suprascapular nerve, artery and vein, and measure the reduction in size of the suprascapular opening in each type of the passage.

Methods: A total of 106 human formalin-fixed cadaveric shoulders were included in the study. After dissection of the suprascapular region, the topography of the suprascapular nerve, artery and vein was evaluated. Additionally, the area of the suprascapular opening was measured using professional image analysis software.

Results: Four arrangements of the suprascapular vein, artery and nerve were distinguished with regard to the superior transverse scapular ligament: type I (61.3 %) (suprascapular artery was running above ligament, while suprascapular vein and nerve below it), type II (17 %) (both vessels pass above ligament, while nerve passes under it), type III (12.3 %) (suprascapular vessels and nerve lie under ligament) and type IV (9.4 %), which comprises the other variants of these structures. Statistically significant differences regarding the suprascapular opening were observed between the specimens with types II and III. Anterior coracoscapular ligaments were present in 55 from 106 shoulders.

Conclusion: The morphological variations described in this study are necessary to better understand the possible anatomical conditions which may promote suprascapular nerve entrapment (especially type III). They may be useful during open and endoscopic procedures at the suprascapular notch to prevent such complications as unexpected bleeding.
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http://dx.doi.org/10.1007/s00167-014-2937-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555201PMC
May 2015

Comparison of knee function in patients with a healed fracture of the femoral shaft fixed with retrograde and antegrade intramedullary nailing.

Ortop Traumatol Rehabil 2013 Oct;15(5):395-405

Department of Trauma and Orthopaedic Surgery and Musculoskeletal Neoplasms, Nicolaus Copernicus Regional Specialised Hospital in Łódź, Poland.

BACKGROUND. Despite extensive current knowledge about fractures of the femoral shaft, the choice between antegrade and retrograde intramedullary (IM) nailing with respect to the future function of the joint serving to introduce the nail continues to raise controversy. To compare knee function in patients with a healed fracture of the femoral shaft fixed by antegrade vs. retrograde IM nailing. MATERIAL AND METHODS. The study involved a group of 65 individuals with traumatic fractures of the femoral shaft who underwent stabilisation with IM nails in the years 2001-2010. Thirty-two cases were retrograde nails (Group R) and 33 antegrade nails (Group A). Patient age at trauma ranged from 19 to 91 years (mean: 47). Knee function was assessed in both groups with the KOOS, KSS1 and KSS2 scoring systems. RESULTS. Knee function as assessed with KOOS differed significantly between retrograde and antegrade nailing, with a greater incidence of poor and fair results in the former and more excellent outcomes in the latter group (p=0.0133). As regards KSS1 and KSS2, there were no significant differences between the groups (p=0.1947, p=0.4038). The range of motion was 86-125 degrees in Group R and 121-125 degrees in Group A. Knee pain was reported by 37.5% of the patients treated with retrograde nailing and 39.4% of those who had the IM nail inserted via the antegrade approach (p=0.22). The mean time to bone union was 180 days in Group R and 219 days in Group A (p=0.25). Age and presence of osteoarthritis at trauma significantly lowered the KOOS (p=0.0027, p= 0.005) and KSS (p=0.0002, p=0.002) scores, as well as the knee range of motion (p=0.0014, p=0.004) CONCLUSIONS. 1. Knee function following retrograde and antegrade IM nailing to stabilise femoral shaft fractures was comparable. 2. The choice of IM nailing method should not be based solely on orthopaedic indications, but also on the severity of osteoarthritis present at trauma.
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http://dx.doi.org/10.5604/15093492.1084241DOI Listing
October 2013

Shelf acetabuloplasty in the treatment of severe Legg-Calvé-Perthes disease: good outcomes at midterm follow-up.

Biomed Res Int 2013 27;2013:859483. Epub 2013 Nov 27.

Clinic of Orthopaedics and Paediatric Orthopaedic, Medical University of Łódź, ul. Drewnowska 75, 91-002 Łódź, Poland.

The aim of the study was to retrospectively review results of operative treatment for coverage deficit of femoral head in children with severe epiphysis displacement in Legg-Calvé-Perthes (LCP) disease. The material included 23 shelf acetabuloplasty procedures for LCP disease. The average age at diagnosis was 8.1 years (range 4-12). Mean follow-up was 5.8 years (range from 2.2 to 11.2 years). Mean Reimer's index decreased statistically significantly from a mean of 32% before surgery to 10.0% at the last follow-up (P < 0.00001). The mean Wiberg center-edge angle increased also statistically significantly from a mean of 17.3° before procedure to 32.3° at the last follow-up (P < 0.00001). According to the Stulberg classification, type I was observed in 2, type II in 13, type III in 6, and type IV in 2 hips. There were no differences in the range of motion or leg length discrepancy in preoperative and postoperative standing. Partial, not significant, bone graft resorption was noted in 6 cases in the first 6-9 months after surgery. To conclude, shelf acetabuloplasty allows achieving good midterm results in the treatment of severe stages of LCP disease. The procedure improves coverage of femoral head and allows its remodelling.
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http://dx.doi.org/10.1155/2013/859483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860075PMC
August 2014

Do gene expression changes in articular cartilage proteases of the synovial membrane correlate with expression changes of the same genes in systemic blood cells?

Int Orthop 2014 Mar 22;38(3):649-54. Epub 2013 Nov 22.

Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, ul. Drewnowska 75, 91-002, Lodz, Poland,

Purpose: The aim of our study was to find whether an injury of the knee joint tissues increases gene expression of selected hyaline cartilage degenerating enzymes such as matrix metaloproteinases (MMP) and aggreacaneses (Agg).

Methods: A total of 138 patients (81 female, 57 male) were admitted for knee arthroscopy with a mean age of 38.8 years. Full blood samples were collected preoperatively and synovium samples intraoperatively. Joint tissue lesions such as menisci, anterior cruciate ligament (ACL) and hyaline cartilage were estimated. Real time PCR with spectrophotometric analysis was performed.

Results: An ACL lesion was found in 56 patients, medial menisci (MM) in 65, and lateral menisci (LM) in five. Chondral lesions were estimated according to Outerbridge's grading system. In laboratory tests correlation between ACL tear and gene expression was seen except TIMP1 in serum (p < 0.05). In MM lesions MMP9, Agg2 elevation in serum was observed. LM lesions erased MMP13, MMP14 in serum and MMP8 in synovium. Chondral lesions revealed that many genes had higher expression in patients without hyaline degeneration. All of the gene expressions correlated between serum and synovium.

Conclusion: An ACL lesion provokes elevation in expression of proteases genes, while the influence of other lesions remains elusive. Gene expression in synovium correlates with peripheral blood.
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http://dx.doi.org/10.1007/s00264-013-2195-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936096PMC
March 2014

Variation in morphology of suprascapular notch as a factor of suprascapular nerve entrapment.

Int Orthop 2013 Nov 27;37(11):2185-92. Epub 2013 Jul 27.

Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136, Łódź, Poland,

Purpose: The shape and size of the suprascapular notch (SSN) is one of the most important risk factors in suprascapular nerve entrapment. The aim of the study was to perform a morphological study of SSN variations.

Methods: A total of 616 computer tomography scans of scapulae were retrospectively analysed in 308 patients. The examination focused on the suprascapular region. The type of suprascapular notch was determined by using a classification based on three geometrical measurements: maximal depth (MD), superior (STD) and middle (MTD) transverse diameters.

Results: In the scans, five types of SSN were noted. In type I (24.18%) maximal depth was greater than superior transverse diameter. Type II (1.95%) has equal MD, STD and MTD. In type III (56.16%) the superior transverse diameter was greater than the maximal depth. Scapulae with bony foramen were classified as type IV (4.72%). In type V a discrete notch (12.99 %) was found. Additionally, types I and III were divided into three subtypes: A, B and C. The frequency of type I and IV was lower in females than in males, but type III was more common in females than males. Distribution of other types of SSN in both groups was similar.

Conclusion: Knowledge of the anatomical variations of the suprascapular notch described in this study should be helpful in endoscopic and open procedures of the suprascapular region and also may increase the safety of operative decompression of the suprascapular nerve.
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http://dx.doi.org/10.1007/s00264-013-2005-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824898PMC
November 2013

Reliability of clinical evaluation of meniscus repair with the all-inside technique.

Ortop Traumatol Rehabil 2013 Mar-Apr;15(2):131-7

Department of Orthopaedics and Paediatric Orthopaedics, Medical University in Łódź.

Introduction: The study aimed to compare questionnaire data and clinical evaluation with an assessment of meniscal morphology conducted at arthroscopic anterior cruciate ligament (ACL) reconstruction following meniscal repair.

Material And Methods: The study involved a selected group of 17 subjects (5 women and 12 men) aged 14-33 years, who underwent meniscal repair with the Fast-Fix system followed by ACL reconstruction. The mean interval between the procedures was 9 months. Prior to each procedure, the patients were requested to fill in the Lysholm Knee Questionnaire.

Results: At review, 14 patients met the criteria of a healed meniscal repair, whereas the remaining 3 subjects presented with signs of meniscal injury. These observations were confirmed at repeat arthroscopy. The Lysholm score for the entire study group increased from a baseline value of 57.3 to 92.2 points postoperatively, with the patients with reruptured menisci also improving, from 58 to 75.3 points.

Conclusions: 1) Our results show that clinical examination is reliable to evaluate the healing of meniscal lesions following all-inside repair, as confirmed by repeat arthroscopy. 2) A far greater increase in the Lysholm score seen in patients whose menisci were confirmed to have healed by repeat arthroscopy indicates that such questionnaires may be of help in the evaluation of treatment outcomes.
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http://dx.doi.org/10.5604/15093492.1045945DOI Listing
April 2015

Development of human hip joint in the second and the third trimester of pregnancy; a cadaveric study.

BMC Dev Biol 2013 May 7;13:19. Epub 2013 May 7.

Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland.

Background: The purpose of the study was an evaluation of fetal hip joint morphology during the second and the third trimester of pregnancy. Serial sections were performed on 23 cadaver infants.

Results: The mean lunar age was 6.6 months. Femoral shaft length (FSL) and width of the proximal and distal epiphysis were x-rayed to determine fetal age. The neck shaft angle (NSA), the femoral antetorsion angle (FAA), the acetabulum anteversion angle (AAA) and the acetabulum slope angle (ASA) were measured. Hip development ratios were plotted for all cadaveric species and revealed: flat FSL/NSA slope pattern, upward FSL/FAA slope pattern and downward slope pattern for FSL/ASA and FSL/AAA ratios. The changes, observed during the developmental period, were not statistically significant. NSA did not change during the second or the third pregnancy trimester. FAA increased during pregnancy but the changes were not statistically significant. AA, as well as ASA, showed a decreasing trend during the second and the third pregnancy trimester, however, with no correlations to age.

Conclusion: Despite an increasing depth and growing dimensions of the acetabulum in the uterus, its orientation does not change in any significant way.
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http://dx.doi.org/10.1186/1471-213X-13-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668287PMC
May 2013

Quality of life and functional disability in skeletally mature patients with myelomeningocele-related spinal deformity.

J Pediatr Orthop B 2013 Mar;22(2):106-9

Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland.

The purpose of the study was to assess the quality of life, physical function, self-motivation, and self-perception of skeletally mature patients with spina bifida and scoliosis. This is a prospective study on 19 skeletally mature patients with a mean age of 21.4 years. Several questionnaires were used for the study: Activities Scale for Kids, Quality of Life in Spina Bifida Questionnaire, The Health Self-Determinism Index for Children, Harter's Self-Perception Profile for Adolescents, and the Spina Bifida Spine Questionnaire. This study found no association between spinal deformity or other features related to spina bifida and self-perception, motivation, and overall physical function. More severe scoliosis affects quality of life and is related to the degree of pelvic obliquity and the age of the patients. Individuals with motor-level dysfunction below L3 had significantly better overall physical function compared with those with a higher level of lesions. This was the only factor found to affect physical function. Our findings suggest that most limitations in patients with spina bifida are not related to the degree of scoliosis but to other associated disabilities.
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http://dx.doi.org/10.1097/BPB.0b013e32835c2a65DOI Listing
March 2013

Hip joint pain in spastic dislocation: aetiological aspects.

Dev Med Child Neurol 2011 Nov 16;53(11):1019-23. Epub 2011 Aug 16.

Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland.

Aim: Children with severe forms of cerebral palsy (CP) are at high risk of hip joint displacement. Various studies have found that the pain from affected joints occurs in 40 to 84% of studied individuals. The purpose of this study was to establish a correlation between the density of nociceptors localized in selected areas of the spastic dislocated hip joint and clinical evidence of hip joint pain in children with CP.

Method: Nineteen samples of articular capsule and 19 samples of teres ligaments, collected during open hip joint reduction from 19 non-ambulatory children with spastic CP (Gross Motor Function Classification System level V; mean age 9y 6mo; 10 males, nine females), were studied. Pain was assessed using the numeric rating scale completed by caregivers. The density of nociceptive fibres was compared between the children with painful and children with painless hip joints, using S-100 and substance P monoclonal antibodies.

Results: The presence of S-100 protein and substance P were significantly increased (p=0.024 and p=0.02 respectively) in the children with painful hip joints. There were significantly positive correlations between the intensity of pain and the density of nerve fibres with S-100 protein (teres ligament, p=0.001; joint capsule, p=0.032) as well as substance P (teres ligament, p=0.001).

Interpretation: Direct and indirect inflammatory factors, present in dislocated hip joints with cartilage damage in children with spastic CP, lead to hip joint sensitization.
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http://dx.doi.org/10.1111/j.1469-8749.2011.04077.xDOI Listing
November 2011

Evaluation of adductor myotomy versus adductor transfer to ischiadic tuber in the treatment of spastic hip in cerebral palsy.

Ortop Traumatol Rehabil 2011 Mar-Apr;13(2):155-61

Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Łódź, Poland.

Background: The muscle imbalance associated with the spastic type of infantile cerebral palsy may result in subluxations or dislocations of the hip. The aim of the study was to compare the clinical and radiological results of myotomy of the hip adductor muscles versus adductor transfer to the ischiadic tuber in the prevention of hip subluxation and dislocation in infantile cerebral palsy.

Material And Methods: The study involved 36 ambulant children with spastic diparetic CP treated at our Department in the years 1987-2002. Group I consisted of 21 children (41 hip joints) who underwent myotomy of the adductor longus, adductor brevis and gracilis muscles. Mean age at the time of surgery was 10 years (3 to 17 years). Group II consisted of 15 children (28 hip joints) who underwent transfer of the tendons of the adductor muscles to the ischiadic tuber. Mean age at the time of surgery in this group was 8 years (3 to 16 years). The mean duration of hospital stay was 6 days in Group I and 9 days in Group II. Rehabilitation was carried out for an average of 3 months in Group I and 4 months in Group II.

Results: The follow-up examination showed improvement in the hip range of motion in both groups and no radiographic differences.

Conclusions: Adductor myotomy is superior to adductor transfer because of easier surgical technique, shorter duration of hospital stay and no need to immobilize the hip.
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October 2011
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