Čekanauskas, Emilis

Background/Objectives: Lateral ankle sprain (LAS) is common in adolescents, but the extent to which structural injury severity is associated with recovery of objective functional measures remains unclear. This study explored the association between Grade I–III injury severity and short-term recovery of objective functional measures following adolescent LAS using a post hoc secondary analysis of a randomized controlled trial (RCT).

Introduction Lateral ankle sprain (LAS) is common in adolescents, yet treatment approaches vary [1]. The traditional PRICE (protection, rest, ice, compression, elevation) acute management protocol, combined with NSAIDs, remains widely used despite limited high-quality evidence [2]. The newer PEACE and LOVE (protection, elevation, avoid anti-inflammatories and icing, compression, education, load, optimism, vascularization, exercise) framework addresses both acute care and rehabilitation. It highlights inflammation in tissue repair and suggests that routine NSAIDs and cryotherapy may impair healing [3]. Aim To compare PRICE + NSAIDs and PEACE and LOVE protocols for adolescent LAS and evaluate functional recovery. Methods In this prospective randomized study, 76 adolescents (12–17 years) with first-time LAS were assigned to either PRICE + NSAIDs or PEACE and LOVE. Diagnosis and severity were confirmed clinically and by imaging. Functional outcomes were assessed at 1–2, 5–7, and 12–15 weeks using Biodex isokinetic dynamometry, including ankle inversion/eversion peak torque normalized to body weight, range of motion (ROM), and dynamic balance (Y-Balance Test composite score). Outcomes were expressed as side-to-side deficits. Data were analyzed using two-way mixed ANOVA. 65 participants completed follow-up (PRICE n=32; PEACE and LOVE n=33). Results Significant main effects of time were observed for inversion strength at 60°/s (F = 5.73, p = 0.006) and 120°/s (F = 10.15, p < 0.001), eversion strength at 120°/s (F = 6.82, p = 0.003), ankle ROM at 60°/s (F = 12.79, p < 0.001) and 120°/s (F = 13.09, p < 0.001), and YBT CS (F = 6.91, p = 0.002), showing progressive improvement over the 12–15 weeks. No significant group effects or group × time interactions were detected for any outcome (all p > 0.05), indicating comparable recovery between the PRICE + NSAIDs and PEACE and LOVE protocols. Conclusions Both approaches led to progressive recovery after LAS in adolescents, with no between-group differences.

Background/Objectives LAS is common in adolescents, yet early management strategies differ. The traditional PRICE + NSAIDs protocol focuses on short-term symptom relief, whereas the PEACE and LOVE framework emphasizes education, early optimal loading, and progressive exercise. This study compared functional recovery between these two approaches.

Anterior cruciate ligament (ACL) injuries are increasingly prevalent among adolescents, posing significant functional and psychological challenges. The optimal autograft choice for ACL reconstruction (ACLR) in this age group remains controversial. This dissertation compares clinical outcomes, knee stability, isokinetic muscle strength, and psychological readiness in 54 patients aged 12–17 years undergoing ACLR with quadriceps tendon (QT) or hamstring tendon (HT) autografts. Patients were assessed using the Genourob arthrometer (3, 6, 12 months post-surgery), Biodex isokinetic testing (6, 12 months post-surgery), and patient-reported outcomes: IKDC and Lysholm scores (preoperative and 12 months) and ACL-RSI scale (12 months). Both graft types demonstrated comparable functional recovery and return-to-sport rates. However, QT autografts showed more consistent anterior tibial translation and strength balance, while female patients exhibited more favorable outcomes with HT autografts. These results highlight that both grafts are effective for adolescent ACLR, with selection influenced by patient sex and strength profiles. The study emphasizes individualized rehabilitation based on objective knee stability, muscle strength and psychological readiness to optimize safe return-to-sport.

Background and Aims: Background. Osteogenesis imperfecta (fragile bone disease) is a genetic disease characterized by bone fragility and risk of fracture. Osteogenesis imperfecta is usually caused by changes in type I collagen. It is a genetically and clinically heterogeneous disease with an incidence of approximately 1 in 10,000 to 1 in 20,000. The aim. The purpose of this article is to provide a literature review on the fragile bone disease of children – osteogenesis imperfecta and to present a clinical case of a 15-year-old patient with osteogenesis imperfecta (OI).Methods: Methodology. Scientific literature was reviewed using the PubMed database. Publications written in English and corresponding to the purpose of the article were selected. Results. Osteogenesis imperfecta is a rare bone disease. It is important to notice the characteristic clinical signs and prescribe the necessary tests and treatment in time. Our patient has undergone multiple traumatic orthopedic surgeries for bone fractures. This genetic disease is incurable, so the patient must be careful of falls or actions that can cause bone fractures. Conclusions: Osteogenesis imperfecta can be diagnosed with X-rays, bone density tests, and genetic testing. The late form of osteogenesis imperfecta is more favorable, although it limits the quality of life. The goals of treatment for osteogenesis imperfecta are to increase bone strength, reduce fracture risk, reduce pain, increase mobility and functional independence, and prevent long-term complications.

Background and Objectives: A prominent area of research in adolescent ACL reconstruction (ACLR) involves graft selection, with particular interest in the quadriceps tendon (QT) as an alternative to hamstring tendon (HT) autografts, although comparative studies on muscle strength outcomes and patient satisfaction in adolescents remain limited. This study aims to evaluate the influence of QT and HT autografts on muscle strength and satisfaction outcomes post-ACLR in adolescents. Methods: This prospective study was conducted at the Lithuanian University of Health Sciences, enrolling 68 patients aged 12–17. ACLRs were performed using QT or HT autografts. Muscle strength was assessed using an isokinetic dynamometer (Biodex), while patient satisfaction was evaluated through IKDC, Lysholm, and ACL-RSI surveys preoperatively and 12 months postoperatively. Results: 54 patients (24 QT and 30 HT) completed the study. The data are non-parametric and are presented as median (IQR). Isokinetic measurements indicated that QT harvesting led to significantly lower extension strength compared to HT 6 months (p = 0.019) and 12 months post-op (p < 0.001) but showed better H/Q ratios 6 months (p = 0.019) and 12 months post-op (p < 0.001). There was no significant difference between the QT and HT groups in ACL-RSI and Lysholm scores. IKDC scores were significantly higher in the HT group (p = 0.009). Conclusions: QT autografts provide favorable H/Q ratios, yet they exhibit weaker extension strength and lower satisfaction outcomes compared to HT. These results suggest a need for individualized rehabilitation protocols and further research to optimize ACLR graft selection for adolescents.

Temos aktualumas Aneurizminės kaulo cistos bei vienkamerinės kaulo cistos yra laikomos gėrybinėmis kaulo displazijomis. Dažniausiai diagnozuojamos žastikaulio proksimalinėje metafizėje ar diafizėje. Aneurizminę kaulo cistą charakteriuoja greitesnis augimas, kraujo pripildytos ertmės, atskirtos fibrozinėmis pertvaromis. Tuo tarpu vienkamerinę kaulo cistą sudaro viena ertmė, pripildyta serozinio skysčio, išklota fibroziniu audiniu. Kaulo cistos – susirgimas dažniausiai nustatomas vaikams ir jaunuoliams. Dauguma atvejų diagnozuojami per pirmus du gyvenimo dešimtmečius. Kartais anerizminės cistos gali pasireikšti lokalizuotu galūnės skausmu, tinimu, kuris didėja kartu su kaulo pažeidimu. Tačiau dažniausiai šios kaulų displazijos nesukelia jokių klinikinių požymių. Patologinis lūžis paprastai yra pirmasis ir vienintelis ženklas apie kaulo cistą arba susirgimas aptinkamas atsitiktinai, atlikus atitinkamos srities rentgenogramas. Dėl šių priežasčių tikrasis patologijos dažnis yra nežinomas, nes nemaža dalis lieka nediagnozuota. Literatūra aprašo įvairius gydymo metodus: steroidinių preparatų injekcijas, krioterapiją, cistos kiuretažą ir užpildymą kaulų čiulpų ląstelėmis ar sintetiniais kaulo pakaitalais, pvz. kalcio sulfatu, su arba be fiksacijos įvariais ortopediniais implantais. Pagrindinis išvardintų minimaliai invazyvių priemonių trūkumas yra mažas efektyvumas, dažni pakartotiniai patologiniai lūžiai. Vienas iš radikalaus chirurginio gydymo būdų yra atvira kaulo cistos rezekcija ir kaulo rekonstrukcija naudojant nevaskuliarizuotą autologinį šeivikaulio transplantatą. Darbo tikslas (-ai) Šio tyrimo tikslas pristatyti vaikų žastikaulio cistų gydymo metodą - osteoplastiką nevaskuliarizuotu šeivikaulio autotransplantu. Tyrimo metodai Retrospektyvinė klinikinių atvejų analizė. Rezultatai Chirurginės operacijos detalus aprašas ir klinikinių atvejų aptarimas. Išvados, rekomendacijos Osteoplastika nevaskuliarizuotu šeivikaulio autotransplantu yra efektyvus chirurginio gydymo metodas, taikomas gydant didelės apimties bei recidyvuojančias žastikaulio cistas, kuris užtikrina ankstyvą grįžimą į pilną fizinį krūvį bei pilnavertę gyvenimo kokybę.

Temos aktualumas A lateral ankle sprain (LAS) is one of the most common injury, which occurs in children. Despite large number of studies, diversity of treatment strategies persists. Over 20 years acronym PRICE (protection, rest, ice, compression, elevation) and anti-inflammatory drugs (NSAIDs) is first option, despite its lack of high quality evidence. Lately acronym PEACE and LOVE (protection, elevation, avoid anti-inflammatory drugs and icing, compression, education, load, optimism, vascularisation, exercise) was announced, which involves immediate care and rehabilitation of soft tissue damage. It is thought that phases of inflammation help tissue to heal and NSAIDs combined with icing interferes it, so new strategy excludes this combination. Darbo tikslas (-ai) To compare PRICE vs PEACE and LOVE for LAS treatment, to evaluate injury severity outcomes and to verify the need of plaster cast immobilization in adolescents. Tyrimo metodai A prospective randomised study of 65 (37 male, 28 female) patients from 12 to 17 years old who admitted LUHS Paediatric emergency department (ED) in year 2022- 2024 after LAS was executed. Inclusion criteria were first time LAS, acute period of 1 to 4 days after injury, exclusion of chronic pain and any fracture, except avulsion. Depending on symptoms immobilization by plaster cast was applied for 30 patients (46,2%) in the ED. At first visit to the policlinics cast was removed for all of them, lace-up splint was prescribed to all 65 patients and they were randomly allocated to two age and gender homogenous groups: classic (A) PRICE (n = 32, male 62,5%, female 37,5%) or new (B) PEACE and LOVE (n = 33, male 51,5%, female 48,5%) treatment method. Patient diagnose was confirmed by x rays and ultrasound system MyLab 9 eXP 20071, Esaote S.p.A., CE 0123. Ankle function was tested by Biodex isokinetic dynamometer to compare range of motion (ROM) and peak torque to body weight (PEAK TQ/BW) of inversion (IN) and eversion (EV), Y balance test composite scores (YBT CS) were counted to evaluate proprioception between involved (I) and uninvolved (U) legs 1 to 2, 5 to 7 and 12 to 15 weeks after injury comparing two methods. Depending on radiologic findings patients were divided into two groups: I – diagnosed with sprains (grade I) or partial tears (grade II) of lateral ankle ligaments; II – diagnosed with complete tears (grade III) and/or avulsions of lateral malleolus. Data analysis was performed by IBM SPSS 22 software. Two independent samples were compared by Mann-Whitney U test, three measurements in each group were compared by Friedman test. Rezultatai Mean patient age in group was A 14,31 (SD 1,67), in group B 14,64 (SD 1,64). Depending on injury severity 30 patients (46.2%) formed group I and 35 patients (53.8%) group II. There was a significant difference measuring YBT CS deficiencies between U and I legs in group I and II after third testing: YBT-3 CS group I -0,47% vs group II 1,43% (U=353, p=0,02). Only first Biodex testing showed higher deficit of IN for I leg: 1 PEAK TQ/BW IN group I 27,43% vs group II 37,77% (U=358, p=0,028) but later testings showed no significant difference depending on injury severity. Group II showed significantly higher ROM deficit at second and third testing: 2 ROM group I 27,83 ° vs 37,43 ° (U=370, p=0,04), 3 ROM group I 26,53 ° vs 38,54 ° (U=331, p=0,011). Immobilization by plaster cast in the ED was applied to total of 30 (46,15%) patients: 12 (40,0%) group I and 18 (51,4%) group II patients (p=0,357). Application of plaster cast had no better outcomes over 3 testings in IN, EV or ROM: : 3 PEAK TQ/BW IN cast group 31,62% vs no cast group 34,19% (U=483,5, p=0,585); 3 PEAK TQ/BW EV cast group 29,8% vs no cast group 35,74% (U=429, p=0,206); 3 ROM cast group 33,40 ° vs no cast group 32,66 ° (U=513, p=0,875). Two different treatment strategies were compared by Friedman test, pairwise comparisons were performed and B treatment method showed significant better results in YBT CS, PEAK TQ/BW IN and ROM deficit scores: group A YBT CS-1 2,28% and YBT CS-3 1,7% vs group B YBT CS-1 2,42% and YBT CS-3 1,61% (p=0,003); group A 1 PEAK TQ/BW IN 2,09 and 3 PEAK TQ/BW IN 1,84 vs group B 1 PEAK TQ/BW IN 2,27 and 3 PEAK TQ/BW IN 1,68 (p=0,049); group A 1 ROM 2,59 ° and 3 ROM 1,45 ° vs group B 1 ROM 2,64 ° and 3 ROM 1,47 ° (p<0,001). Išvados, rekomendacijos Higher grade of lateral ankle ligaments tear has no significant impact on ankle proprioception outcomes, but has impairement of ROM and early post injury inversion force. Immobilization by plaster cast is used too often even for minor injuries because it has no better outcomes for LAS treatment, it should be used as short as possible and only for pain control. PEACE and LOVE treatment method showed better results than PRICE in YBT CS, ROM and inversion force.

Autoimuninės odos ligos yra susijusios su padidėjusiu ortopedinių intervencijų poreikiu ir didesne komplikacijų rizika po sąnarių endoprotezavimo operacijų. Mokslinėje literatūroje yra duomenų, kad psoriaze sergantiems pacientams reikšmingai dažniau buvo atliekamos kelio ir klubo sąnario endoprotezavimo operacijos, ypač tam tikrose amžiaus ir lyties grupėse. Išanalizuoti tyrimai parodė, kad pacientams, sergantiems reumatoidiniu artritu, ankilozuojančiu spondilitu ir kitomis uždegiminėmis artropatijomis, dažniau buvo atliekamos įvairios ortopedinės operacijos. Psoriazė buvo nepriklausomas veiksnys, didinantis periprostetinės infekcijos riziką po klubo sąnario endoprotezavimo ir pooperacinių transfuzijų poreikį po kelio sąnario endoprotezavimo. Nustatyta, kad didžiausias endoprotezų revizijų dažnis dėl infekcijų buvo tarp psoriaziniu artritu sergančių pacientų. Tikslingi tolesni moksliniai tyrimai, vertinantys sąsajas tarp autoimuninių odos ligų, joms gydyti vartojamų medikamentų ir endoprotezavimo operacijų rezultatų.

Tikslas. Apžvelgti šeivinės nervo neuropatijos savitumus, patogenezę, diagnostiką ir gydymą bei pateikti rekomendacijas bendrosios praktikos gydytojams. Metodai. Atlikta mokslinės literatūros apžvalga, apibendrinant naujausius duomenis apie šeivinio nervo neuropatiją. Rezultatai. Pagrindinis šeivinės neuropatijos simptomas - nukarusi pėda. Taip pat gali pasireikšti skausmas, hipoestezija ir (arba) parestezija, miastenija. Šeivinio nervo neuropatijos priežastys gali būti mechaninės traumos arba įvairios kasdienės veiklos. Diagnozei patvirtinti reikalinga tiksli anamnezė, klinika, refleksų vertinimas, radiologiniai tyrimai, o galutinė diagnozė nustatoma atlikus elektroneuromiografiją (ENMG). Konservatyvus gydymas apima pėdos stabilizavimą, kai ji yra nukarusi, naudojant įtvarus ir teipus. Simptominiam gydymui ir nervo regeneracijai skatinti skiriami NVNU ir B grupės vitaminai. Chirurginis gydymas indikuotinas, kai yra atvira žaizda arba nėra atsako į konservatyvų gydymą. Svarbi ilgalaikė paciento stebėsena ir kompleksinis gydymas. Išvados. Šeivinė nervo neuropatija yra dažniausia kojos mononeuropatija, tačiau dėl klaidinančio klinikinio vaizdo ir neįprastos patogenezės ši liga dažnai nediagnozuojama arba diagnozuojama netinkamai. Pagrindinis šios ligos simptomas - nukarusi pėda, tačiau taip pat gali pasireikšti skausmas, hipoestezija ir (arba) parestezija, miastenija. Ilgalaikė pacientų stebėsena, reguliarus vertinimas ir kompleksinis gydymas yra būtini siekiant atkurti nervo funkciją ir pagerinti gyvenimo kokybę.