Galinskas, Laurynas

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.

Aim of the study: To describe anatomical reconstruction of neglected patellar tendon rupture for restoring proper function of the knee. Case description: 14 year old male patient sustained injury to his left knee while playing sports. At first he was diagnosed with acute medial patellar retinaculum tear. Surgery was performed at another hospital to repair retinacular tear and cast immobilization was prescribed for 6 weeks. During rehabilitation process patient noticed high position of the patella and lack of active knee extension. 13 months after initial injury patient was admitted to our clinic with a complaint of inability to extend his left knee. During clinical exam the defect of patellar tendon could be palpated, knee extension deficit of 30⁰. On the x-rays multiple heterotopic ossicles were visible and on the MRI chronic distal rupture of patellar tendon was confirmed. At 16 months post injury patellar tendon reconstruction was performed. During the surgery ossicles were removed and patella was released of scar tissue. Gracilis and semitendinosus graft was harvested preserving their distal tibial attachment. Horizontal tunnel through tibial tuberosity was drilled using 7 mm cannulated drill and both tendons passed to lateral side. 7 mm diameter tunnel was drilled horizontally through patella and one of the tendons was passed form medial to lateral and another one the opposite direction forming a 'figure of 8'. Repair was confirmed isometric before fixing it. The ends of the tendons were fixed in to the tibia using 4.5x14 mm Corkscrew® (Arthrex, Naples, FL, USA) suture anchor. Native patellar tendon was additionally augmented with 2 mm FiberTape® (Arthrex, Naples, FL, USA) using Kessler suture technique and the ends of the suture passed vertically through patella and tied on proximal pole. Conclusions: Hinged knee brace was applied with the maximum flexion set at 30° and weight bearing was allowed as tolerated. CPM was recommended after suture removal. 90° of flexion was gradually achieved at 6th week post surgery and the brace was removed. At 6 month follow-up full ROM of the knee was achieved and extensor mechanism was fully restored with no extension lag. At 12 month follow-up patient was no complaints but still needs to improve quadriceps muscle strength.

Background: The quadriceps tendon (QT) autograft has recently drawn attention for anterior cruciate ligament reconstruction (ACLR). Finding the best autograft option for adolescents after an ACL injury is essential to ensure them a high-quality active lifestyle. There are no studies comparing the all-soft-tissue QT autograft with the hamstring tendon (HT) autograft in such population. Methods: In this study, 68 patients younger than 18 years of age were assigned to the HT (38 patients) or the QT (30 patients) ACLR group. The groups were similar, allowing their comparison. The instrumented knee laxity was evaluated with a Genourob arthrometer. In total, 48 patients (27 HT and 21 QT) were tested 3 months post-op, and 45 patients (26 HT and 19 QT) were tested 6 months post-op. Results: We found that 3 months post-op, the side-to-side anterior tibial translation measurements (GNRB1) were worse in the HT than in the QT group (1.4 (0.2–5.2; 1.715) vs. 0.6 (0.1–2.1; 0.905) mm, p = 0.02). There was no difference in side-to-side anterior tibial translation at 6 months post-op (GNRB2) between the HT and the QT group (1 (0.2–5.3; 1.519) vs. 1.1 (0.3–3.4; 1.279) mm, p = 0.927). At 3 months post-op, the side-to-side anterior tibial translation (GNRB1) was worse in males than in females. irrespective of the graft choice (1.45 (0.1–5.2; 1.696) vs. 0.4 (0.1–3.4; 0.89) mm, p = 0.016). The displacement curve slopes 6 months post-op were better for females (3 (0–13.1; 3.335) vs. 5.3 (0–26.1; 7.848), p = 0.014). At 3 months post-op, the GNRB measurements showed that the side-to-side anterior tibial translation (GNRB1) was better for females when the HT autograft had been used (0.45 (0.2–3.4; 0.942) vs. 2.4 (0.3–5.2; 2.333) mm, p = 0.003). In general, both autografts provided excellent objective outcomes at early follow-up. Conclusions: The all-soft-tissue QT autograft should be considered as a reliable alternative for ACLR in adolescents. This autograft has at least the same properties as the HT autograft in the early stages after ACL reconstruction in adolescent athletes and, in some respects, seems superior to the HT autograft. Research should continue to find the best possible graft choice for the most active and willing-to-return-to-sport population.

Osteosintezė intramedulinėmis elastinėmis stabiliomis vinimis (OIESV) yra aukso standartas gydyti vaikų ilgųjų kaulų lūžius. Literatūros šaltinių duomenimis, šlaunikaulio ir blauzdikaulio diafizių lūžių atvejais bendras komplikacijų dažnis siekia atitinkamai 50 ir 30 procentų. Tinkamas implanto pasirinkimas ir techninių rekomendacijų laikymasis gali šiuos skaičius reikšmingai sumažinti. Per ilgų implantų galų sukeltos komplikacijos yra vienos iš dažniausių po OIESV. Jų dažnis gali būti sumažintas trumpinant galus iki 2 cm ir prišliejant juos prie metafizės. Gijimo, kampinių poslinkių ir galūnių ilgio skirtumų komplikacijų dažniai gali būti sumažinti renkantis 40 proc. ir daugiau intramedulinio kanalo užimančius implantus. Daugiau nei 400 kontūruoti implantai geriau laiko kaulinių fragmentų poziciją. Vinis turėtų būti šalinama, kai rentgenogramose nematyti lūžio linijos, o aplink lūžio vietą matomas susiformavęs kaulinis rumbas. Taip bus išvengta pakartotino lūžio. Veiksmų, galinčių dar labiau pakenkti minkštiesiems audiniams mažinimas, ir repozicija uždaru būdu gali padėti sumažinti raumenų ankštumo sindromo ir infekcijų dažnius.

Pachidermodaktilija yra reta gerybinė fibromatozė, pasireiškianti jungiamojo audinio proliferacija proksimalinių interfalanginių plaštakos sąnarių srityje. Ši patologija vaikystėje dažnai painiojama su sąnarius pažeidžiančiomis ir deformuojančiomis uždegiminėmis ligomis, tokiomis kaip juvenilinis idiopatinis artritas. Viena iš priežasčių, sukeliančių pachidermodaktiliją, gali būti nuolatinis ir nenutrūkstamas pirštų minkštųjų audinių dirginimas ir traumavimas. Šiai patologijai diagnozuoti paprastai pakanka tik klinikinio ištyrimo. Kadangi tai gerybinė, neprogresuojanti liga, pirmiausia rekomenduojama vengti mechaninio traumavimo. Yra duomenų, kad vitaminas D turi antifibrotinį efektą ir gali būti naudojamas kai kurių fibrozinių ligų gydyme. Šio tyrimo tikslas – supažindinti gydytojus su viena iš retų, gerybinių, tačiau sąnarių deformaciją galinčių sukelti patologijų, siekiant išvengti diagnostinių klaidų ir nereikalingo medikamentinio gydymo.