Rutkauskas, Saulius

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.

The aponeurotic expansion of the supraspinatus tendon is a recognized but underappreciated anatomical structure of the shoulder. Its sonographic appearance may mimic or coexist with pathology of adjacent tendons, particularly the long head of the biceps tendon, creating diagnostic challenges. Although described in prior literature, many atypical variants remain insufficiently documented. This study aimed to characterize atypical sonographic manifestations of the aponeurotic expansion of the supraspinatus tendon and to propose new classifications based on its relationship with the supraspinatus tendon, its position within the rotator interval, and its association with the long head of the biceps tendon.

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.

Background and aim. Vitamin K2 (menaquinone-7, MK-7) may influence musculoskeletal health but its effects on human skeletal muscles remain unclear. This study investigated whether MK-7 supplementation could mitigate soleus muscle atrophy and enhance recovery post-ankle injury. Methods. A double-blind, randomised trial included 20 participants (12 men, 8 women; age 50 ± 11 years) with ankle injuries requiring six weeks of immobilisation followed by six weeks of rehabilitation. They received either 333 μg/day of MK-7 or a placebo. Soleus muscle cross-sectional area (CSA) was assessed via ultrasound, while plasma levels of MK-7, IGF-1 (insulin-like growth factor 1), myostatin, and 25-OH vitamin D3 were measured. Results. The MK-7 group had significantly higher plasma MK-7 levels than the placebo group (p < 0.01). Both groups showed similar reductions in CSA post-immobilisation (–11.7% ± 4.4 vs. –12.8% ± 3.5%, p > 0.05) but the MK-7 group exhibited a greater recovery trend after rehabilitation (94.4% ± 4.8 vs. 91.7% ± 2.8% of baseline, p > 0.05). Higher myostatin levels in the MK-7 group may have counteracted its effects. Conclusions. While MK-7 did not prevent atrophy, it showed potential in accelerating muscle recovery. Further studies are needed to optimise the dosage and explore synergies with resistance training.

Įvadas. Pirmas lateralinis girnelės išnirimas sudaro 1-2 % visų kelio traumų, ypač jaunų, aktyvių sportuojančių žmonių tarpe. Šiam pažeidimui didelę įtaką daro du anatominiai požymiai: displastiška šlaunikaulio girnelės vaga ir aukšta girnelės padėtis. Kaip šie du anatominiai požymiai įtakoja patelofemoralinį nestabilumą – diskusijų klausimas.
Darbo tikslas. įvertinti koreliaciją tarp aukštos girnelės padėties ir šlaunikaulio girnelės vagos kampo, vaikams patyrusiems pirmą lateralinį girnelės išnirimą. Išvados. Aukšta girnelės padėtis dažniau buvo tiems pacientams, kurių šlaunikaulio girnelės vagos kampas buvo nuo 138 iki 145 laipsnių. Aukšta girnelės padėtis dažniau buvo traumuotoje kojoje. Displastinė šlaunikaulio vaga dažnesnė traumuotoje kojoje.

Monitoring the muscle mechanical properties and functions of female athletes throughout their training season is relevant to understand the relationships between these factors and to predict non-contact injuries, which are prevalent among female athletes. The first aim of this study was to determine whether female handball players' passive stiffness of the hamstring muscles is associated with hamstring extensibility, strength of knee flexors and extensors, and lower limb stiffness. Additionally, the study monitored fluctuations in these factors over 25 weeks. The study utilized an isokinetic dynamometer to record hamstring passive stiffness, extensibility, and hamstring and quadriceps strength of 18 young handball players. Lower limb stiffness was determined from a countermovement vertical jump conducted on a force plate. The countermovement jump involved the calculation of the peak force during the eccentric phase and the mean force during the concentric phase. The results showed a positive correlation between hamstring passive stiffness and lower limb stiffness (r = 0.660, p < 0.01), knee flexion and extension strength (r = 0.592, p < 0.01 and r = 0.497, p < 0.05, respectively), and eccentric peak force (r = 0.587, p < 0.01) during jumping. The strength of knee extensors increased significantly after six weeks, and hamstring stiffness after 12 weeks of training. In conclusion, the increased hamstring stiffness following training did not match other factors associated with injury risk. Therefore, preventing multifactorial injury risk requires a comprehensive approach, and monitoring one factor alone is insufficient to predict non-contact injuries in female handball players.

INTRODUCTION Acute lateral patellar dislocation is the most common acute knee disorder in children and adolescents, and may lead to functional disability AIMS AND OBJECTIVES The purpose of this study was to identify key differences and correlations of the patellofemoral joint morphology between intact and contralateral injured knees in a first-time traumatic acute lateral patellar dislocation population aged under 18 years. MATERIALS AND METHODS The data were gathered prospectively from a cohort of 58 patients (35 girls and 23 boys). The prevalence and combined prevalence of patella alta (PA) and trochlear dysplasia (TD) in both knees of patients were evaluated using X-ray by two radiologists. RESULTS The patellofemoral joint of patients’ intact knees had a lower rate of TD (1.72% vs. 5.2%) and a less common combination of PA with shallow femoral sulcus (SFS) (22.4% vs. 44.8%) but more frequent PA (62.1% vs. 41.4%) compared with their injured knees. We noted statistically significant positive correlations (SSPCs) between the femoral sulcus angle (FSA) and PA in patients with intact (r = 0.37; p < 0.005) and contralateral injured knees (r = 0.33; p < 0.05). CONCLUSIONS There were SSPCs between the FSA and PA in both gender and age groups of patients with intact and contralateral injured knees. The SSPCs between the FSA and PA of intact knees were higher in the patients with a more dysplastic PFJ anatomy (PA and TD) of the injured knees as compared to patients with only PA of the injured knees.

Introduction 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 NSAID’s combined with icing interferes it, so new strategy excludes this combination. Aims and Objectives To compare PRICE vs PEACE and LOVE for LAS treatment and to evaluate injury severity outcomes in adolescents. Materials and methods A prospective randomised study of 33 (18 male, 15 female) patients from 12 to 17 years old who admitted LUHS Paediatric emergency department in year 2022 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. Patients were randomly allocated to classic (A) PRICE (n = 16, male 61.1 %, female 38.9 %) or new (B) PEACE and LOVE (n = 17, male 50 %, female 50 %) 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 and 5 to 7 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. Results Mean patient age was 15.19 (SD 1.54). Depending on injury severity 15 patients (46.9 %) formed group I and 17 patients (53.1 %) group II. There was no significant difference measuring deficiencies between U and I legs in group I and II in both testing: YBT-1 CS group I 15.46 % vs group II 17.41 % (U = 112, p = 0.558); YBT-2 CS group I 12,30 % vs 15 % (U = 68, p = 0.393); 1 PEAK TQ/BW IN group I 15.17 % vs group II 17.68 % (U = 108, p = 0.450); 1 PEAK TQ/BW EV group I 14.60 % vs group II 18.18 % (U = 99, p = 0,282); 2 PEAK TQ/BW IN group I 15.90 % vs group II 12.88 % (U = 66, p = 0.340); 2 PEAK TQ/BW EV group I 12.85 % vs group II 14.68 % (U = 73.5, 0 = 0,564); 1 ROM group I 13.47° vs group II 19.18° (U = 82, p = 0.086); 2 ROM group I 11.35° vs 15.56° (U = 58.5, p = 0.183). […].

Objectives: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. Methods: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. Results: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. Conclusion: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. Key points: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an [...].

Objectives: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. Methods: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. Results: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. Conclusions: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. Key points: • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.