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author:("morava, S")
1.  A combination of Latarjet and Remplissage for treatment of severe glenohumeral instability and bone loss. A case report 
Journal of Orthopaedics  2013;10(1):46-48.
Recurrent glenohumeral instability is challenging to treat when large bony defects are present in the anterior glenoid and there is a large Hill–Sachs lesion. We present a case with extensive glenoid and humeral bone loss treated with open Latarjet procedure combined with posterior arthroscopic Remplissage. 3.5 years after surgery, there have been no dislocations or any subjective signs of instability. After half a year, the patient was able to return to work as an airline pilot. Constant score has improved from 33 to 74 and the Oxford instability score from 8 to 46. We find that in young patients with difficult instability combining the Latarjet and Remplissage is a good and replicable method.
PMCID: PMC3768247  PMID: 24403748
Latarjet; Remplissage; Shoulder instability
2.  Calcific spurs at the insertion of the Achilles tendon: a clinical and histological study 
In active people, insertional calcific tendinopathy (CT) of the Achilles tendon is rare. We evaluated the results of surgical treatment for Achilles tendon CT and analyzed post-surgery Achilles tendon histological features. The study included 36 operations in 34 patients. Twenty-eight (78%) cases had a resection of a Haglund’s deformity performed. The mean age of the patients was 42 years (range=23 to 68). Thirteen of the patients were professional athletes and 20 recreational athletes. In twenty-five (69%) cases, the result of surgery was rated good, in nine cases (25%) moderate and in two (6%) cases poor. The mean age of those with a good result was 10 years lower (40 versus 50 years) than those with a moderate result (p=0.0239). Higher athletic activity was also related to a better outcome (p=0.0205). Histology samples showed fast remodellation and stem-cell activation. Surgery seemed to result in a good outcome in patients with or without a Haglund’s deformity which failed conservative treatment.
PMCID: PMC3666536  PMID: 23738309
Achilles tendon; achillodynia; calcific tendinopathy; enthesophyte; Haglund’s deformity; surgery
3.  All-Arthroscopic Double-Bundle Coracoclavicular Ligament Reconstruction Using Autogenous Semitendinosus Graft: A New Technique 
Arthroscopy Techniques  2012;1(1):e11-e14.
We present our novel arthroscopic anatomic double-bundle coracoclavicular ligament reconstruction technique using a semitendinosus tendon autograft. The dorsal limb of the graft is positioned around the dorsal edge of the clavicle, re-creating the conoid ligament. The anterior limb proceeds superiorly and re-creates the trapezoid ligament. The solution effectively stabilizes the acromioclavicular joint and prevents anterior posterior translation. This new arthroscopic double-bundle coracoclavicular joint reconstruction is an effective and reliable method in stabilizing the clavicle and neutralizing the anterior-posterior translation, and we find it to be technically practical for the surgeon.
PMCID: PMC3678630  PMID: 23766964
4.  Long-Term Outdoor Reliability Assessment of a Wireless Unit for Air-Quality Monitoring Based on Nanostructured Films Integrated on Micromachined Platforms 
Sensors (Basel, Switzerland)  2012;12(6):8176-8192.
We have fabricated and tested in long-term field operating conditions a wireless unit for outdoor air quality monitoring. The unit is equipped with two multiparametric sensors, one miniaturized thermo-hygrometer, front-end analogical and digital electronics, and an IEEE 802.15.4 based module for wireless data transmission. Micromachined platforms were functionalized with nanoporous metal-oxides to obtain multiparametric sensors, hosting gas-sensitive, anemometric and temperature transducers. Nanoporous metal-oxide layer was directly deposited on gas sensing regions of micromachined platform batches by hard-mask patterned supersonic cluster beam deposition. An outdoor, roadside experiment was arranged in downtown Milan (Italy), where one wireless sensing unit was continuously operated side by side with standard gas chromatographic instrumentation for air quality measurements. By means of a router PC, data from sensing unit and other instrumentation were collected, merged, and sent to a remote data storage server, through an UMTS device. The whole-system robustness as well as sensor dataset characteristics were continuously characterized over a run-time period of 18 months.
PMCID: PMC3436023  PMID: 22969394
gas sensors; metal-oxides; nanomaterials; micromachining; air monitoring; wireless network
5.  Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment 
Hamstring strains are among the most frequent injuries in sports, especially in events requiring sprinting and running. Distal tears of the hamstring muscles requiring surgical treatment are scarcely reported in the literature.
To evaluate the results of surgical treatment for distal hamstring tears.
A case series of 18 operatively treated distal hamstring muscle tears combined with a review of previously published cases in the English literature. Retrospective study; level of evidence 4.
Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland.
Between 1992 and 2005, a total of 18 athletes with a distal hamstring tear were operated at our centre.
Main outcome measurements
At follow‐up, the patients were asked about possible symptoms (pain, weakness, stiffness) and their return to the pre‐injury level of sport.
The final results were rated excellent in 13 cases, good in 1 case, fair in 3 cases and poor in 1 case. 14 of the 18 patients were able to return to their former level of sport after an average of 4 months (range 2–6 months).
Surgical treatment seems to be beneficial in distal hamstring tears in selected cases.
PMCID: PMC2658938  PMID: 17138628
6.  Surgical treatment of partial tears of the proximal origin of the hamstring muscles 
Hamstring injuries are common especially in athletes. Partial and complete tears of the proximal origin may cause pain and functional loss.
To evaluate the results of surgical treatment for partial proximal hamstring tears.
Between 1994 and 2005, 47 athletes (48 cases, 1 bilateral) with partial proximal hamstring tears were operated on. The cases were retrospectively analysed. Before surgery, 42 of the patients had undergone conservative treatment with unsatisfactory results, whereas in five patients the operation was performed within four weeks of the injury.
The mean length of the follow up was 36 months (range 6–72). The result of the operation was rated excellent in 33 cases, good in nine, fair in four, and poor in two. Forty one patients were able to return to their former level of sport after an average of five months (range 1–12).
In most cases, excellent or good results can be expected after surgical repair of partial proximal hamstring tears even after conservative treatment has failed.
PMCID: PMC2579455  PMID: 16790482
hamstring; muscle; partial tear; surgical treatment; injury
7.  Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study 
Objective: To prospectively assess the early results of surgical treatment of chronic Achilles tendinopathy.
Methods: This seven month prospective follow up study assessed the short term results of surgical treatment of chronic Achilles tendinopathy and compared the subjective and functional outcome of patients with Achilles tendinopathy without a local intratendinous lesion (group A) with that of similar patients with such a lesion (group B). Forty two of the initial 50 patients were examined before surgery and after the seven month follow up. Evaluation included an interview, subjective evaluation, clinical tests, and a performance test.
Results: At the follow up, physical activity was fully restored in 28 of the 42 patients (67%), and 35 patients (83%) were asymptomatic or had only mild pain during strenuous exercise. In clinical tests, significant improvements were observed in climbing up and down stairs and the rising on the toes test. Surgical treatment also seemed to be successful from the total test score, which was excellent or good in 35 patients, compared with before surgery when it was excellent or good in one patient only. Patients in group A fared better than those in group B, whether evaluated by recovery of physical activity after surgery (88% v 54%) or the complication rate (6% v 27%).
Conclusions: Surgical treatment of chronic Achilles tendinopathy gives good and acceptable short term results. A lower complication rate and a trend to better recovery was observed in patients with peritendinous adhesions only than in those with peritendinous adhesions combined with an intratendinous lesion.
PMCID: PMC1724497  PMID: 12055111
8.  Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis 
European Spine Journal  1999;8(6):480-484.
We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical examination, and plain radiographs and magnetic resonance images were also obtained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities that corresponded with the location and type of clinical symptoms. Twelve subjects had changes in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction. Six out of eight boys and two out of 11 girls had stress reaction (P = 0.043). Restriction of painful activities was recommended to all subjects, restriction of activities and the use of a dynamic low-back brace for the first 3 months was recommended to patients with posterior vertebral arch stress reaction. The self-reported intensity of low-back pain (scale 0–100) among all the patients was 69 ± 16 (mean ± SD) at baseline and 18 ± 21 at the 1-year follow-up (P < 0.0001). In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoiding the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.
PMCID: PMC3611205  PMID: 10664307
Key words Bone scan; Growth; Intervertebral disk; MRI; Spondylolysis
9.  Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data. 
BMJ : British Medical Journal  1995;311(7018):1465-1468.
OBJECTIVE--To determine the acute injury profile in each of six sports and compare the injury rates between the sports. DESIGN--Analysis of national sports injury insurance registry data. SETTING--Finland during 1987-91. SUBJECTS--621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate. MAIN OUTCOME MEASURES--Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors. RESULTS--54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability. CONCLUSIONS--Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.
PMCID: PMC2543722  PMID: 8520333
10.  Surgical treatment of patellar tendon pain in athletes. 
A series of surgically treated patellar tendon lesions among athletes is presented. The material was collected during 5 years from three sports injury clinics and from two hospitals. During this period the authors treated about 150 cases of jumper's knee, of which 34 cases were treated by operation. The athletes were mostly volley ball players, jumpers or runners. The operation revealed a necrotic focus of the patellar tendon in 21 cases, the retinaculum was thick and adherent in 16 patients and an exostosis of the patellar insertion was seen in two cases. The necrotic areas were excised, the thick and adherent retinaculum was divided and the exostoses were excised and drilled. Surgical treatment of chronic patellar tendon pains may give good results in selected cases.
PMCID: PMC1478326  PMID: 3814988
11.  Overuse injuries in cross-country skiing. 
PMCID: PMC1478258  PMID: 4075067
12.  Blunt injury of the radial and ulnar arteries in volley ball players. A report of three cases of the antebrachial-palmar hammer syndrome. 
Three cases of the antebrachial-palmar hammer syndrome are described in volley ball players. They all suffered from a decreased blood perfusion of their right hand and fingers due to the repeated ball and floor impacts during the volley ball training and playing. The vascular lesions of the radial and ulnar arteries were reversible. The patients recovered spontaneously during the rest from excessive physical activity by their hands. The vascular lesions of this kind are rare but seem to be typical to volley ball players.
PMCID: PMC1859183  PMID: 6652399
13.  Osteochondroses in athletes. 
Osteochondroses are disorders of primary and secondary growth centres, or lesions at the apophyseal or epiphyseal growth areas of bones. Although there are many types of osteochondroses, the history, clinical symptoms and findings as well as radiological findings are typical. Physical exercise is one of the factors that provokes symptoms. In a series of 185 osteochondroses in active young athletes, there were 18 different disorders. The commonest were Osgood-Schlatter's disease, Sever's disease, osteochondritis dissecans of the femoral condyles, various other patellar osteochondroses and Scheuermann's disease. Most of the athletes were from individual events; track and field sports (53.5%), cross-country skiing (8.1%), gymnastics (3.2%) and power events (2.7%). Of the team sports soccer produced the most (20.0%). The treatment was conservative in 84.3% and operative in 15.7%. The duration of symptoms in these athletes persisted in about 43% for less than one year and in 57% for more. The late changes of osteodhondroses do not cause serious risks for a normal life, if the treatment is active and the follow-up efficient.
PMCID: PMC1858947  PMID: 7139227
14.  Diffuse osteochondrosis of the patella. 
PMCID: PMC1858937  PMID: 7139230
15.  Exertion injuries in female athletes. 
Because sports injuries in men form most of the available statistics, the reportage of injuries in female athletes is sparse. We describe exertion injuries and disorders in 281 women athletes, all of which hampered athletic training or performances. Sixty per cent of the injuries occurred to girls ages between 12-19 years, and about forty-eight per cent were track and field athletes. The most common sites of injury were the ankle, foot, heel and leg. Osteochondritic disorders were the most typical injuries in the series, and the chronic medical tibial syndrome was the injury that needed surgical treatment most frequently. Overuse injuries seem to differ very little from each other in the events included in this survey.
PMCID: PMC1858884  PMID: 6797496
16.  Stress fractures. 
PMCID: PMC1858777  PMID: 7378671
17.  Athletes' leg pains. 
The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains.
PMCID: PMC1859755  PMID: 486888
18.  Iliotibial tract friction syndrome in athletes--an uncommon exertion syndrome on the lateral side of the knee. 
An uncommon exertion pain on the lateral side of the knee is described in 88 patients, in four of whom it was bilateral. The disorder is a result of the friction of the iliotibial tract over the lateral femoral epicondyle. The syndrome is the iliotibial tract friction syndrome of ITFS. All the patients in the material were active athletes or middle-aged joggers in regular training. The cases were seen over four years and four months. The mean age of them was approximately 25 years, and there were only nine women in the series. Th pain appeared usually after running and was localised on the outer femoral condyle, and often radiated downwards along the iliotibial tract. Conservative treatment and changes in training habits cured most cases. The disorder has not often been described in the literature, and seems to appear only in physically very active people, such as athletes or military recruits.
PMCID: PMC1859635  PMID: 687887
19.  Exertion injuries in adolescent athletes. 
A series of 147 cases of exertion injuries in less than or equal to 15 years old athletes is presented. All injuries occurred during training or athletic performances without trauma and caused symptoms that prevented athletic exercises. There were 67 girls (46%) and 80 boys (54%) in the material. About 90% of them had been training for more than one year before the onset of the symptoms; 65% were interested in track and field athletics, 13% in ball games, 11% in skiing, 4% in swimming, and 3% in orienteering. The rest were interested in other sports. About 33% of the injuries were growth disturbances or osteochondroses seen also in other children. About 15% were anomalies, deformities or earlier osteochondritic changes, which caused first symptoms during the physical exercise; 50% were typical overuse injuries that may bother adult athletes, too; 43% of the injuries were localized in ankle, foot and heel, 31% in knee, 8% in back and trunk, 7% in pelvic and hip region, and the rest in other parts of the body. The injuries were generally slight, no permanent disability was noticed. Rest and conservation therapy cured most cases; operative treatment was used in only eight cases.
PMCID: PMC1859625  PMID: 24489
20.  Avulsion fractures in athletes. 
34 cases of avulsion fractures are described. Each fracture took place during athletic training or competition. Excepting six sportsmen participating in a general fitness programme, every patient was an active competitive athlete. There were six women and 28 men; their average age was 20.1 years, raised by a few middle-aged "fitness sportsmen". Most avulsion fractures took place in sprinters and hurdlers; next were middle and long distance renner, footballers, fitness joggers, skiers and ice-hockey players. The most usual location of a fracture was the anterior pelvic spines; avulsion fractures were also detected in various parts of lower limbs. There were fewer avulsion fractures in the area of the trunk and upper extremities. Roetgenologically, the diagnosis of an avulsion fracture is generally easy to make. However, the diagnosis is facilitated by knowing the mechanism of the injury, the technique of the athletic event, and some of the training methods. Generally, a fracture heals well, even if it requires both sufficient immobilisation and some delay in resuming physical exertion.
PMCID: PMC1859504  PMID: 884433

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