Poznań, Poland
Poznań, Poland

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Piontek T.,Rehasport Clinic | Ciemniewska-Gorzela K.,Rehasport Clinic | Ciemniewska-Gorzela K.,Poznan University of Medical Sciences | Szulc A.,Poznan University of Medical Sciences | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: Bone marrow mesenchymal stem cells were introduced into clinical practice due to their ability to differentiate into many types of cells. Autologous matrix-induced chondrogenesis (AMIC) combines the microfracture method with matrix-based techniques that utilizes a collagen membrane to serve as a scaffold for new bone marrow mesenchymal stem cells, allowing effective reconstruction of even large fragments of a damaged cartilage surface. Methods: All-arthroscopic technique to repair knee cartilage defects using the AMIC technique, which includes the use of a collagen matrix (porcine collagen type I and III) and fibrin glue-technique presentation. Conclusion: This technical note introduces an all-arthroscopic AMIC technique to reconstruct extensive cartilage defects (without bone defects). The technique may be used for treatment of all location of knee cartilage lesions. Level of evidence: V. © 2011 The Author(s).


Czaprowski D.,Jozef Rusiecki University College | Kotwicki T.,Poznan University of Medical Sciences | Stolinski L.,Rehasport Clinic
Ortopedia Traumatologia Rehabilitacja | Year: 2012

Joint laxity is diagnosed when the mobility of small and large joints is increased in relation to standard mobility for any given age, gender and race, and after excluding systemic diseases. Many of authors noted the co occurrence of joint laxity with the following symptoms: back and joints pa in, as well as disturbance of body posture. Clinicians apply various methods to assess joint laxity. Beighton scale is the most frequent method used in clinical screening. It consists of assessing: extension of the fifth MPC joint to 90°, thumb abduction to front fore arm, hyperextension of el bow and knee joint above 10°, as well as capability to stand bend and place onés palms flat on the ground. Carter and Wilkinson method is similar to this scale. The difference concerns the assessment of passive hyperextension of all four II-V fingers, instead of the assessment of the fifth finger only. The second difference involves assessing the range of an kledorsi flexion, in stead of assessing the ability to touch the ground with onés palms. Marshall test is another method for assessing joint laxity. This test is based on the thumb motion range measured in the fore arm direction. Hakim and Grahame suggests that the diagnosis of joint laxity may be done with a 5-point questionnaire. It would al low a fastove review as its questions refer to symptoms observed both at pre sent and in the past. Taken into account the common occurrence of joint laxity as well as common use the flexibility exercises in the physiotherapeutic process, the joint laxity should be systematically assessed by both physicians and physiotherapists. © MEDSPORTPRESS, 2012.


Bark S.,University of Lübeck | Piontek T.,Rehasport Clinic | Behrens P.,Chirurgie | Mkalaluh S.,University of Lübeck | And 2 more authors.
World Journal of Orthopaedics | Year: 2014

The limited intrinsic healing potential of human articular cartilage is a well-known problem in orthopedic surgery. Thus a variety of surgical techniques have been developed to reduce joint pain, improve joint function and delay the onset of osteoarthritis. Microfractures as a bone marrow stimulation technique present the most common applied articular cartilage repair procedure today. Unfortunately the deficiencies of fibrocartilaginous repair tissue inevitably lead to breakdown under normal joint loading and clinical results deteriorate with time. To overcome the shortcomings of microfracture, an enhanced microfracture technique was developed with an additional collagen I/III membrane (Autologous, Matrix-Induced Chondrogenesis, AMIC®). This article reviews the pre-clinical rationale of microfractures and AMIC®, presents clinical studies and shows the advantages and disadvantages of these widely used techniques. PubMed and the Cochrane database were searched to identify relevant studies. We used a comprehensive search strategy with no date or language restrictions to locate studies that examined the AMIC ® technique and microfracture. Search keywords included cartilage, microfracture, AMIC®, knee, Chondro-Gide®. Besides this, we included our own experiences and study authors were contacted if more and non published data were needed. Both cartilage repair techniques represent an effective and safe method of treating full-thickness chondral defects of the knee in selected cases. While results after microfracture deteriorate with time, mid-term results after AMIC® seem to be enduring. Randomized studies with long-term followup are needed whether the grafted area will maintain functional improvement and structural integrity over time. © 2014 Baishideng Publishing Group Inc.


Lubiatowski P.,Poznan University of Medical Sciences | Kaczmarek P.,Rehasport Clinic | Dzianach M.,Rehasport Clinic | Dzianach M.,Poznan University of Medical Sciences | And 5 more authors.
International Orthopaedics | Year: 2013

Purpose: The purpose of the study was clinical and advanced biomechanical evaluation of shoulder function with respect to rotator cuff (RC) integrity following repair. Methods: This was a retrospective study of 111 cases with solid single row rotator cuff repair and a minimal one-year follow-up. The RC repair was performed as an open procedure in 42 patients, arthroscopically assisted in 34 and fully arthroscopic in 48 cases. Evaluation protocol included ultrasound evaluation of the RC integrity, clinical evaluation using shoulder scores and advanced biomechanical evaluation (isometric and the isokinetic strength testing). Results: Ultrasound evaluation revealed complete retear in 16 %, partial retear in 10 % and intact repair in 74 % of the cases. Isometric testing of flexion and abduction had shown that shoulders with complete retear were weaker by 45 % compared to those with full tendon healing. Isokinetic testing revealed 29-43 % deficits in peak external rotation torque comparing complete retear vs. normal healing. Patients' ability to generate shoulder power and withstand a load proved to be lower in circumstances of a complete lack of healing (40-43 % and 34-55 %, respectively). Partial retears did not have a negative impact on the biomechanical properties of shoulders. Surprisingly, there were no significant differences in the shoulder scores related to the quality of healing. In terms of patient satisfaction the results were good and the patients declared themselves better in all cases, no matter what quality of healing had been recorded ultimately. Conclusions: According to the results of this research rotator cuff integrity after open or arthroscopic repair does not seem to affect clinical scores. Recurrent tears may result in lower muscle performance in terms of active motion, strength and endurance. Advanced shoulder testing may be essential in assessing the patients' ability to return to sports or heavy labour. © 2013 The Author(s).


Stolinski L.,Rehasport Clinic | Stolinski L.,Poznan University of Medical Sciences | Kotwicki T.,Poznan University of Medical Sciences
Studies in Health Technology and Informatics | Year: 2012

Screening for idiopathic scoliosis is not very popular in Poland. Some Polish towns and cities have prevention programmes aimed at discovering spine dysfunctions and disorders in children and adolescents. An assessment of the angle of trunk rotation (ATR) is a reliable, effective and non-invasive action that allows use to determine trunk asymmetry. Since then the scoliometer has spread throughout the United States and other countries, where it is a popular device in the clinical practice of diagnosing scoliosis. 9,500 children aged 7-10 were examined as part of a disease prevention programme entitled "Poznan Chooses Health - Bad Posture Prophylaxis in Class I-IV Primary School Children in Poznan". The analysis included results obtained in 2010 during initial posture assessment in 1000 children, Trunk asymmetry was measured by means of the Bunnell scoliometer. The measurement of the angle of trunk rotation was the spontaneous standing position with use the scoliometer during bending (Adams forward test) at three levels: proximal thoracic, main thoracic and lumbar. For the proximal thoracic section the 0° ATR value was found in 6 children, values of 1°-3° were recorded in 883 children, values of 4°-6° in 108 children, 7° or higher in 3 of the examined children. For the main thoracic section the 0° ATR value was found in 101 children, values of 1°-3° were recorded in 735 children, 4°-6° in 155 children, 7° or higher in 9 of the examined children. For the lumbar section ATR values of 0°, 1°-3°, 4°-6°, and 7° or higher were found, respectively, in 147, 883, 108 and 11 of the examined children. © 2012 The authors and IOS Press. All rights reserved.


PubMed | Adam Mickiewicz University, Rehasport Clinic and Poznan University of Medical Sciences
Type: Journal Article | Journal: International orthopaedics | Year: 2016

The main purpose of this study is to establish which of two methods is more reliable in glenoid assessment for instability in pre-operative planning. Accordingly, we have studied the intra- and inter-observer reliability of glenoid parameters with the use of two-dimensional (2D) and three-dimensional (3D) reconstructed computed tomography (CT) images.One hundred glenoids were measured with the use of 2D-CT and 3D-CT (in 3D orientation) by two independent observers (one experienced and one inexperienced). Measurements were repeated after oneweek for 30 randomly selected glenoids.The intra-class correlation coefficient (ICC) for inter-observer reliability was significantly greater for 3D-CT (0.811 to 0.915) than for 2D-CT (0.523 to 0.925). All intra-observer reliability values for 3D-CT were near perfect (0.835 to 0.997), while those for 2D-CT were less reliable (0.704 to 0.960). A dependent t-test showed that, for both observers, almost all glenoid parameters (except R and d) differed significantly (p<0.05) between 2D and 3D measurement methods.Therefore, it can be concluded that 3D glenoid reconstructions are more reliable for glenoid bone loss assessment than 2D-CT. The results suggest that quantifying a glenoid defect with the use of 2D image only-even if performed by an experienced orthopaedic surgeon-is prone to errors. Differences in measurements between and within observers can be explained by plane setting and identifying glenoid rim in 2D-CT. Accordingly, we recommend that glenoid measurements should be performed in 3D orientation using 3D reconstruction obtained from CT images for pre-operative assessments, which are crucial for surgical planning.


PubMed | Poznan University of Medical Sciences and Rehasport Clinic
Type: Journal Article | Journal: Scoliosis and spinal disorders | Year: 2016

First author attempted to analyse medical records of patients with idiopathic scoliosis for compliance with the Scoliosis Research Society brace studies criteria. A retrospective analysis of medical records of 2705 girls treated from 1989 to 2002 was carried out.Age, Cobb, Risser and menarchal status were analyzed for compliance with the Scoliosis Research Society brace studies criteria: a) age 10 years, b) Risser 0-2, c) 25-40 Cobb angle, d) no earlier treatment, e) patients before first menses or not more than one year from first menses.It has been found that 183 girls out of 2705 were 10 years old and in the range 25-40 Cobb angle. One hundred two out of 2705 patients revealed eligible for brace effectiveness study according to SRS 2005 criteria. 120 out of 2705 patients revealed eligible for brace brace effectiveness study according to SRS-SOSORT 2014 criteria.The excluded patients revealed too old or with too significant Cobb angles. This indicates the changing criteria for scoliosis brace treatment over the time. Direct comparison of current results of brace treatment with historical series of cases turns out to be very difficult.


PubMed | Rehasport Clinic and Poznan University of Medical Sciences
Type: Journal Article | Journal: International orthopaedics | Year: 2016

The evaluation of glenohumeral joint volume in both unstable (with/without laxity) and stable shoulders (subacromial impingement) and volume reduction potential of arthroscopic techniques: (labral anchor repair vs. capsular shift).Material was based on 133 patients: anterior shoulder instability without laxity (group I, n=49), with laxity (group II, n=22) and subacromial impingement (control group, n=62) operated in 2010-2011. Group I received arthroscopic Bankart repair, group; II - arthroscopic anterior capsular plication, control group - subacromial decompression. Joint volume was measured by fluid aspiration into the syringe via arthroscope, before and after procedure. Then volume reduction potential was calculated.The following average values of initial joint volume were recorded: group I - 26.8ml group II - 43.7ml and the control group - 25.6ml with significant differences: impingement vs. instability+laxity (p<0.00001), impingement vs. instability without laxity (p=0.0001). There was no significant difference between groups I and II. Joint volume was significantly reduced after labral repair (by average of 37%, 13.8ml, p<0.0001). Capsular shift led to an even greater and more significant volume decrease (61%, 26.7ml, p<0.001). Joint volume in the control group was reduced only by 11%, 3.8ml (p=0.046).Patients with unstable shoulders have enlarged joint volume as compared to patients with subacromial impingement. Arthroscopic techniques lead to a significant joint volume reduction, with the most powerful effect for capsular shift. Level of Evidence - Level 2.


In the past, the procedure for rehabilitation after hip surgery, related to the long immobilization of the operated joint, was often delayed and limited in time. Today's surgical procedures and rehabilitation allows for a quicker return to full physical fitness. Postoperative physiotherapy is mainly focused on regaining full joint function (range of motion--ROM, strength, stability). The rehabilitation program must be a dynamic process, dosed up to the possibility of the patient, depending on the type of procedure performed. Rehabilitation must take into account not only the type of procedure performed intraarticular, but also surgical approach. Rehabilitation after surgery requiring dislocation of the hip by osteotomy with simultaneous artrotomii trochanter must take into account the time required for the stable union. Range of motion exercises begin in the first days after surgery using a continous passive movement (CPM) and passive exercises, and later a stationary bicycle. Menaging patients after treatment of CAM type femoroacetabular impingement is dependent on the degree of bone resection performed within the femur. In the treatment of Pincer-type f emoroacetabular impingement, as well as injuries of the hip labrum rehabilitation proceedings must take into account the location and the area of pathology. Rehabilitation after surgery for articular cartilage (chondroplasty or osteoplasty) in the first period is mainly focused on the avoidance of intraarticular conflicts in the reconstruction of the full ROM.


Grygorowicz M.,Rehasport Clinic | Grygorowicz M.,Institute of Health Protection | Piontek T.,Rehasport Clinic | Dudzinski W.,Rehasport Clinic
PLoS ONE | Year: 2013

The main objective(s) of the study:The aim of this study was to analyze: a) abnormalities in the length of lower limb muscles, b) the correctness of movement patterns, and c) the impact of functional limitations of muscles on the correctness of fundamental movement patterns in a group of female soccer players, in relation to their skill level.Materials and Methods:21 female soccer players from Polish Ekstraklasa and 22 players from the 1st Division were tested for lower limb muscle length restrictions and level of fundamental movement skills (with the Fundamental Movement Screen™ test concept by Gray Cook). Chi-square test was used for categorical unrelated variables. Differences between groups in absolute point values were analyzed using the non-parametric Mann-Whitney U test. Statistical significance was set at p<0.05.Results:Statistically significant higher number of measurements indicating an abnormal length of rectus femoris was observed in the 1st Division group (p = 0.0433). In the group of Ekstraklasa the authors obtained a significantly higher number of abnormal hamstring test results (p = 0.0006). Ekstraklasa players scored higher in the rotational stability test of the trunk (p = 0.0008), whereas the 1st Division players scored higher in the following tests: deep squat (p = 0.0220), in-line lunge (p = 0.0042) and active straight leg raise (p = 0.0125). The results suggest that there are different functional reasons affecting point values obtained in the FMS™ tests in both analyzed groups.Conclusions:The differences in the flexibility of rectus femoris and hamstring muscle observed between female soccer players with different levels of training, may result from a long-term impact of soccer training on the muscle-tendon system and articular structures. Different causes of abnormalities in fundamental movement patterns in both analyzed groups suggest the need for tailoring prevention programs to the level of sport skills represented by the players. © 2013 Grygorowicz et al.

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