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Poznań, Poland

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. Source

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

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. Source

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

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. Source

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

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. Source

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

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). Source

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