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Izolirana rekonstrukcija prednjeg križnog ligamenta (ACL) predstavlja zlatni standard u kirurškom liječenju rupture prednjeg križnog ligamenta. No, neuspjeh cijeljenja presatka i ostatna rotacijska nestabilnost koljena i dalje su česte postoperativne komplikacije. Anterolateralni ligament (ALL) i njegova uloga u kontroli rotacijske stabilnosti dobila je značajan interes 2013. nakon objave njegova „ponovnog otkrića”. Ta ligamentarna struktura, opisana još davne 1879., potječe od proksimalnog i stražnjeg dijela lateralnog epikondila bedrene kosti i hvata se na goljeničnoj kosti, na sredini između Gerdyjeva tuberkla i glavice fibule. Biomehanička ispitivanja pokazala su da anterolateralni ligament djeluje kao pasivni stabilizator koljena tijekom unutarnje rotacije koljena, i kod rupture ACL-a i lateralnih struktura koljena odgovoran je za nastanak pivot-shift fenomena. Pokazalo se da izolirana rekonstrukcija ACL-a u pacijenata s ozljedom ACL-a i ALL-a ne može vratiti normalnu kinematiku koljena, za razliku od njihove kombinirane rekonstrukcije. Uz to, dosadašnja literatura nudi brojne dokaze u smislu poboljšanja stabilnosti koljena nakon kombiniranog postupka rekonstrukcije ACL-a i ALL-a. Štoviše, nedavne kliničke studije pokazale su da ALL ima zaštitni učinak na očuvanje presatka ACL-a, kao i na brži ponovni povratak u sport i opće zadovoljstvo pacijenata s operativnim zahvatom. Ovaj pregledni rad ima za cilj dati pregled dosadašnjeg znanja anatomije, funkcije i učinka rekonstrukcije ACL-a i ALL-a u pacijenata s puknućem ACL-a., Isolated anterior cruciate ligament (ACL) reconstruction is the gold standard in surgical treatment of anterior cruciate ligament rupture. However, graft failure rates and residual rotational instability of the knee are still common post-operative complications. The anterolateral ligament (ALL) and its role in controlling rotational stability gained considerable interest in 2013 following the announcement of its ‟rediscovery”. This ligamentous structure, described back in 1879, originates just proximal and posterior of the lateral epicondyle of the femur and it ends on the tibia, midway between Gerdy's tubercle and the head of the fibula. Biomechanical studies have shown that the anterolateral ligament acts as a passive knee stabilizer during internal knee rotation and in the rupture of the ACL and lateral knee structures is responsible for the presence of a pivot-shift knee phenomenon. It has been shown that isolated ACL reconstruction in patients with ACL and ALL injury cannot restore normal knee kinematics unlike their combined reconstruction. In addition, recent literature shows evidence in terms of improving knee stability after a combined ACL and ALL reconstruction procedure. Moreover, recent clinical studies have shown that ALL has a protective effect on the preservation of ACL graft as well as on the faster return to sport and overall patient satisfaction. This review aims to give an overview of our current knowledge of the anatomy, function, and effect of combined ACL and ALL reconstruction in patients with ACL rupture.

Izolirana rekonstrukcija prednjeg križnog ligamenta (ACL) predstavlja zlatni standard u kirurškom liječenju rupture prednjeg križnog ligamenta. No, neuspjeh cijeljenja presatka i ostatna rotacijska nestabilnost koljena i dalje su česte postoperativne komplikacije. Anterolateralni ligament (ALL) i njegova uloga u kontroli rotacijske stabilnosti dobila je značajan interes 2013. nakon objave njegova „ponovnog otkrića”. Ta ligamentarna struktura, opisana još davne 1879., potječe od proksimalnog i stražnjeg dijela lateralnog epikondila bedrene kosti i hvata se na goljeničnoj kosti, na sredini između Gerdyjeva tuberkla i glavice fibule. Biomehanička ispitivanja pokazala su da anterolateralni ligament djeluje kao pasivni stabilizator koljena tijekom unutarnje rotacije koljena, i kod rupture ACL-a i lateralnih struktura koljena odgovoran je za nastanak pivot-shift fenomena. Pokazalo se da izolirana rekonstrukcija ACL-a u pacijenata s ozljedom ACL-a i ALL-a ne može vratiti normalnu kinematiku koljena, za razliku od njihove kombinirane rekonstrukcije. Uz to, dosadašnja literatura nudi brojne dokaze u smislu poboljšanja stabilnosti koljena nakon kombiniranog postupka rekonstrukcije ACL-a i ALL-a. Štoviše, nedavne kliničke studije pokazale su da ALL ima zaštitni učinak na očuvanje presatka ACL-a, kao i na brži ponovni povratak u sport i opće zadovoljstvo pacijenata s operativnim zahvatom. Ovaj pregledni rad ima za cilj dati pregled dosadašnjeg znanja anatomije, funkcije i učinka rekonstrukcije ACL-a i ALL-a u pacijenata s puknućem ACL-a., Isolated anterior cruciate ligament (ACL) reconstruction is the gold standard in surgical treatment of anterior cruciate ligament rupture. However, graft failure rates and residual rotational instability of the knee are still common post-operative complications. The anterolateral ligament (ALL) and its role in controlling rotational stability gained considerable interest in 2013 following the announcement of its ‟rediscovery”. This ligamentous structure, described back in 1879, originates just proximal and posterior of the lateral epicondyle of the femur and it ends on the tibia, midway between Gerdy's tubercle and the head of the fibula. Biomechanical studies have shown that the anterolateral ligament acts as a passive knee stabilizer during internal knee rotation and in the rupture of the ACL and lateral knee structures is responsible for the presence of a pivot-shift knee phenomenon. It has been shown that isolated ACL reconstruction in patients with ACL and ALL injury cannot restore normal knee kinematics unlike their combined reconstruction. In addition, recent literature shows evidence in terms of improving knee stability after a combined ACL and ALL reconstruction procedure. Moreover, recent clinical studies have shown that ALL has a protective effect on the preservation of ACL graft as well as on the faster return to sport and overall patient satisfaction. This review aims to give an overview of our current knowledge of the anatomy, function, and effect of combined ACL and ALL reconstruction in patients with ACL rupture.

Aim To assess whether an adenoviral vector carrying the bone morphogenetic protein genes (Ad.BMP-2) can transduce human muscle tissue and direct it toward osteogenic differentiation within one hour. Methods This in vitro study, performed at the Department of Molecular Biology, Faculty of Science, Zagreb from 2012 to 2017, used human muscle tissue samples collected during anterior cruciate ligament reconstructions performed in St Catherine Hospital, Zabok. Samples from 28 patients were transduced with adenoviral vector carrying firefly luciferase cDNA (Ad.luc) by using different doses and times of transduction, and with addition of positive ions for transduction enhancement. The optimized protocol was further tested on muscle samples from three new patients, which were transduced with Ad.BMP-2. Released bone morphogenetic protein 2 (BMP-2) levels in osteogenic medium were measured every three days during a period of 21 days. Expression of osteogenic markers was measured at day 14 and 21. After 21 days of cultivation, muscle tissue was immunohistochemically stained for collagen type I detection (COL-I). Results The new transduction protocol was established using 108 plaque-forming units (P < 0.001) as an optimal dose of adenoviral vector and 30 minutes (P < 0.001) as an optimal contact time. Positive ions did not enhance transduction. Samples transduced with Ad.BMP-2 according to the optimized protocol showed enhanced expression of osteogenic markers (P < 0.050), BMP-2 (P < 0.001), and COL I. Conclusion This study confirms that Ad.BMP-2 can transduce human muscle tissue and direct it toward osteogenic differentiation within 30 minutes.

Aim To assess whether an adenoviral vector carrying the bone morphogenetic protein genes (Ad.BMP-2) can transduce human muscle tissue and direct it toward osteogenic differentiation within one hour. Methods This in vitro study, performed at the Department of Molecular Biology, Faculty of Science, Zagreb from 2012 to 2017, used human muscle tissue samples collected during anterior cruciate ligament reconstructions performed in St Catherine Hospital, Zabok. Samples from 28 patients were transduced with adenoviral vector carrying firefly luciferase cDNA (Ad.luc) by using different doses and times of transduction, and with addition of positive ions for transduction enhancement. The optimized protocol was further tested on muscle samples from three new patients, which were transduced with Ad.BMP-2. Released bone morphogenetic protein 2 (BMP-2) levels in osteogenic medium were measured every three days during a period of 21 days. Expression of osteogenic markers was measured at day 14 and 21. After 21 days of cultivation, muscle tissue was immunohistochemically stained for collagen type I detection (COL-I). Results The new transduction protocol was established using 108 plaque-forming units (P < 0.001) as an optimal dose of adenoviral vector and 30 minutes (P < 0.001) as an optimal contact time. Positive ions did not enhance transduction. Samples transduced with Ad.BMP-2 according to the optimized protocol showed enhanced expression of osteogenic markers (P < 0.050), BMP-2 (P < 0.001), and COL I. Conclusion This study confirms that Ad.BMP-2 can transduce human muscle tissue and direct it toward osteogenic differentiation within 30 minutes.

Bone defects, including normal fracture healing as well as healing problems represent a global health problem. The need for better treatment of bone defects is one of the central issues of tissue engineering and regenerative medicine. Regenerative orthopedics has several approaches – activation of endogenous stem cells, stem cell therapy and tissue engineering. Development of new treatments is mainly focused on the tissue engineering strategies that include stem cells, bioactive signals and appropriate scaffold support. The aim of this review is to describe a variety of stem cells that have an ability to become bone cells and therefore are of central importance for bone tissue engineering. Several cell types have been proposed as starting material - embryonic stem cells, induced pluripotent stem cells and adult stem cells. Due to ethical and safety issues, embryonic and induced pluripotent stem cells may be more suitable for studying human development and tissue formation under diverse experimental conditions, and represent an excellent base for understanding human diseases and development of innovative therapeutic solutions. Among adult stem cells, mesenchymal stem cells are the most suitable for bone tissue engineering. They can be isolated from variety of mesenchymal tissues and can differentiate into osteoblasts when given appropriate mechanical support and osteoinductive signal. The near future of bone healing and regeneration is closely related to advances in tissue engineering. The optimization of protocols of bone graft production using autologous mesenchymal stem cells loaded on appropriate scaffolds, exposed to osteogenic inducers and mechanical force in bioreactor, should be able to solve the current limitations in managing bone injuries.

Bone defects, including normal fracture healing as well as healing problems represent a global health problem. The need for better treatment of bone defects is one of the central issues of tissue engineering and regenerative medicine. Regenerative orthopedics has several approaches – activation of endogenous stem cells, stem cell therapy and tissue engineering. Development of new treatments is mainly focused on the tissue engineering strategies that include stem cells, bioactive signals and appropriate scaffold support. The aim of this review is to describe a variety of stem cells that have an ability to become bone cells and therefore are of central importance for bone tissue engineering. Several cell types have been proposed as starting material - embryonic stem cells, induced pluripotent stem cells and adult stem cells. Due to ethical and safety issues, embryonic and induced pluripotent stem cells may be more suitable for studying human development and tissue formation under diverse experimental conditions, and represent an excellent base for understanding human diseases and development of innovative therapeutic solutions. Among adult stem cells, mesenchymal stem cells are the most suitable for bone tissue engineering. They can be isolated from variety of mesenchymal tissues and can differentiate into osteoblasts when given appropriate mechanical support and osteoinductive signal. The near future of bone healing and regeneration is closely related to advances in tissue engineering. The optimization of protocols of bone graft production using autologous mesenchymal stem cells loaded on appropriate scaffolds, exposed to osteogenic inducers and mechanical force in bioreactor, should be able to solve the current limitations in managing bone injuries.

Osteogenesis imperfecta or brittle bone disease, a heritable disorder of connective tissue, is the most common of the inherited disorders primarily affecting bone. There are approximately 400 individuals with OI in Croatia alone. It is estimated that twice that number is present, represented by individuals with mild OI in whom the diagnosis has not been made. Due to the relatively low number of patients in the general population, treating physicians have limited experience with this disease, either with children or adults. The basis of this disease in European populations is mostly the result of defects in the structure or processing of collagen type I, an important protein of the extracellular matrix of many tissues. Presently, molecular defects in 16 different genes have been discovered to result in at least one type of OI of which 14 are not COL1 mutation loci. Although fractures occurring with no injury or minor injury are the hallmark of OI, other non-mineralized tissues can be affected as well and the pathological changes can be present in skin, tendons, eyes, teeth and blood vessels. Clinical manifestations are very heterogeneous and numerous signs and symptoms such as blue sclera, deafness, abnormal teeth development, joint hypermobility, increased risk of hernias, capillary fragility, aneurysms etc. Although there is no cure for this disease, there are specific therapies that can reduce the pain and complications associated with OI. The purpose of this review is to provide a brief overview of the molecular basis of this disease, describe clinical presentations, as well as to present orthopaedic therapeutic modalities for the patients with OI.

Patients over the age of 65 are the fastest growing segment of the population, and it is estimated that it comprises 12.5% of the entire population in the developed countries. Advances in medicine, science and healthy lifestyles have promoted substantially increased lifespans, aswell as better quality of life with more physical activity. On the other hand, aging is associated with a variety of physiologic changes that affect orthopedic care. Due to natural involution processes older adults may not have the physiologic reserves necessary to promote healing or to prevent or recover fromcomplications. Degenerative diseases and injuries sustained from trauma in combination with physiologic changes and comorbidity in the aged pose a significant health problem in older adults and a major treatment challenge for an orthopaedic surgeon. This review summarizes some of these unique challenges in care for older orthopaedic patient.

Patients over the age of 65 are the fastest growing segment of the population, and it is estimated that it comprises 12.5% of the entire population in the developed countries. Advances in medicine, science and healthy lifestyles have promoted substantially increased lifespans, aswell as better quality of life with more physical activity. On the other hand, aging is associated with a variety of physiologic changes that affect orthopedic care. Due to natural involution processes older adults may not have the physiologic reserves necessary to promote healing or to prevent or recover fromcomplications. Degenerative diseases and injuries sustained from trauma in combination with physiologic changes and comorbidity in the aged pose a significant health problem in older adults and a major treatment challenge for an orthopaedic surgeon. This review summarizes some of these unique challenges in care for older orthopaedic patient.

Cilj je ovoga rada prikazati raspodjelu i zastupljenost patomorfoloških promjena ramenog zgloba otkrivenih ultrazvučnim pregledom bolesnika s radnom dijagnozom humeroskapularnog periartritisa (PHS). Retrospektivno su analizirani ultrazvučni nalazi 141 bolesnika, odnosno 147 simptomatskih ramena kod bolesnika s uputnom dijagnozom PHS. Nalazi su podijeljeni u skupine prema anatomskoj lokalizaciji i ultrazvučno otkrivenoj patomorfologiji te po dobnim skupinama. Podaci su analizirani deskriptivno. Ukupno je nađeno 87 (59,2%) pozitivnih i 60 (40,8%) urednih ultrazvučnih nalaza. Najčešće su promjene na tetivi supraspinatusa (55,3%), potom tenosinovitis duge glave bicepsa (15,2%), burzitisi (12,6%), tendinitis supskapularisa (10,6%) i tendinitis infraspinatusa (0,7%). Najveći broj patomorfoloških promjena, a ujedno i urednih nalaza, nađen je u dobnoj skupini od 40 do 65 godina. Najmanji je broj urednih nalaza u skupini starijih od 65 godina gdje je otkriveno najviše kompletnih ruptura supraspinatusa. Ultrazvuk je zbog svoje visoke specifičnosti i osjetljivosti za otkrivanje promjena rotatorne manšete, subakromijalo-subdeltoidne burze i tetive duge glave bicepsa, a s druge strane dostupnosti, neinvazivnosti i relativno niske cijene, metoda izbora za procjenu mekotkivnih struktura kod bolnog ramena. Ciljana anamneza i klinički pregled smanjit će broj neadekvatno indiciranih pretraga, The aim of this study was to present the distribution and representation of shoulder ultrasonographic (US) examination findings in patients with diagnosis of humeroscapular periarthritis. US examination findings in 141 patients, that is 147 symptomatic shoulders with diagnosis of humeroscapular periarthritis, were evaluated retrospectively. Outcomes of ultrasonography were distributed in groups by anatomical location, US examination finding and age. Descriptive statistics were used to analyze the data. Out of 147 analyzed shoulders, 87 (59.2%) were positive and 60 (40.8%) were negative upon US examination. The most frequent US abnormalities were detected in a supraspinatus tendon (55.3%), followed by long head of the biceps tendon (15.2%), bursitis (12.6%), subscapularis tendinitis (10.6%) and infraspinatus tendinitis (0.7%). The highest number of US abnormalities, as well as negative ultrasonographies, were detected at the age 40 to 65. The least negative US examination findings were at age over 65, where also the highest number of supraspinatus tears were detected. Due to high specificity and sensitivity in the evaluation of the rotator cuff, subacromial bursa and long head of the biceps tendon changes, ultrasound is a reliable method for evaluation of patients with painful shoulder. Its availability, noninvasivity and relatively low cost make it a method of choice for inital evaluation of such patients. Detailed history and clinical examination are going to lessen inadequate medical requests for ultrasonography

U posljednja tri destljeća znatno se povećao broj žena koje se natječu u sportskim aktivnostima na svim razinama. Povećano sudjelovanje žena je dovelo i do povećanog rizika od ozljeda, bilo akutno-traumatskih bilo onih uzrokovanih prenaprezanjem. Ozljede izazvane prenaprezanjem definiraju se kao neravnoteža izazvana preintenzivnim treniranjem bez odgovarajućeg odmora, što s vremenom dovodi do prestanka rada mehanizama za reparaciju tkiva. Ovaj članak daje pregled najčešćih ozljeda izazvanih prenaprezanjem kod sportašica , s posebnim naglaskom na anatomske, fiziološke i psihološke razlike među spolovima., The last three decades have witnessed a tremendous increase in female sports participation at all levels. However, increased sports participation of female athletes has also increased the incidence of sport-related injuries, which can be either acute trauma or overuse injuries. Overuse injuries may be defined as an imbalance caused by overly intensive training and inadequate recovery, which subsequently leads to a breakdown in tissue reparative mechanisms. This article will review the most frequent overuse injuries in female athletes in the context of anatomical, physiological, and psychological differences between genders. The ancient Greeks barred women from participating at the ancient Olympics, even as spectators (1). Baron Pierre de Coubertin, the man credited for the birth of the modern Olympics, regarded women’s taking part in sports as being “against the laws of nature.” To cite his words: “Olympics are solemn and periodic exaltation of male athleticism, with internationalism as a base, loyalty as a means for its setting and female applause as a reward” (2). As a result of this attitude, women did not participate at the first modern Olympic games in Athens in 1896. However, a century later at the same place – during the 2004 Olympics, 4329 women from all over the world competed in the majority of 300 official events. Nowadays, taking part in sports is seen a positive experience for women, since it improves physical fitness, enhances self-esteem, and contributes to better physical and mental health. Apart from professional sport, there has also been a dramatic increase in women’s sports participation on recreational and amateur level.

Prije dvadesetak godina u Klinici za ortopediju ugrađivali smo umjetne ligamente, i to tip proteze ligamenta Gore-Tex (razgranati polytetrafluoroethylen) kao postupak spašavanja nestabilnih koljena. U 13 bolesnika koristili smo protezu ligamenta Gore-Tex za rekonstrukciju stražnje ukrižene sveze (engl. posterior cruciate ligament PCL). U pacijenta F. K. imali smo priliku nakon 20 godina od izvršene rekonstrukcije PCL-a izvršiti kliničku, artroskopsku, magnetskorezonantsku (MRI) i patohistološku evaluaciju. Zbog artrotskih promjena u koljenu u bolesnika je bilo potrebno izvršiti artroskopsku toaletu koljena. Tom prilikom se izvršila i artroskopska evaluacija ugradene proteze ligamenta Gore-Tex te se napravila biopsija za patohistološku analizu (PHD). Prethodno je napravljen MRI koji je pokazivao uredan kontinuitet i volumen PCLa uz uznapredovale artrotske promjene koljena. Nalaz MRI bio je sukladan kliničkom nalazu koji je pokazivao dobru stabilnost koljena. Tijekom artroskopije uz standardne ulaze koristio se i posteromedijalni ulaz radi boljeg prikazivanja PCL-a. Artroskopija je pokazala da je proteza ligamenta Gore-Tex u cijelosti obložena zadebljanom sinovijalnom membranom odnosno fibrozom, a kada se na jednom mjestu odstranila sinovijalna membrana vidjele su se karakteristične polytetrafluoroethylenske niti u kontinuitetu. Probatornom sondom dokazao se kontinuitet PCL-a, a potom se uzelo nekoliko komadića ovojnice umjetnog ligamenta za PHD. Isto tako uzelo se i nekoliko komadića sinovijalne membrane iz drugih dijelova koljena. Patohistološki nalaz je pokazao da nema upalne reakcije u sinovijalnoj membrani koljena, a u ovojnici proteze ligamenta Gore-Tex našlo se zrelo vezivno tkivo s prisustvom multinuklearnih orijaških stanica uz fragmente stranog polarizirajuceg materijala. Ovaj prikaz slučaja pokazuje dobru biokompaktibilnost te dobru stabilnost koljena nakon 20 godina od ugradnje proteze ligamenta Gore-Tex u bolesnika s izrazito nestabilnim koljenom. Zanimlj, Twenty years ago the Gore-Tex expanded polytetrafluoroethylene (PTFE) prosthetic ligament was used as feasible salvage procedure in patients with failed, multiply operated knees, or knees with gross instability. At the Department of Orthopaedic Surgery we operated 13 patients and replaced the posterior cruciate ligament (PCL) with the Gore-Tex prosthetic ligament. Recently we had opportunity to evaluate clinical, arthroscopic, magnetic resonance imagining (MRI) and patohystologic (PH) findings in patient F. K. twenty years after the reconstruction. Due to osteoarthritic changes arthroscopic toilette of the knee was performed. On that occasion arthroscopic evaluation and biopsies for microscopic examination were carried out. MRI performed prior to arthroscopy revealed tidy continuity and volume of PCL with advanced arthritic changes of knee. MRI findings were consistent to clinical findings of good knee stability. Arthroscopy revealed the Gore-Tex prosthetic ligament completely coated with thicken synovial membrane i.e. fibrosis. Partial removal of the synovial membrane showed continuity of characteristic PTFE strands. The continuity of PCL was established by the probe. After that, few pieces of synovial membrane from sheath of PCL and from other parts of synovial membrane of the knee were taken. One PTFP strand of artificial PCL was collected as well. Patohystological findings clearly excluded inflammatory reaction in synovial membrane of the knee. Furthermore, synovial membrane of Gore-Tex prosthetic ligament sheath was found to contain mature fibrotic tissue with multinuclear giant cells and fragments of foreign polarizing material. This case report demonstrated good biocompatibility and good knee stability twenty years after replacement of the PCL with the Gore-Tex prosthetic ligament in patient with gross instability. It is interesting to mention that there was no deterioration of PTFE strands.

Prije dvadesetak godina u Klinici za ortopediju ugrađivali smo umjetne ligamente, i to tip proteze ligamenta Gore-Tex (razgranati polytetrafluoroethylen) kao postupak spašavanja nestabilnih koljena. U 13 bolesnika koristili smo protezu ligamenta Gore-Tex za rekonstrukciju stražnje ukrižene sveze (engl. posterior cruciate ligament PCL). U pacijenta F. K. imali smo priliku nakon 20 godina od izvršene rekonstrukcije PCL-a izvršiti kliničku, artroskopsku, magnetskorezonantsku (MRI) i patohistološku evaluaciju. Zbog artrotskih promjena u koljenu u bolesnika je bilo potrebno izvršiti artroskopsku toaletu koljena. Tom prilikom se izvršila i artroskopska evaluacija ugradene proteze ligamenta Gore-Tex te se napravila biopsija za patohistološku analizu (PHD). Prethodno je napravljen MRI koji je pokazivao uredan kontinuitet i volumen PCLa uz uznapredovale artrotske promjene koljena. Nalaz MRI bio je sukladan kliničkom nalazu koji je pokazivao dobru stabilnost koljena. Tijekom artroskopije uz standardne ulaze koristio se i posteromedijalni ulaz radi boljeg prikazivanja PCL-a. Artroskopija je pokazala da je proteza ligamenta Gore-Tex u cijelosti obložena zadebljanom sinovijalnom membranom odnosno fibrozom, a kada se na jednom mjestu odstranila sinovijalna membrana vidjele su se karakteristične polytetrafluoroethylenske niti u kontinuitetu. Probatornom sondom dokazao se kontinuitet PCL-a, a potom se uzelo nekoliko komadića ovojnice umjetnog ligamenta za PHD. Isto tako uzelo se i nekoliko komadića sinovijalne membrane iz drugih dijelova koljena. Patohistološki nalaz je pokazao da nema upalne reakcije u sinovijalnoj membrani koljena, a u ovojnici proteze ligamenta Gore-Tex našlo se zrelo vezivno tkivo s prisustvom multinuklearnih orijaških stanica uz fragmente stranog polarizirajuceg materijala. Ovaj prikaz slučaja pokazuje dobru biokompaktibilnost te dobru stabilnost koljena nakon 20 godina od ugradnje proteze ligamenta Gore-Tex u bolesnika s izrazito nestabilnim koljenom. Zanimlj, Twenty years ago the Gore-Tex expanded polytetrafluoroethylene (PTFE) prosthetic ligament was used as feasible salvage procedure in patients with failed, multiply operated knees, or knees with gross instability. At the Department of Orthopaedic Surgery we operated 13 patients and replaced the posterior cruciate ligament (PCL) with the Gore-Tex prosthetic ligament. Recently we had opportunity to evaluate clinical, arthroscopic, magnetic resonance imagining (MRI) and patohystologic (PH) findings in patient F. K. twenty years after the reconstruction. Due to osteoarthritic changes arthroscopic toilette of the knee was performed. On that occasion arthroscopic evaluation and biopsies for microscopic examination were carried out. MRI performed prior to arthroscopy revealed tidy continuity and volume of PCL with advanced arthritic changes of knee. MRI findings were consistent to clinical findings of good knee stability. Arthroscopy revealed the Gore-Tex prosthetic ligament completely coated with thicken synovial membrane i.e. fibrosis. Partial removal of the synovial membrane showed continuity of characteristic PTFE strands. The continuity of PCL was established by the probe. After that, few pieces of synovial membrane from sheath of PCL and from other parts of synovial membrane of the knee were taken. One PTFP strand of artificial PCL was collected as well. Patohystological findings clearly excluded inflammatory reaction in synovial membrane of the knee. Furthermore, synovial membrane of Gore-Tex prosthetic ligament sheath was found to contain mature fibrotic tissue with multinuclear giant cells and fragments of foreign polarizing material. This case report demonstrated good biocompatibility and good knee stability twenty years after replacement of the PCL with the Gore-Tex prosthetic ligament in patient with gross instability. It is interesting to mention that there was no deterioration of PTFE strands.

U posljednja tri destljeća znatno se povećao broj žena koje se natječu u sportskim aktivnostima na svim razinama. Povećano sudjelovanje žena je dovelo i do povećanog rizika od ozljeda, bilo akutno-traumatskih bilo onih uzrokovanih prenaprezanjem. Ozljede izazvane prenaprezanjem definiraju se kao neravnoteža izazvana preintenzivnim treniranjem bez odgovarajućeg odmora, što s vremenom dovodi do prestanka rada mehanizama za reparaciju tkiva. Ovaj članak daje pregled najčešćih ozljeda izazvanih prenaprezanjem kod sportašica , s posebnim naglaskom na anatomske, fiziološke i psihološke razlike među spolovima., The last three decades have witnessed a tremendous increase in female sports participation at all levels. However, increased sports participation of female athletes has also increased the incidence of sport-related injuries, which can be either acute trauma or overuse injuries. Overuse injuries may be defined as an imbalance caused by overly intensive training and inadequate recovery, which subsequently leads to a breakdown in tissue reparative mechanisms. This article will review the most frequent overuse injuries in female athletes in the context of anatomical, physiological, and psychological differences between genders. The ancient Greeks barred women from participating at the ancient Olympics, even as spectators (1). Baron Pierre de Coubertin, the man credited for the birth of the modern Olympics, regarded women’s taking part in sports as being “against the laws of nature.” To cite his words: “Olympics are solemn and periodic exaltation of male athleticism, with internationalism as a base, loyalty as a means for its setting and female applause as a reward” (2). As a result of this attitude, women did not participate at the first modern Olympic games in Athens in 1896. However, a century later at the same place – during the 2004 Olympics, 4329 women from all over the world competed in the majority of 300 official events. Nowadays, taking part in sports is seen a positive experience for women, since it improves physical fitness, enhances self-esteem, and contributes to better physical and mental health. Apart from professional sport, there has also been a dramatic increase in women’s sports participation on recreational and amateur level.

Bolni sindromi u području kuka se općenito smatraju najučestalijim sindromima prenaprezanja u nekim sportskim aktivnostima, npr. u nogometu. Razmatrajući lokaciju i anatomske strukture zahvaćene prenaprezanjima u području kuka, lokacija i karakteristika boli može biti točno lokalizirana, a isto tako može se raditi o neodređenoj difuznoj boli u području preponske regije, male zdjelice i natkoljenice. Naziv sindrom se s pravom upotrebljava, jer zaista postoje mnogobrojni simptomi kao što mogu biti i mnogobrojni uzroci nastanka pojave boli u području kuka. Za razumijevanje sindroma prenaprezanja u području kuka treba se samo podsjetiti koliki mišići se hvataju i polaze iz područja kuka. To su: grupa abdominalnih mišića, mišići aduktori, mišići stražnje strane natkoljenice, mišići vanjski rotatori kuka, m. ilopsoas, m. rectus femoris i drugi (sartorius, piramidalis, kremaster). U ovom preglednom radu iznijeti ćemo najnovije spoznaje najvažnijih i najčešćih sindroma prenaprezanja u području kuka, groin strain; osteitis pubis; iliopsoas tendinitis and bursitis; tendinitis of the rectus femoris muscle; hip external rotator syndrome; gluteus medius syndrome; snapping hip; hamstring syndrome

Prijelomi zamora su djelomični ili potpuni prijelomi kostiju koji nastaju djelovanjem mnogobrojnih ponavljanih sila slabijih od sile koja je potrebna da slomi kost jednim djelovanjem i kao takvi predstavljaju sindrome prenaprezanja kostiju. Čest su problem sportske medicine, obuhvačajući između 1,1 i 10% svih sportskih ozljeda. Brojni su čimbenici koji pogoduju nastanku prijeloma zamora, a najčešći uzrok, u 22 do 75% slučajeva, su pogreške u treningu, tj. „prerano, previše“. Za postavljanje dijagnoze prijeloma zamora, važno imati na umu mogućnost takvoga stanja. Klinička dijagnoza jest osnovni postupak koji se kasnije, prema potrebi, nadopunjuje i drugim dijagnostičkim metodama: radiografijom, scintigrafijom, kompjutoriziranom tomografijom i magnetskom rezonancijom. Za najveći broj prijeloma zamora dovoljno liječenje jest kratkotrajan prekid sportske aktivnosti u trajanju od 4 do 6 tjedana koji dovodi do nestanka boli te zatim slijedi postupan povratak sportu. Prijelomi zamora pojedinih lokalizacija, vrat i trup bedrene kosti, prednji dio srednje trećine tibije, navikularna kost stopala, baza pete metatarzalne kosti, itd., imaju veći broj komplikacija tijekom liječenja te zahtijevaju posebno, dugotrajnije liječenje, a katkad i kirurško. Konačno, kao i u svim sindromima prenaprezanja, prevencija je ključna riječ., Stress fractures, which are classified among overuse injuries of bone, may be defined as partial or complete bone fracture that results from repeated application of stress of less strength than the stress required to fracture bone in a single loading. They are common problem in sports medicine comprising between 1.1 to 10% of all athletic injuries. Causes are many, but training errors, i.e. „too soon, too much“, are the most frequently encountered cause of stress fractures, causing stress fractures in as many as 22 to 75% cases. To diagnose a stress fracture, it is essential to have the possibility of such a condition constantly in mind. Clinical examination represents basic diagnostic procedure followed later on by other diagnostic methods: radiography, scintigraphy, computed tomography and magnetic resonance imaging. For the most of stress fractures sufficient treatment is rest from offending athletic activity during 4 to 6 weeks leading to disappearance of pain and gradual return to sport activities. Stress fractures in some localizations, femoral neck (tension side), anterior cortex of the tibia, tarsal navicular, fifth metatarsal, etc., have higher number of complications during the treatment and require additional treatment, and in some cases even surgical intervention is appropriate. Finally, as in the most of the injuries belonging to the overuse group, prevention is the key word.

Bolni sindromi u području kuka se općenito smatraju najučestalijim sindromima prenaprezanja u nekim sportskim aktivnostima, npr. u nogometu. Razmatrajući lokaciju i anatomske strukture zahvaćene prenaprezanjima u području kuka, lokacija i karakteristika boli može biti točno lokalizirana, a isto tako može se raditi o neodređenoj difuznoj boli u području preponske regije, male zdjelice i natkoljenice. Naziv sindrom se s pravom upotrebljava, jer zaista postoje mnogobrojni simptomi kao što mogu biti i mnogobrojni uzroci nastanka pojave boli u području kuka. Za razumijevanje sindroma prenaprezanja u području kuka treba se samo podsjetiti koliki mišići se hvataju i polaze iz područja kuka. To su: grupa abdominalnih mišića, mišići aduktori, mišići stražnje strane natkoljenice, mišići vanjski rotatori kuka, m. ilopsoas, m. rectus femoris i drugi (sartorius, piramidalis, kremaster). U ovom preglednom radu iznijeti ćemo najnovije spoznaje najvažnijih i najčešćih sindroma prenaprezanja u području kuka, groin strain; osteitis pubis; iliopsoas tendinitis and bursitis; tendinitis of the rectus femoris muscle; hip external rotator syndrome; gluteus medius syndrome; snapping hip; hamstring syndrome

Prijelomi zamora su djelomični ili potpuni prijelomi kostiju koji nastaju djelovanjem mnogobrojnih ponavljanih sila slabijih od sile koja je potrebna da slomi kost jednim djelovanjem i kao takvi predstavljaju sindrome prenaprezanja kostiju. Čest su problem sportske medicine, obuhvačajući između 1,1 i 10% svih sportskih ozljeda. Brojni su čimbenici koji pogoduju nastanku prijeloma zamora, a najčešći uzrok, u 22 do 75% slučajeva, su pogreške u treningu, tj. „prerano, previše“. Za postavljanje dijagnoze prijeloma zamora, važno imati na umu mogućnost takvoga stanja. Klinička dijagnoza jest osnovni postupak koji se kasnije, prema potrebi, nadopunjuje i drugim dijagnostičkim metodama: radiografijom, scintigrafijom, kompjutoriziranom tomografijom i magnetskom rezonancijom. Za najveći broj prijeloma zamora dovoljno liječenje jest kratkotrajan prekid sportske aktivnosti u trajanju od 4 do 6 tjedana koji dovodi do nestanka boli te zatim slijedi postupan povratak sportu. Prijelomi zamora pojedinih lokalizacija, vrat i trup bedrene kosti, prednji dio srednje trećine tibije, navikularna kost stopala, baza pete metatarzalne kosti, itd., imaju veći broj komplikacija tijekom liječenja te zahtijevaju posebno, dugotrajnije liječenje, a katkad i kirurško. Konačno, kao i u svim sindromima prenaprezanja, prevencija je ključna riječ., Stress fractures, which are classified among overuse injuries of bone, may be defined as partial or complete bone fracture that results from repeated application of stress of less strength than the stress required to fracture bone in a single loading. They are common problem in sports medicine comprising between 1.1 to 10% of all athletic injuries. Causes are many, but training errors, i.e. „too soon, too much“, are the most frequently encountered cause of stress fractures, causing stress fractures in as many as 22 to 75% cases. To diagnose a stress fracture, it is essential to have the possibility of such a condition constantly in mind. Clinical examination represents basic diagnostic procedure followed later on by other diagnostic methods: radiography, scintigraphy, computed tomography and magnetic resonance imaging. For the most of stress fractures sufficient treatment is rest from offending athletic activity during 4 to 6 weeks leading to disappearance of pain and gradual return to sport activities. Stress fractures in some localizations, femoral neck (tension side), anterior cortex of the tibia, tarsal navicular, fifth metatarsal, etc., have higher number of complications during the treatment and require additional treatment, and in some cases even surgical intervention is appropriate. Finally, as in the most of the injuries belonging to the overuse group, prevention is the key word.