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Traumatic dislocation of the tibialis posterior tendon is an extremely rare injury with few reported cases. It is a complicated injury with high risk of misdiagnosis and mistreatment. MRI is the best tool for diagnosis. Surgical treatment has been reported to have a better outcome than conservative treatment. In the present case, a 23-year-old female athlete sustained a sports-related traumatic tibialis posterior tendon dislocation with retinaculum rupture. The patient underwent late reconstruction of the ruptured retinaculum followed by a personalised rehabilitation programme. Full recovery was achieved after 19 months according to European Foot and Ankle Society Score and Foot and Ankle Outcome Score. Lower leg muscle strength continued to improve until 6 months after surgery in isokinetic strength and physical performance tests.

Decreased physical fitness and inferior physical performance are potentially life-threatening risk factors in a combat situation. To examine the effect of vitamin D on physical performance, a prospective study of young men conscripts in the Estonian Army was designed. The hypothesis of the study was that severe deficiency of vitamin D has a negative effect on physical performance.All conscripts (n = 410) entering 10-month military service in July 2015 at the Kuperjanov Battalion were asked to participate. Initially, a total of 98 conscripts volunteered to participate.A prospective longitudinal study with a 10-month follow-up period was performed. The Army Physical Fitness Test (APFT) was performed three times, and hand grip strength, and blood serum values of 25(OH)D, parathyroid hormone (PTH) and calcium (Ca) were measured four times.A significant decrease in the levels of 25(OH)D compared with baseline values were found, with a lowest mean value of 31.9 nmol/l in March 2016 (p0.001). No significant differences were found in serum Ca levels. In March 2016, PTH was significantly higher in the severe deficiency group (25 nmol/l of 25(OH)D), (p=0.02). No significant differences were found in terms of the APFT or hand grip strength between conscripts with severe deficiency of 25(OH)D or values25 nmol/l.The main finding of the present study was that severe 25(OH)D deficiency was common among male conscripts during the winter season but had no negative effect on physical performance in terms of the APFT test and hand grip strength test.Severe vitamin D deficiency during the winter season is common but has no negative effect on physical performance in young, physically active men in military service.

Introduction Despite the great number of investigations on the effects of injuries during military service, there is limited information available on the use of self-reported instruments. This study evaluated self-reported knee pain (KP) and its effect on physical performance during military service in the Estonian Defense Forces. Material and Methods Ninety-five male conscripts aged 19–25 years were divided into two study groups based on the occurrence of KP or not. Self-reported KP and function according to the Knee Injury and Osteoarthritis Outcome Score (KOOS) were measured. Physical fitness level was scored using the Army Physical Fitness Test (APFT). KOOS and APFT were measured in the beginning and at the end of the 6-month period of military service. Results Significant differences in favor of the group without KP (P Conclusion In conclusion, self-reported KP and limited function according to KOOS did not hinder the improvement of physical condition and running speed as assessed by APFT in Estonian conscripts.

BackgroundThere has been a growing interest in the role of vitamin D for the well-being and physical performance of humans; however, there is a lack of long-term supplementation studies performed on members of the young, physically active, male population.The hypothesis of the study was that vitamin D supplementation during wintertime will decrease the prevalence of critically low vitamin D blood serum levels and increase hand grip strength during the winter season among young male conscripts. Study DesignLongitudinal, triple-blinded, randomized, placebo-controlled trial. MethodsFifty-three male conscripts from the Estonian Army were randomized into two groups: 27 to an intervention group and 26 to a placebo group. The groups were comparable in terms of their demographics. The intervention group received 1200 IU (30 µg) capsules of vitamin D3 and the control group received placebo oil capsules once per day. The length of the follow-up was seven months, from October 2016 until April 2017. Blood serum vitamin D (25(OH)D), parathyroid hormone (PTH), calcium (Ca), ionized calcium (Ca-i), testosterone and cortisol values and hand grip strength were measured four times during the study period. ResultsThe mean 25(OH)D level decreased significantly in the control group to a critically low level during the study, with the lowest mean value of 22 nmol/l found in March 2017. At that time point, 65% in the control group vs 15% in the intervention group had 25(OH)D values of less than 25 nmol/l (p < 0.001). In the intervention group the levels of 25(OH)D did not change significantly during the study period. All other blood tests revealed no significant differences at any time point. The corresponding result was found for hand grip strength at all time points. ConclusionLong-term vitamin D supplementation during wintertime results in fewer conscripts in the Estonian Army with critically low serum vitamin D (25(OH)D) levels during the winter season. However, this did not influence their physical performance in the form of the hand grip strength test. Trial registrationClinicalTrials.gov Identifier: NCT04359524. Registered 20 April 2020 - Retrospectively registered. https://register.clinicaltrials.gov

© 2020, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). Purpose: To establish recommendations for diagnosis, classification, treatment, and rehabilitation of posteromedial corner (PMC) knee injuries using a modified Delphi technique. Methods: A list of statements concerning the diagnosis, classification, treatment and rehabilitation of PMC injuries was created by a working group of four individuals. Using a modified Delphi technique, a group of 35 surgeons with expertise in PMC injuries was surveyed, on three occasions, to establish consensus on the inclusion or exclusion of each statement. Experts were encouraged to propose further suggestions or modifications following each round. Pre-defined criteria were used to refine item lists after each survey. The final document included statements reaching consensus in round three. Results: Thirty-five experts had a 100% response rate for all three rounds. A total of 53 items achieved over 75% consensus. The overall rate of consensus was 82.8%. Statements pertaining to PMC reconstruction and those regarding the treatment of combined cruciate and PMC injuries reached 100% consensus. Consensus was reached for 85.7% of the statements on anatomy of the PMC, 90% for those relating to diagnosis, 70% relating to classification, 64.3% relating to the treatment of isolated PMC injuries, and 83.3% relating to rehabilitation after PMC reconstruction. Conclusion: A modified Delphi technique was applied to generate an expert consensus statement concerning the diagnosis, classification, treatment, and rehabilitation practices for PMC injuries of the knee with high levels of expert agreement. Though the majority of statements pertaining to anatomy, diagnosis, and rehabilitation reached consensus, there remains inconsistency as to the optimal approach to treating isolated PMC injuries. Additionally, there is a need for improved PMC injury classification. Level of evidence: Level V.

In Estonian Defense Forces that are drawn up on the basis of the conscription model considerable numbers of young men are prematurely discharged from military service for medical reasons, but causes leading to premature dropout of conscripts have not been systematically studied. However, one of the factors involved could be relatively demanding physical training that starts at the beginning of military service in the form of basic military training (BMT). Cumulative training and nontraining stresses experienced by conscripts during BMT may exceed their physiological adaptability and increase the probability of becoming prematurely discharged. Therefore, the primary purpose of this study was to assess physiological responses to 10-week BMT in Estonian conscripts.The protocol of the study confirmed to the standards set by the Declaration of Helsinki and it was approved by the Research Ethics Committee of the University of Tartu. Mean ± SD age and body mass index of 94 conscripts studied was 20.9 ± 1.7 years and 24.2 ± 3.0 kg · mSignificant increases in serum testosterone concentration (60.6%), testosterone to cortisol ratio (61.1%), blood erythrocyte count (4.3%), hemoglobin concentration (3.8%) and hematocrit (2.2%), and decrease in serum ferritin concentration (39.3%) occurred between weeks 1 and 10 during BMT (in all cases p0.0001). Fifteen weeks later, these parameters were still at increased or decreased levels, respectively, compared to week 1. The prevalence of vitamin D deficiency (serum 25(OH) D concentration50 nmol · LThese findings suggest that BMT induces anabolic physiological adaptations in conscripts despite vitamin D deficiency and decrease in iron status. However, high prevalence of vitamin D deficiency and decline in iron status may limit physiological adaptations and improvement in physical work capacity to a suboptimal level. Furthermore, as vitamin D influences a variety of functions important for health, deficiency in conscripts should be considered a major concern that needs treatment. An acknowledged limitation of the study is the lack of a control group of conscripts possessing normal vitamin D status and stable serum ferritin levels throughout the study period. Nevertheless, the research design employed enabled to determine two factors that potentially limit physiological adaptability of conscripts to military training loads in ecologically authentic environment.

We studied 178 patients undergoing total hip arthroplasty (66 men and 112 women) retrospectively, with regard to the incidence and severity of heterotopic ossification and the significance of postoperative prophylaxis with non-steroid anti-inflammatory drugs. The overall incidence of heterotopic ossification was 32% 1 year after surgery. The factors increasing the incidence were male gender, previous arthroplasty of the contralateral hip joint, previous surgery on the hip, absence of preoperative treatment with non-steroidal anti-inflammatory drugs and an operating time of more than 100 min. The incidence of heterotopic ossification was lower in the patients of 0 blood group.