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Purpose: The purpose of the current study was to assess the effectiveness of rehabilitation in patients after anterior cruciate ligament reconstruction (ACLR) using a wavelet analysis of the torque-time curve patterns of the extensors of the affected knee. The analysis aimed at the quantitative evaluation of irregularities in these torque-time patterns. Methods: The study involved a group of 22 men who had had ACL reconstruction. The torque-time characteristics were recorded 3, 6 and 12 months after the surgery by an isokinetic dynamometer. They were then examined using the orthogonal Daubechies 4 (Db 4) and biorthogonal Bior 3.1 wavelets. Results: A statistical analysis of the results revealed significant differences in values of the high-frequency energy stored in the details of the signal from the dynamometer between the first and last measurements, both for the Db 4 ( p ≤ 0.023) and Bior 3.1 ( p ≤ 0.01) wavelets. These differences were found in 73% of patients whose curve patterns were analysed using the Db 4 wavelet and in 82% of patients in the case of the Bior 3.1 wavelet. Conclusions: The wavelet transform proved to be an effective research tool in the qualitative evaluation of irregularities occurring in the curve patterns of the torque generated by the extensors of the ACL reconstructed knee. The findings of the study suggest that time-frequency analyses of these characteristics can be of practical importance, as they help assess the state of the patient's knee joint and his progress in rehabilitation after ACLR. [ABSTRACT FROM AUTHOR]

Background. Chronic rotational instability of the knee after damage to the anterior cruciate ligament (ACL) fairly quickly produces undesirable secondary changes in the joint. Concomitant damage may affect the meniscus or the articular cartilage of the femoral condyle. The purpose of our study was to compare outcome in patients who had undergone one-stage surgical repair of damage to the ACL and articular cartilage. Material and methods. We studied 17 patients with associated cartilage and ligament damage. The control group consisted of 36 patients with isolated ACL damage. Joint function was assessed according to the Marshall Scale and the Lysholm and Gilquist Scale. Examinations were performed before treatment, 2 and 6 weeks post-operatively, and again 3, 6 and 12 months after surgery. Results. In the course of rehabilitation we observed a slightly slower recovery in the patients with combined damage up to 6 months after surgery. There were no statistically significant differences in rehabilitation outcome at the end of the observation period Conclusions. This treatment method has the potential to permanently remedy knee slippage and cancel its early effects. The surgical outcome in repair of damage to the patellofemoral joint, combined with centralization of the knee's extension apparatus, are comparable at 2 years to centralization of the patella alone when the normal structure of the articular cartilage has been perserved.

Background. Patellar misalignment is often accompanied by damage to the chondral surface of the patello-femoral joint. The goal of surgical treatment is to address the primary cause by correcting the axis of knee flexion. In the Orthopedics and Traumatology Clinic in Lublin, Poland, we repair damaged cartilage and align the knee extensor in a one-stage operation. The goal of the present study is to compare the course of recovery and outcome in patients operated for recurrent patellar dislocation, in whom chondral damage in the patello-femoral joint is discovered intraoperatively. Material and methods. In a prospective experiment, 14 patients treated in our clinic from 2001 to 2003 were evaluated. The axis of the knee extensor was corrected both proximally and peripherally. Third- or fourth-degree chondral damage according to the ICRS scale was repaired by mosaicplasty. Outcome was evaluated by systematic assessment using the Marshall scale. The control group consisted of patients in whom only realignment was performed due to the absence of chondral damage. Results. Recovery was slower after combined treatment than in the control group. Two years post-operatively the functional outcomes in both groups were comparable, with no statistically significant differences. Conclusions. The treatment method described here gives reason to hope for long-term remediation of patellar misalignment, and removes the effects of earlier abnormalities. After 2 years, the functional outcome after repair to patello-femoral articular cartilage combined with patellar realignment are comparable to those achieved in patients not requiring repair of articular cartilage during patellar realignment.

A series of 15 patients with focal chondral lesions of the femoral condyles were treated at the Orthopaedics Department of the University of Medical Sciences of Lublin between 1998-2000. The patients' age varied from 20 to 72 years and the follow-up period from 6 months to 2.5 years. Osteochondritis dissecans was observed in 9 patients. Articular cartilage defects associated with chronic ligament instability was noted in 5 cases and 1 patient suffered from a chondral fracture of the lateral femoral condyle during a traumatic luxation of the patella. The depth of the lesions was graded according to ICRS scale. Grade IV was found in 11 cases and the remaining 4 cases had grade III lesions. The defects were treated with osteochondral autografts using OATS instrumentation set. Results were prospectively evaluated according to the HSS score. The preoperative value of HSS score ranged from 28 to 51 points (average 40.3). During follow-up the score values ranged from 76 to 91 points (average 84.7 points). All patients regained full range of motion in the knee, although in one case arthroscopic release of intraarticular adhesions was performed 6 months after chondroplasty. The lowest HSS values at follow-up were found in elderly patients with concomitant mild degenerative changes in the lateral knee compartment and in the patello-femoral joint. All patients had MRI examination early post-op, then after 6, 12 and 24 months from the procedure. MRI confirmed proper structure of the grafted cartilage but bony parts of the graft did not integrate with the surroundings.