<p>U savremenoj hirurgiji imperativ je da hirur&scaron;ka procedura bude efikasna, ali i da obezbedi kvalitetan i brz oporavak. Najbitniji segment operativnog lečenja je obezbediti maksimalan učinak kako bi se osobi omogućio brz i potpun povratak aktivnostima dnevnog života. Posebno je pojačano&nbsp;&nbsp; interesovanje za rekonstrukciju prednjeg ukr&scaron;tenog ligamenta kod mlađe i sporsko aktivne populacije. Trendovi u medicini kao i u ortopedskoj hirurgiji idu u pravcu smanjenja postoperativnog krvarenja, bola i skraćenja postoperativnog oporavka. Supstancija sa antifibrinolitičkim delovanjem, kao &scaron;to je traneksamična kiselina, svakako je na&scaron;la svoje mesto u smanjenju postoperativnog krvarenja. Ciljevi istraživanja su se odnosili na utvrđivanje uticaja lokalno aplikovane traneksamične kiseline tokom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena na postoperativno krvarenje, posmatrane laboratorijske parametre, mere obima kolena, učestalosti postoperativnih komplikacija i kvaliteta postoperativnog oporavka između dve grupe ispitanika (ispitivana i kontrolna grupa). Studija je bila eksprimentalnog karaktera i sprovedena je u Kliničkom centru Vojvodine u Novom Sadu uz odobrenje etičke komisije. U istraživanje, metodom slučajnog izbora, bila su uključena 124 ispitanika oba pola raspoređena u dve grupe (ispitivana i kontrolna), a kod kojih je indikovana operativno zbrinjavanje prekida prednjeg ukr&scaron;tenog ligamenta kolena i koji su dali pristanak da budu uključeni u studiju. Svi prikupljeni podaci su beleženi u protokol, koji je za ovo istraživanje posebno dizajniran. Ispitanici su bili podvrgnuti operativnom zahvatu, uz primenu op&scaron;te ili spinalne anestezije, sa postavljenom pneumatskom poveskom na operisanom ekstremitetu. Ispitivanoj grupi bilo je lokalno aplikovano 20 ml traneksamične kiseline, dok je u kontolnoj grupi na isti način aplikovano 20 ml NaCl 0,9 % rastvora. Postoperativni gubici krvi su praćeni i beleženi tokom 24 h od operacije, dok su laboratorijki nalazi uzorkovani preoperativno i sedmog postoperativnog dana. U posmatranom periodu (preoperativno, sedmog postoperativnog dana, treće i &scaron;este postoperativne nedelje) kod ispitanika je praćen obim kolena i pojava komplikacija (hematom, hemartroza). Nakon sprovedenog istraživanje, prikupljeni podaci su dokumentovani i statistički obrađeni. Rezultati istraživanja jasno ukazuju da postoji statistički značajna razlika (t=7.181, p&lt;0.001) u količni postoperativnog krvarenja između grupa. Prosečno postoperativno krvarenje u ispitivanoj grupi je bilo 71.29&plusmn;40.76 ml, u odnosu na kontrolnu grupu gde je postoperativno krvarenje iznosilo 154.35&plusmn;81.45 ml. U kontrolnoj grupi, postoperativno se beleže niže vrednosti hemoglobina (t=9.608, p&lt;0.001) i hematokrita (t=8.325, p&lt;0.001), i vi&scaron;e vrednosti trombocita (t=2.201, p=0.032) nego u ispitivanoj grupi. Podaci o postoperativnom bolu ispitanika govore u prilog statistički značajnoj razlici u jačini bola prve nedelje nakon operacije između ispitivane i kontrolne grupe (t=2.405, p=0.018) i treće nedelje nakon operacije (t=3.700, p&lt;0.001). U ispitivanoj grupi zabeležena je ređa pojava hematoma 6.45% (n=4), dok je u kontrolnoj grupi 19.35% (n=12). Svi pacijenti u uzorku su popunili upitnik o postoperativnom kvalitetu oporavka. Nije zabeležena statistički značajna razlika u kvalitetu postoperativnog oporavka nakon operacije između dve analizirane grupe ispitanika. Dobijeni rezultati o postoperativnom krvarenju, nakon aplikovane traneksamične kiseline, ukazuju na efikasnost leka i pri lokalnoj primeni tokom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena. S obzirom na insuficijentnost podataka, ovo ispitivanje stvara &scaron;iru osnovu za dalja istraživanja.</p> / <p>In modern surgery, we need an effective surgical procedure, which provides quality and rapid recovery. The most important segment of surgical treatment is to provide maximum impact to allow a person to return quickly and fully to the activities of daily living. There has been particular interest in the reconstruction of the anterior cruciate ligament in the younger and sport active population. Trends in medicine, as well as in orthopedic surgery, are heading towards reducing postoperative bleeding, pain, and postoperative recovery. A substance with antifibrinolytic activity, such as tranexamic acid, has certainly found its place in reducing postoperative bleeding. The objectives of the study were to determine the effect of locally applied tranexamic acid during the reconstruction of the anterior cruciate knee ligament on postoperative bleeding, observed laboratory parameters, measures of knee circumference, frequency of postoperative complications, and quality of postoperative recovery between the two groups of subjects (study and control group). The study was prospective, conducted at the Clinical Center of Vojvodina in Novi Sad with the approval of the ethics committee. The study, by random selection method, included 124 subjects of both sexes, divided into two groups (tested and control), which indicated operative management of the anterior cruciate ligament rupture and gave informed consent for inclusion in the study. All data collected were recorded in a protocol, which was specifically designed for this research. Subjects underwent surgery, with general or spinal anesthesia, with pneumatic attachment placed on the extremity undergoing surgery. The test group was given topically 20 ml of tranexamic acid, while the control group was administered 20 ml in the same way. NaCl 0.9% solution. Postoperative blood losses were monitored and recorded within 24 h of surgery, while laboratory findings were sampled preoperatively and on the seventh postoperative day. During the observed period (preoperatively, on the seventh postoperative day, on the third and sixth postoperative weeks), the knee volume and the occurrence of complications (hematoma, hemarthrosis) were monitored in the subjects. Following the survey, the data collected were documented and statistically processed. The study results indicate that there was a statistically significant difference (t = 7.181, p &lt;0.001) in the amount of postoperative bleeding between groups. The mean postoperative bleeding in the study group was 71.29 &plusmn; 40.76 ml, compared to the control group where postoperative bleeding was 154.35 &plusmn; 81.45ml. In the control group, lower hemoglobin values (t = 9.608, p &lt;0.001) and hematocrit (t = 8.325, p &lt;0.001) were observed postoperatively, and higher platelet counts (t = 2.201, p = 0.032) than in the study group. The data on the postoperative pain of the respondents support a statistically significant difference in the severity of pain on the first week after surgery between the study and the control group (t = 2.405, p = 0.018) and the third week after surgery (t = 3.700, p &lt;0.001). In the study group, the incidence of hematoma was less than 6.45% (n = 4), while in the control group it was 19.35% (n = 12). All patients in the sample completed a questionnaire on postoperative quality of recovery. There was no statistically significant difference in the quality of postoperative recovery after surgery between the two analyzed groups of subjects. The results of post-operative bleeding, after administrated tranexamic acid, indicate the efficacy of the drug and at a local application during the reconstruction of the anterior cruciate ligament. Due to the insufficiency of data, this study creates a broad basis for further research.</p>

No description available.

Le ligament croisé antérieur (LCA) demeure un des ligaments du genou le plus souvent blessé. Un mauvais positionnement des tunnels osseux est souvent mis en cause dans les échecs de reconstructions du LCA. Une meilleure compréhension biomécanique du phénomène devient essentielle. Par l’utilisation de l’imagerie biplanaire stéréoradiographique à faible irradiation EOS , notre groupe a développé une méthode de reconstruction 3D permettant une description morphologique osseuse remarquable. Par l’entremise de ce système, un référentiel permet d’évaluer, de manière automatisée, précise et reproductible, le positionnement tridimensionnel des tunnels osseux. Notre groupe souhaite partager ce référentiel afin d’assister les chirurgiens orthopédistes à restaurer une biomécanique optimale dans les reconstructions du LCA. / The anterior cruciate ligament (ACL) remains one of the most injured ligament of the knee. Mispositioning the tunnels remains a common cause of ACL reconstruction failure. A better biomechanical description of this phenomenon is therefore essential. Using the low irradiation biplanar stereoradiographic EOStm imaging system, our group developed a 3D reconstruction method allowing a precise morphologic description of the knee. With this system, the tridimensional positioning of the femoral tunnel can be evaluated in a novel, computerized, precise and reproducible coordinate system. With this referential, our group wish to assist orthopedic surgeons in the restoration of optimal biomechanics in ACL reconstructions.

Parmi les blessures sportives reliées au genou, 20 % impliquent le ligament croisé antérieur (LCA). Le LCA étant le principal stabilisateur du genou, une lésion à cette structure engendre une importante instabilité articulaire influençant considérablement la fonction du genou. L’évaluation clinique actuelle des patients ayant une atteinte au LCA présente malheureusement des limitations importantes à la fois dans l’investigation de l’impact de la blessure et dans le processus diagnostic. Une évaluation biomécanique tridimensionnelle (3D) du genou pourrait s’avérer une avenue innovante afin de pallier à ces limitations. L’objectif général de la thèse est de démontrer la valeur ajoutée du domaine biomécanique dans (1) l’investigation de l’impact de la blessure sur la fonction articulaire du genou et dans (2) l’aide au diagnostic. Pour répondre aux objectifs de recherche un groupe de 29 patients ayant une rupture du LCA (ACLD) et un groupe contrôle de 15 participants sains ont pris part à une évaluation biomécanique 3D du genou lors de tâches de marche sur tapis roulant. L’évaluation des patrons biomécaniques 3D du genou a permis de démontrer que les patients ACLD adoptent un mécanisme compensatoire que nous avons intitulé pivot-shift avoidance gait. Cette adaptation biomécanique a pour objectif d’éviter de positionner le genou dans une condition susceptible de provoquer une instabilité antérolatérale du genou lors de la marche. Par la suite, une méthode de classification a été développée afin d’associer de manière automatique et objective des patrons biomécaniques 3D du genou soit au groupe ACLD ou au groupe contrôle. Pour cela, des paramètres ont été extraits des patrons biomécaniques en utilisant une décomposition en ondelettes et ont ensuite été classifiés par la méthode du plus proche voisin. Notre méthode de classification a obtenu un excellent niveau précision, de sensibilité et de spécificité atteignant respectivement 88%, 90% et 87%. Cette méthode a donc le potentiel de servir d’outil d’aide à la décision clinique. La présente thèse a démontré l’apport considérable d’une évaluation biomécanique 3D du genou dans la prise en charge orthopédique de patients présentant une rupture du LCA; plus spécifiquement dans l’investigation de l’impact de la blessure et dans l’aide au diagnostic. / The anterior cruciate ligament (ACL) is involved in approximately 20% of all sports-related knee injuries. An injury to the ACL, the primary stabilizer of the knee, will lead to knee joint instability and functional impairment. Unfortunately, current clinical assessments of ACL-deficient patients present limitations with respect to the investigation of the impact of the injury on knee function. A 3D knee biomechanical assessment could provide innovative information to overcome these drawbacks. The main objective of the doctoral theses is to demonstrate the role of biomechanics in (1) the investigation of the impact of the injury on knee function and in (2) the diagnostic process. Twenty-nine ACL-deficient patients and a control group of fifteen healthy participants took part in a 3D knee biomechanical assessment during treadmill walking. By assessing the 3D knee biomechanical patterns of each group we observed that ACL-deficient patients adopted a gait compensatory mechanism: the Pivot-shift avoidance gait. The explanation for this adaptative strategy is to avoid placing the knee in a position biomechanically favorable to anterolateral rotatory instability during gait. Furthermore, an automatic classification method capable of distinguishing ACL deficient patients from an asymptomatic population was developed. Features were extracted from the 3D knee biomechanical patterns using a wavelet decomposition method and then classified by the nearest neighbour rule. The proposed classification method obtained a level of accuracy, sensitivity and specificity of 88%, 90% and 87% respectively. This method shows great potential as a diagnostic aid in a clinical setting. This thesis demonstrates that biomechanics plays a substantial role in the management of ACL injuries by improving the understanding of the impact of the injury on knee function and by its capacity to serve as a diagnostic aid.

No description available.

No / We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

Die Ruptur des vorderen Kreuzbandes (VKB) zählt zu den häufigsten Bandverletzungen des Menschen und wird vor allem bei jungen, aktiven Menschen primär operativ versorgt. Obwohl sich das Verständnis der Anatomie, Funktion und die Operationstechniken stetig verbessert haben ist heute die Revisionsrate nach VKB - Operation hoch. Die optimale Platzierung der Insertionspunkte ist unter arthroskopischen Bedingungen einer der kritischsten Schritte der Operation. Das Ziel der Studie war, ein Bildwandler (BV) basiertes Navigationsverfahren zu entwickeln und zu evaluieren, mit dem der femorale Bohrkanal anhand etablierter geometrischer Schablonen präzise navigiert angelegt werden kann. Die Anlage des tibialen Bohrkanals sollte in Relation zur Anatomie des Patienten auf BV-Bildern dargestellt werden können. Zur Ermittlung der Präzision des Systems wurden Insertionspunktlagen anhand abgewandelter geometrischer Schablonen mit dem Navigationssystem bestimmt, deren Lage am Modell radiologisch ausgewertet und mit den geplanten Sollwerten statistisch verglichen wurde. Außerdem wurden der Einfluss von Projektionsfehlern des BV-Bildes durch Rotation der Modelle um die Quer- und Längsachse und der Einfluss von Planungsungenauigkeiten untersucht. Das am Modell entwickelte System wurde anschließend im klinischen Einsatz auf Praktikabilität validiert. Es hat sich gezeigt, dass die femoralen Insertionspunkte am Modell unabhängig von der verwendeten Schablone mit einer hohen Präzision bestimmt werden können. Die medianen Abweichungen vom Sollwert in proximal-distaler (PD) - Richtung und in anterior-posteriorer (AP) - Richtung lagen bei allen Schablonen unter 1,00 mm. In PD-Richtung zeigte die Schablone nach Hertel et al. eine signifikant geringere Abweichung vom Sollwert als die Schablone nach Klos et al.. In AP-Richtung wurden mit der Schablone nach Hertel et al. signifikant geringere Abweichungen als mit den beiden anderen Schablonen erreicht. Bei Bestimmung des Projektionsfehlers durch Rotation lag die mediane Abweichung pro 1°-Rotation um die Längsachse in proximal-distaler (PD) - Richtung bei 0,31 % bzw. 0,07 mm und in anterior-posteriorer (AP) - Richtung bei 0,36 % bzw. 0,17 mm. Bei Quer-Rotation lag die mediane Abweichung pro 1°-Rotation in PD-Richtung bei 0,25 % bzw. 0,06 mm und in AP-Richtung bei 0,64 % bzw. 0,30 mm. Bei den Untersuchungen zur Abweichung durch Planungsungenauigkeit hat sich gezeigt, dass bei allen drei Schablonen Planungsfehler in anterior-posteriorer Richtung entlang der Blumensaat-Linie (BSL) die geringsten Auswirkungen auf die Lage des femoralen Insertionspunktes haben. Abweichungen bei der Planung in Richtung DISTAL / BSL(post.) und PROXIMAL / BSL(post.) haben die größten Fehler erbracht. / The Anterior Cruciate Ligament (ACL) is one of the most often torn ligaments of the musculoskeletal system. Especially in young and active people torn ACL are mainly treated surgically. Despite an increasing knowledge of the anatomical, functional and operative aspects about the ACL, there is still a high rate of long-time failures. Optimal positioning of the ACL-graft during arthroscopic reconstruction is of paramount importance in order to get good results. The aim of this project was to develop and evaluate a fluoroscopically based navigation system which could be used to precisely place the femoral drill hole with help of geometrical templates. The placement and orientation of the tibial tunnel was intended to be displayed on x-rays in relation to the patient’s anatomy. To determine the system’s precision, insertion sites where defined at the fluoroscopic image using geometrical templates and marked on plastic femur models with the help of navigation. The position of the insertion sites on the model was radiologically identified and statistically compared with the aimed ones. Additionally the influence of fluoroscopic projection errors due to axial and planar rotation of the models was tested. Following the model tests, the developed system was clinically tested in the OR to test its feasibility. The model tests revealed a high precision in femoral placement of the insertion sites independent from the three used templates (Hertel et al. / Klos et al. / Cazenave et al.). The median deviations from the aimed positions were in proximal-distal (PD) and in anterior-posterior (AP) direction both below 1.00 mm. In PD-direction the template by Hertel et al. showed a significantly lower deviation from the aimed position than the template developed by Klos et al.. In AP-direction the template by Hertel et al. showed a significantly lower deviation than the two others. The mean projection error due to longitudinal rotation per 1° was for PD-direction 0.31 % (0.07 mm) and in AP-direction 0.36% (0.17 mm). For planar rotation the median projection error per 1° was 0.25% (0.006 mm) for PD-direction and 0,64% (0.30 mm) for AP. The tests for deviation from the aimed position due to imprecise planning revealed for all templates least deviation along the Blumensaat-line (BSL) and most deviation in direction DISTAL / BSL(post.) and PROXIMAL / BSL (post.).

Einleitung: Primäres Ziel der Rekonstruktion des vorderen Kreuzbandes (VKB) ist die Verbesserung der Stabilität des Kniegelenkes, doch daran allein lässt sich das Behandlungsergebnis nicht beurteilen. Mit den Daten von 23 Patienten nach VKB-Plastik (4 Jahre p.o.) sollte diskutiert werden, welche Variablen noch geeignet sind, um den Behandlungserfolg zu bewerten. Ergebnisse und Diskussion: Die Kniefunktion im Alltag wurde in den Knie-Scores als gut oder besser beurteilt, die Bewertung beim Sport war etwas schlechter. Die KOS-Scores ADL und Sport haben sich für die Erfassung der subjektiven Zufriedenheit besonders geeignet. Im klinischen Befund gab es kaum Defizite. Die Gelenkbeweglichkeit und Stabilität des VKB (Lachman) sind die relevanten Beurteilungskriterien. Hinsichtlich der Sportfähigkeit war ein Rückgang in Sportarten mit höherer Kniegelenksgefährdung zu sehen. Nur 36,4 % der Patienten sind auf prätraumatischem Niveau aktiv. Die Sportfähigkeit dürfte jedoch für langfristige Evaluationen nicht von Interesse sein, da altersbedingte Veränderungen im Freizeitverhalten einen zunehmenden Einfluss haben. In einbeinigen sportmotorischen Tests, wie dem Nieder-Hoch-Sprung, zeigten sich auf der operierte Seite verlängerte Bodenkontaktzeiten. Dieser Test ist für die Beurteilung genauso geeignet wie der Einbeinweitsprung. Bei diesem war zwar kein Seitenunterschied, jedoch eine verkürzte Sprungweite gegenüber Kniegesunden zu finden. Bei den isokinetischen Messungen fanden sich persistierende Defizite der Extensoren (op. Bein) sowie bilaterale Veränderungen, verglichen mit dem Referenzwert. Ferner lagen auf der op. Seite verminderte Muskeldicken der Mm. vastus medialis et intermedius (knienah) vor. Die Werte der isokinetischen Messung wie der sonografischen Muskeldickenmessung stellen daher wichtige Indikatoren zur Bewertung des Muskelstatus dar. Untersuchungen wie EMG, Ganganalyse, Einbeinstandtest, Beinumfangsmessung, beidbeinige Sprünge und Beintapping ließen keine Defizite erkennen. Diese Verfahren können kaum einen Beitrag zur Einschätzung des Behandlungsergebnisses leisten. Es gab mehrere Hinweise auf bilaterale Veränderungen, daher ist bei vielen Tests der alleinige Seitenvergleich nicht ausreichend. Somit ist zu fordern, dass künftig zur Bewertung des Behandlungsergebnisses nach VKB-Plastik einheitliche Untersuchungsstandards angestrebt sowie Normwerte für diese Testverfahren geschaffen werden. / Introduction: The primary goal of anterior cruciate ligament (ACL) reconstruction is to improve knee joint stability; however, this factor alone is not enough in evaluating treatment results. With data from 23 patients (4 years post-op) after reconstruction of the ACL variables will be discussed as to which are well-suited in judging treatment success. Results and discussion: Knee joint function for activities of daily life (ADL) was rated by knee-scores as good or better; for sport activities the rating was somewhat worse. KOS scores for ADL and sport are well-suited for the conceived, subjective contentment. Clinical results show hardly any deficits. Joint range of motion and stability of the ACL (Lachman test) are relevant rating criteria. With regard to sport capability a reduction was seen in sports where a high risk for the knee joint was present. Only 36.4 % of the patients are at a „pre-trauma“-level. Long-term evaluation of sport capability is not of interest, since age-related changes in leisure activity are of increasing influence. By sport motor tests such as the one-leg drop-jump, an increase in ground contact time was seen. This test is just as well-suited for evaluation as the one-leg long jump. This test showed no side difference except for a shortened jumping distance in comparison to the healthy reference group. Isokinetic results reveal persistent deficits of the knee extensors (operated knee) as well as bilateral changes when compared to reference values. Furthermore, reduced muscle thickness of the Mm. vastus medialis et intermedius near the joint was seen. Isokinetic measurement values and sonographic muscle-thickness measurements represent important indicators when evaluating muscle status. Tests such as EMG, gait analysis, one-leg standing test, thigh-girth measurements, two legged jumps and leg-tapping do not reveal any deficits. These tests can hardly contribute to an evaluation of treatment results. There is much evidence of bilateral changes; therefore side comparisons alone are not adequate. It is therefore to encourage standardized examination tests as well as normal values when evaluating treatment results after ACL reconstruction.

<p>Ispitivanu grupu činilo je 1247 ispitanika sa povredama prednje ukr&scaron;tene veze kolena koji su operativno lečeni u periodu 2012.-2017. godina na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine. Ciljevi istraživanja bili su utvrđivanje uticaja nivoa sportske aktivnosti i mehanizama povređivanja na nastanak povreda prednje ukr&scaron;tene veze kolena, zatim uticaj spolja&scaron;njih faktora rizika (vrsta sporta, rang takmičenja, vrsta podloge, trening ili utakmica, period treninga) na nastanak povreda prednje ukr&scaron;tene veze kolena, odnosno uticaj unutra&scaron;njih faktora rizika (pol, starost, BMI) na nastanak povreda ove strukture kolena. Od ukupnog broja ispitanika njih 517 (41,5%) su činili aktivni sportisti, a 730 (58,5%) rekreativci. Značajnu većinu u posmatranom uzorku su činili mu&scaron;karci (82,6%), osobe starosti od 16 do 25 godina (62,6%) i normalno uhranjenje osobe (62%). Do povrede prednje ukr&scaron;tene veze do&scaron;lo je kod njih 504 (40,5%) prilikom aktivnog bavljenja sportom, dok su se povrede prilikom rekreativnog bavljenja sportom dogodile kod 741 ispitanika (59,5%). Među aktivnim sportistima, vi&scaron;e od dve trećine se takmičilo na internacionalnom ili republičkom nivou, odnosno u najvi&scaron;im rangovima takmičenja. Kontaktnim kolektivnim sportovima (fudbal, ko&scaron;arka i rukomet) bavilo se 77,9% ispitanika. Nekontaktnim sportovima kao &scaron;to su odbojka, borilački sportovi i skijanje bavilo se 22,1% ispitanika, pri čemu je najveći broj povreda nastao prilikom igranja fudbala (51,3%). Statistički značajno vi&scaron;e povreda (i prilikom aktivnog i prilikom rekreativnog bavljenja sportom) je nastalo bez direktnog kontakta (nekontaktne povrede koje su činile 78,7% povreda), pri čemu je najveći broj povreda nastao usled promene pravca i ritma kretanja. Kod aktivnih sportista najvi&scaron;e povreda dogodilo se na utakmicama (73,8%), slede povrede na treningu (24,1%), dok se na rekreaciji povredilo svega 2,1% ispitanika. Značajno vi&scaron;e povreda dogodilo se na sredini bavljenja sportskom aktivno&scaron;ću (47,4%) u odnosu na povrede na zagrevanju, početku, odnosno kraju sportske aktivnosti. Povrede su značajno če&scaron;će nastajale na travi (42%) i parketu (28%), nego na drugim vrstama podloge. Najveći broj ispitanika povredio se noseći patike prilikom bavljenja sportskom aktivno&scaron;ću. Postoje značajne razlike u kontekstu povređivanja u zavisnosti od pola ispitanika. Žene su u značajno većem procentu povređivane prikom aktivnog bavljenja sportom, dok su se mu&scaron;karci če&scaron;će povređivali na rekreaciji. Žene su se najče&scaron;će povređivale na rukometu, mu&scaron;karci na fudbalu. U odnosu na mu&scaron;karce, kod žena su povrede znatno ređe nastajale prilikom direktnog kontakta, a kad je u pitanju mesto povređivanja, žene su se če&scaron;će nego mu&scaron;karci povređivale na treningu. Preko 50% žena je povređeno na parketu, dok se najveći broj mu&scaron;karaca povredio na travi. Ispitanici sa prekomernom telesnom masom značajno če&scaron;će su se povređivali prilikom rekreacije, dok su se normalno uhranjeni če&scaron;će povređivali prilikom aktivnog bavljenja sportom. Faktori rizika za nastanak povreda prednje ukr&scaron;tene veze su brojni i specifični, odnosno da za svaku populacionu kategoriju postoje rizici, ali se uočava da su u svim sportovima, na svim podlogama i kod svih ispitanika povrede najče&scaron;će nastajale nekontaknim mehanizmom povređivanja. Formiranjem registra povređenih omogućilo bi se bolje razumevanje faktora rizika i njihovog međusobnog uticaja, kao i definisanje profila osoba pod najvećim rizikom za nastanak povrede prednje ukr&scaron;ene veze kolena. Na taj način obezbedile bi se potrebne informacije za planiranje preventivnih programa usmerenih na smanjenje rizika od povređivanja i omogućilo bi se sprovođenje odgovarajućih mera selektivne prevencije.</p> / <p>The study group consisted of 1247 respondents with anterior cruciate ligament injuries who were surgically treated in the period 2012-2017. at the Clinic for Orthopedic Surgery and Traumatology of the Clinical Center of Vojvodina. The objectives of the study were to determine the impact of sports activity levels and injury mechanisms on the occurrence of anterior cruciate ligament injuries, then the impact of external risk factors (type of sport, competition rank, type of surface, training or match, training period) on the occurrence of anterior cruciate ligament injuries and the influence of internal risk factors (gender, age, BMI) on the occurrence of injuries of this knee structure. Out of the total number of respondents 517 (41.5%) were active athletes, and 730 (58.5%) were recreational athletes. A significant majority in the observed group were men (82.6%), persons aged 16 to 25 years (62.6%) and normal BMI respondents (62%). Anterior cruciate ligament injury occurred in 504 of them (40.5%) during active sports, while injuries during recreational sports occurred in 741 respondents (59.5%). Among active athletes, more than two thirds competed at the international or national level- in the highest ranks of the competition. Contact collective sports (football, basketball and handball) were practiced by 77.9% of respondents. 22.1% of respondents practiced non-contact sports such as volleyball, martial arts sports and skiing. The largest number of injuries occurring while playing football (51.3%). Statistically significantly more injuries (both during active and recreational sports) occurred without direct contact (noncontact injuries-78,7% of total injuries number), with the largest number of injuries caused by changes in the direction and rhythm of movement. Among active athletes, most injuries occurred in matches (73.8%), followed by injuries in training (24.1%), while only 2.1% of respondents were injured in recreation. Significantly more injuries occurred in the middle of engaging in sports activity (47.4%) compared to injuries during the warm-up, beginning and end of sports activity. Injuries occurred significantly more often on grass (42%) and floor (28%) than on other types of surfaces. Most of the respondents were injured wearing sneakers while doing sports. There are significant differences in the context of injury depending on the gender of the respondents. A significantly higher percentage of women were injured during active sports, while men were more often injured during recreational sport activities. Women were most often injured in handball, men in football. Compared to men, injuries were much less common in women during direct contact, and when it comes to the place of injury, women were injured more often than men during training acitivities. Over 50% of women were injured on the floor, while the largest number of men were injured on the grass. Subjects with overweight were significantly more likely to be injured during recreational sport acitivites, while those with normal BMI were more likely to be injured during active sports. Risk factors for anterior cruciate ligament injuries are numerous and specific and there are risks for each population category, but it is noticed that in all sports, on all surfaces and in all subjects, injuries were most often caused by a noncontact injury mechanism. The formation of a Register of injuries would enable a better understanding of risk factors and their mutual influence, as well as the definition of the profile of persons at greatest risk for the occurrence of an anterior cruciate ligament injury. This would provide the necessary information for planning prevention programs aimed at reducing the risk of injury and would enable the implementation of appropriate selective prevention measures.</p>

This thesis addresses the problem where we want to apply machine learning over a small data set of multivariate time series. A challenge when classifying data is when the data set is small and overfitting is at risk. Augmentation of small data sets might avoid overfitting. The multivariate time series used in this project represent motion data of people with reconstructed ACLs and a control group. The approach was pairing motion data from the training set and using Euclidean Barycentric Averaging to create a new set of synthetic motion data so as to increase the size of the training set. The classifiers used were Dynamic Time Warping -One Nearest neighbour and Time Series Forest. In our example we found this way of increasing the training set a less productive strategy. We also found Time Series Forest to generally perform with higher accuracy on the chosen data sets, but there may be more effective augmentation strategies to avoid overfitting.