Osteoarthritis is a large problem affecting many patients globally, and diagnosis of osteoarthritis is often done using evidence from arthroscopic surgeries. Making a correct diagnosis is hard, and takes years of experience and training on thousands of images. Therefore, developing an automatic solution to perform the diagnosis would be extremely helpful to the medical field. Since machine learning has been proven to be useful and effective at classifying and segmenting medical images, this thesis aimed at solving the problem using machine learning methods. Multifractal analysis has also been used extensively for medical imaging segmentation. This study proposes two methods of automatic segmentation using neural networks and multifractal analysis. The thesis was performed using real arthroscopic images from surgeries. MultiResUnet architecture is shown to be well suited for pixel perfect segmentation. Classification of multifractal features using neural networks is also shown to perform well when compared to related studies.

Les approches arthroscopiques et l’anatomie normale des articulations antébrachiocarpienne, carpienne moyenne et tarsocrurale n’ont jamais été décrites spécifiquement chez les bovins. Notre étude avait pour buts de définir les abords chirurgicaux et de décrire l’anatomie arthroscopique de ces trois articulations. Deux carpes et deux tarses issus du cadavre frais d’une vache adulte ont été injectés avec un mélange de latex, puis disséqués afin de déterminer les sites arthroscopiques d’intérêt. Par la suite, l’arthroscopie des articulations antébrachiocarpienne et carpienne moyenne (approche dorsale) et de l’articulation tarsocrurale (approches dorsale et plantaire) a été réalisée sur six cadavres frais de vaches adultes ne présentant ni boiterie ni distension articulaire avant leur euthanasie. Les approches dorsolatérale et dorsomédiale des articulations antébrachiocarpienne et carpienne moyenne ont été réalisées de part et d’autre de l’extenseur radial du carpe. Les structures observées étaient le radius distal, les os radial, intermédiaire, ulnaire, II et III fusionnés et IV du carpe, ainsi que des ligaments palmaires. Les approches dorsolatérale et dorsomédiale de l’articulation tarsocrurale ont été réalisées latéralement au long extenseur des doigts et médialement au troisième péronier respectivement. Les approches plantarolatérale et plantaromédiale ont été réalisées latéralement au fléchisseur latéral des doigts et latéralement au fléchisseur médial des doigts respectivement. Les structures observées étaient le tibia distal, les trochlées proximale et plantaire du talus, le processus coracoïde du calcanéus, l’articulation fibulo-calcanéenne et des ligaments articulaires. Quelle que soit l’articulation, l’approche latérale était préférée à l’approche médiale. L’arthroscopie du carpe et du tarse pourra être proposée dans un contexte hospitalier comme outil diagnostique, thérapeutique et pronostique des maladies articulaires bovines. / Arthroscopic approaches and normal anatomy of the antebrachiocarpal, middle carpal and tarsocrural joints have not been specifically described in cattle. Our study aimed to determine surgical approaches and to describe the arthroscopic anatomy of these three joints. Two carpi and two tarsi from the fresh cadaver of an adult cow were injected with a latex mixture and dissected to determine the arthroscopic sites of interest. Thereafter, arthroscopic evaluation of the antebrachiocarpal and middle carpal joints (dorsal approach) and tarsocrural joint (dorsal and plantar approaches) was performed on six fresh cadavers of adult cows exhibiting neither lameness nor joint distension prior to their euthanasia. Dorsolateral and dorsomedial approaches of the antebrachiocarpal and middle carpal joints were performed on either side of the extensor carpi radialis. Observed structures were the distal radius, the radial, intermediate, ulnar, fused second and third and fourth carpal bones, as well as palmar ligaments. Dorsolateral and dorsomedial approaches of the tarsocrural joint were performed laterally to the extensor digitorum longus and medially to the peroneus tertius respectively. Plantarolateral and plantaromedial approaches were performed laterally to the flexor digitorum lateralis and laterally to the flexor digitorum medialis respectively. Observed structures were the distal tibia, proximal and plantar trochleae of the talus, the coracoid process of the calcaneus, the fibulocalcaneal joint and intra-articular ligaments. Whatever the joint, the lateral approach was preferred to the medial one. Arthroscopy of the carpus and tarsus may be offered in a hospital setting as a diagnostic, therapeutic and prognostic tool for bovine joint diseases.

O autor estudou as propriedades biomecânicas dos tendões dos músculos tibial anterior e tibial posterior congelados a -20°C e a -86°C extraídos de cadáveres humanos frescos. Foram realizados ensaios mecânicos de tração até a ruptura e determinadas as seguintes propriedades: resistência máxima, coeficiente de rigidez, módulo de elasticidade e alongamento máximo relativo. Os dados obtidos foram comparados aos existentes na literatura relativos ao ligamento cruzado anterior, ligamento da patela e aos tendões dos músculos grácil e semitendíneo / The author studied the mechanical properties of the anterior and posterior tibialis muscle tendons frozen at -20°C and -86°C obtained from fresh-frozen human cadavers. The tendons were submitted to axial traction until failure and the following properties were determined: ultimate load, stiffness, modulus of elasticity and relative strain. Data obtained were compared to those from the literature related to the anterior cruciate ligament, patellar tendon, gracilis and semitendinous tendons

Author: Bc. Jan Vocásek Thesis title: Analysis of the shoulder girdle injury and therapy of overhead athletes in Czech republic Cíl: The aim of the thesis was to create a literal research for the shoulder girdle injuries of overhead athletes, theoretically to write the anatomical and kinesiological characteristics of the shoulder girdle, to analyze the biomechanics, injury mechanisms in individual overhead sports, rehabilitation treatment and to find out how frequent the injuries of athletes in the Czech Republic follow-up treatment varies from abroad. Methods: For the purpose of this research was established a non-standardized questionnaire, based on literature studied and research questions, and then was distributed to 6 selected physicians dealing with this issue in the Czech Republic, who anonymously filled out questions regarding the shoulder joint injury based on their own clinical experiences. Results: Four of the six hypotheses were confirmed from the data obtained. The number of patients with shoulder girdle injuries in overhead sports in the Czech Republic has risen year- on-year and the most common injury is SLAP lesion. It has also been confirmed that the most common injury is caused by ball overhead sports and on the dominant upper limb. Key words: shoulder girdle, overhead sports,...

O autor estudou as propriedades biomecânicas dos tendões dos músculos tibial anterior e tibial posterior congelados a -20°C e a -86°C extraídos de cadáveres humanos frescos. Foram realizados ensaios mecânicos de tração até a ruptura e determinadas as seguintes propriedades: resistência máxima, coeficiente de rigidez, módulo de elasticidade e alongamento máximo relativo. Os dados obtidos foram comparados aos existentes na literatura relativos ao ligamento cruzado anterior, ligamento da patela e aos tendões dos músculos grácil e semitendíneo / The author studied the mechanical properties of the anterior and posterior tibialis muscle tendons frozen at -20°C and -86°C obtained from fresh-frozen human cadavers. The tendons were submitted to axial traction until failure and the following properties were determined: ultimate load, stiffness, modulus of elasticity and relative strain. Data obtained were compared to those from the literature related to the anterior cruciate ligament, patellar tendon, gracilis and semitendinous tendons

Le conflit fémoro-acétabulaire (femoroacetabular impingement, FAI) est une pathologie mécanique de la hanche qui peut causer des douleurs et limitations fonctionnelles. Le but de cette thèse était d’étudier la fonction musculaire au niveau de la hanche chez des patients présentant un FAI symptomatique. La fonction musculaire de la hanche a été évaluée, dans un premier temps, chez des patients avant qu’ils ne subissent une opération. Ces patients démontraient un déficit de force qui pourrait être expliqué par de l’inhibition musculaire. Cependant, ce déficit de force n’était pas associé à une plus grande fatigabilité musculaire. Dans un deuxième temps, les altérations de force musculaire ont été évaluées chez des patients ayant subi une arthroscopie de la hanche. Après l’opération, les patients récupéraient un niveau de force normal au niveau de tous les groupes musculaires de la hanche excepté les fléchisseurs. Le cas d’un joueur de hockey sur glace ayant subi une chirurgie ouverte aux deux hanches pour traiter un FAI bilatéral a aussi été décrit. On a démontré que la déhiscence de la bandelette iléo-tibiale pouvait survenir après chirurgie, empêcher l’augmentation de force musculaire des abducteurs de la hanche, et retarder la reprise du sport. Enfin, un protocole d’évaluation du taux de développement de la force normalisé, variable permettant d’estimer l’inhibition musculaire de la hanche, a été proposé chez des sujets sains. La fiabilité et reproductibilité des résultats ont été montrées au niveau des adducteurs, rotateurs externes, et fléchisseurs de la hanche. Ces résultats montrent que ces patients ont une fonction musculaire altérée au niveau de la hanche, qui est toutefois récupéré après une opération. / Femoroacetabular impingement (FAI) is a pathomechanical process of the hip joint, which could lead to hip pain and functional disability. Aim of this thesis was to investigate hip muscle function in patients with a symptomatic FAI. Hip muscle function was first investigated before patients underwent any surgical treatment for managing FAI. It was shown that they present with reduced hip muscle strength (i.e., muscle weakness), probably due to hip muscle inhibition. Nevertheless, hip muscle weakness was not associated with exaggerated hip muscle fatigue. Hip muscle strength recovery was then evaluated in a series of patients after hip arthroscopy to treat FAI. These patients demonstrated a good recovery for all hip muscle groups, except for hip flexors. The case of a professional ice hockey player who underwent bilateral hip open surgeries for treating bilateral FAI was also documented. This report showed that iliotibial band dehiscence could occur after hip open surgery, thereby preventing hip abductor strength increase during rehabilitation and delaying the return to sport. In addition, the assessment of the rate of force development scaling factor for the hip muscles was evaluated in a group of healthy adults. This parameter seems to be promising for the evaluation of hip muscle inhibition. The testing protocol was feasible and reproducible for hip adductors, external rotators and flexors. Taken as a whole, these findings show that patients with symptomatic FAI demonstrate an impaired hip muscle function, which is however mainly resolved after surgical treatment.

Zielstellung: Bei der Frage, ob die Durchführung von Korrekturosteotomien zur Ent-lastung betroffener Areale bei Hunden mit ED sinnvoll ist, erscheint es uns von zentraler Bedeutung, auch eine geringgradig ausgeprägte RUI präzise zu bestim-men. In der vorliegenden Arbeit wurden deshalb folgende Ziele verfolgt: (1) Evaluie-rung der Sensitivität und Spezifität der Bestimmung von radioulnaren Gelenks-formationen anhand von dreidimensionalen CT-Modellen und der Arthroskopie. (2) Erweiterung des Untersuchungsgutes, da im Gegensatz zu vorangegangenen Stu-dien sowohl Inkongruenzen mit verkürztem Radius (positive RUI) als auch mit ver-kürzter Ulna (negative RUI) einbezogen wurden. Material und Methode: In das Untersuchungsgut gingen Vordergliedmaßen gesun-der Hunde mittelgroßer und großer Rassen ein. Mit Hilfe eines etablierten Modells wurde experimentell der Radius stufenweise um 1 und 2 mm verkürzt, bzw. verlän-gert. In der ersten Studie wurden 64 radioulnare Gelenksformationen anhand von dreidimensional rekonstruierter CT-Modelle untersucht. In der zweiten Studie wurden 72 radioulnare Gelenksformationen arthroskopisch beurteilt. Die Art der Stufe und ih-re Reihenfolge waren jeweils randomisiert und geblindet. Die Gelenksformationen wurden als -2, -1, 0, 1 und 2 mm Stufe klassifiziert. Ergebnisse: Für die Bestimmung der radioulnaren Gelenksformation anhand von dreidimensional rekonstruierter CT-Modelle konnte ein Interklassen-Korrelations-koeffizient von 0,87 und ein Intraklassen-Korrelationskoeffizient von 0,96 ermittelt werden. Die mediane Sensitivität im Hinblick auf das Erkennen eines inkongruenten Gelenkes lag bei 0,86 (0,82 - 0,98). Die mediane Spezifität bei 0,77 (0,62 - 0,92). Bei der Arthroskopie konnte ein kongruentes Gelenk mit einer Sensitivität von 0,98 (95% KI: 0,90 - 0,99) bestimmt werden. Die Spezifität ein kongruentes Gelenke richtig zu diagnostizieren, lag bei 0,89 (95% KI: 0,65 – 0,98). Schlussfolgerungen: Die Abweichungen zwischen den drei Untersuchern in der ersten Studie legen nahe, dass die Genauigkeit der Bestimmung von radioulnaren Inkongruenzen durch entsprechendes Training deutlich verbessert werden können. Die besten Ergebnisse konnte der Untersucher erzielen, der sich am längsten mit der beschriebenen Technik befasst hatte. Wir postulieren daher, dass die Genauigkeit der semiquantitativen Beurteilung der RUI anhand dreidimensional rekonstruierter CT-Modelle bei regelmäßiger Schulung zunimmt. Dieses Diagnostikum ist in-vitro präzise, wiederholbar und ermöglicht eine nicht invasive Beurteilung der subchondra-len Gelenkflächen. Die Arthroskopie erlaubt eine direkte Visualisierung und Palpation der intraartiku-lären Strukturen und eine präzise Bestimmung sowohl einer positiven als auch negativen RUI. Festzuhalten bleibt, dass es eine minimal invasive Technik ist und sich somit als Standard- beziehungsweise Vorsorgeuntersuchung zur Diagnostik der ED beim Hund kaum eignet. Im Vergleich zu Röntgen- und CT-Untersuchungen kön-nen mittels Arthroskopie jedoch die besten Ergebnisse zur Bestimmung der radio-ulnaren Gelenksformation in-vitro erzielt werden.

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.

Atualmente, os bons resultados na lesão do ligamento cruzado posterior por avulsão óssea na tíbia associam-se ao tratamento cirúrgico e precoce. A técnica convencional é a fixação com parafuso pela via de acesso posterior do joelho, com abordagem direta das estruturas vasculares e nervosas da região. Neste estudo experimental em 20 joelhos de cadáveres, buscamos apresentar uma alternativa com amarrilho por via artroscópica, comparando-o com a técnica convencional, através da inspeção direta e de testes biomecânicos. Houve falha na fixação de apenas um exemplar de cada método e medidas de deslocamento tibial posterior (p=0,23) e rigidez média (p=0,28) sem diferenças significativas entre as duas técnicas. Concluímos ser o amarrilho artroscópico viável e uma alternativa no tratamento desta lesão. / Nowadays, good results on the management of posterior cruciate ligament bony avulsion of the tibia are associated with early surgical repair. The usual method of treatment is the open posterior approach with screw fixation, wich requires popliteal neurovascular bundle direct manipulation. This study presents a new arthroscopic suture and compares it with the conventional technique, using biomechanical tests and direct inspection in cadaveric specimens (20 knees). On both methods there was a fixation fail in one knee. The analisys of tibial posterior displacement (p=0,23) and stiffness (p=0,20) were similar for the two methods. The Arthroscopic suture presented is an effective reattachment method for this fracture pattern.