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Title Post-surgical rehabilitation of the knee menisci (Comparison of post-surgical rehabilitation in Albania and USA/ literature review) Aim The purpose of this thesis is to outline the most frequent injuries occurring in the knee menisci. To evaluate the post-surgical rehabilitation of the knee menisci in Albania and to compare it with recommended guidelines from American Academy of Orthopaedic Surgeons in USA. The main goal is to find out what could be done, to improve the post-surgical rehabilitation program followed in Albania, after a knee menisci injury. Method This thesis is a literature review, reviewing journals with an impact factor higher than 1, clinical trials, systematic reviews and pilot studies not older than the year 2000. All these materials were gathered from web medical databases such as (PubMed, Medline, Science Direct, Scopus, Pedro, Web of Science).Primary sources of information were scientific books in Albanian, Italian and English languages, from period of autumn 2011 to the spring of 2014. Due to lack of literature and both written studies and guidelines concerning rehabilitation in Albania, the data gathered were taken from Military Hospital of Albania-Traumatology Department, either from interviews with the doctors and physiotherapist working in this institution or by...

Na prática clínica, a queixa de dor no joelho em pacientes, a partir da quinta década de vida, é muito freqüente e comumente atribuída à lesão meniscal degenerativa. A relação entre a lesão degenerativa do menisco e a artrose é controversa, assim como a relação do varo e a evolução para artrose do joelho. Foram estudadas as alterações macroscópicas e microscópicas dos meniscos em 21 pacientes com deformidade em varo submetidos a artroplastia total do joelho, decorrente de artrose do joelho. Analisou-se, também, a relação destas lesões com o grau de artrose e varismo dos pacientes. Foram encontrados 9 de 21 meniscos com lesões, sendo o menisco mais acometido o medial e a lesão mais freqüente em clivagem horizontal. Neste modelo clínico de artrose com joelho em varo, afirma-se que: 1) Não foi possível estabelecer correlação entre o grau de artrose e a maior ocorrência de lesões meniscais macroscópicas; 2) Não se observou relação entre a maior gravidade da deformidade angular em varo dos joelhos com o aumento da ocorrência de lesões meniscais; 3) Quando ocorreram, as lesões meniscais preponderaram no menisco medial e as mais freqüentes foram as em clivagem horizontal; 4) Os meniscos apresentaram alterações microscópicas significativas resultantes do processo de artrose dos joelhos; no entanto, não há evidência que a presença de lesões é estatisticamente diferente entre os meniscos lateral e medial / In clinical practice, the knee pain complaint by patients from the fifth life decade is very frequent and commonly assigned to degenerative meniscal injury. The relationship between degenerative meniscal injury and arthrosis is controversial, as well as the relationship between genu varum and evolution to knee arthrosis. Macroscopic and microscopic meniscal changes in 21 patients with varum deformities undergoing total knee arthroplasty secondary to knee arthrosis were also studied. The relationship between these injuries and the degree of arthrosis and varism of patients were also studied. Of 21 menisci, 9 were found to have injuries, the most affected being the medial meniscus and the most frequent was the horizontal cleavage meniscal injury. In this clinical model of arthrosis with varum knee (1) it was not possible to establish any correlation between the degree of arthrosis and the higher occurrence of macroscopic meniscal injuries; (2) no relationship was observed between higher severity of genu varum angular deformity and increase of meniscal injury occurrence; (3) meniscal injuries prevailed in the medial meniscus, horizontal cleavage meniscal injuries being the most frequent; (4) the menisci presented significant microscopic changes resulting from the knee arthrosis process; however, no evidence was found that the presence of injuries is statistically different between lateral and medial menisci

The contact angle defined by Young's equation depends on the ratio between solid and liquid surface energies. Young's contact angle is constant for a given system, and cannot explain the stability of fluid droplets in capillary tubes. Within this framework, large variations in contact angle and explained aassuming surface roughness, heterogeneity or contamination. This research explores the static and dynamic behavior of fluid droplets within capillary tubes and the variations in contact angle among interacting menisci. Various cases are considered including wetting and non-wetting gluids, droplets in inclined capillary tubes or subjected to a pressure difference, within one-dimensional and three-dimensional capillary systems, and under static or dynamic conditions (either harmonic fluid pressure or tube oscillation). The research approach is based on complementary analytical modeling (total energy formulation) and experimental techniques (microscopic observations). The evolution of meniscus curvatures and droplet displacements are studied in all cases. Analytical and experimental results show that droplets can be stable within capillary tubes even under the influence of an external force, the resulting contact angles are not constant, and bariations from Young's contact angle aare extensively justified as menisci interaction. Menisci introduce stiffness, therefore two immiscible Newtonian fluids behave as a Maxwellian fluid, and droplets can exhibit resonance or relaxation spectral features.

Referenzwerterstellung zur gezielten therapeutischen Nachbehandlung von Patienten mit Knietotalendoprothese, arthroskopischer Meniskuschirurgie und Vorderer Kreuzbandplastik. Es wurden 579 Patienten präoperativ untersucht und anschließend erhielten 140 Patienten (KTEP-n=50 ; ASKP-n=40 ; VKB-Plastik-n=50) ein standardisiertes, isokinetisch gesteuertes Rehabilitationsprogramm. Auf dessen Basis wurden die Referenzwerte erstellt.

Diss. (sammanfattning) Linköping : University, 2003. / Härtill 5 uppsatser.

Na prática clínica, a queixa de dor no joelho em pacientes, a partir da quinta década de vida, é muito freqüente e comumente atribuída à lesão meniscal degenerativa. A relação entre a lesão degenerativa do menisco e a artrose é controversa, assim como a relação do varo e a evolução para artrose do joelho. Foram estudadas as alterações macroscópicas e microscópicas dos meniscos em 21 pacientes com deformidade em varo submetidos a artroplastia total do joelho, decorrente de artrose do joelho. Analisou-se, também, a relação destas lesões com o grau de artrose e varismo dos pacientes. Foram encontrados 9 de 21 meniscos com lesões, sendo o menisco mais acometido o medial e a lesão mais freqüente em clivagem horizontal. Neste modelo clínico de artrose com joelho em varo, afirma-se que: 1) Não foi possível estabelecer correlação entre o grau de artrose e a maior ocorrência de lesões meniscais macroscópicas; 2) Não se observou relação entre a maior gravidade da deformidade angular em varo dos joelhos com o aumento da ocorrência de lesões meniscais; 3) Quando ocorreram, as lesões meniscais preponderaram no menisco medial e as mais freqüentes foram as em clivagem horizontal; 4) Os meniscos apresentaram alterações microscópicas significativas resultantes do processo de artrose dos joelhos; no entanto, não há evidência que a presença de lesões é estatisticamente diferente entre os meniscos lateral e medial / In clinical practice, the knee pain complaint by patients from the fifth life decade is very frequent and commonly assigned to degenerative meniscal injury. The relationship between degenerative meniscal injury and arthrosis is controversial, as well as the relationship between genu varum and evolution to knee arthrosis. Macroscopic and microscopic meniscal changes in 21 patients with varum deformities undergoing total knee arthroplasty secondary to knee arthrosis were also studied. The relationship between these injuries and the degree of arthrosis and varism of patients were also studied. Of 21 menisci, 9 were found to have injuries, the most affected being the medial meniscus and the most frequent was the horizontal cleavage meniscal injury. In this clinical model of arthrosis with varum knee (1) it was not possible to establish any correlation between the degree of arthrosis and the higher occurrence of macroscopic meniscal injuries; (2) no relationship was observed between higher severity of genu varum angular deformity and increase of meniscal injury occurrence; (3) meniscal injuries prevailed in the medial meniscus, horizontal cleavage meniscal injuries being the most frequent; (4) the menisci presented significant microscopic changes resulting from the knee arthrosis process; however, no evidence was found that the presence of injuries is statistically different between lateral and medial menisci

Ce travail vise à améliorer la compréhension des mécanismes particuliers du séchage des matériaux céramiques. Cette étape est cruciale lors de la création d’une pièce. En effet, outre l’optimisation de la composition de l’échantillon, la température ainsi que l’humidité relative doivent être contrôlées afin que la perte de masse et le retrait n’entraînent pas l’apparition de contraintes pouvant mener à la création de fissures qui, suite à un traitement thermique, endommageront la pièce finale. Dans un premier temps et après une présentation des différents mécanismes connus du séchage, cette thèse met en avant un ensemble de montages conçus au sein d’une enceinte climatique instrumentée. À l’aide de ces derniers,une première étude portant sur le comportement en température et en humidité du liquide de façonnage seul est réalisée. Ce liquide a ensuite été introduit entre deux substrats identiques et parallèles pour reproduire le cas d’un ménisque au sein d’une porosité. Les contacts hydrophiles et hydrophobes ont alors été étudiés. Enfin, des expériences de séchage ont été menées sur des matériaux céramiques afin de corréler les différentes observations. Les résultats obtenus démontrent l’importance d’un compromis dans le choix des paramètres de séchage. La température et l’humidité relative influencent non seulement la cinétique du procédé lors du départ de l’eau, mais modifient également le contact avec la phase solide de la pièce céramique. En fin de séchage, la rupture des ponts liquides est brutale et peut expliquer certains phénomènes macroscopiques observés lors du séchage de pièces de tailles industrielles. / This work aims at improving the understanding of the specific mechanisms of the drying of ceramic materials. This step is crucial when manufacturing a piece. Indeed, besides the optimization of the sample composition, the temperature and the relative humidity have to be controlled so that the weight loss andthe shrinkage do not cause any stress development, leading to cracks formation which can damage the final piece after a heat treatment. After a presentation of the different known drying mechanisms, this thesis highlights a set of measuring benches conceived within an instrumented climatic chamber. A firststudy concerning the behavior of the shaping liquid as a function of temperature and relative humidity isrealized. Then, this liquid is inserted between two parallel and identical substrates in order to reproduce the case of a liquid bridge within a pore. The hydrophilic and hydrophobic contacts are then studied.Finally, drying experiences are carried out on ceramic materials to correlate the different observations.The obtained results demonstrate the importance of a compromise when selecting the drying parameters.The temperature and the relative humidity not only influence the kinetics of the process during the liquiddeparture, but also modify the contact with the solid phase of the ceramic piece. At the end of drying, the rupture of liquid bridges is brutal and can explain some macroscopic phenomena observed when dryinglarge pieces.

Referenzwerterstellung zur gezielten therapeutischen Nachbehandlung von Patienten mit Knietotalendoprothese, arthroskopischer Meniskuschirurgie und Vorderer Kreuzbandplastik. Es wurden 579 Patienten präoperativ untersucht und anschließend erhielten 140 Patienten (KTEP-n=50 ; ASKP-n=40 ; VKB-Plastik-n=50) ein standardisiertes, isokinetisch gesteuertes Rehabilitationsprogramm. Auf dessen Basis wurden die Referenzwerte erstellt.

A evolução do conhecimento acerca das funções dos meniscos e do tratamento das suas lesões, impulsionada pelo advento da cirurgia artroscópica, consagrou e popularizou a meniscectomia por esta via, por ser uma técnica menos invasiva, com menor morbidade e menores custos hospitalares, a ponto de torná-la, atualmente, a cirurgia ortopédica mais frequentemente realizada no mundo. Embora a maior parte dos pacientes submetidos a esta intervenção cirúrgica tenha resultados favoráveis e resolução rápida dos sintomas, percebe-se que parte considerável dos pacientes, especialmente os mais idosos, não apresenta uma evolução póscirúrgica satisfatória, apresentando piora dos sintomas e, eventualmente, necessitando de nova cirurgia. Partindo da hipótese que em determinados pacientes a meniscectomia, em vez de tratar, precipita e acentua um desequilíbrio biomecânico do joelho, o autor realizou estudo observacional prospectivo não-controlado com 86 pacientes de ambos os gêneros, com idade superior a 50 anos (média de 60,2 ± 7,1 anos), submetidos à meniscectomia artroscópica para tratamento de lesão do menisco medial de natureza degenerativa, com o objetivo de determinar variáveis demográficas, clínicas, anatômicas e cirúrgicas relacionadas aos resultados desfavoráveis. As avaliações funcionais pré e pós-operatórias foram realizadas utilizandose o Índice do KOOS (Knee Injury and Osteoarthritis Outcome Score), aplicado a todos os pacientes antes da cirurgia e 60 meses depois. Após análise estatística dos resultados obtidos, o autor verificou que 10 fatores podem ser considerados preditivos das meniscectomias mediais artroscópicas neste grupo etário, sendo quatro fatores fortemente associados aos resultados desfavoráveis: lesão da raiz posterior do menisco medial, dor pré-operatória intensa, claudicação antes da cirurgia e tempo decorrido entre o início dos sintomas e a cirurgia; dois fatores foram considerados moderadamente associados aos resultados desfavoráveis: presença de edema de medula óssea na ressonância magnética (RM) préoperatória e duração da cirurgia; quatro fatores foram considerados associados de modo fraco aos resultados desfavoráveis: Índice de Massa Corporal (IMC) >= 30 kg/m2 , varismo do joelho, presença de cisto poplíteo na RM pré-operatória e extensão da ressecção do menisco medial / The evolution of knowledge concerning meniscal functions and the treatment of their injuries, boosted by the development of arthroscopic surgery, has established and popularized arthroscopic meniscectomy due to its less invasiveness, less post-operative morbidity and lower hospital costs, to the point it has become, nowadays, the most frequently performed orthopedic procedure in the world. Although the majority of patients undergoing this operation is quite pleased with the outcomes and with the prompt resolution of their symptoms, it is noticeable that a considerable amount of patients with meniscal injuries, mainly the older, does not have a satisfactory postoperative outcome, with worsening of symptoms after being operated on and occasionally requiring another surgery. Based on observations of his medical practice and on the assumption that meniscectomy, rather than treat, can hasten and accentuate a biomechanical imbalance of the knee in those patients, the author conducted an observational prospective uncontrolled study with 86 patients of both genders, aged over 50 years old (average 60.2 ± 7.1 years), who underwent arthroscopic meniscectomy for the treatment of degenerative medial meniscal lesions, aiming to determine demographic, anatomical, clinical and surgical variables related to poor outcomes. The functional pre and post-operative evaluations were performed using the KOOS index (Knee Injury and Osteoarthritis Outcome Score) applied to all patients before surgery and 60 months later. After statistical analysis of the results, the author found that 10 factors can be considered predictors of arthroscopic medial meniscectomy in this age group: four factors were strongly associated with unfavorable results - posterior root lesion of the medial meniscus, intense pre-operative pain, claudication before surgery and time elapsed between onset of symptoms and surgery; two factors were moderately associated with unfavorable results - bone marrow edema in preoperative magnetic resonance imaging (MRI) and surgery time length; four factors that were weakly associated with poor results - bone mass index (BMI) >= 30 kg/m2, varus knee, poplyteal cyst in pre-operative MRI and extension of meniscal ressection