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Lempainen L, Kosola J, Pruna R, Sinikumpu JJ, Valle X, Heinonen O, Orava S, Maffulli N. Tears of Biceps Femoris, Semimembranosus, And Semitendinosus are Not Equal-A New Individual Muscle-Tendon Concept in Athletes. Scand J Surg 2021; 110:483-491. [PMID: 33612019 PMCID: PMC8688976 DOI: 10.1177/1457496920984274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing. Methods: The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced. Results: The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience. Conclusions: Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.
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Affiliation(s)
- L Lempainen
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland.,Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
| | - J Kosola
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland.,Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - R Pruna
- FC Barcelona, Medical Services, FIFA Center of Excellence, Barcelona, Spain
| | - J-J Sinikumpu
- Department of Children and Adolescents, PEDEGO unit and MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - X Valle
- FC Barcelona, Medical Services, FIFA Center of Excellence, Barcelona, Spain
| | - O Heinonen
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
| | - S Orava
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland.,Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
| | - N Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy.,Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK
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Kosola J, Brinck T, Leppäniemi A, Handolin L. Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy. Scand J Surg 2019; 109:89-95. [PMID: 30782110 DOI: 10.1177/1457496919828244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. MATERIALS AND METHODS The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006-2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. RESULTS A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). CONCLUSION The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.
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Affiliation(s)
- J Kosola
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Brinck
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Leppäniemi
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - L Handolin
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lempainen L, Kosola J, Niemi P, Orava S, Pruna R. Complete midsubstance rectus femoris ruptures: a series of 27 athletes treated operatively. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2018.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L. Lempainen
- Sports Trauma Research Unit, Hospital Mehilainen NEO, Turku, Finland
| | - J. Kosola
- Sports Trauma Research Unit, Hospital Mehilainen NEO, Turku, Finland
| | - P. Niemi
- Sports Trauma Research Unit, Hospital Mehilainen NEO, Turku, Finland
| | - S. Orava
- Sports Trauma Research Unit, Hospital Mehilainen NEO, Turku, Finland
| | - R. Pruna
- HMO FC Barcelona, Medical Services, FIFA Center of Excellence, Spain
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Laakso M, Kosola J, Niemi P, Mäkelä K, Ranne J, Orava S, Lempainen L. Operative treatment for the painful posterior thigh after hamstring autograft harvesting. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2017.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Laakso
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - J. Kosola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - P. Niemi
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - K. Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - J. Ranne
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - S. Orava
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - L. Lempainen
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
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Aavikko A, Puhakka J, Haapala J, Kukkonen J, Mäkelä K, Kosola J. Perioperative platelet rich plasma (PRP) in total hip arthroplasty through the Hardinge approach: protocol to study the effectiveness for gluteus medius healing. J Exp Orthop 2018; 5:23. [PMID: 29923073 PMCID: PMC6008270 DOI: 10.1186/s40634-018-0127-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 03/29/2018] [Indexed: 02/07/2023] Open
Abstract
Background Platelet-rich plasma (PRP) has been used to support tendon regeneration mainly in sports medicine. PRP is a concentrate of platelet-rich plasma proteins derived from whole blood by centrifugation to remove erythrocytes and leukocytes. PRP has high amounts of platelets which may promote healing tendons affected by degenerative conditions. These platelets contain growth factors and are known to facilitate the regeneration of injured tendon structures. Total hip arthroplasty (THA) through the Hardinge approach may leave the patient with impaired gait and poor regeneration of the gluteus medius tendon if the tendon is not reattached properly after closure of the surgical wound. Methods The study will be a multicenter, double-blinded and randomized study enrolling 90 patients based on power calculations. The efficacy of perioperative PRP treatment will be assessed by subjective and objective outcome variables. The participants will be randomized (sealed envelope) into either a placebo (saline) or a PRP group (1:1). For subjective outcomes, the Oxford Hip Score (OHS) will be collected before surgery and 3 and 12 months after surgery. The objective measures are findings at magnetic resonance imaging and plain radiographs and recorded values of measured strength. Discussion We present the perioperative use and the ways to measure the clinical efficacy of PRP. As PRP may have benefits regarding degenerative tendon regeneration, studies on the use of PRP in hip arthroplasty are warranted to facilitate postoperative recovery. Trial registration This study has been approved by the ethics committee of the Hospital District of Southwest Finland and approved by the local institutional research board. The study has been registered in ClinicalTrials.gov (NCT02607462).
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Affiliation(s)
- Anni Aavikko
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.
| | - J Puhakka
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - J Haapala
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - J Kukkonen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - K Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - J Kosola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.,Department of Surgery, Satakunta Central Hospital, Pori, Finland
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Itälä A, Alihanka S, Kosola J, Kemppainen J, Ranne J, Kajander S. Tendon Graft Healing in Multiligament Reconstructed Knee Detected by FDG-PET/CT: A Pilot Study. Scand J Surg 2015; 105:133-8. [DOI: 10.1177/1457496915605002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 07/26/2015] [Indexed: 01/14/2023]
Abstract
Background and Aims: The detection of graft viability is challenging in the multiligament reconstructed knee. Magnetic resonance imaging gives structural information but lacks the capability to assess biological activity of the grafts. 18F-labeled fluorodeoxyglucose positron emission tomography combined with computer tomography is shown to be a sensitive method for imaging tissue metabolism and viability. The aim of the present study was to evaluate the feasibility of fluorodeoxyglucose positron emission tomography combined with computer tomography imaging in the detection of the replacement graft metabolism in multiligament reconstructed knees. Materials and Methods: Seven patients (17–44 years) with multiligament reconstructed knee underwent fluorodeoxyglucose positron emission tomography combined with computer tomography to evaluate the biological activity of replacement grafts. The degree of fluorodeoxyglucose uptake reported as standard uptake values from the region of interest was analyzed 3–24 months postoperatively. Results: In all patients, the fluorodeoxyglucose positron emission tomography combined with computer tomography showed increased fluorodeoxyglucose uptake in all replacement grafts at different follow-up time points. Furthermore, fluorodeoxyglucose was higher at femoral condyles of operated knees compared to contralateral reference values. Conclusion: This pilot study shows a significant increase in tendon graft metabolism during two first years of postoperative healing. The fluorodeoxyglucose positron emission tomography combined with computer tomography imaging seems to be adequate method of assessment of graft metabolism and viability during postoperative healing. The clinical value of fluorodeoxyglucose positron emission tomography combined with computer tomography imaging, however, warrants further evaluation with longitudinal studies with a larger patient population.
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Affiliation(s)
- A. Itälä
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - S. Alihanka
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - J. Kosola
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
- Department of Surgery, Central Hospital of Satakunta, Pori, Finland
| | - J. Kemppainen
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - J. Ranne
- Orthopedics and Sports Medicine, Hospital Neo, Turku, Finland
| | - S. Kajander
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Orthopedics and Sports Medicine, Hospital Neo, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
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Kosola J, Ahotupa M, Kyröläinen H, Santtila M, Vasankari T. Both poor cardiorespiratory and weak muscle fitness are related to a high concentration of oxidized low-density lipoprotein lipids. Scand J Med Sci Sports 2011; 22:746-55. [DOI: 10.1111/j.1600-0838.2011.01326.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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