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Soósné Kiss Z, Vitrai J, Dió M, Krémer IL, Ádám S. High prevalence of burnout among midwives in Hungary: High job demands and low resources as potential persistent stressors, a focus on prevention. Heliyon 2024; 10:e24495. [PMID: 38298615 PMCID: PMC10828672 DOI: 10.1016/j.heliyon.2024.e24495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Background Midwifery practice in Hungary is characterized by chronic stress, which may in turn lead to burnout and impaired perinatal care. However, little is known about the degree and potential stressors of burnout, which hinder the development of strategies to promote well-being among midwives in Hungary. Aim To assess the prevalence of burnout and identify persistent individual and occupational stressors among midwives in Hungary over the past decade to inform prevention. Methods We conducted two cross-sectional studies among midwives in 2014 and 2022. We used the Maslach Burnout Inventory to assess burnout (emotional exhaustion, depersonalization, and personal accomplishment) over time. We also collected data on individual and work characteristics. We performed a multivariate regression analysis to explore associations between burnout and respondents' characteristics. Findings The degree and prevalence of emotional exhaustion among midwives increased significantly between 2014 (N = 224) and 2022 (N = 152). High workload, not feeling valued at work, poorly perceived health status and work dissatisfaction emerged as a significant positive correlate of emotional exhaustion or depersonalization in both studies. Living alone showed both a positive and inverse association with burnout in 2014 and 2022, respectively. Work satisfaction was a positive correlate of personal accomplishment in both studies. Conclusions Our results add to and confirm the growing body of evidence about the high prevalence of burnout among midwives in Hungary. We identified potential risk factors and outcomes of burnout, which remained unchanged over time. To prevent or reduce burnout among midwives, future interventions should focus on addressing these potential persistent risk factors. However, the time-varying role of factors influencing burnout makes it advisable to review preventive interventions from time to time.
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Affiliation(s)
| | | | - Mihály Dió
- Semmelweis University, Department of Imaging Analytics and Medical Technology, Budapest, Hungary
| | | | - Szilvia Ádám
- Semmelweis University, Health Services Management Training Centre, Budapest, Hungary
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Lipienné Krémer I, Dió M, Vitrai J, Soósné Kiss Z. [Burnout syndrome among Hungarian midwives in 2014 and 2022]. Orv Hetil 2023; 164:1592-1599. [PMID: 37987703 DOI: 10.1556/650.2023.32884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The healthcare sector is the most studied area of burnout, as the mental health of healthcare workers has a significant impact on the mental health of the people they care for. OBJECTIVE The aim of our study was to investigate whether there have been changes in the dimensions of burnout among midwives, and how the relationships between burnout and the individual factors and working conditions that influence it have evolved, using national data from 2014 and 2022. METHOD An anonymous, voluntary, questionnaire-based survey of midwives working exclusively in maternity units was conducted using the Maslach Burnout Inventory questionnaire, which measures burnout, and questions on respondents' demographic characteristics and working conditions. Multivariate ordinal logistic regression was used to explore associations between burnout and respondent characteristics, and associations were characterized by odds ratios. RESULTS Among the dimensions of burnout, no change in depersonalization was observed in 2022, but both emotional exhaustion and personal ineffectiveness were significantly more common in 2022 than in 2014. Responses from 224 midwives in 2014 and 152 midwives in 2022 were analyzed. Looking at the influencing factors, higher levels of burnout in 2014 were significantly associated with poorer perceived health, lack of a partner, smoking, shorter time in healthcare, having a job in a larger city, feeling overworked and dissatisfied. In 2022, on the other hand, younger age, smoking, shorter time in healthcare, feeling overworked, dissatisfied and unvalued were associated with higher levels of burnout. Looking at the combined effect of these factors, willingness to attend a health promotion lecture and having a second job also showed a significant effect on burnout in 2022. DISCUSSION The authors discuss the change in burnout among midwives and the possible reasons for the correlations shown. CONCLUSION The results of the first study on burnout among midwives in Hungary show that improving the working conditions of midwives is essential for the functioning of family-friendly midwifery. In addition, to prevent burnout, more emphasis should be placed on the prevention of the risk factors identified in the study in education and training. Orv Hetil. 2023; 164(40): 1592-1599.
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Affiliation(s)
- Ibolya Lipienné Krémer
- 1 Semmelweis Egyetem, Egészségtudományi Kar, Szülészeti és Nőgyógyászati Klinikai Ismeretek Tanszék Budapest Magyarország
| | - Mihály Dió
- 2 Semmelweis Egyetem, Egészségtudományi Kar, Képalkotó Analitikus és Orvostechnikai Tanszék Budapest Magyarország
| | - József Vitrai
- 3 Széchenyi István Egyetem, Egészség- és Sporttudományi Kar, Preventív Egészségtudományi Tanszék Győr, Szent Imre út 26-28., 9024 Magyarország
| | - Zsuzsanna Soósné Kiss
- 3 Széchenyi István Egyetem, Egészség- és Sporttudományi Kar, Preventív Egészségtudományi Tanszék Győr, Szent Imre út 26-28., 9024 Magyarország
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Soósné Kiss Z, Szabó-Németh P, Horváth K. [Cooperation between the health visitor and the physician as one of the pillars of the 108-year-old Hungarian Health Visitor Service]. Orv Hetil 2023; 164:1311-1318. [PMID: 37598368 DOI: 10.1556/650.2023.32867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Despite the more than 100-year history of the Hungarian Health Visitor Service, no study has yet been carried out that looked back at the cooperation between health visitors and physicians. OBJECTIVE Our aim was 1) to explore the professional advances of the health visitor service and the cooperation between health visitor and physician by examining historical documents, legal and professional regulations governing the work of health visitor, furthermore, 2) to investigate whether there are compulsory training elements in today's training for health visitors that prepare students for health visitor and physician collaboration, moreover, 3) to search for old tools and documents used by health visitors and doctors in the North-West of Transdanubia. METHOD A literature search was carried out to identify documents relating to the development of the work of health visitors, the cooperation between health visitors and physicians, past and current legal and professional regulations, the current regulation on training of health visitors. Through field research, we tracked down old tools and documents of health visitors and physicians. RESULTS The establishment of the Hungarian Health Visitor Service is associated with the names of professors of medicine. The historical documents and regulations testify the development of the work of the health visitor, the expansion of her competences and the importance of the health visitor and physician cooperation. The training competences required for the cooperation between health visitors and physicians, health visitors and specialists are regulated by the regulation on training of health visitors. We have found many old objects and documents used in the work of the health visitor and doctor. DISCUSSION The documents that have preserved almost invariably describe the health visitor as a person working alongside the physician, in cooperation with the physician. Nowadays, the regulation of cooperation covers for all specialties in the field of health visitor. CONCLUSION Based on our research, it is fair to say that the health visitor-physician cooperation is an important pillar of the 108-year-old Hungarian Health Visitor Service. Orv Hetil. 2023; 164(33): 1311-1318.
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Affiliation(s)
- Zsuzsanna Soósné Kiss
- 1 Széchenyi István Egyetem, Egészség- és Sporttudományi Kar, Preventív Egészségtudományi Tanszék Győr, Szent Imre út 26-28., 9024 Magyarország
| | - Petra Szabó-Németh
- 1 Széchenyi István Egyetem, Egészség- és Sporttudományi Kar, Preventív Egészségtudományi Tanszék Győr, Szent Imre út 26-28., 9024 Magyarország
| | - Krisztina Horváth
- 1 Széchenyi István Egyetem, Egészség- és Sporttudományi Kar, Preventív Egészségtudományi Tanszék Győr, Szent Imre út 26-28., 9024 Magyarország
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Lukács J. Á, Takács J, Soósné Kiss Z, Kapitány-Fövény M, Falus A, Feith HJ. The Effects of a Cyberbullying Intervention Programme Among Primary School Students. Child Youth Care Forum 2022; 52:893-911. [PMID: 36213132 PMCID: PMC9527071 DOI: 10.1007/s10566-022-09714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/10/2022]
Abstract
Background With the increase of cyberbullying, several intervention programmes have been created that aim at reducing cyber-victimisation and perpetration. Objective Our study presents the effects of the STAnD anti-cyberbullying programme with peer-education both on the short and the long run among lower and upper primary school students, with a focus on the participants' cyberbullying roles. Method The sample comprised of 536 students who participated in the intervention programme, involving 36% lower and 64% upper primary school students. Participants were measured by a self-reported questionnaire before and right after the programme, then six months later. Results The main effect of the STAnD programme was a positive change in the participants' willingness to engage in help-seeking and their active-defending reaction, although this effect decreased after six months. The changes were larger among lower primary school students compared to upper primary school participants. Conclusion Our results imply that long-lasting and intensive health promotion programmes are necessary to reach a long-term intervention effect. Anti-cyberbullying programmes should take into consideration participants' involvement and roles in cyberbullying. As our study was a non-randomised uncontrolled study design, thus interpretation of the effectiveness of the programme is limited. Supplementary Information The online version contains supplementary material available at 10.1007/s10566-022-09714-9.
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Affiliation(s)
- Ágnes Lukács J.
- Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Vas utca 17, Budapest, 1088 Hungary
| | - Johanna Takács
- Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Vas utca 17, Budapest, 1088 Hungary
| | - Zsuzsanna Soósné Kiss
- Department of Health Sciences, Faculty of Health and Sport Sciences, Széchenyi University, Szent Imre út 26-28, Gyor, 9024 Hungary
| | - Máté Kapitány-Fövény
- Department of Addictology, Faculty of Health Sciences, Semmelweis University, Vas utca 17, Budapest, 1088 Hungary
- Nyírő Gyula National Institute of Psychiatry and Addictions, Lehel utca 59, Budapest, 1135 Hungary
| | - András Falus
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
- EDUVITAL Foundation, Nagyvárad tér 4, Budapest, 1089 Hungary
| | - Helga Judit Feith
- Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Vas utca 17, Budapest, 1088 Hungary
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Lipienné Krémer I, Harmath Á, Dió M, Soósné Kiss Z. A kiégési szindróma vizsgálata neonatalis intenzív osztályok szakápolói és orvosai körében. Orv Hetil 2022; 163:1268-1274. [DOI: 10.1556/650.2022.32539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022]
Abstract
Bevezetés: Az egészségügyi dolgozók kiégése jól ismert probléma.
Előfordulásával, az okok felderítésével számos tanulmány foglalkozott. A
neonatalis intenzív osztályokon dolgozó szakdolgozók mindennapi munkája
kiemelten magas fizikai és lelki megterheléssel, stresszhatással jár.
Célkitűzés: A kutatás a neonatalis intenzív osztályokon
dolgozó egészségügyi szakdolgozók között a kiégési szindróma előfordulási
gyakoriságát és intenzitását mérte fel, valamint vizsgálta az intézményi
szinttel, munkakörrel és munkatapasztalattal kapcsolatos összefüggéseket.
Módszer: Az adatgyűjtés a Maslach és Jackson által
összeállított Maslach Burnout Inventory (MBI-) kérdőív felhasználásával történt
2019-ben. Eredmények: A kiégési szindróma vizsgált dimenziói
közül a legjellemzőbb az érzelmi kimerülés volt, amely közel 30%-os
gyakorisággal és jellemzően magas intenzitással fordult elő a neonatalis
intenzív osztályon dolgozó szakdolgozók (n = 278) körében. Emellett egyötödüket
a deperszonalizáció magas gyakorisága és intenzitása jellemezte. Ugyanakkor a
személyes hatékonyság csökkenését közel egyharmaduk tapasztalta. A munkakör és
az egészségügyben eltöltött idő nem mutatott jelentős összefüggést a kiégési
szindróma előfordulásával, azonban a kiégési szindróma magasabb gyakorisággal és
intenzitással fordult elő III. szintű neonatalis intenzív osztályon dolgozók
körében. Következtetés: Magyarországon elsőként készült
kiégésre vonatkozó felmérés kora- és újszülött intenzív osztályon dolgozó
egészségügyi szakdolgozók körében átfogó jelleggel. A kiégési szindróma
következményeinek ismeretében fontos a megelőzés és a tünetek mielőbbi
felismerése. Orv Hetil. 2022; 163(32): 1268–1274.
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Affiliation(s)
- Ibolya Lipienné Krémer
- Semmelweis Egyetem, Egészségtudományi Kar, Szülészeti és Nőgyógyászati Klinikai Ismeretek Tanszék Budapest Magyarország
| | - Ágnes Harmath
- Semmelweis Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Klinika Baross utcai Részleg, Neonatális Intenzív Centrum Budapest, Baross u. 27., 1088 Magyarország
| | - Mihály Dió
- Semmelweis Egyetem, Egészségtudományi Kar, Képalkotó Analitikus és Orvostechnikai Tanszék Budapest Magyarország
| | - Zsuzsanna Soósné Kiss
- Széchenyi István Egyetem, Egészség- és Sporttudományi Kar, Egészségtudományi Tanszék Győr Magyarország
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Feith HJ, Soósné Kiss Z, Pilling J, Kovács A, Szabó M, Cuttini M, Berbik I, András G, Gradvohl E. The Impact of Ethical and Legal Decision-Making in Neonatal Intensive Care on Psychosocial Wellbeing of the Health Care Professionals: The Overview of the HUNIC Project Study Design. EJMH 2019. [DOI: 10.5708/ejmh.14.2019.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Soósné Kiss Z, Feith HJ, Szabó M, Gradvohl E. [The professional and family characteristics, difficulties, contentment and resources of physicians working at level 3 neonatal intensive care centres. General overview in Hungary]. Orv Hetil 2018; 159:628-635. [PMID: 29658279 DOI: 10.1556/650.2018.31051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/19/2022]
Abstract
INTRODUCTION A survey that investigates the situation of physicians working at neonatal intensive care (NIC) centres has not been made since 1997. AIM To give an overview of the sociodemographic characteristics; personal and professional problems; the satisfaction with their job and family roles; their levels of healthy lifestyle; resources in the families of physicians working at NIC. METHOD We have made an examination in Hungary at NIC among physicians from April 2015 till January 2016, with an anonym self-fill-in questionnaire. RESULTS The physicians involved in the research (n = 111) are representatively middle-aged people. They are well-qualified and hold a subordinate post. Most of them have second jobs. The manager and deputy-manager positions are characteristic for the men. Most of them live in family. The main problems for them are financial and professional difficulties, not the family or personal problems. They have conflicts in families because of finding partners and having children as well as job problems. They are satisfied with their parenting, partnership and professional roles but they are not contented with their family role as a financial safety provider person and as a person living a healthy life. In difficult situations in their life, they can count on friends and family members, furthermore they can rely on their workmates and superiors. CONCLUSION It is the first research that focuses on the general situation of physicians working at level 3 NIC centres. This is the first time when a survey investigates their professional-personal-family life. Orv Hetil. 2018; 159(16): 628-635.
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Affiliation(s)
- Zsuzsanna Soósné Kiss
- Egészségtudományi Klinikai Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest, Vas u. 17., 1088
| | - Helga Judit Feith
- Társadalomtudományi Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest
| | - Miklós Szabó
- I. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Edina Gradvohl
- Társadalomtudományi Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest
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Feith HJ, Melicher D, Máthé G, Gradvohl E, Füzi R, Darvay S, Hajdú Z, Nagyné Horváth E, Soósné Kiss Z, Bihariné Krekó I, Földvári-Nagy Lászlóné Lenti K, Molnár E, Szalainé Tóth T, Urbán V, Kassay A, Falus A. [Experience and motivation: opinion of Hungarian high school students about health promotion programs]. Orv Hetil 2016; 157:65-9. [PMID: 26726141 DOI: 10.1556/650.2015.30338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/19/2022]
Abstract
INTRODUCTION Health-related attitudes can be encouraged most effectively at young ages. Young generations would require more interactive methods in programs engaged in health promotion. AIM The aim of the authors was to get an insight into the attitudes, experience and motivation of youngsters in connection with health promotion programs and the community service work. METHOD The questionnaires were filled in by high school students studying in Budapest and in the countryside (N = 898). RESULTS 44.4% of the students did not have lessons or extracurricular activities dealing with health promotion. Concerning health promotion programs, youngsters in Budapest had more positive experience, while female students showed a more adoptive attitude. CONCLUSIONS It was concluded that in one of the most susceptible life stages, many youngsters either do not participate in programs dealing with health promotion, or participate in programs that are within the framework of school subjects or extracurricular activities building on traditional teaching methods.
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Affiliation(s)
- Helga Judit Feith
- Társadalomtudományi Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest, Vas utca 17., 1088
| | - Dóra Melicher
- Genetikai, Sejt- és Immunbiológiai Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Gábor Máthé
- Képalkotó Diagnosztikai Analitikus és Orvostechnikai Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest
| | - Edina Gradvohl
- Társadalomtudományi Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest, Vas utca 17., 1088
| | - Rita Füzi
- Népegészségügyi Osztály, Budapest Főváros Kormányhivatala II Kerületi Hivatala. Budapest
| | - Sarolta Darvay
- Természettudományi Tanszék, Eötvös Loránd Tudományegyetem, Tanító- és Óvóképző Kar Budapest
| | - Zsófia Hajdú
- Társadalomtudományi Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest, Vas utca 17., 1088
| | | | - Zsuzsanna Soósné Kiss
- Egészségtudományi Klinikai Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest
| | - Ilona Bihariné Krekó
- Természettudományi Tanszék, Eötvös Loránd Tudományegyetem, Tanító- és Óvóképző Kar Budapest
| | | | | | | | - Veronika Urbán
- Morfológiai és Fiziológiai Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest
| | - Adrienn Kassay
- Társadalomtudományi Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest, Vas utca 17., 1088
| | - András Falus
- Genetikai, Sejt- és Immunbiológiai Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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Feith HJ, Soósné Kiss Z, Kovácsné Tóth A, Balázs P. [Similarities and differences in the social background of female medical, nursing and public health visiting students]. Orv Hetil 2008; 149:1137-42. [PMID: 18539580 DOI: 10.1556/oh.2008.28393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED According to our knowledge, there has never been a comprehensive research in Hungary dealing with healthcare university or college students' social background. AIM The main objectives of our cross-section research were to analyze differences in the social background of female students who decided to become doctors, professional nurses and health visitors. METHOD This research was conducted among female medical and nursing college students at the Semmelweis University. There were 295 students invited to participate, the response rate was 68,08% (N = 201). Data analysis was performed by SPSS software by using descriptive methods of statistics. RESULTS We found a decisive difference among medical, nursing and health visitor students while analyzing a number of socio-demographic characteristics. Most medical students came from families where the parents had college or university degrees, but we can state that there is a minimal likelihood in the case of college students that they are descendants of parents with higher educational degrees. We did not find statistical differences in the three student sample groups regarding their marital status, but fewer nursing college students lived in marriage or household partnership. CONCLUSION We found a significant difference in the social background of nursing college and medical students. The social disadvantages of nursing and health visitor students are more considerable than those of medical students.
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Affiliation(s)
- Helga Judit Feith
- Semmelweis Egyetem, Egészségtudományi Kar, Egészségügyi Kultúrtörténeti Tanszék, Budapest.
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Potter NJ, Brukner PD, Makdissi M, Crossley K, Kiss ZS, Bradshaw C. Navicular stress fractures: outcomes of surgical and conservative management. Br J Sports Med 2006; 40:692-5; discussion 695. [PMID: 16611725 PMCID: PMC2579456 DOI: 10.1136/bjsm.2005.022079] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the long term outcomes of the two treatment options for navicular stress fractures: non-weightbearing cast immobilisation and surgical fixation. DESIGN Retrospective case study. PARTICIPANTS Subjects aged 18 years and older who had been treated for a navicular stress fracture more than two years previously. MAIN OUTCOME MEASURES Questionnaire based analogue pain score and function score; tenderness on palpation; abnormality detected on computed tomography (CT). RESULTS In all, 32 fractures in 26 subjects were investigated. No significant differences were found between surgical and conservative management for current pain (p = 0.984), current function (p = 0.170), or abnormality on CT (p = 0.173). However, surgically treated patients more often remained tender over the "N spot" (p = 0.005), even after returning to competition for two years or more. CONCLUSIONS Surgical fixation of navicular stress fractures appears to be as effective as conservative management over the longer term. However, there remains a small but measurable degree of pain and loss of function over this period. The value of using "N spot" tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite successful completion of treatment and return to competition.
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Affiliation(s)
- N J Potter
- Centre For Health, Exercise and Sports Medicine, The University of Melbourne, Victoria 3010, Australia
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Cook JL, Ptazsnik R, Kiss ZS, Malliaras P, Morris ME, De Luca J. High reproducibility of patellar tendon vascularity assessed by colour Doppler ultrasonography: a reliable measurement tool for quantifying tendon pathology. Br J Sports Med 2005; 39:700-3. [PMID: 16183764 PMCID: PMC1725031 DOI: 10.1136/bjsm.2004.016410] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study examined whether patellar tendon vascularity could be quantified accurately in the clinical setting using colour Doppler ultrasonography. METHODS A sonographer and two radiologists visually estimated tendon vascularity in millimetres in 74 tendons during ultrasound (US) examination and from hard copy films. These estimates were then compared to the length of vessels measured from the digital image in millimetres and the correlation between them was determined. A subset of 16 tendons was used to compare the estimates of vascularity by two examiners at US examination. RESULTS The estimation of vascular length at US examination correlated highly with the measured vascular length (r = 0.92; 95% confidence interval (CI) 0.87 to 0.94), as did the length estimated from the films (r = 0.94; 95% CI 0.9 to 0.96). The correlation between examiners was 0.84 (95% CI 0.51 to 0.94) for the estimates made during US examination and 0.85 (95% CI 0.59 to 0.95) for the vessel lengths measured from the digital images. CONCLUSIONS These excellent correlations indicate that tendon vascularity can be reliably estimated using colour Doppler ultrasonography and tendon vascularity could therefore be used by clinicians to rate clinical change. This method of quantifying tendon vascularity could also be used in research to investigate the effects of tendon treatments on vascularity.
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Affiliation(s)
- J L Cook
- La Trobe University, Bundoora, Victoria, Australia.
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Young MA, Cook JL, Purdam CR, Kiss ZS, Alfredson H. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. Br J Sports Med 2005; 39:102-5. [PMID: 15665207 PMCID: PMC1725109 DOI: 10.1136/bjsm.2003.010587] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Conservative treatment of patellar tendinopathy has been minimally investigated. Effective validated treatment protocols are required. OBJECTIVES To investigate the immediate (12 weeks) and long term (12 months) efficacy of two eccentric exercise programmes for the treatment of patellar tendinopathy. METHODS This was a prospective randomised controlled trial of 17 elite volleyball players with clinically diagnosed and imaging confirmed patellar tendinopathy. Participants were randomly assigned to one of two treatment groups: a decline group and a step group. The decline group were required to perform single leg squats on a 25 degrees decline board, exercising into tendon pain and progressing their exercises with load. The step group performed single leg squats on a 10 cm step, exercising without tendon pain and progressing their exercises with speed then load. All participants completed a 12 week intervention programme during their preseason. Outcome measures used were the Victorian Institute of Sport Assessment (VISA) score for knee function and 100 mm visual analogue scale (VAS) for tendon pain with activity. Measures were taken throughout the intervention period and at 12 months. RESULTS Both groups had improved significantly from baseline at 12 weeks and 12 months. Analysis of the likelihood of a 20 point improvement in VISA score at 12 months revealed a greater likelihood of clinical improvements in the decline group than the step group. VAS scores at 12 months did not differ between the groups. CONCLUSIONS Both exercise protocols improved pain and sporting function in volleyball players over 12 months. This study indicates that the decline squat protocol offers greater clinical gains during a rehabilitation programme for patellar tendinopathy in athletes who continue to train and play with pain.
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Affiliation(s)
- M A Young
- Musculoskeletal Research Centre, La Trobe University, Bundoora, Victoria 3086, Australia.
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Gaida JE, Cook JL, Bass SL, Austen S, Kiss ZS. Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players? Br J Sports Med 2005; 38:581-5. [PMID: 15388543 PMCID: PMC1724954 DOI: 10.1136/bjsm.2003.006015] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. OBJECTIVES To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. METHODS Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180 degrees /s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. RESULTS The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07). CONCLUSIONS Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers.
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Affiliation(s)
- J E Gaida
- Musculoskeletal Research Centre, School of Physiotherapy, La Trobe University, Bundoora, 3086, Australia
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Kiss ZS. [Special support for expectant parents in Hungary: responsibility needs to be learned]. Pflege Z 2004; 57:476-80. [PMID: 15981601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Cook JL, Kiss ZS, Khan KM, Purdam CR, Webster KE. Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross-sectional study. Br J Sports Med 2004; 38:206-9. [PMID: 15039260 PMCID: PMC1724788 DOI: 10.1136/bjsm.2003.004747] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Patellar tendinopathy has been reported to be associated with many intrinsic risk factors. Few have been fully investigated. This cross-sectional study examined the anthropometric and physical performance results of elite junior basketball players with normal or abnormal patellar tendons to see if any measures were associated with changes in tendon morphology. METHODS Agility, leg strength, endurance, and flexibility were measured in 71 male and 64 female players. A blinded radiologist ultrasonographically examined their patellar tendons and athletes were grouped as having normal or abnormal tendons. One-way ANOVA was used to test for differences in anthropometric and physical performance data for athletes whose tendons were normal or abnormal (unilateral or bilateral tendinopathy) on ultrasound. RESULTS Results show that females with abnormalities in their tendons had a significantly better vertical jump (50.9+/-6.8 cm) than those with normal tendons (46.1+/-5.4 cm) (p = 0.02). This was not found in males. In males, the mean sit and reach in those with normal tendons (13.2+/-6.7 cm) was greater (p<0.03) than in unilateral tendinopathy (10.3+/-6.2 cm) or in bilateral tendinopathy (7.8+/-8.3 cm). In females, those with normal tendons (13.3+/-4.8 cm) and bilateral tendinopathy (15.8+/-6.2 cm) were distinctly different from those with unilateral tendinopathy (7.9+/-6.6 cm). CONCLUSION Flexibility and vertical jump ability are associated with patellar tendinopathy and the findings warrant consideration when managing young, jumping athletes.
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Affiliation(s)
- J L Cook
- Musculoskeletal Research Centre, La Trobe University, Bundoora, Vic. 3083, Australia.
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Cook JL, Khan KM, Kiss ZS, Coleman BD, Griffiths L. Asymptomatic hypoechoic regions on patellar tendon ultrasound: A 4-year clinical and ultrasound followup of 46 tendons. Scand J Med Sci Sports 2001; 11:321-7. [PMID: 11782263 DOI: 10.1034/j.1600-0838.2001.110602.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patellar tendon ultrasound appearance is commonly used in clinical practice to diagnose patellar tendinopathy and guide management. Using a longitudinal study design we examined whether or not the presence of a hypoechoic ultrasonographic lesion in an asymptomatic patellar tendon conferred a risk for developing jumper's knee compared with a tendon that was ultrasonographically normal. Ultrasonographic, symptomatic and anthropometric assessment was completed at baseline and followup. Magnetic resonance imaging was performed on four tendons that resolved ultrasonographically in the study period. Forty-six patellar tendons were followed over 47+/-11.8 months. Eighteen tendons were hypoechoic at baseline and 28 were ultrasonographically normal. Five tendons resolved ultrasonographically in the study period. Magnetic resonance imaging in four of these tendons was normal. Seven normal patellar tendons at baseline developed a hypoechoic area but only two became symptomatic. Analysis of ultrasonography at baseline and clinical outcome with Fisher's exact test shows there is no association between baseline ultrasound changes and symptoms at followup. In this study there is no statistically significant relationship between ultrasonographic patellar tendon abnormalities and clinical outcome in elite male athletes. Management of jumper's knee should not be solely based on ultrasonographic appearance; clinical assessment remains the cornerstone of appropriate management.
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Affiliation(s)
- J L Cook
- Musculoskeletal Research Centre, School of Physiotherapy, Latrobe University, Bundoora, Melbourne, Australia
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Cook JL, Khan KM, Kiss ZS, Purdam CR, Griffiths L. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport tendon study group. Br J Sports Med 2001; 35:65-9. [PMID: 11157466 PMCID: PMC1724272 DOI: 10.1136/bjsm.35.1.65] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Palpation is an important clinical test for jumper's knee. OBJECTIVES To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. METHODS In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. RESULTS Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36-38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01). CONCLUSIONS In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.
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Affiliation(s)
- J L Cook
- School of Physiotherapy, Latrobe University, Bundoora, Australia.
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Cook JL, Khan KM, Kiss ZS, Griffiths L. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years. Scand J Med Sci Sports 2000; 10:216-20. [PMID: 10898266 DOI: 10.1034/j.1600-0838.2000.010004216.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Anterior knee pain is a common presenting complaint amongst adolescent athletes. We hypothesised that patellar tendinopathy may occur at a younger age than is generally recognised. Thus, we studied the patellar tendons in 134 elite 14- to 18-year-old female (n=64) and male (n=70) basketball players and 29 control swimmers (17 female, 12 male) clinically and with ultrasonography. We found that of 268 tendons, 19 (7%) had current patellar tendinopathy on clinical grounds (11% in males, 2% in females). Twenty-six percent of the basketball players' patellar tendons contained an ultrasonographic hypoechoic region. Ultrasonographic abnormality was more prevalent in the oldest tertile of players (17-18 years) than the youngest tertile (14-15.9 years). Of tendons categorised clinically as 'Never patellar tendinopathy', 22% had an ultrasonographic hypoechoic region nevertheless. This study indicates that patellar tendinopathy can occur in 14- to 18-year-old basketball players. Ultrasonographic tendon abnormality is 3 times as common as clinical symptoms.
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Affiliation(s)
- J L Cook
- Victorian Institute of Sport, South Melbourne, Australia
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Cook JL, Khan KM, Kiss ZS, Purdam CR, Griffiths L. Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players. J Ultrasound Med 2000; 19:473-479. [PMID: 10898301 DOI: 10.7863/jum.2000.19.7.473] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
To evaluate the ability of ultrasonography to predict eventual symptoms in an at-risk population, 52 elite junior basketball players' patellar tendons were studied at baseline and again 16 months later. The group consisted of 10 study tendons (ultrasonographically hypoechoic at baseline) and 42 control tendons (ultrasonographically normal at baseline). By design, all tendons were asymptomatic at baseline. No differences were noted between subjects and controls at baseline for age, height, weight, training hours, and vertical jump. Functional (P < 0.01) and symptomatic outcome (P < 0.05) were poorer for subjects' tendons than for controls. Relative risk for developing symptoms of jumper's knee was 4.2 times greater in case tendons than in control tendons. Men were more likely to develop ultrasonographic changes than women (P < 0.025), and they also had significantly increased training hours per week (P < 0.01) in the study period. Half (50%) of abnormal tendons in women became ultrasonographically normal in the study period. Our data suggest that presence of an ultrasonographic hypoechoic area is associated with a greater risk of developing jumper's knee symptoms. Ultrasonographic patellar tendon changes may resolve, but this is not necessary for an athlete to become asymptomatic. Qualitative or quantitative analysis of baseline ultrasonographic images revealed it was not possible to predict which tendons would develop symptoms or resolve ultrasonographically.
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Affiliation(s)
- J L Cook
- Victorian Institute of Sport and Latrobe University, Melbourne, Australia
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Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian Institute of Sport Tendon Study Group. Am J Sports Med 2000; 28:183-90. [PMID: 10750994 DOI: 10.1177/03635465000280020801] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic patellar tendinopathy often requires surgical treatment. We compared the outcomes in 25 subjects (29 tendons) who had had open patellar tenotomy and 23 subjects (25 tendons) who had had arthroscopic patellar tenotomy at a mean follow-up of 3.8 and 4.3 years, respectively. At follow-up, outcomes in the open and arthroscopic groups were as follows: 1) symptomatic benefit was seen in 81% of open and 96% of arthroscopic tenotomy patients, 2) sporting success was seen in 54% of open and 46% of arthroscopic tenotomy patients, 3) median time to return to preinjury level of activity was 10 months for open and 6 months for arthroscopic tenotomy patients, and 4) median Victorian Institute of Sport Assessment score at follow-up was 88 for open and 77 for arthroscopic tenotomy patients. There were no significant differences between groups for all outcomes. The appearance of the tendon on sonography remained abnormal in over 70% of subjects at follow-up, and sonographic appearance did not correlate with clinical outcome. Thus, arthroscopic patellar tenotomy was as successful as the traditional open procedure. Both procedures provided virtually all subjects with symptomatic benefit, but only about half the subjects who underwent either open or arthroscopic patellar tenotomy were competing at their former sporting level at follow-up.
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Affiliation(s)
- B D Coleman
- Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
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Khan KM, Visentini PJ, Kiss ZS, Desmond PM, Coleman BD, Cook JL, Tress BM, Wark JD, Forster BB. Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med 1999; 9:129-37. [PMID: 10512340 DOI: 10.1097/00042752-199907000-00003] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report the appearances of ultrasound (US) and magnetic resonance imaging (MRI) before and after surgery for chronic patellar tendinopathy and to correlate postoperative appearances with clinical outcome. DESIGN A 12-month prospective longitudinal study and a retrospective study, each part using different patients. Prospective study included clinical assessment, ultrasound, and MRI all performed before and 12 months after surgery. Retrospective study included ultrasound and clinical assessment only (i.e., no MRI) 24 to 67 months after surgery. SETTING Institutional athlete study group in Australia (Victorian Institute of Sport Tendon Study Group). PATIENTS In the prospective study, 13 patients (all male; 15 tendons) who underwent patellar tenotomy; in the retrospective study, 17 different patients (18 tendons) who had undergone identical surgery. MAIN OUTCOME MEASURES Ultrasound and MRI appearances and clinical assessment at baseline and 12 months after surgery (prospective study). Ultrasound appearance and clinical assessment 24 to 67 months after surgery (retrospective study). Dimensions of abnormal regions on imaging were measured. Clinical assessment included categorical rating and numerical Victorian Institute of Sport Assessment (VISA) score. RESULTS In the prospective study, preoperative ultrasound and MRI appearances confirmed the clinical diagnosis of patellar tendinopathy. Postoperative ultrasound and MRI also revealed abnormalities consistent with patellar tendinopathy. Despite this, 11 of 15 (73%) tendons were rated clinically as either good or excellent. Imaging modalities were unable to distinguish tendons rated as good or excellent from those rated poor at 12 months. In the retrospective study, ultrasound images revealed abnormalities despite full clinical recovery. There was no correlation between dimension of ultrasound abnormality and either VISA score or time since surgery. CONCLUSION After open patellar tenotomy, MRI and ultrasound findings remain abnormal despite clinical recovery. Thus, clinicians ought to base postoperative management of patients undergoing patellar tenotomy on clinical grounds rather than imaging findings. At present, there appears to be no role for routine postoperative imaging of patients recovering slowly after patellar tenotomy. However, this is not to suggest that imaging cannot play a role in special circumstances.
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Affiliation(s)
- K M Khan
- School of Human Kinetics and Allan McGavin Sports Medicine Center, University of British Columbia, Vancouver, Canada
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Cook JL, Khan KM, Harcourt PR, Kiss ZS, Fehrmann MW, Griffiths L, Wark JD. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med 1998; 8:73-7. [PMID: 9641432 DOI: 10.1097/00042752-199804000-00001] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare patellar tendon sonographic findings in active, currently asymptomatic, elite athletes with those in nonathletic controls. DESIGN Cross-sectional cohort study with convenience control sample. SETTING The Victorian Institute of Sport Tendon Study Group, an institutional elite athlete study group in Australia. PATIENTS AND PARTICIPANTS Two hundred elite male and female athletes from the sports of basketball, cricket, netball, and Australian rules football. Forty athletes who had current symptoms of jumper's knee were excluded from analysis, leaving 320 subject tendons in athletes who were currently asymptomatic. Twenty-seven nonathletic individuals served as controls. MAIN OUTCOME MEASURE Sonographic patellar tendon appearance. We measured the dimensions of subject tendons and noted the presence or absence of hypoechoic regions and tendon calcification. Dimensions of hypoechoic regions were measured, and approximate cross-sectional areas were calculated. Chi-squared analysis was used to test the prevalence of hypoechoic regions in subjects and controls and men and women. RESULTS In currently asymptomatic subjects, hypoechoic regions were more prevalent in athlete tendons (22%) than in controls (4%), in male subject tendons (30%) than in female subjects (14%), and in basketball players (32%) than in other athletes (9%) (all p < 0.01). Bilateral tendon abnormalities were equally prevalent in men and women but more prevalent in basketball players (15%) than in other athletes (3%) (p < 0.05). Sonographic hypoechoic regions were present in 35 of 250 (14%) patellar tendons in athletes who had never had anterior knee pain. CONCLUSIONS Patellar tendon sonographic hypoechoic areas were present in asymptomatic patellar tendons of a proportion of elite athletes but rarely present in controls. This has implications for clinicians managing athletes with anterior knee pain.
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Affiliation(s)
- J L Cook
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
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Abstract
The patellar tendon donor site of 20 patients who underwent anterior cruciate ligament (ACL) reconstruction using the patellar tendon tissue as autograft was examined with high resolution 7.5 MHz ultrasound. The patients were randomly divided into four groups and studied at 3, 6, 9 or 12 months postoperatively. The size of the postoperative tendon defect was measured just distal to the lower pole of the patella. The size of the tendon defect diminished progressively from a mean of 109 mm2 at 3 months to a mean of 23 mm2 at 12 months. Increasing echogenicity was first noticed 12 months after tendon repair. Seven patients developed clinical features postoperatively of jumper's knee (patellar tendinosis). There were no ultrasound signs that differentiated these patients from asymptomatic patients. It is concluded that ultrasound provides objective evidence of patellar tendon healing after ACL reconstruction: the surgical defect diminished in size and became echogenic after a period of 12 months.
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Affiliation(s)
- Z S Kiss
- East Melbourne Radiology, Mercy Private Hospital, East Melbourne, Australia
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Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD. The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport 1998; 1:22-8. [PMID: 9732118 DOI: 10.1016/s1440-2440(98)80005-4] [Citation(s) in RCA: 279] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Symptoms of jumper's knee (patellar tendinosis) are not easily quantified and this may explain why there are no evidence-based guidelines for managing the condition. A simple, practical questionnaire-based index of severity would facilitate jumper's knee research and subsequently, clinical management. Thus we devised and tested the Victorian Institute of Sport Assessment (VISA) questionnaire. The brief questionnaire assesses (i) symptoms, (ii) simple tests of function and (iii) ability to play sport. Six of the eight questions are scored on a visual analogue scale from 0-10 with 10 representing optimal health. The maximal VISA score for an asymptomatic, fully performing individual is 100 points and the theoretical minimum is 0 points. We found the VISA scale to have excellent short-term test-retest, and inter-tester reliability (both, r>0.95) as well as good short-term (one week) stability (r=0.87). Mean (SD) of the VISA scores ranged from 95 (8) points in asymptomatic control subjects to 55 (12) points in patients who presented to a sports medicine clinic with jumper's knee and 22 (17) points in patients before surgery for chronic jumper's knee. Six- and twelve-months after surgery VISA scores returned to 49 (15) and 75 (17) points respectively, mirroring clinical recovery. We conclude that the VISA score is a reliable index of the severity of jumper's knee that has potential to aid clinicians and researchers.
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Affiliation(s)
- P J Visentini
- The University of Melbourne (Department of Medicine-RMH), Parkville, Victoria, Australia
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Khan KM, Cook JL, Kiss ZS, Visentini PJ, Fehrmann MW, Harcourt PR, Tress BW, Wark JD. Patellar tendon ultrasonography and jumper's knee in female basketball players: a longitudinal study. Clin J Sport Med 1997; 7:199-206. [PMID: 9262888 DOI: 10.1097/00042752-199707000-00009] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare patellar tendon sonographic findings at baseline and at follow-up in active female basketball players with and without symptoms of jumper's knee. We hypothesized that baseline sonographic morphology would not reliably predict prognosis and, in particular, that it would not predict the need for surgery. DESIGN Prospective longitudinal study with 12-month minimum follow-up. SETTING Institutional elite athlete study group in Australia (Victorian Institute of Sport Tendon Study Group). PATIENTS AND PARTICIPANTS A total of 15 female elite basketball players with 23 sonographically abnormal tendons and 15 matched control basketball players with 23 sonographically normal tendons. MAIN OUTCOME MEASURES Sonographic patellar tendon appearance and clinical assessment of symptoms of jumper's knee at baseline and follow-up. Dimensions of abnormal regions were measured. RESULTS At baseline, the 23 subject tendons contained sonographic hypoechoic regions (six currently symptomatic, eight previously symptomatic only, and nine never symptomatic). At follow-up, the hypoechoic areas in seven tendons had resolved (and caused no symptoms), the hypoechoic areas in 11 tendons had remained essentially the same size (five were symptomatic), and the hypoechoic areas in five tendons had expanded (three symptomatic). At baseline, there were no differences between the mean +/- SD cross-sectional areas of the abnormalities in the tendons that subsequently resolved (15.9 +/- 10.1 mm2) and those that remained unchanged (39.3 +/- 25.8) or expanded (25.3 +/- 12.5). The presence of a baseline sonographic abnormality predicted symptoms of jumper's knee at follow-up (p < 0.05), but the presence of symptoms of jumper's knee at baseline also predicted symptoms at follow-up (p < 0.05). No subject or control missed any games or underwent surgical treatment. CONCLUSIONS Patellar tendon sonographic hypoechoic areas can resolve, remain unchanged, or expand in active sports-women without predicting symptoms of jumper's knee. Thus, symptoms were not directly related to sonographic tendon morphology. Sonographic hypoechoic regions ought not to constitute per se an indication for surgery.
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Affiliation(s)
- K M Khan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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Abstract
OBJECTIVE To determine the functional and radiological status of knee joints of retired Australian Rules footballers compared with those of active community members. DESIGN Retrospective cohort study. PARTICIPANTS Fifty retired elite footballers aged 34-85 years (mean, 53.7 years; SD, 11.4) from four AFL clubs and 50 age-matched controls (35-79 years; mean, 55.7 years; SD, 12.4) who had played no contact sport since their teenage years. MAIN OUTCOME MEASURES Severity of knee functional osteoarthritis as determined by a questionnaire, and assessment of osteoarthritis by posteroanterior weight-bearing radiographs taken of both knees of each participant in 45-degree flexion. RESULTS After adjusting for age, height, weight and body mass index, footballers had a significantly greater prevalence (P < 0.0001) and severity (P < 0.05) of functional and radiological osteoarthritis than controls. Footballers with a history of intraarticular ligamentous and/or meniscal injury (Group 1) had a greater risk of functional osteoarthritis (P = 0.002) and radiological (P = 0.067) osteoarthritis than those with a history of collateral ligament injury or no injury (Group 2). Compared with controls, the odds of developing moderate to severe levels of functional and radiological osteoarthritis were 6.9 times (95% CI, 1.6-29.7; P = 0.01) and 105.0 times (95% CI, 11.8-931.8; P < 0.0001), respectively, those in Group 1 footballers and 3.6 times (95% CI, 0.8-16.2; P = 0.10) and 17.7 times (95% CI, 2.2-146.2; P = 0.0075), respectively, those in Group 2 footballers. CONCLUSIONS Elite Australian Rules footballers have a significant risk of both functional and radiological osteoarthritis, and a history of intra-articular ligament or meniscal injury increases this risk.
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Affiliation(s)
- A Deacon
- Olympic Park Sports Medicine Centre, Melbourne, VIC
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28
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Khan KM, Bonar F, Desmond PM, Cook JL, Young DA, Visentini PJ, Fehrmann MW, Kiss ZS, O'Brien PA, Harcourt PR, Dowling RJ, O'Sullivan RM, Crichton KJ, Tress BM, Wark JD. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology 1996; 200:821-7. [PMID: 8756939 DOI: 10.1148/radiology.200.3.8756939] [Citation(s) in RCA: 293] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the histopathologic findings of patellar tendinosis ("jumper's knee") demonstrated with ultrasonography (US) and magnetic resonance (MR) imaging. MATERIALS AND METHODS Twenty-four athletes (28 knees) with jumper's knee (23 men, one women; mean age, 30.9 years) scheduled to undergo open tenotomy underwent US patellar tendon examination. Seventeen patients (19 knees) also underwent MR imaging. Tissue was obtained for histopathologic examination in all 28 cases. Eleven age-, height-, and weight-matched athletes (22 knees) without previous knee symptoms served as control subjects for the US examination. Control material for histopathologic examination was obtained in 20 cadavers (39 knees). Data were analyzed with standard statistical methods. RESULTS MR imaging and US both revealed an abnormal zone at the proximal patellar tendon attachment. Histopathologic examination revealed mucoid degeneration in all tendons in patients and in 8% (three of 39) of tendons in cadavers (P < .01). CONCLUSION Jumper's knee is characterized by consistent changes at MR imaging, US, and histopathologic examination and is appropriately described as patellar tendinosis.
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Affiliation(s)
- K M Khan
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
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29
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Abstract
Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms per se, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant.
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Affiliation(s)
- A Shawdon
- Alphington Sports Medicine Clinic, Northcote, Victoria, Australia
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30
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Abstract
Stress fracture of the tarsal navicular bone is now frequently recognised. The majority of navicular stress fractures are partial fractures in the sagittal plane. They occur mainly in track and field athletes. A number of theories regarding the aetiology of this fracture have been proposed. Athletes with a history of vague, activity-related midfoot pain, with associated tenderness over the dorsal proximal navicular ('N' spot) should be suspected of having a navicular stress fracture. Plain radiography frequently fails to demonstrate the fracture, thus radionuclide scanning is the investigation of choice to detect navicular stress injury. A computed tomography (CT) scan should be performed to confirm the presence of the fracture. Various methods of treatment have been employed. A minimum of 6 weeks of strict non-weightbearing cast immobilisation is the treatment of choice. After removal of the cast, a further 6 week programme of rehabilitation with a graduated return to activity, joint mobilisation and soft tissue massage is required. Surgery for nonunion or delayed union is rarely required if initial treatment is appropriate.
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Affiliation(s)
- K M Khan
- Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia
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31
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Abstract
OBJECTIVE The purpose of this article is to present the CT findings in 55 cases of tarsal navicular stress fracture before and after treatment and to describe the CT protocol used. MATERIALS AND METHODS Fifty-five navicular stress fractures in 54 patients whose initial and follow-up CT scans were available for study were retrospectively reviewed. In most cases, contiguous 1.5-mm axial and 3-mm coronal scans of the navicular bone had been obtained. Both feet were scanned for comparison. Follow-up scans were obtained between 4 weeks and 6 years. RESULTS On review, fractures were evident in all cases, but six small fractures (11%) were missed at the initial interpretation. All fractures involved the central third of the proximal dorsal margin of the navicular bone. Fifty-three fractures (96%) were partial. Forty-three partial fractures were linear, five were linear with bone fragments, and five were rim defects with ossicles. In 13 cases (24%) the fracture was small, 10% or less of bone height. The earliest sign of healing, slight dorsal cortical bridging, was seen in three of eight cases in which follow-up was done at 6 weeks. Firm cortical union was noted in 10 (32%) of 31 by 4 months. Nonunion occurred in 12 and was indicated by the persistence of the fracture gap and lack of cortical healing. Medullary cysts (five) and cortical notching (two) were noted to persist after complete healing. CONCLUSION CT scanning is a suitable method for detecting navicular stress fracture and for performing follow-up examinations. Small fractures may be overlooked owing to lack of familiarity with their appearance.
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Affiliation(s)
- Z S Kiss
- Department of Radiology, Mercy Private Hospital, East Melbourne, Victoria, Australia
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32
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Abstract
A nonopaque methyl methacrylate mass that had the appearance of an abscess in a postoperative CT scan of the spine is described. Contained gas produced an attentuation range of +20 to -300 HU, with an average of -80 to -250 HU. This finding was confirmed by CT examination of a separate cement mass removed from a similar patient.
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Lau LS, Slonim L, Kiss ZS, Morris C, Beynon J. High-resolution CT scanning of the lumbar spine. Technique and anatomy. Med J Aust 1983; 2:21-5. [PMID: 6223202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Low back pain is a very common clinical problem, the cause of which is frequently poorly understood. Improvements in equipment design and scanning techniques have resulted in a better anatomical display of the lumbar spine by computed tomographic (CT) scanning. Advances in this area have provided a considerable insight into the causes of the lumbago-sciatica syndrome.
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Abstract
A family is described in which there occurred two cases of the lupoid type of active chronic hepatitis with cirrhosis, one of chronic persistent hepatitis, and one of myasthenia gravis. The two cases of lupoid hepatitis were in the proposita, a schoolgirl aged 16 years, and her great-aunt aged 69 years whom she had never met. The case of myasthenia gravis was that of the father. The whole family, except the great-aunt, had been exposed to an epidemic of infectious hepatitis five years previously, and the girl and her brother had contracted this disease. The schoolgirl later developed active chronic hepatitis while her brother had chronic persistent hepatitis without immunological concomitants. APART FROM COINCIDENCE, SOME COMBINATION OF THREE PROCESSES WAS REQUIRED TO ACCOUNT FOR THE ILLNESSES IN THIS FAMILY: a genetic predisposition to chronic liver disease in particular, a genetic predisposition to autoimmune reactions in general, and a ;triggering' effect of infection with the hepatitis virus.
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36
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Alford FP, Kiss ZS, Martin FI, Pearson MJ, Willis MF, Yeomans ND. "Type J" diabetes in New Guinea--studies of insulin release and insulin sensitivity. Australas Ann Med 1970; 19:111-7. [PMID: 5427443 DOI: 10.1111/imj.1970.19.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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37
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Kiss ZS, Neale FC, Posen S, Reed CS. Acute arthritis and hyperuricemia following parathyroidectomy. Arch Intern Med 1967; 119:279-82. [PMID: 6019946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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