BACKGROUND:Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM:To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS:The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation.RESULTS:The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05). Tegner and Lysholm scores showed no difference between the groups.CONCLUSION:Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

Introduction: Adequate nutrition is necessary to prevent muscle wasting in critically ill patients. Decision about enteral or parenteral nutrition is always questionable. Objective: The aim of our study was to assess the impact of nutrition on muscle wasting in critically ill patients with trauma injury. Material and methods: The study was conducted in the period from January to December 2017 and included 30 critically ill patients with trauma injury hospitalized on the Intensive care unit (ICU) of the University clinic for anesthesiology and intensive care in Skopje. Included patients were divided into two groups: group E -patients where enteral nutrition was conducted after the third day of their admission in ICU and group P -patients where total parenteral nutrition was implemented in the first 24 hours of their admission.The study monitored the impact of two different types of nutrition on muscle wasting evaluated by ultrasound measurements of m.quadriceps femoris thickness and biochemical measurements of the serum creatinine level. Results: In group E there was statistically significant muscle wasting evaluated by ultrasound between the1st and the 3 rd and the1 st and the 7 th day. Difference in measured muscle thickness was 1.90 ± 1.49 mm between the 1 st and the 3 rd (p = 0.015) and 4.46 ± 2.81 mm between the 1 st and the 7 th day (p = 0.006). In group P muscle wasting in the same period was without statistical significance. Both groups showed statistically significant decrease in serum creatinine levels between the 1 st and the 3 rd (p = 0.003, p = 0.03) and the 1 st and 7 th (p = 0.003) day. The values of differences between the 1 st and the 3 rd and the 1 st and the 7 th day were 7.57 ± 4.12 mg/dl and 10.71 ± 5.79 mg/dl in group E and 11.43 ± 10.66 mg/dl and 15.28 ± 8.28 mg/dl in group P. Conclusion:In our study we determined a significant decrease of muscle mass evaluated by ultrasound measurements of m.quadriceps femoris thickness in patients with enteral nutrition after the third day.

Introduction: Intracapsular and Para-articular chondroma is a rare variant of the extraskeletal chondromas. It arises from the capsule and/or the para-articular connective tissue of the large joints (mostly the knee) and is a result of cartilaginous metaplasia. In the course of time these tumors ossify and this is where their second name comes from: Para-articular osteochondromas. Case reports: We report six new cases of para-articular chondroma of the knee. On physical examination there was slow-growing solid mass in the knee and moderate pain. The radiological findings and CT scan show soft-tissue mass with variable amount of ossification, and on histological examination the presence of mature hyaline and connective cartilage was confirmed in all of the cases. Conclusion: The diagnosis of these benign tumors is made with correlation of clinical, radiological and histological features. Treatment of choice is surgical excision.

Introduction. The aim of this study was to investigate the appearance of the trochlear groove in infants and to present the possible causes for the development of trochlear dysplasia as one of the most severe pathologic findings in patients with patellar instability. Material and Methods. Knee ultrasonography was performed in 200 infants, 3 to 6 months of age. The measurements were made at 30 and 60 degrees of knee flexion, in order to measure the trochlear bone and cartilaginous sulcus angle on the patellar surface of the femur and to determine the degree of trochlear dysplasia. A 7-megahertz probe was used for measurements, which was tangentially placed with the reference to the posterior femoral joint. Results. A completely flat trochlear bony sulcus angle was registered in all infants aged 3 to 6 months. The mean cartilaginous sulcus angle was between 149 ? 5.4? and 19 infants had a sulcus angle over 159?. Eleven infants with trochlear dysplasia were in breech presentation at birth. Conclusion. Our study showed that the cartilaginous part of the trochlear groove was already well developed at birth. Breech presentation of the fetus could be a predisposing factor for dysplasia of the cartilaginous part of the trochlear groove. The bony part of the trochlear groove is dysplastic in infants and it gradually gets deeper, later getting a shape of the overlying articular cartilage. The influence of the Delpech law, with lower pressure in the trochlear groove, could be the possible mechanical theory explaining the development of the trochlear dysplasia in the later stage of the childhood.

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