Smoking Has No Influence on Outcomes after Repair of the Medial Meniscus in the Hypo and Avascular Zones-A Pilot Study.

Complete loss of the meniscus inevitably leads to knee joint degeneration. Smoking is an important factor predicting poor outcome in orthopedics; however, data about its role in meniscus surgery are inconclusive. Smoking could be an important negative factor in isolated meniscus repair. The aim of this paper was to determine the influence of smoking on functional outcomes after isolated all-inside medial meniscus repair. This study included 50 consecutive patients with isolated, traumatic tear of the medial meniscus who underwent knee joint arthroscopy between 2016 and 2019. All-inside arthroscopic repair of the medial meniscus was performed in each case. All patients followed a uniform, postoperative rehabilitation protocol for 8 weeks. The follow-up examination was based on the functional scores at 3 and 6 months postoperatively. According to smoking status there were 17 smokers and 33 non-smokers. The mean number of cigarettes smoked per day was 11, for a mean of 7.4 years, and the mean pack-years index value was 4.9. There was no correlation between smoking years, number of cigarettes smoked per day, pack-years index, and functional outcomes. The arthroscopic inspection of the knee joints revealed cartilage lesions (≤IIº) in eight subjects, suggesting the secondary pathology to the meniscus tear. In this study, we found no evidence of an association between smoking indices and functional outcomes after all-inside repair of chronic medial meniscus tear. The nature of the chronic meniscal tear could be smoking-resistant owing to the poor blood supply to the sites in which these specific lesions occur.

The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction-A Retrospective Study.

BACKGROUND: The current standard of treatment of anterior cruciate ligament (ACL) is reconstruction (ACLR). This technique has some disadvantages: poor proprioception, donor site morbidity and the inability to restore joint kinematics. ACL repair could be an alternative treatment. The purpose of the study was to compare the stability and the function after ACL primary repair versus single-bundle ACLR. METHODS: In a retrospective study, 12 patients underwent primary ACL repair with internal bracing, 15 patients underwent standard ACLR. Follow-up examinations were evaluated at up to 2 years postoperatively. One patient in the ACL repair group was lost to follow-up due to re-rupture. The absolute value of anterior tibial translation (ATT) and the side-to-side difference in the same patient (ΔATT) were evaluated using the GNRB arthrometer. The Lysholm knee scoring was obtained. Re-ruptures and other complications were recorded. RESULTS: Anterior tibial translation (ATT) was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137). Arthrometric measurements demonstrated a mean side-to-side difference (ΔATT) 1.87 (range 0.2 to 4.9) mm significantly decreased compared to ACLR 3.36 (range 1.2-5.6 mm; p = 0.0107). The mean Lysholm score was 85.3 points in the ACL repair group and 89.9 in ACLR group. No significant differences between ACL repair and ACLR were found for the Lysholm score. There was no association between AP laxity and clinical outcomes. There were two complications in the internal bracing group: one patient had re-rupture and was treated by ACLR, another had limited extension and had arthroscopic debridement. CONCLUSIONS: Anterior tibial translation was significantly decreased after ACL repair. Additionally, the functional results after ACL repair with internal bracing were comparable with those after ACLR. It should be noted that the two complications occurred. The current study supports further development of ACL repair techniques.

Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture-A Pilot Study.

Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients' satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3-13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair.

The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis.

Knee osteoarthritis (KOA) represents a clinical challenge due to poor potential for spontaneous healing of cartilage lesions. Several treatment options are available for KOA, including oral nonsteroidal anti-inflammatory drugs, physical therapy, braces, activity modification, and finally operative treatment. Intra-articular (IA) injections are usually used when the non-operative treatment is not effective, and when the surgery is not yet indicated. More and more studies suggesting that IA injections are as or even more efficient and safe than NSAIDs. Recently, research to improve intra-articular homeostasis has focused on biologic adjuncts, such as platelet-rich plasma (PRP). The catabolic and inflammatory intra-articular processes that exists in knee osteoarthritis (KOA) may be influenced by the administration of PRP and its derivatives. PRP can induce a regenerative response and lead to the improvement of metabolic functions of damaged structures. However, the positive effect on chondrogenesis and proliferation of mesenchymal stem cells (MSC) is still highly controversial. Recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, significant progress has been made in understanding the mechanism of PRP action. In this review, we will discuss mechanisms related to inflammation and chondrogenesis in cartilage repair and regenerative processes after PRP administration in in vitro and animal studies. Furthermore, we review clinical trials of PRP efficiency in changing the OA biomarkers in knee joint.

Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score?

AIM: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. METHODS: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). RESULTS: A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. CONCLUSION: In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.

The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery.

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker's group and 84.06 and 30.93 in the non-smoker's group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers' group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

A 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries.

OBJECTIVE: The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. DESIGN: A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms' duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). RESULTS: The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients' age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. CONCLUSIONS: Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.

Biceps Tenodesis versus Tenotomy with Fast Rehabilitation Protocol-A Functional Perspective in Chronic Tendinopathy.

The study aimed to evaluate the results after arthroscopic tenodesis and tenotomy of the biceps tendon (LHBT), coupled in tenotomy modality with a personalized postoperative rehabilitation protocol. The study included patients who underwent arthroscopic biceps tenotomy or tenodesis due to chronic biceps tendinopathy. Postoperatively, a standard rehabilitation program was prescribed to the tenodesis group and personalized was introduced in the tenotomy group, respectively. The outcomes were assessed using the American Shoulder and Elbow Surgeons scale (ASES), clinical tests that are dedicated to biceps tendinopathy, the occurrence of a Popeye deformity, night pain, and return to previous sporting activities. A cohort of 67 patients was enrolled in the final follow-up examination (mean 27 months) of which 40 patients underwent tenotomy (60%), and 27 patients (40%) underwent tenodesis. The mean ASES score improved from 48.1 to 87.8 in the tenotomy group and from 44 to 72.7 in the tenodesis group during the follow-up (p < 0.0001). The tenotomy group had better mean postoperative ASES scores than the tenodesis group (p < 0.0001). Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128). Moreover, the frequency of night pain decreased in the tenotomy group (p = 0.0059). Return to previous sporting activities was more frequent in the tenotomy group (p = 0.0090). Arthroscopic biceps tenotomy is a reproducible, simple procedure, and augmented by a rapid rehabilitation protocol that provides promising clinical outcomes, reduces shoulder pain, and allows the patient to return to previous sporting activities, even in population older than 50 years.

Correlation between smoking and neovascularization in biceps tendinopathy: a functional preoperative and immunohistochemical study.

AIMS: The purpose of this study was to investigate whether smoking is associated with neovascularization in the tendinopathy of the long head of the biceps tendon (LHBT). METHODS: The study included 40 consecutive patients who underwent arthroscopic biceps tenotomy/tenodesis due to chronic biceps tendinopathy and divided into three groups: (1) non-smokers, (2) former smokers, (3) smokers. LHBT tissue samples were stained with H&E, Alcian blue and Trichrome staining. Immunohistochemical examination was performed using anti-CD31 and anti-CD34. The neovessel density score (NDS) was scored by Bonar criteria. RESULTS: The mean period of smoking was 15.50 years with an average number of 24 cigarettes/day in the former smokers and 21.69 years with an average number of 15 cigarettes/day in the active smokers. The mean NDS was 2.23/3 in non-smokers, whereas it was 1.60/3 in former smokers and 1.31/3 in active smokers. The mean American Shoulder and Elbow Surgeons score equaled 46 in never smoked patients, 43.60 in former smokers, and 41.46 in active smokers. In the patients with smoking history, the disorganized tendinous tissue islands were avascular and composed of compact acidic polysaccharides and mucopolysaccharides. We observed negative correlation between the NDS and the smoking indexes, including cigarettes per day (p = 0.0150), smoking years (p = 0.0140), pack-years (p = 0.0088). CONCLUSION: In conclusion, the present study revealed that smoking impairs the vascularization of the biceps tendon in chronic tendinopathy. Clinically, we observed a negative correlation between smoking and neovascularization. Furthermore, there was no correlation between neovascularization and functional preoperative status.

Genetics in Cartilage Lesions: Basic Science and Therapy Approaches.

Cartilage lesions have a multifactorial nature, and genetic factors are their strongest determinants. As biochemical and genetic studies have dramatically progressed over the past decade, the molecular basis of cartilage pathologies has become clearer. Several homeostasis abnormalities within cartilaginous tissue have been found, including various structural changes, differential gene expression patterns, as well as altered epigenetic regulation. However, the efficient treatment of cartilage pathologies represents a substantial challenge. Understanding the complex genetic background pertaining to cartilage pathologies is useful primarily in the context of seeking new pathways leading to disease progression as well as in developing new targeted therapies. A technology utilizing gene transfer to deliver therapeutic genes to the site of injury is quickly becoming an emerging approach in cartilage renewal. The goal of this work is to provide an overview of the genetic basis of chondral lesions and the different approaches of the most recent systems exploiting therapeutic gene transfer in cartilage repair. The integration of tissue engineering with viral gene vectors is a novel and active area of research. However, despite promising preclinical data, this therapeutic concept needs to be supported by the growing body of clinical trials.

Ultrasound-assisted Endoscopic Evacuation of Recurrent Calf Hematoma Following Anterior Cruciate Ligament Reconstruction. Case Study.

Hematoma of the calf is a rare complication following anterior cruciate ligament reconstruction (ACLR). The golden standard method of its treatment is puncture and aspiration. More advanced procedures are needed in difficult cases, such as prolonged he-ma-tomas. Among the novel management choices is endoscopy with ultrasound guidance. The aim of the study was to present the management of a post-surgical hematoma of the calf using endoscopic and ultrasound-assisted surgery. A 48-year-old patient un-der-went arthroscopic ACLR grafted with hamstrings tendons (semitendinosus and gracilis). Due to a hematoma developing at the donor site, he experienced edema and paresthesiae of the calf and foot that enhanced over time. An open reoperation failed and symptoms recurred. A second reoperation was performed as an endoscopic and ultrasound-assisted mini-invasive procedure. Re-sults were assessed postoperatively using the IKDC 2000 and Lysholm questionnaires. An evident increase in IKDC 2000 Score (from 14.9 points after open surgery to 77.0 one week after endoscopic treatment) and Lysholm Scale (26 points after first surgery and 84 one week after endoscopic surgery) was observed after the mini-invasive procedure. Edema and paresthesiae of the affect-ed limb completely disappeared four weeks after endoscopy. No complications of the novel procedure were found. Accordingly, en-doscopic and ultrasound-assisted evacuation of a prolonged calf hematoma appears an effective minimally-invasive and tar-geted procedure.

Cigarette smoking intensifies tendinopathy of the LHBT. A microscopic study after arthroscopic treatment.

Smoking has a damaging effect on the musculoskeletal system, which was presented by authors in the rotator cuff and Achilles tendons studies; however, there are a lack of data about the effect of smoking on disorders of the long head of the biceps tendon (LHBT), particularly at the microscopic level. The purpose of this study was to investigate the effect of the tobacco smoking on the histopathologic alterations of the LHBT. Thirty-six patients with preoperatively diagnosed tendinopathy of the LHBT were referred to the Orthopaedics Department. All patients underwent arthroscopic treatment with further macroscopic and microscopic evaluation of biceps tendon samples. The active and former smokers were characterised by more advanced degenerative process of the tendinous tissue; moreover, it was intensified in the group of former smokers. Subjects who smoke more than 20 cigarettes per day also had more advanced microscopic alterations. The most severe microscopic alterations occurred in the former smokers who used tobacco for more than 20 years. However, the non-smokers group revealed moderate degeneration in all LHBT samples. Tobacco smoking is an important risk factor of the LHBT disease, which essentially intensifies the degeneration of the tendinous tissue.

Breakage of metal hip arthroplasty components: Retrieval and structural analysis.

BACKGROUND: Breakage of joint arthroplasty components are rare, yet during an implant retrieval program we found several cases. OBJECTIVE: In this study we examined the components to determine the causes and mechanisms of breakage of these implants. METHODS: From our collection of 849 retrievals we selected 682 cases with metal parts (503 hip, 79 knee arthroplasties) and identified fractured components: seven hip resurfacing implants, five total hip replacement stems, one monopolar femoral head, and one modular revision femoral stem from. Implants were examined using optical and scanning electron microscopy; metallographic sections were prepared and samples of periprosthetic tissues underwent microscopic examination. RESULTS: In the resurfacing components breakage occurred in small stems placed in the femoral neck due to necrosis of femoral heads, with no metal flaws detected. Fatigue breakage of femoral stems was caused by presence of material flaws in the CoCrMo alloy, and corrosion. The monopolar head failed in fatigue fracture mechanism, breakage was initiated in an undercut near the taper connection for femoral component. The modular stem from Ti alloy sustained fatigue fracture induced by corrosion caused by debris from previously revised stem; no material flaws were detected in this sample. In most cases periprosthetic tissues had a morphology typical for aseptic loosening. CONCLUSIONS: In our series failure was caused by material flaws, presence of stress raisers and localized corrosion. Our findings indicate that sharp edges and other features which can act as stress raisers should be avoided in newly designed implants. Corrosion induced fracture of the modular Ti stem indicates the need for a detailed debridement of periprosthetic tissues during revision arthroplasties.

Avascular Necrosis of Femoral Condyles in a Patient Treated Due to Lymphoma. A Case Study.

Periarticular avascular osteonecrosis is one of the most severe joint diseases and may result in complete joint destruction. It may affect patients after chemotherapy involving regimens including steroids. The paper describes the case of a female patient who was just under 18 years old when she underwent surgery due to bilateral osteonecrosis of the femoral condyles that developed in the course of treatment of a haematological malignancy. The aim of the paper is to present clinical and imaging-based assessment of the outcome of surgical treatment by reconstruction of osteochondral joint defects with a collagen membrane and bone grafts. In this patient, radiographic and clinical improvement of the joints treated was noted in a 24-month follow-up period. The available literature indicates that this is the first example of using this technique in the treatment of articular lesions associated with osteonecrosis caused by aggressive chemotherapy. The so-called "sandwich" technique is useful in these cases and may be recommended by the present authors.

Is the inflammation process absolutely absent in tendinopathy of the long head of the biceps tendon? Histopathologic study of the long head of the biceps tendon after arthroscopic treatment.

Tendinopathy of the long head of the biceps tendon is a difficult medical issue. Its pathogenesis and etiology is multifactorial and unclear. Tendinopathy is thought to be primarily degenerative in nature, as tendons are characterized by impaired regeneration and healing. Thirty-five patients with preoperatively diagnosed tendinopathy of long head of the biceps tendon were referred to the Orthopedics Department. All patients underwent an arthroscopic-assisted biceps tenodesis or tenotomy. The intra-articular portion of the long head of the biceps tendon was obtained from each of the patients who underwent arthroscopy. A macroscopic and microscopic evaluation of biceps tendon samples revealed degeneration among all specimens. This study demonstrates the prevalence of the degeneration process and the presence of marginal inflammation process in tendinopathy of the long head of biceps tendon. The role, that inflammation process plays in tendinopathy is important in the early phase and gradually becomes secondary to the developing degeneration. The inflammatory cells, occasionally seen in pathological tendons, could be an evidence of re-injury and recent healing response.

Ultrasound-guided arthroscopic management of hallux rigidus.

INTRODUCTION: The use of metatarso-phalangeal joint arthroscopy in the treatment of osteochondritis dissecans was first described in 1988. The technique produces good results. However, it can be difficult to enter a joint when it is deformed by degenerative disease. Sonography is a modern visualisation modality which can be used in orthopaedic surgery. AIM: To describe a method of intraoperative sonographic navigation during first metatarso-phalangeal joint arthroscopy. MATERIAL AND METHODS: The modality was used in 3 patients. The joint was visualised in the ultrasound scanner. After confirming the intra-articular position of the guide needle, a medial portal was established. The procedure started with the removal and vaporisation of the hypertrophic synovium. Gradual resection of the osteophytes was then carried out. The procedure was terminated after the ultrasound image showed that a smooth upper surface of the metatarsal head had been achieved. RESULTS: All 3 patients were satisfied with the procedure and function of the treated feet. Average surgery time was 81 min. No complications were found. CONCLUSIONS: Mini-invasive treatment of hallux rigidus with sonography-guided arthroscopic cheilectomy appears to be a reproducible procedure leading to good clinical results. We encourage surgeons familiar with ultrasound visualisation of the joints to use the technique described in this paper in the arthroscopic treatment of hallux rigidus.

Ultrasound of the knee.

Ultrasound is one of the standard imaging modalities of the knee. In the recent decades many new ultrasound techniques have been introduced, including power Doppler, dynamic examination, and ultrasound-guided techniques. Some of them have clear advantages over magnetic resonance imaging-today's knee imaging gold standard-whereas others have failed to meet expectations. This pictorial article reviews and demonstrates the use of sonography in different knee joint pathologies underlining recent findings and their practical approach.

Medial plica syndrome of the knee: diagnosis with dynamic sonography.

PURPOSE: To perform a feasibility study of dynamic sonography for the diagnosis of medial plica syndrome of the knee. MATERIALS AND METHODS: The study design was approved by the university bioethics board, and all the participants gave informed consent. Inclusion criteria were a palpable medial band, history of painful aching, and giving way or locking, which limited the subject's activity for at least 6 months. Exclusion criteria were a history of trauma with hemarthrosis, previous knee surgery, and arthrosis detectable on radiographs. A prospective evaluation in 88 subjects (56 female subjects, 32 male subjects; mean age, 20 years; range, 7-47 years) who were suspected of having a medial plica and 91 knees was performed. Three sonographic criteria were assessed during patellar movement by using a 12-MHz 38-mm linear transducer: (a) continuous echo sliding over the medial femoral condyle during medial and lateral movement of the patella, (b) entry of the echo under the patella during medial movement of the patella, and (c) pain or discomfort during dynamic sonography. Arthroscopy was the reference standard. An asymptomatic control group consisting of 32 volunteers (mean age, 28 years; range, 10-52 years) and 60 knees was also assessed. RESULTS: Arthroscopy revealed 68 plicae with pathologic findings, 61 of which met all three sonographic criteria. Medial plicae with pathologic findings were absent in 23 knees; 19 plicae were correctly diagnosed by using sonography. Diagnostic accuracy was 88%, sensitivity was 90%, and specificity was 83%. In the asymptomatic control group, there were 37 knees without a plica echo, 16 knees with a plica echo that met one criterion, and seven knees that met two criteria. CONCLUSION: Dynamic sonography allows detection of abnormalities of medial plicae in the knee, with good sensitivity and specificity.

Scarf versus proximal closing wedge osteotomy in hallux valgus treatment.

AIM: The aim of this study was to evaluate the distal metatarsal articular angle as a key factor in choosing between the proximal closing wedge osteotomy and scarf osteotomy. METHOD: The investigation involved 40 feet: 32 females aged 13-68 in whom 24 unilateral and 8 bilateral operations had been performed from 24 to 63 months previously. RESULTS: There were statistically significant differences between groups in the postoperative hallux valgus angle and in first metatarsal shortening. We found an inverse correlation between the preoperative distal metatarsal articular angle and intermetatarsal angle improvement after proximal closing wedge osteotomy and a positive correlation after scarf osteotomy. CONCLUSION: This study confirmed the value of distal metatarsal articular angle assessment.