Correction to: Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial.

The Orthokine product used in the trial was donated by the manufacturer.

Precise nail tip positioning after tibial intramedullary nailing prevents anterior knee pain.

PURPOSE: Anterior knee pain (AKP) is a common complication following intramedullary nailing of tibial shaft fractures. Our aim was, by analysing the postoperative lateral knee X-rays and clinical status (VAS score), to find the best intramedullary tip position of a non protruded nail that will provide the best postoperative outcome avoiding AKP. METHODS: We evaluated the postoperative outcome of 221 patients, from the last four years, with healed fractures initially treated with intramedullary reamed nails with two or three interlocking screws proximally and distally through a medial paratendinous incision for nail entry portal. Our aim was to analyse a possible relationship between AKP according to the VAS scale, and nail position marked as a distance from tip of nail to tibial plateau (NP) and to tibial tuberosity (NT), measured postoperatively on lateral knee X-rays. RESULTS: Two groups of patients were formed on the basis of presence of pain related to AKP (the level of pain was neglected): group A were patients with pain and group B without pain. The difference between the two groups concerning NP and NT measurements appeared to be statistically significant concerning NT measurement (p < 0.05), with high accuracy according to the classification tree. CONCLUSIONS: We presume that the position of the proximal tip of the nail and its negative influence on the innervation pattern of the area dorsal to patellar tendon could be the key factor of AKP. We conclude that the symptoms of AKP will not appear if the tip of the nail position is more than 5.5 mm from the tibial plateau (NP) and more than 2.5 mm from the tibial tuberosity (NT).

All-inside arthroscopic suturing technique for meniscal ruptures.

The most frequent indication for surgical treatment of the knee is lesion of the meniscus. The "all inside" arthroscopic technique with bioresorptive material for meniscus lesion is becoming the most popular treatment. This prospective study included 10 patients with posterior meniscal horn lesion operatively treated at Sports Traumatology Department. The "all inside" technique was performed by intra-articular application of bioresorptive pins-Darts sticks or Meniscus Viper and bioresorptive string. Patients were followed up for 2-6 months postoperatively and graded according to the IKDC 2000 scale. All surgical treatments showed satisfactory results. Young patients with acute longitudinal peripheral lesion-posterior horn lesions, in the red-red or red-white meniscal zone, 1-2 centimeters long are most appropriate for this type of treatment. In these patients, this technique proved to be superior and free from the risk of neurovascular damage. For better authentication of this conclusion, additional prospective randomized studies should be performed.

Elements for successful functional result after surgical treatment of intra-articular distal humeral fractures.

Intra-articular distal humeral fractures (DHF) present great challenge to an orthopedic-trauma surgeon. We analyzed the relationship between functional results of DHF surgical treatment and elements that can affect patient recovery. During the 5-year follow-up study, 32 patients were treated for DHF at our Trauma Department, 30 of them by surgical procedure. Functional results of surgical treatment were scored according to the Jupiter criteria. According to the A-O classification of DHF, there were 11 type A fractures, 5 type B fractures and 14 type C fractures. Postoperative complications were infections, neural lesions, inadequate healing, and instability of osteosynthesis. Analysis of functional results in patients with operated C type fractures according to different elements influencing postoperative result revealed correct healing in 74% of patients, which was statistically significantly higher than the percentage of unsatisfactory results (p < 0.05). Study results provided evidence for patient age, sex, infection, neural function preservation, successful and rigid fixation, anatomical reconstruction of articular surface, and early rehabilitation to be significant elements for successful functional recovery.

Nail position has an influence on anterior knee pain after tibial intramedullary nailing.

Our aim was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT). Nail position has an influence on anterior knee pain after tibial intramedullary nailing. We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial paratendinous incision for nail entry portal. Patients marked a point on the visual analog scale (VAS) that corresponded to the level of postoperative AKP felt. Two groups of patients were formed on the basis of AKP (pain level was neglected): groups A and B, with and without pain, respectively. The difference between the two groups concerning NP measurements was statistically significant (p < 0.05), but not concerning NT measurements at the p < 0.05 level. Patients were classified by pain with high accuracy (98%) according to a classification tree. Symptoms of AKP did not appear if the tip of the nail position was more than 6.0 mm from the NP and more than 2.6 mm from the NT. However, for better evaluation of these results it will be necessary to examine a larger number of postoperative patients with AKP.

Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial.

PURPOSE: Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-ß1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS. METHODS: In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patient-administered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1ß concentrations in the synovial liquid and examined the correlation between the levels of IL-1ß at three different postoperative points. RESULTS: Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1ß synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10. CONCLUSION: The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery.

Combined surgical therapy and orthotic management of stress and tuberosity avulsion fracture of the fifth metatarsal bone: a case report.

The incidence of fifth metatarsal fracture is somewhat common in sports and can be complicated in nature. Fractures of the fifth metatarsal can occur at a number of locations. Although some of these fractures respond well to conservative treatment, others have been notoriously hard to heal, with high rates of nonunions and other complications. Foot orthotic devices are commonly used as aids in the treatment of foot problems. In our case, we considered the combined effect of the surgical treatment and application of the custom-made foot orthoses. Special attention was taken with adjustments to the orthotic devices along and beneath the affected regions of the foot for adequate pain management and quick recovery to return to normal sports activities. Requirements for computer aided design/computer aided manufacturing orthotic design and manufacturing in this case were specific and considerably different from the usual procedure.

Calcaneal fracture--standardized protocol of treatment.

Calcaneal fracture (CF) treatment results are not always satisfied. Our aim was to compare medium-term results between standardized and unstandardized protocol in treatment of displaced intra-articular CF. We evaluate experience of our Department where 50 patients with CF in last 5 years--Group X have been treated with standardized protocol, and compare their postoperative results with unstandardized treatment's effects in 50 patients with CF cured 5 years before--Group Y As based on Sanders classification, radiographic evaluation and Maryland Foot Score, postoperative results were satisfying in 100% X and 90% Y patients with intra-articular type I, in 86% X and 70% Y patients with type II, and sufficient in 75% X and 52% Y patients with type III, in 50% X and 33% Y patients with type IV. We suggest standardized protocol with operative treatment for types II, III and even for type IV of intra-articular CF.

Correlation between synovial fluid and serum IL-1beta levels after ACL surgery-preliminary report.

The possibility of controlling the harmful intra-articular influence of elevated interleukin (IL)-1beta synovial fluid concentration after anterior cruciate ligament (ACL) surgery could be useful. We investigated the correlation between serum and synovial fluid IL-1beta levels following ACL reconstruction. We measured IL-1beta concentration periodically in three synovial fluid and four serum samples in each of 20 patients receiving either autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and several growth factors (group A) or placebo (group B). A decrease in IL-1beta synovial fluid concentration appeared to be more pronounced in absolute terms in group A. In eight patients serum IL-1beta was detected on the 6th postoperative day. In four of them whose synovial fluid levels were over 10 pg/ml on the 6th postoperative day, serum IL-1beta was detected on the 10th postoperative day. The results were different in group B. Correlation between serum and synovial fluid IL-1beta appearance persists in patients after ACL surgery and ACS application. This study is an example of ACS influence on the ACL healing process controlling the IL-1beta levels on the basis of the serum IL-1beta detection.