Polymorphisms of the vitamin D receptor gene and stress fractures.

Our aim was to evaluate the association between VDR polymorphisms and calcaneal Stiffness Index (SI) with stress fractures in a case control study including male military personnel. Thirty- two patients with stress fractures were matched with 32 uninjured healthy volunteers (controls), by gender, age, height, body weight, and level of physical activity. The two groups were genotyped for the FokI, BsmI, ApaI, and TaqI polymorphisms of the VDR gene with PCR-RFLP method. In addition, calcaneal SI was measured by heel quantitative ultrasound in both groups. Data were analyzed by chi-squared test and logistic regression analysis. The f allele was significantly more frequent in patients than in controls (p=0.013), while the B allele showed such a tendency without reaching statistical significance (p=0.052). Among the entire cohort, a 2.7-fold and a 2.0-fold increase in risk of stress fractures was associated with the f and B alleles (OR, 2.7, 95% CI, 1.2-5.9; p=0.014 and OR, 2.0, 95% CI, 1.0-4.1; p=0.053, respectively). No statistically significant association was found between the incidence of stress fractures and t or a alleles. Decreased T-scores were also associated with the presence of f and B alleles. Mean values of T-scores of SI were statistically significantly lower in patients than in controls (p=0.018). These results suggest that the FokI and BsmI polymorphisms of the VDR gene could be associated with increased risk of stress fractures among military personnel. Moreover, a low calcaneal SI could represent a measurable index of this increased risk.

Reconstruction of the anterior cruciate ligament using the polyester ABC ligament scaffold: a minimum follow-up of four years.

We carried out a prospective study of 71 patients who had undergone reconstruction of the anterior cruciate ligament with the ABC scaffold. Their mean age was 28 years (18 to 50). All had either sub-acute or chronic traumatic deficiency of the ligament. The mean period of follow-up was five years (four to seven). Assessment included the use of the International Knee Documentation Committee score, the modified Lysholm score, the Tegner Activity score, the Knee Injury and Osteoarthritis Outcome score and measurement with the KT-1000 arthrometer. Two patients had mild recurrent synovitis. There were no infections and no failures of the ligament. During the period of study, two patients sustained a traumatic fracture of a femoral condyle. The implants retained their integrity in both cases. All patients returned to their previous or enhanced levels of daily activity by three months after operation and 56 (79%) achieved their pre-injury level of sporting activity by six months. The patients who were competing in National level sports returned to play at one level less after operation than before. The Lysholm score showed that 58% of the patients (41) were excellent, 34% (24) good, and 8% (6) fair, with a mean post-operative score of 93. According to the International Knee Documentation Committee score, 35% of knees (25) were 'normal', 52% (37) 'nearly normal' and 13% (9) 'abnormal'. Complete satisfaction was noted in 90% of patients (64). The development of osteoarthritis and the management of anterior cruciate deficiency associated with laxity of the medial collateral ligament remains uncertain. Our results indicate that in the medium-term, the ABC ligament scaffold is suitable and effective when early and safe return to unrestricted activities is demanded. We acknowledge the current general hostility towards reconstruction of the anterior cruciate ligament with artificial materials following reports of early failure and chronic synovitis associatiated with the production of particulate debris. We did not encounter these problems.

Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI.

In this study, we aim to evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Thirty-six patients who had a diagnosis of bucket handle tear in arthroscopy, in either medial or lateral meniscus, were included in our study (32 males and 4 females). Meniscal tears were evaluated in arthroscopy according to Dandy's classification. The MRIs were retrospectively analyzed regarding the following findings: absence of bow tie sign, presence of double posterior cruciate ligament (PCL) sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign, and fragment within the intercondylar region. Locked types I and II fragment of medial meniscus and half-length, whole-width and whole length-half-width fragment of lateral meniscus in arthroscopy were basically correlated with fragment within the intercondylar notch and absent bow tie signs in MRI. We did not find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear. The most common signs in MR images of meniscal bucket handle tears were the fragment in the notch sign and the absent bow tie sign. They were observed with equal frequency of 88.8%. The presence of double PCL sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign were less common (41.66, 33, 25, and 27.7%, respectively). We conclude that the presence of at least two of the six MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.

Association of a COL1A1 polymorphism with lumbar disc disease in young military recruits.

BACKGROUND: Lumbar disc disease (LDD), one of the most common conditions for which patients seek medical care, has been associated with sequence changes of the COL genes. COL1A1, however, has not been studied in young patients with LDD; COL1A1 polymorphisms have been associated with bone mineral density (BMD) in several populations and with LDD in older adults. OBJECTIVE: To study COL1A1 polymorphisms in young Greek army recruits with LDD. SUBJECTS: These young soldiers were diagnosed with early LDD at the time of their presentation to a military training site. All patients had radiological confirmation of their disease; a control group was also studied. METHODS: Sp1-binding site polymorphism of the COL1A1 gene was investigated by standard methods. RESULTS: There was an increased frequency of the "ss" genotype (33.3%) in LDD patients; none of the controls had this genotype. In addition, a significantly smaller number of controls was heterozygotes for this allele. CONCLUSIONS: A previously studied sequence change of the regulatory region of the COL1A1 gene, the same as has previously been associated with low BMD in many populations and LDD in older adults, showed a strong association with LDD in young male soldiers who were recently diagnosed with this disease.

Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up.

We reviewed 100 cemented Endo-model rotating-hinge (Waldemar Link GMBH & Co, Hamburg, Germany) total knee replacements in 80 patients with a mean age of 70 years (56 to 85) at a mean post-operative follow-up of 11 years (7 to 15). Good or excellent results were seen in 91% of knees and survival at 15 years was 96.1%. There were two deep infections, one dislocation and one supracondylar fracture. There were no peri-operative deaths and there was no loosening, malalignment, migration or wear. We consider this prosthesis to be ideally suited for the replacement of the deformed knee when the use of an unconstrained design may be questionable.