Association of the matrix metalloproteinase 3 (MMP3) single nucleotide polymorphisms with tendinopathies: case-control study in high-level athletes.

BACKGROUND: Matrix metalloproteinases (MMPs) play an important role in matrix remodelling, as well as in tendon integrity. Due to overuse, athletes often develop chronic tendinopathies. If not treated, they lead to severe impairment, even complete tendon ruptures. AIM: The main purpose of this study was to investigate whether three functional polymorphisms within the MMP3 gene are associated with increased risk of developing tendinopathies in high-level Croatian athletes. METHODS: We have recruited one hundred fifty-five (63 high-level athletes with diagnosed tendinopathies and 92 asymptomatic controls) unrelated Caucasians for this case-control genetic study. All participants were genotyped for three single nucleotide polymorphisms (SNP) within the MMP3 gene: rs591058 C/T, rs650108 A/G and rs679620 G/A using the pyrosequencing method. RESULTS: The MMP3 rs650108 GG (P = 0.0074) and rs679620 AA (P = 0.0119) genotypes were significantly over-represented in cases compared with controls, while rs591058 TT (P = 0.0759), as well as haplotype variant T - G - A (P = 0.06), implicated that there is an indication of predisposition for tendinopathies. CONCLUSION: These results support association between functional variants within the MMP3 gene and the risk of tendinopathies in high-level athletes. Further research is needed to replicate these results in a larger population.

TREATMENT OF UNICAMERAL BONE CYSTS IN CHILDREN: A COMPARATIVE STUDY.

Unicameral bone cysts (UBC) are benign bone tumor-like lesions. Mostly they are located in the metaphyseal-diaphyseal region of long bones in children and adolescents. The etiology of UBC is still unclear. There is no consensus about the protocol of UBC treatment. The aim of this study was to evaluate the effectiveness of three different techniques for the treatment of UBC. This study included 129 pediatric patients with UBC treated at University Children's Hospital in Belgrade during the 8-year period. The mean follow up was 7.14 years. The following parameters were observed: gender, age, site, length of cyst, cyst index, cortical thickness, presentation of pathologic fracture, healing of cyst, treatment complications and length of hospitalization. These parameters were correlated to three treatment modalities, i.e. intracystic methylprednisolone acetate injection (group 1), curettage with bone grafting (group 2) and osteoinductive procedure using demineralized bone matrix (group 3). We found statistically significant differences in healing of the cysts and length of hospital treatment between groups 1 and 2, and between groups 2 and 3. In conclusion, complete healing of UBC can be achieved only using open surgery procedure. Intracystic methylprednisolone acetate instillation can be considered a good option for initial treatment of UBC.

Single-row arthroscopic cuff repair with double-loaded anchors provides good shoulder function in long-term follow-up.

PURPOSE: The purpose of this study was to evaluate the results of arthroscopic cuff reconstruction, which is currently preferred in our service, and to compare functional outcome after arthroscopic cuff reconstruction comparing different types and sizes of rotator cuff tears. We switched completely from open repair to the full-arthroscopic repair > ten years ago, and since then, we are developing a technique that can produce the best results. Therefore, we decided to verify results. METHODS: Seventy-two patients with rotator cuff tear underwent arthroscopic shoulder surgery. Single-row arthroscopic repair using double-loaded metal anchors and margin-convergence sutures with concomitant procedures were performed in all cases. All patients were assessed and classified before and after surgery using the Constant scoring system and the Oxford Shoulder Score. Tears were measured and classified as medium (1-3 cm), large(3-5 cm) and massive (>5 cm). RESULTS: The average age of participants was 59 ± 9 years (33-76). There were five medium, 43 large and 23 massive tears. The average functional Constant score at the last follow-up was 91.68 ± 10.62, and the Oxford score averaged 43.23 ± 5.84 without statistically significant differences (p > 0.05) among groups Best results were in the massive-tear group, with an overall Constant score of 98.60 ± 2.61 and an average Oxford score of 47.60 ± 0.55. Full recovery was obtained between six months and one year. We used our own modified rehabilitation protocol and found no postoperative stiffness in this series. CONCLUSIONS: Single-row arthroscopic rotator cuff repair using double-loaded metal anchors and margin-convergence sutures with concomitant procedures, when necessary, provides excellent results. Pain, range of motion, muscle strength and function were significantly improved after single-row repair among all morphological types of cuff lesions.

Treatment of congenital leg length discrepancies in children using an Ilizarov external fixator: a comparative study.

The purpose of this study was to evaluate the influence of intramedullary (IM) alignment used in combination with an Ilizarov external fixation on the healing index (HI) and lengthening index (LI) in the treatment of congenital leg length discrepancies (LLD). This study included 35patients aged from 3.5 to 19 (average age 10.73) who underwent thl egalisation procedure using an Ilizarov external fixator. We compared the duration of the external fixator application, LLD, HI and LI between two groups of children: children in Group I underwent limb lengthening by the conventional llizarov technique using an Ilizarov external fixator alone, and children in Group II underwent a combination of Ilizarov technique and intramedullary alignment with two Kirschner wires, introduced through two mini-incisions. We found significant differences between the two groups of patients for duration of external fixator application and HI. Patients with congeni- tal LLD treated with combined method of treatment had benefit from intramedullary alignment due to its better outcome.

Periprosthetic infections after total hip and knee arthroplasty--a review.

Periprosthetic joint infections (PJI) in orthopedic surgery are considered to be very serious and dangerous complications of total joint arthroplasty. PJI becomes a long-lasting medical problem and a heavy burden on patient and his family. Patients with such a complication are a significant financial burden for the health care system. Recognizing this issue, investing in scientific research and simultaneously developing technologies in medicine are efforts taken to increase successfulness in preventing and treating PJI. Each year the number of total joint arthroplasties increases which entails a rise in the number of complications among which infections are the leading ones. Sometimes, in the worst case scenarios, infections can endanger patients' lives. New procedural algorithms and new diagnostic possibilities help us make accurate and early diagnoses of postoperative PJI with a great degree of certainty. These diagnostic methods include laboratory tests, imaging, histopathology and microbiological analyses. Treatment options depend on many factors which include the onset of symptoms, patients'general physical condition and type of pathogen. The approach to treating PJI is complex and it requires a multidisciplinary approach in order to ensure the most successful treatment possible. For adequate and successful treatment we need to take into account antibiotic therapy, one-stage or two-stage revision, Girdlestone operation, athrodesis and amputation. In this review we will try to sum up all relevant findings and suggest further steps in management of PJI.

MMP3 single-nucleotide polymorphisms are associated with noncontact ACL injuries in competing high-level athletes.

Matrix metalloproteinases (MMPs) play an important role in matrix remodeling, as well as in ligament integrity. Anterior cruciate ligament (ACL) rupture is a severe and frequent knee injury in sports. The aim of this study was to investigate polymorphisms within the MMP3 gene with the predisposition for noncontact ACL rupture in the Croatian professional athletes. One hundred eighty-seven (95 with ACL rupture occurring through a noncontact mechanism and 92 asymptomatic controls) unrelated Caucasians were recruited between 2016 and 2017. All participants were genotyped for three single-nucleotide polymorphisms (SNP) within the MMP3 gene: rs591058 C/T, rs650108 A/G, and rs679620 G/A using the pyrosequencing method. For all three investigated SNPs, genotype frequencies have significantly differed between cases and controls. The MMP3 rs591058 TT (p = 0.0012, odds ratio [OR] = 38.541, 95% confidence interval [CI] = 1.7024-8.7254), rs650108 GG (p = 0.0051, OR = 23.338, 95% CI = 1.2899-4.2226) and rs679620 AA (p = 0.0030, OR = 34.750, 95% CI = 1.5266-7.9101) genotypes, as well as haplotype variant T-G-A (p = 0.0104, OR = 1.71, 95% CI = 1.13-2.59) were significantly overrepresented in cases compared to controls. These results support association between functional variants within the MMP3 gene and the risk of ACL rupture. Still, further research is needed to corroborate these results in a larger population.

Running addiction.

BACKGROUND: Running is a common physical activity of an aerobic nature that is carried out mostly outdoors and presents a healthy lifestyle. However, the positive effect of running often masks the downsides of potential addiction that can compromise an individual's physical, mental, and social functioning. Most often there is a thin and unclear line separating passionate athletes and running addicts. Thus, it is necessary to educate the running community to raise awareness of the negative effects of over-training, prevent complications and injuries and to seek the necessary help. METHODS: The study sample consisted of runners from the Croatian population of both genders, aged 18 to 75, who have been running for more than a year. The respondents were divided into groups according to the favorite length of the racing race. Groups were compared in terms of nutritional supplements usage, running-related injuries, as well as the impact of Covid-19 pandemic on their running volume. Difference between groups in Exercise Addiction Inventory (EAI) questionnaire outcome scores was also accessed. RESULTS: The statistical analysis included the answers of 644 people of both genders, among which 309 (48%) men and 335 (52%) women. The average age of the respondents was 42 years (18-75), and the average age of running was 5 years (1-42). Only among the respondents who started running most recently (1 to 10 years), and those who run the longest races (longer than 100 km) were found to use nutritional supplements significantly more (71.43%, P<0.001) and sustained injuries associated with running more than rest of the groups (100%, P=0.013). Due to the pandemic, only respondents who have been running for the longest time (31-42 years) and prefer to run races from 21 to 42 km significantly reduced the amount of training (75%, P=0.037). The risk for addiction was significantly positively associated with the use of dietary supplements, the favorite length of the race and the frequency of injuries, while there was no association with the length of running. CONCLUSIONS: Running is a high-risk sport for addiction development. All the benevolent attitudes and positive effects of running often mask the downsides of addiction that can compromise an individual and his or her physical, mental, and social functioning. Due to the high percentage of addiction risk of 25%, it is necessary to educate the racing community to raise awareness of the negative effects of overtraining, prevent complications and seek the necessary help.

Clinical Outcome of Arthroscopic Repair for Isolated Meniscus Tear in Athletes.

Increased knowledge of the long-term destructive consequences of meniscectomy has created a shift towards operative repair of isolated meniscus lesions. However, in the literature the results of isolated meniscal repair in athletes currently remain underreported. Our objective was to investigate the clinical and functional outcomes as well as survival and return to sport in patients who underwent meniscal repair after isolated meniscal tear, with a focus on athletes (both professional and recreational) in the study population. This retrospective study included 52 athletes who underwent knee surgery for isolated meniscal tear between 2014 and 2020. Patients with concomitant ligamentous and/or chondral injury were not included in this study. The mean age of the patients was 25.5 years (ranging from 12 to 57 years). The mean follow-up period of all patients was 33.3 months (ranging 10 to 80 months). The mean purpose of the study was to report the return to sport. The International Knee Documentation Committee rating (IKDC), Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS) and Tegner activity level were determined at the follow-up. Failure was defined as re-operation with meniscectomy or revision meniscal repair. In total, 44 out of 52 patients (85%) returned to their previous sports activities. At follow-up, the mean Lysholm score was 90, representing a good to excellent result. Assessment of KOOS (mean value 88.8) and IKDC (mean value 89) scores also showed good to excellent results. A mean level of Tegner scale was 6.2, indicating a relatively high level of sports participation. Failure was encountered in 8 out of 52 knees (15%). Therefore, isolated meniscal repair resulted in good to excellent knee function and most athletes can return to their previous level of sports participation.

[How to improve perioperative blood management in patients undergoing total hip or knee replacement surgery?]. / Kako poboljsati transfuzijsko lijecenje bolesnika podvrgnutih ugradnji totalnih endoproteza kuka i koljena?

Total hip and knee arthroplasty is associated with significant perioperative blood loss, necessitating often blood transfusions. Because of risks and cost of allogenic blood transfusion and elective types of surgery several alternative methods have been developed to reduce allogenic blood use. We prospectively audited 65 consecutive patients undergoing primary total hip (THR; n = 30) or knee replacement (TKR; n = 35) at our Department of Orthopaedic Surgery which did not use autologous blood collection methods. Total blood loss in THR (1329.7 +/- 364.8 ml) and TKR (1427.3 +/- 660.4 ml) was similar to previously reported and without significant difference between the groups. However, we reported high transfusion rates with 63.3% of THR and 82.6% of TKR patients receiving allogenic blood. Important steps to reduce allogenic blood use would include implementation of restrictive transfusion protocols with a defined hemoglobin value as a transfusion trigger, correction of preoperative anemia with i.v. iron +/- erythropoietin, use of one or more modalities of autologous transfusion (postoperative autotransfusion, preoperative blood donation), pharmacological agents like tranexamic acid (anti-fibrinolytic) and other complementary procedures. There is sufficient evidence in literature about the cost-benefit of certain methods which makes routine use of allogenic blood in THR and TKR surgery unacceptable even at general orthopaedic surgery departments.

Modified Technique for Combined Reconstruction of Anterior Cruciate Ligament and Anterolateral Ligament.

During the past few decades, surgical techniques for anterior cruciate ligament (ACL) reconstruction have been developing significantly. To date, studies have shown that after ACL reconstruction, rotational stability has a greater impact on the patient's satisfaction, functional scores, and return to sports than translational stability. Although challenged by many authors in the literature, biomechanical studies on the anterolateral ligament (ALL) of the knee and clinical studies regarding ALL reconstruction have been revealing promising results. Thus, the potentially significant role of the ALL in biomechanical load sharing and improving rotational control of the knee has led to the development of various reconstruction techniques whose goal is to achieve simplicity and yield the best results possible. Guided by this idea, we have developed a modified ACL-ALL reconstruction surgical technique. In this article, our simple, bone-saving, anatomic technique to reconstruct both the ACL and ALL using hamstring tendon autograft is described.

Chiari pelvic osteotomy does affect hip survival: a long-term follow-up study.

BACKGROUND: The modern indications for Chiari pelvic osteotomy (CPO) have narrowed and the number of such operations performed has diminished markedly. So far published long-term experience with CPO indicate the fact that in selected patients satisfactory functional results can be achieved. The aim of this study was to investigate the parameters which influence CPO survival and its conversion into total hip arthroplasty (THA). METHODS: This is a single-centre retrospective case-series study. In the period from 1976 to 2012, it included 172 CPO in 158 patients. Of those, in 43 patients (48 hips) the follow-up was discontinued, leaving 115 patients (124 hips) for final analyses. The median age at the time of the surgery was 34 years, and the mean duration of the follow-up was 19 years. RESULTS: In 115 patients (124 CPO) included in the study, a total of 51 THA was performed in 49 patients. The median period between CPO and THA was 14 years. CONCLUSION: Supporting our results, we suggest that CPO should still be indicated in a selected group of younger patients even with advanced stage of hip osteoarthritis who prefer a joint-conserving procedure and consent to a predicted less optimal outcome.

Alternative Interleukin 17A/F Locus Haplotypes are Associated With Increased Risk to Hip and Knee Osteoarthritis.

We studied the genetic epidemiology of primary large-joint (hip and knee) osteoarthritis (OA), in order to find disease risk factors by a candidate-gene approach. We used case-control study in the Croatian Caucasian population. We genotyped 500 OA patients (260 hip, 240 knee; both with total joint replacements) and 597 healthy individuals for single-nucleotide polymorphisms (SNPs) in interleukin 17A (IL17A) (rs2275913) and IL17F (rs763780 and rs1889570) genes. On the basis of our population and allelic and genotypic frequencies haplotypes were predicted by PHASE software and compared between patients and controls. The three-SNP haplotype (rs2275913-rs763780-rs1889570) G-C-A confers predisposition to hip (p < 0.005) but not knee OA. The three-SNP haplotype having opposed nucleotides A-T-G was found significantly associated with 2.6 times higher risk for developing knee (p < 0.02) but not hip OA. The haplotype G-T (IL17A-IL17F; rs2275913-rs763780) is associated with protection to the disease in hip OA (p < 0.01). Our analyses show that two disparate haplotypes within the IL17A-F gene locus are associated with higher risk to developing hip and knee OA in the Croatian population. The data might suggest a difference in the etiology of hip OA from that of the knee OA, perhaps due to an unknown dissimilarity in vulnerability of these joints to the actions of IL17. Alternatively, other differences in genetic factors like the long non-protein coding region LINCMD1 and/or microRNA species like miR133b and miR206 found in the vicinity of the IL17 locus might be involved in the observed risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1972-1978, 2019.

Correlation between hypermobility score and injury rate in artistic gymnastics.

BACKGROUND: Generalized joint hypermobility (GJH) is suggested as a contributing factor for injuries in young athletes and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of joint and soft tissue injuries during sports activities. The aim of this study was to determine the correlation between the hypermobility score (using the Beighton`s modification of the Carter-Wilkinson criteria of hypermobility) in gymnasts and injury rate, during the period of one year. METHODS: This study observed 24 artistic gymnasts (11-26 years old), members of Qatar National Team in artistic gymnastics. We examined the Beighton joint hypermobility screen and a seasonal injury survey. The gymnasts characteristics (age, gender) and gymnastics characteristics (training per day and number of years in training artistic gymnastics) and their relations to injury rate were also included. RESULTS: The most common injury was the lower back pain injury, followed by knee, shoulder, hip and ankle injuries. We found strong correlation of number of years gymnastics training and injury rate (P<0.001). There is no significant correlation in the numbers of training hours during one week and hypermobility score to numbers of injuries (P>0.05). CONCLUSIONS: According to this study there is no correlation between GJH and injury rate in artistic gymnasts in Qatar. Total training period in gymnastics have greater contribution in injury rate.

Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years.

BACKGROUND: Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined. PURPOSE: To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression. RESULTS: At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear. CONCLUSION: A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.

Frequency of Dietary Intake and Physical Activity in Older Adults: A Cross-Sectional Study.

BACKGROUND: Evidence shows that diet is associated with physical activity. However, there has been a lack of studies addressing it in a population of older adults. Therefore, the main purpose of this study was to explore associations between various frequencies of dietary intake and physical activity in older adults. METHODS: In this cross-sectional study, the participants were 810 older adults aged ≥85. Frequency of dietary intake and the level of physical activity were assessed using the Elderly Diet Index score and International Physical Activity questionnaire. Mutual associations were examined using generalized estimating equations with a logistic regression model. RESULTS: "Optimal" intake of fish and seafood (OR (odds ratio) = 1.40; 95% CI (95 percent confidence interval) 1.01 to 2.00), fruits (OR = 2.10; 95% CI 1.45 to 3.02), legumes (OR = 1.73; 95% CI 1.19 to 2.50), olive oil (OR = 1.83; 95% CI 1.09 to 3.08) and bread (OR = 4.62; 95% CI 3.05 to 6.99) and the total Elderly Diet Index score (OR = 4.99; 95% CI 3.20 to 7.70) were associated with "sufficient" physical activity. When all dietary components were entered simultaneously into the model, "optimal" intakes of meat (OR = 1.73; 95% CI 1.10 to 2.71), fish and seafood (OR = 2.26; 95% CI 1.46 to 3.51), cereals (OR = 1.75; 95% CI 1.02 to 3.25), fruits (OR = 1.52; 95% CI 1.02 to 2.26), legumes (OR = 1.48; 95% CI 1.10 to 1.93), and bread (OR = 5.14; 95% CI 3.24 to 8.15) were associated with "sufficient" physical activity. CONCLUSIONS: Our study shows that the total Elderly Diet Index score is the strongest predictor associated with "sufficient" physical activity in a population of older adults. Thus, policies aiming to improve overall diet in order to achieve higher levels of physical activity are warranted.

Sleep Duration and Sleep Quality Associated with Dietary Index in Free-Living Very Old Adults.

The main purpose of the present study was to determine the associations between sleep duration and sleep quality with respect to dietary habits. In this cross-sectional study, 810 free-living older adults aged ≥85 years were recruited from six neighborhoods from the city of Zagreb. Diet, sleep duration and sleep quality were assessed using self-reported questionnaires. The associations between sleep duration and sleep quality with respect to dietary habits were examined using generalized estimating equations with Poisson regression analyses. After adjusting for body-mass index, self-rated health, psychological distress, physical activity, socioeconomic status, chronic disease/s, sex and age, we revealed that 'short' (<7 h; Rate Ratio (RR) = 0.43; 95% CI(confident interval) 0.30 to 0.64) and 'long' (>8 h; RR = 0.26; 95% CI 0.11 to 0.48) sleep durations and 'good' sleep quality (RR = 1.13; 95% CI 1.06 to 1.20) were associated with a 'moderate-to-high' healthy diet. When sleep duration and sleep quality were entered simultaneously into Model 3, 'short' (RR = 0.28; 95% CI 0.16 to 0.44 and 'long' (RR = 0.27; 95% CI 0.15 to 0.52) sleep duration and 'good' sleep quality (RR = 1.14; 95% CI 1.05 to 1.25) remained associated with a 'moderate-to-high' healthy diet. Our study shows that both 'short' and 'long' sleep duration and 'good' sleep quality are associated with 'moderate-to-high' healthy diets.

Sleep Duration and Sleep Quality Are Associated with Physical Activity in Elderly People Living in Nursing Homes.

The main purpose of the study was to explore the associations of sleep duration and sleep quality with physical activity (PA). In this cross-sectional study, participants were 894 elderly individuals (mean age 80 ± 3 years; 56.0% women) living in nursing homes. PA, sleep duration, and sleep quality (based on the Pittsburgh Sleep Quality Index (PSQI)) were self-reported. The associations of sleep duration and sleep quality with PA at the nursing home level were analyzed using generalized estimating equations with clustering. Participants reporting short sleep duration (<6 h; OR = 0.45; 95% CI 0.25⁻0.80) were less likely to report sufficient PA, yet those reporting long sleep duration (>9 h; OR = 2.61; 95% CI 1.35⁻5.02) and good sleep quality (<5 points; OR = 1.59; 95% CI 1.19⁻2.12) were more likely to report sufficient PA. When sleep duration and sleep quality were entered into the same model, the same associations remained. This study shows that elderly individuals who report short sleep duration are less likely to meet PA guidelines, while those who report long sleep duration and good sleep quality are more likely to meet PA guidelines. Strategies aiming to improve sleep duration and sleep quality are warranted.

Arthroscopic All-Inside Repair of Medial Meniscus Grade 2 Horizontal Cleavage Tear Using Additional Posteromedial Portal.

Management of intrasubstance horizontal cleavage meniscal lesions of microtraumatic origin remains poorly defined in young patients. For grade 2 lesions resistant to conservative measures, the standard technique is debridement of the intrasubstance tear and open suture repair via a posteromedial approach. The objective of this Technical Note is to propose an arthroscopic alternative to this open technique, using an arthroscopic additional posteromedial portal. This technique facilitates an approach to the lesion via its peripheral portion without creating an iatrogenic lesion of the free edge of the meniscus, which is located in the white zone and thus exhibits limited vascularity.

Interleukin-17 and Toll-like Receptor 10 genetic polymorphisms and susceptibility to large joint osteoarthritis.

Primary osteoarthritis (OA) is the most common type of a joint disease. It has a polygenic risk inheritance pattern and affects older people. The etiology of this disease is not fully understood. The aim of this study was to investigate the associations between polymorphisms in pro-inflammatory interleukin-17 (IL17A and IL17F) and anti-inflammatory Toll-like Receptor 10 (TLR10) genes with the risk for development of advanced stage hip and knee primary OA in the Croatian population. A total of 500 OA patients and 597 controls were genotyped for IL17A SNP (rs2275913), IL17F SNPs (rs763780 and rs1889570), and TLR10 (rs11096957) genes. The allelic and genotypic frequencies of IL17F SNP (rs763780) showed statistically significant differences in comparisons of controls with hip-but not knee-OA patients. The major allele (T) of rs763780 was associated with the lower risk for developing hip OA (p = 7.9 × 10-4 , OR = 0.45, 95%CI = 0.27-0.74), whereas the minor allele (C) was associated with susceptibility to hip OA (p = 7.9 × 10-4 , OR = 2.24, 95%CI = 1.35-3.72). The genotype T/T was associated with the protection to hip OA (p = 3.9 × 10-4 , OR = 0.41, 95%CI = 0.24-0.70), and, lastly, the genotype T/C was associated with the higher risk to acquiring hip OA (p = 2.6 × 10-4 , OR = 2.50, 95%CI = 1.47-4.25). TLR10 SNP rs11096957 was found significantly associated with predisposition to hip OA (p = 0.04, OR = 1.41, 95%CI = 1.02-1.94) but not knee OA. Our findings suggest that hip OA in Croatian population might have a different genetic risk regarding the IL17 and TLR10 gene locus than knee OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1684-1693, 2018.

Surgical Treatment of Moderate Hallux Valgus: A Comparison of Distal Chevron Metatarsal Osteotomy With and Without Lateral Soft-Tissue Release.

PURPOSE: The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). METHODS: We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. RESULTS: After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between the groups. However, group II showed significant improvements in medial sesamoid bone position and patient satisfaction scores as compared with group I. CONCLUSION: Our midterm follow-up of surgical treatments for moderate HV deformity suggests that both procedures provide good postoperative results. However, according to our results, DCMO with LSTR provides better results than procedures without LSTR. LEVELS OF EVIDENCE: Therapeutic, Level III: Retrospective comparative study.