Osteoarthritis is a degenerative joint disease affecting middle-aged and elderly patients. It mainly involves weight-bearing joints such as the hip, knee and spine as well as the basilar joint of the thumb, causing dysfunction and painful symptoms. Often, joint arthritis is accompanied by cartilage defects, joint space narrowing, osteophytes, bone sclerosis and subchondral bone cysts (SBC). The aim of the present study was to explore the pathophysiology responsible for the development of SBCs as well as the association between SBCs and disease progress, the level of clinical symptoms and their impact on postoperative outcomes and risk of possible complications following joint replacements if left untreated. A literature review on PubMed articles was conducted to retrieve and evaluate all available evidence related to the main objective mentioned above. A few theories have been put forth to explain the formation process of SBCs. These involve MMPs secretion, angiogenesis, and enhanced bone turnover as a biological response to abnormal mechanical loads causing repeated injuries on cartilage and subchondral tissue during the development of arthritis. However, the application of novel therapeutics, celecoxib-coated microspheres, local administration of IGF-1 and activated chondrocytes following surgical debridement of SBCs hinders the expansion of SBCs and prevents the progression of osteoarthritis.

Background: Despite the expanding use of orthopedic devices and the application of strict pre- and postoperative protocols, the elimination of postoperative implant-related infections remains a challenge. Objectives: To identify and assess the in vitro and in vivo properties of antimicrobial-, silver- and iodine-based implants, as well as to present novel approaches to surface modifications of orthopedic implants. Methods: A systematic computer-based review on the development of these implants, on PubMed and Web of Science databases, was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Overall, 31 in vitro and 40 in vivo entries were evaluated. Regarding the in vitro studies, antimicrobial-based coatings were assessed in 12 entries, silver-based coatings in 10, iodine-based in 1, and novel-applied coating technologies in 8 entries. Regarding the in vivo studies, antimicrobial coatings were evaluated in 23 entries, silver-coated implants in 12, and iodine-coated in 1 entry, respectively. The application of novel coatings was studied in the rest of the cases (4). Antimicrobial efficacy was examined using different bacterial strains, and osseointegration ability and biocompatibility were examined in eukaryotic cells and different animal models, including rats, rabbits, and sheep. Conclusions: Assessment of both in vivo and in vitro studies revealed a wide antimicrobial spectrum of the coated implants, related to reduced bacterial growth, inhibition of biofilm formation, and unaffected or enhanced osseointegration, emphasizing the importance of the application of surface modification techniques as an alternative for the treatment of orthopedic implant infections in the clinical settings.

Introduction: Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. Methods: Eight patients with a modular silver-coated arthrodesis implant after failed exchange arthroplasty for infection, were retrospectively reviewed. All patients had significant bone loss, while 5 displayed extensor tendon deficiency. Survivorship, complications, leg length discrepancy, median Visual Analogue Scale (VAS) and Oxford Knee score (OKS) were evaluated. Results: The median follow up was 32 months (range 24–59 months). The survivorship rate of the prosthesis was 86% during the minimum time of follow up of 24 months. In one patient recurrence of the infection was observed and above-knee amputation was performed. The median postoperative leg length discrepancy was 2.07 ± 0.67 cm. Patients were able to ambulate with mild or no pain. The median VAS and OKS was 2.14 ± 0.9 and 34.7 ± 9.3, respectively. Conclusions: The results of our study demonstrated that knee arthrodesis with a silver coated arthrodesis implant, performed for persistent PJI in patients with significant bone loss and extensor tendon deficit, provided a stable construct, allowed eradication of infection and was associated with good functional outcome.

Background: Scheuermann’s kyphosis (SK) is characterized by anterior wedging of >5 degrees at three or more contiguous vertebrae associated with severe back pain and cosmetic disfigurement. Different surgical interventions have been applied for SK correction, but the optimal operational treatment remains controversial. Objectives: The aim of our study is to analyze all the current indications for the surgical correction of SK, as well as to describe the instrumentation methods and techniques in order to detect the ideal operational management and accompanied complications. Methods: This comprehensive review investigates the up-to-date surgical indications and approaches for SK, the current trends, and the associated postoperative functional outcomes. A detailed search of PubMed, Web of Science and Google Scholar databases in English literature was performed for articles during the last 20 years. Additional criteria were peer-reviewed original studies that provided the type of interventions for SK and the clinical outcomes. Results: Thirty studies that met our induction criteria were analyzed. The up-to-date surgical indications such as back pain, failure of conservative treatment, progression of deformity, and neurological complications were described. Anterior (AO) and posterior-only (PO), and combined anterior–posterior (AP) approaches and instrumentation techniques were outlined. The most common side effects of the above interventions were hardware failure, loss of correction and Proximal Junctional Kyphosis. Contrariwise, in PO, reduced blood loss and operational duration was noted. Conclusions: Although the published studies reported contradictory results of the effectiveness of the various techniques applied for SK treatment, the PO fusion was correlated with a decreased rate of complications that resulted in its current increase in popularity.

Introduction: Triceps’ tendon rupture is thought to be a relatively rare injury, and its exact incidence is unknown. As a result of the rareness of this injury, very few cases of weightlifters or bodybuilders taking androgenic anabolic steroids have been published in the literature to date. In this article, we report a very rare case of non-traumatic triceps tendon rupture in a professional body builder under androgenic anabolic steroids. Case Report: A 32-year-old male patient, was admitted to our emergency department, reporting that while trying to maneuver his motorbike to avoid collision with another vehicle, he felt sudden pain at the posterior elbow and heard a popping sound. Active extension of the elbow was found to be reduced, raising suspicion of triceps tendon rupture. Ultrasound and magnetic resonance imaging revealed rupture of the triceps, confirming the clinical diagnosis. Intraoperatively, an almost complete rupture of the triceps was noted at its insertion into the olecranon. After the recognition and preparation of the triceps’ footprint, two 3.5 mm titanium bone sutured anchors were placed at the anatomical insertion of the tendon, and the tendon was repaired using a modified double-row technique. Follow-up at 6 months and 1 year postoperatively revealed perfect Mayo Elbow Performance and Oxford Elbow Scores with no residual pain or range of motion deficits; triceps strength had returned to pre-injury levels Conclusion: Triceps tendon rupture is thought to be a relatively rare injury and among the rarest tendon injuries. It usually occurs in patients with systematic diseases, such as renal disease, or on medication, such as androgenic anabolic steroid use. As a result of its rareness, very few cases of weightlifters or bodybuilders taking steroids have been reported in the literature. To our knowledge, this is the first case of non-traumatic triceps tendon rupture in a bodybuilder under oral androgenic anabolic steroids. Keywords: Triceps tendon, rupture, non-traumatic, athlete, anabolic, steroids.

Background/Objectives: The purpose of this study was to preoperatively estimate the four-strand hamstring graft size in a White Caucasian population, using anthropometric data. Methods: This was a prospective study of a consecutive series of fifty patients with anterior cruciate ligament (ACL) rupture, who were scheduled for reconstruction using hamstring autografts; however, one of them was ultimately not enrolled according to the exclusion criteria (49 patients in total). Preoperatively, age, sex, weight, body mass index (BMI), length, and diameter of the contralateral thigh, length of the harvested gracilis/semitendinosus tendons, and length and thickness of the four-stranded graft were recorded. Graft diameter and length were dependent variables, measured via a graft sizer and a ruler, respectively. Quantitative variables were described with mean ± SD (correlated in a pairwise manner with Pearson’s r correlation). Qualitative variables were described with an absolute count (relative % percent) per categorical level, and their dependency on any quantitative (dependent) variable was assessed via Student’s t-test. Results: The mean lengths of the gracilis and semitendinosus were 25.6 ± 3.2 cm and 28.4 ± 3.3 cm, respectively, and they were positively correlated with the length of the four-strand hamstring graft along with the patients’ height and thigh length. Conclusions: The use of anthropometric data can assist in the prediction of the hamstring autograft size, aiding the selection of an appropriate graft type. The four-strand hamstring graft length was related to the gracilis, semitendinosus, and thigh length. The patients’ height was related to the graft length and diameter.