Zoran Bascarevic

Correlation of clinical examination, ultrasound sonography, and magnetic resonance imaging findings with arthroscopic findings in relation to acute and chronic lateral meniscus injuries

PURPOSE The aim of this study was to evaluate whether ultrasound sonography (USS) performed by orthopedic surgeons is a reliable method of investigating lateral meniscus (LM) knee lesions as compared to magnetic resonance imaging (MRI), and arthroscopy, which is the gold standard in clinical practice. METHODS In total, 107 patients were involved in this study. They were hospitalized for arthroscopy due to LM injury of the knee. Clinical examination (McMurrays, Apleys, and joint line tenderness tests), USS, and MRI were performed prior to arthroscopy. We compared the results of clinical examination, USS, and MRI with the arthroscopic findings for the knee, which were considered the reference values. RESULTS McMurrays clinical test, which is the most sensitive method of detecting lateral meniscus lesions, gave the same sensitivity rate for both acute and chronic LM injuries: 65%. USS was observed to be more sensitive and specific for chronic LM injuries (85 and 90%, respectively) than for acute LM injuries (71 and 87%). MRI also yielded higher values of sensitivity and specificity for chronic lateral meniscus injuries (75 and 95%, respectively) than for acute LM injuries (68 and 87%). CONCLUSIONS The accuracy of ultrasound examination is demonstrated by the high reliability of this method in the diagnosis of lateral meniscus lesions of the knee, and the evaluation performed in this study showed that ultrasound is a useful clinical tool for diagnosing knee pathology.

Predictive genetic markers of coagulation, inflammation and apoptosis in Perthes disease—Serbian experience

AbstractPerthes disease is one of the most common forms of pediatric femoral head osteonecrosis with an unknown etiology. Coagulation factors were the first genetic factors suspected to have a role in the pathogenesis of this disease, but studies showed inconsistent results. It is described that inflammation is present during early stages of Perthes disease, but its genetic aspect has not been studied extensively. Little is known regarding the status of apoptotic factors during the repair process that leads to the occurrence of hip deformity in patients. Therefore, the aim of this study was to analyze major mediators involved in coagulation, inflammation, and apoptotic processes as possible causative factors of Perthes disease. The study cohort consisted of 37 patients. Gene variants of TNF-α, FV, FII, and MTHFR genes were determined by PCR-RFLP, while IL-3 and PAI-1 were genotyped by direct sequencing. The expression level of Bax, Bcl-2, Bcl2L12, Fas and FasL was analyzed by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) technique. Our results showed a significantly increased level of expression of pro-apoptotic factor Bax along with significantly higher Bax/Bcl-2 ratio in the patient group. Conclusion: The results presented indicate that apoptosis could be one of the factors contributing to the lack of balanced bone remodeling process in Perthes patients.What is Known:•The etiology of Perthes disease is unknown. The role of genetic factors involved in the coagulation process has been studied, showing inconsistent results so far.•Genetic factors involved in inflammation and apoptotic processes that could contribute to development of hip deformity have not been studied extensively.What is New:•Our results show significantly increased level of expression of the pro-apoptotic factor Bax as well as significantly higher Bax/Bcl-2 ratios in patient group, indicating that apoptosis could be one of the factors contributing to the lack of a balanced bone remodeling process in Perthes patients.

Intra‐articular injection of autologous adipose‐derived mesenchymal stem cells in the treatment of knee osteoarthritis

Osteoarthritis (OA) is a chronic degenerative joint disease and is considered to be the fourth leading cause of disability and the second cause of inability to work in men. Recently, adipose‐derived mesenchymal stem cells (AD‐MSCs) came into focus for regenerative medicine as a promising tool for the treatment of OA. The administration of stem cells into impaired joints results in pain relief and improves quality of life, accompanied by restoration of hyaline articular cartilage.

A Method for Prediction of Femoral Component of Hip Prosthesis Durability due to Aseptic Loosening by Using Coffin/Manson Fatigue Model

The purpose of this work is to develop a new model estimate of the fatigue life of a hip prosthesis due to aseptic loosening as a multifactorial phenomenon. The formula developed here is a three-parameter model based on Basquins law for fatigue, eccentric compression formula for the compressive stress and torsion in the prosthesis due to the horizontal components of the contact force. With our model, we can accurately predict the durability of a hip prosthesis due to the following four parameters: body weight, femoral offset, duration, and intensity of daily physical activities of a patient. The agreement of the prediction with the real life of the prosthesis, observed on 15 patients, is found to be adequate. Based on the formula derived for a particular implant, there was a high degree of concurrence between the model-predicted and actual values of aseptic loosening (durability) proved by the Mann–Whitney U test. By virtue of the validated model, it is possible to predict, quantitatively, the influence of various factors on the hip life. For example, we can conclude that a 10% decrease of a patients body mass, with all other conditions being the same, causes 5% increase of the hip fatigue life.

Periprosthetic Femoral Fractures in Total Knee Arthroplasty

Total joint arthroplasty has greatly improved the treatment of knee arthrosis, but still is not without complications. Supracondylar fractures above total knee replacements are an uncom‐ mon complication (incidence 0,3% to 2.5%), occuring more frequently in patients older than 60 years with osteoporotic bone. The rate of these fractures is expected to increase in the future because of the growing number of total knee replacements and greater level of acitivity among elderly patients. The timing of such fractures has been reported to range from early in the postoperative period to more than a decade after surgery, with a mean of 2 to 4 years. During the past two decades authors were not agreed in the definition of periprosthetic supracondylar region: the lower 3 inches (7cm) of the femur [1]; 9 cm proximal to the knee joint line [2]; all fractures within 15 cm proximal to the knee joint line [3]. Generally, based on the older literature, supracondylar periprosthetic fractures were those within 15 cm of the joint line, or in the case of stemmed component, within 5 cm of the proximal end of the implant. Never‐ theless, the most important is understanding that these fractures occur in regions of stress concentration adjacent to a prosthetic component, and that the presence of the prosthesis has a significant effect on fracture treatment. So, we suggest that fractures above total knee replacement should be considered supracondylar fractures if they extend within 7 cm of the prosthetic joint line or if they are within 2 cm of the femoral prosthetic flange.

Hip Arthroplasty in Highly Dislocated Hips

Developmental disorder of the hip (DDH) is the most frequent disease of this joint. It is manifested by dysplasia, subluxation or luxation in childhood period and arthrosis in adults. Early degenerative changes of the hip occur at the location of disordered anatomy and biomechanics already in youth, while in the childhood age they are mostly asymptomatic (Ando & Gotoh, 1990). DDH mostly occurs in females, even 4-10 times more often than in males. Also, the disease is unevenly expanded, both ethnically and geographically, but also according to different habits in regard to the nursing care of neonates and infants. For example, the disease does not develop among the Bantu colored population, while in Canadian Indians it is very frequent rating even 12.3%, which is related to their habit of nursing babies in narrow wooden cradles. In those Indians who do not practice it the frequency is considerably lower (1.2%) (Vukasinovic et al., 1994, 2004). In our regions data on the frequency of DDH vary between 0.5-34.8%, depending on the regional customs in nursing children, but also on the method applied in the diagnostics of the disease; clinically it is the lowest, radiographically higher, and ultrasonographically the highest (Klisic et al., 1984). Former classical term of the disease was “congenital dislocation of the hip”, which, over the years became unsustainable, since it has been disclosed that the disease is not congenital, but that it often develops after birth under the influence of environmental factors. In addition, it does not always involve a total dislocation, but only disturbed interrelationship among the joint surfaces of the hip. Although the former term can be still found in the literature, today the term “developmental disorder of the hip” is accepted worldwide (Klisic, 1989).

Foot examination in the period of development.

Feet are maybe the key part of our musculoskeletal system that establishes upright position and movement. Their role is multiple--they maintain the balance of the body, push the body forward when walking and absorb mechanical pressure created in contact with the surface. Therefore, correct anatomic and functional development of foot is of vital importance. The most frequent reasons for examination of foot in the period of development are pain, deformity and incorrect walk. Our task is to detect the cause of the problem with clinical examination in the shortest possible period of time or to assess which additional diagnostic procedure would be the most suitable. A clinical examination of foot in the period of development involves inspection, palpation, percussion, auscultation, examination of joint mobility, examination of sensory-motor function and conducting specific tests. In some cases detailed and properly conducted clinical examination can prove to be sufficient to establish a complete and accurate diagnosis. Patients of this specific age may be insufficiently cooperative, mistrustful, shy or even afraid. Our approach and manipulations during the clinical examination need to be adapted completely to such patients and their characteristics.