Time of Return to Work (RTW) May Not Correlate with Patient-Reported Outcomes Measurements (PROM) at Minimum One Year Post Arthroscopic Bankart Repair.

It is widely recognized that work serves a dual role by not only ensuring financial independence but also functioning as a vital source of psychosocial well-being and contributing significantly to the attribution of meaning in life. The cost of work disability can be a multifactorial problem for both employers and workers; thus the inability to return to work (RTW) may have a destructive effect on mental health and confidence. Shoulder surgery is one of the conditions that inevitably impacts patients' ability to work. As current data focus on restoring range of motion, strength, and the patients' activity, to this day the data about RTW post shoulder surgery remain limited. The purpose of this study was to evaluate the return-to-work time of patients treated with an arthroscopic Bankart repair and to evaluate if patient-reported outcomes (PROM) correlate with the incapacity to work after an arthroscopic Bankart repair. We performed a retrospective review by conducting a questionnaire with patients more than 12 months after surgery and we identified 31 patients who met the criteria for the study and were able to contact 17 of them. In this paper we demonstrated that on average among groups working physically and at the office we may expect patients who underwent arthroscopic Bankart repair to return to work within 7 weeks from the surgery, with office workers tending to return significantly faster with an average of 2.5 weeks (p = 0.0239).

Selected Clinical Features Fail to Predict Inflammatory Gene Expressions for TNF-α, TNFR1, NSMAF, Casp3 and IL-8 in Tendons of Patients with Rotator Cuff Tendinopathy.

The pathophysiology of rotator cuff tendinopathy is not fully understood, particularly in terms of the local inflammatory process. This study aimed to investigate the expression of selected molecules in the tumour necrosis factor (TNF)-α transduction pathway, including TNF-α, TNF receptor 1 (TNFR1), neutral sphingomyelinase activation associated factor (NSMAF), caspase 3 (Casp3), and interleukin (IL)-8, in patients with rotator cuff tendinopathy that had undergone surgical treatment. We included 44 participants that underwent arthroscopy, due to rotator cuff tendinopathy. Samples from the injured tendon were collected during arthroscopy, and RT-PCR was performed to determine gene expression. Pearson correlation analyses or U-Mann-Whitney test were performed to identify associations with the following parameters: sex, age at admission, body mass index, the presence of night pain, previous treatment (nonsteroidal anti-inflammatory drugs and/or steroids), medical history of the shoulder injury, upper subluxation of the humeral head, and the number of tendons injured. RT-PCR showed that the selected pro-inflammatory factors involved in the TNF-α signalling pathway expression levels were expressed in the tendon tissues. However, the levels of expression varied from patient to patient. Variations were over 250-fold for TNF-α, about 130-fold for TNFR1, NSMAF, and Casp3, and 1000-fold for IL-8. We could not confirm that any of the clinical parameters investigated were associated with the level of gene expression in the TNF-α pathway and IL-8.

The Effect of L-Ascorbic Acid and Serum Reduction on Tenogenic Differentiation of Human Mesenchymal Stromal Cells.

BACKGROUND AND OBJECTIVES: Despite significant improvement in the treatment of tendon injuries, the full tissue recovery is often not possible because of its limited ability to auto-repair. The transplantation of mesenchymal stromal cells (MSCs) is considered as a novel approach in the treatment of tendinopathies. The question about the optimal culture conditions remains open. In this study we aimed to investigate if serum reduction, L-ascorbic acid supplementation or a combination of both factors can induce tenogenic differentiation of human adipose-derived MSCs (ASCs). METHODS AND RESULTS: Human ASCs from 3 healthy donors were used in the study. The tested conditions were: 0.5 mM of ascorbic acid 2-phosphate (AA-2P), reduced serum content (2% FBS) or combination of these two factors. The combination of AA-2P and 2% FBS was the only experimental condition that caused a significant increase of the expression of all analyzed genes related to tenogenesis (SCLERAXIS, MOHAWK, COLLAGEN_1, COLLAGEN_3, DECORIN) in comparison to the untreated control (evaluated by RT-PCR, 5th day of experiment). Moreover, this treatment significantly increased the synthesis of SCLERAXIS, MOHAWK, COLLAGEN_1, COLLAGEN_3 proteins at the same time point (evaluated by Western blot method). Double immunocytochemical staining revealed that AA-2P significantly increased the extracellular deposition of both types of collagens. Semi-quantitative Electron Spin Resonance analysis of ascorbyl free radical revealed that AA-2P do not induce harmful transition metals-driven redox reactions in cell culture media. CONCLUSIONS: Obtained results justify the use of reduced content of serum with the addition of 0.5 mM of AA-2P in tenogenic inducing media.

Copper Does Not Induce Tenogenic Differentiation but Promotes Migration and Increases Lysyl Oxidase Activity in Adipose-Derived Mesenchymal Stromal Cells.

BACKGROUND: Copper belongs to the essential trace metals that play a key role in the course of cellular processes maintaining the whole body's homeostasis. As there is a growing interest in transplanting mesenchymal stromal cells (MSCs) into the site of injury to improve the regeneration of damaged tendons, the purpose of the study was to verify whether copper supplementation may have a positive effect on the properties of human adipose tissue-derived MSCs (hASCs) which potentially can contribute to improvement of tendon healing. RESULTS: Cellular respiration of hASCs decreased with increasing cupric sulfate concentrations after 5 days of incubation. The treatment with CuSO4 did not positively affect the expression of genes associated with tenogenesis (COL1α1, COL3α1, MKX, and SCX). However, the level of COL1α1 protein, whose transcript was decreased in comparison to a control, was elevated after a 5-day exposition to 25 µM CuSO4. The content of the MKX and SCX protein in hASCs exposed to cupric sulfate was reduced compared to that of untreated control cells, and the level of the COL3α1 protein, whose transcript was decreased in comparison to a control, was elevated after a 5-day exposition to 25 µM CuSO4. The content of the MKX and SCX protein in hASCs exposed to cupric sulfate was reduced compared to that of untreated control cells, and the level of the COL3. CONCLUSION: Copper sulfate supplementation can have a beneficial effect on tendon regeneration not by inducing tenogenic differentiation, but by improving the recruitment of MSCs to the site of injury, where they can secrete growth factors, cytokines and chemokines, and prevent the effects of oxidative stress at the site of inflammation, as well as improve the stabilization of collagen fibers, thereby accelerating the process of tendon healing.

Results of Treatment of Type 3 Acromioclavicular Joint Dislocation with Three Methods.

BACKGROUND: Rockwood Type III acromioclavicular joint injuries are treated both conservatively and surgically. There is still no consensus on an optimal fixation method. The aim of this study was to evaluate which of the surgical methods used in our Department produces the best outcomes in long-term follow-up. MATERIAL AND METHODS: The study involved 27 patients. Wire cerclage was used in 12 patients, 11 patients were operated on by the Ladermann method, and a hook plate was used in 4 patients. The patients were assessed at a late follow-up visit after a mean of 22 months post-operatively. The Constant Shoulder Scale (CSS), Oxford Shoulder Scale (OSS), and PROMIS v1.2 for the upper limb were used to assess the long-term effects of the treatment. RESULTS: There were no statistically significant differences between the Ladermann method and wire cerclage for the scales applied (p=0.98 at α=0.05). The functional CSS showed a significant advantage of the outcomes of the Lader-mann method and wire cerclage in comparison to the hook plate (p=0.014 and p=0.004, respectively, at α=0.05). The quality of life scales OSS and PROMIS showed no significant difference between the methods. CONCLUSIONS: 1. The outcomes of treatment with the Ladermann method and wire cerclage are excellent and com-parable with regard to both clinical outcomes and the quality of life. 2. The use of a hook plate may substantially contribute to worse clinical outcomes. 3. No considerable difference was found in the quality of life between the different groups, but a study involving a larger number of patients would be necessary for a complete evaluation.

Orthotic treatment of developmental hip dysplasia.

Summary. Abduction orthoses are used in the treatment of hip dysplasia in newborns and infants. These devices force ca. 1000-1100 flexion of the hips and 30-600 abduction. In this position, the femoral head assumed a concentric position in relation to the acetabulum, which is a basic precondition for normal hip development. This article presents the orthoses most commonly used id Poland to treat development hip dysplasia. Flexion-abduction orthoses are an excellent replacement for the plaster casts formerly used in these cases. The selection of orthosis depends on the attendant physician's experience and the type of defect. The treatment of developmental hip dysplasia is charged with the risk of nutritional defects of the femoral head, and thus requires caution. Orthotic treatment is suitable only for children to age 6 months, since at a later age it can disturb hip development. Lack of parent cooperation can cause complications or lack of treatment effect.

Alloplasty of the humeral joint.

Background. Since 1980's, shoulder arthroplasty has become more oftenly performed procedure, and for severe comminuted fractures of proximal humerus (fou r- fragmented fractures, according to Neer's classification) has become first - line therapeutic option. At the beginnig of 90's, contemporary prinicples of shoulder arthroplasty were introduced. It is assumed that 4 mechanical parameters, i.e. range of motion, joint stability, strengh and smoothness of prosthesis components contribute to shoulder function, and we sholud reach toward their reconstruction during surgical procedure. Material and Methods. In our Department from 1995 to1999 we performed 14 shoulder hemiarthroplasties using Bio-Modular prosthesis (12 women and 2 men). Patients' age ranged from 41 to 75 years (average 61.8 years). Indications included: acute comminuted proximal humerus fractures, proximal humerus malunions, and either degenerative arthritis or rheumatoid arthrits of the shoulder. Aftertreatment consisted of passive motions introduced on the first day after an operation, followed by assisted active excercises 4- 6 weeks later, and motions against resistance, allowed 2 months postoperatively. Results. The outcomes were evaluated three years after surgery, and were measured as the score in the Constant scale and as subjective patients' assesments. Improvement was seen as an increase from average 28.3 preoperative Constant score, to 60.3 postoperatively. Subjectively, excellent outcome was reported by 4 patients, good - by 7, and fair by 2 patients. Conclusions. Our experience shows that whereas indications to shoulder artrhroplasty are not frequent in cases of fractures or orthopedic conditions of the affected region, in properly selected group of patients this procedure is effective treatment option, alleviating pain and allowing for regaining well - functioning joint, but long-lasting, at leats one-year long rehabilitation programm after surgery is mandatory.

Arthroscopic treatment of subacromial impingement syndrom.

Background. Subacromial impingement syndrome is a frequently seen disorder of the shoulder, however it is also often misdiagnosed. The aim of the study was the assessment of the clinical value of the arthroscopic subacromial decompression.
Material and methods. From January 1999 to December 2002 sixty five patients were included to our study. The main complaints of patients was severe, long-lasting and progressing pain of the shoulder. Sixty one patients had failed conservative treatment (physical therapy, NSAID's, multiple steriod injections). Average duration of pain before surgery was 20 months, ranged from 1 to 50 months. On examination, restricted range of abduction and narrowing of subacromial space to 5 mm (3-8 mm) on plain AP X-ray view were found. The patients were followed up after six and twelve months after surgery.
Results. Finally, we noted full range of movement and absence of pain in neutral shoulder position in 38 patients. Four patients presented persistent pain while moving their shoulders, but no resting pain. In two cases pain relief was achieved but shoulder joint ROM restriction by 20 degrees abduction and 10 degrees external rotation.
Conclusions. Based on performed study we conclude that treatment emploing arthroscopic subacromial decompression is a valuable method, allowing to achieve very good outcomes and to introduce early rehabilitation.

Shoulder arthroscopy complications.

Shoulder arthroscopy has become a popular diagnostic and therapeutic procedure during the past two decades. In many centers shoulder arthroscopy has become a standard procedure. Complications associated with shoulder arthroscopy are relatively rare. Most of the complications can be minimized through proper surgical technique, good instrumentation, clinical experience and familiarity with anatomy. We evaluated cases from own clinical experience and reviewed the literature on complication of arthroscopic shoulder surgery and their management. Complications can be divided into general, generic to all shoulder procedures, and the type of procedure performed. Complications specific to shoulder arthroscopic procedures may affect articular capsule, brachial plexus nerves and wound healing. Serious and rare complications, like upper limb DVT, pneumothorax or rotator cuff jatrogenic injury require immediate recognition and treatment. Proper patient selection, attention to operative procedure (patient positioning, proper traction, anatomic portal placement), and careful post-operative care can minimize the morbidity associated with complications if they occur.

Functional bracing of the tibial diaphyseal fracture.

This article presents the possibilities of orthotic management of tibial diaphyseal fractures. Functional braces, prefabricated or custom-made allow early guarded weightbearing, mobilization of intact joints and shortening of treatment. Understanding of the philosophy, indications, clinical practise and possible complications of orthotic use is essential for appropriate decision making and good results in treatment.