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).

Coding and noncoding RNA profile of human heterotopic ossifications - Risk factors and biomarkers.

Heterotopic ossification (HO) means the formation of bone in muscles and soft tissues, such as ligaments or tendons. HO could have a genetic history or develop after a traumatic event, as a result of muscle injury, fractures, burns, surgery, or neurological disorders. Many lines of evidence suggest that the formation of HO is related to the pathological differentiation of stem or progenitor cells present within soft tissues or mobilized from the bone marrow. The cells responsible for the initiation and progression of HO are generally called HO precursor cells. The exact mechanisms behind the development of HO are not fully understood. However, several factors have been identified as potential contributors. For example, local tissue injury and inflammation disturb soft tissue homeostasis. Inflammatory cells release growth factors and cytokines that promote osteogenic or chondrogenic differentiation of HO precursor cells. The bone morphogenetic protein (BMP) is one of the main factors involved in the development of HO. In this study, next-generation sequencing (NGS) and RT-qPCR were performed to analyze the differences in mRNA, miRNA, and lncRNA expression profiles between muscles, control bone samples, and HO samples coming from patients who underwent total hip replacement (THR). As a result, crucial changes in the level of gene expression between HO and healthy tissues were identified. The bioinformatic analysis allowed to describe the processes most severely impacted, as well as genes which level differed the most significantly between HO and control samples. Our analysis showed that the level of transcripts involved in leukocyte migration, differentiation, and activation, as well as markers of chronic inflammatory diseases, that is, miR-148, increased in HO, as compared to muscle. Furthermore, the levels of miR-195 and miR-143, which are involved in angiogenesis, were up-regulated in HO, as compared to bone. Thus, we suggested that inflammation and angiogenesis play an important role in HO formation. Importantly, we noticed that HO is characterized by a higher level of TLR3 expression, compared to muscle and bone. Thus, we suggest that infection may also be a risk factor in HO development. Furthermore, an increased level of transcripts coding proteins involved in osteogenesis and signaling pathways, such as ALPL, SP7, BGLAP, BMP8A, BMP8B, SMPD3 was noticed in HO, as compared to muscles. Interestingly, miR-99b, miR-146, miR-204, and LINC00320 were up-regulated in HO, comparing to muscles and bone. Therefore, we suggested that these molecules could be important biomarkers of HO formation and a potential target for therapies.

The role of miRNA and lncRNA in heterotopic ossification pathogenesis.

Heterotopic ossification (HO) is the formation of bone in non-osseous tissues, such as skeletal muscles. The HO could have a genetic or a non-genetic (acquired) background, that is, it could be caused by musculoskeletal trauma, such as burns, fractures, joint arthroplasty (traumatic HO), or cerebral or spinal insult (neurogenetic HO). HO formation is caused by the differentiation of stem or progenitor cells induced by local or systemic imbalances. The main factors described so far in HO induction are TGFß1, BMPs, activin A, oncostatin M, substance P, neurotrophin-3, and WNT. In addition, dysregulation of noncoding RNAs, such as microRNA or long noncoding RNA, homeostasis may play an important role in the development of HO. For example, decreased expression of miRNA-630, which is responsible for the endothelial-mesenchymal transition, was observed in HO patients. The reduced level of miRNA-421 in patients with humeral fracture was shown to be associated with overexpression of BMP2 and a higher rate of HO occurrence. Down-regulation of miRNA-203 increased the expression of runt-related transcription factor 2 (RUNX2), a crucial regulator of osteoblast differentiation. Thus, understanding the various functions of noncoding RNAs can reveal potential targets for the prevention or treatment of HO.

Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41−3.32)), week of delivery (OR = 1.18 (1.00−1.37)), female sex (OR = 8.16 (4.86−13.71)), breech presentation (OR = 5.92 (3.37−10.40)), physical signs of DDH (25.28 (8.77−72.83)) and positive family history in siblings (5.74 (2.68−12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.

Spontaneous osteonecrosis of the knee: what do we know so far? A literature review.

PURPOSE: Spontaneous osteonecrosis of the knee (SONK) is said to be a relatively common disease which may lead to an end-stage osteoarthritis of the knee. The aim of this paper was to review the literature on this field published until now, discuss the results of both conservative and surgical treatment options, as well as to introduce new methods of treatment, which may be applicable in SONK treatment. METHODS: We searched the PubMed and Cochrane databases until November 2019 and presented the most recent findings in this work. RESULTS: The exact aetiology of SONK still remains unclear; however, recent studies suggested that early stage of SONK is rather a result of the subchondral fracture than primary osteonecrosis. So far described conservative treatment includes non-weight bearing or protected weight bearing with a knee brace, nonsteroidal anti-inflammatory drugs, analgesics, and bisphosphonates. Surgical management includes arthroscopic debridement, core decompression, osteochondral autograft, high tibial osteotomy, and unicompartmental knee arthroplasty or total knee arthroplasty. CONCLUSIONS: Although the aetiology of SONK remains unknown, there are many treatment options, and the choice of the most suitable one is challenging. We think that subchondroplasty may be one of the effective methods.

Heterotopic Ossification: A Challenging Complication of Total Hip Arthroplasty: Risk Factors, Diagnosis, Prophylaxis, and Treatment.

BACKGROUND: This review is intended to summarize the risk factors, classification, diagnosis, and treatment of heterotopic ossification (HO) of previously published studies. RESULTS: Heterotopic ossification is a common complication of total hip arthroplasty. Its prevalence is not the same in all of the patient groups. Frequency of HO varies from 15 to 90%. Hip ankylosis, male gender, and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph: the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols have been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac was proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.

Superficial Medial Collateral Ligament Reattachment During High Tibial Osteotomy: Regulate Tension, Preserve Stability!

High tibial osteotomy (HTO) is a commonly performed surgical procedure. Although it is well-known that the superficial medial collateral ligament (sMCL) should be released during HTO, there is still no agreement on performing its reattachment. Considering the function of the sMCL, after its release during HTO, increased medial joint instability may be expected. We present a technique for sMCL reattachment that prevents medial gapping development and maintains nearly native pressure on the medial compartment of the knee joint by matching the tension on the sMCL to the size of the osteotomy gap. This technique is suitable for any correction angle.

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature.

PURPOSE OF REVIEW: Platelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies. RECENT FINDINGS: The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer's elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations. Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.