Cilj : Položaj patele ima značajan utjecaj na pojavu kliničkih simptoma boli i oticanja koljenog zgloba, kao i na pojavu nestabilnosti patele. Cilj ovog istraživanja bio je ispitati pouzdanost primjene metoda mjerenja visine patela po Insall-Salvatiju, modificiranom Insall-Salvatiju, Blackburn-Peelu, Caton-Deschampsu te metodom mjerenja kuta plato - patela. Ispitanici i metode : Ispitivanje je izvršeno na 100 profilnih radiograma koljena bolesnika prosječne dobi od 50,14 godina, koji su pregledani na Klinici za ortopediju Lovran u razdoblju od godine dana. Prosječna vrijednost fleksije koljena na analiziranim profilnim radiogramima ispitanika iznosila je 36,57°. Provedena mjerenja učinila su dva istraživača i ponovljena su u dva navrata u razmaku od mjesec dana. U radu su se koristile statističke metode za analizu preciznosti i točnosti dviju metoda, pri čemu je korišten koeficijent korelacije podudarnosti i modificirani Pearsonov koeficijent. Rezultati : Rezultati su pokazali da u broju klinički dijagnosticiranih patela alta ili infera nije postojala značajna razlika između dvaju istraživača kod svake od primijenjenih metoda mjerenja visine patele. Uspoređujući dobivene rezultate mjerenja na temelju izračuna koeficijenta korelacije podudarnosti, Insall-Salvatijeva metoda pokazala se kao najpouzdanija zbog najbolje preciznosti (p1 = 0,8431, p2 = 0,8337) i zadovoljavajuće točnosti (Cb1 = 0,9171, Cb2 = 0,9275). Kod drugih metoda mjerenja rezultati su pokazali da se postiže jako dobra točnost, no slabija preciznost. Zaključak : Metoda mjerenja visine patele po Insall-Salvatiju na profilnom radiogramu koljena mogla bi se preporučiti kao optimalna metoda za potrebe korištenja u svakodnevnoj kliničkoj praksi.

Osteoarthritis (OA) is a chronic joint disease caused by both mechanical damage and metabolic factors, which intertwine in their pathogenetic pathways. We hypothesise that the oxidised cholesterol derivative, 7-ketocholesterol (7-KCh), represents a danger signal in the synovia of patients with OA and promotes low-grade inflammation. The study would aim to elucidate the possible immune mechanisms initiated by 7-KCh that contribute to oxidative stress and inflammation in the synovia and synovial CD68+ cells, which are mostly macrophages. The polarisation of synovial CD68+ cells, their tissue distribution in relation to T and natural killer (NK) cells, and the influence of 7-KCh on the phenotype and intracellular cytokine and chemokine production in suspension is worth analysing. We envisage that this research would contribute to a better understanding of the biology of CD68+ macrophages influenced by 7-KCh and encourage the development of therapeutic approaches based on directing macrophage polarisation.

Background Oxidized low-density lipoprotein (oxLDL) particles support low-grade inflammation and have been found in synovial fluid from osteoarthritis (OA) joints [1]. Their component is 7-ketocholesterol (7-KC), which arises as the result of the oxidation of cholesterol [1]. 7-KC acts proinflammatory and it binds to Toll-like receptor (TLR) 4 expressed on macrophages [1]. Activation of TLR4 stimulates the classical macrophage maturation program, resulting in a specific phenotype of inducible nitric oxide synthase positive (iNOS+) and macrophage (M) 1 function, which produce and secrete proinflammatory chemokines and cytokines [2]. M2 macrophages are associated with wound healing by the production of arginase-1 [2,3]. Synovial macrophages are of critical importance in the symptomatology and structural progression of OA since M1 polarized macrophages accumulate in human OA synovial tissue during exacerbation [3]. However, it is not known whether 7-KC can re-program synovial tissue macrophages and support M1 polarization. Objectives We analyzed the influence of 7-KC on the polarization of CD68+ macrophages in the suspension of synovial mononuclear cells (SMCs) in respect to lipopolysaccharide (LPS), as M1 inducer. Methods Mature synovial tissue samples were obtained during alloarthroplasty of the knee (N = 56). Paraffin embedded tissue sections were labelled by double immunofluorescence using a combination of antibodies directed toward CD68 and iNOS, arginase-1, CCL2 or CCL22. Suspension of SMCs was prepared by enzymatic digestion of tissue samples using collagenase IV and gradient density centrifugation. We analyzed intracellular (iNOS, arginase-1, CCL2, and CCL22) and surface (CD91, mannose receptor, HLA-DR, CD80, CD86 and decoy D6) antigens expression in CD68+ cells in the suspension of freshly isolated or 18 hour-cultured SMCs with 7-KC (25 μM), LPS (10 ng/ml), their combination or in the medium only. Results iNOS and CCL2 were more frequently labelled in lymphocyte clusters, while arginase-1 and CCL22 were labelled in synovial lining CD68+ cells. Phenotype of CD68+ cells did not change significantly after the 18 hour- culture in the medium only, except the decrease of mannose receptor and CD91, when compared with freshly isolated cells. 7-KC increased the percentage of CD86 expressing CD68+ cells, whereas decreased surface expression of CD91 and chemokine decoy D6, like in the culture with LPS, when compared with cells cultured in the medium only. 7-KC decreased the frequency of arginase-1+/CD68+ cells in the suspension and did not change iNOS+ in CD68+ cells, thus increasing the ratio of iNOS+/arginase-1+ in CD68+ subset. 7-KC was unable to increase CCL2 like LPS in comparison with cells cultured in the medium only. Neither 7-KC nor LPS affected CCL22 expression in the CD68+ subset. Conclusion These data provide a new perspective in understanding the polarization of macrophages toward the M1 phenotype mediated with oxysterol 7-KC in vitro . References [1]Niki E. Biomarkers of lipid peroxidation in clinical material. Biochim Biophys Acta. 2014;1840(2):809-17. [2]Fernandes TL, Gomoll AH, Lattermann C, Hernandez AJ, Bueno DF, Amano MT. Macrophage: A Potential Target on Cartilage Regeneration. Front Immunol. 2020;11:111. [3]Zhang H, Cai D, Bai X. Macrophages regulate the progression of osteoarthritis. Osteoarthritis Cartilage. 2020;28(5):555-561. Acknowledgements The University of Rijeka supported the research by the grants No. Uni-ri-biomed-18-110 and No. Uni-ri-biomed-18-160. Disclosure of Interests None declared.

Osteoarthritis (OA) is a chronic joint disease caused by mechanical damage and metabolic factors that support the development of low-grade inflammation. Increased levels of T helper 1 pro-inflammatory cytokines in the serum of OA patients may support granulysin (GNLY) mediated cytotoxicity, which in-turn may contribute to the pathogenesis of OA. In the present study, GNLY expression and cytotoxic/apoptotic mechanisms mediated by GNLY in the peripheral blood of OA patients were assessed. A total of 40 non-obese women (median age of 64 years old) with knee OA, and 40 controls (median age 62 years old) were enrolled in the study. GNLY, IFN-γ and IL-4 expression levels were investigated in peripheral blood lymphocytes (PBLs) using flow cytometry, immunocytochemistry and/or confocal microscopy. Natural killer (NK) GNLY-mediated apoptosis through NK effectors against K-562 targets was analyzed using the PKH-26 18-h cytotoxicity assay. Serum GNLY levels were assessed using ELISA. The percentage of GNLY+PBLs was higher in the OA patients than that in the controls due to the increase in the proportions of GNLY+ cells in the natural killer (NK), T and natural killer T (NKT) subsets. GNLY localization inside exocytotic lysosomal-associated membrane protein-1+ granules was ~40% in both groups. However, the intensity of GNLY labeling in PBLs was higher in OA patients than in the controls, and it was supported by the increased expression of IFN-γ relative to IL-4 in NK and T cells from OA patients. The serum GNLY concentration was <0.3 ng/ml in both groups. RC8 anti-GNLY mAb by itself was unable to significantly alter early apoptosis, whereas RC8 anti-GNLY mAb combined with anti-perforin mAb significantly reduced NK-mediated early apoptosis of K-562 targets in the OA patients, whilst not exerting a notable effect in the controls. Anti-perforin mAb by itself did not affect apoptosis significantly. These results suggest that in women with knee OA, GNLY expression in the PBL subsets and GNLY-mediated early apoptosis of K-562 targets are increased compared with the controls and accompanied by intracellular dominance of IFN-γ over IL-4 in NK cells.

Cilj: Cilj rada bio je prikazati da i manje traume u adolescentno doba mogu uzrokovati avulziju tuberositasa tibije te ukazati na mogućnost nastanka kompartment sindroma. Prikaz slučaja: Kod dječaka u dobi od 15 godina pri promjeni smjera kretanja došlo je do avulzije tuberositasa tibije. Ozljeda je popraćena velikim edemom. Nakon operacije razvila se pareza peronealnog živca koja je uz medikamentoznu i fizikalnu terapiju regredirala u cijelosti. Zaključak: Pri sumjnji na avulziju tuberositasa tibije potrebna je žurna dijagnostika i liječenje. Zbog mogućeg nastanka sindroma kompartmenta potreban je pojačan nadzor u perioperacijskom periodu.

Cilj: Totalna endoproteza (TEP) gležnja ugrađuje se kod uznapredovalog stadija osteoartritisa gležnja s ciljem održavanja bezbolnog, stabilnog i pokretljivog zgloba. Cilj je ovog istraživanja bio analizirati rane funkcionalne rezultate nakon ugradnje TEP-a gležnja. Ispitanici i metode: Ispitana je skupina od 18 pacijenata s ugrađenim TEP-om gležnja. Prosječna dob pacijenata bila je 62 godine. Kod 12 pacijenata radilo se o sekundarnom obliku osteoartritisa gležnja na osnovi prethodne ozljede, a kod 6 o primarnom osteoartritisu gležnja. Svi su pacijenti kirurški liječeni u Klinici za ortopediju Lovran u razdoblju od 2013. do 2016. godine, a ispitivanje je provedeno uz pomoć anketnog lista institucije American Academy of Orthopedic Surgeons (AAOS), vizualne analogne ljestvice (VAS) bola i goniometra. Rezultati: Dobiveni rezultati pokazali su značajno poboljšanje u funkcionalnom stanju gležnja, kao i u njegovoj pokretljivosti. Prijeoperacijski rezultati AAOS-ova anketnog lista iznosili su 30,34, dok su poslijeoperacijski iznosili 70,01 bodova. Prosječni je opseg pokreta gležnja prije operacije bio 16,11°, a poslijeoperacijski 30,26°. Također se pokazalo da je intenzitet bola nakon ugradnje endoproteze gležnja značajno manji. Prijeoperacijski je prosječna razina VAS-a bola bila 7,83, a poslijeoperacijski 3,5. Zaključak: Rezultati ove studije potvrđuju uspješnost ugradnje TEP-a gležnja u pacijenata s uznapredovalim osteoartritisom gležnja.

Background:Macrophages are abundant inflammatory cell type in the synovial membrane of knee osteoarthritis (OA) (1). Their quantity is associated with radiographic severity of knee OA and joint symptoms (2), while their functions are set in response to micro-environmental signals (3). Classically activated macrophages M1 support T helper 1 (Th1) driven pro-inflammatory reactions, while alternatively activated macrophages M2 strengthen Th2 inflammatory processes (3).Objectives:To investigate activation status of synovial tissue macrophages in patients with mature OA in terms of M1 / M2 polarization.Methods:Synovial tissue samples (6) with abundant lymphocyte infiltration were obtained during aloarthroplasty. Double immunofluorescence labeling was performed on paraffin-embedded synovial tissue sections using primary rabbit anti-macrophage CD68 mAb in combination with mouse anti-human antibodies directed toward CD3, arginase-1, TNF-alpha and IL-15. CD206 and CD163 were single labelled.Results:CD68+ macrophages mostly co-expressed arginase-1 (4/6 samples), indicating their M2 orientation. Macrophages were placed in lining synovial tissue and nearby tissue-resident CD3+ cells. M2 markers CD206 and CD163 were found in the area of macrophage interaction with T cells. CD68+ cells co-expressing TNF-alpha or IL-15 M1 markers were in minority in these synovial tissues. Lymphocyte infiltration was less abundant in remaining (2/6) synovial tissue samples.Conclusion:Mature synovial tissue macrophages, equipped dominantly with arginase-1 are M2 oriented and might support Th2 immune response in surrounding T cells.References:[1]Grieshaber-Bouyer R, Kämmerer T, Rosshirt N, Nees TA, Koniezke P, Tripel E, Schiltenwolf M, Kirsch J, Hagmann S, Moradi B. Divergent Mononuclear Cell Participation and Cytokine Release Profiles Define Hip and Knee Osteoarthritis. J Clin Med. 2019;8(10):piiE1631.[2]Haraden CA, Huebner JL, Hsueh MF, Li YJ, Kraus VB. Synovial fluid biomarkers associated with osteoarthritis severity reflect macrophage and neutrophil related inflammation. Arthritis Res Ther. 2019;21(1):146.[3]Barros MH, Hauck F, Dreyer JH, Kempkes B, Niedobitek G. Macrophage polarisation: an immunohistochemical approach for identifying M1 and M2 macrophages. PLoS One. 2013;8(11):e80908.Acknowledgments:University of Rijeka supported the research by the grants No. Uni-ri-biomed-18-110 and No. Uni-ri-biomed-18-160.Disclosure of Interests:None declared

Carpal tunnel syndrome (CTS) is a well-known, most commonly diagnosed compressive neuropathy and makes up 90% of all neuropathies and is present in the general population at the rate of 3.8%. It is caused by median nerve (MN) damage in the area of the carpal tunnel, restricted by the carpal bones and the transverse carpal ligament. CTS is classified as idiopathic and secondary. Pathogenesis of CTS is complex and includes compression and traction of MN in the carpal tunnel area, and is still not fully clarified. Many clinical tests, electromyoneurography, ultrasonic diagnostics and magnetic resonance imaging are used in diagnostics of CTS. The treatment of CTS can be conservative and surgical. Conservative treatment is recommended for patients with mild to moderate levels, while surgical treatment (MN decompression) is performed in patients with severe impairment. The aim of this review is to show the latest findings related to that clinical syndrome, and to motivate clinicians to speed up diagnosis and treatment. The findings 2are based on the latest results of system reviews and meta-analysis.

The total hip arthroplasty is considered to be one of the most successful orthopedic interventions of its generation, and it completely changed the way of treatment of arthritic hip.It also had great influence on treatment of other joints.Hearwith we described the history of total hip arthroplasty from the first attempts to treat a painful and arthritic hip.

Background: The muscle sparing total hip arthroplasty had generated a distinguishable interest, in both the patients and the surgeons, but its benefits are still often questioned. The main idea of this study was to compare the functional clinical outcome of the patients operated by the anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach), and the patients operated by modified direct lateral approach without the muscle-sparing technique (Bauer/Hardinge approach).Methods: The patients (N = 130) were divided into two groups: 68 in a standard method group (STAND) and 62 patients in a muscle sparing surgery group (MSS). The hip flexibility, mobility, the strength of the hip abduction, the pain scale, Harris hip scores, the duration of the hospital stay and the overall satisfaction were measured seven days, three months, one year and three years (in 80 patients) after the surgery. There were no differences in any of the parameters between the groups prior to the procedure.Results: The statistically significant differences in first three follow-ups (up to one year) were determined between the groups in passive and active hip flexion ability but the hip abduction strength, which is a crucial parameter for functional recovery, and 50 m walk test remained better in MSS group even after three years. Patients, who underwent MSS suffered also less pain, stayed in hospital shorter and were more satisfied with the operation outcome.Conclusions: The functional recovery in patients treated with muscle sparing method was faster than in patients operated with conventional lateral approach. Based on the results, we could recommend anterolateral muscle sparing approach for a total hip replacement for its faster and fuller functional recovery. (C) 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Covering articular surfaces, articular cartilage ensures load bearing and low frictional movement in synovial joints. Articular cartilage has a specific macroscopic, microscopic and molecular structure characterized by an extremely small number of cells – chondrocytes (2 to 10% of the total volume of tissue), which produce and maintain the integrity of the large amount of extracellular matrix in the relatively hypoxic and hyponutritional conditions, due to the lack of blood vessels. In addition, mitotic activity and regeneration potential of chondrocytes are extremely low, which is why articular cartilage does not show its complete tissue regeneration after damage, but it is replaced by the biomechanically poorer bonding cartilage. Despite the development of numerous pharmacological and surgical procedures for treatment of the damaged articular cartilage, they have shown a number of limitations, and currently there is no ideal therapeutic procedure that would lead to a complete morphological and functional restoration of damaged articular cartilage. However, thanks to advances in cellular and molecular biology and tissue engineering, significant progress in understanding mechanisms of maintaining the integrity of tissues and organs have been made, which led to the creation of new concepts of treatment, based on the fundamental principles of relations between elements of regenerative trias. This article briefly describes the role of each element of the trias: productive cells, conductive carrier and signaling molecules as an inductive element of the articular cartilage regeneration.