Background:Reconstruction of the anterior cruciate ligament (ACL) often causes severe postoperative pain. This study aimed to assess how dexamethasone affects the analgesic effectiveness of the adductor canal block (ACB), opioid use, and rebound pain after ACL reconstruction with a bone-patellar tendon-bone (BPTB) graft. Methods:This non-randomized prospective study analyzed a total of 160 patients, who were divided into two groups: the Dexamethasone + ACB group and the ACB group. Results:Within the first 24 h after surgery, there was no difference between the groups in the percentage of patients experiencing pain (73.75% vs. 85%; χ 2 = 2.4433; p = 0.118) or in pain severity during activity (1.74 ± 0.97 vs. 1.59 ± 0.65; p = 0.779). During the first 48 h after surgery, no significant difference was observed in opioid use between the groups. Three patients in the non-dexamethasone group reported rebound pain (χ 2 = 0.2564; p = 0.61), while blood glucose levels were significantly higher in the dexamethasone group (χ 2 = 4.329; p = 0.037). Conclusion:The addition of dexamethasone to the local anesthetic during ACB after ACL reconstruction is not supported due to the lack of benefits related to postoperative pain levels and the associated increase in glucose levels.

The analgesic efficacy of nerve blocks depends on the duration of local anesthetics, whose effects can be extended with adjuvant drugs. This prospective interventional study aimed to assess the impact of adding dexamethasone to levobupivacaine on the postoperative analgesic efficacy of the adductor canal block (ACB) and IPACK block after knee arthroplasty (TKA), as well as the incidence of rebound and chronic postsurgical pain. One year after TKA, 80 patients were analyzed (dexamethasone vs. control group). Opioid analgesics were administered to 10% of patients in the dexamethasone group and 50% of patients in the control group (χ2 = 13.393, p < 0.001), with no difference in opioid dosage (p = 0.368) during the first 24 h postoperatively. Rebound pain was observed in 5% of patients in the dexamethasone group and 30% in the control group (χ2 = 7.013, p = 0.008). Chronic postsurgical pain 1 year after TKA was found in 5% of patients in the control group, without significant differences between the groups. Adding dexamethasone to the local anesthetic for ACB and IPACK blocks, along with a non-opioid scheduling strategy, enhances postoperative pain management, reduces opioid consumption, and helps decrease the occurrence of rebound pain and chronic postsurgical pain 1 year after TKA.

OBJECTIVES:Osteoarthritis (OA), a prevalent and disabling condition, significantly burdens individuals and healthcare systems worldwide. It is characterized by joint pain, stiffness, and structural changes in cartilage, bone, and synovium. The clinical manifestations of OA vary widely, reflecting complex interactions among genetic, metabolic, biomechanical, and environmental factors. Despite progress in identifying OA clinical phenotypes, inconsistent terminology, including "phenotypes," "subtypes," and "subgroups," hinders effective communication and research translation. This review aims to synthesize existing literature on clinical OA phenotypes, terminology, and definitions and propose a research agenda. METHOD:This scoping review followed PRISMA-ScR guidelines, focusing on publications from 2010 to 2023 investigating clinical phenotypes in adult OA patients. Searches were conducted in MEDLINE, SCOPUS, and EBSCOhost using combinations of terms related to clinical phenotypes in OA. Studies were screened, duplicates removed, and relevant data were charted and analyzed by two independent reviewers. RESULTS:From 196 identified studies, 50 were included in the final analysis. Eight clinical phenotypes were categorized, including inflammatory, biomechanical, metabolic, and pain-sensitization. minimal joint disease, psychologically driven, menopause, severe radiographic. Most studies focused on knee OA, with limited exploration of hand, midfoot, and hip OA. Phenotype-based management strategies demonstrated potential for improving treatment outcomes and guiding research. CONCLUSION:Standardizing terminology and leveraging phenotype-based frameworks hold promise for advancing personalized OA care and research. Future efforts should focus on validating criteria, developing accessible diagnostic tools, and addressing understudied OA phenotypes. This work highlights the value of tailoring interventions to specific OA phenotypes for improved patient outcomes. CLINICAL TRIAL NUMBER:Not applicable.

Background and Objectives: Despite the high rate of donor site morbidity, a bone–patellar tendon–bone (BPTB) graft remains the gold standard when choosing a graft for anterior cruciate ligament (ACL) reconstruction. Damage to the infrapatellar branch of the saphenous nerve (IPBSN) during graft harvesting results in sensory deficits. Despite its high occurrence in the postoperative period, many patients go untreated, leading to a lower quality of life and potential professional impairment. The aim of this study was to assess the effectiveness of PRF therapy in alleviating sensory deficits and enhancing sensory nerve function in patients who have undergone BTB ACL reconstruction. Materials and Methods: This study was registered at ClinicalTrials.gov (Name of registry: ClinicalTrials.gov; Trial registration number: NCT07257666; Date of registration: 2 December 2025; Study start date: 7 January 2022). Over a one-year period, the pilot study enrolled 53 patients, treated them with BPTB ACL reconstruction, and divided them into two groups. The testing group’s donor site and subcutaneous tissue were treated with Vivostat® PRF, whereas the standard group’s donor site and subcutaneous tissue remained untreated. The primary outcome measured was a reduction in the subjective numbness, which was tested during follow-up checks. Secondary outcomes included the evaluation of subjective knee scores for functional recovery, reported by the patients on control exams. Results: The use of Vivostat® PRF resulted in a statistically significant reduction in sensory deficit among the groups at eight months (p < 0.05) and twelve months (p < 0.01) following surgery, favoring the testing group. The most substantial decrease in symptomatic patients was observed between four and eight months post-surgery, with no statistically significant difference found between the eight- and twelve-month follow-ups (p > 0.05). Evaluations of subjective knee function and activity scores showed no statistically significant differences between the groups. Conclusions: Using Vivostat® PRF helps reduce sensory impairment in the area and minimizes donor site morbidity after BPTB ACL reconstruction.

We present the case of a 23-year-old patient who sustained a gunshot wound (GSW) during a mass shooting and had an unrecognized rupture of the patellar tendon. The patient was treated with a single-stage reconstruction, using only the semitendinosus tendon with preserved distal tendon insertion and two tunnels, transtibial and trans patellar, along with McLaughlin augmentation of the repair. The reconstruction proved strong enough to withstand the postoperative rehabilitation process. At the one-year follow-up, the patient walked without pain, had a full range of motion, and had enough muscle strength in the upper leg. The MRI showed the injured leg had almost the same Insall-Salvati ratio and Caton-Deschamps index as the uninjured leg.

Within the last two decades, total knee replacement has become one of the most dominant operating procedures in orthopaedic surgery and traumatology. We witness a growth of the elderly population globally, which results in an increased number of patients with osteoarthritis whose clinical evaluation and subjective concerns require total knee replacement. The majority of patients who underwent surgical procedure are satisfied with the outcome in the long term follow-up period. However, these is still certain percent of patients who underwent surgical procedure who are not satisfied with the outcome. The reasons of dissatisfaction are mostly due to intraoperative and postoperative treatment solutions for surgical complications. The aim of this paperwork is to systematize all potential complications, as well as its diagnostic methods and further treatments in clinical practice. It also aims to highlight possible root causes for these complications in pre-operative selection of patients, intraoperative and post-operative treatment solutions.

Introduction. Peri-implant femoral fractures (PIFF) are defined as fractures of the femur with the presence of previously implanted non-prosthetic osteosynthetic material. A review of available literature revealed that there are several proposed classifications and sets of guidelines for surgical treatment of PIFF. Case outline. A 49-year-old patient was injured from a fall on the same level, the day before admission to the hospital. The anamnesis at admission showed that six months earlier, he had sustained a pertrochanteric fracture of the left femur, which had been treated surgically with a short cephalomedullary nail. Two years prior to hospital admission, the patient had sustained a tibial plateau fracture of the same leg, which was treated non-surgically with above the knee cast immobilization. After the fracture had healed, paresis of the peroneal nerve was diagnosed, while subsequent follow-up revealed secondary post-traumatic arthrosis of the knee joint. Reduction and fixation of the fracture was performed on a surgical extension table, with the use of fluoroscopy. Previously implanted osteosynthetic material was removed, a short cephalomedullary nail, and fixation of the fracture was carried out with a long cephalomedullary nail. Six months after the operation, the patient can ambulate independently, without assistance. He reports no pain in the left groin and upper leg but reports pain and limitation of movement in the left knee joint. Conclusion. By reviewing the available literature, we found that the patient was cared for in our hospital in keeping with all current recommendations for surgical treatment of this type of fracture.

Background and Objectives: Total knee arthroplasty (TKA) has become the treatment of choice for advanced osteoarthritis. The aim of this paper was to show the possibilities of optimizing the Perth CT protocol, which is highly effective for preoperative planning and postoperative assessment of alignment. Materials and Methods: The cross-sectional study comprised 16 patients for preoperative planning or postoperative evaluation of TKA. All patients were examined with the standard and optimized Perth CT protocol using advance techniques, including automatic exposure control (AEC), iterative image reconstruction (IR), as well as a single-energy projection-based metal artifact reduction algorithm for eliminating prosthesis artifacts. The effective radiation dose (E) was determined based on the dose report. Imaging quality is determined according to subjective and objective (values of signal to noise ratio (SdNR) and figure of merit (FOM)) criteria. Results: The effective radiation dose with the optimized protocol was significantly lower compared to the standard protocol (p < 0.001), while in patients with the knee prosthesis, E increased significantly less with the optimized protocol compared to the standard protocol. No significant difference was observed in the subjective evaluation of image quality between protocols (p > 0.05). Analyzing the objective criteria for image quality optimized protocols resulted in lower SdNR values and higher FOM values. No significant difference of image quality was determined using the SdNR and FOM as per the specified protocols and parts of extremities, and for the presence of prothesis. Conclusions: Retrospecting the ALARA ('As Low As Reasonably Achievable') principles, it is possible to optimize the Perth CT protocol by reducing the kV and mAs values and by changing the collimation and increasing the pitch factor. Advanced IR techniques were used in both protocols, and AEC was used in the optimized protocol. The effective dose of radiation can be reduced five times, and the image quality will be satisfactory.

Background and Objectives: A bone–patellar tendon–bone (BTB) autograft in anterior cruciate ligament reconstruction (ACLR) is still considered the gold standard among many orthopedic surgeons, despite anterior knee pain and kneeling pain being associated with bone defects at the harvest site. Bioregenerative products could be used to treat these defects, perhaps improving both the postoperative discomfort and the overall reconstruction. Materials and methods: During a year-long period, 40 patients were enrolled in a pilot study and divided into a study group, in which bone defects were filled with Vivostat® PRF (platelet-rich fibrin), and a standard group, in which bone defects were not filled. The main outcome was a decrease in the height and width of the bone defects, as determined by magnetic resonance imaging on the control exams during the one-year follow-up. The secondary outcomes included an evaluation of kneeling pain, measured with a visual analog scale (VAS), and an evaluation of the subjective knee scores. Results: The application of Vivostat® PRF resulted in a more statistically significant reduction in the width of the defect compared with that of the standard group, especially at 8 and 12 months post operation (p < 0.05). Eight months following the surgery, the study group’s anterior knee pain intensity during kneeling was statistically considerably lower than that of the standard group (p < 0.05), and the statistical difference was even more obvious (p < 0.01) at the last follow-up. Each control examination saw a significant decrease in pain intensity in both the groups, with the values at each exam being lower than those from the prior exam (p < 0.01). A comparison of subjective functional test results 12 months post operation with the preoperative ones did not prove a statistically significant difference between the groups. Conclusions: The use of Vivostat® PRF reduces kneeling pain and accelerates the narrowing of bone defects after ACLR with a BTB graft, but without confirmation of its influence on the subjective knee score.

IntroductionPeripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP).MethodsThis prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA.Results166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg).ConclusionPeripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.

This observational study aimed to identify predictors of kinesiophobia and examine its correlation with early functional outcomes in TKA recipients. On the first and fifth postoperative days (POD1 and POD5), we evaluated pain using the International Pain Outcomes Questionnaire (IPO-Q) and created multidimensional pain composite scores (PCSs). The Total Pain Composite Score (PCStotal) assesses the overall impact of pain, taking into account outcomes of pain intensity, pain-related interference with function, and emotions and side effects. Functional status on POD 5 was determined by the Barthel index, 6 min walking test, and knee range of motion. Kinesiophobia was assessed on POD5 using the Tampa Scale for Kinesiophobia (TSK). Among 75 TKA patients, 27% exhibited kinesiophobia. The final regression model highlighted PCStotal on POD5 (OR = 6.2, CI = 1.9–19.9), PCStotal (OR = 2.1, CI = 1.2–3.8) on POD1, and the intensity of chronic pain before surgery (OR = 1.4, CI = 1.1–2.1) as significant kinesiophobia predictors. On POD5, those with kinesiophobia showed increased dependency, slower gait, and poorer knee extension recovery. This study emphasizes the need to identify and address kinesiophobia in TKA patients for better functional outcomes and recovery. Additionally, it is vital to assess different domains of pain, not just pain intensity, as it can lead to kinesiophobia development.

Introduction: Hand injuries often result in soft tissue defects. The treatment of these defects belongs to the most difficult challenges in reconstructive surgery. There are numerous options for covering soft tissue defects, including flaps and skin grafts. Material and methods: This retrospective observational study included seventeen patients with 24 skin defects of the hand, who were treated by primary split-thickness skin graft (STSG) in a single center. The average follow-up period was 6 months. The age of the patients ranged from 36 to 80 years. The majority of patients (n=16) were males, and one patient was female. Skin defects varied in size from 7x8mm to 39x40mm. Primary goals were STSG survival, recipient site infection, and donor site morbidity. Secondary goals were cosmetic appearance and time needed for complete wound healing. Results: All 24 wounds healed successfully in a mean of 28,11±9,94 days. There were no graft infections. Partial graft loss occurred in one case. There was no major donor site morbidity reported. Six patients described the cosmetic result as good (score 3), 10 patients dde-scribed it as acceptable (score 2), and one patient described it as poor (score 1). Conclusion: Split thickness skin graft is an excellent option for immediate treatment of hand and finger skin defects. This method is simple , has less consequences than secondary grafts, requires minimum equipment and can sometimes be done in the emergency room, without hospitalization. Therefore, there is no need to be afraid of primary skin grafting.

Kinesiophobia (fear of movement) has been recognized as a significant barrier to recovery and rehabilitation in patients after total knee arthroplasty (TKA). Our goal was to identify predictors of kinesiophobia and examine its correlation with early functional outcomes in TKA recipients. On the first and fifth postoperative days (POD1 and POD5), we evaluated pain using the International Pain Outcomes Questionnaire (IPO-Q) and created multidimensional pain composite scores (PROs). Functional status on POD 5 was determined by the Barthel index, 6-minute walking test, and knee range of motion. Kinesiophobia was measured on POD5 using the Tampa Scale for Kinesiophobia (TSK) and multivariable logistic regression was used to assess factors associated with kinesiophobia. Among 75 TKA patients, 27% exhibited kinesiophobia. The final regression model highlighted PRO1 (OR=1.6, CI=1.1-2.5), PRO2 (OR=2.1, CI=1.3-3.5), and education level (OR=0.6, CI=0.04-10.6) as significant kinesiophobia predictors. On POD5, those with kinesiophobia showed increased dependency, slower gait, and poorer knee extension recovery. Pain is a significant predictor of kinesiophobia after TKA. Furthermore, kinesiophobia has a significant impact on early functional outcomes after surgery. Using composite pain scores for pain evaluation offers a more comprehensive approach to understanding the connection between pain and kinesiophobia.

Background and Objectives: Idiopathic anterior knee pain is a common condition in adolescents and is mostly of unknown cause. The aim of this study was to examine the influence of the Q-angle and muscle strength on idiopathic anterior knee pain. Materials and Methods: Seventy-one adolescents (41 females and 30 males) diagnosed with anterior knee pain were included in this prospective study. The extensor strength in the knee joint and the Q-angle were monitored. The healthy extremity was used as a control. The Student’s paired sample t-test was applied for testing the difference. Statistical significance was set at 0.05. Results: There was no statistically significant difference in the Q-angle value between the idiopathic AKP and the healthy extremity (p > 0.05) within the entire sample. A statistically significant higher Q-angle of the idiopathic AKP knee (p < 0.05) was obtained in the female subgroup. No statistically significant difference (p > 0.05) was found in the male subgroup. Within the male subgroup, the strength of the extensors within the knee joint of the healthy extremity had statistically significant higher values than the strength of these muscles in the affected extremity (p < 0.05). Conclusion: A greater Q-angle is a risk factor linked to anterior knee pain within the female population. Decreased muscle strength of knee joint extensors is a risk factor linked to anterior knee pain in both sex subgroups.

Periprosthetic joint infection (PJI) after total knee arthroplasty remains a challenging complication. The treatment options for PJI include different procedures; however, regardless of the strategy, antibiotics are required. The combination of different antibiotics increased the rates of PJI eradication. For almost 3 decades, rifampicin has been used as part of antibiotic therapy for PJI. Drug fever, a febrile response that coincides with the onset of drug administration and disappears after drug discontinuation in the absence of other underlying conditions that could cause fever, is frequently misdiagnosed. We present the case of a 72‐year‐old man with PJI 6 months after total knee arthroplasty. Two‐stage revision surgery was followed by culture‐directed antibiotic treatment (ciprofloxacin and rifampicin) against Staphylococcus aureus isolated from the periprosthetic tissue. On the fifth day of antibiotic treatment, the patient became febrile and, in the next 5 days, he had an intermittent fever of up to 40°C, although he showed clinical improvement. The patient was normotensive without a maculopapular rash, urticaria or clotting abnormalities. A drug fever was suspected, and rifampicin was discontinued. A re‐challenge test was performed, and the fever recurred. Antibiotic treatment with ciprofloxacin was continued and, after 12 months of follow‐up, the patient was doing well. Clinicians should be aware that fever could be a clinical presentation of drug fever. If it occurs during an infection, drug fever could necessitate additional diagnostic procedures for further evaluation, inadequate antibiotic therapy and prolonged hospitalisation.

Eggerthia catenaformis has been reported as a human pathogen. We present the first case of the primary knee infection caused by Eggerthia catenaformis in a 23-year-old male patient with a knee infection, after primary anterior cruciate ligament reconstruction. Eggerthia catenaformis was confirmed by MALDI-TOF mass spectrometry from synovial fluid. The dental focus was excluded. The isolated bacterial strain showed sensitivity to all of the tested antimicrobials. However, for successful management of knee infection, besides culture-directed antibiotics therapy, arthroscopic debridement and lavage were necessary.

Purpose: The femoral condyle diameter may influence anterior tibial translation whose main stabilizer is the ACL. The aim of this study is to determine the influence of the size of the lateral and medial femoral condyles on ACL rupture. Methods: 41 matched pairs of subjects were included in the study who had suffered knee injury and were either professional or recreational athletes engaged in track and field or sports involving intensive rotation movements. The experimental group was composed of patients with ACL rupture, while the control group comprised patients with joint distortion without ACL. The diameter of the medial and lateral condyles were measured on sagittal MRI images of these patients’ knees. Results: Subjects with ACL rupture had a highly statistically significantly shorter diameter of the lateral condyle as compared to their matched pairs from the control group (p<0.01). Also, the lateral condyle of the subjects with ACL rupture had a significantly lesser diameter as compared to the medial condyle (p<0.01), which was not the case in patients without ACL rupture (p>0.05). Patients with intact ACL demonstrated significant indirect correlation of the diameter of both femoral condyles with the valgus angle of the lower leg (p<0.01). Conclusions: The shorter diameter of the lateral femoral condyle is connected with ACL rupture, both in women and men. The lack of correlation between the diameter of the femoral condyles and the valgus angle of the lower leg also represents a factor connected to ACL rupture.

Amputations have a devastating impact on patients’ health with consequent psychological distress, economic loss, difficult reintegration into society, and often low embodiment of standard prosthetic replacement. The main characteristic of bionic limbs is that they establish an interface between the biological residuum and an electronic device, providing not only motor control of prosthesis but also sensitive feedback. Bionic limbs can be classified into three main groups, according to the type of the tissue interfaced: nerve-transferred muscle interfacing (targeted muscular reinnervation), direct muscle interfacing and direct nerve interfacing. Targeted muscular reinnervation (TMR) involves the transfer of the remaining nerves of the amputated stump to the available muscles. With direct muscle interfacing, direct intramuscular implants record muscular contractions which are then wirelessly captured through a coil integrated in the socket to actuate prosthesis movement. The third group is the direct interfacing of the residual nerves using implantable electrodes that enable reception of electric signals from the prosthetic sensors. This can improve sensation in the phantom limb. The surgical procedure for electrode implantation consists of targeting the proximal nerve area, competently introducing, placing, and fixing the electrodes and cables, while retaining movement of the arm/leg and nerve, and avoiding excessive neural damage. Advantages of bionic limbs are: the improvement of sensation, improved reintegration/embodiment of the artificial limb, and better controllability. Cite this article: EFORT Open Rev 2020;5:65-72. DOI: 10.1302/2058-5241.5.180038

The aim of this study was to determine the outcome for patients who sustain a second hip fracture compared with those who sustain a first fracture, and to define the optimal measure to evaluate functional outcome after second hip fracture. Methods: 343 patients with acute hip fractures who presented during a 12 month period were included in the study. Patients with a first (318 patients, 78.10 +/− 7.53 years) and second (25 patients, 78.96 +/− 6.02) hip fracture were compared regarding all baseline variables. Regression analysis was also performed to assess the independent relationship between the presence of a second hip fracture and observed outcome variables at discharge (physical disability, complications, length of stay, and mortality) and one-year after surgery (physical disability and mortality). Results: Disability when performing instrumentalized activities of daily living (IADL) at one-year follow-up is independently related to the presence of a second hip fracture. There were no other statistically significant relationships between the presence of a second hip fracture and other observed outcome variables. Conclusions: Patients with a second hip fracture showed worse functional outcome at one-year follow-up when measured with the IADL scale. No increased short-nor long-term mortality rates were found in patients with a secondary hip fracture. IADL is a good tool to assess disability after a second hip fracture and could be thus a more reliable outcome measure when investigating differences in functional recovery in patients with a second hip fracture compared to conventionally used ADL scales.

Ay anesthesia for orthopedic surgery is challenging for anesthesiologist from the patient's perspective, the type of surgery as well as the patient's position during the surgery. Patients may be old with numerous comorbidities but also young, healthy trauma patients who have associated injuries that can have a significant impact on the type of anesthesia. Therefore, it is imperative that the anesthesiologist in orthopedic surgery examine the entire patient and not just focus on the area of surgery, but also to make an adequate preoperative assessment and preparation. In the preoperative preparation of orthopedic patients cardiological, pulmological and neurological evaluation is most often needed, nasal screening and decolonization, preoperative skin preparation, glycemic control and the use of antibiotic prophylaxis. Patients undergoing major orthopedic surgery are at highest risk for venous thromboembolism both during and after surgery, so that the timing of thromboprophylaxis as well as its continuation in orthopedic patients is of exceptional importance. For the optimal use of adequate thromboprophylaxis there are several published guidelines with clear recommendations for daily clinical practice. Understanding the type and course of the surgery as the patient position during surgery provide adequate working conditions with minimal blood loss and complications. Reduction of bleeding, as intraoperatively and postoperatively have been achieved by normovolemic hypotension, tourniquet, but also by topical or systemic application of tranexamic acid.As a surgery with high postoperative requirements in analgesia within the multimodal approach, besides the peripheral nerve blocks, the periarticular injection of local anesthetics is increasingly used in everyday work. Knowing the specificity and requirements of an orthopedic surgery with adequate preoperative preparation, selection of anesthesia type and intraoperative plan in order to reduce intraoperative bleeding requires adapting to each patient individually.