Introduction:This study was conducted to analyze the reliability of clinical diagnosis in ACL tear injuries.Material and methods:All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. From one hundred and three patients with knee problems in 73 were arhroscopicaly diagnosed ACL tears. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings.Results:The accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Our study revealed high sensitivity and specificity and almost high accuracy for ACL injuries of knee joint in comparison to arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients.Conclusion:Magnetic resonance imaging is accurate and non invasive modality for the assessment of ligamentous injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee.

Introduction. There are various methods of anterior cruciate ligament (ACL) reconstruction of which the two main choices in autograft reconstruction involve the use of the bone-patella tendon-bone or hamstring graft. Femoral fixation can be divided into three main types: cortical suspensory devices such as Endobutton (Smith & Nephew, Arthrex), interference screws, and femoral transfixation devices such as Transfix (Arthrex) and Rigidfix (Depuy-Mitek). The aim of this study was to compare the clinical outcome between Rigidfix, Transfix and Endobutton devices for soft tissue femoral fixation in primary ACL reconstruction using the autogenous hamstring graft. Methods. We conducted our study in 48 patients admitted to our clinic, University Traumatology Clinic, Clinical Center "Mother Teresa", Skopje for ACL reconstruction from September 2009 to May 2013. The patients with ACL reconstruction were assigned as Rigidfix group (n=28), the second patients to Transfix group (n=13) and the third to Endobutton group (n=7). MRI of the knee joint was done prior to surgery. A data sheet, containing demographic data, examination findings and Tegner & Lysholm score, was completed for each patient. Results. Tegner & Lysholm the average scores before surgery were 2.52 and 34.75 (p>0.05). Six month after arthroscopy, the average value of Tegner and Lysholm scores in patients with ACL reconstruction was 8.37 and 89.08. Comparison among them showed that the operative mode of Endobutton femoral fixation had the highest level of the Lysholm score. Conclusions. Endobutton (Tight rope-RT) yielded a better outcome compared to the other two modes of femoral fixation in terms of instant stability of the graft and the general results.

INTRODUCTION:In the past distal tibia fractures, including intraarticular fractures, frequently led to poor functional outcomes. The Ruedi-Allgower four steps open method, and later the Patterson and Sirkin recommendations for delayed operative treatment has made a drastic advancement in the treatment of these fractures. The two-stage minimally-invasive protocol using locking plate fixation proved a historical turning point, improving functional results to the highest levels compared to all other methods.AIM:To present the superior results of the two-stage minimally-invasive method using locking plate fixation, making this a historic step forward in treating distal tibia fractures.MATERIAL AND METHODS:A prospective longitudinal study, collecting data from Traumatology-Clinic in the 2014-2016 periods, available for nine-month follow-up. Twenty-three patients were finally included in the study.RESULTS:In analysing the data collected, we focused our attention on the final functional outcomes as indicated by dorsiflexion nine months after injury and also according to the AOFAS Ankle-Hindfoot Scale. Results were excellent with no or minimal consequences. Where complications were present, these were benign and did not require further surgery.CONCLUSION:We believe this modern method for the treatment of distal tibia fractures should be applied routinely and considered as the gold standard in this domain.

Introduction: This study was conducted to compare the clinical and arthroscopic findings in lateral and medial meniscal tear injuries in order to assess the diagnostic significance of the clinical examinations findings. Patients and methods: All patients attending our clinic with knee pain from 2009. to 2013. underwent systematic and thorough clinical assessment. From one hundred and three patients with knee problems in 40 were diagnosed LM (lateral meniscus) tears and in 45 MM (medial meniscus) tears arthroscopically. In this study meniscal tears were clinically diagnosed by positive McMurray and Apley test. All clinically diagnosed patients underwent diagnostic and therapeutic knee arthroscopy to assess the accuracy of clinical diagnosis. The accuracy, PPV, NPV, sensitivity and specificity were calculated based on clinical examinations and arthroscopic findings. Results: Identification of meniscal tears in our study was presented with 85% accuracy of "McMurray" clinical examination test for LM tears and 80% accuracy for the MM tears, and for "Apley" clinical examination test for LM tears was obtained with 73% accuracy and 63% accuracy for MM tears. Conclusion: According to our findings we can conclude that McMurry clinical examination test is more accurate for predicting i.e. diagnosing of meniscal tears. Contrary, Apley clinical examination test showed less accuracy for predicting i.e. diagnosing of meniscal tears.

Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. This study analyzes and compares the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. In the period 2015-2017, 36 patients with 37 large acetabular defects were treated with porous metal augments in cemented and uncemented acetabular revisions. Postoperatively, patients were monitored for two years on average period of 24-36 months. Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. We used lateral approach, 36 mm femoral head, and cementless or cemented acetabular cup depending on local bone quality. Postoperatively, all patients followed total hip arthroplasty precautions, with weight bearing as tolerated regimen with use of crutches during 6 weeks after surgery. The follow-up was radiological and clinical. We used HHS. At a mean follow-up of two years (range 24-36 months) one patient had reinfection and one patient had infection. None of the patients shown signs of aseptic augment or acetabular cup loosening. Porous metal augments show comparable excellent radiographic and clinical short-term outcomes, when combined with cemented or uncemented cups in revision hip arthroplasty. They allow good bone ingrowth, adequate implant contact and good stability. Complications were related to infection and not related to the augments itself.