Background:Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).Objective:The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.Methods:A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.Results:Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.Conclusion:Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

Level IV.

ObjectiveChondroblastoma is a benign aggressive tumor which needs surgical treatment and has a recurrence rate up to 35%. Extended (aggressive) curettage is the mainstay of treatment and local adjuvants have been reported to decrease the recurrence rate.MethodsThe recurrence rates and the functional results of 14 patients who were treated in our institution and 2 other patients who were treated elsewhere between the years 2004–2016 were evaluated. Seventeen cases (13 male, 3 female; mean age: 17.1 [range: 13 to 32] years) who had been diagnosed, treated and followed up in our hospital between 2004 and 2016 were evaluated in terms of recurrence rates and functional outcomes. The average follow-up period was 41.6 (range: 12 to 132) months.ResultsFive cases of recurrence were observed. Two cases had undergone their primary treatment in another institution. Seven cases were performed curettage alone whereas nine others were administered adjuvant treatments. One of the five recurrence patients was advised to undergo disarticulation. Another was treated with curettage and grafting and the remaining three patients with curettage and cementing. No recurrence was observed in their follow-up period. Their mean MSTS score was 27.3 (range: 4 to 30) over a maximum of 30 points and their functional results were good.ConclusionChondroblastoma is a tumor with high recurrence rates in the post-treatment period. However, good functional outcomes can be achieved with early diagnosis and appropriate treatment even after recurrence.Level of evidence: Level IV, therapeutic study.

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Background:Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research.Objective:We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement.Methods:ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement.Results:In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group.Conclusion:The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up.

The aim of this retrospective study was to compare clinical outcomes of the TransFix (Arthrex Inc., Naples, FL) fixation method and the brand-new AperFix (Cayenne Medical, Scottsdale, AZ) device in arthroscopic reconstruction of anterior cruciate ligament. A total of 38 patients with isolated complete anterior cruciate ligament rupture underwent arthroscopic reconstruction via two different fixation methods using hamstring autografts. Patients were evaluated in terms of range of motion values, Lysholm scores, laxity testing, and complications. Average flexion was 136.53 AE 6.9 degrees in the TransFix group and 126.32 AE 4.9 degrees in the AperFix group (p < 0.001). Mean Lysholm score was 82.42 AE 8.5 in the TransFix group and 88.68 AE 9.4 in the AperFix group (p < 0.022). There was no significance between the two groups in terms of laxity testing and complication rates. In the early postoperative period, satisfactory and comparable clinical results were achieved with the AperFix system when compared with crosspin fixation in arthroscopic anterior cruciate ligament reconstruction.

HighlightsThe first case of isolated rupture of vastus intermedius tendon in the literature.Partial quadriceps tendon rupture can be treated by conservative therapy.