Jan Zabrzyński

Background: Lateral extra-articular tenodesis (LET) is a surgical procedure that is additionally implemented in concurrent anterior cruciate ligament reconstruction (ACLR). Although numerous articles have addressed the use of LET in conjunction with ACLR, few definitive contraindications were identified. Given the scarcity of literature evaluating contraindications for LET modality, this study aimed to systematically review the reported contraindications of this procedure in the context of concurrent ACLR. Methods: The searched key terms: (extra-articular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament), with no publication date restrictions in PubMed, ScienceDirect, Cochrane Central, Web of Science, and Embase databases. We included clinical human studies, with levels of evidence I–III and in the English language. Results: The analysis evaluated fourteen articles published between 2012 and 2024. Level III evidence was found in the majority of studies (n = 9) and Level I evidence was found in the rest (n = 5). The majority of the included articles were retrospective (n = 8) and there were also prospective studies (n = 6). The articles reviewed showed that articular cartilage damage and concomitant injuries to other knee ligaments, alongside ACL injury, are the most frequently mentioned. Conclusions: This is the first study that systematized the contraindications for the LET procedure in ACLR. The contraindications remain unclear; however, the following may be highlighted: articular cartilage damage and injury to another ligament in the knee, in addition to ACL injury.

Objective: To evaluate patient-assessed quality of life (QoL) following operative treatment of acetabular fractures and pelvic ring injuries and identify differences in their assessment of QoL depending on sex and age group. Methods: The study included 75 patients, 41 who had suffered acetabular fractures and 34 pelvic ring fractures, who had been treated operatively over a 6-year period (2017–2022). Post-operative HRQOL scores were evaluated using the World Health Organization Quality of Life BREF scale (WHQOL-BREF) and RAND Short Form 36 (SF-36). Separate analyses were completed for men and women, and we compared the data between five age groups. Results: The male patients scored slightly higher in all domains than the women in the acetabular fracture group. In the ring fracture group women reported higher scores in the psychological (72.67 vs. 69.44) and social domains (81.67 vs. 77.08). The men (80%) reported more significant overall satisfaction with their health in the acetabular group compared with the women (p = 0.0306). In the SF36 analysis, for both acetabular and ring fracture groups the lowest average QoL was recorded in the physical health composite summary (PHC) with a score of 41.34 ± 9.49 and 41.21 ± 9.19, respectively. Men scored higher for all eight scales in the ring fracture and all except general health in the acetabular fracture group (p = 0.0166). For the mental health composite (MHC), men had a better mean score in both fracture groups with significant differences for between both genders for the acetabular group (p = 0.0352). For age group analysis of the SF36, in the acetabular group, the youngest age group (70 years) (p = 0.0306 and p = 0.0069, respectively), similarly to the PHC (p = 0.0279). Additionally, for the overall mental health summary of the acetabular group for the five age groups, there were significant differences between the youngest age group and the oldest age group (p = 0.0372). In contrast, for the ring fracture group, the oldest age group (>70 years) scored the worst in all four scales of the physical health composite and the 70 years and the highest in the 61–70 years age group, with a statistical significance (p = 0.0367). Conclusions: Patients that sustain a pelvic fracture and are treated operatively are at a higher risk of deterioration in quality of life. Using both functional assessments, male patients emphasized improved quality in more spheres that was evaluated than women.

Background/Objectives: The aim was to provide a comprehensive, systematic review on the Lateral Extra-articular Tenodesis (LET) methods used in anterior cruciate ligament (ACL) reconstruction in the light of recent data. Methods: To identify all of the essential studies that reported relevant data concerning primary outcomes: indications for surgery, surgical technique, graft type, fixation method, and tibial fixation location, an extensive search of the major and significant electronic databases (PubMed, Cochrane Central, ScienceDirect, Web of Science, Embase) was performed by three independent authors. A systematic investigation was conducted in November 2023, with no limits regarding the year of publication. After the database search, three independent reviewers screened all the papers, which followed strictly the inclusion and exclusion criteria, identifying a title, abstract, and full text concerning LET, surgical technique, femoral attachment, tibial attachment, graft type, fixation method, knee angle during fixation, and graft tension at fixation in ACL reconstruction. A systematic review of the collected literature was carried out according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Study quality was assessed using the Cochrane Risk of Bias Tool. Results: Of the 35 papers reviewed, seven surgical techniques of LET differing in the way the procedure was performed were separated. The majority of papers were from Italy (n = 11), USA (n = 3), France (n = 3), and Canada (n = 3). The number of total participants across all studies was 6253. The majority of studies (17 papers) used the Lemaire modified procedure, and 10 papers used the MacIntosh technique modified by the Coker–Arnold approach. Most of the papers mentioned fixation location on the lateral distal part of the femur including six articles referring directly to lateral femoral epicondyle. Most authors (25 papers) defined tibial attachment as Gerdy’s tubercle. The most common graft was the iliotibial band and fixation method was sutures. The types of fixation in the surgical techniques of the collected papers were Sutures, Staples, Anchor, Interference screw, K-wire, Bioabsorbable Screw and Titanium Screw with a serrated polyethylene washer. Conclusions: Despite variability in technique, the Lemaire-modified procedure emerged as the preferred approach for Lateral Extra-articular Tenodesis, suggesting a general consensus around its reliability and reproducibility in clinical practice. The frequent use of the iliotibial band as graft material reflects its accessibility and suitability for reinforcing anterolateral stability. Similarly, the consistent use of sutures and fixation at Gerdy’s tubercle may indicate a favorable balance between technical ease and biomechanical strength. The variability in femoral fixation points—either at the lateral femoral condyle or epicondyle—highlights the ongoing debate or surgeon preference, underscoring the need for further comparative studies to establish optimal fixation strategy. Collectively, these patterns may help guide surgical decision-making, particularly when tailoring procedures to individual patient anatomy or surgical expertise.

Background: Pelvic ring fractures are a significant and growing health problem in the field of trauma and orthopedic surgery. The aim of this paper was to present a concise description of these musculoskeletal injuries, available classification systems, and vascular and genitourinary complications. Results: The most common complications of serious pelvic ring fractures are arterial and venous hemorrhages, as well as urethral injuries. Arterial hemorrhages most often originate from the trunk or branches of the iliac artery, and the standard treatment is pelvic stabilization and implementation of intravascular procedures. In the case of venous hemorrhages, peritoneal pelvic packing is the most important. Conclusions: A multi-disciplinary approach and treatment algorithmization are important to facilitate the prioritization of therapeutic procedures. Treatment of patients with pelvic ring fractures should take place in specialized trauma centers.

Anterior cruciate ligament reconstruction with concurrent lateral extra-articular tenodesis enhances rotational stability. However, not many studies describe radiological features following the abovementioned procedure. The purpose of this study was to evaluate the visibility and describe the sonographic morphology of the iliotibial band strip harvested during the modified Lemaire technique and to establish a correlation between these findings and clinical outcomes. Thirty-two consecutive patients underwent primary or revision anterior cruciate ligament reconstruction with the addition of lateral extra-articular tenodesis by the mini-open modified Lemaire technique. All individuals completed the following preoperative and postoperative questionnaires: the KOOS-pain, KOOS-symptoms, KOOS-ADL, KOOS-sport, KOOS-quality, IKDC, Lysholm, and WOMAC. Each patient underwent a postoperative ultrasound examination to evaluate the lateral extra-articular procedure, especially the harvested iliotibial band strip. The most common ultrasound findings of the iliotibial band strip were its hyperechoic appearance (87.1%), location at the level of the femur (58.1%), no surrounding effusion (83.9%), and no power Doppler signal (100%). Effusion seen in sonographic images was correlated with KOOS-symptoms postoperative scores (p = 0.0115). However, there were no correlations between other iliotibial band strip sonographic features and clinical outcomes. The functional score value increased in each patient compared to preoperative measurements. This is the first study that evaluated the sonographic features of the iliotibial band strip after the lateral extra-articular procedure by the mini-open modified Lemaire technique. Our study indicates that ultrasonography is a useful tool in identifying the iliotibial band strip after the mentioned procedure. Effusion observed around the strip on ultrasound was significantly associated with worse KOOS-symptoms scores, suggesting potential clinical relevance.

Aim: The aim of this study is to assess the prevalence of depressive disorders in patients with pelvic fractures treated surgically at our center in the years 2017–2022. Materials and Methods: The study included 75 patients, 57 men and 18 women, operated on in our center in the years 2017–2022 due to acetabular fracture and pelvic ring injury. Factors such as age, gender, chronic pain measured with the VAS scale, and the incidence of suicidal thoughts were also analyzed. The participants completed the Beck Depression Inventory (BDI). Results: Thirty-five out of the seventy-five patients showed symptoms of depression (BDI score > 11), which is 47%, with an average score of 29 (p < 0.0001). Women obtained an average BDI score of 23, which corresponds to moderate depression on Beck’s scale (p < 0.008). The correlation between BDI score and chronic pain in pelvic trauma patients has been found to be positive (p < 0.0003; r = 0.4094). Furthermore, women in our studied population reported suicidal thoughts more often than men (44% vs. 14%; p < 0.01). No statistically significant correlation was found between the occurrence of depression and the length of hospital stay and the patient’s age (p < 0.5 and p < 0.06, respectively). Conclusions: The prevalence of depression in the pelvic trauma patients of the studied population has been determined to be 47%.

Obesity is a risk factor for thrombosis-related diseases and a condition that leads to vitamin D deficiency. Furthermore, orthopedic conditions are also at risk for diseases associated with coagulation and endothelial function. This study aimed to assess whether vitamin D supplementation in patients with acute (AOCs) and chronic orthopedic conditions (COCs) and coexisting obesity could affect coagulation and endothelial function. Thirty-three obese individuals with AOCs or COCs were included in the study. Patients were supplemented with vitamin D at 4000 IU/day for 3 months. An enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of alpha 2-antiplasmin (α2AP), vascular cell adhesion molecule 1 (VCAM-1), plasminogen activator inhibitor-1 (PAI-1), tissue factor pathway inhibitor (TFPI), and vitamin D, which were examined at two time points—before and after supplementation. Regardless of the increase in serum vitamin D levels in both groups after supplementation, there was a statistically significant increase in VCAM-1 and PAI-1 levels in the group with AOCs, whereas only VCAM-1 increased statistically significantly in the second group. For obese patients with COCs, vitamin D does not appear to have a potentially beneficial effect on coagulation and the endothelium.

Background: The anterior cruciate ligament (ACL) is a major sagittal plane stabilizer of the knee joint. Even if anterior laxity can be brought under control by utilizing modern surgical techniques, internal rotational instability may not always be controlled adequately. Various surgical techniques are used to prevent this coronal or rotational instability, such as lateral extra-articular tenodesis (LET). Despite an abundance of articles in recent decades discussing LET in ACL reconstruction, no definitive indicators for extra-articular tenodesis have been described in the literature. Purpose: Given the scarcity of literature assessing the indications in LET, the purpose of this study was to conduct a systematic review of the described indications for this operation in the context of concurrent ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: We searched PubMed, Cochrane Central, ScienceDirect, Web of Science, and Embase using the following key terms with no limits regarding the year of publication: (extraarticular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament). We included clinical human studies based on levels of evidence 1 to 4 that were written in English. We excluded studies not written in English, case studies, reviews, letters to editors, conference abstracts, or studies containing incomplete or irrelevant data. Results: The analysis evaluated 29 articles published between 1999 and 2023. We evaluated mostly level 3 (n = 13) and level 4 (n = 12) evidence; however, there were 4 articles with level 1 evidence. The majority of the studies were retrospective (n = 21), although there were prospective studies (n = 8). The mean age of the participants was 24.4 years. The most prevalent indications for LET were high-risk sports (16 articles), medial meniscal repair/excision (11 articles), and pivot-shift test grades 2 and 3 (11 articles). Conclusion: The reviewed articles showed reduced pivoting and laxity, improved clinical outcomes, and decreased revision rates after primary ACL reconstruction. The main frequent and repeated indications for using LET in ACL reconstruction are meniscal surgery, sports activity, and grade 2 and 3 pivoting.

Numerous studies have shown that vitamin D may play an important role in modulating the inflammatory process. This study aimed to evaluate the effect of vitamin D supplementation on inflammatory markers in patients with orthopedic disorders and obesity. Thirty-three obese subjects were included in the study and were divided into two groups based on their medical condition: acute orthopedic diseases and chronic orthopedic diseases. Inclusion criteria for the research included age 18–75 years, BMI > 30 kg/m², vitamin D deficiency, and no previous vitamin D supplementation. Samples were collected before and after 3 months of 4000 IU/day vitamin D supplementation. The study used enzyme-linked immunosorbent assay (ELISA) and measured serum levels of markers such as chitinase-3-like protein 1 (YKL-40), interleukin 6 (IL-6), interleukin 17 (IL-17), tumor necrosis factor (TNF-α), and adiponectin. After 3 months of vitamin D supplementation, a statistically significant increase in vitamin D and IL-17 levels was observed in the group with acute orthopedic diseases. Similarly, after supplementation, a statistically significant increase in vitamin D, IL-6 and TNF-α levels was observed in the group with chronic orthopedic diseases. Moreover, after vitamin D supplementation, statistically significantly higher adiponectin levels were observed in the chronic orthopedic group than in the acute orthopedic group. Despite high-dose vitamin D supplementation, inflammatory markers increased in acute and chronic orthopedic conditions. Based on our study, vitamin D does not reduce inflammation in patients with orthopedic conditions and obesity.

This study aimed to investigate the degeneration of the meniscal tissue in osteoarthritic knees and to adapt the Bonar score and its modifications to develop a microscopic examination. This study included consecutive patients who underwent total knee arthroplasty for symptomatic end-stage gonarthrosis. During the surgery, the menisci were completely dissected to preserve their original shapes. The samples were prepared using the hematoxylin and eosin (H&E) staining method and the Alcian blue protocol and were examined under light microscopy. The extent of histopathological changes was assessed based on the classical Bonar score assumptions. Additionally, in the second step of the examination, menisci remnants were evaluated using the modified Bonar score developed by Zabrzyński et al. The study involved 44 patients, from whom 83 samples of knee menisci were obtained. Histological examination of the meniscal specimens under a light microscope revealed tissue degeneration in all cases, in both the medial and lateral menisci. The mean classical Bonar score was 8.3571 and the mean modified Bonar score was 6.9398. There were no statistically significant differences in classical Bonar score assessment between medial and lateral menisci (p = 0.3014). There were no statistically significant differences in the modified-Bonar score assessment between medial and lateral menisci (p = 0.3620). We show that both menisci are implicated in the degenerative process, with high scores in the Bonar system, regardless of knee axial deformity. The Bonar score, along with its modifications, can be readily employed in the microscopic assessment of meniscus pathology.