Christos Koukos

Background : Rotator cuff calcific tendinopathy (RCCT) has traditionally been described as a localized enthesopathy. However, calcium deposits sometimes extend beyond the enthesis into adjacent soft tissues or humeral bone, resulting in atypical patterns not considered in existing classification systems. Failure to recognize these patterns can lead to diagnostic errors or the indication of unnecessary invasive diagnostic procedures. Methods : In order to describe atypical patterns and to assess their incidence, 100 consecutive shoulder cases with radiographically confirmed RCCT were retrospectively reviewed. Calcific deposits were categorized by tendon involvement, size, and morphology. Based on imaging findings, deposits were also classified according to their anatomic location and extension into: Type I (enthesis-confined), Type II (extension into soft tissue), and Type III (bone involvement). Associations between patient characteristics, calcification size, morphology, and location were analyzed. Results : According to the proposed classification, 67% of cases were Type I, 14% showed soft tissue extension (Type II), and 19% involved bone (Type III). Type III group showed a significantly higher proportion of females (83%) compared to the entire cohort (54%) ( p < 0.001). Larger deposits (>15 mm) were significantly associated with bone involvement ( p < 0.01). Conclusion : Extension of calcium deposits beyond the rotator cuff enthesis was a frequent finding in this series. Incorporating an anatomic extension-based classification may enhance diagnostic precision, possibly avoiding invasive differential diagnostic procedures. Level of Evidence : IV.

BACKGROUND Achondroplasia is an autosomal dominant skeletal dysplasia and the most common genetic cause of dwarfism, characterized by shortened pedicles, thickened laminae, and reduced interpedicular distances that lead to congenital narrowing of the spinal canal. These anatomical abnormalities frequently result in lumbar spinal stenosis (LSS) requiring surgical management. Surgical treatment typically involves decompression of neural elements, with or without fusion, to restore canal patency and prevent postoperative deformity. However, adjusting the surgical approach to the unique anatomical constraints of achondroplasia remains critical for optimizing clinical outcomes. CASE REPORT We present a rare case of a 55-year-old woman with achondroplasia who presented with a 5-year history of progressively worsening low back pain, bilateral foot drop, and neurogenic claudication after walking short distances. Magnetic resonance imaging (MRI) demonstrated critical lumbar spinal stenosis at L2-L3, L3-L4, and L4-L5. She underwent multilevel laminectomy under general anesthesia with intraoperative fluoroscopic guidance and high magnification. Postoperatively, she was mobilized within 3 hours and discharged the same day without complications. At 4-week follow-up, the muscle strength of the anterior tibialis and quadriceps had improved to 4/5 on the MRC scale, patellar reflexes were normalized, and lower-limb sensation showed marked recovery. CONCLUSIONS This case highlights the importance of intraoperative precision and an appropriate surgical approach in managing lumbar spinal stenosis associated with achondroplasia. Decision-making, detailed preoperative planning with assessment of imaginary findings, intraoperative use of microsurgical techniques, and postoperative care are important in minimizing complications and optimizing clinical outcomes.

Background: Post-traumatic elbow stiffness in adolescents is a complex challenge that requires individualized treatment approaches. While open arthrolysis remains the most commonly used technique, arthroscopic techniques have emerged as a promising alternative with potential advantages in this younger population. This narrative review aims to emphasize the advantages of arthroscopic arthrolysis over the open approach in the adolescent patient. In addition, we explore how differences in etiology, diagnostic evaluation, and treatment response between adolescents and adults influence decision-making and outcomes. Methods: A narrative review of the current literature on post-traumatic elbow stiffness in adolescents was conducted. Clinical studies, previous reviews, and recent advancements were analyzed. Clinical examples from our center were also presented. Results: Arthroscopic arthrolysis was associated with improved range of motion, faster recovery, and lower complication rates in selected patients. However, open arthrolysis remains superior in cases with severe deformity, heterotopic ossification, or prior surgical history. In our experience, the indications for arthroscopic arthrolysis can be expanded when performed by experienced surgeons. Conclusion: Even though open arthrolysis remains the gold standard for complex elbow stiffness, arthroscopic approaches show promising outcomes in adolescents and could be used more widely in centers with sufficient expertise.

BACKGROUND Compartment syndrome is a serious condition characterized by increased interstitial pressure within a closed osseofascial compartment, which can result from decreased compartment volume, increased contents, or external pressures. Gluteal and thigh compartment syndrome, although rare, is linked to severe local complications such as tissue necrosis, infection, and even amputation, as well as systemic issues like renal failure and, in some cases, death. Prompt recognition and treatment are essential for improving outcomes, as delays significantly raise the risk of adverse and potentially life-threatening consequences. Acute gluteal compartment syndrome often results from prolonged pressure due to immobilization and can be associated with collapse caused by alcohol or drug abuse. CASE REPORT A 30-year-old male intravenous drug user (IVDU) was admitted with severe pain, swelling, and motor deficits in the right thigh and gluteal region due to prolonged immobilization during loss of consciousness from drug use. Examination revealed sciatic nerve palsy. Magnetic resonance imaging (MRI) showed swelling of the gluteal and posterior thigh muscles along with fluid collection. Emergency fasciotomy and sciatic nerve release were performed through a posterior approach. Postoperatively, the patient experienced rapid improvement in neurological function and mobility. CONCLUSIONS Our findings underscore the importance of maintaining a high index of suspicion among immobilized patients, especially intravenous drug users who may remain unconscious for extended periods, crushing parts of their bodies. Early recognition and intervention are vital for preventing severe complications associated with this condition. This case highlights the need for increased awareness and proactive management when treating IVDUs presenting with severe pain in the gluteal or thigh region and acute sciatic nerve palsy.

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases.

Purpose This study explores how age affects the location, extent, and progression of rotator cuff (RC) lesions in shoulder arthroscopy patients, aiming to identify age-related patterns of injury from localized damage in younger patients to more extensive degeneration in older ones, guiding age-specific diagnostic and treatment strategies. Methods A prospective study of 487 shoulder arthroscopy patients (October 2019–September 2023) categorized cases into < 55 and ≥ 55 years. SLAP lesions, pulley injuries, RC tears (Lafosse and Bateman), and rotator cable damage were systematically documented. All surgeries followed standardized protocols by a single surgeon. Statistical analyses (Pearson correlation, Chi-squared tests) assessed age-related RC pathology associations, with significance set at α = 0.05. Results Among 487 shoulder arthroscopies (mean age: 57.38 years), younger patients (< 55 years) had higher rates of medial (95.2%) and lateral (95.9%) pulley lesions, while older patients (≥ 55 years) exhibited significantly more advanced pathology, including lateral pulley lesions (100%), high-grade subscapularis tears (p < 0.0001), Bateman III-IV cuff tears (p < 0.0001), and combined cable tears (p < 0.0001). Medial pulley lesions correlated strongly with SLAP tears (r = 0.609), and age was positively associated with advanced injuries (r = 0.509) and negatively with partial subscapularis tears (r = − 0.143), indicating an age-related progression in rotator cuff degeneration. Conclusion The study suggests that lesions of the shoulder possibly arise from the biceps pulleys and extend more posteriorly. Distinct age-based patterns of RC pathology highlight the progression from localized injuries in younger patients to extensive degenerative damage in older individuals. These findings underscore the need for age-specific diagnostic and treatment strategies.

Background/Objectives: Reverse shoulder arthroplasty (RSA) has been widely used for the treatment of shoulder pathologies, particularly rotator cuff tear arthropathy. Currently, it is also increasingly performed for different indications. Like in any arthroplasty procedure, periprosthetic joint infection (PJI) is one of the most concerning complications and may have devastating outcomes. This study aimed to identify risk factors for PJI following RSA. Methods: This retrospective case-control study was conducted with patients who underwent RSA during the study period. Based on PJI occurrence during the follow-up period, patients were divided into two groups: Group I (no infection) and Group II (infection). The relationship between numerous clinical variables and PJI was tested. All variables were initially evaluated through univariate analysis between the two groups, and variables showing significant differences between the two study groups were subjected to multivariate logistic regression analysis to determine independent risk factors. Results: The study included 302 patients, with a mean age of 69.6 ± 10.1 years and a mean follow-up duration of 59.8 ± 24.7 months. During the follow-up period, PJI was not detected in 289 patients (95.7%) (Group I), while 13 patients (4.3%) developed PJI (Group II). Univariate analysis revealed a significant association between preoperative C-reactive protein (CRP) value (p = 0.001) and preoperative diabetes history (p = 0.007) with PJI. Multivariate logistic regression analysis, including these two variables, showed that diabetes was an independent risk factor for PJI development (p = 0.01, odds ratio = 4.85). Preoperative CRP elevation was not observed as an independent risk factor. Conclusions: This study demonstrated a significant association between high preoperative CRP levels and diabetes with PJI. Additionally, the presence of diabetes was identified as an independent risk factor for infection, with a 4.85-fold higher risk of PJI development in patients with a history of diabetes.