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Publikacje naukowe

Damage analysis of retrieved BioloxⓇdelta components used in hard and soft bearings
Döring J🇩🇪, Buchholz A🇩🇪, Herbster M🇩🇪, Gehring J🇩🇪, Betke U🇩🇪, Chodór P, Zabrzyński J, Bertrand J🇩🇪, Lohmann CH🇩🇪, Łapaj Ł

Acta Biomater. 2023 Mar 1;158:827-842.


This retrieval study included 43 Biolox delta explants (18 CoC, 25 CoP). Implants were examined macroscopically, whereby damage was evaluated using a semi quantitative scoring system. Confocal microscopy was used to examine wear related damage patterns of the articulating surfaces. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) was used to analyze wear marks on the implant surface and wear debris in periprosthetic tissue samples. Raman spectroscopy and X-ray diffraction (XRD) were used to quantify monoclinic zirconia fractions. On all components, in vivo wear resulted predominantly in different damage patterns caused by metal transfer. In CoC bearings stripe wear was additionally detected, and some implants underwent severe damage due to component breakage. The wear scores were higher for CoC components, with no differences between the scores for CoC heads and liners. Wear features caused comparable roughening on implants from CoC and CoP bearings. SEM studies demonstrated that most wear marks were caused by metal debris released from implant components. Grain pull-out was observed in stripe wear regions. Monoclinic phase shift was observed in a similar quantity on components from CoP and CoC bearings. The increase of monoclinic zirconia content around metal deposits was minimal and was more pronounced in areas of stripe wear. The results of this study indicate, that ZTA components in general undergo minimal wear in both, CoC and CoP bearings, however, it is more pronounced in the former. Metal deposits, as the most common wear feature, have no significant effect on monoclinic phase transition. STATEMENT OF SIGNIFICANCE: In this paper, we classify all damage patterns macroscopically according to an established scoring system and assess them regarding surface roughness (confocal microscopy) and monoclinic phase content (Raman spectroscopy) in order to derive the severity for patients. We compare hard-hard and hard-soft bearings and relate damage patterns with metal transfer based on SEM/EDS examinations. Furthermore, we work out correlations between patient-specific data, cause of revision and the physical condition of each individual sample Our cohort consists of 43 Biolox delta retrievals, a comparatively large quantity. In addition, we address current topics such as metal transfer and, based on the classification of damage patterns, provide incentives and/or meaningful focal points for further research.

The Influence of Body Mass Index on Growth Factor Composition in the Platelet-Rich Plasma in Patients with Knee Osteoarthritis
Wiciński M, Szwedowski D, Wróbel Ł, Jeka S, Zabrzyński J

Int J Environ Res Public Health. 2022 Dec 20;20(1):40.


Background: An abnormally high body mass index is strongly associated with knee osteoarthritis. Usually, obese patients are excluded from clinical trials involving PRP intra-articular injections. Growth factors have been demonstrated to have a disease-modifying effect on KOA treatment, even though data on their influence on treatment effectiveness in obese patients are lacking. Purpose: To prospectively compare the level of selected growth factors including transforming growth factor-b (TGF-β), epidermal growth factor (EGF), fibroblast growth factor, insulin-like growth factor-1 (IGF-1), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and fibroblast growth factor-2 (FGF-2) in platelet-rich plasma (PRP) in obese patients and patients with normal BMI. Methods: A total of 49 patients were included in the study according to inclusion and exclusion criteria. The groups strongly differed in body mass index (median values 21.6 vs. 32.15). Concentrations of growth factors were measured with an enzyme-linked immunosorbent assay. Statistical significance was determined with the Mann-Whitney U test. The compliance of the distribution of the results with the normal distribution was checked using the Shapiro-Wilk test separately for both groups. Results: There were no statistically significant differences in median marker levels between groups. Statistically significant Pearson correlations were observed between IGF-1 serum level and age (weak negative, r = -0.294, p = 0.041) and gender (moderate positive, r = 0.392, 0.005). Conclusions: BMI does not influence the level of selected growth factors in patients with knee osteoarthritis. Obese and non-obese patients had similar compositions of PDGF, TGF-β, EGF, FGF-2, IGF-1, and VEGF. PRP can be used in both groups with similar effects associated with growth factors' influence on articular cartilage.

Resection of Infrapatellar Fat Pad during Total Knee Arthroplasty Has No Impact on Postoperative Function, Pain and Sonographic Appearance of Patellar Tendon
Michalak S, Łapaj Ł, Witkowska-Łuczak A, Chodór P, Zabrzyński J, Kruczyński J

J Clin Med. 2022 Dec 10;11(24):7339.


Routine resection of the infrapatellar fat pad (IFP) during total knee arthroplasty (TKA) is controversial, as it may result in shortening of the patellar tendon (PT) and anterior knee pain. This prospective study examined whether IFP excision during TKA affects joint function, anterior knee pain, PT dimensions and sonographic structure. A total of 65 consecutive patients undergoing TKA for osteoarthritis were randomized into two groups: IFP was resected in one and retained in the other. Patients were examined preoperatively, at 6 weeks and 6 months postoperatively: pain (Numerical Rating Scale-NRS), range of motion (ROM) and knee function (Knee Injury and Osteoarthritis Outcome Score-KOOS score) were evaluated; sonographic examination determined the length, structure and vascularity of the PTs. In both groups there were postoperative improvements in NRS and KOOS scores, although IFP resection did not influence clinical outcomes or sonographic parameters. At 6 weeks and 6 months postoperatively for both groups there were no differences between NRS scores (Mann-Whitney test, p = 0.511 and p = 0.579), ROM scores (Mann-Whitney test, p = 0.331, p = 0.180) or all KOOS subscores. IFP excision had no effect on sonographic parameters. This study suggests that IFP resection during TKA does not influence postoperative functional outcomes, pain scores, patellar tendon length and thickness, or sonographic structure.

Smoking Has No Influence on Outcomes after Repair of the Medial Meniscus in the Hypo and Avascular Zones-A Pilot Study
Zabrzyński J, Paczesny Ł, Zabrzyńska A, Huri G🇹🇷, Graboń K, Pielak T, Kruczyński J, Łapaj Ł

Int J Environ Res Public Health. 2022 Dec 2;19(23):16127.


Complete loss of the meniscus inevitably leads to knee joint degeneration. Smoking is an important factor predicting poor outcome in orthopedics; however, data about its role in meniscus surgery are inconclusive. Smoking could be an important negative factor in isolated meniscus repair. The aim of this paper was to determine the influence of smoking on functional outcomes after isolated all-inside medial meniscus repair. This study included 50 consecutive patients with isolated, traumatic tear of the medial meniscus who underwent knee joint arthroscopy between 2016 and 2019. All-inside arthroscopic repair of the medial meniscus was performed in each case. All patients followed a uniform, postoperative rehabilitation protocol for 8 weeks. The follow-up examination was based on the functional scores at 3 and 6 months postoperatively. According to smoking status there were 17 smokers and 33 non-smokers. The mean number of cigarettes smoked per day was 11, for a mean of 7.4 years, and the mean pack-years index value was 4.9. There was no correlation between smoking years, number of cigarettes smoked per day, pack-years index, and functional outcomes. The arthroscopic inspection of the knee joints revealed cartilage lesions (≤IIº) in eight subjects, suggesting the secondary pathology to the meniscus tear. In this study, we found no evidence of an association between smoking indices and functional outcomes after all-inside repair of chronic medial meniscus tear. The nature of the chronic meniscal tear could be smoking-resistant owing to the poor blood supply to the sites in which these specific lesions occur.

Intra-Articular Injection of Platelet-Rich Plasma Is More Effective than Hyaluronic Acid or Steroid Injection in the Treatment of Mild to Moderate Knee Osteoarthritis: A Prospective, Randomized, Triple-Parallel Clinical Trial
Szwedowski D, Mobasheri A🇫🇮🇳🇱🇱🇹🇨🇳, Moniuszko A, Zabrzyński J, Jeka S

Biomedicines. 2022 Apr 25;10(5):991.


Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections.

The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction-A Retrospective Study
Szwedowski D, Paczesny Ł, Zabrzyński J, Gagat M, Domżalski M, Huri G🇹🇷, Widuchowski W

J Clin Med. 2021 Aug 31;10(17):3948.


Background: The current standard of treatment of anterior cruciate ligament (ACL) is reconstruction (ACLR). This technique has some disadvantages: poor proprioception, donor site morbidity and the inability to restore joint kinematics. ACL repair could be an alternative treatment. The purpose of the study was to compare the stability and the function after ACL primary repair versus single-bundle ACLR. Methods: In a retrospective study, 12 patients underwent primary ACL repair with internal bracing, 15 patients underwent standard ACLR. Follow-up examinations were evaluated at up to 2 years postoperatively. One patient in the ACL repair group was lost to follow-up due to re-rupture. The absolute value of anterior tibial translation (ATT) and the side-to-side difference in the same patient (ΔATT) were evaluated using the GNRB arthrometer. The Lysholm knee scoring was obtained. Re-ruptures and other complications were recorded. Results: Anterior tibial translation (ATT) was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137). Arthrometric measurements demonstrated a mean side-to-side difference (ΔATT) 1.87 (range 0.2 to 4.9) mm significantly decreased compared to ACLR 3.36 (range 1.2-5.6 mm; p = 0.0107). The mean Lysholm score was 85.3 points in the ACL repair group and 89.9 in ACLR group. No significant differences between ACL repair and ACLR were found for the Lysholm score. There was no association between AP laxity and clinical outcomes. There were two complications in the internal bracing group: one patient had re-rupture and was treated by ACLR, another had limited extension and had arthroscopic debridement. Conclusions: Anterior tibial translation was significantly decreased after ACL repair. Additionally, the functional results after ACL repair with internal bracing were comparable with those after ACLR. It should be noted that the two complications occurred. The current study supports further development of ACL repair techniques.

Therapeutic Advances in Tendinopathy Quantified Microscopically Using Bonar Score, with a Special Reference to PRP Therapy—A Systematic Review of Experimental Studies
Zabrzyński J, Gagat M, Huri G🇹🇷, Łapaj Ł, Paczesny Ł, Zielińska W, Zabrzyńska M, Szwedowski D, Kruczyński J

Appl Sci. 2021 May 2;11(11):4973.


(1) Background: The Bonar scoring system serves in the microscopic evaluation of tendon pathology. However, it can be easily adapted to investigate decreasing degeneration after treatment and quantify the healing progress. We believe that there is an actual need for a connection between clinical observations and tissue alterations arising during the treatment process, to gain superior functional outcomes. Herein, we perform a systematic review of the Bonar score’s application in the histopathological assessment of therapeutic advances in tendinopathy, with special reference to PRP therapy. (2) Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The searching strategy was conducted across major databases: PubMed, Cochrane Central, ScienceDirect, SciELO, and Web of Science. The risk-of-bias assessment was made using the Cochrane Collaboration’s Risk of Bias Tool and SYRCLE. (3) Results: The searching strategy produced 807 articles, and after selection, 22 studies were included. We collected 21 animal studies (n = 472) and 1 human study (n = 45). Three types of tendons were taken into account: 14 Achilles tendons, 7 supraspinatus tendons (SST), and in 1 case, Achilles and patellar tendons simultaneously. A variety of therapeutic methods were used—from intra-tendinous substance injections to surgical procedures or mechanical stimuli—but platelet-rich plasma (PRP) therapy dominated among them and was present in six studies. Most of the collected studies included an assessment of the tendons’ histopathology based on the classical Bonar score (with four variables and one observer). The staining protocol was based on the hematoxylin and eosin technique. An evaluation of therapeutic effects showed 15 positive results, 6 negative results, and 1 neutral result of treatments. (4) Conclusions: To understand the tendinopathy phenomenon, a link between histopathology and clinical observations in chronic tendon disorders is required due to the possibility of functional outcome improvements. The Bonar scoring system is well established in tendon pathology assessment and could also be adopted to assess therapeutic results in tendon disorders. Studies that included the PRP application showed Bonar-scoring-system-based evidence of superior tendinous tissue healing related to improved clinical results.

Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture—A Pilot Study
Paczesny Ł, Zabrzyński J, Domżalski M, Gagat M, Termanowski M, Szwedowski D, Łapaj Ł, Kruczyński J

J Clin Med. 2021 May 28;10(11):2370.


Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients’ satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3–13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair.

The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis
Szwedowski D, Szczepanek J, Paczesny Ł, Zabrzyński J, Gagat M, Mobasheri A🇫🇮🇳🇱🇱🇹🇨🇳, Jeka S

Int J Mol Sci. 2021 May 23;22(11):5492.


Knee osteoarthritis (KOA) represents a clinical challenge due to poor potential for spontaneous healing of cartilage lesions. Several treatment options are available for KOA, including oral nonsteroidal anti-inflammatory drugs, physical therapy, braces, activity modification, and finally operative treatment. Intra-articular (IA) injections are usually used when the non-operative treatment is not effective, and when the surgery is not yet indicated. More and more studies suggesting that IA injections are as or even more efficient and safe than NSAIDs. Recently, research to improve intra-articular homeostasis has focused on biologic adjuncts, such as platelet-rich plasma (PRP). The catabolic and inflammatory intra-articular processes that exists in knee osteoarthritis (KOA) may be influenced by the administration of PRP and its derivatives. PRP can induce a regenerative response and lead to the improvement of metabolic functions of damaged structures. However, the positive effect on chondrogenesis and proliferation of mesenchymal stem cells (MSC) is still highly controversial. Recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, significant progress has been made in understanding the mechanism of PRP action. In this review, we will discuss mechanisms related to inflammation and chondrogenesis in cartilage repair and regenerative processes after PRP administration in in vitro and animal studies. Furthermore, we review clinical trials of PRP efficiency in changing the OA biomarkers in knee joint.

The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance—A Systematic Review
Zabrzyńska M, Grzanka D, Zielińska W, Jaworski Ł, Pękala P, Gagat M

Medicina (Kaunas). 2021 Apr 9;57(4):367.


This study aimed to perform a comprehensive systematic review, which reports the role of the Bonar score in the histopathological assessment of tendinopathy and its clinical relevance. To identify all of the studies that reported relevant information on the Bonar scoring system and tendinopathy, an extensive search of the major and the most significant electronic databases (PubMed, Cochrane Central, ScienceDirect, SciELO, Web of Science) was performed. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The extracted data included-year of study, geographical location, type of the study, radiological modifications, gender, number of patients, region of tendinopathy, mean age, control group, characteristics of the Bonar score and alterations in the scale, mean Bonar score, number of investigators, area of tendon investigation, clinical and radiological implications. An extensive search of the databases and other sources yielded a total of 807 articles. Eighteen papers were finally included in this systematic review, and of these, 13 original papers included the clinical and radiological implications of tendinopathy. Radiological evaluation was present in eight studies (both magnetic resonance imaging (MRI) and ultrasound (US)). The clinical implications were more frequent and present in 10 studies. Using the Bonar score, it is easy to quantify the pathological changes in tendinous tissue. However, its connection with clinical and radiological evaluation is much more complicated. Based on the current state of knowledge, we concluded that the neovascularization variable in the Bonar system should be reconsidered. Ideally, the microscopic assessment score should follow the established classification scale with the radiological and clinical agreement and should have a prognostic value.

Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score?
Zabrzyński J, Gagat M, Łapaj Ł, Paczesny Ł, Yataganbaba A🇹🇷, Szwedowski D, Huri G🇹🇷

Ther Adv Chronic Dis. 2021 Feb 24;12:2040622321990262.


Aim: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. Methods: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). Results: A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. Conclusion: In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.

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The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery
Zabrzyński J, Huri G🇹🇷, Gagat M, Łapaj Ł, Yataganbaba A🇹🇷, Szwedowski D, Askin M🇹🇷, Paczesny Ł

J Clin Med. 2021 Feb 5;10(4):599.


The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker's group and 84.06 and 30.93 in the non-smoker's group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers' group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

Current concepts on the morphology of popliteus tendon and its clinical implications
Zabrzyński J, Huri G🇹🇷, Yataganbaba A🇹🇷, Paczesny Ł, Szwedowski D, Zabrzyńska A, Łapaj Ł, Gagat M, Wiśniewski M, Pękala P

Folia Morphol (Warsz). 2021;80(3):505-513.


In this review we described the anatomy and biomechanics of popliteus muscle and its tendon. Furthermore, we combined the anatomy with clinics and discussed a wide spectrum of disorders regarding the popliteus and its musculotendinous complex. There are three main anatomical regions of the popliteus musculotendinous complex: the proximal origin, the mid-portion, the distal part on the tibia. The unique localization and various origins of the tendon, connected with structures such as fibular head, Wrisberg, Humphrey and posterior cruciate ligament, lateral meniscus, medial collateral ligament, give an implication to diagnosis and treatment. Popliteus dysfunction is often overlooked, that is the reason why diagnosis and treatment of its injuries is mostly insufficient. Repetitive or acute direct varus force, when the tibia is in external rotation, and knee hyperextension or flexion with forced external rotation of the tibia, are the main mechanisms of trauma. Popliteus injuries mainly affect the athletic population and lead to severe activity limitations. Chronic disorders of the popliteus tendon, less known, are often described as tendinopathy and are frequently seen in runners. Their symptoms can mimic the lateral meniscal tears. On the other hand, high-energy traumatic injuries of the popliteus tendon often accompany complex, multi ligamentous injuries seen in competitive sports. We also presented the implication of popliteus tendon in knee arthroplasty, due to its particular exposition to iatrogenic trauma during surgery. The issues such as proper tibial component location and well-designed cut systems are crucial to avoid the popliteus impingement and preserve its structure.

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Biceps Tenodesis versus Tenotomy with Fast Rehabilitation Protocol-A Functional Perspective in Chronic Tendinopathy
Zabrzyński J, Huri G🇹🇷, Gryckiewicz S, Çetik RM🇹🇷, Szwedowski D, Łapaj Ł, Gagat M, Paczesny Ł

J Clin Med. 2020 Dec 4;9(12):3938.


The study aimed to evaluate the results after arthroscopic tenodesis and tenotomy of the biceps tendon (LHBT), coupled in tenotomy modality with a personalized postoperative rehabilitation protocol. The study included patients who underwent arthroscopic biceps tenotomy or tenodesis due to chronic biceps tendinopathy. Postoperatively, a standard rehabilitation program was prescribed to the tenodesis group and personalized was introduced in the tenotomy group, respectively. The outcomes were assessed using the American Shoulder and Elbow Surgeons scale (ASES), clinical tests that are dedicated to biceps tendinopathy, the occurrence of a Popeye deformity, night pain, and return to previous sporting activities. A cohort of 67 patients was enrolled in the final follow-up examination (mean 27 months) of which 40 patients underwent tenotomy (60%), and 27 patients (40%) underwent tenodesis. The mean ASES score improved from 48.1 to 87.8 in the tenotomy group and from 44 to 72.7 in the tenodesis group during the follow-up (p < 0.0001). The tenotomy group had better mean postoperative ASES scores than the tenodesis group (p < 0.0001). Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128). Moreover, the frequency of night pain decreased in the tenotomy group (p = 0.0059). Return to previous sporting activities was more frequent in the tenotomy group (p = 0.0090). Arthroscopic biceps tenotomy is a reproducible, simple procedure, and augmented by a rapid rehabilitation protocol that provides promising clinical outcomes, reduces shoulder pain, and allows the patient to return to previous sporting activities, even in population older than 50 years.

Correlation between smoking and neovascularization in biceps tendinopathy: a functional preoperative and immunohistochemical study
Zabrzynski J, Gagat M, Paczesny Ł, Grzanka D, Huri G🇹🇷

Ther Adv Chronic Dis. 2020 Oct 7;11:2040622320956418.


Aims: The purpose of this study was to investigate whether smoking is associated with neovascularization in the tendinopathy of the long head of the biceps tendon (LHBT). Methods: The study included 40 consecutive patients who underwent arthroscopic biceps tenotomy/tenodesis due to chronic biceps tendinopathy and divided into three groups: (1) non-smokers, (2) former smokers, (3) smokers. LHBT tissue samples were stained with H&E, Alcian blue and Trichrome staining. Immunohistochemical examination was performed using anti-CD31 and anti-CD34. The neovessel density score (NDS) was scored by Bonar criteria. Results: The mean period of smoking was 15.50 years with an average number of 24 cigarettes/day in the former smokers and 21.69 years with an average number of 15 cigarettes/day in the active smokers. The mean NDS was 2.23/3 in non-smokers, whereas it was 1.60/3 in former smokers and 1.31/3 in active smokers. The mean American Shoulder and Elbow Surgeons score equaled 46 in never smoked patients, 43.60 in former smokers, and 41.46 in active smokers. In the patients with smoking history, the disorganized tendinous tissue islands were avascular and composed of compact acidic polysaccharides and mucopolysaccharides. We observed negative correlation between the NDS and the smoking indexes, including cigarettes per day (p = 0.0150), smoking years (p = 0.0140), pack-years (p = 0.0088). Conclusion: In conclusion, the present study revealed that smoking impairs the vascularization of the biceps tendon in chronic tendinopathy. Clinically, we observed a negative correlation between smoking and neovascularization. Furthermore, there was no correlation between neovascularization and functional preoperative status.

Genetics in Cartilage Lesions: Basic Science and Therapy Approaches
Szwedowski D, Szczepanek J, Paczesny Ł, Pękała P, Zabrzyński J, Kruczyński J

Int J Mol Sci. 2020 Jul 30;21(15):5430.


Cartilage lesions have a multifactorial nature, and genetic factors are their strongest determinants. As biochemical and genetic studies have dramatically progressed over the past decade, the molecular basis of cartilage pathologies has become clearer. Several homeostasis abnormalities within cartilaginous tissue have been found, including various structural changes, differential gene expression patterns, as well as altered epigenetic regulation. However, the efficient treatment of cartilage pathologies represents a substantial challenge. Understanding the complex genetic background pertaining to cartilage pathologies is useful primarily in the context of seeking new pathways leading to disease progression as well as in developing new targeted therapies. A technology utilizing gene transfer to deliver therapeutic genes to the site of injury is quickly becoming an emerging approach in cartilage renewal. The goal of this work is to provide an overview of the genetic basis of chondral lesions and the different approaches of the most recent systems exploiting therapeutic gene transfer in cartilage repair. The integration of tissue engineering with viral gene vectors is a novel and active area of research. However, despite promising preclinical data, this therapeutic concept needs to be supported by the growing body of clinical trials.

The surgical treatment of the long head of biceps tendon and the autotenodesis phenomenon: an ultrasound and arthroscopic study
Zabrzyński J, Paczesny Ł, Łapaj Ł, Zabrzyńska A, Szwedowski D

Folia Morphol (Warsz). 2020;79(2):395-401.


Background: Open or mini-invasive operative procedures are methods of choice in the treatment of the advanced degenerative process of tendinopathy of long head of biceps tendon (LHBT). Cosmetic arm deformity and fatigue are the main complaints after the surgery. Researchers have noticed that in some cases the typical cosmetic deformity is often barely noticeable and the pain is significantly reduced as it occurs after spontaneous LHBT rupture due to extremely advanced tendinopathy. Materials and methods: This study included 41 of 75 patients who underwent LHBT arthroscopy-assisted tenotomy, followed by examination conducted by means of dedicated clinical tests, the American Shoulder and Elbow Surgeons Score (ASES) and ultrasounds. Results: The average time interval from surgery to follow-up in the cohort was 31 months, the mean outcome measured with the ASES was 87 points and the "Popeye deformity" complication was present in 15 individuals. In the group of 26 patients where the Popeye deformity was absent and the arm contour was similar to that of the opposite arm, sonographic examination revealed the LHBT stump at the level of the intertubercular groove that was hyperechogenic and wider than the part under the groove. Conclusions: Recent reports about the absence of the cosmetic deformity in the anterior area of the arm after shoulder arthroscopy are based on the autotenodesis phenomenon. The intra-articular part of LHBT is painlessly trapped in the bicipital groove by the surrounding soft tissues, which results in unchanged biceps muscle length; however, it is more probable to happen in patients without massive rotator cuff tears.

A 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries
Paczesny L, Zabrzynski J, Kentzer R, Gryckiewicz S, Lewandowski B, Szwedowski D, Kruczynski J

Cartilage. 2019 Dec 6:1947603519892310.


Objective: The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. Design: A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms' duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). Results: The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients' age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. Conclusions: Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.

Ultrasound-assisted Endoscopic Evacuation of Recurrent Calf Hematoma Following Anterior Cruciate Ligament Reconstruction. Case Study
Michalski Ł, Paczesny Ł, Zabrzyński J, Kruczyński J

Ortop Traumatol Rehabil. 2019 Oct 31;21(5):359-368.


Hematoma of the calf is a rare complication following anterior cruciate ligament reconstruction (ACLR). The golden standard method of its treatment is puncture and aspiration. More advanced procedures are needed in difficult cases, such as prolonged he-ma-tomas. Among the novel management choices is endoscopy with ultrasound guidance. The aim of the study was to present the management of a post-surgical hematoma of the calf using endoscopic and ultrasound-assisted surgery. A 48-year-old patient un-der-went arthroscopic ACLR grafted with hamstrings tendons (semitendinosus and gracilis). Due to a hematoma developing at the donor site, he experienced edema and paresthesiae of the calf and foot that enhanced over time. An open reoperation failed and symptoms recurred. A second reoperation was performed as an endoscopic and ultrasound-assisted mini-invasive procedure. Re-sults were assessed postoperatively using the IKDC 2000 and Lysholm questionnaires. An evident increase in IKDC 2000 Score (from 14.9 points after open surgery to 77.0 one week after endoscopic treatment) and Lysholm Scale (26 points after first surgery and 84 one week after endoscopic surgery) was observed after the mini-invasive procedure. Edema and paresthesiae of the affect-ed limb completely disappeared four weeks after endoscopy. No complications of the novel procedure were found. Accordingly, en-doscopic and ultrasound-assisted evacuation of a prolonged calf hematoma appears an effective minimally-invasive and tar-geted procedure.

Cigarette smoking intensifies tendinopathy of the LHBT. A microscopic study after arthroscopic treatment
Zabrzyński J, Szukalski J, Paczesny Ł, Szwedowski D, Grzanka D

Pol J Pathol. 2019;70(2):134-138.


Smoking has a damaging effect on the musculoskeletal system, which was presented by authors in the rotator cuff and Achilles tendons studies; however, there are a lack of data about the effect of smoking on disorders of the long head of the biceps tendon (LHBT), particularly at the microscopic level. The purpose of this study was to investigate the effect of the tobacco smoking on the histopathologic alterations of the LHBT. Thirty-six patients with preoperatively diagnosed tendinopathy of the LHBT were referred to the Orthopaedics Department. All patients underwent arthroscopic treatment with further macroscopic and microscopic evaluation of biceps tendon samples. The active and former smokers were characterised by more advanced degenerative process of the tendinous tissue; moreover, it was intensified in the group of former smokers. Subjects who smoke more than 20 cigarettes per day also had more advanced microscopic alterations. The most severe microscopic alterations occurred in the former smokers who used tobacco for more than 20 years. However, the non-smokers group revealed moderate degeneration in all LHBT samples. Tobacco smoking is an important risk factor of the LHBT disease, which essentially intensifies the degeneration of the tendinous tissue.

Breakage of metal hip arthroplasty components: Retrieval and structural analysis
Łapaj Ł, Woźniak W, Wiśniewski T, Rozwalka J, Paczesny Ł, Zabrzyński J, Janusz P, Kruczyński J

Biomed Mater Eng. 2019;30(3):297-308.


Background: Breakage of joint arthroplasty components are rare, yet during an implant retrieval program we found several cases. Objective: In this study we examined the components to determine the causes and mechanisms of breakage of these implants. Methods: From our collection of 849 retrievals we selected 682 cases with metal parts (503 hip, 79 knee arthroplasties) and identified fractured components: seven hip resurfacing implants, five total hip replacement stems, one monopolar femoral head, and one modular revision femoral stem from. Implants were examined using optical and scanning electron microscopy; metallographic sections were prepared and samples of periprosthetic tissues underwent microscopic examination. Results: In the resurfacing components breakage occurred in small stems placed in the femoral neck due to necrosis of femoral heads, with no metal flaws detected. Fatigue breakage of femoral stems was caused by presence of material flaws in the CoCrMo alloy, and corrosion. The monopolar head failed in fatigue fracture mechanism, breakage was initiated in an undercut near the taper connection for femoral component. The modular stem from Ti alloy sustained fatigue fracture induced by corrosion caused by debris from previously revised stem; no material flaws were detected in this sample. In most cases periprosthetic tissues had a morphology typical for aseptic loosening. Conclusions: In our series failure was caused by material flaws, presence of stress raisers and localized corrosion. Our findings indicate that sharp edges and other features which can act as stress raisers should be avoided in newly designed implants. Corrosion induced fracture of the modular Ti stem indicates the need for a detailed debridement of periprosthetic tissues during revision arthroplasties.

Osseointegration of hydroxyapatite coatings doped with silver nanoparticles: scanning electron microscopy studies on a rabbit model
Łapaj Ł, Woźniak W, Markuszewski J.

Folia Morphol (Warsz). 2019;78(1):107-113.


Background: Modern joint arthroplasties rely on osseointegration of metal components through bone ingrowth into hydroxyapatite (HA) layers. However, such surfaces are prone to colonisation by bacteria and formation of biofilms. Application of silver nanoparticles (SNs) to hydroxyapatite coatings could reduce the risk of infection; however, little is known about how this would affect the process of bone ingrowth. This study examined osseointegration of conventional and SN doped HA coatings in a rabbit model. Materials and methods: In this study, 12 cylindrical implants coated with conven- tional and SN doped HA were implanted into New Zealand white rabbit femora, with each animal receiving both types of implants. After 12 weeks, rabbits were sacrificed, their femora were harvested and implants removed during pull-out testing. Retrieved samples were dehydrated, sputter coated and observed using a scanning electron microscope (SEM) to verify bony ingrowth and retention of SNs. Results: The percentage of implant in direct contact with bone was measured in cross-sections of implants. The SEM analysis demonstrated that osseointegration of the SN doped coatings was similar to the conventional HA samples. A similar morphology of newly formed trabecular bone was observed in both implants, with silver doped HA-coated implants retaining multiple nanoparticles in areas which were not overgrown by bone. Analysis of the bone-implant contact area revealed comparable results for both types of coatings. These finding indicated that SN doped HA coatings are characterised by good osseointegrative properties. Conclusions: Since SNs were found in areas not covered by mineralised bone, it is assumed that the antimicrobial properties of the modified coating may be retained for 12 weeks after implantation. Additional studies are required to fine--tune the composition of HA coatings with SNs, to ensure optimal osseointegrative and antimicrobial properties.


Nowe metody leczenia

Rekonstrukcje wielowięzadłowe stawu kolanowego, rekonstrukcje rewizyjne ACL, rekonstrukcje ACL łącznie z tzw. tenodezą boczną LET


Jak informuje Szpital Jurasza, zespół lekarzy ortopedów z Oddziału Klinicznego Ortopedii i Traumatologii Narządu Ruchu Szpitala Jurasza, pod kierownictwem dr hab. n. med. Jana Zabrzyńskiego, wykonał pierwsze operacje rekonstrukcyjne uszkodzeń wielowięzadłowych kolana u pacjentów z regionu.

- Lekarze rekonstruowali zarówno kompleks więzadłowy przyśrodkowy z rogiem tylno-przyśrodkowym (wg. Danish technique), kompleks boczny stawu kolanowego z rogiem tylno-bocznym (wg. La Prade), a także wprowadzili metodę tenodezy bocznej zewnątrzstawowej podczas operacji więzadła krzyżowego przedniego (mod. met. Lemaire) - wylicza placówka.

Przypomina, że urazy stawu kolanowego stanowią prawie 70 proc. wszystkich urazów sportowych. Dodatkowo, mogą występować jako uszkodzenia towarzyszące w złamaniach kończyny dolnej czy urazach miednicy.

- Częstość występowania urazów w obrębie stawu kolanowego ma obecnie tendencję wzrostową, a główną przyczyną tego coraz większa liczba wypadków komunikacyjnych oraz zwiększona aktywność sportowa społeczeństwa. Najczęściej uszkodzeniu ulegają więzadła poboczne kolana, a dalej w kolejności więzadło krzyżowe przednie. Do uszkodzeń wielowięzadłowych stawu kolanowego, kiedy uszkodzonych jest większa liczba struktur więzadłowych kolana, dochodzi przeważnie w wyniku urazu wysokoenergetycznego, zdarzają się także urazy podczas uprawiania sportu - wyjasniają medycy.

Podkreślają, że "zaniechanie leczenia takich uszkodzeń prowadzi do zaburzenia biomechaniki kończyny dolnej oraz grozi wczesnym rozwojem zmian zwyrodnieniowych stawu kolanowego".

Skład zespołu ortopedów:

Dr Łukasz Jaworski nabywał doświadczenia w przeprowadzeniu tego rodzaju operacji podczas szkoleń zagranicznych, m.in. Kolonia, Niemcy;

Dr n. med. Wojciech Banach nabywał doświadczenia w przeprowadzeniu tego rodzaju operacji podczas szkoleń zagranicznych i krajowych;

Dr hab. n. med. i n. o zdr. Jan Zabrzyński, prof. UMK nabywał doświadczenia w przeprowadzeniu operacji podczas stażu zagranicznego, posiada certyfikat ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) w zakresie rekonstrukcji więzadła krzyżowego przedniego, tenodezy bocznej i operacji rewizyjnych.

Operacje endoprotezoplastyki stawu biodrowego z wykorzystaniem dostępu MIS-DSA


Operacja przeprowadzana jest w ułożeniu pacjenta na boku, a cięcie chirurgiczne (6-9 cm) poprowadzone jest pod kątem ok. 60 stopni z tylnej części krętarza większego.

Następnie preparuje się kolejno powięź m. pośladkowego większego i rozdziela włókna mięśniowe wzdłuż jego przebiegu. W dalszej kolejności odcina się ścięgna m. gruszkowatego, podwiesza na lejcach, przecina się tylną torbę stawu. Dalej, następuje ekspozycja stawu z wykonaniem niezbędnych procedur, aż po implantację elementów endoprotezy z wykorzystaniem specjalnych haków małoinwazyjnych oraz narzędzi dedykowanych do MIS.

Przeciwskazaniami do tego rodzaju małoinwazyjnej techniki są: ciężkie deformacje biodra, konieczność wykonania dodatkowych procedur, skomplikowane rewizje endoprotez.

Dr hab. n. med. i n. o zdr. Jan Zabrzyński nabywał doświadczenia w przeprowadzeniu operacji MIS-DSA w Ortopedyczno-Rehabilitacyjnym Szpitalu Klinicznym im. Wiktora Degi, współpracując z zespołem Prof. Jacka Kruczyńskiego, m.in. z dr hab. Łukaszem Łapajem i dr. Waldemarem Woźniakiem. Dr hab. n. med. i n. o zdr. Jan Zabrzyński zaangażowany był również w prace nad nowoczesną endoprotezą stawu biodrowego polskiej produkcji oraz instrumentarium do jej małoinwazyjnej procedury wszczepiania.

Endoproteza stawu biodrowego uważana jest za jedno z największych osiągnięć medycyny ubiegłego stulecia. Endoprotezoplastyka stawu biodrowego jest zabiegiem operacyjnym mającym na celu zastąpienie naturalnego stawu, zniszczonego chorobą zwyrodnieniową, tzw. sztucznym stawem, czyli endoprotezą. Endoprotezoplastyka jest stosowana w głównie leczeniu zmian zwyrodnieniowych pierwotnych, ale także wtórnych do urazów, chorób metabolicznych, jałowej martwicy, którym towarzyszy ból oraz znaczne ograniczenie możliwości wykonywania aktywności fizycznej.

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