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PURPOSE: Acute Achilles tendon tears in young active individuals are often treated surgically with prolonged rehabilitation, with the leg initially immobilized in plantar flexion in serial non-weight bearing casts and gradually progressing to full weight bearing. This study aimed to evaluate the safety of an early functional unsupervised rehabilitation protocol. METHODS: The medical records of 25 patients treated with open repair were available for follow-up. In 10 patients, an early functional unsupervised rehabilitation protocol was used with a removable cast, active range of motion exercises of the ankle from the first postoperative day, and full weight bearing in a walking boot with the foot plantigrade after the second week. Another 15 patients who followed the classic rehabilitation protocol were used as controls. The patients were evaluated with the Victorian Institute of Sports Assessment-Achilles (VISA-A) and an ultrasound examination-based score. A Wilcoxon test was used to compare the scores between the groups. RESULTS: The mean VISA-A score was 90.1 (SD = 9.87) for the early functional rehabilitation protocol group, while it was 83.8 (SD = 17.06, p = 0.624) for the control group. The mean ultrasound score was 7.75 (SD = 1.71) for the early functional rehabilitation protocol group, while it was 7.60 (SD = 3.05, p = 0.414) for the control group. There were no intra- or early postoperative complications in the groups, and all patients were satisfied with the results of their operation. CONCLUSIONS: An early unsupervised functional rehabilitation protocol after open Achilles repair may allow for safe early mobilization and minimize the need for physiotherapy. The small number of participants is a limitation of this study, and further evaluation with more patients is necessary to document the efficacy.

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Human papillomavirus (HPV) is a virtually necessary cause of cervical cancer, and HPV genotypes are categorized either as high-risk or low-risk based on their potential to cause malignancy of the cervix. HPV-DNA detection is used widely for screening women at risk. However, its clinical significance is not proven sufficiently in pregnancy. The aim of this review was to summarize published data referring to the integration of the HPV-DNA test in cervical cancer screening during pregnancy. PubMed and Scopus were searched for articles investigating the HPV-DNA test during pregnancy as a primary association; greater interest was placed on studies published after 2000. Retrieved articles reported similarities or discrepancies in the HPV-DNA test in pregnant women compared to those who are not pregnant, its accuracy, and its integration in cervical cancer screening. The HPV-DNA test may constitute a helpful tool utilized for monitoring, risk stratification, and triage of cases that require colposcopy. If combined with the HPV-mRNA test, this might improve its specificity. However, when compared to HPV-DNA detection rates in non-pregnant women, the results were ambiguous, without giving the opportunity to draw safe conclusions. Both those findings and the high cost hold it back from wide use. Hence, the Papanicolaou smear (Pap smear) is still the first-line diagnostic tool and colposcopy-guided cervical biopsy is the "gold standard" method for the management of cervical intraepithelial neoplasia (CIN) treatment during pregnancy.

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Objectives This study aimed to determine the efficacy of the self-isolation guidance for elective orthopaedic surgery. We aimed to evaluate the relationship between patient compliance with the self-isolation guidance and the resulting COVID-19 status. This would give planning strategies for managing elective orthopaedic lists. Method For the study, 110 patients who underwent elective orthopaedic surgical procedures during a one-month period were identified. Patients scheduled for surgery were asked to take a SARS-CoV-2 PCR test three days prior to surgery and they were asked to follow the self-isolation guidance. On the day of admission, patients declared compliance with self-isolation regulations. Admission was refused in cases of non-compliance. After discharge, telephone calls were made to patients to determine the degree of compliance with the self-isolation guidance. Results Overall, 106 out of 107 patients that were compliant with the self-isolation guidance tested negative for COVID-19; 15 patients had their operation cancelled over the one-month period; of which one-third were cancelled by the patients themselves. Three patients were found to be non-compliant with the self-isolation guidance. Of these three non-compliant patients, one tested positive for COVID-19. Adherence to the self-isolation guidelines helped to prevent last-minute cancellations and manage the list effectively. Conclusions Compliance with our self-isolation guidance accompanied by PCR screening minimises the risk of testing positive for COVID-19 and is thus an effective system to safely perform elective orthopaedic surgery. Intentionally overbooking theatre lists by 10 to 12.5% may account for cancellations and improve theatre efficiencies during post-pandemic recovery plans for elective orthopaedic surgeries.

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BACKGROUND: New types of glenoid bone block fixation, involving suture buttons, suture anchors or even implant-free impaction of the graft, have been recently introduced. In contrast to screws which allow for a rigid fixation of the bone block, these alternative procedures provide a non-rigid type of fixation. METHODS: Two reviewers independently conducted the search in a systematic way (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "Latarjet" OR "Eden-Hybbinette" OR "bone block" AND "anterior" AND "shoulder" AND "instability." RESULTS: Eight out of the 325 initial studies were finally chosen according to our inclusion-exclusion criteria. In total, 750 patients were included in this review. The overall anterior instability recurrence rate for patients treated with non-rigid fixation was 2.6%, while the overall rate of non-union or graft osteolysis was 5.4%. CONCLUSIONS: Regardless of the graft type, bone block non-rigid fixation showed satisfactory clinical and functional outcomes for the treatment of anterior shoulder instability with substantial glenoid bone deficiency. Furthermore, non-rigid fixation resulted in adequate bone graft healing and osseous incorporation. Lastly, given the relative lack of data, further prospective controlled studies are required to assess bone block non-rigid fixation procedures in comparison with the traditional rigid (with screws) fixation techniques. LEVEL: Systematic review, IV.

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Data on elite gymnast injuries outside North America is sparse. We report the injuries recorded over a period of 10 years in 156 Greek elite male and female gymnasts. A total of 2390 injuries were reported for a rate of 1,5 new injuries per year per athlete. Most commonly affected areas were the hip (18.5%), the ankle (16.5%), the lumbar spine (16%) and the foot (16%). The most frequent diagnosis was tendinitis (32%), followed by low back pain (20%), and sprains (12%). Fifteen athletes (9%) sustained serious injuries that required surgery. Rhythmic gymnasts had significantly more overuse type injuries compared to artistic gymnasts (p = 0.049). Gymnastics is a sport with a high incidence of musculoskeletal pathology that needs proper documentation in order to establish preventive measures.

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Juvenile idiopathic arthritis is a heterogeneous group of conditions encompassing all forms of unknown origin arthritis before the age of 16 years that persist for more than 6 weeks. It is the most common rheumatic disease in young patients and causes severe disabilities, thus an early initiation of the appropriate treatment modalities is necessary. First therapeutic options are nonsteroidal anti-inflammatory drugs, corticosteroids, and conventional non-biologic disease-modifying anti-rheumatic drugs, such as methotrexate. Insufficiency of these drugs led to the introduction of new biological medications that selectively target specific cytokines with an objective to suppress the disease. Despite the success in treatment and physical therapy, some of the patients develop advanced arthritis that can result in severe pain and disability. In such cases, surgical intervention is required to improve quality of life. The surgical methods include soft tissue release, osteotomies, synovectomies, and arthrodesis. Total joint replacement is the last option for endstage degenerative conditions (patients with deformity, poor motion, and severe pain). Deep infections, bone perforation, acetabular protrusion, postoperative dislocations, and the need for re-operation are some of the complications of total joint arthroplasty. This review summarizes published studies of the treatment of juvenile idiopathic arthritis focusing mainly on surgical treatment. Our purpose is to evaluate the general trends in treatment of juvenile idiopathic arthritis, focusing on methods, therapeutic advances, and outcomes of the intervention applied.

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The objective of this study was to evaluate the contribution of the medial retinaculum to the stability of the patella, for several angles of knee flexion. For six cadaveric knees, the patella and patella retinaculum were exposed, and the force required to dislocate the patella laterally by 5 mm was measured, in 0, 45 and 90 degrees of knee flexion, preserving and dissecting the medial retinaculum. Wilcoxon singed rank test (SPSS, version 23, Chicago, USA) was used for data analysis. A p value of < 0.05 was considered as statistically significant. The force required to displace the patella laterally is smaller with the medial retinaculum dissected than intact, in 0, 45 and 90 degrees (p = 0.028, p = 0.046, p = 0.027 respectively). The lateral displacement force is greater as the flexion angle increases, with medial retinaculum intact or dissected (p = 0.028). Thus, an intact medial retinaculum provides more stability against lateral displacement forces to the patella, especially in lower flexion angles. Consequently, surgical methods reinforcing the medial retinaculum combined or not with lateral retinaculum release, are of great importance in the plan of the orthopedic surgeons. The engagement of the bones during flexion of the knee contributes significantly to the stability of the patella.

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Contemporary fixation of the proximal femur is performed utilising a number of implants adopting different concepts and techniques. Cephalomedullary nails in particular represent one of two main options, the other being dynamic hip screw (DHS). The aim of this cohort study is to present the early experience of two large units from different countries of the use of the AFFIXUS nail for stabilisation of proximal femoral fractures. Over a period of almost three years, data from 476 proximal femoral fractures were collected and analysed using a specific research protocol, assessing data relevant to basic demographic details, in-hospital stay, surgical technique and post discharge outcomes with a minimum follow up of 6 months. Both the short and long versions of the nail were used in both centres, however, with some statistically significant differences as far as the type of fractures stabilised with the nail, which also translated to differences in the combination or not of 2 lag screws, and the static or dynamic mode of the proximal fixation construct. Other areas of difference amongst the 2 units, were the length of hospital stay and return of patients to their pre-injury residence, most likely reflecting the different social circumstances between the 2 countries. Overall mortality at a median follow up period of 17 months (range 6 to 35) was limited to 6.3%, nonunion and cut out rates 2.7%, whilst revision surgery occurred in just 2.5%. Over the first 6 months of follow up 63.6% returned to their pre-injury ambulatory status and 90.5% to their pre-injury residence. Further studies and higher level of scientific evidence is needed to verify the findings of this retrospective cohort study as to the effectiveness and safety of this new cephalomedullary nail.

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