Introduction: Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure employing grafts like the hamstring tendon, bone-patellar bone, and quadriceps tendon. Fixation methods include a suspensory loop with a button, interferential screw, and cortical fixation. The optimal screw diameter for tibial tunnel fixation remains undefined, with choices ranging from 1mm smaller to 1-2 mm larger than the tunnel diameter. Screw-related complications such as breakage and thread flattening are concerns. This study was to determine the ideal screw diameter for secure graft fixation in the tibial tunnel during ACL reconstruction. Materials and Methods: A novel arthroscopic probe technique was utilized to assess tibial tunnel bone integrity. Bone quality was categorized into weak, strong, and very strong. Screw size selection, either equal to or 1-2mm larger than the tunnel diameter, was based on bone quality. Screw lengths varied from 25mm to 35mm. Results: The novel technique significantly reduced screw-related complications, from 9.6% (24 out of 248 patients) to 0.5% (1 out of 187 patients). The need for additional cortical stabilization decreased from 14.5% (36 out of 248 patients) to 1.6% (3 out of 187 patients). Conclusion: The low-cost, efficient two-minute probe test is a secure and effective method in the hands of the author for selecting interferential screws in ACL reconstruction, minimizing complications and additional stabilization needs. The multicentric application of the test can substantiate the strength of the study.

Anterior cruciate ligament (ACL) injury is a prevalent clinical condition that significantly impacts physical activity. This retrospective study aims to explore the predictive potential of transverse pelvic diameter (TPD) and height/TPD ratio in females with ACL rupture. A cohort of 22 females aged 18-46 years who underwent arthroscopic ACL reconstruction surgery was retrospectively analyzed. Maximal transverse pelvic diameter measurements were obtained using standardized radiographic techniques. The normal average transverse pelvic diameter is considered to be 130 mm. In our patient population, the average maximal transverse pelvic diameter was 144.04 mm (range: 140.4-157.2 mm), with an average height of 164.2 cm (range: 155-173 cm). The average height/TPD ratio was 11.0043, ranging from 11.151 for the shortest individual to 11.005 for the tallest individual. Statistical analysis was conducted to evaluate the relationship between maximal transverse pelvic diameter, height, and ACL rupture risk. Results indicate that for all participants, maximal transverse pelvic diameter exceeded 140 mm, and height/TPD ratio equaled or exceeded 11, which serves as a cutoff value. These findings suggest that a larger transverse pelvic diameter is associated with an increased risk of ACL injury in females. Moreover, a height/TPD ratio above a certain threshold may serve as a predictor for ACL rupture. Further research is warranted to validate these findings and elucidate potential biomechanical mechanisms underlying this association.

Knee osteoarthritis is a major problem in the European population. Surgical treatment implicates a long absence from work. Alternative treatments postponing major surgery to the age of retirement from work would be beneficial. Patients with severe knee osteoarthritis are treated by four intraarticular injections of ACP (double syringe system, Arthrex). Lequesne and VAS score before and four weeks after treatment are evaluated. Two years after treatment patients are contacted via telephone. Those not requiring major surgery in the meantime and not requiring pain killers in daily living are considered as success. 245 patients were treated, 139 women and 106 men aged 64.1 +/- 10.9 years. 34 (13.9%) patients showed no effect. Lequesne score was 11.2+/- 3.8 before and 3.9 +/- 2.6 (p<0.001) after treatment. Regarding the Lequesne classes 146 patients were classified to the extremely severe and very severe group before whereas after treatment 223 patients were classified as mild or moderate (p<0.001). The VAS score dropped from 6.3 +/- 1.8 before to 2.3 +/- 1.4 after treatment (p<0.001). Two years after treatment 198 patients were contacted (no one lost for follow up). 134 (67.7%) were classified as mid term success. 48 (24.2%) patients had major surgery in the meantime. 16 (8.1%) patients underwent other therapies, mostly an other ACP treatment. Intraarticular ACP therapy shows excellent short term results. The majority of the patients does not require major surgery for another two years, thus avoiding higher costs from incapacity to work.

The puprose of this paper is to describe the clinical and radiographic results of patients with traumatic recurrent anterior shoulder dislocation treated with the Bristow-Latarjet procedure.
Bristow-Latarjet surgery involves using the coracoid process and the conjoint tendon of m. bicpes and m. coracobrachialis to stabilize the shoulder. The procedure is recommended when shoulder dislocation is associated with a bony defect of the anterior glenoid rim, but can be performed as a first procedure for selected patients
The aim of this procedure is to stabilize the shoulder by the bony effect of the coracoid process graft increasing the size of the glenoid and the conjoint tendon sling pushing back the humeral head .
This paper includes 30 patients treated with Bristow – Latarjet proedure in our institution in the period from 2021-2023.
The result was described as good in 90 % of cases , with 3 cases of graft resorption and subluxation of the shoulder
In conclusion we can say that Bristow – Latarjet procedure is very reliable method of treatement for recurrent anterior dislocations and subluxations of the shoulder.
It also can be used in people with increased physical activity. Limiting shoulder mobility does not prevent patients from returning to their usual occupations.

Background Bone age is essential for pediatric patients with active growth zones and anteromedial instability to facilitate optimal treatment strategy and minimize postoperative complications. However, many people are unaware of various tools for determining bone age, including classical methods and modern machine learning techniques.
The objective was to show and compare different methods for calculating bone age and determining surgical strategy for patients with anteromedial instability of the knee joint.
Material and methods All-Inside anterior cruciate ligament reconstruction was performed for 20 patients. Wrist radiographs were performed for bone age assessment using the "point scoring system" of Tanner and Whitehouse and the "atlas matching" method of Greulich and Pyle. Machine learning programs were used in addition to standard bone age assessments.
Results The findings showed an average difference of 21 months (80 %) in a group of 20 individuals with bone age ahead of the passport age and an average difference of 18 months (20 %) in patients with retarded bone age.
Discussion The findings showed the difference between chronological and bone age and could be encountered in scientific articles on endocrinology and pediatrics. No scientific studies on the use of the methods could be found in the specialty “trauma and orthopaedics”.
Conclusion Bone age assessment, prediction of children's target height are essential for surgical treatment of patients with open growth plates

Introduction: Posterior cruciate ligament (PCL) are rare as an isolated injury and more commonly occur in a multi-ligament-injured knee. We reported a case of PCL rupture in monozygotic twins. Case Presentation: A 19-year-old female presented with giving away of her left knee since 4 months. Physical examination demonstrated positive posterior drawer test. MRI showed ruptured PCL and lateral meniscal tear. Her identical twin, also a 19-year old-female, fell from the stairs and complained of giving away. There was positive posterior drawer test. MRI demonstrated ruptured PCL and lateral meniscal tear. Both patients underwent arthroscopic-assisted PCL reconstruction using gracilis, semitendinosus, and peroneus tendon graft. At one year of follow-up, there were no graft failures. Satisfactory outcome measured by Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). Both were athletes prior to their injury and they returned to sport. Clinical Discussion: This report shows that patients may have genetic predisposition to the incidence of PCL rupture. This is likely because of heritable factors, such as biomechanical, anatomic, anthropometric, and neuromuscular traits. A family history of PCL tear may increase the risk of a PCL tear. Further studies are recommended to examine genetic variants as a risk factor for PCL tears.
Conclusions: Multiple variables may lead to the increased risk: the combination of improper neuromuscular control, genetic factors, and possibly hormonal factors contributed to their PCL injuries. Further history exploration, lab tests, and genetic analysis should be done to determine the variables. Both patients returned to sports one year postoperatively.

Introduction: Scaphoid non-union can result in pain, and altered wrist kinematics, leading to a Scaphoid Non-union Advance Collapse. Open techniques have their limitations, We describe the rationale, surgical technique, and outcomes of our series of arthroscopic bone grafting (ABG). Materials and methods: A prospective consecutive study of 22 patients with clinic-radiological established scaphoid non-union between March 2015 and April 2019. In a single surgeon series, data was collected from Electronic Patient Records (EPR-Evolve), Patient Archived Computer system (PACS), and hand therapy assessments. The Disabilities of the Arm, Shoulder, and Hand Score (Quick DASH), Mayo wrist score, Patient Rated Wrist Evaluation (PRWE), and grip strength measurements were collected preoperatively and at follow-up appointments. The surgical technique and assessment algorithm are described. Results: There was an improvement in all outcome measures when comparing preoperative and postoperative results. The Quick DASH score improved by a mean of 24 points, Mayo wrist and PRWE scores improved by 15.1 and 29.7 points respectively. Grip strength analysis also improved by 6.1 kgf (Right) and 3.3kgf (Left). Computerized tomography (CT) follow-up scans revealed union in 18/22 patients with 2 patients lost to follow-up. 1 patient required a revision ABG procedure to achieve union. Conclusion: Arthroscopic bone grafting and fixation of non-union of the scaphoid allows a minimally invasive method of assessment and management of these injuries. It shows minimal morbidity, and accurate articular reduction, resulting in less postoperative stiffness and increased functional outcomes. Human fibrin glue provides an initial scaffold for the bone graft incorporation.

Introduction: Vitamin D deficiency is prevalent amongst the older generation who are also prone to developing degenerative rotator cuff tears. Vitamin D is found to be critical in tendon-to-bone healing, yet there are few studies evaluating the effects of vitamin D levels on RCR outcomes. This study thus aims to evaluate pre-operative serum vitamin D levels and arthroscopic RCR outcomes. Methods: A systematic search of four databases (PubMed, EMBASE, Scopus and Cochrane Library) was performed. Inclusion criteria was studies with (a) arthroscopic rotator cuff repair and (b) pre-operative serum vitamin D levels (‘Vitamin D levels’) reported. Meta-analysis of correlation coefficients was performed to compare the relationship between Vitamin D levels and pre-operative factors including (a) fatty degeneration, (b) tear size and (c) retraction size, as well as post-operative outcomes including (a) patient-reported outcome measures (PROMs) and (b) retear rates. Results: Five articles were included in this study. Total sample size was 1436. Pooled mean serum vitamin D level (ng/ml) was 23.66. Higher Vitamin D level was found to be significantly associated with lower fatty degeneration (p=0.05), but not with tear or retraction size. There was no association between vitamin D levels and post operative PROMs. Only one included study evaluated retear rate and found significantly higher retear rate in the Vitamin D deficient group. Conclusion: Higher level of pre-operative serum vitamin D levels is associated with lower pre-operative fatty degeneration, which may reduce the risk of retear in arthroscopic RCR patients.

Osteochondral lesions pose a significant challenge within the fields of orthopedics and sports medicine. These lesions are characterized by damage to the cartilaginous and subchondral structures of the joint, leading to chronic pain, functional limitations, and degenerative changes in the affected joint over time. The objective of this presentation is to critically examine contemporary strategies and approaches in the surgical treatment of osteochondral lesions, emphasizing the pursuit of optimal therapeutic outcomes. We conducted a thorough literature review, incorporating relevant studies, clinical trials, and insights gleaned from our experience at the Institute for Orthopedics "Banjica". For minor lesions, conservative treatments such as physical therapy and pharmacological interventions are often initial approaches. However, in cases involving larger, deeper lesions and the presence of joint instability, surgical interventions become imperative. Additionally, we will underscore the potential of various scaffolds as promising therapeutic strategies to facilitate damaged cartilage repair and potentially impede the progression of osteoarthritis. In conclusion, the accurate diagnosis, ongoing monitoring, and the judicious selection of appropriate therapy are pivotal in the effective management of osteochondral lesions.

Introduction; ACL is one of the common ligaments injured in knee which needs to address by arthroscopic reconstruction. Proper placement of femoral and tibial tunnel is crucial step for the outcome of reconstruction. Single bundle ACL reconstruction is time tasted procedure. Visualization of femoral and tibial footprint or land mark reduces the chance of improper placement of tunnels. We have used three portal technique with modification of conventional AL and AM portal along with Far medial portal. Method; We treated 123 patients from September 2021 to December 2022 at our center. Symptomatic patients with positive clinico-radiological proven ACL tear included in the study. We have used AL portal, AM Portal, slightly lower and closure to patella tendon then the conventional portals and Far medial portal for femoral and tibial tunnel placement. Graft secured with closed loop endobutton on femoral side and bio-screw / suture disk on tibial side. Result; Minimal follow-up was done till 6 months duration and post operative lysholm scoring was done at 6months. Assessment of the tunnel done on AP and lateral view in full extension. Femoral and tibial tunnel angle, percentage of tibial tunnel and femoral tunnel along with tibial plateau, blumensaat line respectively with graft impingement were in the criteria. Discussion- Most crucial aspect of proper visualization of the lateral wall, making tunnel through rigid instrument with hyperflexion of knee at 120 degrees. Our three-portal technique with inclusion of far medial portal makes a better visualization of wall and better negotiation of instrument.

Introduction: The hamstring tendon has been explored as the ideal graft choice for ACL (anterior cruciate ligament) reconstruction and has shown excellent functional results. The hamstring tendon graft is ideally quadrupled and to avoid failure, the minimum graft diameter for ACL restoration should be greater than 08 mm. This study set out to evaluate how well several anthropometric factors, such as age, thigh circumference, weight, height, and body mass index (BMI), predicted the hamstring graft diameter. Method: A cross sectional study was conducted in a group of young adults who underwent ACL reconstruction using hamstring autografts primarily. The anthropometric variables (age, gender, height, Body mass index and thigh girth) were measured preoperatively and the length and diameter of the quadrupled hamstring graft was measured intraoperatively. All the statistical analysis was done using SPSS. Results: A total of 60 patients were included in the study with mean age of 31.4 +/- 7.8 yrs., height of 1.69 +/- 0.6 meters, weight of 70.06 +/- 9.77, BMI of 24.18 +/- 4.23 kg/msq and thigh girth of 49.5 +/- 4.5 cms. The average length of Semitendinosus tendon graft was 28.28 +/- 2.85, gracilis was 24.74 + /- 2.28 and quadrupled hamstring graft was 8.29 +/- 0.75. There was strong correlation between height with Semitendinosus graft length and quadrupled graft diameter. Conclusion: The hamstring graft may not be adequate in reconstruction of the ligament injuries in short patients and hence harvesting autografts from other sites should be anticipated and planned preoperatively.

Introduction: Femoroacetabular impingement (FAI) has been recognized in recent years as a predominant cause of hip pain in the young population. Subspine impingement is an important cause of FAI-related hip pain, induced by mechanical stress around the subspine region of the anterior inferior iliac spine (AIIS). Case Report: We present a clinical case involving a 14-year-old male, who experienced sudden, sharp pain in his left groin during a football practice. Radiological evaluation revealed AIIS avulsion. He underwent nonoperative treatment, with protected weight bearing for 6 weeks. 9 months later he was pain-free and returned to sports activities. Radiographic imaging demonstrated complete healing of the AIIS. 2 years later, the patient presented again with left groin pain, while sprinting and kicking during football practice. Physical examination revealed tenderness over the AIIS and limited hip flexion range of motion, with pain experienced at 90º of flexion. Radiographic evaluation showed subspine impingement, Hetsroni type III. The patient underwent surgical treatment: Arthroscopic Decompression, with careful preservation of rectus femoris origin. A postoperative anti-inflammatory regimen (celecoxib 200mg twice daily) was prescribed for three weeks to prevent heterotopic bone formation. 8 weeks after surgery he was able to return to sports activity pain-free. Conclusion: Arthroscopic decompression of a symptomatic AIIS is a reproducible and safe procedure that has been shown to provide excellent outcomes at short-term follow-up. If an overly aggressive resection is performed, the rectus femoris could be detached from its origin, leading to a potential hip flexion deficit.

Background: Neglected posterior cruciate ligament (PCL) avulsion fracture malunion poses altered anatomy and functional symptoms in the knee joint such as pain and instability. Case Presentation: We reported a case of a 32-year-old female patient with a neglected PCL avulsion fracture malunion. The patient presented with chronic knee pain and instability but no limited range of motion for 3 years after the index trauma. Physical examination test demonstrated the positive posterior drawer test and posterior sagging. Image study revealed malunion with significant displacement of the avulsed fragment. Surgical intervention was performed utilizing an arthroscopic internal brace technique with fiber-tape augmentation to re-tensioning the PCL without the bony procedure to the malunion fragments correction. Outcome: At a year follow up, the patient demonstrated significant improvement in knee stability, range of motion, and pain scores. Radiographic evaluation revealed satisfactory alignment. Functional International Knee Documentation Committee score indicated satisfactory results. Conclusion: Arthroscopic internal brace with fiber-tape augmentation represents a reasonable surgical approach for neglected PCL avulsion fracture malunion. In this case, the patient had less malunion related impingement symptoms which highlights the efficacy of this technique in restoring knee stability and pain relief without avulsed fragments correction procedure