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Purpose Spontaneous osteonecrosis of the knee (SONK) is said to be a relatively common disease which may lead to an end-stage osteoarthritis of the knee. The aim of this paper was to review the literature on this field published until now, discuss the results of both conservative and surgical treatment options, as well as to introduce new methods of treatment, which may be applicable in SONK treatment. Methods We searched the PubMed and Cochrane databases until November 2019 and presented the most recent findings in this work. Results The exact aetiology of SONK still remains unclear; however, recent studies suggested that early stage of SONK is rather a result of the subchondral fracture than primary osteonecrosis. So far described conservative treatment includes non-weight bearing or protected weight bearing with a knee brace, nonsteroidal anti-inflammatory drugs, analgesics, and bisphosphonates. Surgical management includes arthroscopic debridement, core decompression, osteochondral autograft, high tibial osteotomy, and unicompartmental knee arthroplasty or total knee arthroplasty. Conclusions Although the aetiology of SONK remains unknown, there are many treatment options, and the choice of the most suitable one is challenging. We think that subchondroplasty may be one of the effective methods.

Purpose To assess the recovery of extension and improvement in functional scores after an arthroscopic or open posterior knee capsulotomy in the setting of an extension deficit. Methods A systematic search of articles published between 1980 and 2020 was performed in the MEDLINE/PubMed database, EMBASE/Ovid database and Web of Science database. The inclusion criteria consisted of patients with primary extension deficits > 5° who underwent an arthroscopic or open posterior knee capsulotomy. The assessed outcomes were preoperative and postoperative range of motion and functional outcome scores. Randomized controlled trials, cohort studies and case series with a follow-up longer than 6 months were included. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for case series. The certainty of evidence was assessed using the GRADE approach. Results Of 226 records identified through database searching, 7 studies were included in the final analysis. The outcomes of 107 patients with a mean age of 34.1 (range 15–63) years were available. In all the included studies, a posterior capsulotomy resulted in the restoration of knee extension to normal or nearly normal values (mean postoperative extension deficit: 0.4–4.2 degrees) with a significant increase in functional outcome scores. No neurovascular complications were reported within the studies. Due to the diverse methodology of studies, the direct comparison of arthroscopic versus open approaches was not possible. Concerning the risk of bias assessment, the greatest concerns raised the selection of participants among the included studies and the methods of outcome measurement. The certainty of evidence was very low according to the GRADE. Conclusions Both arthroscopic and open posterior capsulotomy of the knee results in restoration of normal or nearly normal knee extension and significant improvement in functional outcomes. Level of evidence IV.

Background: Techniques incorporating the long head of the biceps tendon (LHBT) into repair of massive irreparable rotator cuff tears (MIRCTs) have been reported to present good clinical outcomes in a short-term follow-up, but there is a lack of studies with longer observation. Purpose: To assess clinical and radiologic results of LHBT redirection with margin convergence repair in patients with MIRCTs in a longer follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients with at least 2 years of follow-up were enrolled in this retrospective study. Shoulder range of motion, pain per the numeric rating scale, Constant score, and American Shoulder and Elbow Surgeons questionnaire were assessed. True anteroposterior radiographs were assessed regarding acromiohumeral distance and cuff tear arthropathy per Hamada and Favard classifications. Magnetic resonance imaging scans were analyzed regarding fatty infiltration of supraspinatus (SST) and infraspinatus (IST) according to Goutallier classification and LHBT–rotator cuff construct features. Results: The study group involved 45 patients (11 female, 34 male) with a mean age of 65 years (range, 50-77) and mean follow-up of 52 months (range, 24-100). One patient was excluded for reverse shoulder arthroplasty. The mean range of motion was 150° of flexion, 148° of abduction, and 35° of external rotation. The mean pain was 1.0. The mean results were 83.9 in American Shoulder and Elbow Surgeons questionnaire and 71.2 in Constant score. The mean acromiohumeral distance was 5.6 mm (range, 2.0-8.7). On radiographs, cuff tear arthropathy was assessed as grade 1 in 23 patients, grade 2 in 14, grade 3 in 3, and grade 4 in 4. Mild glenoid erosion was observed in 9 patients. Among 35 patients, significant fatty infiltration was observed and graded as 3 in 7 patients for SST and 10 patients for IST and graded as 4 in 1 for SST and 2 for IST. The LHBT was presented intra-articularly in 31 of 35 analyzed magnetic resonance imaging scans and as running directly to the greater tuberosity in 10 of 35. The SST was healed proximally to the LHBT in 28 of 35 patients. One complication (2.2%) and 4 (8.9%) clinical failures were observed. Conclusion: At follow-up >2 years, LHBT redirection provided excellent pain-free range of movement, even though muscle strength deficit persisted. The rate of complications and clinical failures seems to be lower than for other nonarthroplasty treatment options for MIRCT.

Background: Vitamin D deficiency is reported in rheumatological diseases in adults. The aim was to evaluate the prevalence of vitamin D deficiency in children with juvenile idiopathic arthritis (JIA) and to investigate potential correlations between vitamin D status and clinical factors, laboratory traits, and medical treatment, including methotrexate (MTX) and glucocorticoids (GCs). Methods: In 189 patients aged 3–17.7 years, with JIA in the stable stage of the disease, anthropometry, clinical status, serum 25-hydroxyvitamin D [25(OH)D], calcium (Ca), phosphate (PO4), total alkaline phosphatase (ALP), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were assessed. Results: Median 25(OH)D level was 15.00 ng/mL, interquartile range (IQR) 12.00 ng/mL. Vitamin D deficiency was found in 67.2% and was independent of sex, disease manifestation, and CRP, ESR, ALP, or PO4 levels. Higher doses of MTX corresponded with lower 25(OH)D levels using both univariate and multivariate models (p < 0.05). No such trend was found for GCs treatment. Serum Ca was lower in patients treated with GCs (p = 0.004), MTX (p = 0.03), and combined GCs/MTX (p = 0.034). Conclusions: JIA patients are vitamin D depleted independently of disease activity or inflammatory markers. MTX therapy may be an iatrogenic factor leading to inadequate 25(OH)D levels. Vitamin D supplementation should be considered in all children with JIA, particularly those receiving long-term MTX therapy.

The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most extensively investigated technique. ACL reconstruction with a pedunculated hamstring graft provides superior revascularization of the graft along with higher mechanical strength. The usage of a graft enveloped with a periosteum was proposed to enhance the tendon-bone unit formation, and consequently, to prevent the bone tunnel widening. The muscle tissue on the graft is a potential source of stem cells. However, an excessive amount may weaken whole graft strength despite its enhanced remodeling. Similarly, amniotic tissue may augment the ACL reconstruction with stem cells and growth factors. Despite the existence of several surgical techniques that utilize amnion, the outcomes of these augmentation methods are lacking. Lastly, the intra-articular transplantation of the synovium on the surface of an ACL was proposed to augment the graft with synovial tissue and blood vessels. In conclusion, diverse approaches are being developed in order to enhance the maturation of an ACL reconstruction graft. Although these approaches have their foundation in on well-established scientific research, their outcomes are still equivocal. Clinical trials of high quality are needed to evaluate their utility in clinical practice.

Purpose: To present the arthroscopic “PCL envelope lack sign” (PELS) and to calculate its diagnostic characteristics in chronic PCL insufficiency. Methods: Recordings of knee arthroscopies performed in a single clinic between April 2015 to March 2020 were retrospectively evaluated, searching for the “PCL envelope”. It was defined as a “soft tissue cuff coursing around the PCL tibial attachment, visible with the arthroscope positioned between the PCL, medial femoral condyle and posterior horn of the medial meniscus at the level of its shiny white fibers”. PELS was defined as “the PCL adhering to the proximal tibia adjacent to the medial meniscal posterior root attachment, inability to observe the normal space between the PCL and posterior tibia and no soft tissue cuff around the PCL tibial attachment”. Inclusion criteria were possibility to evaluate the PELS presence on recordings. Patients who underwent PCL reconstruction were assigned to the study group. The rest of the patients were controls. Criteria to operate on symptomatic PCL patients were at least 5 mm of posterior instability in physical examination and at least 6 months post-injury. Results: Out of 614 available recordings, 592 patients (205 females, 387 males; mean age 45.2 years, SD = 14.36, range 14–81) were included: 38 in the study group and 554 in the control group. In the study group, PELS was positive in 36 of 38 cases (94.7%). In the control group, PELS was negative in 554 PCL-efficient patients (100%). Calculated PELS sensitivity was 94.7%, specificity 100%, positive predictive value 100%, negative predictive value 99.6%. The PELS was present significantly more often in PCL-insufficient patients, p < 0.001. Conclusions: The PCL envelope lack sign was found to be a highly effective tool to arthroscopically confirm chronic PCL insufficiency, and should be considered a direct sign of chronic posterior knee instability.

To identify the enzymes potentially useful for the decolorization of azo dyes, the secretome of the ascomycetous fungus Myrothecium roridum IM6482 was studied by using a bottom-up proteomic approach. Among the identified proteins, the most promising for dye removal was laccase, which decolorized respectively, 66, 91, 79, and 80% of Acid Blue 113 (AB 113), Acid Red 27 (AR 27), Direct Blue 14 (DB 14), and Acid Orange 7 (AO 7). The degradation of dyes was enhanced at the wide range of pH from 4 to 8. The addition of redox mediators allowed eliminating AB 113 in concentrations up to 400 mg/L and decolorization of the simulated textile effluent. Microbial toxicity and phytotoxicity tests indicated that dyes are converted into low-toxicity metabolites. This is the first insight into the M . roridum secretome, its identification and its application for removal of select azo dyes. Obtained results extended knowledge concerning biodegradative potential of ascomycetous, ligninolytic fungi and will contribute to the improvement of dye removal by fungi.

A healthy, balanced diet is essential for both physical and mental well-being. Such a diet must include an adequate intake of micronutrients, essential fatty acids, amino acids and antioxidants. The monoamine neurotransmitters, serotonin, dopamine and noradrenaline, are derived from dietary amino acids and are involved in the modulation of mood, anxiety, cognition, sleep regulation and appetite. The capacity of nutritional interventions to elevate brain monoamine concentrations and, as a consequence, with the potential for mood enhancement, has not been extensively evaluated. The present study investigated an extract from oregano leaves, with a specified range of active constituents, identified via an unbiased, high-throughput screening programme. The oregano extract was demonstrated to inhibit the reuptake and degradation of the monoamine neurotransmitters in a dose-dependent manner, and microdialysis experiments in rats revealed an elevation of extracellular serotonin levels in the brain. Furthermore, following administration of oregano extract, behavioural responses were observed in mice that parallel the beneficial effects exhibited by monoamine-enhancing compounds when used in human subjects. In conclusion, these data show that an extract prepared from leaves of oregano, a major constituent of the Mediterranean diet, is brain-active, with moderate triple reuptake inhibitory activity, and exhibits positive behavioural effects in animal models. We postulate that such an extract may be effective in enhancing mental well-being in humans.