1. DISLOCATION OF BIPOLAR HEMIARTHROPLASTY FOLLOWING BREAKAGE OF THE POLYETHYLENE RING

A. Christodoulou, Ι.Terzidis, S.Metsovitis, A.Ploumis, C.Toptsis.  

Eur J Orthop Surg Traumatol (2002) 12: 105-107.

Abstract

Dislocation after bipolar hemiarthroplasty is rare. In classical dislocations of bipolar prosthesis, the prosthetic femoral head escapes from the natural acetabular cavity. Two cases of a bipolar hip prosthesis are presented in which the dislocation occurred between the cup and the metallic ball head 4 and 12 months postoperatively. The reason for the dislocation was fracturing of the edge of the polyethylene ring - either due to impingement at the full flexion position of the hip or to dislocating forces in extreme positions of the metallic ball head. To avoid this complication we recommend installation of the notch of the polyethylene ring be at the peripheral half of the acetabular cup.

Anastasios Christodoulou, Avraam Ploumis, George Karkavelas, Ioannis Terzidis, Ioannis Tsagias

Αrthritis and Reumatism, Vol. 48, No. 3, March 2003, pp 776-779.

              Abstract

Juxtaarticular osteoid osteoma is frequently misdiagnosed because the symptoms may mimic arthritis, and radiographs may not be characteristic. A rare case of subtalar pain lasting 5 years in a female teenager is presented here. The initial diagnosis was monarticular juvenile chronic arthritis. Family history was misleading because her mother had rheumatoid arthritis (RA).

A. Christodoulou, A. Ploumis, I. Terzidis, A. Koukoulidis.
J Orthop Trauma 2003 Aug; 17(7):527-530.

Abstract

A rare foot injury consisting of an irreducible, closed combined distal and proximal articulation dislocation of two adjacent metatarsals (second and third), called a "double floating metatarsal," was encountered in a 29-year-old man. The anatomy, mechanism of injury, and sequence of the surgical procedure are presented and discussed.

4. ΜORPHOMETRIC CHARACTERISTICS OF THE THORACIC AND LUMBAR PEDICLES IN THE GREEK POPULATION

A. Christodoulou, T. Apostolou, I. Terzidis

Stud Health Technol Inform 2002;91:104-108, Research into Spinal Deformities 4. Health Technology and Informatics. IOS Press. Page 104-109

Abstract
OBJECTIVES: To measure the dimensions of the pedicles of T1 to L5 in the Greek population.
METHODS: A total of 12 whole human cadaver spines were evaluated regarding pedicle dimensions (5 women and 7 men). The mean age at the time of death was 69,6 (range 62 to 84 years). The transverse and sagittal out side pedicle isthmus widths, the internal transverse diameter and cortex width were measured with electronic calipers both on the right and left pedicles. The data collected were statistically analyzed with the t-test.
RESULTS: The widest transverse diameter was at the L5 level with a mean of 11,3mm (range 7,55-15,46mm). The narrowest transverse diameter was at the T5 level with a mean of 5,37mm (range 4,10-6,88mm). The widest sagittal diameter was at the T11 level with a mean of 17,23mm (range 14,84-19,57mm), while the narrowest one was at T1 level with a mean of 9,1mm (range 7,18-11,37mm). The maximum internal transverse diameter was at the L4 level with a mean of 8,26 mm (range 7,10-9,23mm) while the minimum was at the T5 level with a mean of 3,9mm (range 3,14-4,78mm). The maximum cortex width was at the L5 level with a mean of 2,55mm (range 2,15-3,02mm) and the minimum at the T5 level with a mean of 1,30mm (range 0,40-2,10mm).
CONCLUSIONS:From the statistic analysis of the above data it was found that regarding the internal diameter there was statistically significant difference between males and females especially at T3, T7, T8 and L3 levels (P<0,05), and almost in all levels regarding the cortex width. There was also statistically significant difference between right and left pedicles regarding the transverse and the sagittal widths (P<0,05). The narrowest pedicle was at the T5 level and the widest was at the L5.

5. IDIOPATHIC SCOLIOSIS. SEGMENTAL FUSION WITH TRASPENDICULAR SCREWS.

A.Christodoulou, C.Zidrou, I.Terzidis, J. Pournaras

Stud Health Technol Inform 2002;91:433-437, Research into Spinal Deformities 4. Health Technology and Informatics. IOS Press. Page 433-437

Abstract

The purpose of this study is to evaluate whether the surgical correction of the scoliotic curve with the use of segmental pedicle screw fixation system is effective. We studied 20 patients (19 girls, 1 boy) with a mean age of 14,6 years (range from 13 to 22). The spinal deformities were evaluated by Cobb method with anteroposterior and lateral bending radiographs. There were 13 right thoracic curves and 7 left thoracolumbar curves. The width of the pedicles was estimated in all patients by computerized tomography of the thoracic and lumbar spine. Posterior instrumentation (Moss-Miami transpedicular system) was used and additional thoracoplasty was performed in 2 patients. The transpedicular screws were placed between T2 and L5. Intraoperatively the image intensification was indispensable and the wake-up test was always conducted. All the patients were assessed both clinically and radiographically at 3,6,9,12 months and annually until now. The average follow-up was two years. There was an average correction of 73% of the primary curve (pre-op standing average 59 degrees (range from 42 degrees to 87 degrees), lateral bending average 33 degrees (range from 10 degrees to 75 degrees), post-op average 13 degrees (range from 6 to 30 degrees), at last examination average 14 degrees (range from 6 degrees to 33 degrees). Infection and neurological complications were not noted. No major complications were observed. Exact evaluation of the pedicles by CT scan is an essential prerequisite for transpedicular screw insertion. The correction of idiopathic curves with the use of segmental pedicle screw fixation system is a very effective method(correction > 70%) It seems that control of the three columns of the spine by the transpedicular screws offers sufficient apical translation and coronal realignment.

6. SURGICAL MANAGEMENT OF A CONGENITAL KYPHOTIC DEFORMITY IN AN ADOLECENT

A. Christodoulou, A. Ploumis, I. Terzidis, K. Tapsis, P. Hantzidis

Stud Health Technol Inform 2002;91:454-456, Research into Spinal Deformities 4. Health Technology and Informatics. IOS Press. Page 454-457

Abstract
This is a case of an adolescent with kyphoscoliosis due to congenital partially segmented vertebrae T12, L1, L2 who was treated operatively by a back-front-back, one stage operation. A 16 year old patient neurologically intact with a rounded gibbous in the lower thoracic region and a mild scoliotic element had no other congenital anomaly. His kyphotic deformity was 85 degrees measured with the Cobb method. Preoperatively, a CT and MRI scan of the spine was performed and a three-level anterolateral failure of segmentation in the thoracic spine was diagnosed without spinal dysraphism. The operation lasted 8 hours and the Moss-Miami anterior and posterior fixation systems were used for fusion from T10 to T4. It included initially posterior approach for transpendicular screw insertion, wedge resection of the posterior elemens followed by anterior approach (thoracotomy), osteotomy of the defected vertebrae, anterior correction and fusion T11 to L1 and final correction with rod placement posteriorly. The wake-up test was performed twice. The follow-up was 3 years. The postoperative correction of the kyphosis was 45% (42 degrees) and there was practically no loss of correction in the last follow-up. No complications were observed. Detailed preoperative assessment of the patients with congenital deformities is essential in order to establish the correct diagnosis and choose the proper treatment. Substantial kyphotic deformities require combined antero-posterior procedures.

7. THE ROLE OF TIMING OF TOURNIQUET RELEASE AND CEMENTING ON PERIOPERATIVE BLOOD LOSS IN TOTAL KNEE REPLACEMENT.

Anastasios G. Christodoulou, Avraam L. Ploumis, Ioannis P. Terzidis, Paraskevas Chantzidis, Stergios R. Metsovitis, Dionisios G. Nikiforos

KNEE 2004 Aug;11(4):313-317.

Abstract
The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and -) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A- 1017 ml, Group B+ 622 ml and Group B- 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (P<0.001) and demands in blood transfusion P<0.05 as well as a longer operating time (P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.

8. SPLEEN RUPTURE AFTER SURGERY IN MARFAN’S SYNDROME SCOLIOSIS. A CASE REPORT

Anastasios G. Christodoulou, Avraam Ploumis, Ιoannis P. Terzidis, Kristalla Timiliotou, Niki Gerogianni, Charalambos Spyridis.

J Ped Orthop 2004 Sep-Oct;24(5):537-540.

Abstract
Spleen rupture occurred in a 14-year-old girl with Marfan syndrome after posterior spinal instrumented fusion and thoracoplasty for scoliosis. Splenectomy successfully treated this unusual complication of spinal surgery. The etiology, diagnosis, and management of spleen rupture following pediatric spinal surgery are discussed.

9. THE APPEARANCE OF KISSING CONTUSION IN THE ACUTELY INJURED KNEE IN THE ATHLETES.

Ioannis Terzidis, Anastasios Christodoulou, Avraam Ploumis, Stergios Metsovitis, Miltiadis Koimtzis, Panagiotis Givissis.

Br J  Sports Med 2004 Oct;38(5):592-596.

Abstract
BACKGROUND: Bone contusions are often identified at magnetic resonance imaging (MRI) in the acutely injured knee. Contusions of both surfaces of the joint are known as kissing contusions.
OBJECTIVE: To determine the frequency, type, and distribution of kissing contusions occurring in association with injuries of the knee joint.
METHODS: 255 MRI examinations in athletes with acutely injured knees (197 men; 58 women; mean age 24.2 years) were reviewed by two independent examiners; 219 MRIs were done within the first month after the injury and 36 within two to four months. None of the knees had been injured before. No fractures were present on x ray.
RESULTS: Bone contusions were diagnosed in 71 cases (27.8%); 55 (22.5%) were identified as single contusions and 16 (6.3%) as kissing contusions. Eight of the kissing contusions were associated with anterior cruciate ligament tears, three with menisceal tears, four were isolated lesions, and one was delayed, following a menisceal tear. The 32 bone contusions (16 kissing contusions) were located as follows: lateral femoral condyle (n = 14; 8 type I, 6 type II); lateral tibial condyle (n = 9; 3 type I, 1 type II, 5 type III); medial tibial condyle (n = 7; 2 type I, 5 type III); medial femoral condyle (n = 2; both type I). The associated injuries were confirmed by arthroscopy in 12/16 patients.
CONCLUSIONS: Kissing contusion is a significant injury often associated with ligamentous or menisceal injuries. Type I lesions are most common on the lateral femoral condyle and type III on the lateral tibial condyle.

10. INFERIOR SUBLUXATION OF THE FIBULAR HEAD FOLLOWING TIBIAL LENGTHENING PROCEDURES

Ipp. Hatzokos, And. Drakou, An. Christodoulou, Ioannis Terzidis, John Pournaras.

Journal of Bone and Joint Surgery 2004 Jul;86-A(7):1491-1496

Abstract
BACKGROUND: Inferior subluxation of the proximal part of the fibula has been reported to occur with distraction osteogenesis of the tibia; however, the clinical sequelae of this subluxation are unknown. The purpose of this study was to evaluate inferior subluxation of the proximal part of the fibula and its possible clinical implications in patients who had undergone tibial lengthening by distraction osteogenesis with use of a unilateral external fixator.
METHODS: Thirty tibiae in seventeen patients with a variety of conditions underwent tibial lengthening by distraction osteogenesis with use of a unilateral external fixator and were followed clinically and radiographically for a mean of two years and ten months (range, two to four years). Ten patients were female and seven were male. Their mean age at the time of the surgery was seventeen years (range, eight to twenty-five years). The mean tibial lengthening was 8.1 cm (range, 3.5 to 13 cm).
RESULTS: An inferior shift of the fibular head in relation to the tibia was evident in all cases. The shift, which ranged from 0.4 to 3.3 cm, was proportionally related to the amount of tibial lengthening. This type of subluxation is probably attributable to the tension that is exerted by the intact interosseous membrane during the distraction as well as to the tension of the regenerated bone of the fibula and the fact that the fibula itself is not fixed or directly lengthened by the external fixator.
CONCLUSIONS: It appears that inferior subluxation of the fibula is a common phenomenon in patients undergoing tibial lengthening by distraction osteogenesis with use of a unilateral external fixator. However, no clinical symptoms or findings related to the inferior subluxation of the fibula were found in our series.

Anastasios Christodoulou, Avraam Ploumis, Ioannis Terzidis, Panagiotis Givisis, Ippokratis Hatzokos, Ioannis Pournaras.

Orthopaedics, 2003 Nov;27(11) :1155-8

Double overlapping plate configuration for the treatment of low energy, extensile, diaphyseal and metaphyseal fractures of the distal tibia is a reliable fixation method.
In recent years, there has been great debate about the treatment of pilon fractures. Low-energy trauma leads to type I and II pilon fractures, as classified by Rüedi and Allgöwer.1 These injuries are best treated following the AO group guidelines. Their recommendations include fibular fracture fixation, followed by tibial joint articular surface restoration, bone defect restoration, and medial tibia buttressing.2
A large number of distal tibial intraarticular fractures occur, which extend into the tibial diaphysis. They usually are infraisthmal spiral tibial fractures at the junction of middle and distal one third of the bone. Maale and Seligson3 classified these spiral extension fractures as type IV in the above classification and reported their good prognosis. Mast et al4 classified these fractures as type II.

12. SUPRACONDYLAR FEMORAL FRACTURES IN ELDERLY PATIENTS TREATED WITH THE DYNAMIC CONDYLAR SCREW AND THE RETROGRADE INTRAMEDULLARY NAIL.

A COMPARATIVE STUDY OF THE TWO METHODS.

A. Christodoulou, Ι. Terzidis, Α.Ploumis, S. Metsovitis, A. Koukoulidis, C.Toptsis.

Arch Orthop Trauma  Surg. 2005 Mar;125(2):73-79

Abstract
INTRODUCTION: The objective of this study is to present the results of surgical management of supracondylar fractures of the femur (types A and C according to the AO/ASIF classification) in elderly patients with the use of two different methods of fixation: the mini open dynamic condylar screw fixation (DCS) and the closed retrograde intramedullary nailing (RIN).
MATERIALS AND METHODS: Eighty patients with supracondylar fractures of the femur were treated from January 1994 to June 2000 and 72 of them followed up completely. There were 25 (34%) men and 47 (65%) women with a median age of 73.2 years (range 60-88 years). In patients with the same type of fracture, the chosen method was random, one after the other (alternately). RIN was used in 35 patients, and DCS was used in 37. The mean operative time for the DCS fixation group was 145 min (range 115-180 min), whereas for the RIN group it was 92 min (range 76-110 min) (p<0.001) with an average estimated blood loss of 310 cc (range 120-450 cc) and 118 cc (range 90-165 cc), respectively (p<0.001). The mean follow-up was 28 months (range 18-42 months).
RESULTS: According to the criteria set by Schatzker and Lambert, excellent results were recorded in 18 (51%), good in 11 (31%), moderate in 3 (9%), poor in 3 (9%) patients with RIN and excellent in 19 (51%), good in 11 (30%), moderate in 4 (11%) and poor in 3 (8%) patients with DCS (p>0.05). The complications that occurred in the RIN group were 2 (6%) stiffness of the knee (mean flexion 80 degrees), 2 (6%) non-unions, 2 (6%) varus deformity and in the DCS group 2 (5%) haematomas, 4 (11%) stiffness of the knee (mean flexion 73 degrees) and 2 (5%) non-unions.
CONCLUSION: Although the two methods appear to have the same percentage of excellent results and same time to bony union, RIN is preferable to DCS in terms of less blood loss and shorter operating time.

13. WILSON OSTEOTOMY STABILISED BY MEANS OF INTERNAL FIXATION FOR THE TREATMENT OF HALLUX VALGUS

Panagiotis Givisis, Dimitrios Karataglis, Anastasios Christodoulou, Ioannis Terzidis, John Pournaras.

Acta Orthopaedica Belgica 2004 Feb;70(1):57-63.

Abstract
The results achieved in 20 patients (32 feet) who underwent Wilson's osteotomy of the first metatarsal for the treatment of hallux valgus were reviewed. In all cases the osteotomy site was stabilised with one or two cortical screws. The patients' average age was 50.7 years (range: 34-74 years) and they were followed for a mean period of 33.1 months (range 12-63 months). The average AOFAS score was 85.5 (range: 62-100) at the final follow-up and in 84.4% of the cases the final outcome was very satisfactory as far as symptomatic improvement was concerned. Wilson's osteotomy stabilised with cortical screws was found to reliably give satisfactory correction of the hallux valgus and first intermetatarsal angles, while allowing safe patient mobilisation and early weight bearing. This effectively resulted in shorter rehabilitation time, early return to work or normal activities and a very satisfactory functional outcome.

14. SOLEUS ACCESSORIUS. AN ANOMALOUS MUSCLE IN A YOUNG ATHLETE. Case report and analysis of the literature

Anastasios Christodoulou MD, Ioannis Terzidis MD, Konstantinos Natsis MD, Ioannis Gigis MD, John Pournaras

Br Journal of Sports Med 2004 Dec;38(6): e38

Abstract

The soleus accessory muscle is a rare anatomical variation. It usually appears as a soft tissue mass and may be mistaken for a tumour or an inflammatory lesion. The differential diagnoses include ganglion, lipoma, haemangioma, synovioma, and sarcoma. This is a report of such a muscle mass in the leg of a young athlete with 16 years follow up. A review of the English literature on this subject is also presented.

15. LACERATION OF TIBIALIS ANTERIOR TENDON COMPLICATING A CLOSED TIBIAL FRACTURE. A case report.

Panagiotis Givissis MD, Anastasios Christodoulou MD, Dimitrios Karataglis MD, Ioannis Terzidis MD, John Pournaras MD.

Journal of Foot and Ankle Surgery, 2004 Nov-Dec; 43(6):426-9

Abstract
Traumatic laceration of the tibialis anterior tendon complicating a closed tibial shaft fracture is a rare injury pattern. Only 3 such cases have been reported to date in the English literature and all were missed on initial examination. A case of a 17-year-old motorcyclist with an acute laceration of the tibialis anterior tendon resulting from a closed oblique tibial shaft fracture is presented. The tendon laceration was suspected preoperatively because of the patient's inability to actively dorsiflex his ankle joint and the existence of a palpable gap in the soft tissues over the anterolateral aspect of his tibia. Tibialis anterior tendon repair was performed simultaneously with fracture fixation. The role of careful physical examination is stressed so that this rare injury combination will not be missed.

16. COMBINED INTERBODY CAGE AND ANTERIOR PLATING IN THE SURGICAL TREATMENT OF CERVICAL DISC DISEASE

Anastasios CHRISTODOULOU, Avraam PLOUMIS, Ioannis TERZIDIS, Paraskevas HANTZIDIS, Konstantinos TAPSIS, Ioannis POURNARAS

Acta Orthopædica Belgica, 2004 Oct;Vol. 70 ( 5):461-5

Abstract
The purpose of this study was to evaluate the results of treatment of symptomatic cervical disc herniation using interbody cages and anterior plate fixation. Fifteen patients were studied retrospectively. An MRI study of the cervical spine was performed preoperatively in all patients. The levels involved were C5-C6 in 9 cases, C6-C7 in 4 and C3-C4 in 1, while 1 patient had disc disease at the C5-C6, C6-C7 levels, Surgical treatment included anterior approach of the cervical spine, removal of the degenerative disc, excision of osteophytes and insertion of an interbody cage which was filled in with bovine allograft and demineralised bone matrix. The spinal unit was stabilized with an anterior plate and screws. No cervical splint was used postoperatively. The patients were followed up for 7 years on average after surgery. No failure or migration of the implants was noted, while bone fusion was achieved radiologically within 6 months postoperatively in all cases. The benefits of this surgical technique are the maintenance of cervical lordosis and disc space height, the high fusion rate, as well as avoidance of cervical orthoses.

17. DELAYED ULNAR NEUROPATHY AND INFECTION DUE TO A RADIOLUCENT FOREIGN BODY IN THE HYPOTHENAR. A CASE REPORT

Anastasios Christodoulou, MD, Avraam Ploumis, MD, Ioannis Terzidis, MD, Eleni Bibasi, MD.

Orthopedics. 2007 Feb;30(2):163-5

18. PEDICLE DIMENSIONS OF THE THORACIC AND LUMBAR VERTEBRAE IN THE GREEK POPULATION

Christodoulou AG, MD, Apostolou T, MD, Ploumis A, MD, Terzidis I MD, Hatzokos I, MD, Pournaras J, MD.

Clin Anat. 2005 Sep;18(6):404-8.

Abstract
The aim of this study is to understand the magnitude of the pedicle's diameters for the use of pedicle screw fixation in spinal instrumentation. Pedicle dimensions from T1 to L5 were measured in 16 whole human cadaver spines (eight women and eight men). The mean age at the time of death was 67.2 (range: 59-84 years). The external transverse, the external sagittal, and the internal transverse diameter pedicle widths were measured with electronic calipers both on the right and left pedicles. The widest external transverse diameter was at the L5 level with a mean of 13.61 mm (range: 10.29-16.20 mm). The narrowest external transverse pedicle diameter was at the T5 level with a mean of 5.09 mm (range: 4.10-6.88 mm). The widest external sagittal pedicle diameter was at the T11 level with a mean of 17.02 mm (range: 14.84-19.57 mm), while the narrowest one was at T1 level with a mean of 8.90 mm (range: 7.18-11.37 mm). The maximum internal transverse pedicle diameter was at the L5 level with a mean 8.95 mm (range: 7.10-11.21 mm), while the minimum was at the T5 level with a mean 3.90 mm (range: 3.10-4.82 mm). Statistical significant greater pedicle dimensions were found in males at multiple levels. Pedicle dimensions at the levels from T3 to T8 need preoperative evaluation with computed tomography before the insertion of pedicle screws with diameter more than 5 mm. Pedicles at T12 to L5 levels may accommodate screws of 7 mm diameter.

19. OPEN TRAUMATIC AVULSION OF THE FLEXOR POLLICIS LONGUS TENDON FROM THE MUSCULOTENDINOUS AREA: A CASE REPORT.

P. Givissis, D. Karataglis, A. Christodoulou, I. Terzidis, J. Pournaras.

J Hand Surg [Am] 2005 Jul;30(4):850-853

Abstract
A traumatic avulsion of the flexor tendon at the musculotendinous junction in nonamputated digits is a very rare injury. We present a 14-year-old girl who sustained a longitudinal, tensile, injurious force directly to the flexor pollicis longus tendon after an open thenar injury resulting in its avulsion at the musculotendinous junction. In an effort to minimize soft-tissue damage and preserve the transverse ligament of the carpus the tendon was retrieved through a separate forearm incision. Direct repair was made by encapsulation of the tendon into the muscle belly. The functional result 30 months after surgery was satisfactory.

20. VERTEBRAL BODY RECONSTRUCTION WITH INJECTABLE HYDROXYAPATITE CEMENT FOR THE MANAGEMENT OF UNSTABLE THORACOLUMBAR BURST FRACTURES: A PRELIMINARY REPORT.

Christodoulou A, Ploumis A, Terzidis I, Pournaras I.

Acta Orthop Belg. 2005 Oct;71(5):597-603.

Abstract
The aim of this prospective study was to evaluate the efficacy of an injectable hydroxyapatite cement in combination with long posterior transpedicular instrumentation, without fusion, for the treatment of unstable thoracolumbar burst fractures. Ten patients with this type of fracture were treated in the period 1999-2000 with bisegmental posterior transpedicular stabilisation above and below the fracture site, indirect reduction of the fracture, and transpedicular injection of hydroxyapatite cement into the fractured vertebral body. Postoperatively the mean Cobb kyphotic deformity angle (CKDA) and vertebral compression index (VCI) were statistically improved (p < 0.001). Both variables deteriorated slightly between surgery and follow-up after +/- 39 months; this was statistically not significant for the CKDA (p > 0.05), but significant for the VCI (p < 0.001). These data suggest that hydroxyapatite cement can be a reliable way to reinforce the fractured vertebral body in the thoracolumbar region.

21. MENISCAL TEAR CHARACTERISTICS IN YOUNG ATHLETES WITH A STABLE KNEE: ARTHROSCOPIC EVALUATION.

Terzidis IP, Christodoulou A, Ploumis A, Givissis P, Natsis K, Koimtzis M.

Am J Sports Med. 2006 Jul;34(7):1170-5. Epub 2006 May 9.

BACKGROUND: There has been great interest in the literature regarding meniscal tears in unstable knees, but there is not as much information available on stable knees.
PURPOSE: To report the characteristics of isolated meniscal tears (type and location) in athletes with intact cruciate ligaments.
METHODS: Arthroscopic surgery was performed on 314 (83.1%) knees in the acute phase ( < 6 weeks) of injury and on 64 (16.9%) knees more than 6 weeks after injury for a total of 364 athletes (378 knees). Cooper's classification was used to classify the meniscal tears according to the type and location.
RESULTS: Overall, 262 of 378 tears (69.3%) were located in the medial meniscus and 116 (30.7%) in the lateral meniscus. Vertical tears (77.5%) were significantly more frequent than were horizontal tears (22.5%; chi(2) test, P < .001). A total of 23.2% of tears involved the peripheral zones (zone 0 or 1), and tears that extended into the posterior horn accounted for 75.7%. Regarding the tear shape between male and female athletes, on both sides there were no statistically significant differences in the percentage of horizontal, bucket-handle, longitudinal, or radial tears.
CONCLUSION: The characteristics of isolated meniscal tears differ with regard to the sport, sex, and tear location and type from those seen in unstable knees. This knowledge is useful in knee injury management.

22. THE INTRA – ARTICULAR USE OF ROPIVACAINE FOR THE CONTROL OF POST KNEE ARTHROSCOPY PAIN.

Samoladas EP, Chalidis B, Fotiadis H, Terzidis I, Ntobas T, Koimtzis M.

J Orthop Surg. 2006 Dec 23;1(1):17

AIMS: The purpose of this prospective randomised study is to evaluate the efficacy, safety and the appropriate dose of the ropivacaine in the control of post-knee arthroscopy pain.
METHODS: We randomised 60 patients in two groups to receive 10 ml/7.5 mg/ml ropivacaine (Group B) or 20 ml/7.5 mg/ml (Group A) at the end of a routine knee arthroscopy. We monitored the patient's blood pressure, heart rate, allergic reactions, headache, nausea, we assessed the pain using the visual analogue score at intervals of 1,2,3,4 and 6 hours after the operation. and we recorded the need for extra analgesia.
RESULTS: The intraarticular use of the ropivacaine provided excellent control of pain after knee arthroscopy. At two hours post-operatively there wasn't any difference between the two groups. Afterwards, the Group A showed increased pain and need for supplementary medication.
CONCLUSION: We believe that intraarticular use of ropivacaine is effective to reduce post-operative pain minimising the use of systematic analgesia.

23. CROSSOVER TRAINING EFFECTS OF THREE DIFFERENT REHABILITATION PROGRAMS AFTER ARTHROSCOPIC MENISCECTOMY.

Koutras G, Pappas E, Terzidis IP.

Int J Sports Med. 2009 Feb;30(2):144-9. Epub 2008 Jul 30.

Abstract
The present study investigated the crossover effect of three rehabilitation programs (isokinetic, isotonic and home exercise), that were focused on the involved extremity, on the isokinetic performance of knee flexors and extensors and the functional performance of the uninvolved leg in subjects who underwent arthroscopic partial meniscectomy. Twenty-eight patients (mean age: 28) were measured for isokinetic performance and functional performance with the single jump, triple jump and vertical jump 14 days and 33 days after surgery. Peak torque of hamstrings at 60 degrees /sec (p = .008), hamstrings at 180 degrees /sec (p < 0.001), quadriceps at 180 degrees /sec (p = 0.024), single jump (p < 0.001), triple jump (p = 0.002), and vertical jump (p = 0.005) were significantly increased during the final measurement session compared to the initial measurement session. The knee flexors exhibited higher gains than the knee extensors. There were no differences between the isokinetic, isotonic, and home exercise program group (p = 0.506). Researchers and clinicians are encouraged to obtain measurements of the uninvolved leg at consistent time points between groups in order to allow for accurate comparisons.

24. ROTAGLIDE TOTAL KNEE ARTHROPLASTY: A MINIMUM OF TEN YEARS FOLLOW UP STUDY

Ploumis A.L., .Metsovitis S.R., Tsakonas A.C, Chantzidis P.T., Terzidis I.P. Christodoulou A.G., Dimitriou C.G.

υπό δημοσίευση   JBJS-D-09-01702R1.

BACKGROUND: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing implants in total knee arthroplasty. The purpose of this study was to determine the clinical results of a mobile-bearing knee implant.
METHODS: From 1990 to 1998, 326 primary consecutive mobile-bearing total knee prostheses were implanted in 260 patients who had a mean age and standard deviation of 66.7 ± 6.9 years. Femoral and tibial components were cemented in all knees, and the patella was resurfaced in 199 knees (61%). Patients were evaluated with the use of the Knee Society clinical rating system and radiographic examinations. Complications were noted, and survivorship of the prostheses was determined.
RESULTS: The mean follow-up period was 156 ± 27.3 months, with maximum follow-up at eighteen years. The mean Knee Society knee score improved from 32.4 ± 21.2 preoperatively to 92.6 ± 10.0 at the time of the last follow-up (p = 0.00), and the mean Knee Society functional score improved from 39.3 ± 18.7 preoperatively to 66.7 ± 18.6 at the time of the last follow-up (p = 0.00). Mean knee flexion improved from 92.3° ± 14.5° preoperatively to 112.1° ± 13.4° at the time of the last follow-up (p = 0.00). There were twenty-four (7.4%) knees that required revision. In eighteen (5.5%) knees, worn out or broken polyethylene was found and a polyethylene-only exchange was done. Six knees (1.8%) were fully revised. The survival rate was 0.96 (95% confidence interval, 0.93 to 0.98) at ten years and 0.87 (95% confidence interval, 0.79 to 0.93) at eighteen years.
CONCLUSIONS: A fully congruent, mobile-bearing total knee prosthesis had excellent survivorship during the ten to eighteen-year follow-up interval.