Digital Ventilated Cages (DVC) offer an innovative technology to obtain accurate movement data from a single mouse over time [1]. Thus, they could be used to determine the occurrence of a tendon damage event as well as inform on tissue regeneration [2,3]. Therefore, using the mouse model of tendon experimental damage, in this study it has been tested whether the recovery of tissue microarchitecture and of extracellular matrix (ECM) correlates with the motion data collected through this technology.

Mice models were used to induce acute injury in Achilles tendons (ATs), while healthy ones were used as control. During the healing process, the mice were housed in DVC cages (Tecniplast) to monitor animal welfare and to study biomechanics assessing movement activity, an indicator of the recovery of tendon tissue functionality. After 28 days, the AT were harvested and assessed for their histological and immunohistochemical properties to obtain a total histological score (TSH) that was then correlated to the movement data.

DVC cages showed the capacity to distinguish activity patterns in groups from the two different conditions. The data collected showed that the mice with access to the mouse wheel had a higher activity as compared to the blocked wheel group, which suggests that the extra movement during tendon healing improved motion ability. The histological results showed a clear difference between different analyzed groups. The bilateral free wheel group showed the best histological recovery, offering the highest TSH score, thus confirming the results of the DVC cages and the correlation between movement activity and structural recovery.

Data obtained showed a correlation between TSH and the DVC cages, displaying structural and movement differences between the tested groups. This successful correlation allows the usage of DVC type cages as a non-invasive method to predict tissue regeneration and recovery.

Acknowledgements: This research is part of the P4FIT project ESR13, funded by the H2020-ITN-EJD MSCA grant agreement No.955685.

The relationship of degeneration to symptoms has been questioned. MRI detects apparently similar disc degeneration and degenerative changes in subjects both with and without back pain. We aimed to overcome these problems by re-annotating MRIs from asymptomatic and symptomatic groups onto the same grading system. We analysed disc degeneration in pre-existing large MRI datasets. Their MRIs were all originally annotated on different scales. We re-annotated all MRIs independent of their initial grading system, using a verified, rapid automated MRI annotation system (SpineNet) which reported degeneration on the Pfirrmann (1-5) scale, and other degenerative features (herniation, endplate defects, marrow signs, spinal stenosis) as binary present/absent. We compared prevalence of degenerative features between symptomatics and asymptomatics. Pfirrmann degeneration grades in relation to age and spinal level were very similar for the two independent groups of symptomatics over all ages and spinal levels. Severe degenerative changes were significantly more prevalent in discs of symptomatics than asymptomatics in the caudal but not the rostral lumbar discs in subjects < 60 years. We found high co-existence of degenerative features in both populations. Degeneration was minimal in around 30% of symptomatics < 50 years. We confirmed age and disc level are significant in determining imaging differences between asymptomatic and symptomatic populations and should not be ignored. Automated analysis, by rapidly combining and comparing data from existing groups with MRIs and information on LBP, provides a way in which epidemiological and ‘big data’ analysis could be advanced without the expense of collecting new groups

Introduction. Orthopedics is experiencing a significant transformation with the introduction of technologies such as robotics and apps. These, integrated into the post-operative rehabilitation process, promise to improve clinical outcomes, patient satisfaction, and the overall efficiency of the healthcare system. This study examines the impact of an app called Mymobility and intra-operative data collected via the ROSA® robotic system on the functional recovery of patients undergoing robot-assisted knee arthroplasty. Method. The study was conducted at a single center from 2020 to 2023. Data from 436 patients were included, divided into “active” patients (active users of Mymobility) and “non-active” patients. Clinical analyses and satisfaction surveys were carried out on active patients. The intra-operative parameters recorded by ROSA® were correlated with the Patient-Reported Outcome Measures (PROMs) collected via Mymobility. Result. Intra-operative data showed significant correlations with PROMs for the 48 active patients, highlighting the importance of parameters such as medial joint space and ligament laxity. No significant differences were observed between the sexes, but a positive correlation was detected between age and PROMs. The data analysis indicated that an increased medial joint space and reduced ligament laxity are associated with better PROMs. The adoption of Mymobility remained limited, with only 10% of patients fully utilizing the app. Critical factors have been identified to improve recruitment, engagement, and overall experience with the platform. Conclusion. The integration of technologies such as Mymobility and ROSA® in post-operative rehabilitation offers numerous advantages, including the objectification of data, active patient involvement, and personalized care. Challenges remain related to costs, patient compliance, and demographic limitations. Nevertheless, these technologies represent a milestone in modern peri-operative management, being able to improve clinical outcomes and the quality of care

Introduction. When designing a new osteosynthesis device, the biomechanical competence must be evaluated with respect to the acting loads. In a previous study, the loads on the proximal phalanx during rehabilitation exercises were calculated. This study aimed to assess the safety of a novel customizable osteosynthesis device compared to those loads to determine when failure would occur. Method. Forty proximal phalanges were dissected from skeletally mature female sheep and divided into four testing groups. A custom 3D printed cutting and drilling guide was used to create a reduced osteotomy and pilot holes to insert four 1.5 mm cortical screws. A novel light-curable polymer composite was used to fixate the bones with an in situ fixation patch. The constructs were tested in cyclic four-point bending in a bioreactor with ringer solution at 37°C with a valley load of 2 N. Four groups (N = 10) had increasing peak loads based on varying safety factors relative to the physiological loading (G1:100x, G2:150x, G3:175x, G4:250x). Each specimen was tested for 12,600 cycles (6 weeks of rehabilitation) or until failure occurred. After the test the thickness of the patch was measured with digital calipers and data analysis was performed in Python and R. Result. All samples survived in G1, and all failed in G4. G2 and G3 had 1 and 8 failures, respectively. There was no significant difference in patch thickness in all survivor samples against failures (p = 0.131), however, there was a significant difference in the displacement amplitude in the final cycle (0.072 mm vs. 0.15 mm; p < 0.001). Conclusion. This study found the survival and failure limits of a novel osteosynthesis device as a function of physiological loading. These results indicate that such fixations could withstand 100x the loading for typical non-weightbearing rehabilitation. Further studies are needed to confirm the safety for other conditions

Sarcopenia is an age-related geriatric syndrome which is associated with subsequent disability and morbidity. Currently there is no promising therapy approved for the treatment of sarcopenia. The receptor activator of nuclear factor NF-κB ligand (RANKL) and its receptor (RANK) are expressed in bone and skeletal muscle. Activation of the NF-κB pathway mainly inhibits myogenic differentiation, which leads to skeletal muscle dysfunction and loss. LYVE1 and CD206 positive macrophage has been reported to be associated with progressive impairment of skeletal muscle function with aging. The study aims to investigate the effects of an anti-RANKL treatment on sarcopenic skeletal muscle and explore the related mechanisms on muscle inflammation and the polarization status of macrophages. Sarcopenic senescence-accelerated mouse P8 (SAMP8) mice at month 8 were treated intraperitoneally with 5mg/kg anti-RANKL (IK22/5) or isotype control (2A3; Bio X Cell) antibody every 4 weeks and harvested at month 10. Senescence accelerated mouse resistant-1 (SAMR1) were collected at month 10 as the age-matched non-sarcopenic group. Ex-vivo functional assessment, grip strength and immunostaining of C/EBPa, CD206, F4/80, LYVE1 and PAX7 were performed. Data analysis was done with one-way ANOVA, and the significant level was set at p≤0.05. At month 10, tetanic force/specific tetanic force, twitch force/specific twitch force in anti-RANKL group were significantly higher than control group (all p<0.01). The mice in the anti-RANKL treatment group also showed significantly higher grip strength than Con group (p<0.001). The SAMP8 mice at month 10 expressed significantly more C/EBPa, CD206 and LYVE1 positive area than in SAMR1, while anti-RANKL treatment significantly decreased C/EBPa, CD206 and LYVE1 positive area. The anti-RANKL treatment protected against skeletal muscle dysfunctions through suppressing muscle inflammation and modulating M2 macrophages, which may represent a novel therapeutic approach for sarcopenia. Acknowledgment: Collaborative Research Fund (CRF, Ref: C4032-21GF)

Osteoarthritis (OA) is the most common degenerative joint disorder. Its multifactorial etiology includes age, sex, joint overloading, genetic or nervous influences. In particular, the autonomic nervous system is increasingly gaining in importance. Its two branches, the sympathetic (SNS) and parasympathetic nervous system, are well-balanced under healthy conditions. OA patients seem to be prone to an autonomic imbalance and therefore, we analyzed their autonomic status. More than 200 participants including patients with early and late stage knee OA (before and 1 year after knee replacement surgery) and healthy probands (age-matched) were analyzed. Heart rate variability was measured via electrocardiogram to assess long-term sympathetic (low-frequency=LF) and parasympathetic (high-frequency=HF, pRR50) activities or general variability (RMSSD, SDRR). Serum cortisol concentrations were measured by ELISA. Perceived chronic stress (PSQ) was assessed via questionnaire. Multivariant regression was performed for data analysis. LF/HF value of early OA was slightly increased compared to healthy controls but significantly higher compared to late OA patients before (p>0.05) and after TKR (p>0.01). HF in late OA patients before TKR was significantly decreased compared to patients after TKR (p>0.001) or healthy controls (p>0.05). Healthy probands exhibited the highest SDRR values, early OA patients had slightly lower levels and late OA patients before TKR displayed significantly reduced SDRR (p>0.001). The same differences were observed in pRR50 and RMSSD. Serum cortisol concentrations and PSQ scores increased in late OA patients before TKR. At the time point of TKR, women with beta blocker medication had significantly higher age (71 ± 9 years) than those without (63 ± 12 years)(p>0.01). An autonomic dysfunction with sympathetic dominance occurs in OA patients. The fact that beta blocker medication in women delayed the need of TKR indicates that SNS inhibition might counteract OA. Future therapeutic interventions for OA should consider a systemic approach with special regard on the ANS

Abstract. OBJECTIVE. Knee varus malalignment increases medial knee compartment loading and is associated with knee osteoarthritis (OA) progression and severity. 1. Altered biomechanical loading and dysregulation of joint tissue biology drive OA progression, but mechanistic links between these factors are lacking. Subchondral bone structural changes are biomechanically driven, involve bone resorption, immune cell influx, angiogenesis, and sensory nerve invasion, and contribute to joint destruction and pain. 2. We have investigated mechanisms underlying this involving RANKL and alkaline phosphatase (ALP), which reflect bone resorption and mineralisation respectively. 3. and the axonal guidance factor Sema3A. Sema3A is osteotropic, expressed by mechanically sensitive osteocytes, and an inhibitor of sensory nerve, blood vessel and immune cell invasion. 4. Sema3A is also differentially expressed in human OA bone. 5. HYPOTHESIS: Medial knee compartment overloading in varus knee malalignment patients causes dysregulation of bone derived Sema3A signalling directly linking joint biomechanics to pathology and pain. METHODS. Synovial fluid obtained from 30 subjects with medial knee OA (KL grade II-IV) undergoing high tibial osteotomy surgery (HTO) was analysed by mesoscale discovery and ELISA analysis for inflammatory, neural and bone turnover markers. 11 of these patients had been previously analysed in a published patient-specific musculoskeletal model. 6. of gait estimating joint contact location, pressure, forces, and medial-lateral condyle load distribution in a published data set included in analyses. Data analysis was performed using Pearson's correlation matrices and principal component analyses. Principal Components (PCs) with eigenvalues greater than 1 were analysed. RESULTS. PC1 (32.94% of variation) and PC2 (25.79% of variation) from PCA analysis and correlation matrices separated patients according to correlated clusters of established inflammatory markers of OA pain and progression (IL6/IL8, r=0.754, p<0.001) and anti-inflammatory mediators (IL4/IL10, r=0.469, p=0.005). Bone turnover marker ALP was positively associated with KL grade (r=0.815, p=0.002) and negatively associated with IL10 (r=−0.402, p=0.018) and first peak knee loading pressures (r=−0.688, p=0.019). RANKL was positively associated with IL4 (r=0.489, p=0.003). Synovial fluid Sema3A concentrations showed separate clustering from all OA progression markers and was inversely correlated with TNF-α (r=−0.423, p=0.022) in HTO patients. Sema3A was significantly inversely correlated with total predicted force in the medial joint compartment (r=−0.621, p=0.041), mean (r=−0.63, p=0.038) and maximum (r=−0.613, p=0.045) calculated medial compartment joint pressures during the first phase and mean (r=−0.618, p=0.043) and maximum (r=−0.641, p=0.034) medial compartment joint pressures during midstance outputs of patient-specific musculoskeletal model. CONCLUSIONS. This study shows joint inflammatory status and mechanical overloading influence subchondral bone-remodelling. Synovial Sema3A concentrations are inversely correlated to patient-specific musculoskeletal model estimations of pathological medial overloading. This study reveals Sema3A as a biological mediator with capacity to induce OA pain and disease progression that is directly regulated by gait mechanical loading. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Abstract. Objectives. Currently, the golden standard for the management of ankle fractures is open reduction and internal fixation (ORIF), a procedure which preserves joint anatomy and function. However, ORIF is associated with high risk of infection, especially in the elderly population, who tend to suffer from osteoporosis and vascular disease. Studies recommend hindfoot nailing (HFN) as a safe and efficient management alternative for this demographic. Unlike ORIF, HFN allows immediate weight-bearing, which has been linked to a lower rate of complications. This study aims to evaluate the outcomes of hindfoot nailing in ankle fractures using a case series of 43 patients. Methods. This is a retrospective study with a sample size of 43 patients, that have a mean age of 77.3 years and several medical conditions. These patients experienced ankle fractures that were treated with HFN. Data collected included injury patterns, operative complications, rate of radiological union, comorbidities and changes in mobility and housing before and after surgery. Results. Before their fracture, 62.8% of patients mobilised using a walking stick or a wheeled frame. Following surgery, 52.4% experienced decreased level of mobility. 50% of patients achieved radiological union at the time of data analysis, whereas 52.4% of patients reported a post-operative complication, most commonly soft tissue or bone infection. Conclusions. Our study has a large sample size compared to previous research. The follow-up period varies depending on patient attendance to follow-up clinical appointments. Our patient cohort exhibits significantly lower rates of radiological union, higher incidence of complications and poor post-operative functional outcomes associated with HFN. These data contradict previous studies suggesting HFN for the surgical management of ankle fractures in the elderly and frail population and demonstrate that a more thorough evaluation of HFN is needed

Targeted delivery of drugs is a major challenge in diseases such as infections and tumors. The aim of this study was to demonstrate that hydroxyapatite (HA) particles can act as a recruiting moiety for various bioactive molecules and as a proof-of-concept demonstrate that the affinity of drugs to hydroxyapatite can exert a biological effect. A bisphosphonate, zoledronic acid (ZA), was used as a model drug. Experiment 1 (ZA seeks HA): Calcium sulphate (CaS)/hydroxyapatite (HA) biomaterial pellets (diameter¸=5 mm, height=2 mm) were implanted in the abdominal muscle pouch of rats. After 2-weeks of implantation, a sub-cutaneous injection of 14C-ZA (0.1 mg/kg) was given. 24 h later, the animals were sacrificed and the uptake of ZA determined in the pellets using scintillation counting. Experiment 2 (Systemically administered ZA seeks HA and exerts a biological effect): A fenestrated implant was filled with the CaS/HA biomaterial and inserted in the proximal tibia of rats. 2-weeks post-op, a subcutaneous injection of ZA (0.1 mg/kg) was given. Animals were sacrificed at 6-weeks post-op. Empty implant was used as a control. Peri-implant bone formation was evaluated using different techniques such as micro-CT, mechanical testing and histology. Welch's t-test was used for mechanical testing and Mann-Whitney U test for micro-CT data analysis. Experiment 1: Uptake of radioactive ZA in the CaS/HA biomaterial was confirmed. Almost no ZA was present in the surrounding muscle. These results show high specific binding between systemically administered ZA and synthetic particulate HA. Experiment 2: Significantly higher peri-implant bone was measured using micro-CT in the group wherein the implant contained the CaS/HA biomaterial and ZA was administered systemically (This study presents a method for biomodulating HA in situ by different bioactive molecules. The approach of implanting a biomaterial capable of recruiting systemically given drugs and thereby activate the material is novel and may present a possibility to treat bone infections or tumors

Patient-reported outcome measures are a cornerstone of outcome assessment in orthopaedics. However, completing the pencil and paper questionnaires in clinic is something of a burden to the individual patient and the health care institution. We do not provide much in the way of incentives to collect PRO data. Lengthy questionnaires and hidden data analysis offer no direct benefit to the individual patient nor the clinician. Employing ePRO, utilising tablet PCs for questionnaire completion, can improve this situation considerably. Swift and cost-effective data management and instant availability of results using intuitive graphical display make questionnaire completion more rewarding. Direct feedback of PRO data during the consultation can inform the individual's care. Completing electronic questionnaires also makes computer-adaptive testing (CAT) possible. CAT creates dynamic questionnaires, adapting to the individual symptom burden of the individual patient. CAT both increases measurement precision and reduces the number of questions required. As such, ePRO assessment may help to maximise the efficiency and the utilisation of PRO data

A risk factor for patellofemoral instability is trochlear dysplasia. Trochleoplasty is a surgical procedure used to reshape the trochlear groove to improve patellar stability. This study seeks to compare pre-op MRI measurements and post operative MRI measurements for patients who have undergone trochleoplasty in correlation with their clinical outcomes scores. Data was collected from a database of patients known to have trochlear dysplasia who underwent trochleoplasty. Radiological Data was collected pre-op and subsequent post op MRI data collected included TT-TG, Patella Tilt, IS, sulcus angle. Data score sheets pre-op and post op trochleoplasty completed by patients were also collected. 10 patients had pre and post op MRI's documented. 80%(8/10) females and 20%(2/10) males, average age of 30 years old (range 23 – 32 years old). Average MRI pre-op scores: IS ratio: 1.2, Patella tilt: 24.14, sulcus angle 160.13, and TT-TG distance of 16.94. 1 year average MRI post-op scores: IS ratio: 1.28, Patella tilt 15.56, sulcus angle 148.66 and TT-TG distance 16.78. 1 year post op Kujala and Norwich instability scores patient reported improved stability, function and confidence post op compared to pre-op. Subjective and objective scores reflected an improvement of stability. MRI demonstrated a deeper trochlear groove post-operatively which should provide resistance against lateral patella movement and patellar dislocations. TT-TG pre and post op remained constant. Pre op and post op Kujala scores reflected improved function. The Norwich instability scores pre and post op reflected satisfaction of treatment. There are not a lot of studies published on trochleoplasty. Based on this study it is clear that patients with patellofemoral instability with severe trochlear dysplasia will benefit from trochleoplasty. The sample size of the data analysis was only 10. However it reflected that function 1 year post procedure remained stable

Aim. To evaluate the association of BMI and improvement in patient-reported outcomes after TKA. Methods. Knee replacement outcome data for procedures carried out over an eight month period was extracted from a regional arthroplasty register in the UK. Data was available before surgery and 12 months after. We analysed the impact of overweight on post-operative change in the Forgotten Joint Score − 12 (FJS-12) measuring joint awareness and the Oxford Knee Score (OKS) measuring pain and function using five BMI categories (A: <25, B: 25–29.9, C: 30–34.9, D: 35–39.9 and E: >40). Results. We analysed data from 431 TKA patients with a mean age of 70.1 (SD=9.2 years) and 54.5% being female. Frequency of the BMI categories in our sample were as follows: A) 15.8% with a BMI<25, B) 32.8 % with a BMI 25–29.9, C) 27.7% with a BMI 30–34.9, D) 16.5 % with a BMI 35–39.9, and E) 7.1 % with a BMI above 39.9. Data analysis showed a statistically significant association (Z= 12.10, p=0.02) of BMI with post-operative improvement in the FJS-12 from pre-surgery to 12 months: A) + 37.9 points (Cohen”s d= 1.67); B) + 40.3 points (Cohen”s d= 1.67); C) + 34.0 points (Cohen”s d= 1.54) D) + 29.7 points (Cohen”s d= 1.29) and E) + 23.5 points (Cohen”s d= 1.24). Post-operative change in OKS did not show a statistically significant association with the BMI categories (Z=1.24, p=0.872). Conclusions. Our study shows that obesity has an impact on improvement after TKA in terms of joint awareness, with overweight patients being at higher risk of less benefit from surgery. Whereas the FJS-12 showed a substantial difference in the recovery process, the postoperative improvement measured with the OKS was comparable for patients in the different BMI categories. This highlights that outcome scores may differ in their ability to capture the impact of BMI on postoperative recovery

INTRODUCTION. Osteoarthritis (OA) is a growing societal burden, due to the ageing population. Less invasive, less damaging, and cheaper methods for diagnosis are needed, and sound technology is an emerging tool in this field. AIMS. The aim of the current research was to: 1) investigate the potential of visual scalogram analysis of Acoustic Emission (AE) frequencies within the human audible range (20–20000 Hz) to diagnose knee OA, 2) correlate the qualitative visual scalogram analysis of the AE with OA symptoms, and 3) to do this based on information gathered during gait. METHODS. The analysis was carried out on a database collected during a prospective sound study on healthy and osteoarthritic knees. Sound recordings obtained with a contact microphone mounted on the patella and attached to a digital pre-amplifier, whilst patients were walking on a treadmill, were visualised, manually sampled, and transformed into scalograms. Features of the scalograms were described and qualitatively analysed through chi-squared tests for association with healthy or OA knees (knee status), and with severity of OA pain and functional symptoms and impact on quality of life (QoL), activities of daily living (ADL) and sports using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. RESULTS. 28 patients (56 knees) were included in the analysis. Our method provides a wide variety of different scalogram features: if no events were recorded, the scalogram was classified as “quiet” (Fig 1). In case of abnormal recordings, data analysis evaluated association with the total count of the three most common events that appeared: 1. Peak (Fig 2), 2. Scattered (Fig 3) or 3. Island (localized noise but not presenting as a peak) (Fig 4) – “scalogram features”. No association was found between global scalogram characteristics (quiet versus “any noise”) and knee status (healthy or OA) (χ. 2. =3.163, p=0.075), but was found between knee status and three specific scalogram features (χ. 2. =9.743, p=0.008). The strongest association was a higher frequency of the “scattered” feature in the OA group (χ. 2. =9.06, p=0.01). Scalogram characteristics had no significant association with the sports and recreation (χ. 2. =1.74, p=0.419) nor the activities of daily living (χ. 2. =1.80, p=0.406) KOOS subscales. Significant association was found between scalogram characteristic and the pain (χ. 2. =10.34, p=0.006), quality of life (χ. 2. =6.58, p=0.037), and symptoms (χ. 2. =7.54, p=0.023) subscales. CONCLUSION. Promising results from analysis of individual features and of KOOS subscales establish the potential of acoustic analysis in evaluation of OA knees. More analysis of the data is needed to better define the variety of scalogram features. The future consequences of this research would be the development of a fast and affordable, non-invasive, radiation-free and potentially portable approach to evaluation, diagnosis and longitudinal monitoring of knee disorders

Introduction. Orthopaedic trauma surgery is characterised by repetitive, forceful tasks that are physically demanding, thus theoretically increasing the risk of musculoskeletal injuries in these surgeons. The aim of this study is to assess prevalence, characteristics and impact of musculoskeletal disorders among orthopaedic trauma surgeons. Methods. A modified version of the physical discomfort survey was sent to surgeon members of the Orthopaedics Trauma Association (OTA) via e-mail. For data analysis, one-way ANOVA and Fisher Exact test were performed to compare the variables where appropriate. P values<0.05 were considered statistically significant. Results. A total of 86 surgeons completed the survey during the period of data collection. Of the respondents 84.9% were males and more than half were aged between 30–45 years old. The majority of musculoskeletal complaints and disorders were low back pain (29.3%), wrist or forearm tendinitis (18.0%), elbow lateral epicondylitis (15.4%), plantar fasciitis (14.7%). When data was analysed according to number of years in practice the results yielded a significant difference between the groups in both number of regions involved (p<0.05) and number of musculoskeletal disorders (p<0.05), as a higher proportion of these were documented in surgeons practicing for 16–20 years and more than 30 years. Also surgeons working in a private setting (p<0.005), surgeons working in more than one institute (p<0.005), increased number of regions involved (p<0.001) and increased number of musculoskeletal disorders (p<0.001) were significantly more likely to require time-off work. Conclusion. To our knowledge, our study is the first of its kind that shows a high percentage of orthopaedic trauma surgeons sustain occupational injuries some time in their careers. Cost of management and rehabilitation of these injuries, in addition to the amount of missed workdays due to these injuries indicate that these injuries have a significant economic burden on the health-care system

Background The internet is an increasingly utilised resource for accessing information regarding a variety of heath conditions. YouTube is a popular video sharing platform used to both seek and distribute information online. Materials & Methods. A search for ‘scoliosis’ was carried out using YouTube's search engine and data was collected on the first fifty videos returned. A JAMA score (to determine currency, authorship, source and disclosure) and scoliosis specific score (that measures the amount of information on the diagnosis and treatment options as devised by Mathur et al in 2005; scored 0–32) was recorded for each video to measure quality objectively. Additionally the number of views, number of comments and feedback positivity was documented for each. Data analysis was conducted using R 3.1.4/R Studio 0.98 with control for the age of each video in analysis models. Results. The average number of views per video was 71,152 with an average length of 7 minutes 32 seconds. Thirty six percent of the videos fell under the authorship category of personal experience. The average JAMA score was 1.32/4 and average scoliosis specific score was 5.38/32. There was a positive correlation between JAMA score and number of views P=0.003. However in contrast there was a negative correlation between scoliosis specific score and number of views P=0.01. Conclusions. Online health information has historically been poor and our study shows that in an environment like YouTube which lacks a peer review process, the quality of scoliosis information is low. Further work is needed to determine whether accessing information on YouTube can play a role in patient care other than simple education pertaining to the disease and its management. Level of Evidence. Health Services Study Level 3

The most common reasons for total joint arthroplasty (TJA) failure are aseptic loosening (AL) and prosthetic joint infection (PJI). There is a big clinical challenge to identify the patients with high risk of AL/PJI before the TJA surgery. Although there is evidence that genetic factors contribute to the individual susceptibility to AL/PJI, a predictive model for identification of patients with a high genetic risk of TJA failure has not been developed yet. We aimed to develop a risk evaluation tool utilising the AL/PJI-associated polymorphisms for identification of patients with high genetic risk of TJA failure based on inflammation-gene polymorphism panel. Based on allele and genotype frequencies of twenty-five single nucleotide polymorphisms (SNPs) in TNF, IL2, IL6, IL10, IL1b, IL-1Ra, MBL2, MMP1, FTO genes and those influencing the serum levels of biomarkers of TJA outcomes (IL6, CCL2/MCP-1, CRP, ESR) in peripheral blood obtained from patients with TJA (AL, n=110; PJI, n=93; no complications, n=123), we calculated a hazard ratio and a relative entropy of alleles and genotypes associated with AL and PJI and their combinations in patient subgroups. We conducted a risk evaluation tool based on the presence of risk alleles and genotypes in TNF (rs361525, rs1800629), DARC (rs12075), MBL2 (rs11003125) and FTO (rs9939609, rs9930506) genes associated with implant failure (AL/PJI). Of these, FTO gene variations (rs9939609, rs9930506) were associated mainly with PJI (P=0.001, OR=2.04, 95%CI=1.132–2.603; P=0.011, OR=1.72, 95%CI=1.338–3.096) and DARC (rs12075) with AL (P=0.005, OR=1.79, 95%CI=1.193–2.696). This tool calculates a hazard ratio of a combination of SNPs associated with AL and PJI for identification of patients with high and low risk of AL/PJI TJA failure. We proposed a risk evaluation tool for stratification of patients before the TJA surgery based on the genetic risk of AL/PJI development. The effect size for each genotype combination described in the study is small. Further multiparametric data analysis and studies on an extended patient cohort and other non-genetic and genetic parameters are ongoing. Grant support: AZV MZ CR VES16-131852A, VES15-27726A, IGA LF UP_2016_011

Summary. In the sample studied, reparability of large and massive tears was associated with pre-op ASES and active external rotation in neutral position. Surgical factors affecting reparability were tear size, tendon mobility and shape of the tear. Introduction. The limited literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. 1–3. The purpose of this study was twofold, 1) to explore the predictive value of clinical and surgical factors on reparability of large and massive rotator cuff tears and 2) to examine the relationship between reparability and clinical and disability measures. Patients and Methods. This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (full or partial repair) and had returned for their two year follow-up. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (RCMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regression and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student's T-tests and non-parametric statistics. Results. One hundred and fourteen patients (40 women, mean age 64, SD=9) were included in the analysis. There were 79 large (34 fully reparable, 45 partially reparable) and 35 (10 fully reparable, 25 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p>0.05) but the fully repairable tear group showed a better pre-operative ASES score (p=0.01) and a better active external rotation in neutral (p=0.05). Reparability was associated with tear shape (p<0.0001) and size (p=0.007), and tendon mobility (p<0.0001). Discussion/Conclusion. Among demographics, clinical examination and patient-oriented outcomes, the pre-op scores of the ASES and active external rotation in neutral position were predictive of reparability of a large or massive tear. Surgical variables associated with a partial repair were the tear size, tendon mobility and shape of the tear. Patients with partial repair had a statistically significant improvement in range of motion and strength and all disability scores over time. However, they had less flexion and abduction and reported a higher level of residual disability at 2 years post-operatively

Summary. In the sample studied, reparability of large and massive tears was associated with pre-op ASES and active external rotation in neutral position. Surgical factors affecting reparability were tear size, tendon mobility and shape of the tear. Introduction. The limited literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear . 1-3. The purpose of this study was twofold, 1) to explore the predictive value of clinical and surgical factors on reparability of large and massive rotator cuff tears and 2) to examine the relationship between reparability and clinical and disability measures. Patients and Methods. This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (full or partial repair) and had returned for their two year follow-up. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (RCMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regression and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student's T-tests and non-parametric statistics. Results. One hundred and fourteen patients (40 women, mean age 64, SD=9) were included in the analysis. There were 79 large (34 fully reparable, 45 partially reparable) and 35 (10 fully reparable, 25 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p>0.05) but the fully repairable tear group showed a better pre-operative ASES score (p=0.01) and a better active external rotation in neutral (p=0.05). Reparability was associated with tear shape (p<0.0001) and size (p=0.007), and tendon mobility (p<0.0001). Discussion/Conclusion. Among demographics, clinical examination and patient-oriented outcomes, the pre-op scores of the ASES and active external rotation in neutral position were predictive of reparability of a large or massive tear. Surgical variables associated with a partial repair were the tear size, tendon mobility and shape of the tear. Patients with partial repair had a statistically significant improvement in range of motion and strength and all disability scores over time. However, they had less flexion and abduction and reported a higher level of residual disability at 2 years post-operatively