This narrative review provides the outcomes of minimally invasive surgery (MIS) and describes the available conservative treatment options for patients with osteoporotic vertebral compression fractures (OVCFs) that have risk factors for Kummell’s disease (KD). It aims to explore the evidence, emphasize the possible therapy complications, and aims to propose the most efficient clinical strategies for maintaining a good overall condition of individuals who may suffer from neurological deficits from a late-diagnosed OVCF complication. The secondary objective is to sum up the diagnostic particularities concerning individuals prone to OVCFs and KD, as the major risk factor for developing these severe conditions remains osteoporosis. Findings of our narrative review are based on the results found in PubMed, Embase, and Google Scholar from the beginning of their inception to December 2020, described independently by two authors. All of the studies included in the review focus on reporting the following treatment methods: conservative methods, vertebroplasty, kyphoplasty, targeted percutaneous vertebroplasty, frontal and side-opening cannula vertebroplasty, SpineJack, bone-feeling mesh container treatment, and the difference in the cement viscosity used (high vs. low) and the approach used (unilateral vs. bilateral). The comparison of randomized control trials (RCTs) as well as prospective and retrospective case series showed a comparable efficacy of kyphoplasty and vertebroplasty, and described cement-augmented screw fixation and the SpineJack system as effective and safe. Although it should be noted that several studies revealed inconsistent results in regards to the efficacy of using back braces and analgesics in patients who had vertebral fractures that were overlooked or not enrolled in any active surveillance program to track the patient’s deterioration immediately. Nevertheless there are non-standardized guidelines for treating patients with OVCFs and their complications already established. Using these guidelines, a treatment plan can be planned that takes into consideration the patients’ comorbidities and susceptibilities. However, the primary approach remains the management of osteoporosis and that is why prophylaxis and prevention play a crucial role. These measures reduce the risk of disease progression. Unfortunately, in the majority of cases these measures are not taken into account and KD develops.

Introduction: Kummell disease(KD) is a relatively rare condition, which refers to a lack of blood supply to the bone leading to collapse. It typically presents in the thoracic vertebrae of elderly patients, as a compressive deformation of the vertebral body and its osteonecrosis. It appears as a result of minor trauma experienced weeks to months before the onset of the disease. Osteoporosis tends to be the biggest risk factor for KD, hence its high frequency in the affected patient population. Patients concerns: A 67-year-old female patient presented to the hospital with a back pain deteriorating since 1 year, limiting her daily activities. Over the time it progressed to involve extremities and caused hypersensitivity of the skin at the level of the affected thoracic region. She had a history of osteoporotic vertebral compression fracture 2 years earlier after a fall. It was treated by conservative methods. Diagnosis: Computed tomography procedure revealed a compression fracture at the level of Th11. Further investigation and collection of the past medical history showed a delayed nonunion of the vertebral fracture and intravertebral vacuum cleft. The final diagnosis was KD. Conservative treatment of the patient's condition in another hospital resulted in non-healing. Interventions: As there is no specific treatment for patients suffering from delayed posttraumatic vertebral body collapse, an attempt of the most promising surgical combination of methods was performed. SpineJack system procedure resulted in satisfactory vertebral height improvement. This included vertebroplasty and minimally invasive percutaneous transpedicular fixation using bone-cement screw augmentation, providing stabilization and kyphotic angle correction. All these procedures facilitated pain relief and alleviation of spinal symptoms. Outcomes: The radiological outcomes of the patient's condition showed improvement after the surgery. Patient reported subjective improvement in daily life functioning. Follow up period at 6 and 9 months postoperatively showed stable condition and a satisfactory feedback from the patient. Conclusion: The conservative treatment in this patient, provoked an occurrence of markedly diminished vertebral height, debilitating back pain and neurological symptoms. These features caused a significantly lower quality of life. An accurate diagnosis of KD requires a detailed medical history and awareness of this rare condition and its irreversible complications. The treatment chosen for specific cases should primarily involve a meticulous observation of the efficacy of conservative methods. Furthermore, after the appearance of any deterioration of vertebral fracture, surgical method should be planned in order to avoid undesirable effects.

Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger’s method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA—NAVIO and mTKA—CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.

In recent years, many studies on the safe return to sport (RTS) have been published, but there are still no clear and validated guidelines. After ACL reconstruction between limbs, asymmetry of muscle strength affects knee mechanics during walking and running, and asymmetrical joint kinematics and kinetics are considered as a strong risk factor of musculoskeletal injury. Therefore, proper diagnosis of any motor deficits remaining after ACL reconstruction seems particularly important. The aim of this study was to analyze how many tests should be included in the RTS test battery and which of them are most indicative for functional deficits related to anterior cruciate ligament (ACL) reconstruction. Sixty-five male football players (age 18–25 years) were divided into three groups: ACL group—after ACL rupture and reconstruction, mild injury group—post mild lower limb injuries, and the control group—without injuries. They performed five tests: Functional Movement Screen, Tuck Jump Assessment, Y-balance Test, Hop Test for Distance, and Isokinetic Test. The Composite Score of Readiness (CSR) index was calculated and expressed as the sum of z-scores. The multiple regression model for all tests was calculated, and then redundant variables were excluded. We observed that all tests significantly influenced the final CSR index. The Y-balance Test, Tuck Jump Assessment, and Isokinetic Test for knee flexion influenced the final CSR index the most, which means that these tests are greatly indicative of functional deficits related to ACL reconstruction. The strength of the extensor (quadriceps) muscle and the quadriceps/hamstring ratio appeared to be non-sensitive for testing functional deficits related to ACL reconstruction. If the test battery includes 4–5 tests, it better differentiates the athletes following ACL reconstruction from those after mild injuries, even if they all were cleared to play.

Background Monitoring body composition and changes in energy expenditure during maturation and growth is significant, as many components can influence body structure in adulthood. In the case of young players, when these changes can influence their strength and power, it seems to be equally important. Our aim was to examine whether resting energy expenditure (REE) and body composition would change after 10 months from baseline in physically active children and adolescents. Methods We obtained data from 80 children and adolescents aged 9 to 17 years at two measurement points: the baseline in September 2018 and after 10 months in July 2019. The study was carried out using a calorimeter (Fitmate MED, Cosmed, Rome, Italy), a device used to assess body composition using by the electrical bioimpedance method by means of a segment analyzer (TANITA MC-980). The Student’s t-test and linear regression analysis were used. Using the stepwise forward regression procedure, the selection of factors in a statistically significant way that describes the level of REE was made. Results We noticed that REE was not significantly different between baseline (1596.94 ± 273.01 kcal) and after 10 months (1625.38 ± 253.26 kcal). When analyzing the difference in REE between studies girls, we found body height as a significant predictor. The results of our study show a negative relationship between growth and REE. Differences between sexes and age in REE between baseline and after 10 months were not significant. Conclusions Our study involving physically active children and adolescents, which used repeated objective measures and longitudinal statistical modeling to analyze them, was unable to demonstrate any interaction between body weight change, body composition measurements, and REE.