Objectives. The purpose of the present study was to investigate the clinical outcomes and complications of the cortical button distal biceps fixation method. Material and Methods. All methods followed the PRISMA guidelines. Included studies had to describe clinical outcomes and complications after acute distal biceps repair with cortical button fixation. Eligibility criteria also included English language, more than 5 cases with minimum follow-up of 6 months, and preferably usage of at least one relevant clinical score (MEPS, ASES, and/or DASH) for final outcome. A loss of at least 30° in motion—flexion, extension, pronation, or supination—and a loss of at least 30% of strength were considered an unsatisfactory result. Results. The review identified 7 articles including 105 patients (mean age 43.6 years) with 106 acute distal biceps ruptures. Mean follow-up was 26.3 months. Functional outcome of ROM regarding flexion/extension and pronation/supination was satisfactory in 94 (89.5%) and 86 (82%) patients in respect. Averaged flexion and supination strength had been reported in 6/7 studies (97 patients) and were satisfactory in 82.4% of them. The most common complication was transient nerve palsy (14.2%). The overall reoperation rate was 4.8% (5/105 cases). Conclusion. Cortical button fixation for acute distal biceps repair is a reproducible operation with good clinical results. Most of the complications can be avoided with appropriate surgical technique.

OBJECTIVES:The aim of this study was to assess the validity, reliability and responsiveness of the developed Greek version of the KOOS in total knee replacement (TKR) patients. METHODS:For the translation procedure, guidelines for cross-cultural adaptation were followed (Beaton et al, 2000). KOOS was translated into Greek independently by 3 Greek native raters (2 physiotherapists with > 5 years of clinical musculoskeletal experience and one Orthopedic surgeon).The 3 raters had a meeting where all translations were discussed and a consensus was achieved to a preliminary (synthesis) version. This version was utilized for a backtranslation (Greek to English) by another rater, an English native professional translator who had no prior knowledge of the KOOS. The synthesis and back translation were discussed in a second meeting and a consensus on a prefinal Greek version of KOOS was reached. This prefinal version was tested in a pilot study. It was administered to 10 total knee replacement (TKR) patients with variable educational levels, to confirm the comprehensibility and syntax of all questions. Following the pilot, a final meeting was organized, where all raters discussed the comments made by the patients within the pilot. There were only two points of discussion regarding a) question P4 & P5, the translation and comprehension of full flexion and extension by patients b) the translation of the word «extreme» , the 5th point of the Likertscale in questions S6-Q4. Thus, following this meeting the final version of Greek KOOS questionnaire was developed. Validation procedure:For exploring validity, reliability and responsiveness of KOOS Greek version, 51 consecutive TKR patients (mean age 72.2±7.2 years, 39 women) within the University Hospital of Patras, Greece participated in the study. KOOS's psychometric properties were evaluated according to the COSMIN checklist.Preoperative clinical status and postoperative outcomes at 2 occasions (at discharge and 10-12 days postoperatively) were evaluated using the Greek versions of the KOOS, KOS-ADL, and SF-12 Health Survey. Psychometric properties of both Greek versions of KOS-ADL and SF-12 have been previously tested and have been found satisfactory (Roos et al, 1998, Goncalves et al, 2009). All questionnaires were administered by one orthopedic surgeon. Questionnaires were self-filled.For the analysis, criterion-related validity was evaluated by Pearson's correlation. Internal consistency by Cronbach's alpha; Reliability, by intra-class correlation coefficient (ICC).The SEM was calculated on the basis of the error variance, whereas responsiveness was calculated by effect size, standardized response mean (SRM) and by relating the smallest detectable change (SDC) with the minimal important difference (MIC). RESULTS:Internal consistency: Internal consistency was excellent with Cronbach's a being 0.801 preoperatively, and 0.920 at discharge and at 2 weeks after TKR. Chronbach's a for the 5 subscales of KOOS was found 0.785 preoperatively, 0.822 at discharge and 0.781 at 2 wee...

AimThe purpose of this study was to produce a modified Greek translation of the CS and to test this version in terms of reliability and validity.Materials and methodsTranslation of the modified Constant score testing protocol was done according to established international guidelines. Sixty-three patients with shoulder pain caused by degenerative or inflammatory disorders completed the Greek version of CS along with the Greek versions of SF-12 and Quick Dash Scores and the ASES Rating Scale and were included into the validation process. To assess test–retest reliability, 58 individuals completed the subjective part of the test again after 24–36 hours, while abstaining from all forms of treatment; internal consistency was measured using Cronbach's alpha (α); reliability was assessed with test–retest procedure and the use of Interclass Correlation Coefficient (ICC), whereas the validity of the reference questionnaire was evaluated using Pearson's correlation coefficient in relation to control questionnaires.ResultsThere were no major problems during the forward–backward translation of the CS into Greek. The internal consistency was high (Cronbach's alpha 0.92) while the test–retest reliability for the overall questionnaire was also high (intra-class coefficient 0.95). Construct validity was confirmed with high values of Pearson's correlation between CS and Q-DASH (0.84), SF-12 (0.80) and ASES score (0.86) in respect.ConclusionA translation and cultural adaptation of CS into Greek was successfully contacted. The Greek version of the modified Constant Score can be a useful modality in the evaluation of shoulder disorders among Greek patients and doctors.

Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.

Purpose The Knee Injury Osteoarthritis Outcome Score (KOOS)-Child questionnaire is one of the frequently child-friendly measures used in pediatric studies. The aim of this study was to transculturally adapt the Greek version of KOOS-Child and evaluate its clinimetric properties in children with knee disorders. Methods Children visiting the Outpatients Orthopaedic Clinic of a Greek Paediatric General Hospital were considered eligible if they were aged 8-14 years, had a knee soft tissue injury and associated physical limitations. The transcultural adaptation was based on a multistage backward translation approach. Participants completed the KOOS-Child at their irst visit to the orthopedic specialist (baseline), 2 weeks and 3 months after baseline. Content validity of the KOOS-Child was evaluated using general QoL measures (KIDSCREEN and Kid-KINDL) and construct validity was explored by correlating relevant items. Responsiveness was evaluated according to the children's response on the given orthopeadic treatment. Results Sample consisted of 59 children (30 males), aged: 11 ± 1.8 years. The KOOS-Child showed high internal consistency (Cronbach's a: 0.80-0.96). Adequate convergent validity with > 75% relevant a priori hypotheses was conirmed. Construct validity was moderate to strong (Pearson's r correlations between related KOOS and Kid-KINDL subdimensions: 0.54-0.62). KOOS and KIDSCREEN subdimensions correlations were fair (Pearson's r correlations: 0.32-0.65). KOOS-Child's diagnostic accuracy was high. Factor analysis extracted height factors accounting for 76.15% of the total variance, conirmed by the scree plot. Responsiveness was moderate to high with Cohen's d from 0.6 to 1.4. ConclusionThe Greek version of the KOOS-Child demonstrated excellent internal consistency, good construct validity, diagnostic accuracy and interpretability as well as good responsiveness. The measure could be used across Greek children with orthopaedic knee problems. Generalisability of indings is limited due to the relatively limited cohort. Level of evidence II. KeywordsCross-cultural adaptation • Greek • KOOS-child • Knee injury osteoarthritis outcome score • Patient health questionnaire • Pediatric orthopaedics • Validation study Abbreviations ACL Anterior cruciate ligament KOOS Knee Injury and Osteoarthritis Outcome Score QoL Quality of life ADL Activities of Daily living PROMs Patient-reported outcome measures COSMIN COnsensus-based Standards for the selection of health Measurement INstruments ES Efect size EQ-5D EuroQol 5D indices SD Standard deviation ROC Receiver-operating characteristic AUC Area under the curve * Maria Moutzouri