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Papers by Konstantinos Ditsios

Orthopedics and Rheumatology Open Access Journal, 2017

MOJ Orthopedics & Rheumatology, 2017

Rotator cuff (RC) tears are the most common soft tissue injuries of the shoulder. Despite the sur... more Rotator cuff (RC) tears are the most common soft tissue injuries of the shoulder. Despite the surgical improvement with new techniques in the repair site of the tears, the clinical results remain with high rate of failure. Deferent experimental studies in many animal models try to evaluate the complexity of the clinical problem. In this review article we summarize the knowledge from studies regarding the tendon to bone repair and healing, the early inflammatory reaction, the bone, tendon and muscle condition and the diversity of scaffolds that have been used in order to bridge a gap between RC tendon and the recipient site on bone. To answer the spectrum of questions regarding the treatment of RC tears further specific knowledge using the aforementioned animal models is compulsory.

Journal of clinical medicine, Apr 24, 2024

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Frontiers in Surgery, May 3, 2022

Introduction: Simultaneous olecranon and radial head fractures are rare injuries and due to this ... more Introduction: Simultaneous olecranon and radial head fractures are rare injuries and due to this factor, the outcome of the selected therapy is not widely studied. The aim of this study is to report and evaluate the functional outcome of the surgical treatment of simultaneous olecranon and radial head fractures. Materials and Methods: This is a retrospective study of fifteen patients with concomitant olecranon and radial head fractures presenting to our orthopedic department between 2015 and 2020. Olecranon fractures were classified by Mayo classification and radial head fractures by Mason classification and were managed appropriately. Main outcome measures include range of elbow extension-flexion, pronation-supination, Broberg and Morrey rating system score, and quickDASH score. Results: Our study included 6 females and 9 males with a mean age of 50 (r, 25-73). The mean of follow-up was 31 months (r, 3-51). Olecranon fractures were fixed with tension band with K-Wires or intramedullary compression screw or locking plate. Radial head fractures were fixed with headless compression screws or mini plate or replaced (radial head arthroplasty). Postoperatively, an average 115 • extension-flexion arc and 135 • pronation-supination arc was noted. The mean Broberg and Morrey rating system score was 78 and the mean quick DASH score was 25, indicating a good result. Two cases of heterotopic ossification were present and no nonunion was noted. Conclusion: Surgical management of concomitant olecranon and radial head fractures with appropriate technique can result in the restoration of a functional movement arc and a satisfactory outcome.

Orthopedic Reviews

Background The purpose of this study is to compare the vascularized bone flaps (VBF) that are use... more Background The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing. Materials and Methods Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG. Results Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient’s 7.7 times greater probability of healing of the non-union. Meta-analysis of the d...

JAAOS: Global Research and Reviews

Journal of Orthopaedic Reports

Orthopedic Reviews, 2022

Non-union of radial neck fractures is a rare entity in adults, and conservative treatment is usua... more Non-union of radial neck fractures is a rare entity in adults, and conservative treatment is usually applied. However, when the patient is symptomatic, an optimal functional outcome can only be obtained after operative treatment. There is currently no consensus on the best surgical technique to treat this condition. We present a 34-year-old male with a radial head non-union and our proposed technique of using a cylindrical bone autograft harvested from the iliac crest and fixation with headless compression screws. At 12 months follow-up, the patient was pain free and had comparable range of motion to the uninjured side. We recommend a useful technique for the treatment of radial neck fracture nonunion. The preliminary postoperative outcomes show excellent results, while a longer follow-up and a greater number of cases are necessary to confirm the efficacy of this technique.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2022

Purpose of this study is to create an experimental model on rats for EMG evaluation of the supras... more Purpose of this study is to create an experimental model on rats for EMG evaluation of the supraspinatus muscle after traumatic rupture of its tendon. The population of this study consisted of 5 male rats of 300–400g. Under general anaesthesia we proceeded with traumatic rupture of the supraspinatus tendon and exposure of the muscle. The electrode of a stimulator was placed under suprascapular nerve and the supraspinatus tendon was sutured on a transducer for digital record of the produced signal. Initially we found the resting length and the electric intensity for higher muscle contracture. The parameters that were evaluated after single contracture (single twitch) were strength, time to peak, half relaxation time. Furthermore, it was evaluated the strength of tetanic contractures at 10,20,40,80,100 Hz (Stimulation for 350msec each time).Finally it was evaluated the muscle fatigue with stimulation at 40Hz for 250msec and total duration of 3 minutes. Fatigue index was calculated acc...

MUSCULOSKELETAL SURGERY, 2021

Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy ... more Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy and other degenerative shoulder diseases. In recent years, aiming for bone stock preservation has led to the design of metaphyseal humeral components without a stem. The aims of this study were to evaluate the complication and reintervention rates, as well as the clinical and radiographic outcomes in patients who underwent reverse shoulder arthroplasty (RSA) with stemless implants. A systematic review of the literature was completed until May 2020 using PubMed, EMBASE, CINAHL and Cochrane databases, according to PRISMA guidelines. The literature search revealed 2942 studies, of which 13 were included in this review, with a total of 517 patients and a mean follow-up between 6.4 and 101.6 months. The total complication rate was 6.5%, while 3.3% were humeral associated complications. Finally, the rate of shoulders that underwent a reintervention was 6.7%, with 1.4% relating to a humeral component reason. Stemless RSA led to substantial improvements in patient reported outcome measures and range of motion across all studies. Scapular notching was reported in 15.2%, and lucencies around humeral component were reported in 0.8% of shoulders. Stemless RSA resulted in low complication and reintervention rates at the mid-term follow-up. The reported clinical and radiological outcomes showed that these prostheses have at least equivalent outcomes with their stemmed counterparts. Further studies are required to investigate the long-term longevity and performance of the stemless humeral implants. Level IV; Systematic Review

Journal of Hand Surgery (European Volume), 2019

We present a case of delayed dorsal tendon dislocation after surgery for de Quervain’s disease an... more We present a case of delayed dorsal tendon dislocation after surgery for de Quervain’s disease and a modified technique of pulley reconstruction. A 32year-old man had a 5-month history of persistent wrist pain. Finkelstein’s test and MRI results were positive for de Quervain’s disease. After an adequate period of unsuccessful non-operative treatment, we proceeded to surgery. Through a transverse skin incision, the retinaculum of the first dorsal compartment was divided longitudinally along its dorsal margin. The tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) were released and checked for subluxation through passive wrist flexion and extension – single APL and EPB tendons were found without the presence of a subcompartment. The patient’s hand and thumb were placed in a bulky bandage and sutures were removed at 2 weeks. We advised avoidance of heavy mechanical activities for 6 weeks. Eight months later, he returned describing a painful snapping in his wrist. Clinical examination revealed dorsal dislocation of APL and EPB tendons during wrist extension. The patient admitted starting weightlifting shortly after suture removal and stated that the symptoms began 3 months after surgery. We proceeded to secondary surgery. The former skin incision was extended proximally and distally in a zig-zag fashion. Both tendons dislocated dorsally during wrist extension (Video 1). A longitudinal incision was made in the remaining palmar extensor retinaculum, elevating a 3 by 1.5 cm strip, distally based (Figure 1). This was passed deep to APL and EPB tendons from palmar to dorsal side (Figure 2), and then superficial to the tendons suturing it back to its origin at the palmar retinaculum with two 4-0 nonabsorbable sutures. The dorsal border of this sling was secured with two 4-0 nonabsorbable sutures to the dorsal remnant of the retinaculum (Figure 3), ensuring that tendon gliding was unobstructed with no palmar or dorsal subluxation (Video 2). Postoperatively, a thumb spica was applied for 4 weeks. Three years postoperatively the patient remains asymptomatic, with no recurrence of tendon dislocation, a normal range of motion and a negative Finkelstein test. He has returned to work.

Journal of the American Geriatrics Society, 2012

ments, as illustrated by the decrease in 25OHD concentration during follow-up (Table 1). With thi... more ments, as illustrated by the decrease in 25OHD concentration during follow-up (Table 1). With this design, the effect of receiving vs not receiving vitamin D supplements and, indirectly, the effect of increasing vs decreasing 25OHD concentrations was captured. Finally, an improvement was also found in executive functions after vitamin D3 supplementation. This is concordant with previous studies suggesting that brain structures underlying executive functions are the target of neuroprotective and vasculoprotective properties of vitamin D. Nevertheless, the pre–post design of the current study without randomization limits the exploration of the cognitive effect of vitamin D repletion. Placebo-controlled randomized clinical trials are needed to corroborate these results with higher levels of evidence.

Injury, 2011

There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from spo... more There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group. The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol. We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52 weeks postoperatively, with a final follow-up at 24 months. Follow-up at 4, 16 and 52 weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score. The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.

MOJ Orthopedics & Rheumatology, 2017

The digital extensor mechanism at the level of the MCP joint consists of the extensor tendon, sag... more The digital extensor mechanism at the level of the MCP joint consists of the extensor tendon, sagittal bands, and volar plate. The sagittal bands are part of a complex extensor retinacular system that includes the triangular ligament between the lateral bands, the transverse retinacular ligament, and the oblique retinacular ligament at the proximal interphalangeal (PIP) joint level.

Orthopedics and Rheumatology Open Access Journal, 2017

MOJ Orthopedics & Rheumatology, 2017

Rotator cuff (RC) tears are the most common soft tissue injuries of the shoulder. Despite the sur... more Rotator cuff (RC) tears are the most common soft tissue injuries of the shoulder. Despite the surgical improvement with new techniques in the repair site of the tears, the clinical results remain with high rate of failure. Deferent experimental studies in many animal models try to evaluate the complexity of the clinical problem. In this review article we summarize the knowledge from studies regarding the tendon to bone repair and healing, the early inflammatory reaction, the bone, tendon and muscle condition and the diversity of scaffolds that have been used in order to bridge a gap between RC tendon and the recipient site on bone. To answer the spectrum of questions regarding the treatment of RC tears further specific knowledge using the aforementioned animal models is compulsory.

Journal of clinical medicine, Apr 24, 2024

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Frontiers in Surgery, May 3, 2022

Introduction: Simultaneous olecranon and radial head fractures are rare injuries and due to this ... more Introduction: Simultaneous olecranon and radial head fractures are rare injuries and due to this factor, the outcome of the selected therapy is not widely studied. The aim of this study is to report and evaluate the functional outcome of the surgical treatment of simultaneous olecranon and radial head fractures. Materials and Methods: This is a retrospective study of fifteen patients with concomitant olecranon and radial head fractures presenting to our orthopedic department between 2015 and 2020. Olecranon fractures were classified by Mayo classification and radial head fractures by Mason classification and were managed appropriately. Main outcome measures include range of elbow extension-flexion, pronation-supination, Broberg and Morrey rating system score, and quickDASH score. Results: Our study included 6 females and 9 males with a mean age of 50 (r, 25-73). The mean of follow-up was 31 months (r, 3-51). Olecranon fractures were fixed with tension band with K-Wires or intramedullary compression screw or locking plate. Radial head fractures were fixed with headless compression screws or mini plate or replaced (radial head arthroplasty). Postoperatively, an average 115 • extension-flexion arc and 135 • pronation-supination arc was noted. The mean Broberg and Morrey rating system score was 78 and the mean quick DASH score was 25, indicating a good result. Two cases of heterotopic ossification were present and no nonunion was noted. Conclusion: Surgical management of concomitant olecranon and radial head fractures with appropriate technique can result in the restoration of a functional movement arc and a satisfactory outcome.

Orthopedic Reviews

Background The purpose of this study is to compare the vascularized bone flaps (VBF) that are use... more Background The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing. Materials and Methods Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG. Results Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient’s 7.7 times greater probability of healing of the non-union. Meta-analysis of the d...

JAAOS: Global Research and Reviews

Journal of Orthopaedic Reports

Orthopedic Reviews, 2022

Non-union of radial neck fractures is a rare entity in adults, and conservative treatment is usua... more Non-union of radial neck fractures is a rare entity in adults, and conservative treatment is usually applied. However, when the patient is symptomatic, an optimal functional outcome can only be obtained after operative treatment. There is currently no consensus on the best surgical technique to treat this condition. We present a 34-year-old male with a radial head non-union and our proposed technique of using a cylindrical bone autograft harvested from the iliac crest and fixation with headless compression screws. At 12 months follow-up, the patient was pain free and had comparable range of motion to the uninjured side. We recommend a useful technique for the treatment of radial neck fracture nonunion. The preliminary postoperative outcomes show excellent results, while a longer follow-up and a greater number of cases are necessary to confirm the efficacy of this technique.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2022

Purpose of this study is to create an experimental model on rats for EMG evaluation of the supras... more Purpose of this study is to create an experimental model on rats for EMG evaluation of the supraspinatus muscle after traumatic rupture of its tendon. The population of this study consisted of 5 male rats of 300–400g. Under general anaesthesia we proceeded with traumatic rupture of the supraspinatus tendon and exposure of the muscle. The electrode of a stimulator was placed under suprascapular nerve and the supraspinatus tendon was sutured on a transducer for digital record of the produced signal. Initially we found the resting length and the electric intensity for higher muscle contracture. The parameters that were evaluated after single contracture (single twitch) were strength, time to peak, half relaxation time. Furthermore, it was evaluated the strength of tetanic contractures at 10,20,40,80,100 Hz (Stimulation for 350msec each time).Finally it was evaluated the muscle fatigue with stimulation at 40Hz for 250msec and total duration of 3 minutes. Fatigue index was calculated acc...

MUSCULOSKELETAL SURGERY, 2021

Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy ... more Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy and other degenerative shoulder diseases. In recent years, aiming for bone stock preservation has led to the design of metaphyseal humeral components without a stem. The aims of this study were to evaluate the complication and reintervention rates, as well as the clinical and radiographic outcomes in patients who underwent reverse shoulder arthroplasty (RSA) with stemless implants. A systematic review of the literature was completed until May 2020 using PubMed, EMBASE, CINAHL and Cochrane databases, according to PRISMA guidelines. The literature search revealed 2942 studies, of which 13 were included in this review, with a total of 517 patients and a mean follow-up between 6.4 and 101.6 months. The total complication rate was 6.5%, while 3.3% were humeral associated complications. Finally, the rate of shoulders that underwent a reintervention was 6.7%, with 1.4% relating to a humeral component reason. Stemless RSA led to substantial improvements in patient reported outcome measures and range of motion across all studies. Scapular notching was reported in 15.2%, and lucencies around humeral component were reported in 0.8% of shoulders. Stemless RSA resulted in low complication and reintervention rates at the mid-term follow-up. The reported clinical and radiological outcomes showed that these prostheses have at least equivalent outcomes with their stemmed counterparts. Further studies are required to investigate the long-term longevity and performance of the stemless humeral implants. Level IV; Systematic Review

Journal of Hand Surgery (European Volume), 2019

We present a case of delayed dorsal tendon dislocation after surgery for de Quervain’s disease an... more We present a case of delayed dorsal tendon dislocation after surgery for de Quervain’s disease and a modified technique of pulley reconstruction. A 32year-old man had a 5-month history of persistent wrist pain. Finkelstein’s test and MRI results were positive for de Quervain’s disease. After an adequate period of unsuccessful non-operative treatment, we proceeded to surgery. Through a transverse skin incision, the retinaculum of the first dorsal compartment was divided longitudinally along its dorsal margin. The tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) were released and checked for subluxation through passive wrist flexion and extension – single APL and EPB tendons were found without the presence of a subcompartment. The patient’s hand and thumb were placed in a bulky bandage and sutures were removed at 2 weeks. We advised avoidance of heavy mechanical activities for 6 weeks. Eight months later, he returned describing a painful snapping in his wrist. Clinical examination revealed dorsal dislocation of APL and EPB tendons during wrist extension. The patient admitted starting weightlifting shortly after suture removal and stated that the symptoms began 3 months after surgery. We proceeded to secondary surgery. The former skin incision was extended proximally and distally in a zig-zag fashion. Both tendons dislocated dorsally during wrist extension (Video 1). A longitudinal incision was made in the remaining palmar extensor retinaculum, elevating a 3 by 1.5 cm strip, distally based (Figure 1). This was passed deep to APL and EPB tendons from palmar to dorsal side (Figure 2), and then superficial to the tendons suturing it back to its origin at the palmar retinaculum with two 4-0 nonabsorbable sutures. The dorsal border of this sling was secured with two 4-0 nonabsorbable sutures to the dorsal remnant of the retinaculum (Figure 3), ensuring that tendon gliding was unobstructed with no palmar or dorsal subluxation (Video 2). Postoperatively, a thumb spica was applied for 4 weeks. Three years postoperatively the patient remains asymptomatic, with no recurrence of tendon dislocation, a normal range of motion and a negative Finkelstein test. He has returned to work.

Journal of the American Geriatrics Society, 2012

ments, as illustrated by the decrease in 25OHD concentration during follow-up (Table 1). With thi... more ments, as illustrated by the decrease in 25OHD concentration during follow-up (Table 1). With this design, the effect of receiving vs not receiving vitamin D supplements and, indirectly, the effect of increasing vs decreasing 25OHD concentrations was captured. Finally, an improvement was also found in executive functions after vitamin D3 supplementation. This is concordant with previous studies suggesting that brain structures underlying executive functions are the target of neuroprotective and vasculoprotective properties of vitamin D. Nevertheless, the pre–post design of the current study without randomization limits the exploration of the cognitive effect of vitamin D repletion. Placebo-controlled randomized clinical trials are needed to corroborate these results with higher levels of evidence.

Injury, 2011

There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from spo... more There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group. The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol. We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52 weeks postoperatively, with a final follow-up at 24 months. Follow-up at 4, 16 and 52 weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score. The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.

MOJ Orthopedics & Rheumatology, 2017

The digital extensor mechanism at the level of the MCP joint consists of the extensor tendon, sag... more The digital extensor mechanism at the level of the MCP joint consists of the extensor tendon, sagittal bands, and volar plate. The sagittal bands are part of a complex extensor retinacular system that includes the triangular ligament between the lateral bands, the transverse retinacular ligament, and the oblique retinacular ligament at the proximal interphalangeal (PIP) joint level.