Introduction: Each year millions of people are treated for hip, knee or foot surgery which require rehabilitation programs that typically involve limited or controlled weight bearing on an affected limb. Weight bearing reduces edema & facilitate rapid rehabilitation.

Current weight-bearing instruction protocols involve non-quantitative guidelines, based on the patient’s amount of discomfort while walking or subjective perception. However, the interpretation of these instructions is inaccurate and subjective, and varies among clinicians and patients.

New biofeedback technology concepts are beginning to be implemented in the rehabilitation process. The Smart-Step system is a new weight bearing monitoring system that assists clinicians and physical therapists to accurately assess, train and monitor patients’ weight bearing capabilities.

Purpose: To assess the effectiveness of the SmartStep system in guiding weight bearing restrictions, and to assess the effectiveness of the SmartStep system as a tool to reeducate full weight bearing.

Material and Methods: 8 Patients in the Orthopedic rehabilitation department & 5 patients in the orthopedic physiotherapy out-patient clinic, post orthopedic surgery with FWB instructions were randomly divided into Study & Control groups.

During treatment, the patients were trained by the PT in FWB according to the instruction of the surgeon. Data of age and body weight was collected from all patients. Patients in both study groups used the SmartStep System. This system consists of an in-shoe inflatable insole, pressure sensors and a control unit for data storage. The control unit provides also an audio signal whenever the patient was bearing body weight at a recommended and pre-calibrated level.

Results: The mean age and body weight were 62±12 years and 76±15 kg in the study group and 65±15 years and 70±13 kg in the control group.

Data obtained in both groups (in kg) during the pre-test and during the gait tests was converted into percentage of the patients BW. The means of the differences between the pre-test results and the gait test results in both groups were 9 + 6.7% and 1.5 + 6% in the study and control group, respectably (p=0.0002).

Conclusions: The new Smartstep system was proved to be a useful tool in assisting gait rehabilitation since its biofeedback system enhances and improves weight bearing over the affected limb in cases where FWB is recommended.

Introduction: MRI is considered to be highly effective in the diagnosis of internal derangement of the knee after acute trauma. 90–95% of meniscal and ligamentous injuries can be diagnosed by MRI and diagnostic arthroscopy can be effectively replaced with this modality. The drawbacks of MRI are its cost and availability. In recent years limited bone SPECT scan has been introduced as an alternative to MRI in the preoperative workup of patients with suspected meniscal and ligamentous injuries.

Purpose: To evaluate the diagnostic accuracy of bone SPECT in the pre-operative work up of patients with suspected meniscal tears.

Materials and Methods: 47 patients were included, average age was 41.9 years (range 18–78 years), 61.7% of the patients are male and 38.3% female. The results of limited bone SPECT scans of the knee were evaluated for accuracy as compared to the diagnosis established by knee arthroscopy, which is considered the gold standard for the diagnosis of meniscal tears.

Results: Bone SPECT scan of the knee was sensitive in 91.9% and specific in 20% of the cases compared to arthroscopy in the diagnosis of meniscal tears.

Positive predictive value calculated for SPECT is 81%, while the negative predictive value calculated is 40%. Separate calculations revealed a PPV of 90.5% in medial meniscal tears and a PPV of 86.7% in lateral meniscal tears respectively. In 13 cases additional inra-articular pathology was noted. In five cases the presumptive diagnosis of a meniscal tear on SPECT was rejected on arthroscopy, in three of these cases the anterior cruciate ligament was injured. One patient with a negative SPECT scan was operated and a meniscal tear found.

Discussion: The diagnostic accuracy of bone SPECT in suspected tears of the meniscus has not been fully validated. Our results correlate with results shown by other authors who reported a sensitivity of about 90 %. The value of the calculated specificity is difficult to interpretation, while patients with a negative SPECT scan are usually not operated. In these cases the SPECT scan should be compared to MRI results when available. In our setup bone SPECT should be included in the preoperative workup whenever the clinical diagnosis of a meniscal tear is doubtful until MRI becomes more readily available.

Osteochondral lesions are frequent as a result of sport and daily activities.

The healing processes of these defects are prolonged and complicated and often leading to irreversible ostheo-arthritic changes. In this study, biotechanical and bioChemical approaches are being combined in an attempt to identify potential uses of biofabricated marine carbonate materials in biomedical applications, particularly as for remodeling cartilage and bone tissue. Biofabricated material was grafted into osteochondral induced defects in animals’ models during knee arthrotomy. Using histological sections, SEM, EDS studies it was revealed that the biofabricated, porous material is highly biocompatible. The graft was incorporated into the osteochondral defect area and followed by surface remodeling. After 4 months the interface and subchondral areas were been replaced by new cartilage and bone.

We believe that it is the first time that such biofabricated materials have been used for biomedical purposes. In face of the obvious environmental disadvantages of harvesting from limited natural resources, we propose the use of bio-engineered coralline and other materials such as those cultured by our group under field and laboratory conditions as a possible biomatrix for hard tissue remodeling.