Total knee revision arthroplasty: comparison between tibial tubercle osteotomy and quadriceps snip approach. Complication rate

BACKGROUND AND AIM OF THE WORK: The total knee arthroplasty (TKA) revision is not a second time of primary implant surgery but is a very complex issue for orthopedic surgeon. When local conditions make necessary a greater visualization, medial para-patellar access with quadriceps snip (QS) or the osteotomy of the tibial tuberosity (TTO) can be the solutions. This work aims to compare the quadriceps snip and the detachment of the tibial tubercle, focusing on possible complications. MATERIALS AND METHODS: At our institution, between January 2017 and February 2019 52 TKA revision for periprosthetic joint infection (PJI) or aseptic mobilization were performed. In 43 cases an extensive surgical approach was required: for patients with range of movement (ROM) 60\ub0 a QS was performed. Clinical and radiological follow-up was available for all the 43 cases. RESULTS: The data about clinical outcome in our study show that both groups have a positive trend in KSS score over time with similar ROM results. Two partial avulsions of patellar tendon during revision surgery were reported. Clinical outcome in both groups has shown good results at the end of follow-up with no post-operative incidence of complications. CONCLUSION: We can assert that both QS and TTO are good approach for TKA revision. Future studies will be needed to understand if preparatory ROM is a good way to decide which surgical approach to use.(www.actabiomedica.it)

Biomarkers and infections in orthopedics: our experience and literature review

The issue of infections in Orthopedics is rising in importance day by day. In management of Periprosthetic Joint Infection (PJI), classical biomarkers involved in diagnosis process are C-reactive protein (CRP) and Erythrocyte Serum Rate (ESR). Although wide use in PJI diagnosis process, CRP and ESR are not sensitive and specific enough for a correct diagnosis. Orthopedic surgeons, Microbiologists and Infectivologists are very interested in research about new (or rediscovered) biomarkers that can help in the diagnosis of orthopedics infections. In our Institution, a rigid protocol is applied to face suspicious PJI, implemented with LE testing routinely. In our retrospective observational study, we has compared reliability of LE test in relation ICM criteria and the comparison with other diagnostic tests or exams. Our results show that LE is a reliable method especially for intra-operatively PJI diagnosis

Access to the HIP: What’s new?

Starting from first attempt to access the hip in arthroscopy in 1931 by Burman to date, we have witnessed an evolution in different fields: certainly, the technological evolution, with improved instruments and even dedicated to the anatomical district, has also allowed the evolution of the surgical technique. On the other hand, the surgical technique has evolved over the years, initially starting from the pediatric field, studying the positioning, access and distraction technique with the aim of avoiding iatrogenic lesions, subsequently with the aim of treating different pathologies arthroscopically. Today we can claim to have achieved a wellestablished and safe arthroscopic technique but the continuous progress of studies, the better knowledge of the pathology and also the requests of patients force us to progress on the path of technical and technological evolution. Therefore, in recent years, several colleagues have proposed new hip access techniques rather than new arthroscopic portals. In this chapter the main innovative techniques and the new arthroscopic portals will be discussed

Capsular management in the arthroscopic treatment of the femoro-acetabular impingement in athletes: Our experience

Background and aim of the work: In the last decade, thanks to the improvement of the surgical techniques, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral-acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been better understood, opening a heated debate. The Literature is still torn about a proper capsular management and the need for a capsular suture, but latest studies are more oriented to its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function on primary stability, so a conservative capsulotomy and its final closure are therefore reccomended to restore the native anatomy and physiology. Although capsular management remains a controversial topic, in recent years we have developed a new conservative capsulotomy technique associated with a final capsular suture. The aim of the present retrospective study is to assess the influence of different capsulotomy techniques and a possi-ble capsular suture role on the patient\u2019s functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated. Hypothesis: Our hypothesis is that a conservative \u201clongitudinal\u201d cap-sulotomy with a proper capsular suture positively influences the patient\u2019s functional outcome in athletes. Methods: 36 patients (competitive athletes) treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two years (2016-2018); collected data have been analyzed and compared with a retrospective model. Patients have been divided into three equivalent groups, 12 without a suitable capsular management (T-Capsulotomy technique), 12 performing a Longitudinal Capsulotomy but without a final suture and 12 treated with a conservative Longitudinal Capsulotomy and a capsular suture. Patient\u2019s post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and the Hip Outcome Score-Sport Scale (HOS-SS). Return to sport. Results: In our series there was no statistically significant difference in functional scores, however longitudinal capsulotomy seems to be associated with a higher percentage of return to sports activity (91,6% vs 75%). Conclusions: The new longitudinal shape capsulotomy technique and a capsular suture with a single side-to-side stitch at the end of the procedure in athletes can positively influence the patient\u2019s functional outcome. (www.actabiomedica.it)

Treatment options for massive rotator cuff tears: A narrative review

The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears. Compared with smaller tears, massive rotator cuff tears are often complicated by structural failure and poor outcomes and present a higher rate of recurrent tearing after surgical repair. Several management options are available but the selection of the most appropriate treatment for each patient can be challenging. To achieve the best outcomes, the orthopedic surgeon should have a good understanding of the indications, the pathomechanics and the clinical outcomes of the various treatment modalities. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. The purpose of this article is to review treatment options and clinical outcomes for the management of massive rotator cuff tears. (www.actabiomedica.it)

Kinetic and kinematic analysis of ACL reconstruction in association with lateral-extrarticular tenodesis of the knee in revision surgery: A pilot study

Background. Anterior cruciate ligament reconstructions are a very frequent surgery. The key role of the anterolateral ligament in the knee rotational stability has been undelighted in recent years. Extra-articular tenodesis in association with ACL reconstructions, serves to eliminate anterolateral rotatory instability. The aim of our study is to compare treated knees with the contralateral uninjured knee in those cases whom been treated with ACL arthroscopic reconstruction and lateral extra-articular tenodesis in revision surgery, and evaluate clinical results with kinematic and kinetic examinations methods. Materials and methods. Sixteen patients (10 males and 6 females) with ages from 21 to 37 had been treated at the Orthopaedic Clinic of Udine for failure of previous ACL reconstruction. In all patients was performed ACL arthroscopic reconstruction with the association of a lateral extra-articular tenodesis (Coker-Arnold). We have decided to asses the patients at one year after surgery with GNRB arthrometer and Bioval inertial sensor system. Results. All patients treated with arthroscopic ACL reconstruction and lateral extra-articular tenodesis have regained pre-injury sagittal knee stability and gait dynamics. Conclusions. Clinical and instrumental evaluation showed how a combination of procedures can restore the kinematic and stability of a joint, even if the procedures performed are not anatomical. These are only preliminary data. (www.actabiomedica.it)

Are vascular grafts at risk of occlusion after total hip replacement? A systematic review of the literature

Vascular complications during and after total hip replacement are relatively uncommon despite the close relationship between the involved structures. Previous surgical procedure of arterial reconstruction or substitution may be at higher risk of damage due to the modification in the anatomical landmarks or to the mechanical properties of the grafts different from native vessels. In literature few cases of graft occlusion or failure are reported during or soon after a total hip replacement. The aim of this review is to report them highlighting common features and risk factors. (www.actabiomedica.it)

Anterior cruciate ligament reconstruction: The role of lateral posterior tibial slope as a potential risk factor for failure

Background and aim of the work: Anterior cruciate ligament (ACL) reconstructions is an extremely frequent surgery. The analysis of anatomical factors is becoming increasingly important and the study of clinical, arthroscopic and radiological methods to evaluate and understand them aims to positively affect the patient\u2019s outcome. This work aims to analytically analyze the anatomical factors that can influence the failure of an ACL reconstruction, to evaluate the data collected on a sample of patients undergoing ACL revision and compare them with those is present in the literature. Materials and Methods: At the Clinic of Orthopedic of Udine, between November 2018 and August 2020 were performed 47 revisions of the ACL. We analyzed MRI scans about Lateral Posterior Tibial Slope (LPTS). Patient surveys were analyzed by a single senior orthopedic surgeon who was blinded to patient history, age and gender. Results: Comparing with a value considered in the norm (LPTS estimated 6.5\ub0) we see how the difference between the average LPTS values in the sample is significantly higher than the normal values (P <.0001). Dividing the simple according to sex, we notice that the LPTS in female patients is 11.8 while in male patients it is 8.7\ub0 (P <.005). Conclusion: The data collected show how an increased posterior lateral tibial slope can be correlated with a higher risk of ACL failure. The results are in line with what is present in the literature. Our analysis is absolutely preliminary, but it is intended to be the starting point of a path that allows us to think of the reconstruction of the ACL as an intervention to be planned more carefully based on the individual characteristics of the patient. (www.actabiomedica.it)