Controversies in ACL revision surgery: Italian expert group consensus and state of the art

Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction. Methods A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience. Conclusions The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case

How reproducible are clinical measurements in robotic knee surgery?

Abstract Purpose Robotic‐assisted surgery has been recently introduced to improve biomechanical restoration, and thus better clinical and functional outcomes, after knee joint arthroplasty operations. Robotic‐assisted uni‐compartmental knee arthroplasty (UKA) aims indeed to improve surgical bone resection and alignment accuracy, optimized component positioning and knee balancing, relying on a series of calibration measurements performed during the surgery. These advantages focus therefore on improving the reproducibility of UKA surgeries, reducing (if not eliminating) eventual differences among high‐ and low‐volume surgeons. The purpose of this study is to investigate and quantify the reproducibility of in‐vivo measurements performed with a robotic system: the intra‐ and inter‐observer variability of a series of measurements was therefore analyzed and compared among differently experienced operators. Methods Five patients were analyzed and underwent robotic‐assisted UKA using a semi‐active robotic system. Three different observers with different experience levels were involved to independently perform the measurements of two parameters of the preoperative knee (Hip‐Knee‐Ankle angle [HKAa], Internal‐External Rotation) at different degrees of knee flexion. Inter‐observer and intra‐observer comparisons were performed. Results The average variability in the measurements obtained from the intra‐observer and inter‐observer comparisons were always  0.75) for most cases and good agreement (> 0.60) in the remaining ones. Conclusion This study demonstrated high reproducibility of the measurements obtainable in clinical environment with the robotic system. The inter‐observer results furthermore showed that the level of confidence with the robotic system is not significantly influencing the measurement

The New Challenge in the Management of Proximal Femur Fractures during SARS Cov-2 outbreak

: The aim of this study is to evaluate how the spread of Sars-Cov-2 has changed the epidemiology of proximal femur fractures in two major trauma centers in Italy, understanding the workload and the best allocation of the resources for the orthopedics department in such an emergency situation. The rate of patients from January 2019 to April 2020 hospitalized with femoral neck fractures (group A) and trochanteric fractures (group B) were recorded. Demographic data, timing of surgical treatment and the length of stay were recorded. Data show that the number of proximal femur fractures has remained unchanged in the COVID and pre-COVID era (ranging from an average of 91.14/month in the pre-COVID era to 76/month in March and 80/month in April). In our trauma centers, the rate of patients operated on within 48 hours has remained stable (78.19% vs 77.92%), while the length of stay has decreased during the COVID period (8.9 days vs 6.5 days in March and 6.8 days in April). Proximal femur fractures, even during the COVID period, are a constant issue and a new challenge for the healthcare system. The main goals of management are to preserve patients from viral infection, to provide early surgical treatment and fast track protocol for discharge