double acl reconstruction failure in a young soccer player in treatment with retinoids a case report

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Does anterior cruciate ligament reconstruction prevent osteoarthritis?

Il rischio d’insorgenza di gonartrosi è incrementato in pazienti con rottura di LCA. In letteratura, non ci sono prove solide in merito al fatto che la ricostruzione di LCA possa prevenire l’artrosi del ginocchio. Inoltre, è stato dimostrato che diversi fattori influenzano l’insorgenza della patologia degenerativa articolare e il risultato clinico finale dopo ricostruzione di LCA. Lo scopo di questa tesi è stato analizzare in modo prospettico i risultati clinici e radiografici della ricostruzione di LCA (con tecnica “over-the-top+ tenodesi laterale extra-articolare”) dopo 20 anni di follow-up minimo, valutando la percentuale di insorgenza di artrosi e paragonando i risultati con quelli a 5 anni e a 10 anni di follow-up minimo. L’ipotesi di partenza era che la meniscectomia fosse il principale fattore determinante l’insorgenza di artrosi a lunghissimo termine dopo ricostruzione di LCA. Per questa ragione sono stati comparati all’interno di questo gruppo i sottogruppi di pazienti sottoposti a ricostruzione di LCA e meniscectomia con quelli sottoposti alla sola ricostruzione di LCA. La tecnica di ricostruzione del LCA over-the-top combinata a tenodesi laterale extra-articolare ha dimostrato un tasso di successo di 84.3% a 20 anni di follow-up minimo. La plastica laterale extra- articolare associata alla ricostruzione di LCA non ha generato artrosi tibio-femorale laterale o femoro-rotulea. Il fattore determinate nell’incremento dell’artrosi è stato la meniscectomia.Background: There is no clear evidence that anterior cruciate ligament (ACL) reconstruction is capable of preventing osteoarthritis. Purpouse: To analyze clinical and radiographic outcomes of ACL reconstruction at minimum 20-year follow-up, and to evaluate the onset of osteoarthritis in this procedure. Study Design: Case series; Level of evidence, 4. Methods: Fifty-two patients (M/F:41/11; mean age at final follow-up 51.5±7.6 years) who underwent double-stranded hamstrings over-the-top ACL reconstruction with extra-articular lateral plasty were prospectively evaluated at a minimum 20-year (mean 24-year) follow-up. Twenty-nine patients were available for prospective clinical (Lysholm, Tegner and objective IKDC), instrumental (KT-2000) and radiographic evaluations. Subjective KOOS was carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications/re-rupture/revision-surgery. Results: At final follow-up mean Lysholm score was 85.7±14.6, median Tegner score was 4 (range 3-5), sport activity resumption was 82.6% and objective IKDC score was A or B in 86% of patients. Only 4 patients (14%) had >5 mm manual maximum KT-2000 side-to-side difference. Statistically significant changes were: decrease in Tegner score from 5-year to 10-year follow-up from 7(range 6-8) to 4(range 3-5) (P<.0001) and decrease in Lysholm score from 10-year to 20-year follow-up from 96.1±7.3 to 85.7±14.6 (P=.0003). Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knee in patients with concomitant medial meniscectomy (n=8; 3.2±0.6 Vs. 5.0±1.8mm; P=.0114). No significant differences were reported regarding lateral or patellofemoral joint space. Complications: one re-rupture (2%), 3/52 contralateral ACL injury (5.8%). Overall composite (objective IKDC/KT-2000/re-rupture) failure rate was 15.7% (4/29 clinical failures and 1/52 re-rupture) at final follow-up. Conclusion: Studied surgical technique demonstrated a success rate of 84.3% at 20-year minimum follow-up. The lateral extra-articular plasty associated to ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy

No kinematical difference between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment: an in vivo dynamic RSA study

Purpose: To explore in vivo kinematical behavior of the same total knee arthroplasty (TKA) cruciate-retaining (CR) femoral design with either medial-congruent (MC) or ultra-congruent (UC) inlay using model-based dynamic radiostereometric analysis (RSA). The hypothesis was that there would be comparable kinematics between the two groups. Methods: A cohort of 16 randomly selected patients (8 MC Persona Zimmer, 8 UC Persona Zimmer) was evaluated through dynamic radiostereometric analysis (RSA) at a minimum of 9 months after TKA, during the execution of a sit-to-stand. The antero-posterior (AP) translation of the femoral component and the AP translation of the low point of medial and lateral femoral compartments were compared through Student's t test (p &lt; 0.05). Results: Both groups showed a medial pivot behavior, with a significantly greater anterior translation of the Low Point of the lateral compartment with respect to the medial compartment (MC medial range: 2.4 ± 2.4 mm; MC lateral range: 7.7 ± 3.0 mm; p &lt; 0.001 - UC medial range: 3.3 ± 3.3 mm; UC lateral range: 8.0 ± 3.2 mm; p &lt; 0.001). A statistically significant greater degree of flexion was clinically recorded at follow-up visit in the MC group respect to the UC group (126° vs 101°-p = 0.003). Conclusion: The present study did not show difference in the medial pivot behavior between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment; however, the MC group demonstrated a greater degree of flexion. The MC design examined is a valid alternative to the UC design, allowing to achieve a screw-home movement restoration combined with a high flexion

Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in-vitro study

Purpose The anterolateral ligament (ALL) has been defined as a key stabilizer of internal tibial rotation at 35 degrees or more of knee flexion, with a minimal primary or secondary stabilizing role in the AP direction. This study aimed to demonstrate that anatomical reconstruction of the ALL confers rotational stability equal to that of the uninjured knee. Hypothesis: anteroposterior (AP) and rotatory laxity will significantly vary after ALL tenotomy and ALL reconstruction with the author's previously described technique. Methods After ultrasound (US) ALL identification, different kinematic measurements were performed with an image-less Computer-Assisted Navigation System with dedicated software for Laxity Analysis in 5 knee specimens. Anteroposterior (AP) translations and varus/valgus (VV) and Internal-External (IE) rotations were evaluated by two trained orthopedic surgeons before ALL section, after ALL section, and after ALL anatomical reconstruction with doubled ipsilateral autologous gracilis tendon. Results ALL resection significantly increased laxity in IE rotations with knee 90 degrees flexed (IE90) and AP translation with tibia internally rotated and the knee 30 degrees flexed (APlat) (p &lt; 0.05). ALL reconstruction significantly reduced laxity in IE90 and APlat (p &lt; 0.05) and reduced VV rotations at 30 degrees of flexion (VV30) (p &lt; 0.05). There were no statistically significant elongation differences between native ALL and reconstructed ALL (graft) during laxity tests. The inter-operator repeatability of the tests was excellent for each measurement. Conclusions ALL acted as an important internal tibial rotation restrain at 90 degrees and a significant (secondary) AP stabilizer at 30 degrees of knee flexion. The presented ALL reconstruction technique significantly restored the increase of knee laxity produced by the ALL section. Scientific level Case-Controlled Laboratory Study, Level III

Intra- and inter-operator reliability assessment of a novel extramedullary accelerometer-based smart cutting guide for total knee arthroplasty: an in vivo study

Purpose The purpose is to verify the intra- and inter-operator reliability of an extramedullary (EM) accelerometer-based smart cutting guide for distal femoral resection during primary total knee arthroplasty (TKA). The hypothesis of the present study was that the use of the device would result in a good correlation between different operators with a difference between repeated measurements of less than 1 degrees.Methods Twenty-five not consecutive patients with knee osteoarthritis undergone to primary TKA using an EM inertial-based cutting guide to perform distal femoral resection. In order to assess the agreement in femoral axis definition of the device, two operators performed three time each the manoeuvres necessary to define axis. Inter-rater agreement was evaluated with Bland and Altman agreement test. Intra-rater repeatability was evaluated analysing average results distribution of repeated measurements. Accuracy of the device was evaluated comparing differences between intra-operative device data with final implant alignment measured on post-operative longstanding x-rays using Students' t test.Results Agreement between the two operators was statistically significant (p &lt; 0.05) with a bias of - 0.4 degrees (95% CI -0.6 degrees to - 0.2 degrees). Average difference between cut orientation measured with device and final implant position, measured on x-rays, was 0.2 degrees (95% CI - 1.5 degrees to 1.7 degrees) with no statistical difference between the two measurements. Final implant alignment, measured on x-ray, was 90.2 degrees, with 95% of cases distributed within range 88.0 degrees to 92.0 degrees for varus-valgus and 2.8 degrees and with 95% of cases distributed within range 2.0 degrees to 4.0 degrees for flexion-extension.Conclusions The EM accelerometer-based smart cutting guide used to perform distal femoral resection during primary TKA demonstrated a good intra- and inter-operator reliability in the present in vivo study

Custom-Made Implants in Ankle Bone Loss: A Retrospective Assessment of Reconstruction/Arthrodesis in Sequelae of Septic Non-Union of the Tibial Pilon

Background and Objectives: Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developing fracture-related infection with associated chronic osteomyelitis in patients. Segmental tibial and ankle bone loss have recently received new and improved treatments. Materials and Methods: Above all, 3D printing allows for the customization of implants based on the anatomy of each patient, using a personalized process through the layer-by-layer deposition of materials. Results: This article presents different cases from the authors' experience. Specifically, four patients suffered tibia and ankle fractures and after radical surgery for chronic osteomyelitis combined with high-performance antibiotic therapy underwent ankle reconstruction/arthrodesis with custom-made tibial spacers. Conclusions: Thanks to 3D-printed patient-specific devices, it is possible to perform surgical procedures that, for anatomical reasons, would have been impossible otherwise. Moreover, an improvement in overall functionality and an important reduction in pain were shown in the last follow-up in all patients