Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

Introduction.Te vascularized corticoperiosteal fap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. Tis fap is usually harvested as a free fap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. Te frst surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled fap from the medial femoral condyle. We considered union to have occurred 3.5 months afer surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfed with the procedure. Discussion. Te corticoperiosteal fap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled fap graf is a reliable and efective treatment for distal femur nonunion

Evaluation of the accuracy of a patient-specific instrumentation

Patient-specific instruments (PSI) has been introduced with the aim to reduce the overall costs of the implants, minimizing the size and number of instruments required, and also reducing surgery time. The aim of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability and accuracy of patient specific instrument system in total knee arthroplasty (TKA). A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications. Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%. PSI seem not to be able to result in the same degree of accuracy as for the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers

Risultati clinico-strumentali del trattamento dell'artrosi trapezio-metacarpale mediante artroplastica di interposizone

Introduzione: La rizoartrosi (artrosi trapezio-metacarpale) rappresenta il 10% delle localizzazioni artrosiche di tutto il corpo. L’ artroplastica di interposizione secondo Robinson prevede l’esecuzione di trapeziectomia ed innesto tendineo con emi Abduttore Lungo del Pollice (APL) inserito nel gap creato dalla trapeziectomia. Lo scopo dello studio è quello di valutare i risultati clinici e strumentali dell’artroplastica di interposizione ad un follow-up di medio-lungo termine valutando mediante studio RMN l’evoluzione del innesto, ed una sua eventuale associazione con gli risultati clinici. Materiali e Metodi: Da Luglio 2006 a Maggio 2012, sono stati trattati chirurgicamente 75 pazienti affetti da rizoartrosi.64 pazienti rientravano nei criteri di inclusione dello studio. La valutazione clinica è stata effettuata mediante Grind test, Kapandji test, DASH score, VAS score, valutazione della ROM in abduzione radiale, e soddisfazione soggettiva del paziente. L’esame strumentale è stato effettuato mediante RX in antero-posteriore e laterale, sono state inoltre analizzate sequenze T1-, T2-, STIR-, Spin Echo e Gradient Echo-MRI alla RMN. Risultati: 44 pazienti (68.75%) sono risultati pienamente soddisfatti, 16 pazienti (25%) hanno riportato grande beneficio e hanno ripreso tutte le attività quotidiane con limitazione minima. Solo 4 pazienti (6.25%) non sono stati soddisfatti dell’intervento. La distanza scafo-metacarpale (SMD) valutata radiograficamente nel 1 mese post operatorio ha mostrato un valore medio di 6.6±1.7SD mm. All’ultimo follow-up il valore medio (SMD) è risultato essere di 4.3±1.2SD mm, con una migrazione prossimale media di 2.3±0.9SD mm. La valutazione con RMN ha mostrato nel 100% dei pazienti la presenza di tessuto fibroso residuo nello spazio tra la base del primo metacarpo e lo scafoide. Nel 37.5% dei pazienti è stata osservata la presenza di edema osseo subcondrale. Il 50% dei pazienti mostravano sinovite reattiva alla RMN. Discussione/Conclusioni: L’artroplastica di interposizione è un trattamento sicuro e validato per il trattamento dei pazienti affetti da rizoartrosi di stadio III-IV secondo Eaton-Littler che garantisce buoni risultati clinici ed il ritorno alle normali attività di vita quotidiana. La quantità di tessuto fibroso residuo interposto dopo la trapeziectomia sembra essere correlate a migliori risultati clinico / radiografici e maggiore soddisfazione da parte dei pazienti

Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players

PURPOSE: The growing popularity of elite soccer among female participants has led to increased incidents of anterior cruciate ligament (ACL) ruptures. Many authors underline a positive glide after ACL reconstruction (ACLR), especially in women. In fact, an isolated intra-articular ACLR may be inadequate to control rotational instability after a combined injury of the ACL and the peripheral structures of the knee. Extra-articular procedures are sometimes used in primary cases displaying excessive antero-lateral rotatory instability. The purpose of this case series was to report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis (LET) with a minimum 4-year follow-up in a selected high-risk population of elite female football players. METHODS: Between January 2007 and December 2010, 16 elite Italian female football players were included in the study. All patients underwent the same surgical technique: anatomical ACLR with autogenous semitendinosus and gracilis tendons. After the intra-articular reconstruction was performed, an additional extra-articular MacIntosh modified Coker-Arnold procedure was carried out. Patients were assessed pre- and post-operatively with the subjective and objective International Knee Documentation Committee (IKDC) evaluation form, Tegner activity scale (TAS) and Lysholm score. Joint laxity was assessed with KT-1000 by measuring the side-to-side (S/S) differences in displacement at manual maximum (mm) testing. RESULTS: At a mean follow-up of 72.6 ± 8.1 months, two independent examiners reviewed all players. All of the patients had a fully recovered range of motion. Lachman test was negative in all patients (100 %). The evaluation of joint laxity and clinical evaluation showed a statistically significant improvement. No patients experienced complication or a re-rupture. DISCUSSION: The rationale of combining extra-articular procedures with ACLR is to restrict the internal rotation of the reconstructed knee, taking advantage of its long lever arm and thus providing more stability in the rotational axis and preventing the ACL graft from undergoing further excessive strain. CONCLUSIONS: The combination of an LET with ACLR in elite female football players demonstrated excellent results in terms of subjective scales, post-operative residual laxity and re-rupture rate with no complication, and a complete return to sport activity

Partial tendon tear as unusual cause of trigger finger. a case report

We report a case of post-traumatic trigger finger due to a partial longitudinal tear of the flexor digitorum superficialis. The suspect came from the clinical history and the young age of the patient. It was successfully treated with tendon flap suture and pulley A1 release

Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

There are different techniques for drilling the femoral tunnel in the anterior cruciate ligament reconstruction (ACLR), but their influence in the bone tunnel enlargement in unknown. The purpose of this study was to compare two different surgical techniques for evaluating femoral tunnel enlargement in ACLR. The hypothesis was that tunnel placement using the outside-in technique leads to less tunnel enlargement compared to the transtibial technique. METHODS: Forty-four patients treated for ACLR between March 2013 and March 2014 were prospectively enrolled in this study. According to the surgical technique, subjects were assigned to Group A (Out-in) or Group B (Transtibial). All patients underwent CT examination in order to evaluate the femoral tunnel enlargement at four different levels. Moreover, all patients were evaluated with the Lachman test and pivot shift test, and the KT1000 arthrometer was used to measure the anterior laxity of the knee. A subjective evaluation was performed using the 2000 International Knee Documentation Committee Subjective Knee score, Lysholm knee score and Tegner activity scale. All patients were assessed after 24 months of follow-up. RESULTS: At the final follow-up, there were statistically significant differences (p 0.05). CONCLUSIONS: In ACLR with a suspension system, the outside-in technique leads to less enlargement of the femoral tunnel lower than the transtibial technique. KEYWORDS: Anterior cruciate ligament reconstruction; CT imaging; Drilling technique; Femoral tunnel enlargement PMID: 28389757 DOI: 10.1007/s00590-017-1950-8 Share on FacebookShare on TwitterShare on Google+ LinkOut - more resource

Single harvesting in the all-inside graft-link technique. is the graft length crucial for success? A biomechanical study

Background: The all-inside graft-link technique for anterior cruciate ligament reconstruction is performed with two cortical suspension devices with adjustable loops on both femur and tibia. This technique requires meticulous graft preparation. The aim of this study was to biomechanically test three different graft configurations resulting from differences in initial graft length. Materials and methods: Thirty bovine digital extensor tendons were arranged in three different ways: “half-quadrupled”, “tripled” and “quadrupled”. The final graft length was 65–75 mm. The specimens were fixed vertical to the loading axis of a tensile testing machine. After a static pre-conditioning of 50 N for 5 min, a load to failure test was performed and data regarding the ultimate failure load (UFL), the stiffness and mode of failure were recorded. Results: The evaluation of UFL showed a significant differences between group means as determined by one-way analysis of variance (F = 21.92, p = 0.002). Post hoc comparisons showed a significantly better UFL of “tripled” (p = 0.007) and “quadrupled” preparations (p = 0.014) compared to the “half-quadrupled” configuration, with no significant differences between “tripled” and “quadrupled” grafts (p = 0.061). No significant differences were found when evaluating the stiffness between the groups. Failure occurred by tendon slippage across the suture in all specimens. Conclusion: The “quadrupled” tendon achieved the best UFL, with even the “tripled” configuration having sufficient biomechanical characteristics to withstand the loads experienced during early rehabilitation. For this reason, with a total semitendinosus length of less than 260 mm it could be better to “triple” instead of “half-quadruple” it to achieve better performance of the graft

Operative treatment of chronic Achilles tendinopathy

Seventy-six patients with Achilles tendinopathies (n=86) operated between 1980 and 1995 were retrospectively evaluated at an average follow-up of 13 (5–21) years. Total or gross partial ruptures were excluded. Patients' average age at surgery was 38 (18–58) years. The majority of patients were active in competitive or recreational sports. Tendinopathies were classified in peritendinitis, tendinosis, insertional tendinopathies, and mixed forms. The surgical technique depended entirely on the pathology encountered. For 32 cases of peritendinitis, results were excellent in 26, good in four, and poor in two. For eight cases of tendinosis, results were excellent in four and good in four. For 34 cases of insertional tendinopathy, results were excellent in 22, good in four, fair in four, and poor in four. For 12 cases of mixed tendinopathies, results were excellent in ten and good in two. Forty-nine patients (52 cases) were able to return to sport at the desired level