563 AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION OF THE KNEE JOINT ASSISTED BY COMPUTER NAVIGATION. CADAVERIC STUDY

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Sequential versus automated cutting guides in computer-assisted total knee arthroplasty

The accuracy and efficiency of automated cutting guides in CAS systems have not been previously compared with conventional CAS techniques. Therefore, it is not yet clear if these more advanced technologies are warranted. We hypothesized that a novel automated cutting guide with CAS for total knee arthroplasty would be more efficient and more accurate than conventional navigation with sequential cutting blocks. Twelve cadaver legs were used in total. Each leg was randomly assigned to either an automated guide positioning or a conventional freehand computer-navigated guide positioning. The guide positions postosseous fixation and the final bone-cut surfaces were digitized and compared to the targeted cutting planes. The final location of the impacted trial implant was also digitized and compared to the planned implant location. The time for each step and the total time taken to prepare the femur were measured for both groups. The mean femoral preparation time was shorter with the automated cutting guide than the conventional method (5.5. min versus 13.8. min, p < 0.001). The average deviation in the final bone resections from the planned resections was significantly lower for the automated cutting guide in the frontal/rotational plane (0.55° versus 1.1°), sagittal plane (0.75° versus 2.0°), and cut height direction (0.56. mm versus 1.6. mm). Therefore, based on these results, we concluded that automated cutting-guide positioning resulted in more efficient and more accurate femoral cuts in comparison to the conventional navigation method in a cadaveric model. © 2010 Elsevier B.V

Comparative study of navigated versus freehand osteochondral graft transplantation of the knee

Background: Osteochondral lesions are a common sports-related injury for which osteochondral grafting, including mosaicplasty, is an established treatment. Computer navigation has been gaining popularity in orthopaedic surgery to improve accuracy and precision. Hypothesis: Navigation improves angle and depth matching during harvest and placement of osteochondral grafts compared with conventional freehand open technique. Study Design: Controlled laboratory study. Methods: Three cadaveric knees were used. Reference markers were attached to the femur, tibia, and donor/recipient site guides. Fifteen osteochondral grafts were harvested and inserted into recipient sites with computer navigation, and 15 similar grafts were inserted freehand. The angles of graft removal and placement as well as surface congruity (graft depth) were calculated for each surgical group. Results: The mean harvesting angle at the donor site using navigation was 4° (standard deviation, 2.3°; range, 1°-9°) versus 12° (standard deviation, 5.5°; range, 5°-24°) using freehand technique (P < .0001). The recipient plug removal angle using the navigated technique was 3.3° (standard deviation, 2.1°; range, 0°-9°) versus 10.7° (standard deviation, 4.9°; range, 2°-17°) in freehand (P < .0001). The mean navigated recipient plug placement angle was 3.6° (standard deviation, 2.0°; range, 1°-9°) versus 10.6° (standard deviation, 4.4°; range, 3°-17°) with freehand technique (P = .0001). The mean height of plug protrusion under navigation was 0.3 mm (standard deviation, 0.2 mm; range, 0-0.6 mm) versus 0.5 mm (standard deviation, 0.3 mm; range, 0.2- 1.1 mm) using a freehand technique (P = .0034). Conclusion: Significantly greater accuracy and precision were observed in harvesting and placement of the osteochondral grafts in the navigated procedures. Clinical studies are needed to establish a benefit in vivo. Clinical Relevance: Improvement in the osteochondral harvest and placement is desirable to optimize clinical outcomes. Navigation shows great potential to improve both harvest and placement precision and accuracy, thus optimizing ultimate surface congruity. © 2009 American Orthopaedic Society for Sports Medicine

Osteomyelitis of the femur effectively treated with medulloscopy debridement: a case report

Background: Medulloscopy refers to the visualization of the intramedullary canal with an arthroscope, providing access to the infection site without the need for an extensive approach therefore not compromising the surrounding soft tissue. It provides information regarding the extent of the infected endosteal surface of bone, and it allows a thorough debridement of the intramedullary canal in a controlled manner. Therefore, it can be used as an adjunct to traditional open surgical techniques, to perhaps help to visualize hard to see intramedullary areas. Materials and methods: This article reports a patient with chronic osteomyelitis of the distal metaphysis of the femur that was treated successfully with intramedullary debridement through medulloscopy. The sinus tract reaching down to the femoral bone and communicating with the intramedullary canal was excised, and a cortical window was formed through which the arthroscope was inserted and thorough irrigation of the intramedullary canal and excision of necrotic and infected bone was done. A second medulloscopy through the same approach was necessary 3 months later because of persistent infection. Re: sults: At 3-year follow-up, the patient was well without any clinical or radiographic evidence of recurrent infection. Conclusion: Medulloscopy can be very useful in localized osteomyelitis as an adjunct to traditional surgical techniques; it helps to visualize hard to see intramedullary areas and adequately addresses the infection, while the damage to surrounding soft-tissue is limited. © 2020, Springer-Verlag France SAS, part of Springer Nature

Donor's site evaluation after restoration with autografts or synthetic plugs in rabbits

Aim: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. Methods: Thirty New Zealand White rabbits were used in this study. A full-thickness cylindrical defect of 4.5 mm (diameter) × 7 mm (depth) was created with a hand drill in the femoral groove of every animal. In Group A (n = 10) the defect of the donor site was repaired with a biosynthetic osteochondral plug, in Group B (n = 10) with an osteochondral autograft, while in Group C (control group of 10) rabbits were left untreated. Results: Twenty-four weeks postoperatively, smooth articular cartilage was found macroscopically in some trocleas' surfaces; in all others, an articular surface with discontinuities was observed. Twenty-eight out of 30 animals were found with predominantly viable chondrocytes leaving the remaining two -which were found only in the control group- with partially viable chondrocytes. However, histology revealed many statistical differences between the groups as far as the International Cartilage Repair Society (ICRS) categories are concerned. Immunofluoresence also revealed the presence of collagen II in all specimens of Group B, whereas in Group A collagen II was found in less specimens. In Group C collagen II was not found. Conclusion: The matrix, cell distribution, subchondral bone and cartilage mineralization ICRS categories showed statistically differences between the three groups. Group A was second, while group B received the best scores; the control group got the worst ICRS scores in these categories. So, the donor site area, when repairing osteochondral lesions with autografting systems, is better amended with osteochondral autograft rather than bone graft substitute implant. © 2014 Baishideng Publishing Group Inc

Developmental Dysplasia of the Hip: A Review

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal disorder of the infant age. Its incidence ranges from 0.06/1000 to 76.1/1000 live births and is more frequent in female infants. Breech posi-tion, family history and firstborn children are the main risk factors for DDH and this disorder is also associated with the presence of other congenital deformities. Anatomically, the acetabulum remains shallow and the femoral head grows in a wrong position. Clinical examination is important and tests such us Barlow and Ortolani give indications only for a part of the spectrum of this entity. Nowadays the sonographic examination is the most accurate option for the diagnosis. Graf classification categorizes the DDH cases in four types, from normal to dislocated hip, by description and measuring specific angles in sonographic examination. The wide usage of ultrasonography has decreased the non-diagnosed or neglected cases; treatment begins immediately in young age and is usually conservative with the usage of devices such as Pavlik harness and hip spica. To enhance the literature, we searched for published studies on DDH, to summarize the pathogenesis and the diagnosis and to discuss the treatment and outcome of the patients with this disorder. © 2022 by Begell House, Inc