A complication following ACL reconstruction using bioabsorbable cross-pins

This is a case of a proximal pin migration after ACL reconstruction in medial soft tissue with pain, inflammatory reaction and functional reduction. 33-year-old male presented at our clinic with a complete ACL rupture. Reconstruction with autogenous gracilis and semitendinosus hamstring tendons was performed and graft fixed in the femoral canal with two PLLA bioabsorbable pins (RIGIDFIX\uae Cross Pin System). Two months postoperatively the patient presented swelling and pain on the medial side of the knee, full range of motion and negative results at the Lachman and Pivot shift tests. MRI examination showed the superior femoral tunnel crossing both the lateral and medial cortex lodging the pin in the knee\u2019s medial soft tissue corresponding to the swelling area reported by the patient. The tendon graft was properly positioned. After surgical removal of the pin through a small skin incision, the pain and swelling promptly subsided allowing the patient return to normal activities in few weeks without any pain. In our opinion the painful swelling of the knee was due to a displacement of the pin that had been accidentally lodged in the soft tissues instead of the bone causing a foreign-body reaction resulting in granuloma formation with local inflammation. This dislodgement could have been due to an inappropriately long femoral tunnel

Use of a non-medicated plaster in shoulder tendinopathies

We assessed 20 shoulders with rotator cuff tendinopathy and partial tendon tears treated with FIT\uae plasters (far infrared technology). The criteria for inclusion were pain at night and during active shoulder movement. Patients with restricted passive movement (adhesive capsulitis) and complete tendon tears were excluded. Two different types of FIT\uae plasters were used according to the different power of action. Plasters were replaced after 7 days and dismissed after 15 days. The patients were assessed using the VAS pain scale and the Constant Murley score for function. The use of FIT\uae plasters have shown a certain effectiveness in activation of the endogenous analgesic action, with a role in alleviate painful symptoms and improve function in rotator cuff tendinopathies, without adverse events. On the base of the safety of this technology and promising results of our study, further studies should be encouraged to confirm its effectiveness, increasing the sample number and follow up so as to demonstrate definitely that the use of technologies, on which FIT\uae plasters is based, may be a valid alternative as "non-medicated pain relief"

Impalement injuries of the shoulder: a case report with literature review

The management of penetrating skeletal extremity trauma is a clinical challenge even for experienced surgeons. While the treatment of associated vascular injuries should be prioritized, there is still a lack of evidence regarding the management of foreign bodies in case of bone fractures or neurological injuries. Here we present a case of impalement of the right proximal humerus with a construction steel rod. The 54-year-old man was successfully treated without vascular, neurological, and thoracic sequelae. A review of the current literature about the most appropriate extrication sequences and soft tissue reconstruction following massive foreign body injuries was carried out

A clinical and radiological study of biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tears

Purpose: The aim of this retrospective study was to report the clinical and radiographic results of the biodegradable subacromial spacer (InSpace Balloon\uae) implantation in patients with massive irreparable rotator cuff tears. Materials and methods: From February 2014 to October 2015, 30 patients affected by massive irreparable rotator cuff tears were treated with the implantation of InSpace Balloon\uae. Clinical evaluation (Constant Score and VAS), X-rays and MR imaging were performed preoperatively in all patients and 3, 6, 12 and 24 months after surgery, dividing patients in different groups according to the time elapsed from surgery. Results: Constant Score increased from 39.89 to 62.33 points (p 0.0002) in the 6 months group and from 41.66 to 65.38 points (p< 0.0001) in the 12 months group. ROM (Range of Movement) and ADL (Activity of Daily Living) significantly improved with the contemporary reduction of VAS and pain at 12 months and, furthermore, an increase of functional performance with reduction of pain was registered at 24 months. Conclusions: Our results supported the surgical procedure of the arthroscopic implantation of biodegradable subacromial InSpace Balloon\uae for irreparable massive cuff tears in worker patients and with recreational activities\u2019 demands in order to recover the shoulder function with a reduction of the pain. (www.actabiomedica.it