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

Acromioclavicular third degree dislocation: surgical treatment in acute cases

BACKGROUND: The management of acute Rockwood type III acromioclavicular joint (ACJ) dislocation remains controversial, and the debate about whether patients should be conservatively or surgically treated continues. This study aims to compare conservative and surgical treatment of acute type III ACJ injuries in active sport participants (<35 years of age) by analysing clinical and radiological results after a minimum of 24 months follow-up. METHODS: The records of 72 patients with acute type III ACJ dislocations who were treated from January 2006 to December 2011 were retrospectively evaluated. Patients were categorised into two groups. group A included 25 patients treated conservatively, and group B included 30 patients treated surgically with the TightRope™ system. Seventeen patients were lost to follow-up. All patients were evaluated at final follow-up with these clinical scores: Constant, University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeons Scale (ASES) and Acromioclavicular Joint Instability (ACJI) and with a subjective evaluation of the patient satisfaction, aesthetic results and shoulder function. The distance between the acromion and clavicle and between the coracoid process and clavicle were evaluated radiographically and compared with preoperative values. Δ, the difference in mm between the distance at the final follow-up and at T0 in the injured shoulder, and α, the side-to-side difference in mm at follow-up, were calculated. Heterotopic ossification and postoperative osteolysis were evaluated in both groups. RESULTS: There were no major intraoperative complications in the surgical group. The subjective parameters significantly differed between the two groups. Constant, ASES and UCLA scores were similar in both groups (P > 0.05), whereas ACJI results favoured the surgical group (group A, 72.4; group B, 87.9; P < 0.05). All measurements of radiographic evaluation were significantly reduced in the surgical group compared with the conservative group. In group A, we detected calcifications in 30% of patients; in group B we detected two cases of moderate osteolysis and calcifications in 70% of patients. CONCLUSION: Although better subjective and radiographic results were achieved in surgically treated patients, traditional objective scores did not show significant differences between the two groups. Our results cannot support routine use of surgery to treat type III ACJ dislocations

I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines

This work provides easily accessible guidelines for the diagnosis, treatment and rehabilitation of Achilles tendon ruptures. These guidelines could be considered as recommendations for good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care for the individual patient and rationalize the use of resources. This work is divided into two sessions: 1) questions about hot topics; 2) answers to the questions following Evidence Based Medicine principles. Despite the frequency of the pathology andthe high level of satisfaction achieved in treatment of Achilles tendon ruptures, a global consensus is lacking. In fact, there is not a uniform treatment and rehabilitation protocol used for Achilles tendon ruptures

Functional evaluation of professional athletes treated with a mini-open technique for achilles tendon rupture

Introduction: in this study we report the functional results of 36 professional athletes treated with a combined percutaneous and mini-open technique. Methods: patients were evaluated with Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A), the objective 100-points Hannover scale and the Ergo-jump Bosco System device. Results: at a mean 28- month follow-up no re-rupture cases were observed. Six patients had minor complications. The Ergo-jump Bosco System device showed no significant differences in the side-to-side evaluation in regard to strength (-0.94%) and elasticity (+2.44%), while a significant post-operative loss was detected in the endurance trials (-6.78%). The Hannover scale showed an average score of 94.5, while the VISAA had an average of 93.1. Thirty-one patients resumed their pre-perative sports activity level within five months from surgery. Conclusions: our results showed that the combined mini-open and percutaneous repair is an effective treatment for professional athletes, with satisfactory clinical and functional results, lack of major complications and a quick return to professional sports activity

Comparison between carbon-peek plate and conventional stainless steal plate in ankle fractures. A prospective study of two years follow up

NTRODUCTION: The aim of our study is to compare the clinical and radiological outcomes of the treatment of distal fibular fracture with the traditional stainless steel or the new radiolucent CFR-PEEK plates. The hypothesis is that there are no differences in clinical and radiological outcomes at the final follow-up between the two fixation devices. METHODS: All consecutive patients aged from 18 or over, who had undergone operative treatment for malleolar fracture between 2013 and 2014, have been included in the study. 87 were available for the study. The patients were assigned to group A (47 patients, radiolucent plate group) and group B (41 patients, stainless steal plate group). At 6, 12 and 24 months all patients were prospectively reviewed with radiographic and clinical evaluations (OMAS scale, AOFAS, VAS, ROM). RESULTS: The groups were homogenous with regard to age, gender, BMI, dominance and disease duration. The mean follow-up was 23+/-2 months. The mean waiting time to operation was 2.94days (SD 2.74) (range 0.2-6.8). Statistical analysis showed no difference (p>0.05) about the VAS, OMAS, AOFAS and ROM evaluation at 6, 12 and 24 month follow-up between two groups. Radiographic evaluation showed no difference between two groups at all the follow-up with similar results obtained with the two fixation devices. DISCUSSION: Our results showed a substantial equivalence of the two fixation devices at 6, 12 and 24 month of clinical and radiographic follow-up. Fixation of the lateral malleolus fractures with a CFR-PEEK plate provides satisfying clinical and radiographic results after 2 years of follow-up. These results are comparable to those achieved with conventional plates. Copyright © 2017 Elsevier Ltd. All rights reserved. KEYWORDS: Ankle fractures; Carbon-PEEK; Fixation devices PMID: 28366469 DOI: 10.1016/j.injury.2017.03.035 Share on FacebookShare on TwitterShare on Google+ LinkOut - more resource

The treatment of long bones nonunions of upper limb with microsurgical cortico-periosteal free flap

Background and purpose: Medial condyle corticoperiosteal flap is an emerging option for the treatment of upper limb non-infected nonunions. The hypothesis of our study is that corticoperiosteal flap could be an effective and safe procedure for the treatment of upper limb non-infected nonunions, evaluating radiographic and clinical outcome. Methods: We enrolled 14 patients who underwent vascularized medial femoral condyle corticoperiosteal free flaps from January 2011 to December 2014. All patients were clinically evaluated (VAS, DASH) before surgery and at 6 and 12 months post surgery. The radiographic evaluation was performed every 30 days until the complete healing and at 12-month follow-up. We also recorded the range of motion pre and post surgery at the donor site. Results: All nonunion sites healed primarily at an average time period of 5.2 months ±1. Preoperative DASH score was 70 ± 15.6; at 6 month follow-up was 21.51 ± 10.63; at 12 month follow-up 18.0 ± 9.9. Preoperative VAS was 7.05 ± 2; at 6-month follow-up was 2.1 ± 2; at 12-month follow-up was 1.8 ± 1.16. Statistical analysis showed a significant difference ( p &lt; 0.001) about the preoperative and the postoperative VAS and DASH evaluation both at 6 and 12-month follow-up, but we did not record any statistical difference between the 6-month and 12-month follow-up. At the donor site, the mean VAS score was 2 ± 2.1 at seven days post operatively. All patients restore the full ROM at 7 days post surgery. Conclusions: Vascularized medial condyle corticoperiosteal free flap represents an effective and safe procedure for the treatment of upper limb nonunions

The role of diabetes mellitus and BMI in the surgical treatment of ankle fractures

Open reduction and internal fixation is the standard treatment for displaced ankle fractures. However, the presence of comorbidities such as diabetes mellitus and body mass index (BMI) are associated with poor bone quality, and these factors may predict the development of postoperative complications. The study aim was to assess the role of diabetes mellitus and BMI in wound healing in patients younger than 65 years who were surgically treated for malleoli fractures