Chapter: Posterolateral Instability[Show abstract] [Hide abstract] ABSTRACT: Posterolateral corner complex (PLC) plays a critical role in maintaining knee stability. It acts synergistically with the posterior cruciate ligament [1, 2] providing posterior translation, varus, and external rotation stability.
- [Show abstract] [Hide abstract] ABSTRACT: In the last year, we have performed a new technique for combined medial collateral ligament (MCL) and posterior oblique ligament (POL) reconstruction in chronic setting of anterior cruciate ligament and MCL complex deficiency. Autogenous semitendinosus tendon with the tibial attachment preserved has been used for the medial/posteromedial compartment reconstruction. We describe the operative technique. Between January and December 2014, 12 consecutive patients with multiligamentous injuries underwent concomitant MCL/POL using a novel technique. The usefulness of the novel technique is the semitendinosus sling on the semimembranosus tendon and the POL fixation with the knee in full extension. An ideal anteroposterior and rotational stability avoiding the medial compartment over constraint was achieved, in the immediate after surgery, due to the sequence of the bundle fixations and to the semitendinosus sling below the semimembranosus tendon. This technique is easily reproducible and useful and restores the medial stability immediately after surgery.
- [Show abstract] [Hide abstract] ABSTRACT: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. level I, validating cohort study with good reference standards.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: the purpose of this study was to analyze our preliminary results obtained with the KineSpring system in patients suffering from medial compartment knee osteoarthritis (OA). Methods: between September 2012 and May 2014, 53 patients underwent treatment with the KineSpring system. Patient self-assessment was performed pre-operatively and at 3, 6 and 12 months postoperatively, and included the KOOS, Tegner activity score, Lysholm functional knee score, VAS knee pain score, and IKDC score. Device- and procedure-related adverse events were recorded. Results: mean KOOS subscales, except for the Sport/Recreation subscale at six months, improved over time. Mean WOMAC Pain and Function domains, Lysholm score, IKDC score and VAS knee pain score improved over the follow-up period and were significantly improved at 3, 6 and 12 months postoperatively compared to baseline. Mean Tegner score improved slightly over time. In 5 of the 53 (9.4%) patients re-operation was necessary. In 3 patients the device was removed due to infection (one case) or persistent knee pain (two cases). Surgical arthrolysis was performed in two patients. Conclusions: in our preliminary experience, the KineSpring system gave good short-term clinical results. Level of evidence: Level IV, therapeutic case series.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: this study aimed to investigate the efficacy of intra-articular (IA) administration of a hydrogel formulation obtained from a hyaluronic acid (HA) derivative (HYADD4(®)) in the management of meniscal tears and in meniscal tear repair. Methods: fifty subjects with degenerative meniscal tears were enrolled into this single-site, observer-blind, parallel-group study. Clinical evaluations were performed at baseline and after 14, 30 and 60 days. Clinical outcomes included: pain reduction (Visual Analog Scale), improvement of knee functionality (WOMAC questionnaire), reduction in length and depth of the meniscal lesion (MRI-confirmed) and SF-36 questionnaire scores. Local tolerability and safety were also investigated. Results: a significant reduction in VAS pain (p< 0.001) in favor of HYADD4(®) was recorded at day 14 and maintained at all the follow-up assessments. Data on knee functionality were in line with the VAS pain assessment results. A significant reduction in length and depth of the meniscal lesion, assessed using MRI, was found in the HYADD4(®) group compared to the control group (p<0.001). Conclusions: the results of this study may indicate a new treatment option in the conservative management of patients complaining of pain due to meniscal tears. The MRI data suggest that the hydrogel formulation of HA used in this study may also play a role in the healing process of the lesion. Level of evidence: Level I, prospective randomized clinical trial.
- [Show abstract] [Hide abstract] ABSTRACT: Enhanced wear resistance of ceramics in general and improved mechanical characteristics of composite ceramics in terms of strength and resistance meet the demands for application in TKA. The aim of this prospective international multi-centre study was to evaluate the 5-year clinical and radiological outcomes of an unconstrained TKA with a composite ceramic femoral component. A total of 107 patients (109 knees) underwent TKA with the MULTIGEN-PLUS Ceramic Knee at seven centres in three European countries. Clinical and radiological assessments were performed preoperatively and postoperatively at 3, 12, 24 and 60months, using HSS, WOMAC, SF-36 and standardised radiographs. Mean HSS and WOMAC increased significantly from 55.1±11.5 (21-83) and 48.1±16.6 (3-90) preoperatively to 85.6±9.6 (49-98) and 73.3±20.4 (17-100) at 60months. Mean SF-36 showed significant improvements in patients' quality of life (49.1±17.6 (12-96) preoperatively versus 67.7±23.1 (12-100) at 60months). Non-progressive radiolucent lines (<1mm) were observed around the femoral component in four cases. Neither implant migration nor loosening were registered. Kaplan-Meier survivorship was 96.0% at 60months (92.1-100%, CI 95%). Five-year implant survival rate of the ceramic knee is comparable to other metallic and ceramic unconstrained TKA systems. Although the assessment of long-term implant survivorship is still pending, the ceramic implants represent a promising solution for patients with allergies against metallic components and furthermore for the general osteoarthritis population due to enhanced wear resistance. Copyright © 2015 Elsevier B.V. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: There is a distinct need for minimally invasive surgical options for the treatment of knee osteoarthritis. This manuscript describes a minimally invasive implant that reduces the load carried by the medial compartment of the knee joint during the stance phase of gait. Implantation is achieved without resection of bone, muscle, or ligaments and without violation of the joint capsule. The procedure is completely reversible should the need arise, allowing for simple device removal without comprising future surgical options. The surgical techniques for implant and explant are explained in detail.
Article: Ankle tendinopathies in athletes[Show abstract] [Hide abstract] ABSTRACT: Ankle tendinopathies in athletes are a major problem given the consider- able diffusion of sport in non-professionals. Recreational athletes are more affected be- cause of an improper athletic training. The most common tendon injuries affect Achilles tendon, posterior tibial tendon and peroneal tendons. The treatment of these condi- tions is not easy: diagnosis requires a good knowledge of the conditions that may pro- vide the biomechanical substrate for the onset of tendinopathy. This means being able to conduct not only a good clinical investigation but also be able to analyze the play- ing habits and the type of training that is leading the patient. Moreover, despite the huge variety of therapeutic strategies available nowadays, there is a serious lack of sci- entific evidence. This treaty aims to analyze causes and types of tendinopathy enshrin- ing the available therapeutic pathways
- [Show abstract] [Hide abstract] ABSTRACT: Over the years, the surgical treatment of meniscal injury or damage has changed from total meniscectomy to partial meniscectomy or repair. The goal with arthroscopic methods is to preserve as much functional meniscal tissue as possible, rather than to remove it. During recent years, efforts have increasingly focused on the promotion of meniscal healing, as well as the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. This chapter will focus on three types of meniscal substitutes, their biological and biomechanical properties, and their clinical relevance. None are available for patient use in the USA at the time of this writing. These substitutes are: the biological MenaflexTM or collagen meniscal implant (CMI), the biomimetic ActifitTM meniscal scaffold, and the nonbiological NUsurface® meniscal substitute. In addition to the surgical techniques, clinical outcomes for the respective devices will be reviewed.
- [Show abstract] [Hide abstract] ABSTRACT: Iatrogenic vascular injuries to the knee in orthopedic surgery are a major concern for surgeons and a major problem for patients. They are fortunately rare, but it is equally difficult to process. The first decisions taken as soon as you confirm the diagnosis are the most important for the pa-tient's recovery. We did a review of the cases in our center where they are present simultaneously in the Department of Orthopaedic Surgery and Vascular Surgery.
- [Show abstract] [Hide abstract] ABSTRACT: The menisci are semi-lunar wedge-shaped structures that play critical roles in load distribution, shock absorption, and joint congruity in the knee. Meniscal tears are common knee injuries that subsequently lead to degenerative arthritis, attributed primarily to the changes in stress distribution in the knee. In such cases there is a need to protect the articular cartilage by either repairing or replacing the menisci. While traditionally, meniscal replacement involves implantation of allografts, problems related to availability, size matching, cost and risk of disease transmission limit their use. Another potential treatment option is that of biodegradable scaffolds, which are based principally on tissue engineering concepts. The variability in body response to biodegradable implants and the quality of the tissue formed still pose a problem in this respect, particularly in light of the intense loading conditions in the knee. Moreover, the aforementioned repair and regenerative approaches are generally limited to younger patients. Therefore, the goal of this study was, to develop a synthetic meniscal implant which can replace the injured meniscus, restore its function, and relieve pain.
- [Show abstract] [Hide abstract] ABSTRACT: Le lesioni legamentose multiple di ginocchio sono una patologia complessa che costituisce una vera e propria sfida per lo specialista ortopedico sia da un punto di vista diagnostico che terapeutico. La scarsità in letteratura di studi significativi rende ad oggi non univoca la scelta dell’approccio terapeutico, le indicazioni ed il timing del trattamento chirurgico, le tecniche di riparazione/ricostruzione più adeguate per ciascun caso.
- [Show abstract] [Hide abstract] ABSTRACT: Total knee arthroplasty can be considered as a reliable surgical procedure with a good long-term clinical result. However, implant failure due to particle induced aseptic loosening as well as the aspect of hypersensitivity to metal ions still remains an emerging issue. The purpose of this prospective international multi-centre study was to evaluate the clinical and radiological outcomes and the reliability of the unconstrained Multigen Plus Total Knee System with a new BIOLOX® delta ceramic femoral component. Cemented total knee arthroplasty was performed on 108 patients (110 knees) at seven hospitals in three countries. Clinical and radiological evaluations were performed preoperatively, and after 3, 12 and 24 months postoperatively using the HSS-, WOMAC-, SF-36-score and standardised X-rays. The mean preoperative HSS-Score amounted to 55.5 ± 11.5 points and improved significantly in all postoperative evaluations (85.7 ± 11.7 points at 24 months). Furthermore, improvements in WOMAC- and SF-36-score were evaluated as significant at all points of evaluation. Radiolucent lines around the femoral ceramic component at 24 months were found in four cases. Progression of radiolucent lines was not seen and no implant loosening was observed. During the 24 month follow-up eight patients underwent subsequent surgery due to reasons unrelated to the implant material. The observed clinical and radiological results are encouraging for a long-term survival of the ceramic femoral component. Therefore, ceramic implants could be a promising solution not only for patients with allergies against metallic implant materials, but also for the osteoarthritic knee joint. Long-term follow-up is necessary to draw conclusions regarding the superiority of the ceramic knee implants concerning in vivo wear and long-term survivorship.
- [Show abstract] [Hide abstract] ABSTRACT: We describe a case of dorsal-lumbar vertebral tuberculosis (Pott's disease) first treated with antibiotic therapy, bed rest, and cast. After 2 months of treatment patient's symptoms worsened. Minimally invasive posterior vertebral stabilization was carried out, with excellent clinic and radiographic results.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose The posterolateral corner (PLC) is more likely to be injured in combination with the posterior cruciate ligament (PCL) or the anterior cruciate ligament than in isolation. This leads to instability of the knee and loss of function. We hypothesised that combined PCL and PLC reconstruction would restore sufficient stability to allow improvement in patient symptoms and function. Methods 19 patients who underwent arthroscopic-assisted single-bundle PCL and PLC reconstruction by a single surgeon were analysed retrospectively. The PLC reconstruction was a modified Larson reconstruction of the lateral collateral ligament and the popliteofibular ligament. The IKDC and Tegner scores were used to assess outcome. Dial test and varus laxity were used to assess improvements in clinical laxity. Posterior laxity was tested using the KT-1000. Results The mean follow-up was 38 months (±(2× standard deviations), ±12.3). There were no postoperative complications. All patients had less than 5 mm posterior step-off. 17 of 19 patients had negative dial and varus stress tests. Measured range of motion was reduced by a mean of 10°, but patients did not report any daily activities restrictions. Tegner scores improved from a median pre-operative value of 2 (range 1–4) to 6 (4–9) at final follow-up. The mean postoperative IKDC score was 86 (±11). Conclusions Subjectively, the knee stability achieved allowed daily activities. However, there were remaining abnormalities in range of motion, posterior drawer and rotational laxity, suggesting that normal knee laxity was not restored. Level of evidence IV.
Ospedale Sacro Cuore-Don CalabriaVerona, Veneto, Italy