Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study

PURPOSE

the purpose of this retrospective study was to present the outcomes of three different techniques for the treatment of type III acromioclavicular joint dislocations: arthroscopic TightRope (TR), arthroscopic GraftRope (GR), and open reconstruction of the coracoclavicular (CC) ligament using the Ligament Augmentation and Reconstruction System (LARS).

METHODS

eighteen patients underwent clinical and radiological evaluations after a mean follow-up time of 43 months. The following clinical outcome measures were considered: the Disability of the Arm, Shoulder and Hand outcome measure (DASH), the Nottingham Clavicle Score (NCS), and the Constant score (CS). On X-rays, the CC distance was measured.

RESULTS

the median DASH score at follow-up was 12.5 in the TR group, 5 in the GR group, and 4.2 in the LARS group. The median NCS value was 88 in the TR group, 88 in the GR group, and 91 in the LARS group. The median CS was 100 in the TR group, 95 in the GR group, and 94.5 in the LARS group. The mean CC distance was 10.3 mm in the TR group, 13.8 in the GR group, and 16.6 in the LARS group.

CONCLUSIONS

all three techniques proved to be reliable in providing good clinical outcomes, although none of the studied techniques demonstrated reliability in maintaining anatomical reduction after surgery.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Implantation of matrix-induced autologous chondrocyte (MACI ®) grafts using carbon dioxide insufflation arthroscopy

PURPOSE

The purpose of this study was to determine the safety of a new arthroscopic Matrix-induced autologous chondrocyte implant (MACI) technique with carbon dioxide insufflation utilized to improve visualization during the dry phase of the scaffold implant.

METHODS

Between 2004 and 2007, thirty patients were treated for symptomatic focal chondral lesions of the medial femoral condyle. All patients were monitored during surgery for gas embolism signs and symptoms and were evaluated preoperatively and at a median follow-up of 70.5 months (range 48-93 months) using the KOOS subjective evaluation score, the Lysholm function score, the Tegner activity scale for the knee, and the IKDC objective score.

RESULTS

No cases of intraoperative or postoperative symptoms or signs related to gas embolism or persistent subcutaneous emphysema were registered. Each subscale of the KOOS subjective score improved from preoperative to follow-up. The median Lysholm score was 50 (range 15-66) at baseline and 87.5 (range 54-100) at follow-up (p < 0.05). The median Tegner score was 2 (range 1-4) at baseline to 5 (range 2-7) at follow-up (p < 0.05).

CONCLUSIONS

No complications registered, and the satisfactory clinical results achieved in this series suggest that carbon dioxide insufflation during arthroscopic MACI is a safe and accessible option to improve visualization during the dry phase of the scaffold implant on medial femoral condyles.

All-inside meniscal repair using the FasT-Fix meniscal repair system: is still needed to avoid weight bearing? A systematic review

The aim of this study was to review the published clinical outcomes of meniscal repair using the FasT-Fix device comparing standard rehabilitation program to an accelerated rehabilitation protocol. A review of the Medline database was performed involving searches for clinical outcomes of all-inside meniscus repair performed with the FasT-Fix device. Eight studies were identified for inclusion. On the basis of the clinical outcomes of these studies, there appears to be no notable difference between an accelerated rehabilitation regimen with full weight bearing allowed as soon as tolerated and a standard postoperative rehabilitation program. Failure rate was 13 % for patients following an accelerated rehabilitation regimen, and 10 % for standard protocol. Accelerated rehabilitation after all-inside meniscal repair using the FasT-Fix device appears to be safe, and the incidence of retears is in line with those reported for standard rehabilitation protocol.

Open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow: a multicenter study

BACKGROUND

Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis has recently been developed for the treatment of lateral elbow arthritis. However, few data have been published on LRE results.

MATERIALS AND METHODS

A prospective multicenter study was designed to assess LRE preliminary results. There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11 and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis. Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score (MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.

RESULTS

At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P = .001) and 34 (P = .001) respectively; the average Quick DASH decreased by 29 (P = .001). Average range of motion was improved by 35° (P = .001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in 3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant survival rate was 100%.

CONCLUSION

LRE showed promising results in this prospective investigation. Most patients had an uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional recovery at short-term follow-up. Further studies with longer follow-up are warranted.

The use of parallel pre-contoured plates in the treatment of A and C fractures of the distal humerus

The purpose of this study was to retrospectively evaluate the clinical and radiological results of fixation with parallel pre-contoured plates in intra-articular and extra-articular distal humerus fractures. We retrospectively evaluate seven cases of type A and six cases of type C fracture treated with the Mayo Clinic Congruent Elbow Plate system (Acumed, Hillsboro, Oregon) after a mean follow-up of 14.8 and 21.3 months, respectively. Mayo Elbow Performance Score (MEPS) was utilized for functional evaluation. Mean MEPS was (92.86 +/- 16.8) in the first group showing 6 excellent and one poor result, while (94.17 +/- 12) showing five excellent and one fair in the second group, showing no significant difference between the two groups (P = 0.87). The mean active motion recovered postoperatively was 120 degrees (+/-34.5 degrees) in type A fractures and 113 degrees (+/-14.7 degrees) in type C fractures, and there was no significant difference (P = 0.67). Complications occurred in 6 of the 13 patients analysed at follow-up (3 radial neuropathy, one ulnar neuropathy, one screw mobilization and one heterotopic ossification). The fractures healed in every patient, and no synthesis failed. The parallel plate system has proved to be extremely useful in the treatment of intra-articular and extra-articular distal humerus fractures. The pre-contoured geometry allows easier reduction and stabilization of complex fractures. The higher stability achieved permits early mobilization, thus obtaining a higher percentage of excellent results.

Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder

Background

There are several treatment modalities for calcifying tendinitis of the shoulder. If the pain becomes chronic after several months of conservative treatment, open or arthroscopic removal is usually recommended. Recently, extracorporeal shock wave therapy has shown encouraging results in treating calcific deposits.

Materials and methods

We report a retrospective study to compare the outcome after arthroscopic extirpation (group I, 22 cases) with the effect of low extracorporeal shock wave therapy (group II, 24 cases) in patients with a chronic homogeneous calcific deposit in the supraspinatus tendon. Patients included in the study had undergone unsuccessful conservative therapy in the previous six months with no evidence of subacromial impingement of the rotator cuff independent of the calcium deposit or rupture of the rotator cuff detected by sonography or magnetic resonance imaging. AP and LL radiographies were performed for all of the patients at least one week before the treatment and 24 months after the treatment. To keep the possibility of spontaneous resorption low, the deposit had to be sharply outlined and densely structured on the radiograph (types I and II in the Gärtner classification). In group II, the patients underwent an average of three treatment sessions of extracorporeal shock waves therapy with 1,500 impulses/session of 0.10–0.13 mJ/mm².

Results

Preoperative symptoms (P = 0.09), sex (P = 0.17), operated (P = 0.11) and dominant (P = 0.33) limbs, and age (P = 0.99) of the two groups did not show a significative difference between groups. According to the University of California Los Angeles (UCLA) rating system, the mean score in group I improved from 9.36 (±5.2) to 30.3 (±7.62) points after 24 months, with 81.81% reporting good or excellent results (P < 0.001). In group II the mean score after 24 months rose from 12.38 (±6.5) to 28.13 (±9.34) points, with 70.83% reporting good or excellent results (P < 0.001). Radiologically, after two years of follow up, there was no calcific deposit in 86.35% (P < 0.001) of the patients of group I and in 58.33 % (P < 0.001) of the patients of group II. According to the UCLA scores, there was no significant difference between the groups at two years of follow-up (P = 0.38).

Conclusions

We conclude that shock wave therapy is equivalent to arthroscopy, and so shock wave therapy should be preferred because of its noninvasiveness.

Arthroscopic rotator cuff repair in patients older than 60 years

PURPOSE

The purpose of this study was to analyze results by age, tear size, and type of suture repair (margin convergence by side-to-side suture, direct tendon-to-bone repair with suture anchor, or side-to-side plus suture anchor) of arthroscopic rotator cuff repair in patients older than 60 years (average, 67.7 years).

TYPE OF STUDY

Retrospective case series.

METHODS

From January 1999 to January 2001, 64 patients (64 shoulders) older than 60 years had an arthroscopic rotator cuff repair performed by the same surgical team. Fifty-four patients (84.3%) were available for follow-up (average, 27 months); 54 shoulders were evaluated using the UCLA rating scale (0-35 points). Tears were categorized according to size. The pattern of tears determined the repair technique: crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears by margin convergence with or without suture anchor.

RESULTS

The mean of postoperative UCLA score improved from 10.4 (range, 8.2-20 points) to 30.5 (range, 21-35 points) (P < .0001). Sixteen patients (29.6%) had excellent results (34-35 points), 28 (51.8%) had good results (28-33 points), 10 (18.5%) had fair results (21-27 points), and none had poor results. There were no statistical differences between postoperative UCLA score and groups by age (P = .53), suture technique (P = .06), and tear size (P = .5). The correlation between technique of repair, age, and postoperative score has not shown statistical differences between margin convergence with or without suture anchor and direct tendon-to-bone repair with suture anchor in the 61- to 65-year-old patients. Patients older than 65 years achieved the best results with margin convergence by side-to-side suture.

CONCLUSIONS

Arthroscopic rotator cuff repair in the elderly achieves satisfactory results in a large percentage of cases regardless of the patient's age, tear size, and type of suture repair. These results are comparable to those of traditional open repair. We believe that arthroscopic evaluation allows an accurate assessment of rotator cuff tear configuration resulting in a more precise repair.

LEVEL OF EVIDENCE

Level IV, case series (no, or historical, control group).

IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases

This retrospective study evaluates the results obtained in five Italian departments of traumatology in the treatment of peritrochanteric (pertrochanteric and subtrochanteric) fractures by the intramedullary hip screw (IMHS; Smith & Nephew Richards, Memphis, TN, USA) nail. One thousand two hundred and seventy-three patients were treated with the IMHS nail between March 1992 and February 2000. The results of these operations were evaluated clinically and radiological in 981 patients. The 90.3% of patients could walk unaided or with simple support. Because of the low complication rate requiring re-operation (postoperative shaft fractures, screw penetrated the acetabulum, cut out and non-union) (1.7%), we think that this device is an advance in the treatment of peritrochanteric fractures.

Isolated fracture of the capitate with proximal pole dorsal dislocation. A case report

Isolated fractures of the capitate are uncommon. We report a rare case of isolated fracture of the capitate with dorsal dislocation of the proximal pole. After open reduction and K-wire fixation the fracture united, and a full range of wrist motion was achieved. No signs of avascular necrosis were observed after 3 years.

In vitro effect of inosiplex on T lymphocytes. I. Influence on T cells with receptors for IgG (T gamma)

Inosiplex, a complex of inosine and 2-hydroxypropyldimethyl ammonium-4-(acetylamino)benzoate, 1:3 molar ratio, originally developed for antiviral use, is now under wider investigation because of its immunopotentiating properties. This compound can have some actions on T cells at various stages of differentiation, thus promoting an enhancement of their blastogenic responses to varied mitogenic agents (PHA, Con A, PWM, MLC, tetanus toxoid, and viral antigens). Our studies demonstrated that under the influence of inosiplex human peripheral blood T lymphocytes bearing Fc IgG receptors have an augmented receptor avidity for SRBC which result in an increased E active rosette formation, and that T cells preincubated with the drug at the appropriate concentrations express more Fc IgG receptors. Even though T gamma cells exert "in vitro" immunoregulatory properties, the increase in percentage of T gamma lymphocytes do not correlate with a potentiation of the Con A-induced suppressor activity of T cells. Moreover, the lymphocytes treated with the substance in the absence of Con A exert helper functions, increasing the mitogenic responses of the second culture PHA--treated lymphocytes. These data appear to suggest a pro-proliferative inosiplex-induced effect which could mask a concomitant suppressor cell induction.

[Inhibition of EA and EAC rosette formation by sera of patients with vesical schistosomiasis]

Circulating immune complexes were investigated by the E.A. and E.A.C. rosette inhibition test in sera samples from patients infested by Schistosoma haematobium. About 60% of the patients demonstrated significantly higher inhibition values than controls. The material inhibiting E.A.C. rosette formation was precipitated by 3.5% polyethilene glycol, thus excluding the role of C3 fragments and suggesting that inhibition was due to immune complexes.