Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 6 Articles
Purpose. Primary septic arthritis is a rare differential diagnosis of acute hip pain in adults. Inspired by the success of all-arthroscopic\ntreatment in pediatric patients, we developed a diagnostic and surgical pathway for our adult patients. Methods. Seven patients,\naverage age 44 Ã?± 13.7 years with acute hip pain since 4.4 Ã?± 2.9 days in the average, were included. Septic arthritis was confirmed\nby joint aspiration and dissemination was excluded by MRI and standard radiographs. Surgical treatment consisted of immediate\narthroscopic lavage using 4 portals for debridement, high-volume irrigation, partial synovectomy, and drainage. Results. Patients\nwere treated in hospital for 12.4 Ã?± 3.1 days (range 7ââ?¬â??16 days). WBC and CRP returned to physiological levels. During the mean\nfollow-up of 26.4Ã?±19.4 months (range 13ââ?¬â??66months) no patient showed recurrence of infection.The5 patients with an unimpaired\nhip joint prior to the infection had ameanmodifiedHarrisHip Score of 94Ã?±5.6 points (range 91ââ?¬â??100) at final follow-up. Conclusions.\nArthroscopic therapy using a minimally invasive approach with low perioperative morbidity for the treatment of primary septic\narthritis of the adult hip is able to restore normal hip function in acute cases without dissemination of the infection. Level of Evidence.\nIV....
Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pairmatched\nfresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture\nBridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-tofailure\ntest were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The\nMSB technique had the significantly greatest load to failure (515.6 �± 78.0N, P = 0.04 for KSB group; P < 0.001 for USB group),\nstiffness (58.0 �± 10.7 N/mm, P = 0.005 for KSB group; P < 0.001 for USB group), and lowest elongation (1.49 �± 0.39 mm, P = 0.009\nfor KSB group; P = 0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5 �± 65.0 N)\nthan USB repair (363.5 �± 52.3N, P = 0.024). However, there was no statistical difference in stiffness and elongation between KSB\nand USB technique (P = 0.396 for stiffness and P = 0.242 for elongation, resp.). The failure mode for all specimens was suture\npulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical\nproperties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a\npromising alternative in arthroscopic rotator cuff repair....
Background: The meniscus plays a crucial role in knee joint stability, load transmission, and stress distribution.\nMeniscal tears are the most common reported knee injuries, and the current standard treatment for meniscal\ndeficiency is meniscal allograft transplantation. A major limitation of this approach is that meniscal allografts do not\nhave the capacity to remodel and maintain tissue homeostasis due to a lack of cellular infiltration. The purpose of\nthis study was to provide a new method for enhanced cellular infiltration in meniscal allografts.\nMethods: Twenty medial menisci were collected from cadaveric human sources and split into five experimental groups:\n(1) control native menisci, (2) decellularized menisci, (3) decellularized menisci seeded with human adipose-derived stem\ncells (hASC), (4) decellularized needle-punched menisci, and (5) decellularized needle-punched menisci seeded with\nhASC. All experimental allografts were decellularized using a combined method with trypsin EDTA and peracetic acid.\nNeedle punching (1-mm spacing, 28 G microneedle) was utilized to improve porosity of the allograft. Samples were\nrecellularized with hASC at a density of 250 k/g of tissue. After 28 days of in vitro culture, menisci were analyzed for\nmechanical, biochemical, and histological characteristics.\nResults: Menisci maintained structural integrity and material properties (compressive equilibrium and dynamic moduli)\nthroughout preparations. Increased DNA content was observed in the needle-punched menisci but not in the samples\nwithout needle punching. Histology confirmed these results, showing enhanced cellular infiltration in needle-punched\nsamples.\nConclusions: The enhanced infiltration achieved in this study could help meniscal allografts better remodel post-surgery.\nThe integration of autologous adipose-derived stem cells could improve long-term efficacy of meniscal transplantation\nprocedures by helping to maintain the meniscus in vivo....
Introduction. Ankle arthrodesis is performed in a variety of methods.We propose a new technique for tibiotalar arthrodesis using a\nnewly designed intramedullary nail. Methods.We proposed development of an intramedullary device for ankle arthrodesis which\nspared the subtalar joint using a sinus tarsi approach. Standard saw bones models and computer assisted modeling and stress\nanalysis were used to develop different nail design geometries and determine the feasibility of insertion. After the final design was\nconstructed, the device was tested on three cadaveric specimens. Results. Four basic nail geometries were developed. The optimal\ndesign was composed of two relatively straight segments, each with a different radius of curvature for their respective tibial and talar\ncomponent. We successfully implemented this design into three cadaveric specimens. Conclusion. Our newly designed tibiotalar\nnail provides a new technique for isolated tibiotalar fusion. It utilizes the advantages of a tibiotalar calcaneal nail and spares the\nsubtalar joint. This design serves as the foundation for future research to include compression options across the tibiotalar joint\nand eventual transition to clinical practice....
Background: Open reduction with internal fixation (ORIF) and percutaneous surgery (PS) are the most common\nsurgical procedures for the treatment of displaced intra-articular calcaneal fractures. The purpose of this\nretrospective study was to compare the clinical and radiological results of these techniques and to verify the\nprognostic value of the radiographic measurement tools proposed in the literature.\nMethods: A consecutive series of 104 calcaneal fractures was included in this analysis. Essex-Lopresti and Sanders\nclassifications were used to evaluate the injuries, and their prognostic correlation was tested. B�¶hlerâ��s angle was\nmeasured pre- and postoperatively and evaluated as radiological outcome. Clinical outcomes were evaluated using\nthe American Orthopaedic Foot and Ankle Society hindfoot scale (AOFAS), Maryland Foot Scale (MFS), 17-Foot\nFunction Index (FFI), Short Form-36 (PCS), and a 10-point visual analogue scale (VAS).\nResults: A total of 87 fractures (5 bilateral), 54 in males and 28 in females, were evaluated with a mean follow-up of\n77.0 months. Overall mean age was 51.6 years old. The most frequent cause of trauma was a fall from a height.\nAccording to Essex-Lopresti, there were 58 joint depression fractures, 26 tongue, and 3 comminute. According to\nSanders: 37 type II, 31 type III, and 19 type IV. Patients were divided into three groups according to surgical\ntreatment: 19 in the ORIF group, 35 in the PS Screw group, and 33 in PS K-wire group. The ORIF group obtained\nsignificantly better results (82 AOFAS, 86 MFS, 19.6 FFI, 46.2 PCS, 8 VAS) with respect to the PS K-wire group (74\nAOFAS, 76 MSF, 26.4 FFI, 40.8 PCS, 6 VAS). The PS Screw group obtained intermediate results (79 AOFAS, 82 MFS,\n22.4 FFI, 41.6 PCS, 7 VAS). The restoration of the B�¶hlerâ��s angle was achieved most frequently (p = 0.02) in the ORIF\ngroup, without better clinical results.\nConclusion: The results were best in the ORIF group, despite its risk of complications, inferior in the PS Screw\ngroup, however without statistical significance (p > 0.05), and worse in the PS K-wire group. Finally, our data\nconfirmed the prognostic correlation between the two radiographic classifications used and the clinical outcomes....
In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the\nlocation and extent of defect and requires proper surgical procedure. Metal augmentation\nis readily available for both femoral and tibial bone defects. We report the\noperative technique of modular metal augmentation using a downsized block for\nambiguous proximal tibial and distal femoral bone defects in primary and revision\nTKA. Regarding bone defects, bone loss can be minimized by using a different size of\nmetal augmentation, and suitable reinforcement for bone defects can be achieved.\nOnce our technique is properly used, it will be very helpful in treating bone defects....
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