Repair of an anteroinferior glenoid defect by the latarjet procedure: quantitative assessment of the repair by computed tomography.

PURPOSE: The purpose of this study was to determine quantitatively whether the Latarjet procedure (coracoid transfer to the glenoid) is sufficient to restore a significant defect area of the glenoid. METHODS: Fourteen cadaveric shoulders were used (mean age, 76 years; range, 72 to 87 years). An anteroinferior glenoid defect was created and then the coracoid osteotomized to its angle and transferred to the defect. A 3-dimensional computed tomography scan was used to calculate the surface area of (1) the intact glenoid, (2) the osteotomized glenoid, and (3) the reconstructed glenoid. RESULTS: The mean area of the intact inferior glenoid was 734 +/- 89 mm(2). After creation of the defect, the surface area of the glenoid was reduced significantly to 523 +/- 55 mm(2) (P = .011). The mean defect area was 28.7% +/- 6% of the intact glenoid. After coracoid transfer, the mean surface area of the reconstructed glenoid was 708 +/- 71 mm(2) but it was not significantly smaller than that of the intact glenoid (P = .274). The mean surface area of the coracoid that was used to repair the defect was 198 +/- 34 mm(2), or 27% +/- 5% of the intact glenoid. CONCLUSIONS: In our cadaveric model, a mean 29% defect size of the inferior glenoid was restored to normal after coracoid transfer by use of the Latarjet procedure. CLINICAL RELEVANCE: In the clinical scenario, the existence of a glenoid bone defect of more than 25% to 30% is very rare in patients with anterior shoulder instability. Therefore, when clinically indicated, large bony defects of the anterior glenoid can be adequately treated by the Latarjet procedure.

Ankle and foot osteomyelitis: treatment protocol and clinical results.

INTRODUCTION: A management protocol for ankle and foot osteomyelitis and the outcome in 84 patients treated in a unit with special interest in musculoskeletal infection, is presented. PATIENTS AND METHODS: Patients' mean age was 50.7+/-16.5 years and mean follow-up 31.5+/-18.2 months. Systemic antibiotics were administered initially empirically, and later according to cultures. Surgical treatment included surgical debridement and bead-pouch technique, minor amputation (ray or toe), below knee amputation, and joint fusion. "Second-look" procedures were performed after 48-7h. Vascularised grafts or Ilizarov's technique were used for bone defect reconstruction. Soft tissues were managed according the 'reconstructive ladder' concept. RESULTS: Host-type (Cierny's classification) was A in 25, B in 53 and C in 6 patients. Seventy-six infections were chronic. Causes were: open trauma without fracture (45/84), open fractures (9/84), ORIF of closed fractures (25/84) and elective surgery (5/84). Patients underwent 3.0+/-1.5 (range 1-10) operative procedures and spent 14.8+/-12.2 (range 3-60) days in hospital. Two (host-C) patients died. Complications requiring reoperations occurred in 20/84 (2/25 host-A, 16/53 host-B, 2/6 host-C; significant difference between host-A versus host-B and -C patients, p<0.001). Infection recurrence occurred in 12 (none host-A; significant difference between host-A versus host-B and -C patients, p<0.001). Multiple organisms were isolated in 39/84. Ankle arthrodesis using external fixation was performed in 9 (fusion rate 8/9). The free vascularised fibula graft was used in 2 and distraction osteogenesis in 8 patients with a mean bone defect of 5.4 cm (range 3-13). Below knee amputations were performed in 5/84 (3/53 host-B, 2/6 host-C) and foot ray amputations in 8/84 (6/53 host-B, 2/6 host-C). Soft tissue coverage required: free muscle flap transfer in 6/84, reverse soleus flap in 1/84, local fasciocutaneous flaps in 7/84, split thickness skin grafts in 5/84, and vacuum assisted closure in 5/84 patients. Eighty-two surviving patients, including amputees, were able to mobilise independently and were satisfied with the result of treatment. CONCLUSIONS: Host-B and -C patients had more complications and infection recurrences and occasionally required amputations. Reconstructive procedures were performed for limb salvage in patients with soft tissue and bone defects and restoration of a functional limb was achieved.

Patellar tendon length after anterior cruciate ligament reconstruction: a comparative magnetic resonance imaging study between patellar and hamstring tendon autografts.

Patellar tendon shortening after anterior cruciate ligament reconstruction may be associated with anterior knee pain or patellofemoral arthritis. The present study was designed to compare postoperative changes in patellar tendon length after anterior cruciate ligament reconstruction between patellar tendon and hamstring tendon autograft. Magnetic resonance images of both knees (operated and healthy) and functional outcome were documented at least 1 year postoperatively in 16 patellar tendon harvested patients and in 32 hamstrings harvested patients. Patellar tendon length, patella length and Insall-Salvati ratio were measured. The operated knee values were compared to the respective values of the non-operated control knees. A significant 4.2 mm or 9.7% patellar tendon shortening in patellar tendon group and a non-significant 1.14 mm or 2.6% shortening in hamstrings group was detected. No significant difference was detected in terms of major shortening-patella baja-(6% for the patellar tendon group vs. 0% for the hamstring group). There was no significant difference in anterior knee problems between the two groups as evidenced by the Shelbourne score (94 for the patellar tendon group vs. 98 for the hamstring group). Harvesting of the patellar tendon for anterior cruciate ligament reconstruction resulted in a significant shortening of the remaining tendon. In contrast harvesting of the hamstring tendons did not affect significantly the patellar tendon length. However, the incidence of patella baja and overall functional outcome was not significantly different between the two groups.