Unestable knee osteochondritis dissecans: arthroscopic fixation with bio-absorbable device. / Osteocondritis disecante inestable de rodilla: fijación artroscópica con implante bioabsorbible.

INTRODUCTION: Knee ostheochondritis dissecans is an osteochondral disease, whose treatment is still debated. The purpose this study was to analyze the patients attached with bioabsorbable nail, assisted by arthroscopy. MATERIAL AND METHOD: Analysis was performed using median and interquartile range (P25-P75), with a follow-up of 9 patients (10 knees) operated for stage III osteochondral lesions. After a minimum of 12 months, the KOOS, IKDC, satisfaction questionnaires were evaluated and a MR control was perfomed. RESULTS: Bone healing was observed in 80% of patients in the first year, with a delay in union in 20%. The median for age was 15 years. The average follow-up was 5.93 years. All cases were located in the internal condyle. The OCD lesions did not show comminution or necrosis. The 40% of stable lesions, according to preoperative MR, were unestable in arthroscopy and it were attached with internal nail. Two groups of osteochondral lesions were differentiated: juvenile OCD (60%) and adult OCD (40%); all of them were stage III lesions. IKDC questionnaire results were an improvement of 29.5 (22.25, 37.52). In the KOOS questionnaire, an improvement was obtained in symptoms of 18.07, in pain of 29.12, in daily living 25.53, in function (sports, recreational activities) of 35 and in quality of life of 34.42. CONCLUSIONS: The bioabsorbable nail is a valid, reproducible option for unestable lesions with lesion integrity, with great improvement in function, quality of life and with few complications.

Long-Term Results of ACL Reconstruction Using a Nonanatomic Double-Bundle Technique with Extra-Articular Reinforcement.

Extra-articular procedures for the improvement in rotational stability after anterior cruciate ligament (ACL) reconstruction have gained popularity in the last decade. This surgical gesture hoped to improve resistance to the high tensional forces affecting the ACL graft during cutting and pivoting movements of the lower extremity and eventually prevent ACL reconstruction failure. We performed this study to analyze the long-term results of patients undergoing ACL reconstruction using a nonanatomic double-bundle technique with an additional extra-articular augmentation. All the cases that underwent an ACL reconstruction using a nonanatomic double-bundle technique with an extra-articular reinforcement during the period between 1992 and 1997 were reviewed. The inclusion criteria for this study included a minimum follow-up of 10 years and age between 14 and 45 years at the time of the surgery. Forty patients were included in this series (34 males and 6 females). The mean Lysholm score after a minimum follow-up period of 10 years was 92.3 (standard deviation [SD], 9.4). The average preoperative Tegner score of the participants was 7.0 (SD, 1.1). This score decreased to 5.7 (SD, 1.2) at the end of follow-up. Follow-up X-rays were reviewed to assess the degenerative changes in the three knee compartments. Degenerative changes ≥ Kellgren-Lawrence grade 2 were observed in our six (15%) patients, all of them in the medial knee compartment. With these results, we conclude that double-bundle nonanatomic ACL reconstruction combined with an extra-articular reinforcement resembling the anterolateral ligament offers good overall long-term results, with relatively low rates of osteoarthritis.

Fresh-frozen bone: case series of a new grafting material for sinus lift and immediate implants.

STATEMENT OF THE PROBLEM: Although autologous bone is considered to be the gold standard grafting material, it needs to be harvested from patients, a process that can be off-putting and can lead to donor site morbidity. For this reason, homologous fresh-frozen bone (FFB) was used in the current study as an alternative graft material. PURPOSE OF THE STUDY: The aim of this study was to evaluate the effectiveness of FFB as a grafting material in complex maxillary sinus lift with immediate implant insertion. METHODS: FFB was obtained from the Veneto Tissue Bank and preserved at -80 degrees C. Twenty-one patients were surgically treated with FFB block grafts in 26 maxillary sinus rehabilitations, with 47 immediate implant insertions, with a reopening phase after six months. All patients underwent orthopanoramic X-rays and CT scans before, immediately after and four months (X-ray only) post surgery. Bone biopsies were performed in order to evaluate the volume and density of the bone grafts, which all showed optimal adherence without complications. RESULTS: Four months post surgery, 64% of grafts showed no evidence of bone resorption or resizing. In all other cases resorption was slight. All implants were clinically osseointegrated, with only one implant failure during the provisional prosthetic loading stage (97.8% success rate). Histological studies confirmed these results, showing the presence of new bone and sparse osteoclastic activity four months post implantation, with 80% mature bone material observed after 12 months. CONCLUSIONS: Use of FFB permits effective bone-adding surgery and immediate implant insertion under local anaesthesia, decreasing both chair time and patient discomfort.

Evaluating children's reports of sexual abuse: results from a survey of professionals.

Two hundred and twelve professionals were surveyed on their assessment and validation procedures in cases of children's sexual abuse allegations. Specific questions garnered information about practices in interviewing children and accused adults, assessment protocols, criteria used to substantiate the allegations, and factors that might distort children's responses.