Current surgical options for articular cartilage repair.

The articular cartilage lesions represent one of the major unsolved problems in the orthopaedic surgery. This is because articular cartilage has a limited capacity of self-repair following trauma. The aim of this study is to review the different surgical options for articular cartilage repair. They can be divided into three groups: techniques without transplant of cells or tissues; techniques based on the transplantation of tissues; the tissue engineering techniques.The first group includes the joint debridement and the techniques based on the bone marrow-stimulation principle.The second group includes the transplantation of periosteum and the transplantation of autologous or allogeneic osteochondral plugs. The tissue engineering techniques could be further divided as follows: methods based on the transplantation of cells either in solution, or in the form of microspheres, or carried on a biocompatible scaffold; the transplant of cartilage fragments; the cell-free techniques, based on the use of an acellular scaffold, able to entrap the reparative cells recruited from the host tissue and to guide their differentiation toward a chondral phenotype.In this work we present various options for the treatment of chondral or osteochondral lesions. Today, however, due to the lack of comparative studies, it is not always possible to define the best treatment choice for the different cartilage pathologies.

The use of bioabsorbable polymers in reconstruction of the anterior cruciate ligament. A preliminary experiment conducted on bioabsorbable interference screws: bovine model vs. ovine model.

The use of interference screws in the reconstruction of the anterior cruciate ligament has increased over the years. Despite doubtless advantages there are some problems, too, some involving method of fixation, others the metallic nature of the screws. With the purpose of overcoming the latter, the authors evaluated the possibility of using interference screws made of bioabsorbable material. This preliminary study was conducted on two animal models (bovine and ovine); as a comparison parameter the torsional pair of screw insertion was used. A substantial similarity in the results thus obtained was observed that, together with the minor difficulties observed in the surgical field, contributes to the indication of the ovine model as preferential, based also on successive tests of functional validation conducted in vivo.

Spontaneous recurrent hemarthrosis of the knee with lesion of the lateral meniscus and arthrosis of the lateral compartment.

One of the possible atraumatic causes of recurring hemarthrosis of the knee is constituted by the association of a lesion of the lateral meniscus with severe gonarthrosis of the lateral compartment. In the case described we were able to determine the cause of frequent bleeding (12 times in 15 months) in a traction caused by the injured meniscal tissue on the terminal branches of the geniculated arteries in the area of the popliteal hiatus. Thus, this clinical manifestation cannot be attributed to a synovial pathology. Total arthroscopic meniscectomy solved the problem.

Out-patient arthroscopy.

The results and complications of knee arthroscopy performed using local (982) and truncular anesthesia (523) at the out-patient arthroscopy clinic of the Rizzoli Orthopaedic Institute between 1982 and 1994 were analyzed. Furthermore, the literature on technique and surgical indications for the use of out-patient arthroscopy with a 3 in 1 block was reviewed.

Meniscus repair: cases and review of the literature.

The authors present 39 patients submitted to meniscus repair, and then analyze the various techniques used for suturing, emphasizing advantages, disadvantages, and complications. The results obtained with arthrotomic repair are not significantly different from those obtained with arthroscopic repair, except for the fact that the former method is less invasive. The stability of the knee is of essential importance to healing of a meniscal lesion. A long-term evaluation of the results obtained with meniscus repair is needed, as repetitive tearing has been described even after as many as three years.

Lateral discoid meniscus: treatment and results.

Forty-six patients (47 knees) who had symptomatic discoid lateral menisci were operated on between August 1981 and May 1989. The patients were categorized according to Watanabe's classifications: complete (80.8%), incomplete (10.6%), and Wrisberg type (8.5%). The treatment of the discoid meniscus is based on total or partial meniscectomy, achieved by the percutaneous or arthrometric technique. Of the 47 knees, 30 underwent a follow-up evaluation. Using Ikeuchi's knee scale, 27 cases (90%) had either excellent or good ratings, and 3 (10%) received fair ratings. There were no poor outcomes. The results in the knees treated by partial meniscectomy were better than those in the knees treated with total meniscectomy.

Arthroscopic lateral meniscectomy in adults with stable knees. A medium term evaluation of the results and a comparison with similar lesions of the medial meniscus.

The results obtained in 37 cases of arthroscopic meniscectomy in isolated lesions of the lateral meniscus in adult patients are analysed. Isolated lesions were chosen as it is our belief that the results may be considerably influenced by the presence of ligamentous lesions. After an average follow-up of 33 months the results were: excellent, 32; good, 2; fair, 2; poor, 1. The lowest percentage of improvement was observed in subtotal meniscectomies. The presence of changes in the joint cartilage is not always responsible for mediocre results.

[Expression of the interleukin-2 receptor in T lymphocytes of the rheumatoid synovial membrane]. / Espressione del recettore per l'interleuchina-2 nei T-linfociti della membrana sinoviale reumatoide.

Indirect immunofluorescence was used to stain DR antigen and interleukin-2 receptor (Tac) of T-lymphocytes (Leu 4+). Tissue samples of synovial membrane were cut from arthroscopic biopsies of inflamed knees in four patients with active rheumatoid arthritis (RA). Consecutive cryostatic sections of rheumatoid sinovium were analysed using monoclonal antibodies. It was found that a high percentage of T-lymphocytes express DR antigen. In contrast the proportion of T cells expressing Tac was small. We conclude that T cell activation in synovial membrane is incomplete, and this disfunction may contribute to the chronic inflammation of RA.

Arthroscopic surgical technique in the treatment of lesions of the discoid meniscus.

The authors analyse the results which emerged from a long-term follow-up of 15 patients affected with lesions of the discoid meniscus treated arthroscopically, by expressing both a subjective and an objective evaluation and emphasizing several details concerning the surgical method used.

Arthroscopic medial meniscectomy. Technique, results, complications and medium-term follow-up in adult patients with no ligamentous lesion.

The authors report the medium-term results of arthroscopic medial meniscectomy performed on 102 adult patients. Some notes on the surgical technique and the objective and subjective results obtained in each type of meniscal lesion are also reported.

Fractures of the intercondylar eminence of the tibia in children.

The authors review 31 cases of fracture of the intercondylar tibial eminence in children and adolescents. In view of the constant relationship observed between the initial clinical and radiological findings and the final results, they advise that a clinical examination in narcosis be done in all cases in order to ascertain the existence or otherwise of ligamentous laxity, which is the determining factor in the end result. After emphasizing the differences as compared with these fractures in adults, the principal surgical techniques are reviewed, including the role of arthroscopy.

Meniscectomy in children. Evaluation of results after growth has ceased.

The results of 28 total meniscectomies in children were reviewed after the end of the growth period. From a purely clinical point of view these were satisfactory in 26 cases and in the remaining 2 cases the poor results were due to faulty initial diagnosis. From the radiographic survey, 50% of cases showed early signs of degenerative arthritis in the femorotibial joint, but there was no evidence of the patellar syndrome. In meniscal lesions in children, the surgical approach should therefore be as conservative as possible.

Posterolateral lumbosacral arthrodesis (P.L.A.). A study of 85 cases.

Posterolateral lumbar and lumbosacral arthrodesis has been used during the last 50 years as a method of posterior arthrodesis in patients who have undergone previous laminectomies or after previous unsuccessful attempts at posterior fusion. The higher percentages of successful fusion has extended the use of this technique to other conditions such as spondylolisthesis and lumbar pain due to segmental instability. The present study is a clinical and radiographic evaluation of the results obtained in a series of 84 patients affected by lumbar or lumbosciatic pain arising from different causes - spondylolisthesis, degenerative lumbar disc disease or failed operations for lumbar disc prolapse. The follow-up was 2-6 years.

Mesenchymal chondrosarcoma of the soft tissues.

The authors report a case of mesenchymal chondrosarcoma of the soft tissues. They review the characteristics of this neoplasm, with particular reference to the differential diagnosis with chondrosarcoma, Ewing's sarcoma, haemangiopericytoma and reticulosarcoma.