Surgical treatment of acromioclavicular dislocation with LARS artificial ligament.

The choice of the most appropriate procedure for surgical treatment of type IV-V and VI dislocations of the acromioclavicular joint according to Rockwood's classification has always been troublesome because of complications such as residual instability of the joint, delayed arthrosis of the A-C, delayed osteolysis of the clavicle, host intolerance towards artificial ligaments and because of the need of early mobilization of the affected limb. In our study, 17 male patients, ranging in age from 21 to 79 years and affected by A-C dislocation grade IV and V, both acute and chronic, underwent surgical reconstruction of the A-C joint capsule and extra-articular ligaments with ligament augmentation and reconstruction system (LARS) artificial ligament. Following surgery, their affected limb was braced for 3 days and thereafter all patients began an early active and passive mobilization programme. Patients eventually all returned to their previous working and recreational activities. Throughout thorough clinical and radiographic evaluation and the use of both Constant score and Simple Shoulder test, the aim of our study is to prove that at mid-term follow-up, the reconstruction of the conoid and trapezoid ligaments with LARS is a valid and safe alternative to other procedures.

Elastofibroma dorsi: case series of a rare benign tumour of the back.

We analyse this rare pseudotumour with few case reports in the orthopaedic literature. Elastofibroma dorsi is an uncommon benign soft tissue pseudotumour usually located at the lower pole of the scapula. This study is a clinical assessment of 5 patients. All the patients had their diagnosis based on clinical and MRI findings and had excision biopsy. The patients were followed for a mean period of 24 months. No patient had residual symptoms. We have only one recurrence. Surgical excision is recommended when it causes functional disability, compression symptoms, an asymmetric outline of the chest wall, or when it is more than 5 cm in diameter. Pre-operative tissue diagnosis is not necessary in most cases. Despite its rarity, the elastofibroma dorsi should always be suspected with the emergence of a swelling in the subscapularis, especially in females and in old age.

The biphasic bioresorbable scaffold (Trufit(®)) in the osteochondral knee lesions: long-term clinical and MRI assessment in 30 patients.

BACKGROUND: Chondral or osteochondral defects have been reported in 60-67 % of patients in studies reporting knee arthroscopies. The surgical management of chondral and osteochondral defects (OCD's) of the articular surface of the knee joint remains a controversial topic. Osteochondral injuries can be treated with transfer cartilage procedure and with implantation of biodegradable scaffolds. For patients over 50 years old with largest osteochondral lesions, we prefer to use the biodegradable scaffold, like Trufit(®) plug (Smith & Nephew, Andover, MA). The purpose of this study is to evaluate the outcome of this series of surgical procedure with Trufit. METHODS: In our institute, the Trufit was used for the treatment of one or more focal osteochondral lesions of the femoral condyles positive MRI with or without concomitant ligamentous or meniscal pathology. We reviewed 30 patients with mean age of 60.57 years (range 32-79 years) with a clinical and imaging control at 6, 12, 24 and 48 months of follow-up. RESULTS: The clinical evaluation has shown the good outcome. The MRI conducted has shown the progressive partial integration of the scaffolds. CONCLUSIONS: The results obtained indicate a clear improvement of the clinical symptoms and slowing joint degeneration. The clinical and imaging results confirm that the Trufit constitutes a valid surgical alternative in case of focal osteochondral.