Soaking of autografts with vancomycin is highly effective on preventing postoperative septic arthritis in patients undergoing ACL reconstruction with hamstrings autografts.

PURPOSE: To evaluate the impact of local soaking of the autografts with vancomycin during anterior cruciate ligament (ACL) reconstruction on postoperative infection rates. METHODS: Between 2003 and 2014 (first study period), 1,242 patients underwent ACL reconstruction using autografts, without soaking them in vancomycin solution, while between 2014 and 2019 (second study period) all ACL autografts in 593 patients were soaked in a 5-mg/ml vancomycin solution, in a territory University Hospital. The same standard treatment of perioperative IV antibiotics was applied in both groups. RESULTS: Postoperative septic arthritis occurred in seven out of 1,242 patients (0.56%) during the first study period. Bone patellar tendon bone autograft was used in 311 (25%) patients, and hamstring tendon autograft was used in the rest 931 (75%) of the study population during this period. All infected cases were male and had a hamstrings graft implanted. There were no postoperative infections (0%) in 593 ACL reconstructions during the second study period. Bone patellar tendon bone autograft was used in 178 (30%) patients while hamstring tendon autograft was used in the rest 415 (70%) of the study population, during this period. Statistical analysis revealed a significantly reduced postoperative infection rate (p = 0.018) between the two reported periods, with the main impact referring to the use of hamstrings autograft (p = 0.031) for the first study period. CONCLUSIONS: Septic arthritis following ACL reconstruction can be significantly reduced (or even eliminated) by soaking ACL autografts in a 5 mg/ml vancomycin solution. Of note, this strategy seems to be more effective in the setting of hamstring tendon autograft use, since the risk of postoperative knee infection is significantly higher when this type of graft is used.

Biomechanical evaluation of three patellar fixation techniques for MPFL reconstruction: Load to failure did not differ but interference screw stabilization was stiffer than suture anchor and suture-knot fixation.

PURPOSE: The purpose of this study was to compare the maximum load to failure and stiffness of three medial patella-femoral ligament (MPFL) reconstruction techniques: (i) suture anchor fixation (SA), (ii) interference screw fixation (SF), and (iii) suture knot (SK) patellar fixation. The null hypothesis was that the comparison between these three different patella fixation techniques would show no difference in the ultimate failure load and stiffness. METHODS: Reconstruction of the MPFL with gracilis tendon autograft was performed in 12 pairs of fresh-frozen cadaveric knees (24 knees total; mean age, 63.6 [Formula: see text] 8.0 years). The specimens were randomly distributed into 3 groups of 8 specimens; SA reconstruction was completed with two 3.0-mm metal suture anchors; (SF) fixation was accomplished by two 6-mm bio-composite interference screws; SK fixation at the lateral side of the patella was accomplished after drilling two semi-patellar tunnels with a diameter of 4.5 mm. The reconstructions were subjected to cyclic loading for 10 cycles to 30 N and tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). The final load of failure (N), stiffness (N / mm) and failure mode was recorded in each specimen and followed by statistical analysis. RESULTS: There was no significant difference in mean ultimate failure load among the three groups. The SK group failed at a mean ([Formula: see text] SD) ultimate load of 253.5 [Formula: see text] 38.2 N, the SA group failed at 243 [Formula: see text] 41.9 N and the SF group at 263.2 [Formula: see text] 9.06 N. The SF group had a mean stiffness of 37.8 [Formula: see text] 5.7 N/mm. This was significantly higher (p < 0.05) than the mean stiffness value achieved for the SK group 21.4 [Formula: see text] 9.5 N/mm and the SA group 18.7 [Formula: see text] 3.4 N/mm. The most common mode of failure in the SA group was anchor pullout, and in the SK group was failure at the graft-suture interface. All the reconstructions in the SF group failed due to tendon graft slippage from the tunnel. CONCLUSION: Load to failure was not significantly different between the 3 techniques. However, screw fixation was found to be significantly stronger than the anchor and the suture knot fixation in terms of rigidity of the reconstruction. From a clinical point of view, all methods of fixation can be used reliably for MPFL reconstruction, since they were found to be stronger than the native MPFL.

Anatomy and terminology of groin pain: Current concepts.

Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.

Anterior and Posterior Cruciate Ligaments Mechanoreceptors: A Review of Basic Science.

Proprioception is a specialized sensory modality encompassing the movement of the joint and its position in space, and it involves the conversion of mechanical deformation of tissues into neural signals. Mechanoreceptors are specialized nerve structures able to transmit mechanical deformation through electrical signals to dorsal root ganglion sensory neurons and are abundant in the muscles, tendons and ligaments of the knee joint. They are believed to play an important role in knee proprioception and dynamic knee stability. Proprioception should always be taken into consideration for successful reconstruction of the cruciate-deficient knee and for pain and function management in the arthritic knee. Advances in histological methods of detection are numerous and continue to highlight the presence and role of mechanoreceptors after ligament reconstruction, depending on choice of graft. In this review, we present the current knowledge of anterior and posterior cruciate ligaments and grafts mechanoreceptors, and their role in proprioception of knee joint, focusing on each type of mechanoreceptors.

Reconstruction of the medial patellofemoral ligament using two blind transverse semi-patella tunnels and an implant-free technique for patellar fixation: a technical note.

BACKGROUND: The double-bundle technique with two points of patellar fixation in the upper half of the patella replicating the broad attachment site of the native medial patellofemoral ligament (MPFL) is the most commonly performed procedure for MPFL reconstruction. Complete transverse patella tunnels pose a threat to the integrity of the patella. We present an implant-free, double-bundle technique for MPFL reconstruction with gracilis autograft, overcoming the problem of complete patella bone tunnels and over-drilling. METHODS: After standard gracilis graft harvesting, the anteromedial side of the patella is exposed. With the guidance of an anterior-cruciate-ligament (ACL) tibia-aiming device, two 2-mm parallel guide pins are inserted from medial to lateral at the upper half of the patella. The two guide pins are over-drilled with a cannulated 4.5-mm drill bit 2-cm deep, to create two transverse blind semi-patellar tunnels. For the femoral fixation, a 2.4-mm guide pin with an eyelet is drilled at the Schöttle point and over-reamed with a 6-mm cannulated reamer to a depth of 30 mm. The two free ends of the graft (with two running Krakow sutures placed) are pulled into the two patella tunnels and the graft sutures are tied together with tension for stable graft fixation at the lateral patella rim. With the help of a femoral suture loop (which is inserted in the femoral bone tunnel), the graft-loop is advanced into the femoral bone tunnel and the graft is finally fixed with a 7-mm interference screw at 30° of knee flexion. RESULTS: The utilization of blind transverse tunnels (not trans-patellar tunnels) offers the advantage of avoiding stress risers at the patella. Thanks to the ACL tibia aiming device, multiple drilling, and breaching of the anterior patellar cortex or articular surface of the patella is avoided. CONCLUSIONS: This implant-free, and consequently affordable technique, isolated or combined with bony procedures, minimizes possibilities for perioperative bony complications at the patella fixation site.

A Review of the Outcomes of the Implementation of Case-Based Anatomy Learning.

PURPOSE: Clinically-oriented anatomy education has been proposed as an effective strategy in anatomy curricula. We aimed to explore the level of extent the literature supports the fact that case-based learning (CBL) can play a significant role in anatomy education. MATERIALS AND METHODS: We searched PubMed, Scopus, Education Resources Information Center (ERIC), and Cochrane database to find articles with the purpose to explore the educational outcomes of case-based anatomy learning. We extracted from each paper authors, type of study (comparative or not), number of participants, level of outcome according to the Kirkpatrick hierarchy, outcomes of CBL concerning the acquisition of anatomical knowledge, and the participants' perceived enjoyment, motivation, and aid to anatomy learning. RESULTS: Nine articles were included. Three of them evaluated the acquisition of anatomical knowledge, while six papers evaluated the participants' perceptions. All studies showed positive outcomes regarding the students' anatomy examination performances, reported confidence, enjoyment, motivation, and ability of CBL to facilitate anatomy learning. CONCLUSION: Although the existing research has mainly evaluated students' perceptions, the outcomes of CBL in anatomy education encourage more extensive use of this method in anatomy curricula. Further research is expected to shed more light on the role that CBL can play in modern anatomy education and to clarify if it can replace or supplement didactic teaching.

Surgical Implications of the Arterial Anatomy around the Knee: A Cadaveric Pictorial Essay.

We completed an anatomic cadaver study in order to examine the arterial supply around the knee and to create useful images regarding the arterial surgical anatomy around the knee. A total of four unmatched fresh-frozen cadaveric knees were utilized. There was no medical history of osteoporosis, bony or soft-tissue injury or surgery in any of the knees. The femoral arteries were cannulated with a large catheter at the proximal aspect of the cadavers, and liquid latex in different colours was injected. Τhe specimens were then placed into a bath of 8.0% sodium hypochlorite to complete debridement of the soft tissues to various degrees. The specimens were checked every 15 to 30 min until adequate debridement occurred, and photographs were taken during each stage of this process. Sodium hypochlorite, among others, chemically debrides the vessel walls leaving the casts of the vessel lumens filled with solid coloured latex in order to illustrate the vascular supply pattern to the structures of interest. Knowing the probability of where these arteries should be located adds to the knowledge that surgeons have at their disposal when performing procedures involving arthroscopy, arthroplasty and osteotomies, which can help decrease unnecessary damage to the arteries.

Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits.

AIM: This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted. MATERIAL AND METHODS: 50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia. Four weeks later, 1 ml of inoculum of a standardised CA-MRSA strain (3 × 108 cfu/ml) was injected through a femoral artery catheter (groups B, C, D, E) while in group A, 1 ml of sterile saline was injected in a similar way (control group). Subjects were killed 8 weeks after the initial procedure and 3 samples of each tibial specimen were subjected to conventional cultures and PCR studies. RESULTS: The number of the specimens (conventional cultures and PCR studies) contaminated by the standardized pathogen was as follows: Group A: 0/10, Group B: 7/10, Group C: 6/10, Group D; 5/10 and Group E: 5/10. Comparing the number of colony form units isolated from the implant samples, Group B (GB titanium) showed statistically significantly higher values (Mann-Whitney test) compared to Group C (p = 0.044), Group D (p = 0.040) and Group E (p = 0.038). Local active infection was observed in 6 animals: 3 in Group B; 1 in Group C, 1 in Group D, and 1 in Group E. CONCLUSIONS: Modern cementless implants (trabecular metal and cancellous titanium) showed a lower risk of implant contamination and late clinical haematogenous infection.

Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study.

The purpose of this study was to compare the measurement of several anatomical features of the medial patellofemoral ligament (MPFL) between magnetic resonance imaging (MRI) and by direct fashion during dissection. We hypothesized that the measurements between these two techniques would agree. MRI of 30 fresh-frozen cadaveric knees was followed by dissection. MPFL patella and femoral attachment were evaluated; their shape, length, and width were measured; and measurements were compared. MRI was deemed unreliable for the determination of several of the aforementioned anatomical features. Important findings include: (a) observations on MPFL attachment at medial patella side and attachment to quadriceps were identical between dissection and MRI; (b) average width at patella insertion was significantly different between the two methods (p = 0.002); and (c) an attachment to the quadriceps tendon was present in 20/30 specimens and d. detailed measurements of a thin, non-linear, and three-dimensional structure, such as the MPFL, cannot be performed on MRI, due to technical difficulties. This anatomical radiological study highlights the shape, anatomical measurements (length and width), and attachment of the MPFL using a relatively large cadaveric sample and suggests that MRI is not reliable for detailed imaging of its three-dimensional anatomy.

Results of Arthroscopic Bankart Repair in Recreational Athletes and Laborers: A Retrospective Study With 5 to 14 Years of Follow-up.

BACKGROUND: Arthroscopic Bankart repair is the most common procedure for anterior shoulder instability management. However, the long-term efficacy of the procedure is questionable, and the results are different among different populations. Few studies have focused on specific populations, such as recreational athletes and laborers. HYPOTHESIS: Good to excellent long-term results, with a low recurrence rate, can be achieved using arthroscopic Bankart repair in recreational athletes and laborers suffering from anterior shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A specific group of laborers and recreational athletes were included in this study. A total of 52 patients (52 shoulders) with anterior-inferior traumatic shoulder instability underwent arthroscopic Bankart repair and met our strict criteria for study inclusion. The recurrence rate was recorded. Patients were evaluated at a minimum follow-up of 5 years using the American Shoulder and Elbow Surgeons (ASES) score, the Rowe score, the Constant score, and a visual analog scale (VAS) for pain. A radiological evaluation for arthritis was also performed according to the Samilson-Prieto classification. RESULTS: The mean follow-up was 105.4 months (range, 65-164 months). Our overall recurrence rate was 11.5% (6/52 patients). All patients were able to return to their previous job status with minimum limitations, and 76.7% of our study population reported returning to their preinjury sporting activities. Postoperatively, all scores were improved, with statistically significant increases from preoperative values (P < .001). At the last radiographic follow-up, 9 patients (18.8%) had mild arthritis, while 2 patients (4.2%) had moderate arthritis. CONCLUSION: Arthroscopic soft tissue Bankart repair may provide good to excellent long-term clinical results with an acceptable recurrence rate in medium-demand patients (recreational athletes and laborers).