Infection after Anterior Cruciate Ligament Reconstruction: A Narrative Review of the Literature.

Infection is an uncommon side effect of arthroscopic surgery, and this percentage is higher in anterior cruciate ligament reconstruction (ACLR) surgery, where graft and fixation devices are used. Infections can not only lead to high re-admission rates and poor functional recovery of the knee but can also have a significant negative impact on the patient's psychological and economic health, especially in athletes, as it can affect their sports career. It is important to be aware of the many risk factors, especially the manifestation of symptoms. These may sometimes be non-specific to the infectious pathology and common to other situations, such as the presence of a significant intra-articular hematoma. Septic arthritis after ACLR can occur at any time after surgery but typically presents acutely, while late manifestation is relatively rare. Diagnosis of infection is based on patient history, physical examination, laboratory parameters, and analysis of synovial fluid after joint aspiration, which is the gold standard for diagnosing post-operative infection. Once symptoms appear and the diagnosis seems certain, it is necessary to intervene quickly with arthroscopic debridement and long-term antibiotic treatment to try to save the graft and resolve the infectious situation to avoid graft failure and arthrofibrotic sequelae. The aim of this paper is to provide an overview of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic evaluation, and current treatment guidelines of septic arthritis after ACLR surgery by analyzing recent literature, in particular meta-analyses and systematic reviews.

Surgical strategies in pediatric supracondylar humeral fractures: our experience.

BACKGROUND AND AIM: Supracondylar humeral fractures are the most common skeletal injury of childhood elbow. Treatment option for Gartland type II-III-IV fractures is based on closed reduction and percutaneous pinning (CRPP) fixation using Kirshner wires. Seldom open reduction is needed. Literature described different method of CRPP. The aim of the study is to report our experience in the surgical management of supracondylar humeral fractures comparing it with the literature, in order to identify useful information for a correct and better approach to reduce complications and improve clinical outcomes. METHODS: 148 patients with a mean age of 5.72 ± 2.52 years and with Gartland type II-III-IV humeral supracondylar fractures were treated with CRPP at our Orthopedic Pediatric Unit. They were divided into three groups according to surgical technique. Group A was represented by patients treated with cross pinning (1 medial and 1 lateral pin), Group B represented by 2 lateral pins while Group C represented by 2 lateral and one medial pin. Evaluation criteria are based on Mayo Elbow Performance Index (MEPI); Bauman's and Carrying Angle and Flynn's criteria. Data were recorded at the following times: T0 (before surgical procedure); T1 (one-month post-surgery); T2 (six months post-surgery). RESULTS: The three surgical techniques showed comparable results according to MEPI, Bauman's angle, Carrying's angle and Flynn's criteria from T0 to T1. There is an improvement for all Groups. Group C reported the best MEPI outcome at T2. However, 2 patients in this group did not show excellent results according to Flynn's criteria. CONCLUSIONS: There is no single and superior treatment for displaced humeral supracondylar fractures and that each fracture has its own personality.

Graft Intra-Articular Remodeling and Bone Incorporation in ACL Reconstruction: The State of the Art and Clinical Implications.

The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteristics similar to the native ligament. After the first incorporation stage, the remodelling process is divided into an early stage that could last 4 weeks, a proliferative stage that lasts 4 to 12 weeks, and a final stage of ligamentization that could last over 1 year. The period of return to sport (RTS) after ACLR, which is becoming shorter and shorter, can be a high-risk period for athletes due to the risk of graft failure. This systematic review aims to define the phases of the ligamentization process considering graft type and fixation techniques, as well as the graft's anatomopathological and biomechanical characteristics, to evaluate a criterion-based rehab progression and maximize patient outcomes for an RTS respecting graft biology. The rehabilitative program has to promote and optimize the graft remodelling and incorporation processes; moreover, it has to accommodate physiological graft healing and avoid overloading. An early RTS and noncompliance with the biological characteristics of the graft in the various phases are associated with a high incidence of re-injury.

Quality of Life and Clinical Evaluation of Calcaneoplasty with a Balloon System for Calcaneal Fracture at 5 Years of Follow-Up.

Calcaneal fractures are a challenging clinical problem. Management of this type of injury remains controversial, especially in the context of intra-articular fractures. Surgical treatment with open reduction and internal synthesis (ORIF) is considered the standard treatment for CF, but it is associated with many complications. Several minimally invasive techniques such as balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation have been proposed to avoid the frequent and recurrent postoperative problems related to these fractures. We retrospectively examined 20 patients (mean age was 54.5), all undergoing minimally invasive calcaneoplasty surgery at our Department of Orthopaedics and Traumatology between 2012 and 2016. X-ray and CT scan were performed preoperatively and at 5 years of follow-up (57.9 ± 6 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for clinical examination, and the Short-Form (36) Health Survey (SF-36) score and Visual Analogue Scale (VAS) were used to assess the Health-Related Quality of Life (HRQoL). All 20 patients were available at the final follow-up. The mean AOFAS score was 82.25/100. The VAS results attest an overall average of 2.7/10 (0-9). The average of the parameters "Physical Health" and "Mental Health" was, respectively, 81.25 and 83.55. In terms of postoperative complications, we observed no cases of superficial or deep infections. Clinical response after balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation has shown a comparable or better outcome according to the AOFAS and VAS score. Quality-of-life scores, obtained according to the SF-36 questionnaire, are considered high. From both a clinical and quality-of-life point of view, our study highlights that there is not gender distinction. Further comparative studies with a higher number of patients are needed which assess the quality of life in the various techniques used to treat calcaneal fractures.