Posterior cruciate ligament reconstruction with "all-inside" technique: a technical note.

INTRODUCTION: posterior cruciate ligament (PCL) injuries are an increasingly recognized cause of knee instability in the practice of orthopaedic surgery and sports medicine. Clinical interest in these injuries has been increasing over the last several decades as knowledge and understanding of the biomechanical consequences and surgical reconstruction options have progressed. These injuries can be extremely challenging for the treating physician as substantial controversy exists regarding the optimal management of this problem. There has also been increasing interest and recognition of the importance of secondary stabilizing structures, including the posterolateral and posteromedial corner injuries as well as the issues with malalignment that must also be addressed at the time of PCL surgery to optimize results. Thanks to the continuous research for a correct anatomical placement and new systems of fixation, we can now perform the tibial and femoral bone tunnel more easily and safely by retrograde out-in approach with a special "drill-pin". CONCLUSION: this technique provides a graduated precise execution of the tunnels. New methods were also developed to determine the so-called "second-generation cortical suspensory fixations" that have the feature of being "Adjustable": shortens implant by pulling on strands to allow cinching graft passing and tensioning button to regulate their length after fixation and then to create tension in the new graft, once introduced into the joint.

Ibandronate and periprosthetic bone mass: new therapeutic approach in periprosthetic loosening prevention.

A prosthetic implant modifies the physiological transmission of loads to the bone, initiating a remodeling process.Studies of the mechanisms responsible for periprosthetic bone loss contributed to the definition of new pharmacological strategies that may prevent aseptic implant loosening. Bisphosphonates are a class of drugs useful to this purpose, and have been shown to be effective in reducing periprosthetic resorption during the first year after the implant. We aimed to assess the inhibitory effect on periprosthetic osteolysis of ibandronate, a highly potent aminobisphosphonate, administered orally and IV with an extended interval between doses and optimal treatment adherence. In view of the fact that periprosthetic remodeling takes place during the first 6-12 months after surgery and is ultimately responsible for prosthesis longevity, we may conclude that the administration of high dosage ibandronate postsurgery by IV bolus and subsequently as cyclic oral treatment reduced cortical osteopenia in the metaphyseal region, and in the calcar region of the proximal femur. This therapy might therefore be used as preventive measure against postsurgical osteopenia and probably also against aseptic loosening.