Anterior Cruciate Ligament Reconstruction with Quadrupled Semitendinosus Graft or Synthetic Ligament: Knee Stability and Clinical Outcomes at Three Years Follow-Up.

The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and graft choice is important for a rapid return to activity, especially in patients older than 30 years. The aim of this study is to compare in term of quality of life and knee stability of patients who undergone ACLR using quadrupled semitendinosus (ST4) graft against patients who undergone ACLR with synthetic ligaments. Thirty-nine patients undergoing ACLR were enrolled in the study and were divided into two groups: ACLR with synthetic ligaments-LARS (group A) and ACLR with quadrupled semitendinosus graft ST4 (group B). They underwent surgery at Policlinico di Bari Orthopedic Unit between January 2017 and January 2020. Group A was composed by nineteen patients (36.16 ± 4.41 mean age-years, 22.47 ± 2.63 mean BMI-kg/m2, 39.37 ± 10.05 mean time evaluation after surgery-months) and group B was composed by twenty patients (34.95 ± 3.59 mean age-years, 21.1 ± 2.88 mean BMI-kg/m2, 36.75 ± 8.69 mean time evaluation after surgery-months). For each patient, the following data were recorded: age; side of injury, BMI, date of surgery, anterior knee laxity with the arthrometer, and Lysholm knee scoring scale. Mean value of anterior tibial translation (ATT) in group A was 3.09 mm ± 0.65 and in group B was 2.66 mm ± 1.61 (pvalue of 0.1139). Mann--Whitney U test used to compare the Lysholm means values between groups showed a pvalue of 0.9307. LARS has comparable clinical and functional outcomes compared with hamstring autografts at short-term of 3 years follow-up. Level of Evidence: IV.

A Newly Identified Complication of Patellofemoral Arthroplasty: Case Report and Literature Review.

Background: Patellofemoral arthroplasty (PFA) is a surgical option for patients older than 40 years old who are affected by patellofemoral osteoarthritis. Regarding the complications of PFAs, few studies have investigated periprosthetic fractures. The purpose of this literature review was to highlight a previously overlooked complication of primary prosthetic surgery of the patellofemoral joint. Methods: Three literature databases were searched for studies published between 2000 to 2020 using relevant keywords. A total of 4,942 articles were originally identified. After excluding duplicates and analysing the titles and abstracts, 20 studies were considered. From these, data regarding the number of cases, clinical outcomes and complications were extracted. Results: Among the 20 selected articles, only one described periprosthetic fractures as a complication of PFAs. Herein, we also report an illustrative case of an unknown fracture complication. No cases in the literature were found that described the type of complications experienced by our patient during the postoperative period. Conclusions: This review confirms the lack of data about clinical outcomes and fracture complications of PFAs. In primary prosthetic surgery of the patellofemoral joint, patient selection and close consideration of demographic factors (such as BMI and age) and intraoperative factors (such as patellar thickness and size of the trochlear component) play a key role in optimising pre-operative planning to avoid intraoperative periprosthetic fractures.

The effects of a new protocol on blood loss in total knee arthroplasty.

The aim of study was to evaluate the efficacy of blood loss prevention with Tranexamic acid in patients undergoing total knee arthroplasty (TKA). The Authors defined a new protocol that foresees the use of Tranexamic acid both pre-intra and post-operatively. Seventy patients indicated for TKA were enrolled. Thirty-five patients (control group) followed standard protocol without Tranexamic acid and the other 35 patients (study group) followed standard protocol with Tranexamic acid. We analyzed the values of hemoglobin (Hb), hematocrit (HCT) and red blood cells (RBCs) both pre-operatively (T0) and post-operatively: immediately after surgery (T1), at one day (T2) and three days post-op (T3). We observed statistical differences at T0 and T3 regarding the Hb, HT and RBCs value between the two groups. Moreover, 11.4% in the study and 28.5% in the control group required blood transfusion. No thrombotic or thrombo-embolic events were reported. We conclude that Tranexamic acid use, as in our protocol, reduces postoperative bleeding in primary knee arthroplasty, with the absence of thrombo-embolic events.

The autoclaving and re-implantation of an infected prosthesis as a spacer during resection knee arthroplasty: a systematic review.

BACKGROUND: Hofmann et al., in 1995, first described an articulating spacer made by cleaning and autoclaving the original femoral component, which is then re-implanted with a new tibial polyethylene. This systematic review aims to assess the state of existing evidence on the intraoperative autoclaving and re-use of an infected prosthesis, as a spacer, during a two-stage revision following Periprosthetic Joint Infections (PJI). METHODS: A systematic review was conducted with methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Web of Science, Google Scholar and PubMed were searched from 1995 to April 2020 to identify relevant studies. RESULTS: Fourteen studies were included in this systematic review: two prospective case series; six retrospective comparative studies and six retrospective case series. The reviewed studies included 567 patients (571 knees): 394 patients treated with autoclaved components and 173 with a spacer made of new components. The cumulative re-infection rate in patients treated with re-used autoclaved components was 13.7% (54 re-infections in 394 patients), whereas in control patients the re-infection rate was 13.3% (23 re-infections in 173 patients). The final Range of Movement in patients treated using the autoclaved components as a spacer, compared with patients receiving static spacers, was significantly higher in three out of four comparative studies. CONCLUSION: There is a moderate level of evidence that the intraoperative autoclaving and re-use of an infected prosthesis as a spacer, during a knee resection arthroplasty, is an effective procedure in the management of knee PJI.

Bilateral Extensor Mechanism Allograft Reconstruction for Chronic Spontaneous Rupture: A Case Report and Review of the Literature.

CASE: A 51-year-old woman, affected by end-stage renal disease, presented with 16-month-old ruptures of the right patellar tendon and the left quadriceps tendon. Since she had been nonambulatory for more than a year, the authors decided to perform a bilateral one-staged reconstruction with an Achilles tendon allograft on the right side and a full extensor mechanism allograft on the left side, achieving excellent clinical and functional results at 57 months' follow-up. CONCLUSIONS: Bilateral spontaneous rupture of the extensor mechanism of the knee is a rare but dramatic occurrence. Allograft can be considered as a treatment option in case of chronic lesion or delayed reconstruction, with satisfactory midterm outcomes.

Total knee arthroplasty in elderly osteoporotic patients.

Often in daily practice the choice of a prosthesis does not rise out of considerations about literature evidences, but it seems to be related to the personal experience and "surgical philosophy" of surgeon. The choice of prosthesis in total joint replacement is usually justified by biological and mechanical parameters that the surgeon considers before surgery. Osteoporosis is a disease characterized by a reduced bone mass and a degeneration of the bone tissue; it leads to bone fragility, so to a higher risk of fractures. Bone resistance, as all the changes in the microarchitecture of the bone tissue, is linked to bone density. Because of the bone density variation and/or the changes in the bone micro-architecture, as the bone strength decreases, the risk of fractures increases. It is important to understand all the factors taking part in both normal and abnormal bone remodelling. Osteoporosis does not imply a concrete bone loss, but a change of the bone micro-architecture itself. In these cases the choice of the patient and implant design are very important. In the period between March 1997-July 2002, we implanted 100 consecutive TKA (total knee arthroplasty) Genesis II in 97 subjects (79 female); mean age was 77.1 years old. All TKA were performed because of primary osteoarthritis of the knee. All patients had complete pain relief and excellent knee score. The surgical and medical complications were in accordance with the published literature. We must consider all existing medical conditions, the state of the knee and local needs of the elderly patient. Thus, within these limits, the total knee can improve the ability of patients to manage the activities of daily living and improve their quality of life.

Multilobulated popliteal cyst after a failed total knee arthroplasty.

Popliteal cyst is a rare finding after total knee arthroplasty (TKA), but when present, it might indicate a malfunction of the TKA related to generation of wear-particles, or loosening. We present a case of a multilobulated popliteal cyst developing in a patient 8 years after primary TKA. The cyst was associated with a mechanical prosthetic loosening. The primary complaint of the patient was pain in the posterior region of the knee. A two-stage procedure consisting of cyst excision at first, followed after 5 months by a revision TKA was performed. Intraoperatively, a darkish, multilobulated cyst with a well-defined thick wall filled with fluid containing polyethylene debris, communicating with the knee joint was found. After 3 years of follow-up, the patient was satisfied and walked without the support of a cane. The patient presented a satisfactory knee range of motion. Clinical, radiological and ultrasound investigations ruled out popliteal cyst recurrence. A dissecting popliteal cyst associated with a failed TKA should be excised because it contains polyethylene debris that constitutes an induced factor for prosthetic loosening. A two-stage procedure with quite a long time in-between, as presented in this paper, can be a useful alternative to manage such a problem, in particular in very old patients associated with other medical problems.