Posterior cruciate ligament reconstruction in skeletally immature athletes.

Posterior cruciate ligament rupture is a rare knee ligamentous injury in skeletally immature patients with unfused growth plates. Despite being very uncommon, it still represents a significant challenge in terms of decision-making and treatment choice. The purpose of this case series was to report subject and objective outcomes (IKDC, TAS,LYSHOLM,KT2000) after PCL reconstruction in two teenage elite football players aged 15 and 16 respectively, who underwent surgical repair in July 2017 using for the femoral and tibial fixation of the PCL graft (hamstring tendons) respectively a curve cross-pin system and interferential screw. At fifteen months follow up, both athletes had returned to normal, pre-injury, competing levels with no leg discrepancy.

Modular dual mobility cups with multihole metal back in total hip arthroplasty revision: a systematic review.

Dislocation after hip revision is a frequent complication; amongst the strategies to prevent dislocation dual mobility (DM) implants are gaining popularity. We want to evaluate the reliability of non cemented DM cups with multihole metal back and chrome-cobalt liner called Modular Dual Mobility (MDM). We performed a systematic review and selected 5 studies with a total of 285 hips who underwent revision surgery with MDM implants. The mean survivorship rate of the 5 studies was 92.46% (range 90-96%). 267 prosthesis (93.6%) were still implanted at the last follow-up; the mean weighted follow up was 38.7% (range 24-48). We found 13 mechanical complications in 285 hips (4.5%). Five of them were treated conservatively; the other 8 were treated with re-revision. Nine of these complications were dislocation and recurrent instability; 2 of them were associated to metallosis and adverse local tissue reaction. There was 1 patient that had episodes of subluxation; 2 cases of impingement and 1 case of metallosis. Zero intraprosthetic dislocations (IPD) occurred in 285 hips. A 93.6% survivorship is a good result for MDM implants, considering that most of patients had important bone loss and went through multiple revisions. The rate of dislocation is very low compared to the mean rate of dislocation in revision hip surgery. In our review, fretting is a rare complication but it can lead to ALTR and metallosis. For this reason, MDM implants have to be used in selected cases at high risk of dislocation. In conclusion MDM is a great option for decreasing dislocation rate in hip revision, but a longer follow-up and a greater number of cases is needed to assess its reliability.

Angiosarcoma around total hip arthroplasty: case series and review of the literature.

BACKGROUND: Angiosarcoma (AS) is a rare and malignant tumor which mainly arises in the skin and superficial soft tissue and less frequently in deep soft tissue and bones. Some cases of AS are described in association with vascular and orthopedic devices. Nonetheless, only a few cases of AS around THA are reported in the literature. MATERIALS AND METHODS: We describe five cases of AS arising around total hip arthroplasty who received surgery at our institution (Istituto Ortopedico Rizzoli, Bologna, Italy), and we report the cases described in literature. RESULTS: Foreign bodies such as polyethylene were demonstrated to have a carcinogenic role in animals, but reports of similar cases in humans are rare. Nevertheless, osteolysis induced by wear particles of polyethylene is a frequent event and could induce to desist form considering other more rare causes of osteolysis such as AS. This could be the reason why the diagnosis in several cases was significantly delayed. Common features of these cases could be helpful for doing a prompt diagnosis. The initial presentation is suggestive for septic or aseptic loosening with a massive osteolysis around the cup and/or the stem associated with peculiar aspects as bleeding and loss of weight. Frequently, needle biopsy is negative because foreign-body reaction might have "covered" the most relevant condition of epithelioid AS. CONCLUSIONS: In conclusion in a patient who presents with uncontrollable bleeding, loss of weight and massive osteolysis, AS must be actually considered as possible diagnosis.

Minimally-invasive treatment of calcaneal fractures: A review of the literature and our experience.

The optimal treatment of calcaneal fractures (CF) is currently controversial and is still under debate. It is well established that conservative treatment of these fractures is associated with poor results. Several surgical techniques are described in the literature; however, there is no consensus on which of these is more effective. The main goals of surgery are to restore the subtalar joint congruence, and calcaneal width, height, shape and alignment, thus avoiding medial and lateral impingement and enabling the patient to resume a normal lifestyle. ORIF is the most popular technique for these fractures, but it is associated with high rates of wound complications, hardware failure and infections. Several minimally-invasive techniques have been developed recently for the treatment of CF, with the common aim to be as simple, effective and inexpensive as possible and to reduce surgical times, complications and length of hospital stay.