Anterior Medial Meniscal Root Tears: A Novel Arthroscopic All Inside Repair.

BACKGROUND: Management of tears of the anterior and posterior roots of the meniscus is still controversial. We wish to propose a simple technique of suture anchor to repair tears of the anterior root of the medial meniscus. METHODS: Twelve patients, active males, underwent arthroscopic repair of the anterior meniscal horn between 2009 and 2011. All were assessed postoperatively at an average follow-up of 1 year after the index operation. RESULTS: At the last appointment, the average Lysholm scores was improved from a pre-operative average value of 48±17 to a postoperative value of 91±7 (P<0.001); five patients (45.3%) were scored as excellent (≥95), and 7 (54.6%) as good (85-94). At the last appointment, 8 of 9 active patients practiced sport at the same preoperative level, 1 (8.5%) had changed to lower level of activity. No technique related complications were evident.

Stress radiography for osteoarthritis of the knee: a new technique.

Stress radiographs have been used for several years to detect the amount of varus/valgus knee laxity and to evaluate the degree of compartmental involvement in degenerative osteoarthritis. However, the popularity of these radiographic methods has been affected by their technical limits due to the x-ray exposure for the personnel involved and the variability of the stress forces applied. A device was developed with the aim to create a constant varus or valgus stress force to the knee with the patient in a supine position. The device does not require personal assistance during the actual film taking. Sixty consecutive patients where included in the study and measured prior to their total knee replacement. All patients had standard weight-bearing AP and lateral views as well as stress views in varus and valgus. Both knees were examined in full extension and 30° of flexion. The joint space width in both the lateral and medial compartments were measured and subsequently compared with the standard weight-bearing films. A significant decrease in joint space distance in the affected compartment was found in the stress radiographs compared with the standard weight-bearing views. The medial compartment was best examined with the knee extended and varus stress force (P < 0.001) and for the lateral compartment 30° of flexion proved to be more efficient (P < 0.01). In conclusion, this stress radiographic device offers a possibility to enhance the varus/valgus force in a standardized way compared to standard weight-bearing views of the knee. The reliability and reproducibility is high. It is suitable for clinical practice and a valuable tool in research.

A simple modified arthroscopic procedure for fixation of displaced tibial eminence fractures.

SUMMARY: Avulsion fractures of the tibial eminence have been well described in children and adults with an increased in incidence resulting from road traffic and athletic accidents. According to the literature, only surgical treatment is advocated because of the high incidence of the nonunion and instability following conservative treatment. Open reduction can cause some morbidity and, therefore, arthroscopic techniques have been developed. The limitations of the techniques are related to technical difficulty and unstable fixation. We report a simple and effective method of fixation with the following advantages: (1) use of metallic suture for stable fixation, (2) the fixation device is easily removed in the office, (3) there is no need of additional instruments, and (4) the minimal size of the fixation device avoids damage to the anterior cruciate ligament insertion. This technique has been used in a series of 10 consecutive patients treated for avulsion fractures of the tibial spine since 1991, resulting in a high rate of excellent and good results without any case of nonunion fracture or related complication.

Prospects and advantages in the use of cartilage cell cultures for in vivo transplants.

The authors present a critical analysis of the literature in order to evaluate the current prospects and advantages of cartilage cell cultures for in vivo transplants. The analysis is relative to their use or to the treatment of isolated osteochondral lesions of the knee, and it is preceded by an analysis of the methods used in the treatment of this pathology, such as: 1) debridement, 2) abrasion of the subchondral bone, 3) perforations and decortication of the subchondral bone, 4) perichondral transplants. The most significant results obtained for cartilage cell transplants for the repair of focal osteochondral defects in experiments conducted on animals and in successive clinical trials in man, also revealing the complex problems that may lead to a variability in chondrocytary activity, going from an in vitro to an in vivo environment, are presented.

[Algodystrophic syndrome of the temporo-mandibular joint: a clinical experience]. / La sindrome algo-disfunzionale dell'articolazione temporomandibolare. Nostra esperienza clinica.

Algo-dysfunctional syndrome (ADS) of the temporo-mandibular joint (TMJ) is frequently encountered and, since its clinical expression is extremely polymorphic, it is often misdiagnosed. As there are many causes for ADS, even in a single patient, in line with the most recent interpretations found in the literature, an attempt was made to determine how important the lack of muscular coordination is in the onset of clinical symptoms. The study was conducted on 48 patients (32 females, 16 males, age range 17-68 years, average age 41.7 years) with ADS, clinically diagnosed according to the criteria defined by Rendell et al. The patients belonged to three distinct groups: -Group 1: patients with ADS of articular origin (9 cases); -Group 2: patients with ADS of dental and/or periodontal origin (18 cases); -Group 3: patients with ADS for which there was no apparent cause (21 cases). All patients were treated with a rehabilitation protocol aimed at eliminating the muscle spasm and restoring correct coordination. The results obtained showed that conservative treatment to resolve the muscle spasm gave positive results in 69% of the cases. The patients with concomitant articular pathology proved the least responsive to treatment. It was, therefore, considered likely that the main cause for clinical expression of this pathology is the muscle spasm itself. On this basis it can be concluded that muscular rehabilitation of the TMJ is valid in the treatment of ADS as it has proved able to break the vicious cycle of symptoms at the base of this pathology.

Our experience in the treatment of rheumatoid knee by arthroscopic synovectomy.

The authors present the results obtained in the treatment of rheumatoid knee by arthroscopic synovectomy. A total of 29 knees operated on in 25 patients after a mean follow-up of 38 months based on the Laurin evaluation scale were re-examined. There was significant improvement for pain, synovitis, and overall function (mean values pre- and postoperative 2.07 vs 0.98; 2.14 vs 0.84, 2.37 vs 1.26, respectively); there were no, substantial variations in joint movement (2.47 vs 2.58). By dividing the patients into the 4 Larsen radiographic classes, the worst results were observed in patients in classes 3 and 4. In this series of patients complications of significance were not observed. Thus, we consider arthroscopic synovectomy to be the treatment of choice for rheumatoid knee because of the intrinsic advantages of minimum disease rate, rapid functional recovery, with expectations of results inversely proportional to the stage of progression of the disease.

Our experience in the arthroscopic treatment of fracture-avulsion of the tibial spine.

The authors present their experience in the arthroscopic treatment of fracture-avulsion of the intercondyloid eminence in the adult with a variation in the original method. In fact, an ACUFEX tibial guide is used for reconstruction of the ACL positioning 2 Kirschner wires with hole at the margins of the fragment, successively sliding the metal wire through the hole. Successive traction on the outside of the wires allows the metal wires to be arranged dome-like to stabilize the avulsed fragment. The distal ends of the wires are stabilized with a metal pull-out in the area corresponding to the anteromedial surface of the tibia. In the 10 patients treated by this method, evaluated after a minimum follow-up of 6 months, we obtained overall satisfactory clinical and functional results. There was significant residual ligamentous laxity in 2 patients with no clinical symptoms of instability. Variations in arthroscopic technique described in the literature are analyzed.

A new cervical orthosis with multiplanar adjustment.

It is the purpose of this paper to introduce a new cervical orthosis with multiplanar adjustment. Many orthoses are available to the physician today, but all of them may be classified based on function into two groups: 1) orthoses that immobilize the neck in a fixed position; 2) orthoses that immobilize the patient in a position that may be set in the sagittal plane. At present no orthosis are available to immobilize the neck in a position to anything but the sagittal plane. This new orthosis, with four tridimensional swinging posters, allows for immobilization of the neck in the desired position, according to the clinical evaluation performed. This treatment offers advantages in terms of patient compliance and functional results. An alternative model, with increased stability, has especially been planned for the treatment of pathology at C1-C2.

The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination.

We reviewed 38 patients with arthroscopically-proven complete ACL tears operated on less than three weeks after injury. Their average age was 26 years (16 to 43), with 27 males and 11 females. All patients had had MRI preoperatively. The same examiner performed the Lachman, anterior-drawer, and pivot-shift tests without anaesthesia, recording the differences between the injured and the normal knees. The patients then had KT-1000 arthrometry by the same examiner at 15 lb (6.8 kg) and 20 lb (9 kg), with active displacement, and with maximum manual displacement. All scored positive for differences greater than 3 mm. The results of physical examination, KT-1000 tests and MRI were analysed using McNemar's test for matched data with continuity correction and a 95% confidence interval for each test. The sensitivity of the KT-1000 manual maximum test was 97% for 3 mm and 100% for 2 mm; this was the most useful arthrometric result. The Lachman test gave 95% sensitivity, providing the best simple clinical assessment. MRI was 97% sensitive for the detection of all ACL injuries, but this fell to 82% with respect to complete rupture. We found no significant differences between the results of the Lachman test and the KT-1000 manual maximum test, but these were significantly better than all other tests. In an era of cost-containment, we have shown that inexpensive tests in the clinic can allow treatment to proceed rapidly and in the most economical manner without the routine use of MRI.

Biomechanics of two types of bone-tendon-bone graft for ACL reconstruction.

We measured the initial fixation strength of a new graft, bone-hamstring-bone (BHB), for reconstruction of the anterior cruciate ligament (ACL) in 79 porcine knees and compared it with that of the normal porcine ACL and of the bone-patellar tendon-bone (BPB) graft. All specimens were subjected to ultimate load to failure and cyclic loading tests to assess the amount of graft slippage. The ultimate load to failure for the intact ACL was 1266 +/- 250 N, for the BPB graft 663 +/- 192 N and for the BHB graft 354 +/- 92 N (p < 0.01). After cycling to 235 N (the maximum load for all groups without failure) the average residual displacements after removal of the load for the ACL, BPB and BHB grafts were 0.031 +/- 0.013 cm, 0.078 +/- 0.033 cm, and 0.322 +/- 0.222 cm, respectively (p < 0.01). For the BHB graft the load to failure was less and the amount of graft slippage was more than for the BPB graft. Neither form of reconstruction was as strong as the intact ACL.

Partial lateral meniscectomy in athletes.

Arthroscopic partial lateral meniscectomies performed for isolated meniscal tears, without associated ligamentous injury, in 41 athletes between August 1, 1988 and June 1, 1991 were reviewed for clinical and functional outcome. The study population was composed of 27 males and 14 females, with an average age of 26 years (range 17-40). Thirty-seven patients (90%) reported previous trauma to the knee. At an average follow-up of 3 years (range 2-5), 85% of the patients had excellent/good results, and 98% of the athletes returned to full sports activities after an average of 55 days. Patients' prognoses depended on (a) type of meniscal tear and (b) presence/absence of an articular cartilaginous lesion. Athletes who had isolated, longitudinal type tears of the lateral meniscus had the best outcome: 100% achieved excellent/good results and averaged 41 days to return to full sports activities. Athletes with complex meniscal tears and tears associated with articular cartilaginous lesions had the poorest results, achieving 79% and 64% excellent/good results, respectively, and averaging 64 and 78 days, respectively, for return to full sports activities.

Meniscal ossicles: two case reports and a review of the literature.

Intrameniscal ossicles of the knee are rare lesions. We present two cases. The first case occurred in a male soccer player who had knee trauma, with radiographic findings of a meniscal ossicle. Meniscal motions were normal, and symptoms resolved with conservative measures. The second case was found in a male athlete with acute medial compartment instability and complex meniscal tears. His medial meniscus, containing the ossicle, was removed. Initial conservative management is recommended for all cases of meniscal ossicle, and arthroscopic resection of the ossicle is recommended for symptomatic cases.

Anterior cruciate ligament tear. A new diagnostic index on magnetic resonance imaging.

An objective index of anterior cruciate ligament (ACL) tears based on posterior cruciate ligament (PCL) shape has been introduced. The PCL shapes on magnetic resonance imaging (MRI) were measured in 67 patients (31 normal ACL, 31 torn ACL, and five partial ACL tears, all confirmed by arthroscopy). All of the measurements were performed in a blinded manner, without previous knowledge of the MRI or arthroscopy diagnosis. The index consisted of the ratio B/A, with B equaling the length of the line between the posterior inferior tibial and the superior anterior femoral attachment of the PCL, and A equaling the maximum perpendicular distance from this line to the PCL. All measurements were performed twice, and the mean was used for statistical significance. The average index ratio was 5.4 and 3.9 for normal ACL and torn ACL, respectively. Using a cutoff value of 4.75, the sensitivity of the index was 87% and the specificity was 84%. An objective and reproducible index measurement of PCL shape for normal and injured ACL has been established. It provides additional information for both orthopaedic surgeons and radiologists in the diagnosis of ACL injury.

Arthroscopic treatment of anterolateral ankle impingement.

Fifty-five ankle arthroscopies performed for anterolateral ankle impingement between January 1987 and April 1992 were reviewed for functional outcome and patient satisfaction. There were 33 men and 22 women with an average age of 34 years (range 20-67). All patients reported a previous history of ankle injury, and 60% of the patients had at least one ankle sprain. At an average follow up of 2.6 years (range 1.0-4.5), 87% of the patients had good/excellent results, 98% were satisfied, and 84% returned to their previous sports.

Ganglion cysts of the anterior cruciate ligament: a case report and review of the literature.

Ganglion cysts on the anterior cruciate ligament (ACL) should be suspected in any patient having pain and clicking sensation during terminal knee extension. Previous investigators have reported incidental findings of ganglion cysts on the ACL. However, we report a symptomatic case of a ganglion cyst on the ACL that was treated successfully with arthroscopic debridement.

[Evaluation of atopy risk factors during the first year of life. Multicentric study]. / Valutazione dei fattori di rischio di atopia nel 1 degree anno di vita. Ricerca policentrica.

The AA studied 406 newborn babies during the 1st year of life in order to verify the correlation between atopy risk factors and the appearance of early symptoms, particularly gastroenteric (GE). The results obtained did not demonstrate a significant difference concerning the blood cord IgE level and subsequent appearance of food allergy symptoms, whereas positive familiarity showed a better correlation. No significant difference was observed between breast--or formula--fed infants, or between those weaned before or after the 5th month of life. The comparison of dietary regimen adopted during the 1st quarter in the asymptomatic and atopic children respectively, demonstrated that the presence of predisposing factors influences the appearance of GE symptoms much more than the diet in itself. An allergologic study, randomly performed by Prick-test in 156 cases and by RAST in 200 cases, showed a prevalent, positive response with RAST technique in symptomatic children.

Serum zinc concentration in exclusively breast-fed infants and in infants fed an adapted formula.

Serum zinc concentrations have been determined in 28 healthy full-term Italian infants of both sexes at birth, as well as at 3 and at 5 months of age. Fourteen exclusively breast-fed infants who served as a control group were compared with 14 infants fed a cow's milk based adapted infant formula. No significant differences in serum zinc concentration between the breast-fed and the bottle-fed group became apparent during the study. The results of this study suggest a similar zinc nutriture in both groups. The availability of zinc from the adapted infant formula was not significantly different from that of human milk. These findings may be explained by the composition of the adapted formula tested, e.g. by a protein composition fairly close to that of human milk, by the presence of zinc derived from the natural ingredients only, by the low Fe/Zn ratio and by the elevated citrate content.

[Possibility of prenatal diagnosis of progressive muscular dystrophy: evaluation of creatine kinase activity in serum and the capping of lymphocytes]. / Possibilita' di diagnosi prenatale di distrofia muscolare progressive: valutazione dell'attivita' creatina-chinasica del siero e del "capping" dei linfociti.

Duchenne muscular dystrophy is a severe inherited disease. The pathogenesis is unknown. Duchenne dystrophy is characterized by a large number of membrane abnormalities, which are manifested by a leakage of muscle enzymes, such as creatine kinase (CK), and a reduction in cap formation in lymphocytes. In the present study serum CK and percentage lymphocyte capping in 8 patients with progressive muscular dystrophy, 6 with different myopathies and normal controls are investigated. Reduced antibody-induced redistribution of membrane antigens of B and T lymphocytes and high serum CK activity is found in boys with Duchenne dystrophy if compared with normal subjects and no correlation exists between the two parameters. Our data indicate that the determination of fetal serum CK activity associated with fetal lymphocyte capping may have diagnostic value in antenatal detection of Duchenne dystrophy.

Suprarenal abscess in a newborn.

A case report of a new born with unilateral suprarenal abscess extending in to the right kidney is represented. Both the adrenal gland and the kidney had to be surgically removed. Early diagnosis is important, so the surgical intervention, the only successful therapy, can be kept as conservative as possible.

A radiopharmaceutical in the diagnosis of congenital biliary atresia.

Diethyl-HIDA, a new hepatobiliary radiopharmaceutical labeled with 99mTc, was used in the preoperative diagnosis of biliary atresia and in the postoperative evaluation of hepatic-porto-enterostomy function. The good results obtained in the four first cases suggest extensive use of the method, with the aim of a more precocious and more attendable diagnosis.