Satisfactory clinical outcomes with autologous matrix-induced chondrogenesis in the treatment of grade IV chondral injuries of the knee.

OBJECTIVE: The research aims to evaluate short- and medium-term outcomes of patients treated using autologous matrix-induced chondrogenesis (AMIC) with a hyaluronic acid scaffold (Hyalofast, Anika Therapeutics, MA, USA) in grade IV chondral lesions according to the Outerbridge classification in the knee. METHODS: This is a multicentre, non-randomized, retrospective study conducted between 2017 and 2022. To determine the clinical outcome of the patients, the follow-up was done with the subjective International Knee Documentation Committee (IKDC) score, pre-surgery, and with a follow-up at 12, 24, and 32 months. RESULTS: Fifty patients (28 female) with a mean age of 45.9 ± 12.7 years were recruited. The mean size of the lesion was 3.5 cm2, and the injuries located in the patella (30%) and trochlear groove (24%) were the most frequent. The total IKDC clinical score significantly increased from baseline to the 32 months of follow-up with a mean difference of 36.4 (95% CI, 29.1-43.7, p < 0.001). Besides, there was a statistically significant improvement in all categories of the IKDC (symptoms, sports activities, function, and activity of daily living) compared between pre-surgery and 24 and 32 months of follow-up. The patients younger than 45 years presented better clinical outcomes than older ones with a difference between medians of 10.40 (95% CI, 1.10-11.50, p = 0.0247), and a negative correlation was found between the 32-month IKDC score and the age. In addition, no statistically significant difference was found when comparing the last results of the IKDC between patients with and without associated surgical procedures or between patients with single and several lesions, neither nor between men and women. The level of satisfaction with the procedure of all the patients, on a score of 1-10, was on average 8 ± 1.5. CONCLUSION: Results of this study indicate that patients who underwent the AMIC procedure with hyaluronic acid scaffold for the treatment of grade IV chondral lesions in the knee presented satisfactory results throughout the follow-up. LEVEL OF EVIDENCE: Level IV.

Avulsión de la tuberosidad posterior del calcáneo en pico de pato. Reporte de un caso / Avulsion of the posterior calcaneal tuberosity (Beak fracture): A Case report

Las fracturas del calcáneo representan el 2-3,1% de las fracturas en general y las avulsiones del tendón de Aquiles son las menos frecuentes de este grupo. Fueron descritas por Bohler como "fracturas en pico de pato". Los casos publicados son muy escasos, Sang-Myung y cols. publicaron la revisión más grande con 764 casos de fracturas de calcáneo, 20 de ellos con avulsión de la tuberosidad del calcáneo. Los mecanismos de acción más frecuentes son tropiezo, caída o golpe directo. Se presenta a un paciente de 48 años que concurre al Servicio de Urgencias de un hospital de segundo nivel, tras caerse de un árbol y quedar suspendido sobre la pierna derecha. Ingresó para estudio con evidencia radiográfica de fractura por avulsión del calcáneo y fue sometido a una osteosíntesis, con una excelente evolución clínica. Consideramos importante comunicar este caso, dada la escasa frecuencia de este tipo de fracturas. Nivel de Evidencia: IV

Calcaneal fractures account for 2-3.1% of all fractures; among these the least common are avulsions of the Achilles tendon, described by Dr Bohler as "Beak fractures". Descriptions in the literature are very scarce, the largest report being that of Sang-Myung et al in 2012, where a summary of 764 cases of calcaneal fractures contained 20 avulsion fractures. The most common mechanisms of trauma are tripping, falling, or a direct knock. This report presents the clinical case of a 48 year-old patient, who attended the Emergency Service of a second-level hospital after falling from a tree which resulted in being suspended by the lower right limb. Radiographs revealed signs of a calcaneal avulsion fracture, which was surgically managed via osteosynthesis with excellent clinical outcomes in follow-up. Given the infrequency of this type of fracture, we considered it important to present this article. Level of Evidence; IV