All-Inside Arthroscopic Repair For Longitudinal Meniscal Tears: Clinical and Functional Results.

Meniscal injuries are a common challenge in orthopaedic surgery. Depending on their location and the patient's age and functional needs, they can be treated either conservatively or surgically. A surgical approach can consist of arthroscopic meniscectomy or meniscal suture. The latter is the treatment of choice in case of lesions involving the red-red or red-white areas of the meniscus, especially for young high-demanding patients. We report here our experience with the repair of longitudinal meniscal tears using the all-inside technique with the Fast-Fix™ 360 Meniscal Repair System (Smith & Nephew Endoscopy, Andover, MA). We retrospectively evaluated 20 consecutive cases of longitudinal meniscal tears. In 4 cases, concomitant ACL rupture was diagnosed and treated alongside the meniscal repair. All patients underwent periodic clinical evaluations. At the latest check-up, their functional outcomes were rated according to the Tegner-Lysholm Knee and KOOS scoring scales. The mean Tegner-Lysholm Knee score was 84.85 (44-100) and the mean KOOS score was 88.58. No failure or major complications were observed. Furthermore, a negative statistical association was observed between age at surgery and the post-operative Tegner-Lysholm Knee score (coef. = -1.01189 [-1.942073,-0.0817063], p = 0.035). This relation, independent of gender, meniscus involved, eventual associated ACL reconstruction, and chondral injury, suggests that functional outcomes worsen with increasing patient age. Our results suggest that the arthroscopic all-inside suture is both safe and effective in cases of longitudinal meniscal tear, considering the good post-operative functionality and low rates of local complications and surgical failures.

Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up.

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7-67.30, and the HSS from 56-89). The rate of implants' survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.

Water quality and solute sources in the Marsyangdi River system of Higher Himalayan range (West-Central Nepal).

Surface waters, cold and hot springs were collected in different catchments along the Marsyangdi basin, in the Himalayan Range of West-Central Nepal, during the post-monsoon season in 2017 and analyzed for major ions and trace elements, with the aim of assessing the sources of dissolved species and to contribute in watershed planning. The major element data indicate that surface waters coming from the Tethyan Himalayan Sequence (THS) range from the Ca-Mg-HCO3 to the Ca-Mg-HCO3-SO4 water-types and reflect a two-component mixing of waters from carbonate- and sulfate-bearing sources. The latter component is attributable to sulfide oxidation with minor silicate weathering. In the Greater Himalaya Sequence (GHS), alteration of pedogenetic carbonates formed in response to silicate weathering under a variable CO2 gas pressure dominates, yielding a Ca-HCO3 signature. The stability diagram in the K2O-Al2O3-SiO2-H2O system and the paired increases in Ca2+, Na+, K+ and silica indicate that degradation of silicate minerals through kaolinization and possibly plagioclase albitization reactions is the main process for hot groundwater. Cold and hot springs define a trend of increasing Li, SiO2 and Cl-, suggesting that lithium was leached from silica-rich sources, such as pegmatite dykes and sills occurring in host rocks, and concentrated into halite-bearing salt aquifers. In hot waters Sb, As and Tl exceed the EU and USEPA thresholds. Tl is usually incorporated into pyrite and correlates with Li indicating the occurrence of an ore-bearing zone possibly related to hydrothermal activity at the transition zone between THS and GHS, as suggested by the relatively high Ba, Ni, Cu, Sb, As and Mn contents. The obtained data on water quality have significant implications for people living along the Upper Marsyangdi River in the management of water resources, especially in terms of the enhancement of cold water aquaculture and hot water uses for recreation purposes and tourism.

Reconstruction and rehabilitation of severe mandibular atrophy using distraction osteogenesis technique: a case report.

PURPOSE: The purpose of this article is to describe a rehabilitation technique for patients with severe anterior atrophy using a combination of distraction osteogenesis and implants to support fixed or removable prostheses. MATERIALS AND METHODS: The surgical technique involves the use of an extraosseous distraction device followed by more than 14 mm of distraction of the mandibular symphysis. RESULTS: The patient was successfully treated by the application of 4 implants in the region of the mandibular symphysis, stabilized by an Ackerman bar, and a removable prosthesis. CONCLUSION: Osseous distraction techniques, when possible, are preferable to block bone grafting techniques because they present considerable advantages for patients and surgeons. The combination of distraction and implant placement can rehabilitate patients with severe defects.