Reconstruction of the Extensor Apparatus Using a Hybrid Augment with Polyethylene Mesh and Fascia Lata Allograft: Report of a Case with Patellar Gigant Cell Tumor of the Bone.

Introduction: The extensor apparatus of the knee can be thought of a chain that transmits the muscular strength developed by the quadriceps muscles to the proximal tibia. This complex is essential to allow the extension of the tibia over the femur, being essential to provide knee mobility and stability. In case of lesions which irreparably damage the patella, such as a locally aggressive bone tumor, it is necessary to restore both the apparatus' anatomical continuity and its strength. Case Report: A 67-years-old Caucasian woman developed atraumatic swelling and soreness in her left knee. X-rays and MRI images evidenced an osteolytic degeneration of the patella. A diagnosis of Gigant cell tumor of bone was made with a needle biopsy. We performed an en bloc resection of the patella and replaced it with a composite augment made with a polypropylene mesh and a fascia lata allograft. No complication was observed. In her latest follow-up, our patient did not have any extension lag and quadriceps strength was completely restored. Conclusion: The combination of internal layers of polypropylene surgical mesh and a surface allogenic graft can provide good mechanical performances for patients who underwent patellectomy due to a locally aggressive tumor.

ACL Replacement with Synthetic vs. Biological Tendon Grafts: Long-Term Follow-Up Comparison Using Objective Evaluations.

BACKGROUND AND AIM OF THE STUDY: Anterior cruciate ligament (ACL) tears are among the most common articular injuries in sports and can be responsible for knee instability and reduced articular performance. Treatment can be either conservative or operative, and ligament reconstruction may be carried out using biological autologous grafts or synthetic materials. Several studies have sought to evaluate and compare functional results in treated patients. However, there is still very limited information available on long-term follow-up and clinical outcomes are generally evaluated only using subjective scores. In this study, we assessed long-term functional and biomechanical results in patients treated with biologic and synthetic ligaments using objective measures. MATERIALS AND METHODS: Patients were divided according to whether ACL reconstruction was biologic or synthetic. The Tegner activity scale was used before and after surgery. Post-operative subjective scores such as the IKDC Questionnaire and the Tegner-Lysholm score were also recorded. The Y Balance Test was used to assess global stability and mobility of the lower limb. Kinematic Rapid Assessment (KiRA) was used to evidence and estimate ligamentous laxity during the Pivot Shift and Lachman tests. RESULTS: Clinical subjective patient and operator-dependent scores as well as objective biomechanical findings were similar and comparable in patients treated with biologic and synthetic reconstructions after more than 10 years of use. CONCLUSIONS: Both synthetic and biological tendon grafts may represent good reconstructive approaches to treat torn ACLs, and remain effective even for a long period of time if implanted in suitable target patients.

The New Challenge in the Management of Proximal Femur Fractures during SARS Cov-2 outbreak.

The aim of this study is to evaluate how the spread of Sars-Cov-2 has changed the epidemiology of proximal femur fractures in two major trauma centers in Italy, understanding the workload and the best allocation of the resources for the orthopedics department in such an emergency situation. The rate of patients from January 2019 to April 2020 hospitalized with femoral neck fractures (group A) and trochanteric fractures (group B) were recorded. Demographic data, timing of surgical treatment and the length of stay were recorded. Data show that the number of proximal femur fractures has remained unchanged in the COVID and pre-COVID era (ranging from an average of 91.14/month in the pre-COVID era to 76/month in March and 80/month in April). In our trauma centers, the rate of patients operated on within 48 hours has remained stable (78.19% vs 77.92%), while the length of stay has decreased during the COVID period (8.9 days vs 6.5 days in March and 6.8 days in April). Proximal femur fractures, even during the COVID period, are a constant issue and a new challenge for the healthcare system. The main goals of management are to preserve patients from viral infection, to provide early surgical treatment and fast track protocol for discharge.