Occurrence of inadequate ACL healing after Dynamic Intraligamentary Stabilization and functional outcome-a multicentre case series.

INTRODUCTION: Dynamic Intraligamentary Stabilization (DIS) is a technique for preservation, anatomical repair and stabilization of a freshly injured anterior cruciate ligament (ACL). The main purpose of this study was to evaluate the short-term re-operation rate when compared to traditional autograft reconstruction. METHODS: Four, from the developer independent, centres enrolled patients that underwent ACL repair by DIS, according to the specific indications given by MRI imaging at a minimum follow-up of 12 months. The re-operation rate was recorded as primary outcome. Secondary outcome measures were the postoperative antero-posterior knee laxity (using a portable Rolimeter®), as well as the Tegner, Lysholm and IKDC Scores. RESULTS: A total of 105 patients were investigated with a median follow-up of 21 months. Thirteen patients were lost to follow-up. Of the remaining 92 patients 15 (16.3%) had insufficient functional stability and required subsequent ACL reconstruction. These patients were excluded from further analysis, leaving 77 consecutive patients for a 12 months follow-up. The median age at time of surgery was 30 years for that group. At time of follow-up a median antero-posterior translation difference of 2 mm was measured. None of these patients reported subjective insufficiency (giving way), but in 14 patients (18.2%), the difference of antero-posterior translation was more than 3 mm. We found a median Tegner Score of 5.5, a median Lysholm Score of 95.0 and a median IKDC Score of 89.4. CONCLUSION: The main finding of this multicentre study is a relevant re-operation rate of 16.3%. Another 18.2% showed objective antero-posterior laxity (≥ 3 mm) during testing raising the suspicion of postoperative non-healing. The failure rate of DIS in this study is higher than for reconstruction with an autologous tendon graft. However, our successfully treated patients had a good clinical and functional outcome based on antero-posterior knee laxity and clinical scores, comparable to patients treated by autograft reconstruction.

Arthroscopic repair of isolated subscapularis tears: clinical outcome and structural integrity with a minimum follow-up of 4.6 years.

BACKGROUND: After isolated subscapularis repair, improvement in shoulder function has been reported at short-term review. The purpose of this study was to determine whether arthroscopic subscapularis repair provides durable improvement in objective and subjective shoulder function with a low structural retear rate. METHODS: All patients treated with arthroscopic repair of an isolated subscapularis tear between August 2003 and December 2012 with a minimum follow-up period of 4.6 years were identified from our database. A number of patients in our study cohort underwent a prior complete midterm assessment, which allowed a subgroup analysis to detect changes in structural integrity and corresponding function. Clinical and radiographic outcomes, including outcomes on conventional radiography and magnetic resonance imaging or ultrasound, were assessed. RESULTS: The study enrolled 36 shoulders with a mean patient age of 57.7 years (range, 31-75 years; standard deviation, 10.6 years). The mean follow-up period was 8.6 years (range, 4.6-13.9 years; standard deviation, 2.44 years). Internal rotation to the thoracic vertebrae was achieved in 94% of cases and was significantly improved (P < .001) compared with the preoperative situation. The mean relative Constant score improved from 68% preoperatively to 93% at final follow-up (P < .001). Magnetic resonance imaging evaluation showed a rerupture rate of 2.7% (1 of 36 shoulders). Twenty patients underwent previous complete midterm assessment (mean, 2.9 years; range, 1-4.5 years), with comparisons between midterm and long-term follow-up showing comparable results without statistically significant deterioration. CONCLUSIONS: Functional and subjective improvements in shoulder function are maintained at a mean follow-up of more than 8 years after isolated subscapularis repair and are associated with a low structural failure rate of the repair.

Does previous hip arthroscopy negatively influence the short term clinical result of total hip replacement?

INTRODUCTION: The risk that hip preserving surgery may negatively influence the performance and outcome of subsequent total hip replacement (THR) remains a concern. The aim of this study was to identify any negative impact of previous hip arthroscopy on THR. METHODS: Out of 1271 consecutive patients who underwent primary THR between 2005 and 2009, 18 had previously undergone ipsilateral hip arthroscopy. This study group (STG) was compared with two control groups (CG, same approach, identical implants; MCG, paired group matched for age, BMI and Charnley categories). Operative time, blood loss, evidence of heterotopic bone and implant loosening at follow-up were compared between the STG and the MCG. Follow-up WOMAC were compared between the three groups. RESULTS: Blood loss was not found to be significantly different between the STG and MCG. The operative time was significantly less (p < 0.001) in the STG. There was no significant difference in follow-up WOMAC between the groups. No implant related complications were noted in follow-up radiographs. Two minor complications were documented for the STG and three for the MCG. CONCLUSION: We have found no evidence that previous hip arthroscopy negatively influences the performance or short-term clinical outcome of THR.

High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years.

PURPOSE: High tibial osteotomy is a well-established method for the treatment of medial unicompartmental osteoarthritis of the knee. METHODS: We analysed retrospectively the long-term outcome of open and closing wedge valgisation high tibial osteotomies. Out of 71 patients, 54 (76%) were available for the study. Survival rates and the influence of the osteotomy type were investigated. Secondary outcome measures were the course of radiological leg axis and osteoarthritis as well as score outcomes. RESULTS: During a median follow-up of 16.5 years (IQR 14.5-17.9; range 13-21), 13 patients (24%) underwent conversion to total knee arthroplasty; the other 41 patients (76%, survivor group) were studied by score follow-up as well as clinical and radiological examinations. Osteotomy survival was of 98% after 5 years, 92% after 10 years and 71% after 15 years. Comparison between open and closing wedge high tibial osteotomy showed no significant difference in survival and score outcome. The median Visual Analogue Score (VAS) was 0 (IQR 0-1; range 0-4), the Satisfaction Index was 80% (IQR 63-89; range 30-100), the median Knee Injury and Osteoarthritis Outcome Score was 71 (IQR 49-82; range 9-100) and the median Western Ontario and McMaster Universities Osteoarthritis index was 84 (IQR 66-96; range 9-100). Radiological evaluation showed only a slight progression of the degree of osteoarthritis following the Kellgren and Lawrence classification. In each case, the axis passed through the healthy compartment or at least through the centre of the knee. CONCLUSION: Open and closing wedge high tibial osteotomies are a successful choice of treatment for unicompartmental degenerative diseases with associated varus in active patients. Survival of both techniques is comparable in our series and is associated with low pain scores, high satisfaction and high activity levels of the survivors.

Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer.

BACKGROUND: Prospective assessment of accuracy and safety of video-mediastinoscopy (VMS) in patients without pretreatment and those after induction therapy for potentially operable non-small cell lung cancer. METHODS: Between 1996 and 1999, 219 patients underwent VMS at our institution: 195 patients without pretreatment and 24 after completion of induction therapy. Mediastinal lymph nodes were dissected and biopsied according to the American Thoracic Society (ATS) lymph node mapping system using a video-assisted approach. The accuracy of VMS was assessed for each patient according to the results obtained from mediastinal lymph node dissection (MLND) performed during lung resection. RESULTS: Video-mediastinoscopy in patients without pretreatment revealed a sensitivity, specificity, and accuracy as compared with MLND of 87%, 100%, and 95.6%, respectively, and a procedure-related complication rate of 4% (8/195 patients). Video-mediastinoscopy in patients after induction therapy revealed a sensitivity, specificity, and accuracy of 81%, 100%, and 91% as compared with MLND, without apparent complications. CONCLUSIONS: Video-mediastinoscopy performed after induction therapy for non-small cell lung cancer is as accurate as mediastinoscopy in patients without pretreatment and did not confer additional morbidity.