Current Trends and Outcomes for Open vs. Arthroscopic Latarjet.

PURPOSE OF REVIEW: This paper aims to analyze and compare the existing research on open and arthroscopic Latarjet procedures for treating anterior shoulder instability. The review will assess different factors such as graft positioning, functional outcomes, complications, and return-to-play rates for both approaches. The study's primary goal is to establish which technique yields superior outcomes. RECENT FINDINGS: Recent studies have suggested that arthroscopic Latarjet surgery can produce outcomes similar to open surgery regarding functional scores and patient satisfaction. Some research indicates that arthroscopy may even provide slightly better results. Both techniques have similar complication rates, but arthroscopy requires a longer learning curve and operating time. It is crucial to ensure the proper placement of the graft, and some studies suggest that arthroscopy may be better at achieving accurate positioning. Both open and arthroscopic Latarjet procedures are equally effective in treating shoulder instability. While arthroscopy offers a faster recovery time and causes less soft tissue damage, it requires surgeons to undergo a steeper learning curve. The optimal graft position for both techniques is still debated. More long-term data is needed to establish superiority. Future research should compare approaches in larger cohorts and identify outcome-affecting factors to improve the treatment of shoulder instability. Both techniques are promising, but arthroscopy may be a better option as the procedure evolves into a less invasive reconstruction.

A comparison of continuous cold flow and compression device and traditional icing regimen and no icing following anterior cruciate ligament reconstruction: A pilot study.

The aim of this study was to investigate the effectiveness of continuous cold flow and compression device as against traditional icing regimen and without icing after anterior cruciate ligament (ACL) reconstruction. All patients undergoing ACL reconstruction from June 2021 to August 2021 were enrolled in this study. Patients were randomly allocated to three groups: A control group (n=10) with no ice regimen post-operatively, a second control group (n=10) with ice bag, and a third group (n=10) with continuous cold flow and compression device (physiolab). All patients who had isolated ACL tear evident on magnetic resonance imaging were included. Pain intensity, limb girth, Oxford Knee Score, and 12-item survey form were measured pre- and post-operatively. Significant difference was noted between pain scores in all groups at two- and six-week follow-ups with p-value of 0.004 and 0.01. The test for "between subject effects" showed significant difference (p=0.007) in limb girth between the two groups. Cold and compression device can be used to reduce swelling immediately after ACL reconstruction.

Core Decompression Combined with Intraosseous Autologous Conditioned Plasma Injections Decreases Pain and Improves Function in Patients with Symptomatic Knee Bone Marrow Lesions.

The purpose of this prospective case series was to determine the effectiveness of using a combination of the core decompression and injection of autologous conditioned plasma (ACP) for the treatment of symptomatic knee bone marrow lesions (BML), as well as to report on the preliminary clinical results based on magnetic resonance imaging (MRI) and patient-reported outcomes (PROMs). Patients with OA-related BML who failed to improve on conservative treatment for three months underwent an identical procedure consisting of arthroscopy, core decompression, and the intraosseous injection of ACP and were followed up for 12 months. A statistically significant reduction in pain and an improvement in function, as measured by the Numeric Pain Rating Scale (NPRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS), was observed at one-week follow-up (8.3 ± 0.8 to 1.5 ± 1.0; p ≤ 0.001 and 33.4 ± 10.6 to 53.9 ± 13.6; p ≤ 0.001 respectively). After six weeks, weight-bearing was allowed, but the trend did not change-the NPRS continued to be low (average 1.4 on 12-month follow-up) and the total KOOS increased 44.6 points from the baseline (average 78.0 on 12-month follow-up). The Whole-Organ Magnetic Resonance Imaging Score improved from 66.1 ± 19.4 prior to surgery to 58.0 ± 15.9 (p < 0.001) after 3 months. In our study, there was no control group, randomisation was not performed, and the sample size was relatively small. A combination of core decompression and the intraosseous injection of ACP into the affected subchondral area proved to be a safe and effective procedure that provides rapid pain relief and a significant increase in joint function up to one year postoperatively.

Clinical Outcome of Arthroscopic Repair for Isolated Meniscus Tear in Athletes.

Increased knowledge of the long-term destructive consequences of meniscectomy has created a shift towards operative repair of isolated meniscus lesions. However, in the literature the results of isolated meniscal repair in athletes currently remain underreported. Our objective was to investigate the clinical and functional outcomes as well as survival and return to sport in patients who underwent meniscal repair after isolated meniscal tear, with a focus on athletes (both professional and recreational) in the study population. This retrospective study included 52 athletes who underwent knee surgery for isolated meniscal tear between 2014 and 2020. Patients with concomitant ligamentous and/or chondral injury were not included in this study. The mean age of the patients was 25.5 years (ranging from 12 to 57 years). The mean follow-up period of all patients was 33.3 months (ranging 10 to 80 months). The mean purpose of the study was to report the return to sport. The International Knee Documentation Committee rating (IKDC), Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS) and Tegner activity level were determined at the follow-up. Failure was defined as re-operation with meniscectomy or revision meniscal repair. In total, 44 out of 52 patients (85%) returned to their previous sports activities. At follow-up, the mean Lysholm score was 90, representing a good to excellent result. Assessment of KOOS (mean value 88.8) and IKDC (mean value 89) scores also showed good to excellent results. A mean level of Tegner scale was 6.2, indicating a relatively high level of sports participation. Failure was encountered in 8 out of 52 knees (15%). Therefore, isolated meniscal repair resulted in good to excellent knee function and most athletes can return to their previous level of sports participation.

Running addiction.

BACKGROUND: Running is a common physical activity of an aerobic nature that is carried out mostly outdoors and presents a healthy lifestyle. However, the positive effect of running often masks the downsides of potential addiction that can compromise an individual's physical, mental, and social functioning. Most often there is a thin and unclear line separating passionate athletes and running addicts. Thus, it is necessary to educate the running community to raise awareness of the negative effects of over-training, prevent complications and injuries and to seek the necessary help. METHODS: The study sample consisted of runners from the Croatian population of both genders, aged 18 to 75, who have been running for more than a year. The respondents were divided into groups according to the favorite length of the racing race. Groups were compared in terms of nutritional supplements usage, running-related injuries, as well as the impact of Covid-19 pandemic on their running volume. Difference between groups in Exercise Addiction Inventory (EAI) questionnaire outcome scores was also accessed. RESULTS: The statistical analysis included the answers of 644 people of both genders, among which 309 (48%) men and 335 (52%) women. The average age of the respondents was 42 years (18-75), and the average age of running was 5 years (1-42). Only among the respondents who started running most recently (1 to 10 years), and those who run the longest races (longer than 100 km) were found to use nutritional supplements significantly more (71.43%, P<0.001) and sustained injuries associated with running more than rest of the groups (100%, P=0.013). Due to the pandemic, only respondents who have been running for the longest time (31-42 years) and prefer to run races from 21 to 42 km significantly reduced the amount of training (75%, P=0.037). The risk for addiction was significantly positively associated with the use of dietary supplements, the favorite length of the race and the frequency of injuries, while there was no association with the length of running. CONCLUSIONS: Running is a high-risk sport for addiction development. All the benevolent attitudes and positive effects of running often mask the downsides of addiction that can compromise an individual and his or her physical, mental, and social functioning. Due to the high percentage of addiction risk of 25%, it is necessary to educate the racing community to raise awareness of the negative effects of overtraining, prevent complications and seek the necessary help.

Modified Technique for Combined Reconstruction of Anterior Cruciate Ligament and Anterolateral Ligament.

During the past few decades, surgical techniques for anterior cruciate ligament (ACL) reconstruction have been developing significantly. To date, studies have shown that after ACL reconstruction, rotational stability has a greater impact on the patient's satisfaction, functional scores, and return to sports than translational stability. Although challenged by many authors in the literature, biomechanical studies on the anterolateral ligament (ALL) of the knee and clinical studies regarding ALL reconstruction have been revealing promising results. Thus, the potentially significant role of the ALL in biomechanical load sharing and improving rotational control of the knee has led to the development of various reconstruction techniques whose goal is to achieve simplicity and yield the best results possible. Guided by this idea, we have developed a modified ACL-ALL reconstruction surgical technique. In this article, our simple, bone-saving, anatomic technique to reconstruct both the ACL and ALL using hamstring tendon autograft is described.

Implementation of the three-dimensional printing technology in treatment of bone tumours: a case series.

PURPOSE: With the ability to overcome specific anatomical and pathological challenges, 3D printing technology is setting itself as an important tool in patient-specific orthopaedics, delivering anatomical models, patient-specific instruments, and custom-made implants. One of the most demanding procedures in limb salvage surgery is the reconstruction of bony defects after tumour resection. Even though still limited in clinical practice, early results of the use of 3D technology are gradually revealing its potentially huge impact in bone tumour surgery. Here, we present a case series illustrating our experience with the use of 3D printing technology in the reconstruction of bone defects after tumour resection, and its impact on cosmesis and quality of life. METHODS: We performed a retrospective analysis of 11 patients in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour. Ten out of 11 patients were children (aged between 5 and 16 years) with osteosarcoma or Ewing sarcoma of the pelvis (2 children) or the arm (8 children), and one patient was a 67-year-old lady with a chondrosarcoma of the pelvis. All underwent wide resections resulting in considerable bone defects necessitating further reconstruction. RESULTS: Custom-made implants were extremely useful both in reconstruction of bone defects and in terms of cosmesis, recovery facilitation, and quality of life. In this respect, pelvic and humeral reconstructions with 3D-printed custom implants particularly showed a great potential. The mean follow-up was 33 months. Four patients died of disease (36%) and overall the major and minor complication rate was 54% (6 out of 11 patients). Three patients had implant dislocation (27% [3/11 cases]), one had leg-compartment syndrome, and one patient reported limited range of motion. Only two out of 11 patients developed local recurrence. CONCLUSION: Use of 3D customized implant helped us achieve two major goals in orthopaedic oncology-clear surgical resection and functional recovery with a good quality of life. Large studies with long-term follow-up are needed to reveal the value and future of 3D printing in orthopaedic oncology.

Meniscal scaffold for the treatment of partial meniscal defect-clinical and radiological outcomes in a two-year follow-up.

PURPOSE: The aim of meniscal scaffolds is to fill the defect, allow regeneration of meniscal-like tissues, and to prevent long-term risk of cartilage wear and tear. The aim of this study was to evaluate clinical results after two years and magnetic resonance imaging (MRI) results a year after implantation of a meniscal scaffold. METHODS: Fifteen patients were recruited into a prospective, single-arm, single-center study, and treated with meniscal scaffolds as a result of segmental meniscal defect due to previous partial meniscectomy. Patients were evaluated using functional knee scores used pre-operatively and 6, 12, and 24 months postoperatively. The radiological outcome was assessed using MRI at 12 months by evaluating scaffold size, morphology, and intensity according to the Genovese grading system. Cartilage assessment was completed according to The International Cartilage Repair Society (ICRS) score. RESULTS: All patients completed a follow-up of 24 months. A statistically significant increase in mean levels of all functional scores was present in all patients. On the MRI, all but one of the patients presented an incorporated meniscal implant. In most of the patients (73%), the meniscal implant was a Genovese type III. Type II and III signal intensities were present in all scaffolds when compared with the residual meniscal tissue. A stable cartilage (ICRS) status was observed in 80% of the patients compared with the pre-operative cartilage scores. CONCLUSION: In our case series of patients treated with the meniscal scaffold implant, we observed good clinical results at a two year follow-up. Furthermore, MRI findings suggest that meniscal scaffolds might have a beneficial effect on articular cartilage.

Histological and cellular evaluation of anterior cruciate ligament.

BACKGROUND: We hypothesized that the torn anterior cruciate ligament (ACL) demonstrates a great healing response after initial trauma and has competent cells leading to the healing but differs in its response based on the type of tear and duration of injury. This study aimed to evaluate the histological and cellular responses to the injured ACL. METHODS: Fifty-two tissue samples from the ACL were harvested from patients undergoing arthroscopy. Detailed histological and cellular examinations were performed for ligament angiogenesis, fibrocytes, and synovial tissue infiltration. We compared the cellular response to injury in partially and completely ruptured ACLs. The duration of ACL injury and its response to cellular characteristics were also examined. Immunohistochemical studies using cluster of differentiation 34 (CD34) staining was used to evaluate endothelial cells and fibrocytes. RESULTS: We found a significantly higher density of synovial and ligament angiogenesis and fibrocytes at the torn end of ACL (Mann-Whitney, P < 0.050). Numerous fibrocytes were identified in complete ACL tears versus partial tears (Mann-Whitney = 0.020). Increased cellular proliferation was identified at the ruptured end of ACL remnant (Kruskal-Wallis, P < 0.050). The cellular proliferation of ruptured ACL decreased after 12 months. CONCLUSIONS: Based on our findings of the time-dependent decrease in the cellular response at the torn ends of the ACL, we recommend early intervention, preservation of the ACL remnant, and primary ACL repair or augmented reconstruction.