The long-term efficacy of the GraftRope technique.

BACKGROUND: Acromioclavicular joint separations continue to be a challenge for surgeons, and modern arthroscopically assisted techniques are becoming increasingly widespread. The aim of this study is to evaluate if the use of a biological support in association with a nonresorbable subcoracoid fixation can improve long-term stability in acromioclavicular joint dislocation surgically treated. We assessed clinical and radiographic results, patients' return to daily activities and the risk of complications. MATERIALS AND METHODS: Fourteen patients underwent subcoracoid fixation with the GraftRope system for chronic Rockwood type IV acromioclavicular joint dislocation. A total of 12 patients were evaluated clinically and radiologically with a minimum of 7 years of follow-up. RESULTS: Good reduction was obtained in all patients. All patients returned to work and sports at the pretrauma level with high mean scores on clinical evaluation. Regarding complications, 3 patients developed acromioclavicular arthritis. Ossifications were a common finding on x-rays, but they did not worsen the clinical outcome. CONCLUSIONS: The GraftRope surgical technique allows us to obtain an anatomical reduction of the acromio-clavicular joint, along with the restoration of the mechanical properties of the joint, owing to the use of a biological material with rigidity and load resistance features. Clinical results over the long term are encouraging. However, a 6-mm bone tunnel is too large since the average thickness of the coracoid process is only approximately 12 mm. This technique has some advantages over others: it avoids detachment of the deltoid, avoids the use of bulky metal implants with an important dissection of soft tissue, while it has all the advantages of an arthroscopic procedure.

Effectiveness of intra-articular injections of sodium hyaluronate-chondroitin sulfate in knee osteoarthritis: a multicenter prospective study.

BACKGROUND: Intra-articular injection of hyaluronic acid is a well-established therapy for the treatment of knee osteoarthritis. The aim of the study was to assess the effectiveness and safety of the use of Arthrum HCS(®) (40 mg hyaluronic acid and 40 mg chondroitin sulfate in 2 mL). MATERIALS AND METHODS: This was an open, multicenter, prospective study. Men or women over 40 years of age with documented knee osteoarthritis and WOMAC subscore A (severity of pain) ≥25 were enrolled. They received three weekly intra-articular injections of sodium hyaluronate 2 % and chondroitin sulfate 2 % in combination. WOMAC subscore A was assessed at 1, 3 and 6 months after the last injection. RESULTS: One hundred and twelve patients were included (women, 66 %). The mean (SD) WOMAC subscore A decreased from 52.1 (15.2) at inclusion to 20.5 (19.7) at month 6 (P < 0.0001). The mean subscore was already significantly decreased 1 month after the last injection at 25.7 (P < 0.0001). Pain relief and consumption of analgesic drugs, both assessed with visual analogic scale (VAS), consistently decreased. The investigators were satisfied/very satisfied as regards the therapeutic effectiveness of sodium hyaluronate-chondroitin sulfate in reducing pain (77 %), improving mobility (78 %) and reducing the consumption of analgesics (74 %). Only one adverse effect was reported by one patient (knee tumefaction). CONCLUSION: These results suggest that intra-articular injections of Arthrum HCS(®) (sodium hyaluronate plus chondroitin sulfate) in patients with knee osteoarthritis are efficient and safe. These results should be confirmed in a randomized controlled study. LEVEL OF EVIDENCE: IV.