Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis.

PURPOSE: Currently, autografts and allografts are largely used to treat large or massive rotator cuff tear (RCT), without any evidence in favour of one graft or the other. The purpose of this study was to determine the rate of retear of autograft and allograft in the treatment of large or massive posterosuperior RCT. METHOD: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating clinical and radiological results of surgical treatment with autograft or allograft for large or massive RCT since 2008. The main criterion was the retear rate of the graft assessed on MRI or US scan at 1-year minimum follow-up. Partial tear were classified as "tear". RESULTS: The overall retear rate was 23.6% (15.5-32.7) at a mean follow-up of 18.4 ± 7.8 (12-36) months. There was no significant difference between the two kinds of graft, with a retear rate of 27.0% (15.4-40.2) and 20.9% (9.9-34.2) with autograft and allograft respectively (n.s.). Similar improvements of functional scores (+ 28.8 to 38.4 points for the Constant score, + 33.6 to 38.4 points for the ASES, and - 4.0 to - 4.1 points for pain-VAS) were reported in the two groups after at 27.2 ± 11.1 (12-48) months. The rate of complications except retear was 1.8% (0.2, 3.7) with autograft and 0.5% (0.8, 1.8) with allograft (n.s.). CONCLUSION: The use of autograft and allograft for the treatment of large or massive RCT leads to similar retear rate and clinical outcomes at short to medium terms. LEVEL OF EVIDENCE: Level IV.

Combined Medial Meniscus Allograft Transplantation and Open-Wedge High Tibial Osteotomy Using a Patient-Specific Instrumentation Guide.

Despite technical advances in meniscus allograft transplantation, there remains a need to improve postoperative outcomes.1 , 2 The bone plugs technique using osseous fixation of the anterior and posterior roots has demonstrated increased stability and long-term survival. Recently, the importance of limb alignment has been demonstrated for this procedure. In case of malalignment, osteotomy is essential to improve the long-term viability of both meniscus allograft and cartilage. The recent introduction of patient-specific instrumentation has raised the possibility of making instrumentation specific to each patient achieving an optimal correction in a safe and reliable manner. This Technical Note describes the use of a combined medial meniscus allograft transplantation and open wedge high tibial osteotomy using a patient-specific instrumentation guide.

Irradiation at 11 kGy conserves the biomechanical properties of fascia lata better than irradiation at 25 kGy.

The objective of this study was to determine the biomechanical properties of the fascia lata and the effects of three preservation methods: freezing, cryopreservation with dimethylsulfoxide solution and lyophilization; and to compare the effects of low-dose (11 kGy) and normal-dose (25 kGy) gamma-ray sterilization versus no irradiation. 248 samples from 14 fasciae latae were collected. Freezing samples were frozen at -80 °C. Cryopreservation with dimethylsulfoxide solution samples were frozen with 10 cl dimethylsulfoxide solution at -80 °C. Lyophilization samples were frozen at -22 °C and lyophilized. Each preservation group were then randomly divided into 3 irradiation groups. The cryopreservation with dimethylsulfoxide solution samples had significantly worse results in all 3 irradiation conditions. Young's modulus was lower for the freezing samples (p < 0.001) and lyophilization samples groups (p < 0.001). Tear deformation was lower for the freezing samples (p = 0.001) and lyophilization samples groups (p = 0.003), as was stress at break (p < 0.001 and p < 0.001). Taking all preservation methods together, samples irradiated at 25 kGy had worse results than the 0 kGy and 11 kGy groups in terms of Young's modulus (p = 0.007 and p = 0.13) and of stress at break (p = 0.006 and p = 0.06). The biomechanical properties of fascia lata allografts were significantly worse under dimethylsulfoxide cryopreservation. The deleterious effects of irradiation were dose-dependent.

Risk of infection and secondary displacement in pediatric supracondylar or lateral condyle fractures treated with unburied Kirchener-wires removed before complete bone healing.

This study evaluated the risk of infection and of secondary displacement among children with displaced lateral condyle or supracondylar fractures treated by surgery. The study included a consecutive sample of 84 supracondylar fractures and 21 lateral condyle fractures treated with closed reduction and percutaneous pinning. The mean time to Kirchener wire removal was 29 days (range: 25-37 days) postsurgery. Two out of 105 (1.9%) patients developed infectious complications and two of 105 (1.9%) patients had a secondary displacement. Removal of unburied Kirchener wires before complete bone healing in the physician's office does not increase risk of infection or the risk of secondary displacement. The protocol does, however, enable significant savings and eliminates the need for additional anaesthetic.