ACL surgical trends evolve in the last five years for young European surgeons: results of the survey among the U45 ESSKA members.

PURPOSE: Although the outcomes of ACL reconstruction are generally satisfying, there are several patients who do not regain their pre-injury sporting level and suffer persistent symptoms. Orthopaedic practice has evolved significantly over the last five years to address these drawbacks. The aim of the present survey was to analyze the changes in the approach to ACL reconstruction among a population of young ESSKA surgeons dedicated to ACL surgery. METHODS: The survey was uploaded on the ESSKA website and was accessible to members under the age of 45. The ESSKA society has 1035 U45 members involved in multiple aspects of Orthopaedic practice. One hundred and forty questionnaires were returned. Several aspects of ACL surgery were investigated at baseline and 5 years prior. They included general details such as the volume of ACL reconstructions per surgeon per year, the graft choice in cases of low and high demanding patients, the technique for femoral tunnel drilling and the preferred device for femoral fixation. The approach to the management of damage to peripheral structures, as well as meniscal ramp and root tears were also investigated. RESULTS: Hamstrings and quadrupled semitendinosus were the preferred graft choice in low-demanding patients (92.9%) while quadriceps tendon is gaining popularity in contact sport practitioners (from 4.3 to 10.7%). The percentage of surgeons using femoral screws had decreased from 37.9 to 29.3 while the percentage of those who used buttons increased from 52.9 to 69.3%. Extra-articular procedures (antero-lateral ligament (ALL) or lateral tenodesis have become popular. The percentage of surgeons who perform an additional peripheral reconstruction rose from 28.5 to 71.5%. Of those who perform the meniscal repair more than 50% of patients rose from 14.3 to 27.9%. Similarly, the percentage of surgeons who performed a medial meniscus ramp lesion repair rose from 29.4 to 54.7%. While the percentage of those who choose to perform a transtibial pull-out repair of lateral meniscus root tears significantly rose from 17.9 to 59.3%. CONCLUSIONS: The present survey among under 45 years old ESSKA surgeons yields some notable findings. The new evidence on the impact of injuries on peripheral structures and menisci is stimulating surgeons towards a more anatomic approach if identified at the time of ACL reconstruction. This evidence will probably influence future research and decision-making. LEVEL OF EVIDENCE: IV.

Effect of mitomycin-C on post-operative adhesions in tendon surgery: an experimental study in rats.

We investigated the effect of mitomycin-C on the reduction of the formation of peritendinous fibrous adhesions after tendon repair. In 20 Wistar albino rats the tendo Achillis was cut and repaired using a modified Kessler technique. The rats were divided into two equal groups. In group 1, an injection of mitomycin-C was placed between the tendon and skin of the right leg. In group 2, an identical volume of sterile normal saline was injected on the left side in a similar fashion. All the rats received mitomycin-C or saline for four weeks starting from the day of operation. The animals were killed after 30 days. The formation of peritendinous fibrous tissue, the inflammatory reaction and tendon healing were evaluated. The tensile strength of the repaired tendons was measured biomechanically. Microscopic evidence of the formation of adhesions and inflammation was less in group 1. There was no significant difference in the tensile load required to rupture the repaired tendons in the two groups. Mitomycin-C may therefore provide a simple and inexpensive means of preventing of post-operative adhesions.

Comparison of distal and proximal centralising devices in hip arthroplasty.

Centralising devices were introduced to ensure that the prosthesis is implanted in a neutral position and that a cement mantle of optimal thickness is achieved proximally and distally. A distal centralising device (DCD) is compared with a proximal midshaft centralising device (PCD) to test which one provides a more neutral prosthetic alignment. Thirty consecutive patients undergoing hemiarthroplasties for femoral neck fractures were studied prospectively. Patients were blindly randomised to receive either a femoral component with proximal midshaft centraliser or distal centraliser. Both components were implanted following the manufacturer's protocol. Postoperative true anteroposterior and lateral radiographs were made to assess the stem position. There was no statistically significant difference between the two groups in zones 1, 2, 3, 4, 5, 6 and 7 in both anteroposterior and lateral radiographic measurements. DCP and PCD both have similar centralisation and cement mantle. Future studies should be done to evaluate their long-term effect.

Iron deficiency prevalence and dietary patterns by school district in Istanbul.

INTRODUCTION: The aim of this study was to record the prevalence of iron deficiency (serum ferritin concentration <15 microg L(-1)) among schoolchildren and identify possible factors related to the development of this medical condition. MATERIALS AND METHODS: The study population consisted of 504 schoolchildren attending three primary schools, located in two districts of Istanbul with higher and lower socio-economic level (SEL) respectively. Certain biochemical and haematological indices of iron status were measured. Dietary intake was estimated using the 24-h recall technique and a food frequency questionnaire. RESULTS: The prevalence of iron deficiency in the lower SEL school district was twice that of the higher SEL school district (42% and 21.2% respectively). Furthermore, the levels of serum ferritin, mean corpuscular volume, mean corpuscular haemoglobin (all P < 0.001) and mean corpuscular haemoglobin concentration (P = 0.016) were higher for students in the higher than in the lower SEL school district. Consumption of tea, cola beverages and dairy products was more frequent by children living in the lower than in the higher SEL school district. Furthermore, consumption of red meat and citrus fruits was less frequent by boys in the lower than in the higher SEL school district. CONCLUSIONS: Iron deficiency was more prevalent among children from the lower SEL school district. Different patterns in the consumption of foods and beverages that inhibit or enhance intestinal iron absorption between children in the two school districts could provide some explanation for the observed differences in the prevalence of iron deficiency.

Pediatric diffuse lipoblastomatosis of the foot -- a case report and review of the literature.

Diffuse lipoblastomatosis is a rare lipomatous tumor of infancy that derives from fetal-embryonal fat. It usually affects infants and children and presents as a superficial mass that extends from the subcutis to the underlying muscle in the upper or lower extremities. In spite of its benign nature, the tumor may behave in a locally aggressive manner and invade the surrounding tissues. A case of isolated diffuse lipoblastomatosis of a 5-year-old boy in the plantar aspect of his right foot that has not been documented in that area before is described. The clinical and radiological presentation and histologic evaluation of diffuse lipoblastomatosis are discussed, in order to make a differential diagnosis between this rare tumor and other soft tissue tumors. In addition, the treatment principles of the tumor are described. This case demonstrates that diffuse lipoblastomatosis can be difficult to diagnose without histologic evaluation and, once diagnosed, should be treated by adequate surgical excision in order to prevent recurrence.

Prevalence of iron deficiency among schoolchildren of different socio-economic status in urban Turkey.

OBJECTIVE: To investigate the prevalence of iron deficiency among schoolchildren of different socio-economic status (SES), living in the three largest cities of Turkey. DESIGN: Cross-sectional study. SETTINGS: Primary schools of Istanbul, Ankara and Izmir. SUBJECTS: Schoolchildren aged 12 and 13 y (males: 504; females: 510) from nine primary schools. Inclusion of subjects in the study was on a voluntary basis. METHODS: Data were obtained on children SES, anthropometry, haematological and biochemical indices of iron status and consumption of food items related to dietary iron bioavailability. One-way analysis of variance was mainly applied, for the evaluation of the tested hypotheses, using Bonferroni correction in order to take into account the inflation of Type I error. RESULTS: Iron deficiency (serum ferritin <15 microg/l) prevalence was 17.5% among boys and 20.8% among girls. Furthermore, iron deficiency was significantly more prevalent among boys of lower SES, who were also found to have significantly lower levels of serum iron, serum ferritin, transferrin saturation, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration compared to those of higher SES. In terms of dietary factors affecting iron bioavailability, low SES boys exhibited significantly higher frequency of tea consumption and lower frequency of citrus fruit, red meat and fish consumption, compared to their higher SES counterparts. CONCLUSION: The prevalence of iron deficiency was relatively high, particularly among lower SES schoolboys. Higher tea and lower citrus fruits, red meat and fish consumption by boys of lower SES may provide an indication about the possible role of certain dietary patterns in the different manifestation of this medical condition among the socio-economic groups. However, further research is needed.