Cross-cultural adaptation and validation of the Italian version of the Western Ontario Rotator Cuff (WORC) index.

The aim of the study was to accomplish translation, cross-cultural adaptation and validation of the Western Ontario Rotator Cuff (WORC) Index questionnaire for its use in Italy. The WORC original version was translated and cross-culturally adapted into Italian. Subsequently, it was administered to a population of 60 patients suffering from rotator cuff disease to evaluate the validity and reliability of the Italian version. The content validity evaluated the correlation between questions and total score of each domain through Pearson's correlation coefficient. The construct validity was similarly assessed through Pearson's correlation coefficient by testing the correlation between the Italian WORC and the Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Reliability was assessed using two methods: internal consistency by calculating the Cronbach's alpha coefficient for each domain; and test-retest by means of the intraclass correlation coefficient (ICC). The translation and cross-cultural adaptation of the Italian version did not reveal any major problems. No significant floor or ceiling effects were found. All the questions were linearly related to the concept expressed by the domain of belonging. Overall correlation with the DASH score was 0.75. Internal consistency was very high overall (α = 0.93) as well as reliability (overall ICC = 0.87). The Italian version of the WORC questionnaire is a valid and reproducible measuring instrument and can be considered a valid tool for the evaluation of the effectiveness of a treatment in terms of quality of life, in Italian patients affected by rotator cuff diseases.Level of evidence Diagnostic study, level II.

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.

Popliteomeniscal fascicles tears with lateral meniscus instability: outcomes of arthroscopic surgical technique at mid-term follow-up.

PURPOSE: The popliteomeniscal fascicles (PMFs) are a crucial part of the posterolateral corner of the knee. They provide stability to the lateral meniscus and stabilize the joint during tibial internal rotation. The clinical diagnosis of a torn PMFs is difficult, and magnetic resonance imaging (MRI) may be inconclusive as well. The aim of the present study was to report the outcomes of a continuous series of patients affected by PMF lesions and treated with an arthroscopic repair. METHODS: Seventeen patients (average age of 22 ± 3.6 years) with PMF lesions and lateral meniscus instability were prospectively enrolled. All patients were evaluated with clinical examination, International Knee Documentation Committee (IKDC), Lysholm and Tegner scores and 1.5 T MRI. All patients had the same arthroscopic procedure consisting of meniscal repair with an all-inside meniscal repair system (mean 2.2 ± 0.77 anchors) and followed with the same postoperative protocol. RESULTS: All patients were available at a mean follow-up of 68 ± 24 months (range 49-84 months). Mean IKDC increased from 60.2 ± 13.5 to 83.1 ± 12, mean Lysholm score improved from 56.7 ± 8.2 to 89.8 ± 3.2, and mean Tegner score improved from 2.9 ± 1.3 to 6.5 ± 2. No intraoperative or postoperative complications were reported. MRI evaluation at 6-month follow-up showed successful healing of the menisco-popliteal fascicles in all cases. CONCLUSIONS: The diagnosis and treatment of tears of the PMFs is still debated. Diagnostic confirmation of tearing of the PMFs is usually determined at the time of arthroscopy. Meniscal repair with an all-inside meniscal repair system appears to be an excellent treatment option, since it yields good functional results at mid-term follow-up, no local complications, and complete radiographic healing at 6-month follow-up MRI. Further studies are needed to confirm these promising early results. LEVEL OF EVIDENCE: Case series, 4.

Liner dissociation in total hip arthroplasty: a systematic review.

OBJECTIVE: Liner dissociation (LD) is a rare catastrophic mechanical failure of total hip arthroplasty (THA). The study aims at reviewing the available literature regarding liner dissociations to point out their prevalence, describing any possible association and highlighting the surgical management at the time of revision. MATERIALS AND METHODS: A systematic review of the literature was conducted from January 2002, until February 2022, according to the PRISMA guidelines. The main keywords were: "dissociation" AND "liner" OR "hip arthroplasty" OR "THA" and their MeSH terms in any possible combination. Cases of liner dissociation with all levels of evidence of any age published in indexed journals were included. The study quality of all included studies was evaluated using the MINORS criteria. The kappa (k) value was used to assess the consensus between reviewers in the selection of articles and methodological quality assessment. Finally, a sub-analysis was performed specifically concerning the elderly population. RESULTS: Thirty-one manuscripts met the inclusion criteria of the systematic review (21 case reports and 10 case series). 124 LD in 123 patients, (53% females and 47% males) were evaluated. The overall prevalence of LD was 0.15%. The mean age at surgery was of 56.5 years (range 31-75 years). LD occurred in a primary surgery setting in 86% of the cases, at a mean time of presentation of 45.8 months after replacement surgery. 39.5% of the cups and 8.8% of the stems required revision. The mean follow-up after the revision was 18.4 months. Complications after revision occurred in 19.6% of cases, including 3 cases of re-dissociations. Re-revision was required in 13.6% of the revisions. The sub-analysis of the elderly population included 28 cases of LD identified in 10 manuscripts, with an average age of 73.5 years. CONCLUSIONS: LD is a rare but catastrophic mechanical complication of modular THA that requires implant revision. The LD is not related to a specific prosthetic implant, liner material or design, acetabular positioning within the safe zone or age group.

CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis.

PURPOSE: Medial open-wedge high tibial osteotomy (MOWHTO) is an accepted option in the treatment of medial compartment osteoarthritis of the knee in young and active patients. Functional results are closely correlated to the correction of the mechanical axis of the lower limb. Although several angular and geometrical methods and values have been proposed in the past, the ideal target is still debated. In addition, it is important to have a deep correlation between the planned correction and the achieved correction after surgery. The aim of the present systematic review was to identify the ideal coronal correction after MOWHTO and the most accurate method to achieve it. METHODS: A systematic review of the literature was completed on July 3rd 2020 in the Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the Medical Subject Headings (MeSH) terms: "high tibial osteotomy" AND "accuracy" OR "planning". RESULTS: 28 studies were included; 18 were focused on computer-assisted surgery (CAS) and 10 on patient-specific instrumentation (PSI). There were 598 patients in the CAS group and 501 in the control group; the rate of outliers was 16% and 38.2% respectively (P = 0.04), while there was no significant difference between the two groups (SMD = - 0.10; 95% CI 1.31 to 1.12; P = n.s.) in terms of coronal accuracy. Likewise, there were 318 patients in the PSI group and 40 in the control group; the rate of outliers was 15% and 40% respectively (P = 0.98), while there was no significant difference between the two groups (SMD = 0.01; 95% CI 0.58 to 0.59; P = 0.98). CONCLUSIONS: A statistically significant reduced outlier rate and a non-significant increased accuracy emerged with the use of CAS when compared to the traditional surgical technique, whereas the results of PSI were still inconclusive. In addition, it emerged clearly that no consensus still exists on the ideal correction target to be achieved after surgery. LEVEL OF EVIDENCE: III.

Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion.

PURPOSE: There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals' lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry. METHODS: Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant. RESULTS: Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008). CONCLUSION: The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities. LEVEL OF EVIDENCE: Level III.

Comparable clinical and functional outcomes after anterior cruciate ligament reconstruction over and under 40 years of age.

PURPOSE: The aim of the present meta-analysis was to update the literature on the outcomes and complications of ACL reconstruction in patients aged 40 years and older. It has been hypothesized that patients older than 40 years of age may have comparable clinical outcomes to those of younger patients. METHODS: A systematic review of articles from 1996 to 2018 was completed using Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the keyword terms "anterior cruciate ligament reconstruction" and "middle-aged OR elderly OR over 40 OR age factors." Functional and clinical outcomes (International Knee Documentation Committee, Lysholm and Tegner score and KT-1000 arthrometer), complication and graft failure rate were evaluated. RESULTS: Eleven articles met inclusion criteria. In total, 306 middle-aged patients and 566 younger patients were included in this study. The mean age of patients > 40 was 49 ± 7 (range 40-75) years with a mean follow-up of 25 ± 9 months (range 12-68). The mean age of younger patients was 26 ± 2.7 (range 15-39) years with a mean post-operative follow-up of 26.7 ± 11.5 months (range 3-64). The results were slightly higher (but no significantly different) towards the younger group in terms of objective IKDC (P = n.s.), Lysholm (P = n.s.) and Tegner (P = n.s.) scores and knee laxity assessment (P = n.s.). Complication rate (P = n.s.) and graft failure (P = n.s.) were low even in this cohort. CONCLUSIONS: The present meta-analysis shows that patients older than 40 years achieve comparable clinical outcomes to those of younger patients following primary ACL reconstruction. This evidence may push the surgeons toward a more aggressive approach in this specific cohort of patients. LEVEL OF EVIDENCE: III.

Comparison of high-intensity laser therapy and combination of ultrasound treatment and transcutaneous nerve stimulation in patients with cervical spondylosis: a randomized controlled trial.

The aim of the study was to compare the effect of high-intensity laser therapy (HILT) and a combination of ultrasound (US) treatment and transcutaneous nerve stimulation (TENS) on pain, range of motion (ROM), and functional activity in patients with cervical spondylosis (CS). A total of 84 patients with a mean age of 51.54 years (52 women and 32 men) affected by CS were enrolled in this study. Patients were randomly divided into two groups. In group A (42 subjects), patients received 12 sessions of HILT plus exercise, while in group B (42 subjects), they received a combination of US, TENS, and exercise. The outcomes measured were cervical segment ROM, pain level measured by visual analogue scale (VAS), and functional activity measured by neck disability index (NDI) at the end of the therapy. The level of statistical significance was set as p < 0.05. In the two groups, cervical ROM, VAS, and functional scores showed significant changes. Both HILT plus exercise and US/TENS plus exercise effectively increased cervical ROM and reduced pain (with a significant greater decrease in group A). Statistically significant differences in NDI scores were observed after treatment sessions with better results for participants enrolled in group A (HILT plus exercise) Both therapeutic modalities demonstrated analgesic efficacy and improved function in patients affected by cervical spondylosis 4 weeks after the therapy. HILT plus exercise was more effective than US/TENS plus exercise. HILT can be promoted and used in this pathology with positive outcomes. However, further studies are needed to optimize the dose and duration of HILT therapy.

Orthopedic resident's learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes.

BACKGROUND: Arthroscopic subscapularis (SSC) repair is a technically demanding procedure with a long learning curve. As effective completion of resident's practical experience remains controversial, a prospective clinical study was performed to assess the functional and anatomical outcomes of subscapularis (SSC) arthroscopic repair by orthopedic residents. The pathological anatomy of the tears, the surgical approach and the difficulties encountered at the beginning of the learning curve were reported. MATERIALS AND METHODS: Between June 2009 and June 2010, 30 patients with rotator cuff tear were preoperatively evaluated with clinical exam, Constant and UCLA scores. Surgery was performed under arthroscopy by a team of three orthopedic surgeons in training. A SSC tear, if present, was recorded and treated. The same clinical exam and functional scores were repeated at minimum 6 months of follow-up. Subscapularis strength recovery and tendon healing were investigated with arthromagnetic resonance imaging. RESULTS: A SSC tear was observed in 11 cases out of 30 and treated arthroscopically. The clinical scores improved in all patients: the average Constant score increased from 34 ± 14 to 77 ± 11 and the UCLA score from 11 ± 5 to 29 ± 3. The SSC tests were negative in all patients with the exception of one. Tendon healing was observed in 10 out of 11 cases. CONCLUSIONS: Arthroscopic SSC repair performed by educated residents is possible and leads to good clinical and anatomical results. Surgery duration progressively improved as the learning curve advanced. LEVEL OF EVIDENCE: Level 2.

Arthroscopically assisted fixation is a reliable option for patellar fractures: A literature review.

Proper reduction and stable fixation of articular fractures is essential for an early recovery and to avoid late complications. Arthroscopically assisted techniques for minimally invasive fixation have been introduced to reduce local morbidity and improve anatomic reduction of the fragments. However up to date no clear indications for surgery have been given. In addition, the precise rates of functional outcomes and complications are controversial. The hypothesis was the systematic analysis of the available literature would provide precise indications, outcomes and complications of arthroscopically assisted techniques for patellar fracture fixation. A comprehensive literature review was performed using the keywords "patellar fracture", "arthroscopy" with no limit regarding the year of publication. All the selected articles were in English language and were evaluated with the Coleman score by three independent surgeons. The interclass correlation coefficient between the three examiners was calculated. Six full text articles were retrieved. The initial cohort included 60 patients with a displaced transverse fracture in the majority of the cases. At an average FU of 27.2 months the Lysholm score was 91.3. The rate of complication was 7%; Average Coleman score for the three observers was 55.8±6.5 with an ICC of 0.89, indicating adequate inter-rater agreement. Arthroscopically assisted techniques for minimally invasive fixation of patellar fractures represent a reliable option. The positive clinical outcomes and low rates of complications must be confirmed with further studies including larger series and longer FU. LEVEL OF EVIDENCE: Level IV, systematic review of retrospective series.

No relationship between critical shoulder angle and glenoid erosion after shoulder hemiarthroplasty: a comparative radiographic study.

INTRODUCTION: Symptomatic glenoid erosion is one of the most common causes of functional impairment after shoulder hemiarthroplasty. A decrease in the critical shoulder angle (CSA) has been associated with the development of shoulder arthritis. The inter-observer reliability of the CSA and the relationship between CSA and symptomatic glenoid erosion after shoulder hemiarthroplasty were investigated. MATERIALS AND METHODS: Twenty-eight patients with symptomatic glenoid erosion after anatomic hemiarthroplasty were compared to a control group of 30 patients with no signs of symptomatic glenoid erosion. The CSA was measured by two blinded shoulder surgeons at a mean follow-up of 105.2 and 54.7 months, respectively. The inter-observer reliability was calculated. RESULTS: The mean CSA in the control group in neutral, internal, and external rotations was 34°, 33°, and 33°, respectively. The corresponding values in the study group were 33°, 33°, and 33° (<0.01). The interclass correlation coefficient between the two examiners was 0.917 (P < 0.01), 0.924 (P < 0.01), and 0.948 (P < 0.01), respectively. The Mann-Whitney test between the control group and the study group were, respectively, 0.907, 0.932, and 0.602. CONCLUSION: There were no significant differences of CSA values between the two groups. Good inter-observer reliability was found for the CSA method.

Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series.

PURPOSE: The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. METHODS: Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. RESULTS: All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention. CONCLUSIONS: Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing.

Scapulothoracic arthroscopy for symptomatic snapping scapula: a prospective cohort study with two-year mean follow-up.

BACKGROUND: Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnormal tissue at this site. Surgical treatment, when needed, may be either open or arthroscopic. The aim of this study was to evaluate prospectively the clinical outcomes of arthroscopic decompression in ten subjects with symptomatic snapping scapula. PATIENTS AND METHODS: Ten subjects, five men and five women, mean age 24 years, were treated by arthroscopy after unsuccessful conservative management for 6 months. Clinical outcomes were evaluated with the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score (CS), and simple shoulder test (SST). Follow-up was at 3 and 6 months; the final evaluation was conducted at a mean interval of 24 months. The final and preoperative X-rays were compared. RESULTS: The WORC index increased significantly at 3 (p < 0.05), 6 (p < 0.01), and 24 months (p < 0.01). Similar outcomes were found for the CS at all 3 follow-up points (3 months, p < 0.05; 6 months, p < 0.01; 24 months, p < 0.01). Mean "yes" responses on the SST were 9.8 ± 1.4 at 3 months (p < 0.05), 10.2 ± 1.2 at 6 months (p < 0.01), and 10.6 ± 1.2 at 24 months (p < 0.01). X-ray examination depicted flattening of the anterior surface of the superior-medial angle of the scapula in the five patients who had had bone resection, whereas no significant difference with preoperative imaging was detected in the five patients who were managed by bursectomy and debridement alone. CONCLUSIONS: Arthroscopy is a feasible and minimally invasive treatment for painful snapping scapula syndrome. Comparative clinical trials are needed to collect conclusive data to state that it is the most suitable treatment for this condition.

Metallosis following knee arthroplasty: a histological and immunohistochemical study.

Metallosis represents a rare and severe complication of knee replacement surgery. It is caused by the infiltration and accumulation of metallic debris into the peri-prosthetic structures, deriving from friction between metallic prosthetic components. In knee arthroplasty, this event generally occurs as a result of polyethylene wear of the tibial or metal-back patellar component. The real incidence of metallosis is still unknown, although it seems to be more frequent in hip than in knee arthroplasty. The metallic debris induces a massive release of cytokines from inflammatory cells, making a revision necessary whenever osteolysis and loosening of the prosthesis occur. We report four patients who underwent revision of their knee arthroplasty because of severe metallosis. In one of these patients, polyethylene wear had determined friction between the metal-back patellar component and the anterior portion of the femoral component. In the remaining three cases, metallosis was caused by friction between the femoral and tibial prosthetic metal surfaces, resulting from full-thickness wear of the tibial polyethylene. T lymphocytes were activated by metal particles present in periprosthetic membranes. In all patients, one-stage revision was necessary, with rapid pain disappearance and a complete functional recovery of the knee joint.

The manangement of knee cartilage defects with modified amic technique: preliminary results.

Cartilage defects represent a common problem in orthopaedic practice. The knee is frequently involved and the medial femoral condyle is the most common localization. Predisposing factors are: traumas, inflammatory conditions and biomechanics alterations. Several surgical options are available once correct diagnosis is given and accurate patient evaluation has been performed. The aim of our study was to prospectively evaluate functional results of modified autologous matrix induced chondrogenesis (AMIC) technique in a population of patients affected by focal cartilage defects A population of 17 patients was enrolled in this study. 10 patients were male, mean age at the time of surgery was 39 years, right side was involved in 11 cases. All patients were evaluated with accurate physical exam and complete imaging study. At an average FU of 36 months, mean IKDC score and Lysholm score improved from 32 to 82 and from 38 to 74. 13 patients out of 17 (76.5%) were satisfied or extremely satisfied with their functional result. MRI control showed reduction of the defect area and subchondral oedema in 10 cases (58.8%). AMIC technique is a relatively new option in the treatment of full thickness cartilage lesions. It enhances the advantages of microfractures since the Chondrogide membrane protects and stabilizes the blood plug acting as a matrix for new cartilage formation. First reports on AMIC technique, show comparable results to autologous chondrocyte implantation (ACI) with the advantage of a single stage technique and no donor site morbidity. AMIC technique represents a new option in the treatment of full thickness cartilage defect. It is safe and reliable. Our data are in accordance with previously reported series in literature and confirm the good objective and subjective results of this procedure.

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty.

Blood loss after total knee arthroplasty (TKA) is often associated with cardiovascular complications and a high transfusion rate of allogenic blood. In our study we focused our attention on developing a new intra-surgical procedure that appears safe, easy to perform and effective in the reduction of bleeding in TKA. We evaluated 84 patients who underwent TKA and met our inclusion criteria; they were assigned to two groups: 55 controls in which a saline solution was used to wash the surgical field before tourniquet release, and a second group of 29 patients, in which a saline solution containing a low dose of norepinephrine was locally applied before tourniquet release. The local administration of a low dose of norepinephrine has induced a significant reduction of perioperative blood loss and blood transfusion requirements; in addition, this method was characterised by the absence of complications or adverse effects. In conclusion, our data suggest that intraoperative local administration of a low dose of norepinephrine could represent an effective and safe method of reducing blood loss and preventing blood transfusions in patients with TKA.

["Isolated" injury of the posterior cruciate ligament. Surgical treatment of isolated posterior cruciate ligament tears: a multicentric retrospective study of 103 patients]. / Traitement chirurgical d'une rupture isolée du ligament croisé postérieur: résultats d'une série rétrospective multicentrique de 103 patients.

PURPOSE OF THE STUDY: We present a retrospective multicentric series of carefully selected patients presenting "isolated" laxity of the posterior cruciate ligament. MATERIAL AND METHODS: The series included 103 patients who were reviewed clinically (with a dedicated review chart) and radiographically with measurement of posterior laxity (Telos 15 kg). RESULTS: In these patients with an isolated injury of the PCL (without associated injury of the peripheral ligament) DISCUSSION: The short follow-up of this series (four years) does not enable an assessment of the risk or benefit of PCL ligamentoplasty for arthrosic knees.

[An effective method to prevent deep venous thrombosis in total hip arthroplasty: a study in patients with and without risk factors for thrombotic disease]. / Efficacia della profilassi della trombosi venosa profonda nell'artroprotesi totale d'anca. Studio di pazienti con e senza fattori di rischio aggiuntivi.

PURPOSE: The aim of this study was to determine a safe and effective method of prophylaxis for thromboembolis diseases after THA. MATERIALS AND METHODS: This study was conducted on 157 patients consecutively admitted to our Department of Orthopedics to undergo elective THA from October 2000 o May 2001. We have preoperatively investigated plasma levels of homocysteine, AT III activity, Fibrinogen levels, Anticardiolipin antibodies, and circulating vWFag D-dimer levels were measured by Asserachrom D-dimer ELISA preoperatively and on day 4 postoperatively. Thromboprophylactic regimen was based on a prolonged subcutaneous administration of nadroparin (for 40 days after surgery) and was used in all patients, with a dose based on body weight. Compression ultrasonography was udes as screening test for the diagnosis of deep venous thrombosis and performed in each patient on postoperative day 4, 15, and 30. RESULTS: Although all patients enrolled in this study showed increased risk for thrombotic disease, none oh them developed either symptomatic or asymptomatic deep venous thrombosis. No complications were observed, including major bleeding or abnormalities of laboratory tests. CONCLUSIONS: Our study indicates that prolonged thromboprophylaxis with nadroparin for 40 days postoperatively, associated with early mobilization, is an effective and safe protocol of antithrombotic prophylaxis in patients operated for THA with and without risk factors for thrombotic disease.