Postoperative Management for Articular Cartilage Surgery in the Knee.

The postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients. These key principles consist of preoperative assessments that include physical, mental, and behavioral components critical to recovery; education and counseling with respect to expectations and compliance; and careful monitoring and adjustments throughout the rehabilitation period based on consistent communication among rehabilitation, surgical, and imaging teams to ensure strict patient compliance with restrictions, activities, and timelines to optimize functional outcomes after surgery.

Osteochondral Allograft Transplantation in the Knee.

The technique of osteochondral allograft (OCA) transplantation has been used to treat a wide spectrum of cartilage deficiencies in the knee. Its use has been supported by basic science and clinical studies that show it is a safe and effective treatment option. What sets fresh OCA transplantation apart from other cartilage procedures in the knee, is the ability to treat large defects with mature hyaline cartilage. Studies looking at transplantation of fresh OCAs in the general population have shown reliable pain relief and return to activities of daily living. Reports of cartilage injuries in athletes have risen over the years and more research is needed in evaluating the successfulness of OCA transplantation in the athletic population.

Allograft augmentation in proximal humerus fractures.

OBJECTIVE: Achieve stable fixation to initially start full range of motion (ROM) and to prevent secondary displacement in unstable fracture patterns and/or weak and osteoporotic bone. INDICATIONS: (Secondarily) displaced proximal humerus fractures (PHF) with an unstable medial hinge and substantial bony deficiency, weak/osteoporotic bone, pre-existing psychiatric illnesses or patient incompliance to obey instructions. CONTRAINDICATIONS: Open/contaminated fractures, systemic immunodeficiency, prior graft-versus-host reaction. SURGICAL TECHNIQUE: Deltopectoral approach. Identification of the rotator cuff. Disimpaction and reduction of the fracture, preparation of the situs. Graft preparation. Allografting. Fracture closure. Plate attachment. Definitive plate fixation. Radiological documentation. Postoperative shoulder fixation (sling). POSTOPERATIVE MANAGEMENT: Cryotherapy, anti-inflammatory medication on demand. Shoulder sling for comfort. Full active physical therapy as tolerated without pain. Postoperative radiographs (anteroposterior, outlet, and axial [as tolerated] views) and clinical follow-up after 6 weeks and 3, 6, and 12 months. RESULTS: Bony union and allograft incorporation in 9 of 10 noncompliant, high-risk patients (median age 63 years) after a mean follow-up of 28.5 months. The median Constant-Murley Score was 72.0 (range 45-86). Compared to the uninjured contralateral side, flexion was impaired by 13 %, abduction by 14 %, and external rotation by 15 %. Mean correction of the initial varus displacement was 38° (51° preoperatively to 13° postoperatively).

Utilização da técnica de túnel para reconstrução maxilar com osso homógeno û relato de caso / Using the tunnel technique for maxillary reconstruction with homogenous bone û case report

A busca de técnicas e de materiais para reconstrução do tecido ósseo é constante. Atualmente, o osso autógeno é considerado o padrão ouro. Enxertos ósseos homógenos surgiram como alternativa, principalmente quando é necessária grande quantidade de material para enxertia e quando da impossibilidade de um segundo sítio cirúrgico. Já a técnica de tunelização modificada visa o restabelecimento da estrutura óssea, com menores danos aos tecidos e com menor tempo cirúrgico, o que não ocorre nas demais técnicas. Paciente de 64 anos, sexo masculino, apresentava reabsorção avançada da maxila e não desejava submeter-se a cirurgias em nível hospitalar e/ou remover tecido ósseo autógeno de regiões doadoras possíveis. Decidiu-se pela realização de enxertia óssea maxilar total através da Técnica de Tunelização modificada com a utilização de osso homógeno proveniente de banco de ossos. Após 10 meses da intervenção cirúrgica foi observado clínica e tomograficamente ganho ósseo considerável em altura e largura permitindo o planejamento cirúrgico para a colocação de implantes dentários. Concluiu-se que na impossibilidade do uso de osso autógeno a utilização de osso homógeno é um procedimento possível e que deve ser levado em consideração, porque possibilita uma menor morbidade devido a não necessidade de um segundo sítio cirúrgico e possibilita a obtenção de grande quantidade de material enxertivo. Já a técnica de tunelização modificada é de fácil execução permitindo menor tempo cirúrgico e pequena morbidade, o que revela o grande significado desta técnica e a importância de sua incorporação ao rol de procedimentos enxertivos já existentes...

The search for techniques and materials for reconstruction of bone tissue is constant. Currently, autogenous bone is considered the golden standard, but homogenous bone grafts have emerged as an alternative, especially when a large amount of material for grafting is needed and when a second surgical site is not viable. The modified tunnelling technique aims to restore the bone structure, with less tissue damage and lower surgical time, which is not possible through other techniques. A 64 year-old male patient had advanced resorption of the maxilla and did not want to undergo a surgery performed in a hospital and/or obtain autogenous bone tissue from possible donor regions. Thus, the choice for full maxillary bone grafting was made, and the modified tunnelling technique was applied using homogenous bone from a bone tissue bank. Ten months after surgery, a considerable bone gain, both bone height and bone width, was observed clinically and tomographically, thus allowing a better surgical planning for the placement of dental implants. Given the impossibility of obtaining autogenous bone, the use of homogenous bone is a viable alternative that should be taken into account. Not only does it enable lower morbidity, since there is no need for a second surgical site, but it also enables the acquisition of large amounts of grafting materials. Moreover, the modified tunnel technique shows a number of advantages: it is an easy, minimally invasive procedure, allowing less surgical time, and low morbidity, which demonstrates the significant importance of its incorporation into the list of existing grafting techniques...

Programa de rehabilitación de pacientes sometidos a trasplante de progenitores hematopoyéticos / Rehabilitation program of patients who have undergone hematopoietic stem cell transplantation

Introducción. La recuperación de la capacidad funcional es un objetivo terapéutico primordial, proponiéndose el ejercicio como terapia coadyuvante, para combatir los efectos del decondicionamiento físico tras el trasplante de células precursoras hematopoyéticas (TPH). Presentamos nuestro estudio con el fin de exponer nuestra experiencia con el protocolo usado en nuestra unidad dentro del enfoque integral de los pacientes sometidos a TPH. Material y métodos. Estudio descriptivo prospectivo, incluyendo a todos aquellos pacientes sometidos a TPH, en el periodo comprendido entre enero de 2011 y julio de 2012, admitidos en el protocolo realizado en nuestro servicio. Revisamos y recopilamos los datos epidemiológicos, demográficos, características de su enfermedad, grado de actividad física y funcionalidad, en un total de 50 casos registrados en nuestra base de datos. Resultados. Edad media de 48,94 años (10-66). Síndrome mielodisplásico como causa más frecuente (30,4%). Todos los pacientes sometidos a trasplante presentaron una pérdida de fuerza, medida por un descenso global medio en el balance muscular de un punto; mientras solo el 24% precisaron tratamiento rehabilitador específico, porque presentaban signos de fragilidad funcional. Todos ellos recibieron recomendaciones respecto a la actividad física y normas higienicodietéticas. La distancia capaz de recorrer se vio considerablemente disminuida, con un 45% únicamente capaz de caminar 0-500 m, frente a un 60% capaz de caminar más de 2 km pretrasplante. No se objetivó aumento de fatiga postrasplante. Conclusiones. Todos los pacientes sometidos a TPH deben participar en un programa de rehabilitación, para prevenir las consecuencias de la inmovilidad y efectos adversos del tratamiento oncohematológico(AU)

Introduction. Recovering functional capacity is a fundamental therapeutic target. Exercise is proposed as an adjuvant therapy to combat the effects of loss of physical conditioning after Hematopoietic Stem Cell Transplantation (HSCT). We present our study in order to describe our experience with the protocol having a comprehensive approach to patients subjected to HSCT which is currently being used in our unit. Material and methods. A descriptive prospective study including all patients who had undergone HSCT, admitted in the protocol from January 2011 to July 2012, was carried out. The epidemiologic and demographic data as well as characteristics of the condition, physical activity level and functionality from 50 cases recorded in the database of our unit were collected and reviewed. Results. Mean age of the sample was 48.94 years (10-66). Myelodysplastic syndrome was the most common cause (30.4%). All patients who underwent transplant showed a loss of strength, measured by a mean global decrease of 1 point in muscle balance, although only 24% required specific rehabilitation treatment due to signs of functional frailty. All of them received recommendations regarding physical activity and hygiene and diet guidelines. The distance the subjects could cover decreased considerably, 45% only being able to walk approximately 0-500 m, while 60% had been able to walk more than 2 km prior to the transplant stage. No increase in fatigue was observed after the transplant. Conclusions. All patients who undergo HSCT should participate in a physical exercise program to prevent the effects of the lack of mobility and the adverse effects of the oncological and hematological treatment(AU)

Robust revascularization, despite impaired VEGF production, after meniscus allograft transplantation in rabbits.

BACKGROUND: Little is known about vascularization restoration and vascular circulation after allogenic graft transplantation, which are both important prerequisites for optimal use of allograft meniscus transplantation. PURPOSE: To study vascularization restoration through autograft and allograft meniscus models in Oryctolagus cuniculus. STUDY DESIGN: Controlled laboratory study. METHODS: Forty-eight rabbits at mature bone age were randomized to receive either an autograft or allograft after the meniscus of the left knee was completely resected. Vascularization, blood circulation, histological characteristics of the grafted meniscus and surrounding tissues, and vascular endothelial growth factor (VEGF) expression in the meniscus were assessed at 4, 8, and 12 weeks after allograft or autologous transplantation. RESULTS: The grafted meniscus was in good condition and was well connected to the surrounding joint capsule, and no obvious damage of the joint cartilage at the tibial plateau was observed. Even though the revascularization pattern was similar in the 2 groups, the meniscus body showed vessel growth mainly at the adhesion margin for less than one-third of the meniscus transverse diameter, and no significant vascular distribution was found at the free margin. Blood circulation peaked after 8 weeks at the anterior and posterior horns and declined thereafter. This was mimicked by VEGF expression, which showed a progressive decrease with time, even though the vascular endothelial cells gradually increased over time. There were no statistical differences in the various assessments between the allograft and autograft groups. CONCLUSION: At 12 weeks after meniscus allografting, the vascular circulation had almost recovered and gradual reconstruction of cells and fibers had begun, mimicking similar observations in the autograft group. CLINICAL RELEVANCE: Our data provide test reference for clinical rehabilitation after meniscus autograft.

Reconstrução pélvica com aloenxerto ósseo após excisão de tumor / Pelvic reconstruction with allogeneic bone graft after tumor resection

Objetivos: A reconstrução pélvica após excisão de tumor é um desafio. Métodos: realizou-se um estudo retrospectivo para comparar os desfechos entre pacientes submetidos a cirurgia de reconstrução da pelve com aloenxerto ósseo após excisão em bloco de tumores pélvicos e pacientes submetidos apenas à excisão. Resultados: os pacientes sem reconstrução tiveram escores funcionais significantemente menores 3 meses (10 vs. 15, P = 0,001) e 6 meses após a cirurgia (18,5 vs. 22, P = 0,0024), menor tempo de hospitalização (16 dias vs. 40 dias, P < 0,001) e menor custo hospitalar (97.500 vs.193.000 yuans, P < 0,001) do que os que foram submetidos a reconstrução pélvica. Os escores funcionais foram similares 12 meses depois da cirurgia (21,5 vs. 23, P = 0,365) sem diferença na taxa de complicações entre os dois grupos (P > 0,05). Conclusões: A reconstrução pélvica com aloenxerto ósseo depois de cirurgia de tumores pélvicos é associada a desfechos cirúrgicos e funcionais satisfatórios. Outros estudos clínicos são necessários para explorar como selecionar o melhor método de reconstrução. Nível de Evidência IV, Séries de Casos.

Objectives: Pelvic reconstruction after tumor resection is challenging. Methods: a retrospective study had been performed to compare the outcomes between patients undergoing reconstructive surgery of the pelvis with allogeneic bone graft after en bloc resection of pelvic tumors and patients undergoing en bloc resection only. Results: Patients without reconstruction had significantly lower functional scores at 3 months (10 vs. 15, P = 0.001) and 6 months after surgery (18.5 vs. 22, P = 0.0024), a shorter duration of hospitalization (16 days vs. 40 days, P < 0.001), and lower hospital costs (97,500 vs. 193,000 RMB, P < 0.001) than those undergoing pelvic reconstruction. Functional scores were similar after 12 months of surgery (21.5 vs. 23, P = 0.365) with no difference in the rate of complications between the two groups (P > 0.05). Conclusions: pelvic reconstruction with allogeneic bone graft after surgical management of pelvic tumors is associated with satisfactory surgical and functional outcomes. Further clinical studies are required to explore how to select the best reconstruction method. Level of Evidence IV, Case Series.

[Experimental study on protective effect of early motion on articular cartilage after joint allograft].

OBJECTIVE: To investigate the protective effect of early motion on articular cartilage after joint allograft by performing a controlled trial between different post-operation strategies after joint allograft in an animal model. METHODS: Twenty hemi-knee joints were harvested from 10 6-month-old New Zealand white rabbits (male or female, weighing 2.5-3.0 kg); 10 hemi-knee joints by deep frozen treatment (donors) were transplanted to unilateral knee joints (recipients) of 10 6-month-old Chinchilla rabbits (male or female, weighing 2.5-3.0 kg), which were divided into early motion group (n = 5) and sustained fixation group (n = 5); and 10 hemi-knee joints were used as blank control (n = 5) and frozen control (n = 5). The articular cartilage of allogenic joints was detected by X-ray film, gross, and histology at 6 weeks after operation. RESULTS: Gross observation: no obvious limitation of joint movements was observed in early motion group, but obvious limitation in sustained fixation group. X-ray films: the bone ends between donor and recipient healed well with good para position and alignment on the operation day and 2 weeks after operation; at 6 weeks, angulation deformity was observed in early motion group of 3 rabbits, and para position and alignment were satisfactory in sustained fixation group. Histological observation: HE staining showed that the chondrocytes had normal quantity and morphology with few nuclear fragmentation and karyolysis in early motion group, but the quantity of chondrocytes sharply decreased with dissolved nuclei and numerous fibrous tissues in the cartilage matrix in sustained fixation group. The cell survival rate of the early motion group (49.66% +/- 2.15%) was significantly higher than that of the sustained fixation group (20.68% +/- 1.24%) (P < 0.05). Scanning electron microscopy observation: nuclear membrane was intact with chromatin condensation and edema of mitochondria and rough surfaced endoplasmic reticulum in early motion group, and that the membrane of chondrocyte vanished with blurring border between chondrocyte and matrix, rupture of nuclear membrane and the disappearance of chromatin and organelles could be found in sustained fixation group. CONCLUSION: Early motion has protective effect on articular cartilage after joint allograft, but cannot completely prevent degeneration of the allogenic articular cartilage.

The impact of early rehabilitation on the duration of hospitalization in patients after allogeneic hematopoietic stem cell transplantation.

BACKGROUND: We examined the relationship between the improved physical activity by early rehabilitation and the duration of hospitalization among patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: Thirteen allo-HSCT patients with myeloablative conditioning regimens (group A) and 13 patients with nonmyeloablative conditioning regimens (group B) were assessed retrospectively in this study. All patients received physical exercise immediately after neutrophil engraftment at the class 10,000 bioclean room (class 10,000). The mean daily steps at class 10,000 were measured as a substitute for the amount of physical activity, and the duration of hospitalization as one of the clinical outcomes. RESULTS: The degree of physical activity showed a negative correlation with the duration of hospitalization in group A (r = -.71; P = .0071), regardless of complications such as acute graft-versus-host disease, infections, and cytomegalovirus reactivation. However, there was no significant association in group B (r = .09; P = .77). CONCLUSION: The improved physical activity through early rehabilitation may be an independent, favorable prognostic factor for allo-HSCT patients with myeloablative conditioning regimens.

Primary ACL reconstruction using allograft tissue.

While bone-patellar tendon-bone (BPTB) autograft continues to be the "gold standard" and most popular graft choice for primary anterior cruciate ligament (ACL) reconstructions, the use of allograft tissues in ACL reconstruction has steadily increased over the last 2 decades. Advantages of allograft include a lack of donor-site morbidity, unlimited available sizes, shorter operative times, availability of larger grafts, smaller incisions, improved cosmesis, lower incidence of postoperative arthrofibrosis, faster immediate postoperative recovery, and less postoperative pain. Disadvantages include the potential for disease transmission and prolonged graft healing. Presented in this article are 2 techniques used at the authors' institution for primary ACL reconstruction with allograft. With the proper indications, knowledge of graft preparation and handling, and technique, allograft tissues in ACL reconstructions can provide the surgeon with clinical results equal to those of autograft reconstructions.

Composite tissue allotransplantation: a proposed classification system based on relative complexity.

Numerous achievements have been made encompassing a wide array of composite tissue allograft (CTA) subtypes. We sought to develop a simple, reproducible CTA classification system for the purpose of comparing clinical investigation. Each CTA subtype differs in relative complexity and can therefore be theoretically classified based on its unique combination of multiple factors. Eight complexity factors (CFs) are hypothesized: anatomic detail, psychological obstacles, rejection risk, required rehabilitation, relative antigenicity, functionality/cosmesis, skin ratio, and salvageability. A distribution of total complexity scores, ranging from 8 to 24, is classified into 3 ordered categories representing varying degrees of complexity. In conclusion, we have created a new classification system so that ongoing research and future data may be compared in a type-specific fashion.

A detailed comparison of the functional outcome after midforearm replantations versus midforearm transplantation.

OBJECTIVES: The functional outcome after midforearm transplantation (HT) is believed to be similar to the outcome after replantation. However, the few existing reports comparing functional outcomes are based on amputations at the level of the distal forearm. This report provides a comparative analysis of the functional results after midforearm replantation (HR) versus HT. MATERIALS AND METHODS: Transplantation of a dominant right forearm performed in a 32-year-old man was compared to the outcomes after five dominant (right) forearm replantations (four men and one woman) in patients ranging from 22 to 38 years of age. Cold ischemia time ranged from 6 to 12.5 hours in all cases. We used similar operative technique and rehabilitation protocol. At 26 (+/-2) months after replantation/transplantation, we recorded, bony union (x-ray), arterial flow (ultrasonography), range of motion, grip strength, sensation (2 PD Weisensten's filaments), quality of life (DASH, 30-150 points), general evaluation of function according to Chen's or the IRHCTT scoring system. RESULTS: A complication of wound infection was observed in one HR patient; Marginal skin necrosis accompanied by prolonged wound healing, in one HT patient. Unification of bones was achieved faster after forearm replantation when compared with transplantation. Grip strength was 17% greater after replantation, but ranges of motion were comparable in both groups. Sensitivity was superior after forearm transplantation (2 PD 15 mm) and overall patient satisfaction was comparable (90 points of DASH questionnaire for HR versus 108 points for HT patients). None of the patients returned to their previous occupations. CONCLUSION: The functional outcome after HT was comparable, and in some respects superior, to the outcome after replantation performed at the midforearm level.

Fresh cortical autograft versus fresh cortical allograft effects on experimental bone healing in rabbits: radiological, histopathological and biomechanical evaluation.

Bone grafting is used to enhance healing in osteotomies, arthrodesis, and multifragmentary fractures and to replace bony loss resulting from neoplasia or cysts. They are source of osteoprogenitor cells and induce bone formation and provide mechanical support for vascular and bone ingrowth. Autografts are used commonly but quantity of harvested bone is limit. This study was designed to evaluate fresh cortical autograft and allograft effects on bone healing process. Twenty male White New Zealand rabbits were used in this study. In autograft group the defect was filled by fresh autogenous cortical graft, in allograft group the defect was filled by a segment of fresh allogenous cortical bone which was harvested at the time of surgery during the creation of radius bone defect. Then all surface soft tissue, such as muscle attachments, were removed from the harvested bone and changed between rabbits as a fresh allogenous cortical bone graft and was fixed by cercelage wire. Radiological, histopathological and biomechanical evaluations were performed blindly and results scored and analyzed statistically. Statistical tests did not support significant differences between two groups at the 14th and 56th postoperative day radiographically (P > 0.05). There was a significant difference radiologically for the 28th and the 42nd postoperative (P < 0.05). Autograft was superior to allograft at the 28th and 42nd postoperative day in radiological evaluation (P < 0.03). Histopathological and biomechanical evaluation revealed no significant differences between two groups.

The use of unicondylar osteoarticular allografts in reconstructions around the knee.

Unicondylar osteoarticular allografts (UOA) of the knee are mainly used after bone tumour resections for benign aggressive tumours or small malignant tumours with clearly defined margins. They are also used less often in large posttraumatic condylar defects. Between 1989 and 2004, 12 deep-frozen UOA reconstructions (in 11 patients) were performed at our Institute. The diagnosis was chondrosarcoma in four cases, giant cell tumour in three, osteosarcoma in three, posttraumatic defect in one, and one failed UOA. The involved site was the medial femoral condyle in six cases, the lateral femoral condyle in three, the medial side of the tibial plateau in two, and the lateral in one case. One allograft was removed after 29 months because of an intra-articular displaced fracture, and substituted with a new UOA. One patient died of metastatic disease at 24 months. We report the functional and radiographical outcome of the remaining 10 UOAs with a minimum follow-up of 4 years (average 11 years). Two of the 10 patients had excellent results, five were good and three were fair. Radiographically, five patients had "mild" and five had "severe" degenerative changes. One patient with severe degenerative changes had pain and stiffness, therefore the UOA was converted into a prosthesis allograft composite, using a conventional total knee prosthesis. In selected cases of distal femoral and proximal tibial tumours, UOA reconstructions give good functional outcomes with relatively few major complications.

Dez anos de experiência com a substituição da valva aórtica com homoenxertos valvares aórticos implantados pela técnica da substituição total da raiz / Ten years experience of aortic valve replacement with aortic homograft root replacement

OBJETIVO: Avaliar os resultados imediatos e tardios de 10 anos da substituição da valva aórtica por homoenxertos valvares aórticos implantados pela técnica de substituição total da raiz, e identificar eventuais fatores de risco correlacionados com a degeneração tecidual primária dos enxertos. MÉTODO: Entre maio/1995 e janeiro/2006, 282 pacientes com média de idade de 52,8±16,6 anos foram submetidos à substituição da valva aórtica com homoenxertos valvares. As etiologias prevalentes foram a valva aórtica bicúspide calcificada e a degeneração senil em 49 por cento dos casos. Quarenta e sete pacientes eram reoperações e 26 tinham endocardite bacteriana aguda. Procedimentos associados foram realizados em 113 pacientes. O homoenxerto valvar foi implantado pela técnica de substituição total da raiz em todos os casos. O tempo de seguimento pós-operatório variou de 1 a 129 meses (média = 41±25 meses). RESULTADOS: A mortalidade imediata foi de 7 por cento, sendo de apenas 2,6 por cento nos casos de operação eletiva para a substituição isolada da valva aórtica. Dos 262 que receberam alta hospitalar, foi possível obter avaliação clínica e/ou ecocardiograma em 209 deles, sendo 51 (20 por cento) perdidos durante o seguimento. Houve 17 óbitos tardios, entre o 2° e 81° meses de pós-operatório, o que resultou em curva atuarial de sobrevida global de 90 por cento e 80,1 por cento aos 5 e 10 anos de evolução, respectivamente. Foram observados apenas oito episódios tromboembólicos (quatro imediatos e quatro tardios), durante a evolução para uma incidência linearizada de 0,3 por cento/100 pacientes/ano. Endocardite bacteriana ocorreu em três ocasiões (0,4 por cento/100 pacientes/ano). Nove pacientes foram reoperados, dos quais apenas três por problemas no homoenxerto (uma degeneração tecidual e dois casos de endocardite), o que resultou numa probabilidade de 94 por cento livres dessa complicação aos 10 anos de seguimento. A análise do ecocardiograma...

OBJECTIVE: To evaluate the imediate and late results of 10 years of aortic valve root replacement with aortic homografts and to identify possible risk factors related with homograft primary tissue failure. METHODS: Between May 1995 and January 2006, 282 patients with a mean age of 52.8±16.6 years were submitted to aortic valve root replacement with an aortic homografts. The most prevalent etiologies were calcified bicuspid aortic valves and senile degeneration, corresponding to 49 percent of the cases. Forty-seven patients were reoperations and acute bacterial endocarditis were present in 26. Associated procedures were necessary in 113 patients. The homograft was implanted as a root replacement in all. Follow-up time varied between 1 and 129 months (mean= 41±25 months). RESULTS: Early overall mortality was 7 percent, with only 2.6 percent for cases of aortic valve replacement in isolation. Of the 262 patients discharged from hospital, it was possible to obtain clinical and echocardiographic evaluations in 209. Fifty-one patients (20 percent) were lost in the follow-up. There were 17 late deaths between the 2nd and 81st postoperative months, which resulted in an actuarial survival rate of 90 percent and 80.1 percent at 5 and 10 years respectively. There were eight thromboembolic events (four early and four late), for a linearized incidence of 0.3 percent events/100 patients/year. Bacterial endocarditis occurred in three occasions (0.4 percent/100 patients/year). Nine patients were re-operated, of which only three were related to the homograft (one case of primary tissue failure and two of bacterial endocarditis), corresponding to a probability of 94 percent of the patients free from this complication at 10 years of follow-up. Late echocardiographic analysis demonstrated maximum gradients varying between 3 and 47 mmHg (mean= 14.5 mmHg), with only two patients having a maximum gradient greater than 40 mmHg. Moderate valvar...

Allograft reconstruction for massive, irreparable rotator cuff tears.

BACKGROUND: There is currently no widely accepted treatment for massive, irreparable rotator cuff tears. HYPOTHESIS: Allograft reconstruction to span the remaining defect in massive, irreparable rotator cuff tears will lead to increased functional results and will demonstrate healing of the allograft on follow-up magnetic resonance imaging studies. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1989 and 2003, 32 patients underwent allograft reconstruction of massive rotator cuff tears. University of California, Los Angeles shoulder scores were compared preoperatively and postoperatively and analyzed using paired Student t tests. In addition, 15 patients underwent postoperative magnetic resonance imaging to evaluate the structural integrity of the allograft reconstruction at the greater tuberosity insertion. RESULTS: Of 32 patients, 28 were available for review at a mean follow-up of 31.3 months; 23 of the 28 patients were satisfied with their outcome. There was 1 postoperative infection and 1 acute allograft rejection. The mean University of California, Los Angeles score increased from 12.1 preoperatively to 26.1 postoperatively (P < .001). All 15 patients evaluated with postoperative magnetic resonance imaging arthrograms demonstrated complete radiographic failure of the allograft rotator cuff reconstruction. Despite radiographic failure, the mean University of California, Los Angeles score increased from 13.2 preoperatively to 28.3 postoperatively in this subset of patients. CONCLUSION: The functional results of this reconstruction method are similar to those reported for debridement and subacromial decompression alone and are satisfactory, despite magnetic resonance imaging arthrogram evaluation demonstrating failure of the structural integrity of the allograft. Allograft reconstruction carries increased risk of infection and rejection and is technically more difficult than other less expensive treatment options with similar functional results. Therefore, we do not recommend allograft reconstruction of massive and otherwise irreparable rotator cuff tears.

Aloinjerto masivo del aparato extensor de la rodilla / Massive allograft of the knee extensor mechanism

Se presenta un caso de rotura antigua del tendón rotuliano de la rodilla derecha, en una paciente de 49 años de edad afecta de una artritis reumatoide seropositiva de 20 años de evolución. Quince meses después de la rotura acude a nuestra consulta por primera vez, en silla de ruedas, refiriendo que durante todos estos meses presenta una impotencia funcional absoluta para la extensión de la rodilla que le impide la marcha. Fue intervenida quirúrgicamente realizándole un aloinjerto masivo del aparato extensor de la rodilla rótula tendón rotuliano - tuberosidad tibial. Tras una evolución postoperatoria de tres años, la paciente camina prácticamente normal y presenta una movilidad de la rodilla de 120° de flexión con una extensión activa de -20° y pasiva completa. En los estudios radiográficos se comprueba la plena osteointegración del aloinjerto (AU)

Trasplante meniscal con aloinjerto: estado actual / Meniscal allograft implants: state of the art

La cirugía meniscal ha sufrido un cambio radical en los últimos veinticinco años. La ausencia de los meniscos conduce casi invariablemente a la artrosis precoz. Actualmente se preconiza la reparación meniscal como primera aproximación al problema, aunque, como no siempre es posible, se están estudiando y empleando técnicas de implantes meniscales con materiales sustitutivos y de trasplante meniscal con aloinjerto. Este artículo es una revisión bibliográfica del estado actual en que se encuentra el trasplante de menisco con aloinjerto. (AU)