scholarly journals Polyurethane scaffold for the treatment of partial meniscal tears. Clinical results with a minimum two-year follow-up

Joints ◽  
2013 ◽  
Vol 01 (04) ◽  
pp. 161-166 ◽  
Author(s):  
Paolo Bulgheroni ◽  
Erica Bulgheroni ◽  
Gianmarco Regazzola ◽  
Claudio Mazzola
Keyword(s):  
Lateral Meniscus ◽  
Case Series ◽  
Collagen Scaffold ◽  
Good Alternative ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Second Look ◽  
Hyperintense Signal ◽  
Meniscal Scaffold

Purpose: to evaluate the safety and effectiveness of the polyurethane meniscal scaffold through clinical examination, MRI and arthroscopic second look, over a minimum two-year follow-up. Methods: between 2009 and 2011, 19 patients underwent meniscal scaffold implantation in our department (medial meniscus in 16 cases lateral meniscus in two cases, and bilateral in one case). All the patients were clinically evaluated preoperatively, and at 6, 12, and 24 months after surgery using Lysholm score, Tegner score, and VAS. Ten patients were studied with MRI, and nine patients were evaluated arthroscopically. Results: no adverse reactions to the implant were observed. The clinical scores showed a significant improvement at 6 months and increased progressively over time. On MRI studies, the implants showed a clear hyperintense signal, sometimes irregular, and the chondral surface was preserved in all cases. At arthroscopic second look in the first months after surgery, the scaffold size was unchanged and the scaffold appeared light yellowish in color and well integrated into the surrounding tissues. At arthroscopic second look at 12 and 24 months the scaffold was found to have an irregular morphology and to be slightly reduced in size. Conclusions: polyurethane meniscal scaffold is a good alternative to a collagen scaffold, but a longer follow-up is needed to evaluate the scaffold degradation and chondral coverage. Level of Evidence: level IV, therapeutic case series.

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

2021 ◽  
pp. 036354652110591
Author(s):  
Joo-Hwan Kim ◽  
Dong Jin Ryu ◽  
Sung-Sahn Lee ◽  
Seung Pil Jang ◽  
Jae Sung Park ◽  
...  
Keyword(s):  
Case Series ◽  
Preoperative Assessment ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Valgus Instability

Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.

scholarly journals Preliminary Experience Using Bioactive Glass Wedges for Cotton Osteotomy

2018 ◽  
Vol 3 (4) ◽  
pp. 247301141879686
Author(s):  
Tood Borenstein ◽  
Tyler Gonzalez ◽  
Janet Krevolin ◽  
Bryan Den Hartog ◽  
David Thordarson
Keyword(s):  
Bioactive Glass ◽  
Case Series ◽  
Clinical Results ◽  
Delayed Union ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Radiographic Outcomes ◽  
Initial Correction

Background: Medial cuneiform dorsal opening wedge (Cotton) osteotomy is often used for treating forefoot varus in patients undergoing surgery for stage II posterior tibialis tendon dysfunction. The goal of this study was to examine the radiographic outcomes of Cotton osteotomy with bioactive glass wedge to assess for both maintenance of correction and clinical results and complications. We hypothesized that bioactive glass wedges would maintain correction of the osteotomy with low complication rates. Methods: Between December 2015 and June 2016, the charts of 17 patients (10 female and 7 male) who underwent Cotton osteotomy using bioactive glass wedges were retrospectively reviewed. Patient age averaged 56.8 years (range, 16-84). The average follow-up was 6.5 months. Radiographs were reviewed to assess for initial correction and maintenance of correction of medial column sag as well as for union. Charts were reviewed for complications. Results: The medial column sag correction averaged 15.6% on the final postoperative lateral radiograph. Meary angle averaged 19 degrees (3.14-42.8 degrees) preoperatively and 5.5 degrees (0.4-20.7 degrees) at final follow-up. All patients achieved clinical and radiographic union. One patient developed neuropathic midfoot pain and was managed with sympathetic blocks. One patient had a delayed union that healed at 6 months without surgical intervention. No patients required the use of custom orthotics or subsequent surgical procedures. Conclusion: Cotton osteotomy with bioactive glass wedges produced consistent correction of the medial column with low risk. Level of Evidence: Level IV, case series.

Popliteomeniscal Fascicle Tears Causing Symptomatic Lateral Compartment Knee Pain

2005 ◽  
Vol 33 (8) ◽  
pp. 1231-1236 ◽  
Author(s):  
Robert F. LaPrade ◽  
Brian K. Konowalchuk
Keyword(s):  
Physical Examination ◽  
Knee Pain ◽  
Open Repair ◽  
Lateral Meniscus ◽  
Case Series ◽  
Lateral Compartment ◽  
Level Of Evidence ◽  
Arthroscopic Examination ◽  
Examination Techniques

Background Injuries to the popliteomeniscal fascicles of the lateral meniscus are difficult to identify from physical examination and magnetic resonance imaging scans. To our knowledge, there have been no described physical examination techniques to identify symptomatic isolated popliteomeniscal fascicle tears. The popliteomeniscal fascicles have been demonstrated to be important for lateral meniscus stability, and it has been reported that tears can lead to painful symptoms. Hypothesis Popliteomeniscal fascicle tears cause symptomatic lateral compartment knee pain and can be diagnosed by physical examination. Surgical repair can improve patient function. Study Design Case series; Level of evidence, 4. Methods Six patients with isolated tears of the popliteomeniscal fascicles, which caused lateral joint line knee pain, were identified by positive figure-4 test results. Results All patients were found to have replication of their symptoms while placing the affected knee in the figure-4 position and were found to have lateral meniscal hypermobility due to tears of the popliteomeniscal fascicles on arthroscopic examination. All patients had an open repair of the popliteomeniscal fascicles of the lateral meniscus with complete resolution of their symptoms at a mean follow-up of 3.8 years postoperatively. Conclusions The figure-4 test was found to be useful in identifying the source of lateral compartment knee pain due to popliteomeniscal fascicle tears. Open repair of isolated popliteomeniscal fascicle tears was also found to be effective in resolving lateral compartment knee pain due to popliteomeniscal fascicle tears.

scholarly journals Bipolar fresh osteochondral allograft of the shoulder

Joints ◽  
2013 ◽  
Vol 01 (04) ◽  
pp. 150-154 ◽  
Author(s):  
Sandro Giannini ◽  
Elisa Sebastiani ◽  
Alba Shehu ◽  
Matteo Baldassarri ◽  
Susanna Maraldi ◽  
...  
Keyword(s):  
Constant Score ◽  
Case Series ◽  
Clinical Results ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Fresh Osteochondral Allograft ◽  
Post Traumatic ◽  
Glenohumeral Osteoarthritis ◽  
End Stage

Purpose: to describe an original technique and preliminary results of bipolar fresh osteochondral allograft implantation for the treatment of end-stage glenohumeral osteoarthritis. Methods: three patients underwent bipolar fresh osteochondral allograft implantation to the shoulder. Clinical and radiographical evaluations were carried out periodically through to final follow-up. Results: constant Score increased from 38.3 ± 2.9 preoperatively to 78.7 ± 16.2 at 12 months, 72.3 ±15.3 at 24 months, and 59.3 ± 22.0 at 34 months. Arthritis and partial reabsorption of the implanted surfaces were evident radiographically. Conclusions: the clinical results obtained in these patients seem to support the applicability of bipolar fresh osteochondral allograft implantation in the shoulder in subjects with severe post-traumatic arthritis and intact rotator cuff. The development of arthritis of the implanted surfaces, while not impacting the clinical result, is a cause of concern. Level of Evidence: level IV, therapeutic case series.

Resection-Induced Leveling of Elevated Plug Cartilage in Osteochondral Autologous Transplantation of the Knee Achieves Acceptable Clinical Results

2017 ◽  
Vol 46 (3) ◽  
pp. 617-622 ◽  
Author(s):  
Kohei Nishitani ◽  
Yasuaki Nakagawa ◽  
Shinichiro Nakamura ◽  
Shogo Mukai ◽  
Shinichi Kuriyama ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Japanese Orthopaedic Association ◽  
Autologous Transplantation ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Second Look ◽  
Osteochondral Autologous Transplantation

Background: Plug protuberance occasionally occurs in osteochondral autologous transplantation (OAT). The incongruity of plugs results in poor clinical outcomes, especially in cases of protuberance. However, a surgical procedure to deal with this problem has not been reported. Purpose/Hypothesis: The purpose was to evaluate the efficacy and safety of cartilage resection of elevated plugs, with the hypothesis that patients whose elevated plugs were resected and leveled would achieve clinical outcomes equivalent to those of patients with flush plugs. Study Design: Cohort study; Level of evidence, 3. Methods: Cases (group P) included 22 patients who underwent OAT of the knee and whose plugs showed protuberance greater than 1 mm that was resected with a scalpel to obtain smooth congruity, while controls (group C) included 22 background-matched patients who did not require plug resection. The International Knee Documentation Committee (IKDC) subjective score, IKDC objective grade, and Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were used preoperatively and at the final follow-up (mean ± SD, 49.3 ± 18.1 months). International Cartilage Repair Society (ICRS) Cartilage Repair Assessment was used to evaluate lesion healing during the second-look arthroscopy. Results: IKDC subjective scores of group C (82.5 ± 11.8) and group P (82.1± 15.1) showed no difference at the final follow-up. On postoperative IKDC objective grading, 86% of group C and 82% of group P patients were graded as “nearly normal” or better ( P = .639). The mean JOA knee scores of group C (90.9 ± 8.9) and group P (90.1 ± 9.5) did not differ significantly ( P = .647). Nine second-look arthroscopies were performed in group C versus 8 in group P, and all patients had plugs that were graded as “nearly normal” or better by the ICRS Cartilage Repair Assessment. Larger plugs tended to be used in those patients who required resection. Conclusion: Resection of the elevated plug surface did not negatively affect patient outcomes in the midterm follow-up period.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction

2018 ◽  
Vol 39 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Kar Hao Teoh ◽  
Kartik Hariharan
Keyword(s):  
Minimally Invasive ◽  
Callus Formation ◽  
Case Series ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Average Improvement ◽  
The Mean

Background: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. Methods: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). Results: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. Conclusion: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. Level of Evidence: Level IV, retrospective case series.

Joint Preservation Surgery for Varus Ankle Arthritis with Large Talar Tilt

2021 ◽  
pp. 107110072110272
Author(s):  
Chul Hyun Park ◽  
Ji Beom Kim ◽  
Jaeyoung Kim ◽  
Young Yi ◽  
Woo-Chun Lee
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Posterior Tibial Tendon ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Joint Preservation ◽  
Small Series ◽  
Talar Tilt

Background: Varus ankle arthritis with large talar tilt (TT) is a challenging condition when considering joint preservation surgery. Three-dimensional deformity of the talus has been demonstrated with weightbearing computed tomography in varus ankle arthritis with large TT. The aim of this study was to investigate the clinical and radiographic results of posterior tibial tendon (PTT) transfer generally combined with bony realignment for varus ankle arthritis with large TT in nonparalytic ankle arthritis and to determine the indications for PTT transfer. Methods: This study includes 23 ankles with varus arthritis and TT larger than 7.5 degrees. Patients were categorized into improved (19 ankles) and unimproved (4 ankles) groups according to the postoperative clinical results at the last follow-up. Clinical and radiographic results were compared between the groups. A cut-off point for preoperative TT that indicated a borderline between improved and unimproved groups was determined to suggest the appropriate indication for joint preservation surgery. Results: In the improved group, TT, radiographic stage, Meary angle, and hindfoot alignment significantly improved at 6 months after surgery and were maintained at the last follow-up. In the unimproved group, the radiographic parameters mentioned above did not improve at 6 months after surgery, and TT decreased to 0.8 degrees as radiographic stage had progressed to end-stage arthritis at the last follow-up. In this small series, the cut-off point for predicting failure of surgery was 14.3 degrees of preoperative TT. Conclusion: PTT transfer often combined with bony realignment procedures may be a reasonable option for treating painful varus ankle arthritis with TT less than 14 degrees and hindfoot varus. Level of Evidence: Level IV, case series.

Results of Trabecular-Metal Total Ankle Arthroplasties With Transfibular Approach

2019 ◽  
Vol 41 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Hannu Tiusanen ◽  
Sami Kormi ◽  
Ia Kohonen ◽  
Mikhail Saltychev
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Total Ankle Arthroplasty ◽  
Trabecular Metal ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Functional Scores ◽  
Component Loosening ◽  
And Function

Background: Total ankle arthroplasty is an alternative for arthrodesis. The objective of this study was to investigate the safety of trabecular-metal ankle prosthetic system with transfibular approach and external frame and its association with changes in clinical and functional scores. Methods: Between May 2013 and June 2017, a total of 104 consecutive patients underwent primary total ankle arthroplasty with a trabecular metal implant. The prospective clinical and radiographic data were collected. The mean follow-up time was 43.6 (14.6) months. Results: Of 104 patients, 88 (89%) reported improved functioning and 65 (66%) were very satisfied with the surgery. Of the patients, 51 (50%) did not report any pain at the end of follow-up at all. The average Kofoed score was 37.6 (SD 17.4) points at baseline and 74.8 (SD 20.6) points at the end of follow-up. There were 37 additional procedures, and the complication rate was nearly 20%. Conclusion: Trabecular-metal total ankle prosthesis showed promising clinical results concerning pain and function. At 5-year follow-up, osteolysis and component loosening were rare. Level of Evidence: Level IV, case series.

scholarly journals The Use of a Bio-Inductive Collagen Patch to Supplement Repair of Large and Massive Rotator Cuff Tears Including Revisions: Clinical and Radiographic Outcomes at 2-year Follow Up

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Stephen Thon ◽  
Lawrence K. O’Malley ◽  
Michael John O’Brien ◽  
Felix H. Savoie
Keyword(s):  
Rotator Cuff ◽  
Case Series ◽  
Collagen Scaffold ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Massive Rotator Cuff Tears ◽  
Radiographic Outcomes ◽  
Early Results ◽  
Tendon Thickness

Objectives: Failures of large, massive, and revision rotator cuff repairs is a challenging problem within orthopedics. Poor tendon tissue and vascularity are known causes for failure of rotator cuff repairs. The purpose of this study was to assess the outcomes and healing rates when large and massive rotator cuff repairs are augmented with a bio-inductive collagen scaffold patch. Methods: Twenty-three patients undergoing repair of large (two tendon) or massive (three tendon) rotator cuff tears augmented with a bio-inductive collagen patch were followed prospectively for 2 years. Postoperative ultrasound (US) assessed tendon thickness at 3, 6, 12, and 24 months. MRI was utilized to confirm healing and tendon thickness at least 6 months post-operatively. Results: 16 of 23 patients had previous failed rotator cuff repairs. Eleven patients had large rotator cuff tears while twelve patients had massive rotator cuff tears. 21 of 23 patients successfully healed their rotator cuff repairs and new tissue formation was appreciated in all 23 patients. Ultrasound rotator cuff thickness ranged from 4.5-9mm at most recent follow-up. Overall, a 91% (21/23) success rate was confirmed on US and MRI. Conclusion: Clear indications for the use of this bio-inductive collagen scaffold have yet to be established. Our results show that it may have utility in improving the healing rates of large and massive rotator cuff repairs. New tendon formation was apparent on both US and MRI with relatively high healing rates at two years. While these early results are promising, long term-follow up is needed to identify the proper indications for its use. Level of Evidence:: Level IV - Case series.

Combined Posteromedial and Posterolateral Approaches for 2-Part Posterior Malleolar Fracture Fixation

2020 ◽  
Vol 41 (10) ◽  
pp. 1234-1239 ◽  
Author(s):  
Yunfeng Yang ◽  
Wenbao He ◽  
Haichao Zhou ◽  
Jiang Xia ◽  
Bing Li ◽  
...  
Keyword(s):  
Case Series ◽  
Good Alternative ◽  
Retrospective Case ◽  
Malleolar Fracture ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
The Mean ◽  
Mean Time

Background: This study investigated the clinical efficacy of combined posteromedial and posterolateral approaches for repair of 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Methods: This case series report included 27 Weber B with Haraguchi type II patients with medial and lateral malleolar fractures combined with 2-part posterior malleolar fractures. Patients were treated with open reduction and internal fixation through a combination of posteromedial and posterolateral approaches from January 2015 to January 2018. There were 11 males and 16 females, with an average age of 61.5 years (range, 53-67 years). The procedures were performed on prone patients under spinal anesthesia. The medial, lateral, and posterior malleolar fractures were exposed through posteromedial and posterolateral approaches performed at the same time. The lateral malleolar fracture was fixed using a plate, the medial malleolar fracture was fixed using screws, and the posterior malleolar fracture was fixed using a plate or cannulated screws according to the size of the fragments. We performed follow-up on 22 patients for an average of 30 months (range, 18-48 months). Results: Primary healing of the incisions was achieved in all cases, and no infection was found. The mean time of bone union was 12.5 weeks (range, 10-15 weeks). The mean time from the operation to full weightbearing was 13 weeks (range, 11-16 weeks). We used the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale to score patient outcomes; the mean score was 85.4 (range, 80-92) at the final follow-up. No significant pain was found at the final follow-up. Conclusion: This study showed that satisfactory outcomes were achieved with combined posteromedial and posterolateral approaches. Therefore, we believe this approach was a good alternative strategy to repair 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Level of Evidence: Level IV, retrospective case series.

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