An update on osteochondritis dissecans of the knee.

Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is indicated in young, active patients who have knee pain and/or effusion, to make an early diagnosis and decide about treatment, according essentially to the MRI stability signs. The choice of treatment should be also tailored, based on the patient's skeletal maturity, as well as the size and location of the lesion. Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion. Stable lesions with intact articular cartilage may be treated by drilling of the subchondral bone aiming to stimulate vascular ingrowth and subchondral bone healing. Every attempt should be made to retain the osteochondral fragment when possible. Instable lesions should be fixed or "replaced" with salvage procedures to prevent the onset of early osteoarthritis in this young population. Furthers studies are needed to improve the knowledge and optimizing non-operative and surgical treatment and to develop noninvasive diagnostic tools to predict with more accuracy the fragment's stability.

Micro-fragmented stromal-vascular fraction plus microfractures provides better clinical results than microfractures alone in symptomatic focal chondral lesions of the knee.

PURPOSE: To evaluate clinical outcomes over a 1-year period in patients affected by symptomatic focal chondral lesions of the knee treated with micro-fragmented stromal-vascular fraction plus microfractures compared to microfractures alone. METHODS: Two groups of 20 patients were arthroscopically treated with microfractures for a symptomatic focal chondral defect of the knee. At the end of surgery, in the experimental group, micro-fragmented stromal-vascular fraction was injected into the joint. Primary end point was WOMAC score at 12 months. Secondary end points were any adverse events, Oxford Knee Score, EQ-5D score, VAS for pain, analgesic and anti-inflammatory consumption. RESULTS: All the patients were evaluated at 12-month follow-up. No adverse reactions were noted. Analgesic and anti-inflammatory consumption was similar in both groups. At 1-month follow-up, no differences were noted between groups when compared to pre-operative scores. At 3-month follow-up, patients in both groups improved from the baseline in all variables. Significantly lower VAS scores were found in the experimental group (4.2 ± 3.2 vs. 5.9 ± 1.7, p = 0.04). At 6- and 12-month follow-ups, patients in the experimental group scored better in all outcomes with a moderate effect size; in particular, better WOMAC scores were obtained at 12 months, achieving the primary end-point of the study (17.7 ± 11.1 vs. 25.5 ± 12.7; p = 0.03). CONCLUSIONS: Injection of micro-fragmented stromal-vascular fraction is safe and, when associated with microfractures, is more effective in clinical terms than microfractures alone in patients affected by symptomatic focal chondral lesions of the knee. Results of the current study provide information that could help physicians to improve their counseling for patients concerning ADMSCs. LEVEL OF EVIDENCE: Level 1-therapeutic study.

Irreducible Posterolateral Fracture Dislocation of the Knee in an Elderly Patient Treated with Rotating Hinge Total Knee Replacement.

Knee dislocation is one of the few real orthopaedic emergencies. It is a serious but relative uncommon injury, representing less than 0.02% of all orthopaedic injuries. Especially posterolateral knee dislocation is much rarer condition that is often missed or misdiagnosed. The main feature of this very rare condition is to be irreducible by closed reduction due to the interposition of soft tissues inside the enlarged medial joint space, such as the medial capsule and retinaculum, vastusmedialis, and medial meniscus. The pathognomonic sign of a posterolateral knee dislocation is the anteromedial distal thigh transverse "pucker" or "dimple sign." We report the case of an 87-year-old man who sustained an irreducible posterolateral fracture dislocation of the knee after being hit by car which has been treated with rotating hinge knee replacement with 1-year of follow-up.

Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery.

BACKGROUND: Deep wound infection in spine surgery is a debilitating complication for patients and increases costs. The objective of this prospective study was to evaluate the efficacy of wound pulse irrigation with a dilute povidone-iodine solution in the prevention of surgical site infection. METHODS: 50 patients undergoing spinal surgery were randomly divided into two groups (A and B) of 25 patients each. In group A, wounds were irrigated with dilute (3%) povidone-iodine solution through a low-pressure pulsatile device. In group B, wounds were irrigated with saline solution through a bulb syringe. In both groups, specimens for bacterial culture were harvested from surgical site before and after irrigation. RESULTS: In group A, no surgical site infection occurred; in group B, deep wound infection was observed in 3 patients. In both groups, before irrigation some cultures have been found positive for bacterial contamination. CONCLUSION: Our study seems to support the idea that low-pressure pulsating lavage of surgical wounds with povidone-iodine diluted to a nontoxic concentration of 3% is an effective therapeutic adjunct measure to prevent surgical site infection in spine surgery. However, the number of the enrolled patients is small and a significant statistical analysis is not practicable. This trial is registered with NCT03249363.

Transient Common Peroneal and Tibial Nerve Palsy Following Knee Arthroscopy for the Treatment of Discoid Lateral Meniscus.

The number of knee arthroscopies has increased rapidly since the 1980s and are among the most common orthopedic procedures today. It is generally considered a minimally invasive surgery with relatively low morbidity, but it is not without risk of complications. We report the case of a 14-year-old boy who developed a lesion of common peroneal nerve and tibial nerve after knee arthroscopy for a torn discoid lateral meniscus, which was confirmed by electromyogram study.

HYADD 4 versus methylprednisolone acetate in symptomatic knee osteoarthritis: a single-centre single blind prospective randomised controlled clinical study with 1-year follow-up.

OBJECTIVES: The aim of the present study was to compare the clinical results and the quality of life in patients with symptomatic knee osteoarthritis randomised to either a new HA (HYADD 4) or corticosteroid (CS). A separate rationale was to evaluate the safety profile of HYADD 4. METHODS: All the patients presenting for unilateral symptomatic primary knee osteoarthritis were prospectively randomly assigned to receive 2 injections of either HYADD 4 or CS, and were evaluated before the injections and at 6, 12, 26 and 52 weeks. Primary end point was WOMAC score at 26 weeks; secondary end points were WOMAC score, VAS for pain, and SF-36 score at any time point. RESULTS: There were 53 females and 22 males in the HYADD 4 group (mean age 71.5±10.6 years), and 50 females and 25 males in the CS group (mean age 68.6±9.9 years). The observed sided effects were mild and their incidence was similar in the two groups. Patients in the HYADD 4 group reported significantly better WOMAC scores at 26 weeks. The patients improved in all considered outcomes after the injections, with a peak of therapeutic effect between 6 and 12 weeks. Patients in the HYADD 4 group obtained significantly better scores than the CS group up to 26 weeks. At the 1-year follow-up no statistically significant differences between treatments were detected. CONCLUSIONS: HYADD 4 did not have significantly higher side effects when compared to CS injections and provided better short-term (but not long-term) control of symptoms in patients with mild to moderate knee osteoarthritis. Patients with less pain and dysfunction at baseline may be the best candidates for HYADD 4 injections.

Surgical repair of isolated triceps tendon rupture using a suture anchor technique: a case report.

Rupture or avulsion of the distal triceps tendon is one of the least common tendon injuries. The most common clinical presentation of the injury is avulsion from the olecranon. The diagnosis of acute triceps tendon rupture may be missed and this can result in prolonged disability. We report the case of a 42-year-old man with isolated triceps rupture treated by an open surgical repair technique involving the use of bone suture anchors.