Double Vector: A Combined Biomechanical and Anatomical Posterolateral Corner Reconstruction Technique.

Posterolateral corner (PLC) injuries are complex knee injuries that are becoming increasingly frequent. Often undiagnosed and underestimated, a systematic diagnostic workup is necessary to assess the severity of PLC injury in order to then be able to select the proper surgery approach. Anatomical and nonanatomical PLC-reconstruction techniques have been described. In this Technical Note, we describe our technique of biomechanical reconstruction of PLC in case of severe posterolateral rotational instability.

Anatomic Combined Anterior Cruciate Ligament and Antero-Lateral Ligament Reconstruction Using Autologous Gracilis and Semitendinosus Graft With Single Tibial and Femoral Tunnel.

Anterior cruciate ligament (ACL) injuries are among the most common lesions in orthopaedics practice, but still today, rates up to 24% of unsatisfactory results are reported. Unaddressed anterolateral complex (ALC) injuries have been claimed to be responsible for residual anterolateral rotatory instability (ALRI) after isolate ACL reconstruction and have demonstrated to increase graft failure. In this article, we present our technique for reconstruction of the ACL and anterolateral (ALL) ligament combining the advantages of the anatomical position and the intraosseous femoral fixation to ensure anteroposterior and anterolateral rotational stability.

Is intra-articular injection of autologous micro-fragmented adipose tissue effective in hip osteoarthritis? A three year follow-up.

BACKGROUND: Recently, increased attention on regenerative medicine and biological injective treatments have been proposed to restore native cartilage. Micro-fragmented adipose tissue (MFAT) has been studied for its anti-inflammatory, paracrine, and immunomodulatory effects. The long-term effects of MFAT are still poorly understood: the aim of the present study is to demonstrate how hip articular injections with autologous MFAT can have an impact on clinical outcomes. METHODS: Seventy-one consecutive patients affected by early hip osteoarthritis underwent an ultrasound-guided hip injection of autologous MFAT between June 2017 and December 2018. Patients were divided into four groups according to the Oxford Hip Score. All patients received 4 mL of autologous micro-fragmented adipose tissue under an ultrasound guide. A clinical evaluation was done between 29 and 41 months after the initial treatment. During this follow-up period, we recorded any new treatment the patients had done, whether that be injection or arthroplasty surgery. RESULTS: The study included 55 patients. Out of 55 patients, 28 saw benefits and were in no need of further treatment. Moreover, the score between the beginning and control increased by 6.9 points. Ten patients underwent a new articular injection: the mean time between the two injections was 635.7 ± 180 days. Seventeen patients underwent total hip replacement: the mean period between the autologous MFAT injection and the surgery was 495 days. CONCLUSION: This study found that intra-articular injections with autologous MFAT achieve beneficial clinical results in patients affected by early to moderate hip osteoarthritis, with an OHS between 48 and 30. Furthermore, these subjects are the ideal patients for whom this treatment obtains good clinical results.

The use of autologous platelet-rich fibrin matrix combined with meniscal repair in the treatment of parameniscal cyst: clinical results and cyst recurrence after 2-year of follow up.

PURPOSE: Parameniscal cysts are associate with horizontal meniscal tears. Arthroscopic meniscal repair and the excision of the cyst by mini-open approach represent a valid treatment. However, the recurrence of cyst is still a current issue. Therefore, biological factors may be considered to promote the biological repair and avoid recurrence. The aim of the present study was to report the clinical results and the rate of recurrence of the cyst after minimum 2-year of follow up in a cohort of patients treated by meniscal repair and autologous platelet-rich fibrin matrix augment. METHODS: Patients with lateral parameniscal cyst undergoing arthroscopic meniscal repair and autologous platelet-rich fibrin matrix augment between 2016 and 2019 were retrospectively reviewed in March 2021. Inclusion criteria were absence of prior surgery on the affected knee with minimum 2-year of follow-up. Exclusion criteria were concomitant ligament lesions, rheumatic diseases and knee osteoarthritis. After reviewing the database, each selected patient was contacted and asked to participate in the study; at the follow-up evaluation all patient signed an informed consent. Tegner-Lysholm knee score, IKDC and NRS were collected before surgery and at follow-up. RESULTS: This study included 15 patients (8 male) with mean age of 32.8 years old. No recurrence of the cysts was observed. The Tegner-Lysholm knee score and IKDC subjective scores increased respectively from 41.3 ± 5.4 and 37.6 ± 5.1 at baseline to 92.3 ± 4.6 and 89.4 ± 2.6 at the final follow up. Concerning pain relief, the Numeric Pain Rating Scale (NRS) displayed a significant improvement reaching at the follow up a score of 1,3 ± 1.1 in comparison to 6.8 ± 0.9 at the baseline. CONCLUSION: Surgical management of symptomatic lateral parameniscal cyst with cyst excision, autologous PRP membrane application and meniscus repair demonstrated excellent subjective clinical outcome with any cyst reoccurrence. LEVEL OF EVIDENCE: III, retrospective cohort study.

Autologous Platelet-Rich Fibrin Matrix-Augmented Repair for Parameniscal Cysts: Surgical Technique.

Parameniscal cysts are defined as an internal disorder of the knee joint. It is known that parameniscal cysts are associated with horizontal meniscal tears that could lead to the collection of synovial fluid within the cyst. Despite the treatment of meniscal tears, cyst recurrence is still an issue that needs to be addressed. In this regard, there has been an increasing interest in the use of biologic agents to enhance the vascularity and healing of the meniscus. Preliminary results for biologic therapeutic agents, such as growth factors, bone marrow, and aspirate concentrate, have been encouraging. However, these options are more demanding in regards to time, financial burden, resources, and so on. Autologous platelet-rich plasma is readily available, easy to use, affordable, and minimally invasive. This Technical Note will describe a step-by-step and reproducible technique for the harvesting, preparation, and use of an autologous platelet-rich fibrin matrix used to augment the healing of meniscal repairs.

Open-Wedge High Tibial Osteotomy Associated With Lipogems® Intra-Articular Injection For The Treatment Of Varus Knee Osteoarthritis - Retrospective Study.

BACKGROUND AND AIM: Open-wedge high tibial osteotomy (HTO) is a good choice in the treatment of varus knee medial osteoarthritis, with the restore of the correct mechanical axis of the lower limb. Autologous adipose derived stem cells (aASCs) are used in cartilage regeneration and in the treatment of early osteoarthritis. Aim of this study is to retrospectively analyze clinical (and radiological) results in two populations of patients with initial varus medial knee osteoarthritis, treated with HTO, with or without associated intra-articular injection of aASCs. METHODS: In this study we analyze 85 patients treated with HTO for varus knee osteoarthritis with or without Lipogems® intra-articular injection. It was used of a single model of HTO plate. No associated procedure was performed. RESULTS: Significant improvement in the daily life activity assessment (KOOS score) was observed in the group treated also with aASCs compared with group treated with isolated HTO. CONCLUSIONS: We suggest, in these patients, the surgical indication of an open-wedge high tibial osteotomy (HTO) and simultaneous injection with aASCs associated procedure to improve cartilage regeneration, with clinical improvement.

Comparison between standard technique and image-free robotic technique in medial unicompartmental knee arthroplasty. Preliminary data.

The factors that guarantee the survival of the unicompartmental prosthesis implant seems to be linked to the accurate positioning of the components. The aim of our study is to compare the standard operative technique and the assisted navigation technique to understand if the robotic technology is able to obtain more accurate implants and with a better outcome. In the period between January 2016 and February 2018, in our Clinic, were performed 94 medial unicompartmental knee implants. The implantation of the medial unicompartmental prosthesis was performed in 30 cases with the standard technique and in 29 cases with the image-free robotic technique (Navio Surgical System). The objective of our study was to evaluate the anatomical and mechanical axes, the tibial slope, the coronal inclination of the femoral tibial space, the coronal angulation of the tibial and femoral component and the height of the Joint-Line. Furthermore, to evaluate the outcome we has execute international scores (IKDC and KSS Insall mod.). The advanced navigation seems to allow the implantation of the unicompartmental prosthesis more precisely, although not always with a statistically significant difference compared to the standard technique. further clinical studies are needed to analyze the medium and long-term survival rate, as well as the patient's subjective outcome.

Groin pain caused by iliopsoas synovial cyst treated with endoscopic approach. A case report.

The diagnosis of iliopsoas synovial cyst is a rare finding. The normal approach to treat this condition has been conservative therapies or open surgery, with its associated complications and morbidity. The arthroscopic - endoscopic surgery is less invasive and with an increase in complications and days of hospitalization. We report the case of a 70-year old woman with clinical and imaging signs of a fluid-filled cyst near iliopsoas distal tendon. After fluid aspiration, the patient reported symptom-free interval of several weeks, but then groin pain and swelling feeling return, increased with hip movements. The cyst was removed through arthroscopy approach and the iliopsoas tendon was released. The removal of iliopsoas synovial cyst is necessary to avoid complications such as pain and functional limits. Arthroscopy has the advantage of less soft-tissue damage and quicker recovery. The treatment of associated tendon pathology can be done. Hip arthroscopy can be a safe and effective technique for the removal of iliopsoas synovial cyst.

Heterotopic Ossification in Primary Total Hip Arthroplasty: which is the role of drainage?

BACKGROUND AND AIM OF THE WORK: The Heterotopic Ossification (HO) is a common complication following Total Hip Arthroplasty (THA). Although there is no concordance in Literature regarding the etiopathogenic mechanism, various HO risk factors have been recognized, both related to the patient and associated with the surgical procedureLiterature does not consider the use of intra-articular drainage as a possible risk factor. Our hypothesis is that this item can contribute to the development of HO. MATERIALS AND METHODS: 425 implants of hip arthroplasty performed between 2014 and 2017 at the Ortopedic Clinic of Udine were included in the study. No patient performed pre-operative or post-operative anti-HO prophylaxis during follow-up. Radiographs of preoperative and postoperative at 1 year were analyzed according to the Brooker Classification. RESULTS: The incidence of HO in patients with intra-articular drainage is 24.6%, while the incidence of HO in patients without intra-articular drainage is 15.3%, with a statistically significant difference. CONCLUSIONS: The data obtained suggest to consider the use of intra-articular drainage as a possible intra-operative risk factor for HO. This is a retrospective cohort study, so we need more studies and more robust experimental designs to confirm these results.

Arthroscopic treatment of iliopsoas impingement syndrome after hip arthroplasty.

BACKGROUND AND AIM OF THE WORK: Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA. METHODS: Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months. RESULTS: After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series. CONCLUSIONS: Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions.