Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities.

AIMS: The aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities. PATIENTS AND METHODS: Between 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle. RESULTS: The mean follow-up was 3.3 years (2 to 4.6). The modified Harris Hip Score improved by 33.0 points from 53.5 preoperatively to 83.4 postoperatively (p = 0.03). The Western Ontario McMasters University Osteoarthritic Index score improved by 30 points from 62 preoperatively to 90 postoperatively (p = 0.029). All radiological parameters showed significant improvement. There were no long-term disabilities and none of the hips required early conversion to total hip arthroplasty. CONCLUSION: FHRO combined with a PAO resulted in clinical and radiological improvement at short-term follow-up, suggesting it may serve as an appropriate salvage treatment option for selected young patients with severe symptomatic hip deformities.

Patología articular y meniscal asociada con la reconstrucción primaria del ligamento cruzado anterior / Articular and meniscal pathology associated with primary ACL reconstruction

Objetivo: Determinar la gravedad, tipo y localización de las lesiones condrales y meniscales en pacientes con reconstrucción del ligamento cruzado anterior (LCA) según el tiempo entre la lesión y el momento de reconstrucción. Metodología: Análisis retrospectivo de pacientes sometidos a cirugía de reconstrucción de LCA. Se obtuvieron los datos personales de los pacientes, la localización, gravedad y número de lesiones condrales y lesiones meniscales en el momento de la reconstrucción. Los pacientes se dividieron, según el tiempo desde la lesión hasta la cirugía, en agudos, menos de 4 semanas, subagudos, entre 4 y 8 semanas y crónicos, más de 8 semanas. Resultados: Los pacientes de mayor edad presentaron mayor incidencia, gravedad y número de lesiones condrales. Aquellos sometidos a cirugía 8 semanas o más, posterior a la lesión, presentaron estadísticamente lesiones condrales de mayor grado en el compartimiento medial en comparación con aquellos sometidos 4 semanas posterior a la lesiones. Con respecto a las lesiones meniscales, las lesiones del menisco interno eran tipo asa de cubo y las del menisco externo tipo colgajo, independientemente del tiempo entre la lesión y reconstrucción de LCA. Conclusiones: Pacientes sometidos a una reconstrucción de LCA 8 semanas o más, posterior a la lesión, presentan una mayor incidencia de lesiones condrales en el compartimiento medial. Nivel de evidencia: Nivel IV (estudio pronóstico) (AU)

Purpose: The purpose of this study was to determine the severity and location of meniscal and chondral lesions in patients undergoing ACL reconstruction at variable times from injury to surgery. Methods: The patient demographics, location, grade and number of chondral injuries as well as location and pattern of meniscal injuries at the time of ACL reconstruction was recorded. Patients were divided into three subgroups according to their time from injury to surgery: acute (less than 4 weeks), subacute (4 to 8 weeks) and chronic (8 weeks or more). Results: Patients undergoing surgery more than 8 weeks after surgery had a statistically significant more severe chondral grade in the medial compartment of the knee when compared to those patients that had surgery acutely. A similar observation was not found in the lateral compartment. The medial meniscal tears were likely to be bucket type tears regardless of the chronicity of the injury and in the lateral meniscal tears were more often flap type tears independent of the time interval between injury and surgery. Conclusions: These findings support early reconstruction in an effort to slow the progression of further damage to the knee. Level of Evidence: Level IV (Prognostic study) (AU)

Anti-apoptotic treatments prevent cartilage degradation after acute trauma to human ankle cartilage.

OBJECTIVES: To investigate the effect of anti-apoptotic agents on cartilage degradation after a single impact to ankle cartilage. DESIGN: Ten human normal tali were impacted with the impulse of 1 Ns generating peak forces in the range of 600 N using a 4 mm diameter indenter. Eight millimeter cartilage plugs containing the 4 mm diameter impacted core and a 4 mm adjacent ring were removed and cultured with or without P188 surfactant (8 mg/ml), caspase-3 (10 uM), or caspase-9 (2 uM) inhibitors for 48 h. Results were assessed in the superficial and middle-deep layers immediately after injury at day 0 and at 2, 7 and 14 days after injury by live/dead cell and Tunel assays and by histology with Safranin O/fast green staining. RESULTS: A single impact to human articular cartilage ex vivo resulted in cell death, cartilage degeneration, and radial progression of apoptosis to the areas immediately adjacent to the impact. The P188 was more effective in preventing cell death than the inhibitors of caspases. It reduced cell death by more than 2-fold (P<0.05) in the core and by about 30% in the ring in comparison with the impacted untreated control at all time points. P188 also prevented radial expansion of apoptosis in the ring region especially in the first 7 days post-impaction (7.5% Tunel-positive cells vs 46% in the untreated control; P<0.01). Inhibitors of caspase-3 or -9 were effective in reducing cell death in the impacted core only at early time points, but were ineffective in doing so in the ring. Mankin score was significantly improved in the P188 and caspase-3 treated groups. CONCLUSIONS: Early intervention with the P188 and caspase-3 inhibitor may have therapeutic potential in the treatment of cartilage defects immediately after injury.