Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic, biomechanical and clinical outcomes.

PURPOSE: The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) femoral tunnel positioning techniques for the reconstruction of chronic anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS: It is a randomized prospective study of 106 patients who underwent ACL reconstruction because of a chronic ACL rupture (55 AMT, 51 TT). Minimum follow-up was 2 years. Demographic, clinical and radiological data, including MRI grafts' anatomy and biomechanics intraoperative navigation system evaluation, were analyzed. Also, International Knee Documentation Committee score, Tegner Knee score, Lysholm Knee Score, Short-Form Health Survey and 4-point Likert Scale were evaluated. RESULTS: The AM technique achieves a more anatomic graft than TT technique in both sagittal and coronal plane (6° approximately). Immediate postoperative biomechanical evaluation of the graft showed both techniques significantly improved translational and rotational laxity (p = 0.000). AMT showed superiority only in controlling internal rotation (p = 0.016). Both techniques reported significant improvement in all evaluated score scales, without differences between techniques. Independently of the femoral tunnel positioning technique, patients with cartilage lesion had worse clinical outcomes. CONCLUSIONS: Our findings suggest that AMT achieves a more anatomical and biomechanically accurate graft allowing better control over internal rotation laxity; however, this does not lead to better clinical outcomes if we compare with TT in the reconstruction of chronic ACL rupture. Patients with chronic ACL rupture and cartilage lesion had worse clinical outcomes, independently the femoral tunnel positioning technique.

Modificaciones en la altura patelar por el uso del injerto hueso-tendón-hueso / Changes in patellar height due to bone-tendon-bone graft

Objetivo: Las complicaciones asociadas al uso de injertos del ligamento cruzado anterior (LCA) son frecuentes. Los cambios en la altura, sobre todo de la patela baja, pueden ser la razón de la aparición de dolor en la zona anterior de la rodilla. Diversos estudios han asociado la reconstrucción del LCA mediante la técnica de injerto hueso-tendón-hueso con patela baja. Métodos: Cuarenta y tres pacientes con reconstrucción del LCA mediante injerto hueso-tendón-hueso fueron incluidos en el presente estudio. Todos los pacientes fueron sometidos a la misma cirugía, con el cierre del paratendón del tendón rotuliano. Se realizó un estudio radiológico antes de la cirugía y 2 años después de la misma. En todos los casos se estudió el índice Insall-Salvati, el corte axial y la inclinación patelar. Como control se utilizó la rodilla sana contralateral del paciente. Resultados: No se encontraron diferencias significativas entre el estudio preoperatorio y el realizado tras 2 años de la cirugía. Conclusiones: El uso del tendón patelar con cierre del paratendón en la reconstrucción del LCA no ha demostrado modificar la altura patelar en estudios radiológicos a los 2 años de seguimiento

Purpose: Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. Methods: Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. Results: No significant differences were observed from the preoperative measurements or at the 2-year follow-up. Conclusions: The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years

Changes in patellar height due to bone-tendon-bone graft. / Modificaciones en la altura patelar por el uso del injerto hueso-tendón-hueso.

PURPOSE: Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. METHODS: Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. RESULTS: No significant differences were observed from the preoperative measurements or at the 2-year follow-up. CONCLUSIONS: The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years.

How 3D patient-specific instruments improve accuracy of pelvic bone tumour resection in a cadaveric study.

OBJECTIVES: To assess the accuracy of patient-specific instruments (PSIs) versus standard manual technique and the precision of computer-assisted planning and PSI-guided osteotomies in pelvic tumour resection. METHODS: CT scans were obtained from five female cadaveric pelvises. Five osteotomies were designed using Mimics software: sacroiliac, biplanar supra-acetabular, two parallel iliopubic and ischial. For cases of the left hemipelvis, PSIs were designed to guide standard oscillating saw osteotomies and later manufactured using 3D printing. Osteotomies were performed using the standard manual technique in cases of the right hemipelvis. Post-resection CT scans were quantitatively analysed. Student's t-test and Mann-Whitney U test were used. RESULTS: Compared with the manual technique, PSI-guided osteotomies improved accuracy by a mean 9.6 mm (p < 0.008) in the sacroiliac osteotomies, 6.2 mm (p < 0.008) and 5.8 mm (p < 0.032) in the biplanar supra-acetabular, 3 mm (p < 0.016) in the ischial and 2.2 mm (p < 0.032) and 2.6 mm (p < 0.008) in the parallel iliopubic osteotomies, with a mean linear deviation of 4.9 mm (p < 0.001) for all osteotomies. Of the manual osteotomies, 53% (n = 16) had a linear deviation > 5 mm and 27% (n = 8) were > 10 mm. In the PSI cases, deviations were 10% (n = 3) and 0 % (n = 0), respectively. For angular deviation from pre-operative plans, we observed a mean improvement of 7.06° (p < 0.001) in pitch and 2.94° (p < 0.001) in roll, comparing PSI and the standard manual technique. CONCLUSION: In an experimental study, computer-assisted planning and PSIs improved accuracy in pelvic tumour resections, bringing osteotomy results closer to the parameters set in pre-operative planning, as compared with standard manual techniques.Cite this article: A. Sallent, M. Vicente, M. M. Reverté, A. Lopez, A. Rodríguez-Baeza, M. Pérez-Domínguez, R. Velez. How 3D patient-specific instruments improve accuracy of pelvic bone tumour resection in a cadaveric study. Bone Joint Res 2017;6:577-583. DOI: 10.1302/2046-3758.610.BJR-2017-0094.R1.

Bilateral insufficiency hip fractures after bariatric surgery.

Bariatric surgery is one of the most common surgeries within developed countries due to the increase in morbid obesity that has been observed in the past decades. The short-term alterations in the metabolism of calcium and vitamin D are well known after these procedures; however, the clinical and biochemical consequences may not be detected for years or even remain undiagnosed. We present the first case of bilateral insufficiency hip fracture after years of bariatric surgery. Although this is a long-term and rare complication, with the high number of gastric bypass performed in the past years, the number of these cases could increase with time. Moreover, it is important as an undiagnosed hip fracture can cause a displacement that could need an arthroplasty, with all the complications that entails. For that reason, this long-term complication highlights the need to reevaluate the optimal follow-up of these patients and the importance to continue monitoring metabolic bone diseases in the prevention of insufficiency fractures.

Hip arthroscopy complications regarding surgery and early postoperative care: retrospective study and review of literature.

PURPOSE: The purpose is to describe the rate of complications in a series of hip arthroscopies performed at our center, as well as perform a systematic review of the current literature in order to compare our outcomes. METHODS: Two hundred and fifty-eight patients affected of femoroacetabular impingement and treated with hip arthroscopy have been studied. All minor and major complications were studied during the first postsurgery year. Furthermore, a systematic review was performed comparing major and minor complications with our series. Two attending orthopedic surgeons selected the different studies with the same inclusion and exclusion criteria, remaining with 48 studies that have been reviewed and included in the present study. RESULTS: Mean age was 36.6 years old (SD 17.45), and the ratio men:women was 137:121. The mean complication rate observed was 14.34% (37/258) of global complications. Only three patients showed major complications: femoral neck fracture, septic arthritis and avascular necrosis of the femoral head. Any of these patients had permanent side effects. CONCLUSIONS: Hip arthroscopy has a low rate of major complications, but a higher number of minor complications that could be avoided with certain preventive measures.

Fracture of the Modular Neck in Total Hip Arthroplasty.

Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades. We present the case of a 53-year-old man with a history of avascular necrosis of the femoral head due to a hypophyseal adenoma. A total hip modular arthroplasty was implanted. Three and a half years after the surgery the patient attended the emergency room due to acute left hip pain with no prior traumatism. Radiological examination confirmed a fracture of the modular neck. A revision surgery was performed finding an important pseudotumoral well-organized periprosthetic tissue reaction. Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted. There are several potential advantages when using modularity in total hip arthroplasty that surgeons may benefit from, but complications have arisen and must be addressed. Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.

Perfil hormonal preoperatorio en pacientes sometidos a prostatectomía radical por cáncer de próstata / Preoperative Hormonal Pattern in Patients Undergoing Radical Prostatectomy due to Prostate Cancer

Objetivos: Los niveles preoperatorios de testosterona (T) relacionados con factores de mal pronóstico después de la prostatectomía radical (PR) han sido motivo de controversia. Nuestro objetivo fue determinar la relación entre los niveles preoperatorios de T, los resultados anatomopatológicos y la recidiva bioquímica tras la PR. Material y métodos: Analizamos de manera prospectiva 143 pacientes sometidos a PR desde febrero de 2008 a junio de 2010 en nuestro centro. Se determinaron los niveles preoperatorios de T y globulina transportadora de hormonas sexuales como parte de nuestro protocolo clínico. La T libre (Tl) y la biodisponible (Tbio) fueron calculadas usando la formula de Vermeulen. Se definieron niveles bajos de testosterona sérica como T menor o igual a 346 ng/dL. Se realizó un análisis comparativo analizando las variables pTNM, márgenes positivos, tamaño tumoral,escala de Gleason, multifocalidad, recidiva bioquímica (usando los 2 cortes de PSA > 0,4 ng/dLy PSA > 0,2 ng/dL como valores de corte) en función de los niveles preoperatorios de T. Resultados: Las variables Gleason, la tasa y número de márgenes positivos, el tamaño tumoral, la multifocalidad, el tiempo a recidiva bioquímica y el estadio patológico final no se correlacionaron con los niveles preoperatorios hormonales. Los niveles preoperatorios bajos de T (< 346 ng/dL) no se relacionaron con recidiva bioquímica (PSA > 0,4 ng/dL de log-rank, p = 0,512),aunque sí se observó una tendencia cuando PSA > 0,2 ng/dL (log-rank, p = 0,097).Conclusión: Los niveles preoperatorios de T no se relacionaron con las características anatomopatológicas del cáncer de próstata ni con la presencia de recidiva bioquímica (AU)

Objective: There is controversial evidence regarding preoperative testosterone (T) levels related to poor prognosis factors after radical prostatectomy (RP). The aim of this manuscript is to determine the relationship between preoperative T levels and final pathologic report together to biochemical recurrence after RP. Materials and methods: We prospectively analysed 143 patients submitted to RP from February 2008 to June 2010 in our centre. Pretreatment T and sex hormone-binding globulin levels were determined as part of our clinical protocol. Free calculated (fT) and bioavailable (bioT) T were calculated using Vermeulen’s formula. Low T levels were defined as 346 ng/dL or less. A comparative analysis with variables pTNM, positive margins, tumour burden, Gleason score, multifocality and biochemical recurrence (using both PSA > 0.4 ng/dL and PSA > 0.2 ng/dL as cut-off values) was performed, according to preoperative levels of T. Results: Variables Gleason score, rate and number of positive margins, tumour burden, tumour multifocality, time to biochemical recurrence and pathological stage were not related to preoperative hormonal levels. Preoperative T < 346 ng/dL was not found to be related to PSA recurrence (PSA > 0,4 ng/dL log-rank, P = 0.512), although a trend was observed whenPSA > 0,2 ng/dL (log-rank, P =0 .097). Conclusion: Preoperative T levels were not related to final pathological report or to biochemical recurrence (AU)

Preoperative hormonal pattern in patients undergoing radical prostatectomy due to prostate cancer.

OBJECTIVE: There is controversial evidence regarding preoperative testosterone (T) levels related to poor prognosis factors after radical prostatectomy (RP). The aim of this manuscript is to determine the relationship between preoperative T levels and final pathologic report together to biochemical recurrence after RP. MATERIALS AND METHODS: We prospectively analysed 143 patients submitted to RP from February 2008 to June 2010 in our centre. Pretreatment T and sex hormone-binding globulin levels were determined as part of our clinical protocol. Free calculated (fT) and bioavailable (bioT) T were calculated using Vermeulen's formula. Low T levels were defined as 346 ng/dL or less. A comparative analysis with variables pTNM, positive margins, tumour burden, Gleason score, multifocality and biochemical recurrence (using both PSA>0.4 ng/dL and PSA>0.2 ng/dL as cut-off values) was performed, according to preoperative levels of T. RESULTS: Variables Gleason score, rate and number of positive margins, tumour burden, tumour multifocality, time to biochemical recurrence and pathological stage were not related to preoperative hormonal levels. Preoperative T<346 ng/dL was not found to be related to PSA recurrence (PSA>0,4 ng/dL log-rank, P=.512), although a trend was observed when PSA>0,2 ng/dL (log-rank, P=.097). CONCLUSION: Preoperative T levels were not related to final pathological report or to biochemical recurrence.