Tibial spine fractures: State of the art.

Tibial spine fractures (TSFs) are avulsion fractures at the site where the anterior cruciate ligament inserts onto the tibial eminence. TSFs typically affect children and adolescents aged 8-14 years. The incidence of these fractures has been reported to be approximately 3 per 100,000 per year, but the rising involvement of paediatric patients in sporting activities is increasing the number of these injuries. TSFs are historically classified on plain radiographs according to the Meyers and Mckeever classification system, which was introduced in 1959, but the renewed interest in these fractures and the increasing use of magnetic resonance imaging led to the recent development of a new classification system. A reliable grading protocol for these lesions is paramount to guide orthopedic surgeons in determining the correct treatment for young patients and athletes. TSFs can be addressed conservatively in the case of nondisplaced or reduced fractures or surgically in the case of displaced fractures. Different surgical approaches and, specifically, arthroscopic techniques have been described in recent years to ensure stable fixation while limiting the risk of complications. The most common complications associated with TSF are arthrofibrosis, residual laxity, fracture nonunion or malunion, and tibial physis growth arrest. We speculate that advances in diagnostic imaging and classifications, combined with greater knowledge of treatment options, outcomes, and surgical techniques, will likely reduce the occurrence of these complications in paediatric and adolescent patients and athletes, allowing them a timely return to sports and everyday activities.

Extension of Tibial Spine Fractures Beyond the Tibial Spine: An MRI Analysis of 54 Patients.

BACKGROUND: To the authors' knowledge, no previous study has thoroughly described the anteroposterior dimensions of tibial spine fractures (TSFs) on 3-dimensional imaging. The extension of TSFs into weightbearing regions of the tibial plateau, posterior extension within the epiphysis, and potential association between fracture size and patient age may have implications for treatment strategies and clinical outcomes. HYPOTHESIS: TSF fragments would commonly involve weightbearing regions of the tibial plateau, would be larger in younger patients, and would extend more posteriorly than the anatomic footprint of the tibial spine. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive magnetic resonance imaging studies obtained between 2012 and 2020 in patients 5 to 18 years of age at the time of imaging for TSFs were included, measured, and classified via the Green and Tuca grading system. Anteroposterior fracture dimensions were measured and normalized to anteroposterior midepiphyseal length, as was fracture height to epiphyseal height. Extension into the weightbearing surface of the tibial plateau was recorded. Intraclass correlation coefficient and kappa values were calculated. Mean fracture bed size was compared using independent-samples t tests between older and younger patients based on median age and sex. RESULTS: Of 54 TSFs, 1 (2%), 28 (52%), and 25 (46%) were grades 1, 2, and 3, respectively. Fracture beds spanned 45% of the anteroposterior midepiphysis, and 54% of the TSF beds extended to the posterior third of the epiphysis. Younger and female patients, on average, had larger anteroposterior dimensions to TSF beds (P = .018 and .006, respectively). The medial and lateral weightbearing surfaces of the tibial plateau were affected 57% and 25% of the time, respectively. CONCLUSION: This study demonstrated that TSF beds were larger in younger patients, extended to the posterior third of the epiphysis in 54% of cases, and should be examined carefully for extension into weightbearing regions of the tibial plateau. In pediatric patients, the TSF often involves more of the tibial plateau than the anatomic footprint of the tibial spine, and clinicians should be aware of the potential for extension posteriorly and into the weightbearing surfaces.

Simultaneous anterior cruciate ligament reconstruction and implant-mediated guided growth to correct genu valgum in skeletally immature patients.

OBJECTIVES: Adolescents with anterior cruciate ligament (ACL) tears can present with concomitant lower extremity coronal plane angular deformity (CPAD) that both predispose to injury as well as may increase the risk of graft rupture following ACL reconstruction (ACLR). The goal of this study was to examine the safety and efficacy of concomitant ACLR with implant-mediated guided growth (IMGG) compared to isolated IMGG procedures in paediatric and adolescent patients. METHODS: Operative records of all paediatric and adolescent patients (age ≤ 18 years) that underwent simultaneous ACLR and IMGG by one of two paediatric orthopaedic surgeons between 2015 and 2021 were retrospectively reviewed. A comparison cohort of isolated IMGG patients was identified and matched based on bone age within one year, sex, laterality, and fixation type (i.e. transphyseal screw vs. tension band plate and screw construct). Pre- and post-operative mechanical axis deviation (MAD), angular axis deviation (AAD), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were recorded. RESULTS: A total of 9 participants who underwent concomitant ACLR and IMGG (ACLR â€‹+ â€‹IMGG) were identified, with 7 of these participants meeting the final inclusion criteria. The participants had a median age of 12.7 (IQR â€‹= â€‹12.1 - 14.2) years and median bone age of 13.0 (IQR â€‹= â€‹12.0 - 14.0) years. Of the 7 participants that underwent ACLR and IMGG, 3 underwent a modified MacIntosh procedure with ITB autograft, 2 received quadriceps tendon autograft, and 1 underwent hamstring autograft reconstruction. There were no significant differences in the amount of correction obtained between ACLR â€‹+ â€‹IMGG and matched IMGG subjects with respect to any measurement variable (MAD difference: p â€‹= â€‹0.47, AAD difference: p â€‹= â€‹0.58, LDFA difference: p â€‹= â€‹0.27, MPTA difference: p â€‹= â€‹0.20). There were also no significant differences in alignment variables per unit time between cohorts (MAD/month: p â€‹= â€‹0.62, AAD/month â€‹= â€‹0.80, LDFA/month â€‹= â€‹0.27, MPTA/month â€‹= â€‹0.20). CONCLUSION: The results of the current study indicate that concomitant ACLR and lower extremity CPAD correction is a safe approach to treat CPAD concomitantly with ACLR in young patients who present with an acute ACL tear. Furthermore, one can expect reliable correction of CPAD after combined ACLR and IMGG, no different than the correction obtained in the setting of IMGG alone. LEVEL OF EVIDENCE: III.

Clinical and functional evaluation of bone marrow aspirate concentrate vs autologous conditioned serum in the treatment of knee osteoarthritis.

BACKGROUND AND AIM: The aim of this study was to compare the efficacy of a single Bone Marrow Aspirate Concentrate (BMAC) with a cycle of 4 Autologous Conditioned Serum (ACS) injections in the treatment of early-stage knee osteoarthritis (OA). METHODS: Two groups of 12 patients with degenerative knee OA were treated with a single BMAC injection and with a cycle of 4 ACS injections respectively. Follow-up was set at baseline (t0), one-month (t1) and six-months (t2) evaluating VAS for pain, WOMAC index and range of motion (ROM). RESULTS: We reported a significant improvement in WOMAC after BMAC injection both at t1 (p= 0,001) as well as t2 (p< 0,001), plus a reduction of VAS values in BMAC group at six months follow-up (p = 0,024). In contrast, no significant differences in ROM between the two groups were observed. CONCLUSIONS: Both the approaches are safe and effective in the treatment of knee OA, with a major efficacy of BMAC.

Pseudoparalytic shoulder in a CoViD-19-positive patient treated with CPAP: A case report.

The Authors report a case of a 46 years old man affected by severe acute respiratory syndrome caused by Novel Coronavirus 2019 and admitted to our hospital. The patient required continuous positive airway pressure therapy (CPAP) in the hospital ward and subsequently orotracheal intubation while in intensive care unit. The patient laid in lateral decubitus position for several hours every day while receiving CPAP therapy. During the hospitalization, he reported limitation of range of motion of the left upper limb, without any history of acute or previous trauma. The clinical appearance of the arm was suggestive of pseudoparalytic shoulder. This case emphasizes the importance of proper body positioning during invasive and non-invasive mechanical ventilation in order to prevent peripheral nerve compression and further disability.

Orthopaedic patient workflow in CoViD-19 pandemic in Italy.

CoViD-19 epidemic started in China in late December 2019, and soon spread, turning into a pandemic. All medical specialties have soon been involved in the management of CoViD-19 patients; the daily Orthopaedic activity has been affected profoundly by this dramatic health emergency. The present paper aims to summarize all the measures and changes that had to be made in order to avoid the healthcare system collapse in the most affected areas, and provides an operative flowchart.