Treatment of pincer-type femoroacetabular impingement.

Pincer femoroacetabular impingement (FAI) consists of pathological contact between the acetabular labrum and rim and the femoral head-neck junction. Manifold conditions underlie pincer FAI: anatomical abnormalities, malorientation of the acetabulum, torsional abnormalities of the neck and femoral shaft (these defects can be constitutional, post-traumatic or post-surgical), and involvement in sports characterized by repeated and sudden maximum joint excursions. In a high percentage of cases, pincer FAI is associated with cam FAI. The aims of surgical treatment of pincer FAI are to eliminate the cause of the contact and repair the joint damage; the surgery may be open or arthroscopic, performed with an articular or extra-articular approach. Recently, arthroscopic treatment of FAI had a rapid and widespread diffusion due to the advantages it offers compared with the open technique. Arthroscopic treatment can repair the joint damage and in some cases, characterized by minor deformity, compensate for extra-articular defects. The acetabular labrum must always be preserved and sutured; only in extreme cases can it be sacrificed. Post-operative mobilization must respect the healing time of the labral repair.

Successful surgical treatment of a four part fracture dislocations of the proximal humerus and coracoid avulsion.

racture-dislocation of the proximal humerus (usually occurring after violent trauma) may be more frequently associated with a poor long-term results because the destruction of the hinged periosteum is associated with an high-risk of avascular necrosis of the head of the humerus (1, 2). Concomitant coracoid fracture with anterior shoulder dislocation in such case is something extremely rarely reported (8). Herein, we describe a challenging case of a 44 years old man with 4-parts fracture of the right proximal humerus, dislocation of the glenohumeral joint associated with coracoid avulsion. Considering the severe functional damage on the right shoulder, the patient was immediately treated with open reduction internal fixation (ORIF) at the level of the proximal humerus and with the concomitant placement of one screw at the level of coracoid avulsion. At a 15 months follow up we observed an excellent clinical and radiographic results. We take the opportunity of this unusual case for briefly discuss on such clinical condition and surgical options. (www.actabiomedica.it).

Use of innovative biomimetic scaffold in the treatment for large osteochondral lesions of the knee.

PURPOSE: Large osteochondral defects involve two different tissues characterized by different intrinsic healing capacity. Different techniques have been proposed to treat these lesions with results still under discussion. The aim of the study is to evaluate the clinical outcome of 19 patients treated with a type I collagen-hydroxyapatite nanostructural biomimetic osteochondral scaffold at minimum follow-up of 2 years. METHODS: Twenty lesions, 19 patients were treated with this scaffold implantation. The lesions size went from 4 to 8 cm(2) (mean size 5.2 ± 1.6 cm(2)). All patients were clinically evaluated using the International Repair Cartilage Society score, the Tegner Score and EQ-VAS. MRI was performed at 12 and 24 months after surgery and then every 12 months and evaluated with magnetic resonance observation of cartilage repair tissue scoring scale. RESULTS: The IKDC subjective score improved from a mean score of 35.7 ± 6.3 at the baseline evaluation to 67.7 ± 13.4 at 12-month follow-up (p < 0.0005). A further improvement was documented from 12 to 24 months (mean score of 72.9 ± 12.4 at 24 months) (p < 0.0005). The IKDC objective score confirmed the results. The Tegner activity score improvement was statistically significant (p < 0.0005). The EQ-VAS showed a significant improvement from 3.15 ± 1.09 to 7.35 ± 1.14 (p < 0.0005) at 2-year follow-up. The lesion' site seems to influence the results showing a better outcome in the patients affected in the medial femoral condyle. CONCLUSIONS: The use of the MaioRegen scaffold is a good procedure for the treatment for large osteochondral defects where other classic techniques are difficult to apply. It is an open one-step surgery with promising stable results at medium follow-up. LEVEL OF EVIDENCE: IV.