A different unhappy triad in the knee: a case of acute simultaneous rupture of Patellar Tendon, Anterior Cruciate Ligament and lateral meniscus treated in one stage and review of literature.

We present a case report of a 43-year-old male patient with simultaneous ruptured of anterior cruciate ligament (ACL), patellar tendon (PT) and lateral meniscus tear, occurred during a tennis match. This combinate tear is not frequent, and literature reports only few cases. Clinical diagnosis can be difficult and the support of MRI and X-Ray is needed. Surgery was performed within seven days from injury in a one-step fashion. Clinical and radiological outcome treatment was successful.

Anterior Capsulolabral Reconstruction with Semitendinosus Autograft after Latarjet Failure: A Case Report.

INTRODUCTION: The treatment of chronic shoulder instability, associated with poor tissue quality, remains challenging in the setting of anterior capsular deficiency. There are a few viable alternatives in the end-stage shoulder instability when multiple surgical attempts to correct the pathology have failed. The purpose of the present paper is to demonstrate the efficacy of anterior capsular reconstruction with semitendinosus autograft for the management of capsulolabral deficiency without associated bone loss. CASE REPORT: A 39-year-old female admitted in our institution with a history of recurrent atraumatic anterior dislocation of the left shoulder after three unsuccessful surgical attempts: Arthroscopic and open capsulorrhaphy and a Latarjet coracoid transfer. CT scan images showed adequate placement (flush) of the coracoid transfer without any sign of reabsorption. Reconstruction of anterior capsulolabral structure was performed using a Semitendinosus autograft. The middle and inferior glenohumeral ligaments, the more crucial ligaments for anterior-inferior shoulder stability, were effectively recreated. The patient did not suffer any recurrent dislocation or subjective symptoms of instability at the time of the final follow-up, 2 years after surgery, and the ASES score increased from 36 preoperatively to 86. CONCLUSION: This technique, described for the first time as a salvage procedure after Latarjet failure, could represent a safe and viable treatment option in the context of multiple ineffective surgeries.

Bone methabolic disorders in HIV positive patients: a case report.

Fractures in patients affected by HIV are more frequent than what is reported in patients with no retroviral diseases. Chronic infection with HIV likely contributes to increased systemic inflammation, which has been associated with increased rates of fracture.  We report a case of a 56-year-old male (HIV + in treatment with Atripla) heavy worker, at the beginning affected by intra-articular proximal humerus fracture treated with endoprosthesis replacement and later by periprosthetic fracture treated with plate, screws and cerclages. Follow up was performed with clinical evaluation (ROM, VAS, Quick Dash, ASES, Simple shoulder test, UCLA Score, Constant score) and shoulder radiographs. Bone metabolism disorders in HIV patients lead to low BMD values, changes in bone turnover markers, and histomorphometric abnormalities, especially when HIV is present along with HCV or other hepatopathies. Additional therapy with bisphosphonate and Vitamin D should always be carried out when possible to prevent such types of orthopaedic complications.

Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty?

PURPOSE: The aim of this prospective study was to perform a clinical and radiologic evaluation of patients undergoing total hip arthroplasty (THA). The hypothesis is that there is a correlation between the pre-operative degeneration state of the gluteal muscle-tendinous unit and the clinical outcome in terms of functional recovery. METHODS: Fifty-five patients have met inclusion criteria. All patients included in the sample were subjected to clinical evaluation. The ultrasound examination of the patients of the study was conducted and the following parameters were assessed: Thickness in mm of the gluteus medius tendon; Quality of the gluteus medius tendon; and Trophy and muscular composition. RESULTS: The degree of degeneration of the pre-operative tendon shows a negative statistical correlation with all the pre- and post-operative clinical scales, but presents statistical significance (p < 0.05) only with the post-operative Harris, the post-operative Oxford, the Harris and HOOS-modified post-operative, lameness, and Trendelenburg; it correlates positively with the quality of the macroscopic tendon detected intra-operatively, the degree of the pre-operative contralateral tendon, and the operated and contralateral pre-operative muscle (p < 0.05). The degree of fatty degeneration of the pre-operatively operated muscle correlates negatively (p < 0.05) with all pre- and post-operative clinical scales except for the pre-operative WOMAC and HOOS modified, with the lameness and the Trendelenburg sign; it correlates positively (p < 0.05) with age, the quality of the macroscopic tendon detected intra-operatively, degree of tendon degeneration, fatty infiltration of the contralateral pre- and post-operative muscle and of the post-operative operated muscle. CONCLUSION: Tendon degeneration and fatty infiltration of the gluteus medius muscle appeared to be determinants of the post-operative persistence of lameness and Trendelenburg sign positivity in patients undergoing hip arthroplasty.