Arthroscopic autologous chondrocyte transplantation: technical note.

We describe an arthroscopic surgical technique for tissue engineered cartilage grafting. A three-dimensional hyaluronic acid support is used for autologous chondrocyte culturing. The technique reduces morbidity of classic autologous implant and avoids open surgery and the use of a periosteal flap. The procedure includes the advantages of arthroscopic osteochondral grafting without donor site morbidity. With this technique is possible to reduce the patient morbidity, time and cost of surgery.

Micromotion between the half bearings in the interax prosthesis: a roentgen stereophotogrammetric analysis.

We assessed the migration and movement between the half-bearings of the Interax prosthesis in 18 patients using roentgen stereophotogrammetric analysis (RSA). This study showed movements of the tibial component even in successful knee arthroplasty: 17 prostheses migrated only initially and remained stable after 1 year, whereas 1 prosthesis migrated consistently throughout 3-year follow-up. RSA revealed no or minimal displacement between the half-bearings until the 4-year follow-up, confirming that their fixation to the baseplate was adequate. In the case of loosening, a rotation about the longitudinal axis of 1.3 degrees and a medial-lateral translation of 0.5 mm was observed between the half-bearings. Cold flow was revealed by RSA in the posterior region of the medial half-bearing.

Results of the original Putti-Platt procedure for shoulder instability: review of Putti's scholar experience.

Twenty patients who underwent Putti-Platt shoulder capsulorraphy were retrospectively evaluated at long-term follow-up (24-34 years). The aim of this study was to analyse the efficacy and possible degenerative changes associated with this procedure. Patients' charts were reviewed to analyse the pre-operative picture, surgical technique and post-operative program. All patients were re-examined using ASES, Rowe and Lysholm scales. Range of movement (ROM) of the shoulder operated on was compared with the non-operated one. A-P, axillary and outlet views were taken for radiographic control. Samilson criteria were followed to determine the degree of arthrosis. Clinical outcome was satisfactory in 85% of the cases with only three cases with fair results (15%). No recurrence was present in this series. The mean limitation of external rotation in abduction was 9 degrees with respect to the contra-lateral shoulder. Severe degenerative changes were observed in two cases. In conclusion, after a long follow-up period, the Putti-Platt technique has shown highly satisfactory results, with an incidence of loss of motion and joint degeneration changes similar to other procedures.

The mobility of the proximal tibio-fibular joint. A Roentgen Stereophotogrammetric Analysis on six cadaver specimens.

In six cadaver specimens the mobility of the proximal fibula in relation to the tibia was investigated during plantar/dorsiflexion of the ankle, using Roentgen Stereophotogrammetric Analysis (RSA). The role of the ankle joint, and of the calcaneofibular and talofibular ligaments was also evaluated. The greatest movements were observed along the mediolateral and anterior-posterior axes, resulting in an anterolateral displacement of the fibula head during dorsiflexion and in a postero-medial displacement during plantarflexion. This study demonstrated a limited mobility of the proximal tibiofibular joint. Moreover, the ligament cutting and the presence of constraints in the ankle region did not show any effect on the fibular movement.

Cryo/Cuff use after arthroscopic surgery: effect on knee joint temperature.

Any modality that alters joint homeostasis could have a potential negative effect on cartilage. During arthroscopic knee surgery, the temperature in the knee joint decreases significantly. The use of cryotherapy after this surgical procedure could maintain or increase these temperature variations. This prospective, randomized study evaluated the change in intra-articular knee temperature with the use of the Cryo/Cuff (Aircast Inc, Summit, New Jersey) in 30 patients after arthroscopic knee surgery. In 15 patients, a Cryo/Cuff with an automatic pump was applied immediately after surgery (group 1), and in the remaining 15 patients, only a wound dressing was applied (group 2). The mean intra-articular temperature at the beginning of the procedure was 34.8+/-1 degrees C for both groups. At the end of surgery, the temperature was 26.8+/-2.2 degrees C for group 1 and 27.5+/-2.2 degrees C for group 2. One hour after the end of the procedure, the mean temperature was 34+/-1.6 degrees for group 1 and 34.8+/-1.7 degrees C for group 2. These differences were not statistically significant. These results demonstrated that the use of the Cryo/Cuff does not alter temperature recovery in the knee, thereby excluding potential damage to the articular cartilage.

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons.

Numerous surgical procedures have been developed and used for anterior cruciate ligament (ACL) reconstruction. Patellar tendon is probably the most common graft used, but gracilis and semitendinous tendons present some interesting advantages: small incision, large graft when doubled, characteristics close to ACL, rapid harvest. We describe a combined intra- and extra-articular arthroscopic ACL reconstruction using hamstring tendons which includes some original steps. The tendons are harvested, leaving the distal insertion intact, and sutured together. After drilling of the tibial tunnel, an over-the-top arrangement is formed, creating a groove in the posterolateral aspect of the femur. The tendons are then fixed with double staples in the groove, and their remaining part is fixed distally to Gerdy's tubercle passing under the fascia, but over the lateral collateral ligament (LCL). This technique ensures sufficient strength in the graft and permits correction of any associated instability, because of the presence of the extra-articular portion of the tendons. Furthermore, the over-the-top arrangement reduces trauma and possible pitfalls related to tunnel construction and permits isometry of the extra-articular portion to be established. Forty patients involved in sports activity were prospectively selected and evaluated at a minimum 2 years' follow-up. IKDC score and Lysholm score were used for clinical evaluation, and the KT-2000 was used for instrumental laxity measurements. Resumption of sport and time to that point were recorded as well as Tegner activity score. We had 92.5% normal and fairly normal knees according to IKDC score and only 7.5% abnormal knees. Mean Lysholm score was 95. Mean Tegner score was 7.2. KT-2000 showed a mean injured/uninjured difference of 2.1 mm. In all, 90% of patients resumed sports at the same level, 67.5% in 3-4 months and 27.5% in 4-6 months. The highly satisfactory results of this series with no major complications confirm the reliability of this technique and the possibility of guaranteeing functional behaviour in the knee.

Total knee arthroplasty without patellar resurfacing in active and overweight patients.

Overweight patients are often considered poor candidates for total knee arthroplasty (TKA). A retrospective study of this was done on 47 osteoarthritic knees treated by TKA without patella resurfacing between March 1991 and June 1993. The Hospital for Special Surgery (HSS) rating system was used for clinical evaluation, and radiographs to study the degree of osteoarthritis and radiolucency. Correlations between overweight, range of motion (ROM) and stage of patellar damage and other measured variables (HSS score, patellar pain and radiolucency) were studied. Overweight was not correlated with HSS score, radiolucency or patellar pain. ROM was significantly correlated with patellar pain and HSS score, with better results in patients with ROM between 90 degrees and 110 degrees. Therefore, we believe that TKA in osteoarthritic knees can lead to successful results, even in active or overweight patients.