Metallic versus Non-Metallic Cerclage Cables System in Periprosthetic Hip Fracture Treatment: Single-Institution Experience at a Minimum 1-Year Follow-Up.

Metallic cerclage cables are reliable and cost-effective internal fixation devices, which are largely used in surgical practice for the treatment of periprosthetic fractures. Nevertheless, complications connected with their use have been described in the literature, including the following: third-body generation, failure and consequent migration, fraying, allergies, and injury to the surgical team. The development of new materials offers alternatives to traditional metallic cables. This study compares the outcomes between two groups of patients affected by periprosthetic hip fractures, treated with titanium cables or with ultra-high-molecular-weight polyethylene (UHMWPe) iso-elastic cables. Our retrospective study aims to compare the clinical and radiological outcomes of titanium cables and UHMWPe iso-elastic cables, isolated or associated with dedicated plates, for the surgical treatment of periprosthetic fractures with stable implants. Two groups of 30 (group A-metallic cables) and 24 (group B-UHMWPe iso-elastic cables) patients have been surgically treated in our institution for hip periprosthetic fractures, between September 2017 and June 2020. The mean age of the patients was 81 years in group A and 80 years in group B. In our study, we included fractures classified as B1 or C, according to the Vancouver postoperative fractures classification; the patients were evaluated retrospectively at 1 year postoperatively, regarding the following: surgery time, blood loss, partial weight-bearing time, radiographical healing time, Harris hip score, and postoperative complications. Comparable outcomes were observed in patients from both groups. Group A showed a higher complication rate compared to group B, at 1 year postoperatively. Non-metallic nylon fiber and ultra-high-molecular-weight polyethylene (UHMWPe) cerclage cables could represent a reliable fixation device, ensuring comparable healing and complication rates with traditional titanium cerclage cables.

Impact of Anterior Cruciate Ligament Injury on European Professional Soccer Players.

BACKGROUND: The impact of anterior cruciate ligament reconstruction (ACLR) on the performance and career of professional soccer players has not been extensively investigated. PURPOSE: To evaluate in professional European soccer players (1) the ACL injury incidence, (2) the return-to-play (RTP) rate and time after ACLR, (3) career survival and athlete performance in the first 3 postoperative seasons after RTP, (4) factors likely related to different outcomes after ACLR, and (5) any related differences between the top 8 European soccer leagues. STUDY DESIGN: Descriptive epidemiology study. METHODS: Included were professional soccer players in the top 8 European Soccer leagues (Serie A [Italy], Premier League [England], Ligue 1 [France], LaLiga [Spain], Bundesliga [Germany], Jupiler Pro League [Belgium], Liga NOS [Portugal], and Premier Liga [Russia]) who sustained an ACL injury during seasons 2014 to 2015, 2015 to 2016, and 2016 to 2017. Data were retrieved from publicly available online sources. Outcomes were evaluated based on player age (<25 years, 25-30 years, and >30 years), position (goalkeeper, defender, midfielder, and forward), affected side (dominant vs nondominant), and league. RESULTS: Overall, 195 players sustained an ACL injury, for a mean annual ACL injury incidence of 1.42%. The RTP rate was 95%, with a mean RTP time of 248 ± 136 days. Within the third postoperative season, 66 players (36%) competed in a lower level national league, and 25 (13.6%) ended their careers; a significant reduction in the mean minutes played per season was found in all 3 postoperative seasons. Player age correlated significantly with reduction in performance or recovery from an ACL injury. No significant correlation was found between postoperative player performance and affected side, position, league, or time to RTP. CONCLUSION: A substantial ACL injury incidence was found in top European elite soccer players; however, a high RTP rate in a reasonable time was seen after ACLR. Nevertheless, professional soccer players experienced a short-term decline in their performance.

Bilateral Post Traumatic Myositis Ossificans of Adductor Longus in a Young Soccer Player: A Case Report and Literature Review.

ABSTRACT: Myositis ossificans traumatica (MOT) is a self-limiting and self-resolving pathology. In most cases, conservative treatment is chosen as the first step. Surgical treatment is reserved for cases of failure of conservative treatment with persistence of pain and mass. The case presented concerns an 18-year-old soccer player suffering from bilateral adductor longus (AL) MOT results following two different sports injuries. The patient reports the appearance of swelling and palpable mass at the proximal and medial region of the thigh, about 2 cm from the pubic symphysis, along the course of the adductor magnus. The radiological investigation showed the presence of a calcification along the course of the right and left AL muscles. Surgical treatment was considered for the right thigh injury, being symptomatic 1 year after the onset and refractory to other treatments. At 3 months of follow-up, the patient was asymptomatic and completed the rehabilitation program for the recovery of muscle strength and range of motion (ROM). In cases where MOT manifests with resistant pain, ROM restriction and daily activity reduction, surgical excision is the preferred option.

Segond Fractures Involve the Anterolateral Knee Capsule But Not the Iliotibial Band.

PURPOSE: To investigate the relationship between the Segond fracture and the anterolateral complex of the knee. METHODS: Between January 2014 and March 2020, patients who presented with an anterior cruciate ligament (ACL) tear requiring acute surgical reconstruction (within 10 days from trauma) were evaluated for inclusion in this study. Patients were included if they had an acute ACL tear with an associated Segond fracture (or "Segond lesion") as detected by radiograph or magnetic resonance imaging. The lateral compartment was exposed in all cases using a 5-cm lateral hockey-stick incision, which was carried down to the iliotibial band. The fascia lata was first inspected and then longitudinally divided along its fibers to expose lateral compartment. The posterolateral corner to Gerdy's tubercle anteriorly was exposed and examined. Once the Segond fracture was identified, it was recorded and photographed. RESULTS: Seventeen patients were enrolled in the study. Dissection of the Segond fracture demonstrated attachment to the anterolateral capsule only. No other discernible attachment to the Segond fracture was noted. Surgical exploration of the anterolateral knee did not reveal injury to the iliotibial band. CONCLUSIONS: Careful dissection of Segond fractures during repair revealed that there is a discernible attachment with the anterolateral capsule to the bone injury in all patients with acute ACL tears undergoing surgical reconstruction and no connections to the iliotibial band. CLINICAL RELEVANCE: The precise pathogenesis of Segond fractures has been the subject of debate, partially due to the complexity of the anatomy of the anterolateral aspect of the knee. Proper understanding of the anatomy of type IV ALL injures with Segond fractures is important to improve treatment of these injuries.

The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation.

The functional positioning of components in a total hip arthroplasty (THA) and its relationship with individual lumbopelvic kinematics and a patient's anatomy are being extensively studied. Patient-specific kinematic planning could be a game-changer; however, it should be accurately delivered intraoperatively. The main purpose of this study was to verify the reliability and accuracy of a patient-specific instrumentation (PSI) and laser-guided technique to replicate preoperative dynamic planning. Thirty-six patients were prospectively enrolled and received dynamic hip preoperative planning based on three functional lateral spinopelvic X-rays and a low dose CT scan. Three-dimensional (3D) printed PSI guides and laser-guided instrumentation were used intraoperatively. The orientation of the components, osteotomy level and change in hip length and offset were measured on postoperative CT scans and compared with the planned preoperative values. The length of surgery was compared with that of a matched group of thirty-six patients who underwent a conventional THA. The mean absolute deviation from the planned inclination and anteversion was 3.9° and 4.4°, respectively. In 92% of cases, both the inclination and anteversion were within +/- 10° of the planned values. Regarding the osteotomy level, offset change and limb length change, the mean deviation was, respectively, 1.6 mm, 2.6 mm and 2 mm. No statistically significant difference was detected when comparing the planned values with the achieved values. The mean surgical time was 71.4 min in the PSI group and 60.4 min in the conventional THA group (p < 0.05). Patient-specific and laser-guided instrumentation is safe and accurately reproduces dynamic planning in terms of the orientation of the components, osteotomy level, leg length and offset. Moreover, the increase in surgical time is negligible.

Neurogenic Heterotopic Ossification of the Hip after Brain Injury. Function Recovery Preserving Hip Joint: A Case Report.

Introduction: Up to 30% of patients with spinal cord injury and to 20% of patients with traumatic brain injury develop neurogenic heterotopic ossification (NHO). Patients develop restriction in joint range of motion (ROM) and impairment in activities of daily life. When neurological recovery occurs, joints dysfunction represents the cause for patients' autonomy loss. Case Report: We present the case of a 39-year-old Caucasian male involved in a car accident and experienced 14 days of post-traumatic coma. After rehabilitation, no residual motor or sensory neurological deficit was present, but bilateral NHOs surrounding hip joints developed. Seventeen months after trauma, the patient was admitted to our institute. He was confined to bed, absolutely unable to walk, stand or sit. Radiological evaluation consisted in Antero-Posterior X-ray view only, due to the inability to open up his hips for lateral views, and 3D computed tomography scan. "Functional resection" of the ossifications was performed and rehabilitation started from day 1 after surgery. At the final follow-up 24 months from the second operation high grade of clinical satisfaction was reported. The patients were able to walk independently, to put on his socks, and to drive a car and bike. Painless right and left hip ROM was, respectively, 100° and 90° for flexion, 10° for extension, 35° and 30° for abduction, and near normal internal and external rotation. The patient referred that further improvement in mobility and fluency was still present day by day. Conclusion: The rarity of the condition frequently bring to a delay in treatment and the absence of specific guidelines made treatment still dependent on surgeon experiences. A multidisciplinary approach is essential for success. Surgeons should be aware that it is important to refer patients to specialized center, because early resection could provide excellent results, preserving hip, and restoring function and patient independency.

Measurement technique for posterior tibial slope on radiographs can affect its relationship to the risk of anterior cruciate ligament rupture.

PURPOSE: The purpose of this study was to determine the most reliable radiographic measurement method to evaluate PTS as a risk factor for ACL reconstruction failure. METHODS: Patients who underwent ACL reconstruction or ACL revision reconstruction between January 2009 and December 2014 by a single surgeon were included. Fifty-two consecutive patients who underwent ACL revision reconstruction were compared to a random selection of 52 patients who underwent primary ACL reconstruction and a control group of 52 patients without ACL injury. ACL reconstruction was performed using either ipsilateral (primary) or contralateral (revision) quadrupled hamstring autograft. Lateral knee radiographs were evaluated using three methods: (1) longitudinal axis, (2) anterior tibial cortex axis, and (3) posterior tibial cortex. RESULTS: A significant difference was found between subjects who underwent ACL reconstruction and control knees (6.79° vs. 5.31°, p = 0.046) using the posterior tibial cortex method. No other statistical significance was found between groups. A multiple linear regression analysis found that the PTS as measured by any method was not affected by the patient's age, sex, height, weight, and BMI. All methods of measurement for PTS demonstrated excellent (ICC > 0.90) intra-rater and inter-rater reliability, but only the posterior tibial cortex method maintained excellent intra-rater and inter-rater reliability (ICC > 0.90) when evaluating patients with ACL revision reconstruction. CONCLUSIONS: The posterior tibial cortex measurement is the most reliable method for analyzing the PTS on lateral knee radiographs in patients undergoing ACL revision reconstruction.

Is dual cup mobility better than hemiarthroplasty in patients with dementia and femoral neck fracture? A randomized controlled trial.

PURPOSE: Treatment of patients with dementia and hip fracture is challenging. Total hip arthroplasty (THA) with dual mobility cup (DMC) has been designed to reduce the rate of dislocation by increasing the stability of the implant. This study aimed to compare the dislocation rates of DMC THA with hemiarthroplasty (HA) in elderly patients with displaced femoral neck fracture (FNF) and a diagnosis of dementia. METHODS: All patients with a displaced FNF and dementia diagnosis were prospectively randomized to hemiarthroplasty or THA with DMC treatment during a 2-year period. Finally, the outcomes of 30 patients in the HA group were compared with those of 30 patients in the DMC THA group. Dislocation rate at a minimum follow-up of 1 year was evaluated as the primary outcome. Reoperation rate, time to surgery, surgical time, length of hospital stay, and 30-day and 1-year mortality were also evaluated. RESULTS: There was a significant difference regarding rates of dislocation in favor of THA with DMC and with regard to length of surgery (p = 0.04) in favor of bipolar HA. Dislocation occurred in five patients (16.6%) treated with bipolar HA and no one (0%) in patients treated with THA with DMC (p = 0.019). There was no difference with regard to the 30-day mortality, 1-year mortality, reoperations, and length of hospital stay between the two groups of patients. DISCUSSION: THA with DMC seems to be a safe and reliable choice to reduce the rate of dislocation at 1 year in patients with dementia and FNF without a higher risk of mortality.