Treatment of patellofemoral chondropathy with the Bandi tibial tubercle osteotomy More than 10years follow-up.

Isolated degenerative patellofemoral chondropathy is a prevalent disease. There is still controversy regarding its ideal type of management. A retrospective study was performed to assess the outcomes of 28 patients with a minimum of 10-year follow-up, in whom the Bandi tibial tubercle osteotomy was performed. The Bentley score was applied pre and postoperatively to evaluate the clinical results. Preoperatively, 21 (67%) patients were rated as fair and seven (33%) as poor according to the Bentley functional scale for patellofemoral osteoarthritis. At 5 years of follow-up, one case was rated as excellent, 23 (81%) cases as good, three as fair and one as poor. At 10 years of follow-up no cases were rated as excellent, 17 (61%) cases as good, four (14%) as fair and seven (25%) as poor. The difference in terms of poor results evaluated at five and 10 years after the surgery was statistically significant (p<0.05). We concluded that excellent and good short-term results can be expected with the use of the Bandi tibial tubercle osteotomy in patients with isolated degenerative patellofemoral chondropathy; however, such outcomes tend to deteriorate over the time, especially in patients with advanced chondromalacia, making its indication controversial.

Arthroscopic Treatment of Femoroacetabular Impingement in Patients over 60 Years Old: Preliminary Report of a Pilot Study.

The objective was to evaluate short-term outcomes of patients of more than 60 years old, who underwent arthroscopic treatment for femoroacetabular impingement (FAI). The study design was a nonrandomized controlled clinical trial; this was a prospective study in 15 patients (15 hips) over 60 years old. Inclusion criteria were symptomatic FAI, no prior surgeries of the affected hip, and osteoarthritis Tonnis classification grade I or II. Exclusion criteria were multiple or large (≥5 mm) chondral defects or subchondral bone cysts in the acetabulum or the femoral head seen on magnetic resonance imaging (MRI). Radiographs and MRI arthrograms were used for the imaging assessment in all cases. Procedures performed arthroscopically included labrum resection, acetabuloplasty, and femoral osteoplasty in all cases. The Harris Hip Score was applied preoperatively and 2 years postoperatively. At 2 years postoperatively, the average increase in the Harris Hip Score was 21 points (mainly pain reduction) from a mean preoperative score of 66 points to a mean postoperative score of 87 points; this difference was significant (P < 0.05). Three cases (20%) had poor outcomes and required a total hip replacement during the first year after the surgery. Poor results were associated with Tonnis grade II osteoarthritis and Outerbridge grade III or IV chondral defects. Arthroscopic treatment of FAI of patients over 60 years old showed a significant Harris Hip Score increase as a result of excellent and good short-term clinical results in most of the patients of our study. Nevertheless, despite strict selection criteria for very well-selected patients, we observed an early failure rate of up to 20%.

Anterior and Posterior Femoral Head-Neck Offset Ratio in the Cam Impingement.

PURPOSE: The purpose of this study was to determine if the anterior-posterior offset ratio is altered in patients with symptomatic cam impingement. STUDY DESIGN: Preoperative radiographs of 15 symptomatic patients with isolated cam-type impingement diagnosed by physical examination and magnetic resonance imaging arthrogram (MRIA) and confirmed by hip arthroscopy findings were assessed. Fifteen asymptomatic volunteers made up the control group. The anterior offset (AO), posterior offset (PO), and AO/PO ratio were calculated. RESULTS: The mean ± SD AO/PO ratio was 0.56 ± 0.1 for the symptomatic group and 0.9 ± 0.2 for the asymptomatic group. This difference was statistically significant. Intra- and interobserver correlation factor for calculating the AO/PO ratio was 0.8 and 0.5, respectively, and differences were not statistically different. CONCLUSIONS: The AO/PO ratio in this study was a useful radiological parameter for the assessment of patients with a cam-type impingement.