Summary:

Hamstring tendons (HT) represent a widely used autograft for ACL reconstruction. Harvesting, processing and pretensioning procedures together with the time out of the joint could theoretically hamper tendon cells (TCs) viability. The authors hypothesize that HT cells are not impaired at the end of the surgical procedures and their tenogenic phenotype may be strongly improved by exposure to PEMF.

Summary Statement

Mesenchymal stem cells from minced umbilical cord fragments may represent a valuable cell population for cartilage and bone tissue engineering

Summary Statement

Hypoxia enhances chondrocyte phenotype of cells migrating from cartilage fragments, thus supporting the use of chondral fragment as a potential cell source for one-stage cartilage repair

Summary Statement

Preoperative bone-marrow-derived cell mobilization by G-CSF is a safe orthopaedic procedure and allows circulation in the blood of high numbers of CD34+ve cells, promoting osseointegration of a bone substitute.

Aim of study is to verify feasibility of peroneal tendoscopy and to clarify the histological structure of peroneal vincula, so formulating a hypothesis regarding their functional role.

Peroneal tendons possess a vascular supply through mesotendineal structures (vincula), previously related to trophic role and healing response; aim of study is to verify feasibility of tendoscopy in evaluating peroneal tendon and vincula and to clarify histological structure of vincula and presence of nervous tissue, so formulating a hypothesis regarding their functional role.

Cadaver study was performed on 8 fresh-frozen ankles, verifying accessibility of endoscope to tendon and vincula; samples from cadaveric vincula were taken; 5 peroneal vincula biopsies were obtained from 5 patients affected by ankle instability, undergoing tendoscopy for chronic lateral ankle pain. Tendoscopy was performed for persistent pain at the posterior margin of lateral malleolus after at least 4 months of nonoperative treatment. Biopsies were taken from center of pathologic vincula.

Patients biopsies and cadaveric samples were analyzed with light microscopy and immunohistochemistry (anti-humanS100antibody)

Peroneal tendons are accessible by endoscope along whole common sheath; vincula were found in all cadaveric specimens; intraoperative finding of vincula lesion (thickening/scarring) was found in all patients biopsies. Histology and immunohistochemistry revealed presence of nervous fibers inside the intimate structure of peroneal vincula both in cadaveric specimens and in patients biopsies.

Tendoscopy as a useful tool in visualizing the entire length of peroneal tendons, allowing the surgeon to diagnose and treat different peroneal disorders.

Although literature provides no data about innervations of peroneal vincula, presence of free nervous fibers inside vincula structure is consistent with a proprioceptive role of the vinculum in peroneal tendon physiology.

Moreover, our findings in patients biopsies suggest lesion of peroneal vinculum is a nociceptive source and an important element leading, synergistically with other soft tissues (i.e. joint capsule, lateral ligaments) injuries, to proprioception impairment in clinical pictures of chronic ankle instability. So selective excision of degenerated areas of vincula can be justified as accessory procedure in treatment of chronic lateral pain in patients affected by chronic ankle instability.

This study reports the 5-year clinical and radiological outcomes of a simple arthroscopic-assisted technique for Schatzker type II and III tibial plateau fractures, without bone grafting. Forty six patients (46% males, 54% females, average age 48 years, SD 13.6 years), with tibial plateau fractures Schatzker type II (41%) and III (59%), underwent an arthroscopic-assisted technique conceived to use a compacted cancellous bone graft, taken from the medial metaphyseal side of the tibia, and a percutaneous fixation.

The patients were prospectively followed-up at one, three and five years from surgery. Independent assessments were carried out using Knee Society Score, HSS score and Rasmussen’s clinical and radiological scores. At 5-year follow-up patients underwent a weight-bearing radiograph of both limbs.

At last follow-up evaluation Knee Score (average 93.2, SD 7.7) was excellent in 37 patients (80%), good in six (13%), fair in three (7%). Function Score (average 94.8, SD 8.51) was excellent in 38 patients (83%), good in five (11%), fair in three (6%). HSS score (average 93.4, SD 8.23) was excellent in 41 patients (89%), good in five (11%). The average Rasmussen clinical score was 28.2 (SD 1.4). The radiological Rasmussen score was excellent in five patients (11%), good in 39 (85%) and fair in two (4%). In the weight-bearing radiographs a valgus deviation was present in four patients (8.7%).

Arthroscopic-assisted technique for lateral tibial plateau fractures without bone grafting has outcomes encouraging and comparable to the results of other techniques that use either iliac crest graft or bone substitutes.

Aim: Evaluate the incidence of complications related to timing (time between admission ad operation) and oral antiplatelet/anticoagulant therapy in patients treated for a hip fracture.

Materials and Methods: We prospectively evaluated 5 groups of 30 patients each, selected out of 875 consecutive patients admitted at the First Aid Unit of our Hospital with a proximal femoral fracture: group A – patients on Warfarin therapy, treated more than 5 days after admission (in order to allow the wash-out of Warfarin, as advised by many Anaesthesiologist Associations); B – patients treated more than 5 days after admission, not on Warfarin therapy; C – patients treated less than 48 hours after admission, not on Warfarin therapy; D – patients on Aspirin/NSAIDS therapy, treated more than 5 days after admission; E – patients on Ticlopidine/Clopidogrel therapy, treated more than 5 days after admission. The groups were comparable regarding age, gender, pre-trauma walking ability, mental state, fracture type and treatment. Blood loss, number of RBC transfusions, complications during hospitalization and up to 6 months after discharge, duration of hospitalization, degree of functional recovery and 2 years mortality were recorded. Statistical analysis included Kruskall-Wallis, U-Mann-Whitney and Logistic Regression Tests (SPSS 13.0 software).

Results: Group A showed higher preoperative blood loss (p=0.002), and longer hospitalization (p< 0.001), compared to all other groups. Groups D and E showed no higher complication and mortality rate in comparison to group B and C, while group A showed higher complication and mortality rate. Standing alone, timing and Warfarin appear not to be significant risk factors, while taken together they represent a high risk factor for complications ad mortality (p=0.009).

Conclusion: Patients on Warfarin therapy, affected by hip fracture, are at high risk of complications and mortality, if the recommendation of postponing treatment until drug wash-out is accepted. Reversal of anticoagulation using vitamin K and straight-forward treatment should be considered. Antiplatelet therapy appears not to have the same adverse effect as anticoagulant therapy.

Aims: Peroneal tendons possess a vascular supply through a mesotendineal structure named vinculum; vincula are identifiable with tendoscopy and are supposed to play a role in tendon healing response, due to prominent vascularity; aim of the study is to verify the feasibility of tendoscopy in evaluating peroneal tendons, to clarify the histological structure of peroneal vincula and to investigate the presence of nervous tissue, so formulating a hypothesis regarding the functional role of vincula.

Methods: cadaver study was performed on 8 fresh-frozen ankles; dissection were conducted to verify accessibility of endoscope, proximity with superficial peroneal nerve and presence of vincula; samples of vincula were obtained; light microscopy and immunohisto-chemistry (anti-human S100 antibody) were performed, describing structure of vincula and identifying peripheral nerve fibers.

5 peroneal vincula biopsies were analyzed from patients affected by ankle instability and undergoing tendoscopy for peroneal tenosynovitis.

Results: peroneal tendons are accessible along the whole common tendon sheath and a discrete distance between the endoscope and the superficial peroneal nerve is present in all specimens; a membranous mesotendineal structure was found in all specimens between both tendons and tendon sheath; macroscopic inspection revealed the presence of a vessel network, arising from the sheath toward the tendon; light microscopy of cadaver samples confirmed the presence of multiple vessel branches crossing the entire structure of the vinculum and identified nervous structures close to the vessels, resembling a neurovascular bundle; immunohistochemical analysis revealed nerve fibers in each specimen;tendoscopy in patients affected by ankle instability showed lesions of the vincula and histology from intraoperative biopsies showed presence of nerve fibers.

Conclusions: tendoscopy is a useful tool to visualize peroneal tendons and to diagnose and treat different disorders; although literature provides no data about innervations of peroneal vincula, the study shows nervous fibers consistently present inside the intimate structure of vinculum; besides its function in repair and healing processes, this suggests a proprioceptive role of the vinculum in peroneal tendon physiology and lesion of vinculum could be an important element acting synergistically with joint capsule and surrounding tissues lesions and ultimately leading to clinical pictures of ankle instability.

Aims: Hydroxyapatite coatings have been proven to improve the osteointegration of metal implants however they are not stable and they might delaminate from the metal surface when challenged by the mechanical stresses experienced by the implant. Therefore, efforts of different researchers are being devoted to find more stable coatings or surface treatments that could replace HA.

In particular, spontaneous calcium phosphate deposition on titanium surfaces from aqueous electrolyte containing calcium and phosphate ions, such as simulated body fluid solutions, has been observed and is believed to be related to the excellent bonding capability in contact with bone tissue.

In the present study, a new multiphase anodic spark deposition (ASD) method combined with chemical etching is presented It has been optimized and such modified titanium surface exhibited high mineralisation potential, selective protein adsorption, quicker and more intensive osteoblasts adhesion and differentiation. Such treatements was labelled BioSpark™ and consisted in a thick calcium-phosphate-doped oxide film growth on the titanium bulk. This oxide layer exhibits anatase lattice, micro-porosity and a thin nano-roughened texture.

Methods: The effect of this process, was investigated invitro and in vivo in cortical and spongy bone of 12 adult sheep. Histomorphometric and microhardness measurement were carried out at each experimental time (4, 8, 12 weeks) to quantify the bone-to-implant contact around the implants, the bone ingrowth as well as the newly bone hardness and bone maturation index

Results: Data suggests that the BioSpark treatment produces a modification of the Ti surface, which represents good bioactivity and may be suitable for achieving a stable implant osseointegration.

Conclusions: Such surface modification treatments was applied in the last two years on dental implants with great success and is now being tested in human being for histological studies. In the future, it will be applied on orthopaedic prostheses devices in order to improve device osteintegration. The data demonstrate that this type of surface improves the material osteointegration potential when compared to conventional surfaces while offering high mechanical stability.

Introduction: This paper presents the short term results of 56 (28 males and 28 females) consecutive Unicompartimental Knee Arthroplasties (UKAs) and 54 (29 males and 25 females) High Tibial Opening Wedge Osteotomies (HTOs), performed in two centres (Toronto-Canada and Torino-Italy), between 2001 and 2004.

The aim of this prospective study was to compare UKAs to HTOs, in terms of clinical and functional Results: Materials and Methods:

In all UKAs we implanted an Accuris prosthesis (Smith& Nephew, Memphis TN), in all HTOs we performed a medial opening wedge osteotomy, according to the surgical technique and syntesized with a Puddu Plate (Arthrex, Naples FL).

We evaluated all patients preoperatively and at 6 months postoperatively, at 1 year, 2 years and at the last follow-up visit (mean 3,5 years for UKAs and 2,5 years for HTOs), using the Knee Society Score (KSS) and the WOMAC (Western Ontario and McMaster Universities) Score.

Results: The mean age at operation was 55 years for the HTO group and 65 years for the UKA group.

Postoperative program for the HTO group was: 4 weeks of CPM (continuous passive movement), partial weight-bearing al 4 weeks (30–50% of body weight) and then full weight-bearing at 8 weeks postoperatively.

In the UKA group, full weight bearing was allowed immediately after operation.

We observed only one significant complication postoperatively: an early infection in an HTO patient. We thought this complication was not related to the treatment chosen, but to external factors, so we decided to exclude this patient from our study.

In the HTOs group, the KSS knee score (KS) and function score (FS) improved from respectively 38 and 55 preopertively to 76 and 91 at the final follow-up evaluation, while in the UKA group KS increased from 43 to 93 and FS increased from 50 to 84.

The WOMAC Score improved from respectively 48 (HTO Group) and 45 (UKA Group) preoperatively to 15 (HTO Group) and 14 (UKA Group) at the final follow-up evaluation.

Discussion and conclusion: According to both scores (Womac and KSS), the two groups did not differ significantly at 1 year, 2 year and last followup evaluation, considering the different ages of the patients (55 years of the HTO Group versus 64 years of the UKA group).

Comparison of study groups shows good outcome at early and mid-term follow-up. All patients had scores rated good to excellent (both KSS and WOMAC).

However, we found a little difference in KSS between the two groups: UKAs have a higher Knee Score (better knee assessment), while HTOs have a significantly higher Functional Score (better performances, maybe due to a more “anatomic saving” procedure).

This data suggests that the UKAs have better knee assessment, meanwhile the HTOs have better function. Given that, both treatments lead to a good to excellent outcome at early followup.

The purpose of this study is to identify the optimal amount of knee flexion required to drill the femoral tunnel in ACL reconstruction using the transtibial technique in order to ensure the correct alignment between the femoral tunnel and the interference screw.

Methods: Twenty (10 × 2) fresh-frozen cadaveric knees were used. The native ACL was resected and its tibial attachment was identified. The angle of the tibial tunnel was set at 55° using an Arthrex tibial guide. The extra-articular tibial tunnel entry point was located at the anterior border of the superficial MCL. The intra-articular exit point of the guide wire was digitized with a digital camera and referenced to anatomical landmarks (the anterior border of the PCL, the lateral aspect of the medial spine and the anterior horn of the lateral meniscus). The femoral tunnels were made using the transtibial technique and a 5mm femoral guide to insert guidewires at 70, 80, and 90 degrees of knee flexion (groups a, b, c respectively). The angles of divergence between the longitudinal axis of the femoral tunnel and the interference screw (placed through an anteromedial portal at 120° of knee flexion) were then measured.

Results: The degrees of divergence were: 5° ± 2° for group a, 12° ± 4 for group b, and 15° ± 3° for group c.

Conclusions: Optimal femoral tunnel and interference screw alignment is achieved using the transtibial technique when the femoral tunnel is drilled with the knee in 70 degrees of flexion and the screw is inserted at 120 degrees of knee flexion.

This study identifies a mathematical formula for the optimal amount of knee flexion required to drill the femoral tunnel in ACL reconstruction using the transtibial technique in order to ensure the correct alignement between the femoral tunnel and the interference screw.

The failure rate of peritrochanteric fracture implants ranges from 5 to 20 % The aim of the present preliminary study is to evaluate the relationship between Singh index (SI), and failure of internal fixation (cut-out), examining bone mechanical properties from ex-vivo human femoral heads.

The failure rate of peritrochanteric fracture implants ranges from 5 to 20 % The aim of the present preliminary study is to evaluate the relationship between Singh index (SI), and failure of internal fixation (cut-out), examining bone mechanical properties from ex-vivo human femoral heads.

From a methodological point of view we decided to use SI on the basis of previous literature,, our data seems not to be influenced by the use of this methodological approach. > Three load speeds were set: 3, 10, 500 mm/min resulting values of BW/s were compared with Davy and Bergmann ones (obtained with instrumented prosthesis), and test validity was confirmed. In conclusion our data demonstrated that: cut out phenomenon occurs for lower mechanical load in femoral heads of patients with lower SI.

The ABG total hip prosthesis had been studied to prevent any kind of stress shielding and to allow the localization of the loads in the metaphiseal region of the femur. The aim of this study was to analize the effective behaviour of the loads in long-term implants and the possible correlations of those findings with the clinical situation of the patients.

We considered 87 total hip arthroplasty implants executed from 1989 to 1995 and performed by using Anatomique Benoist Girard I uncemented prosthesis. The radiographical findings have been classified observing Engh’s stability criteria according to Gruen’s subdivision of the periprosthetic femoral zones.

The radiographical analysis shows a higher presence of can cellous densification in Gruen’s zones 3 and 5 than the one found in zones 2 and 6. Furthermore the presence of a cortical reaction is more relevant in the distal zones.> Radiolucent lines are present in 16% of the cases in zone 4; their percentage in zones 3 and 5 decreases to 7.14% and 10.71%.

Our study shows the certain presence of the stress shielding mechanism in long-term analysis and documents that the main region of late anchorage is the distal, not hydroxyapatite-coated, one.> The comparison with other similar studies shows the decrease of the presence of radiolucent lines in proximal femoral zones with the rise of the follow-up: it can be interpreted as the lesser presence of micro movements of the tip of the prosthesis due to the distalization of the anchorage.

The ABG stem (Anatomique Benoist Girard, How-medica) was realized of titanium alloy (TA6V) and it was designed to provide anchoring only at the femour’s metaphyseal portion. The long-term stability is achived by osteointegration of the implant at the metaphyseal region, which is coated with hydroxyapatite (HA) crystals. The plasma-sprayed HA coating has a tickness of 60 μm for the stem.

The current study presents radiographic outcomes of more than one hundred primary uncemented HA stems with a long-term follow-up. One hundred and eleven ABG hip arthroplasties were evaluated with a mean follow-up of 9.8 years. The radiographical findings have been classified observing Engh’s stability criteria according to Gruen’s subdivision of the periprosthetic femoral zones.

Dividing the hips into two different groups (in the first one the prosthesis implanted 11, 12 or 13 years ago and in the second one the prosthesis with a maximum age of 10 years) it’s possible to see as in the first group the radiolucent lines are quite reduced. Among the older prosthesis the percentage of radiolucent lines is 3.1% in zones 3 and 5 and 18.8% in zone 4. For what concerns the younger ones the percentage are 10.1% (zone 3), 21.5% (zone 4) and 15.2% (zone 5).

We believe that there is a load transfer from the metaphyseal to the metadiaphyseal portion of the femur without a worsening of the clinical outcomes. The absence of reactive lines and lucencies around the proximal HA-coated portion of the stem supports an excellent circumferential bony ingrowth in the metaphyseal area of the proximal femur. According to these percentages we can say that there’s less presence of radiolucency in the oldest prosthesis and it could be possible to argue that radiolucent lines tend to reduce along the time. This is probably due to the increase of the strength of the stem anchorage.

Aims: evaluate the relationship between Singh index (SI), bone mineral density (BMD) examining bone mechanical properties from ex-vivo human femoral heads.

Methods: we collected the femoral heads of 22 patients that underwent arthroplastic for fracture of femoral head under low energy trauma. 5 patients were male while 17 were female. In each patient a pelvis X-ray was performed to estimate Singh Index. From 2 to 3 bone cylinders of cancellous bone were obtained from each femoral head. 52 bone cylinders (7x10mm) were obtained. In each specimen densitometric scans were performed by means of a Hologic QDR 4500 X-ray densitometer, using a small animal software. The coefficient of variation (CV) was calculated by repositioning a sample for 5 scans by different operators. The data obtained were expressed as bone mineral content (BMC) and bone mineral density (BMD). Compression tests with a JJ Instruments T5K machine were conducted on 52 spongy bone cylinders. Each specimen was loaded in movement control; maximum failure load and Young modulus were recorded.

Results The CV for the precision was 1.8% for BMC and 2.7% for BMD. There are no differences between males and females in age, BMC, BMD and Young modulus, while there is a significant difference in maximum load and SI. As regards SI values, there are significant differences among different categories of SI for age, sex, BMC, BMD, Young modulus and maximum failure load. Considering each sample position, namely 1, 2 or 3, there was no significant difference in densitometric parameters and in mechanical properties Statistical analyses of correlations by Pearson’s coefficient showed significant inverse correlations between age and mechanical bone properties (Young modulus and maximum failure load), while the correlations between BMC, BMD and biomechanical bone behaviour were strictly direct Linear regression model demonstrated only maximum load predictors are Young modulus and BMD

Conclusions The maximum failure load is lower in females than in males with similar BMD but lower SI for different SI categories there are significant differences both in biomechanical behaviour both in densitometric parameters.The age is inversely correlated with bone densitometric features and bone biomechanical behaviour, while bone density is directly correlated with bone strength and elastic modulus.The bone strength is predicted with 93% accuracy by Young modulus and BMD.

Aims: Propose of this study is to evaluate the results of mini open surgical technique in treatment of tibial plateau fractures. Methods: Between September 1999 and September 2000, 10 patients (6 men, 4 women) with closed tibia plateau fractures were treated with arthroscopic and mini open surgical technique. The mean age was 48 (range 28–72 years). The mean follow-up was 26 months (range 20 months to 36 months). Schatzker classiþcation system was used for evaluation and classiþcation of the fracture patterns. Hence, three cases were type 1, four were type 2 and three cases were type 3. The arthroscopy was done in all the cases. No meniscus tears were found in all the patients. The plateau fracture has been reconstructed with elevation, through an antero-medial window in the proximal metaphysis of the tibia, with a particular carrot system. No autograft bone was adopted. We used a percutaneous þxation with AO cannulated screws (1–3 screws). Results: The results were evaluated with the HSS Knee Score System. There were no preoperative and postoperative complications. The results were 80% excellent, 20% good. The average of the Knee Score was 94 (range 78–100) and the average of the Functional Score was 96 (range 80–100). Conclusions: The arthroscopy and the mini open surgical technique create a complete anatomical reduction of articular fractured area with no graft.