Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management.

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based on high-quality research are lacking.

Medial open wedge high tibial osteotomy is a viable option in young patients with advanced arthritis in a long-term follow-up.

Purpose: This study aimed to evaluate the long-term outcomes of medial open wedge high tibial osteotomy (MOWHTO) as a treatment option for advanced medial compartment knee osteoarthritis (OA) Kellgren-Lawrence (K-L) III and IV.

Methods: Patients with severe medial compartment arthritis, who underwent MOWHTO with locking plate between 2003 and 2015, were retrospectively reviewed. A locking plate for the osteotomy was utilized.

Reconstruction of a Neglected Patellar Tendon Rupture in an Adolescent: A Case Report.

We present a case of a neglected patellar tendon rupture, misdiagnosed as an anterior cruciate ligament tear, in a 12-year-old child with open physis without an avulsion fracture. The patient was treated with an ipsilateral hamstring tendon autograft with preserved distal insertions, a transpatellar tunnel, and a transtibial fixation. At the final follow-up, the patient had a full range of motion and a fully functional knee.

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part III-indications for different clinical scenarios using the RAND/UCLA appropriateness method.

Purpose: The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev).

Methods: The RAND/UCLA Appropriateness Method (RAM) was used to provide recommendations on the appropriateness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidence in conjunction with expert opinion. A core panel defined the clinical scenarios with a moderator and then guided a panel of 17 voting experts through the RAM tasks.

Lateral augmentation procedures in anatomic anterior cruciate ligament reconstruction. How to avoid tunnel collision with intraoperative tunnel visualization: A technical note.

Lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction can be used as an augmentation procedure in anatomic anterior cruciate ligament (ACL) reconstruction and are thought to minimize rotational instability, lower re-rupture rates of the ACL graft and improve functional outcomes after surgery. Young patients with high-grade pivot shift or generalized laxity participating in high demand/pivoting sports are considered as the ideal candidates for such a procedure. Both in LET and in ALL reconstruction, femoral fixation of the graft using an interference screw remains a challenge due to the possibility of tunnel convergence of the two tunnels created in the femur, namely the ACL femoral tunnel and the tunnel created in the lateral femur for the LET or ALL procedure.

Postoperative Infection after Anterior Cruciate Ligament Reconstruction: Prevention and Management.

Infection following anterior cruciate ligament (ACL) reconstruction can be one of the most debilitating complications following ACL reconstruction. Its reported incidence is around 1%. Utilization of vancomycin for presoaking the graft is considered an established method for infection prevention.

Transfusion Rates in Total Hip Arthroplasty Are lower in Patients with Direct Anterior Approach.

Background: Blood conservation and reduction in the need for allogeneic blood transfusion (ABT) has been a subject of importance in total hip arthroplasty. There are a number of well-recognized parameters that influence blood loss during total hip arthroplasty (THA). The role of surgical approach on blood loss and the rate of ABT during THA is not well studied.

The aspiration test reveals an instability of the posterior horn of the lateral meniscus in almost one-third of ACL-injured patients.

Purpose: Anterior cruciate ligament (ACL) injuries often lead to associated injuries of the posterior horn of the lateral meniscus (PHLM). Arthroscopic, assessment of PHLM instability may be difficult in the absence of a visible meniscus damage. The main objective of this prospective multi-center study was to compare the ability of the probing and aspiration tests to identify PHLM instability in a population of patients undergoing ACL reconstruction (ACLR) and a control group of patients with an intact ACL undergoing knee arthroscopy.

Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes.

DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies.Most studies report infection recurrence rates or infection-free time intervals.

A Challenging Case of Extraordinary - Long standing Forearm Non-union Treated with Extensive Debridement, Locking Plates, and Bone Grafting. Technical Considerations in Multiple-operated, Neglected Non-unions.

Introduction: Forearm non-unions pose a significant treatment challenge to orthopedic surgeons. Repetitive treatment failures can lead to a devastating situation for the patient. Forearm function influences both elbow and wrist proper function.

Comparison of Minimally Invasive Operative Treatment with Conservative Treatment for Acute, Minimally Displaced Scaphoid Fractures at 12 Months' Follow-up.

 Minimally displaced scaphoid fractures can be challenging to diagnose and treat. Cannulated scaphoid screws have made percutaneous stabilization highly effective.  Would minimally invasive operative treatment of minimally displaced scaphoid fractures yield faster return to work when compared with patients treated conservatively? How do functional and patient satisfaction scores compare between the two groups at 12-months follow-up?  Records from 18 patients (mean age 28.

Direct medical costs of interprosthetic femoral fracture treatment: A cohort analysis.

Introduction: Periprosthetic femoral fractures (PPFs) represent a challenging clinical problem with a fast-rising incidence. Interprosthetic fractures (IPFs) represent one of its most difficult variants. There is a paucity of data regarding the financial burden of PPFs, and none for IPFs.

Evaluating the "Patella-Friendly" Concept in Total Knee Arthroplasty: A Minimum 15-Year Follow-Up Outcome Study Comparing Constant Radius, Multiradius Cruciate-Retaining, and Nonanatomical Cruciate-Retaining Implants.

Background: Patella-friendly femoral components were developed in order to reduce anterior knee pain and patellofemoral complications in total knee arthroplasty (TKA), but their effect on long-term outcome is still unclear.

Methods: We retrospectively evaluated prospectively collected data from 3 groups consisting of 100 patients (100 knees in each). In group A, the constant radius a-MP, in group B the multiradius cruciate-retaining Genesis II, and in group C the nonanatomic, multiradius, cruciate-retaining AGC TKA was implanted.

Inadvertent direct pulmonary artery catheterization complicating the effort for subclavian venous cannulation and central venous catheter placement: A case report and review of the literature.

Subclavian access is commonly used in the intensive care unit (ICU) for central venous catheterization. Many complications have been reported during the placement of central venous catheters including pneumothorax, hemothorax, hematoma, and bleeding. The direct, through the thoracic wall, catheterization of pulmonary artery is a very rare one with only three previous reports in the literature.

Prior Femoroacetabular Osteoplasty Does Not Compromise the Clinical Outcome of Subsequent Total Hip Arthroplasty.

Background: Total hip arthroplasty (THA) is the most effective treatment option for patients with symptomatic osteoarthritis after a prior femoroacetabular osteoplasty (FAO). This study evaluated clinical outcomes of THA after a prior FAO and compared the results with a matched group of patients who underwent THA with no prior surgical procedures in the affected hip.

Methods: By reviewing our prospectively maintained database, we identified 74 hips (69 patients) that underwent THA after previous FAO between 2004 and 2017.

Individualized surgery in primary total knee arthroplasty.

Total knee arthroplasty (TKA) is a satisfactory procedure for end-stage knee joint pathology. However, there is a significant incidence of unsatisfied patients.In recent years conventional total knee arthroplasty surgical technique has been challenged and a modern trend to respect individual anatomy, alignment and soft tissue laxities has been developed.

Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place: What Should Be Done with the Silent Prosthetic Joints.

Background: Although periprosthetic joint infection (PJI) can affect multiple joints concurrently, the majority of patients with multiple prosthetic joints present with PJI of a single joint. Data regarding the optimal management of these patients are limited. We aimed to identify the prevalence, risk factors for a subsequent PJI, and clinical circumstances of PJI in patients with multiple prosthetic joints.

Stenotrophomonas maltophilia periprosthetic joint infection after reverse total shoulder arthroplasty.

is a well-known opportunistic Gram-negative bacterium causing mainly hospital-acquired infections, . We report the first case, to our knowledge, of a periprosthetic infection caused by this pathogen in an artificial joint. has the ability to form biofilm, and subsequently should not be excluded in the investigation of prosthetic joint infections.

Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits.

Aim: This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted.

Material And Methods: 50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia.

Soaking of autografts with vancomycin is highly effective on preventing postoperative septic arthritis in patients undergoing ACL reconstruction with hamstrings autografts.

Purpose: To evaluate the impact of local soaking of the autografts with vancomycin during anterior cruciate ligament (ACL) reconstruction on postoperative infection rates.

Methods: Between 2003 and 2014 (first study period), 1,242 patients underwent ACL reconstruction using autografts, without soaking them in vancomycin solution, while between 2014 and 2019 (second study period) all ACL autografts in 593 patients were soaked in a 5-mg/ml vancomycin solution, in a territory University Hospital. The same standard treatment of perioperative IV antibiotics was applied in both groups.