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Background: Different surgical approaches are currently available to treat knee chondral defects. Microfracture is the most commonly applied, but it often leads to a mechanically inferior fibrocartilaginous tissue. To overcome this shortcoming, the Autologous, Matrix-Induced Chondrogenesis (AMIC) technique has been proposed. To further enhance the outcome of AMIC, the addition of haemoderivatives containing growth factors that stimulate cartilage healing has emerged as a new treatment method. Recently, a novel leucocyte-platelet-concentrated membrane (CLP-MB), highly enriched in platelets, monocytes/macrophages, fibrinogen, CD34 + and CD34 + VEGFR-2 + CD133 + cells, has been developed. Additionally, an injectable collagen scaffold (Cartifill) has been proposed as a replacement of the AMIC standard collagen membrane., Aims: This preliminary study is aimed to evaluate the short-term safety and efficacy of the use of the CLP-MB membrane and injectable collagen scaffold when combined in single-step AMIC procedures for the treatment of knee chondral lesions., Methods: Medical records of patients who underwent an AMIC procedure with the CLP-MB membrane combined with Cartifill were reviewed retrospectively. Follow-up assessments were conducted at 6 and 12 months after surgery. Clinical function was assessed on the basis of the International Knee Documentation Committee (IKDC) score. Pain was evaluated using the visual analogue scale (VAS)., Results: Twenty-five patients were identified as meeting the inclusion criteria. Mean IKDC and VAS scores significantly improved during the follow-up time. The postoperative course was uneventful., Conclusions: AMIC combined with the CLP-MB membrane, and Cartifill seems to be a promising approach to treat knee chondral defects.

The ideal treatment for displaced intraarticular calcaneal fractures is still under debate. Open reduction and internal fixation is the most popular surgical procedure; however, wound complications, hardware failure and infection remain a major concern. The aim of this study was to evaluate the results of a new minimally-invasive surgical procedure: closed reduction technique combined with balloon-assisted fracture augmentation with cement or calcium phosphate (minimally-invasive percutaneous calcaneoplasty). We retrospectively reviewed 11 patients that sustained Sander's type II and III calcaneal fractures treated in our institution from January 2008 to June 2010. The same approach and technique was utilized in all cases. Conventional X-rays and CT scan have been performed pre- and post-operatively. The average follow-up was 24 months. The American Orthopaedic Foot and Ankle Society ankle/hindfoot score has been utilized for clinical evaluation and Bohler's angle to assess bone reduction. All cases obtained bony union in 2/3 months, with average Bohler's angle of 22.97° (from 14.21° to 32.83°). No skin complications or adverse reactions were observed, with only one patient complaining of residual pain in the hindfoot. Minimally-invasive percutaneous calcaneoplasty can represent an alternative to open reduction internal fixation in the treatment of calcaneal fractures, allowing stable reduction without plating, early function recovery and short hospital stay.

Proximal tibial fractures are difficult lesions to treat because of the involvement of the articular surface, the often occurring comminution, and the precarious condition of the soft tissues, especially following high-energy trauma. Aim of the treatment is to restore the congruence of the articular surface supporting the tibial plateau cartilage which is usually depressed; to fix the fracture with a stable device; to allow early rehabilitation. We present our treatment strategy, utilising closed or open reduction and internal fixation, angle-stable polyaxial plates, immediate osteointegration, when necessary, with autologous bone graft or other osteoconductive material augmented with autologous platelet gel. Surgery is soft-tissue dependent in terms of timing, and it is usually performed directly or under supervision of an experienced surgeon utilising, whenever possible, a tissue sparing technique. A cohort of 58 proximal tibial fractures, surgically treated, from January 2004 to June 2007, was retrospectively reviewed. Fractures were classified according the OTA/AO classification. The assessment of the functional outcome with the use of the Rasmussen score identified good to excellent results in 78% of the cohort 12 months post-surgery. Internal fixation with locking plates, following the principles of MIPO (Minimally Invasive Percutaneous Osteosynthesis), provides satisfactory fracture reduction with good results regarding the mid-term clinical outcome., (Copyright © 2010 Elsevier Ltd. All rights reserved.)