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Purpose: To assess the return to sport rate of young professional athletes, to analyze their careers in terms of matches played and league participation over a minimum period of 6years after Meniscal Allograft Transplantation (MAT), as well as to assess the long-term clinical subjective outcomes and satisfaction. Methods: Thirteen professional athletes (ten soccer and one basketball players, one fencer and one wrestler) with a mean age at surgery of 23.4 ± 4.0 underwent MAT (six medial, seven lateral). The time required to return to sport, post-operative performance level and the number of reoperations were evaluated. At an average follow-up of 9.0 ± 2.8years, Lysholm, KOOS and Cincinnati scores were administered and collected. Results: Thirteen patients (100%) returned to sports practice after an average period of 11.8 ± 3.8months. Nine athletes (69%) returned to sports at the same pre-injury level. Overall, 93%, 85%, 62% and 55% were active until the 3rd, the 5th, the 7th and the 9th season after MAT, respectively. Seven patients (54%) underwent a reoperation after MAT, where only two of them (15%) were related to graft problems (one meniscectomy and one graft suture). Of the ten athletes that completed subjective evaluation, the mean Lysholm score was 72 ± 15 (0% “Excellent”, 10% “Good”, 60% “Fair”, 30% “Poor”). Of the athletes with lower scores, one suffered from patellar tendon rupture, one from post-operative infection and one from a previous femoral fracture. The mean Cincinnati knee score was 77 ± 18, while the average KOOS values were 60 ± 34 for sports. Conclusion: Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous activities allowed all patients to return to pre-injury sport and in nearly 70% of cases at their pre-injury level. After five seasons following MAT, 85% of patients were still active or playing more than 20–30 matches per season. On the other hand, nearly 50% underwent at least one reoperation and only 70% of patients were rated as “Good”, or “Fair” using the Lysholm score. Level of evidence: IV.

Purpose This study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery training in Europe by conducting an online survey among orthopaedic trainees. Methods The survey was conducted among members of the Federation of Orthopaedic and Trauma Trainees in Europe (FORTE). It consisted of 24 questions (single-answer, multiple-answer, Likert scales). Orthopaedic trainees’ demographic data (six questions), clinical role changes (four questions), institutional changes due to the COVID-19 pandemic (nine questions), and personal considerations (five questions) were examined. Results Three hundred and twenty-seven trainees from 23 European countries completed the survey. Most trainees retained their customary clinical role (59.8%), but a significant number was redeployed to COVID-19 units (20.9%). A drastic workload decrease during the pandemic was reported at most institutions. Only essential activities were performed at 57.1% of institutions and drastic disruptions were reported at 36.0%. Of the respondents, 52.1% stated that faculty-led education was restricted and 46.3% pursued self-guided learning, while 58.6% stated that surgical training was significantly impaired. Concerns about the achievement of annual training goals were expressed by 58.2% of the participants, while 25.0% anticipated the need for an additional year of training. Conclusions The SARS-CoV-2 pandemic significantly affected orthopaedic and trauma training in Europe. Most trainees felt the decrease in clinical, surgical, and educational activities would have a detrimental effect on their training. Many of them consulted remote learning options to compensate training impairment, stating that after the COVID-19 pandemic electronic educational approaches may become more relevant in future. Electronic supplementary material The online version of this article (10.1007/s00264-020-04742-3) contains supplementary material, which is available to authorized users.

Prosthetic joint infection (PJI) management is not standardized worldwide and the outcome is frequently unsatisfactory. More and more arthroplasties are now being performed. An increasing number of highly virulent and antibiotic-resistant bacteria and an ageing population of patients presenting with many comorbidities make it necessary to focus on this important topic. Diagnosis of PJI remains challenging because the clinical signs and symptoms and elevation of systemic biomarkers (C-reactive protein, erythrocyte sedimentation rate) may be unclear. In the last few years, the clinical research has focused on synovial fluid biomarkers as a possible breakthrough in the complex scenario of PJI diagnosis. Synovial biomarkers have shown encouraging results and they should be used as diagnostic adjuncts to synovial white cell count and culture bacteriology. Synovial leukocyte esterase (LE) and synovial C-reactive protein (CRP) have been evaluated as good screening measures; however, the most promising synovial fluid biomarker in terms of sensitivity and specificity for PJI seems to be alpha defensin (AD). The laboratory-based alpha defensin enzyme-linked immunosorbent assay (ELISA) test demonstrated the highest ever reported accuracy for PJI diagnosis. However, an alpha defensin lateral flow test could have its place in ruling in a suspected PJI intraoperatively because of its high specificity and rapid results.Cite this article: EFORT Open Rev 2019;4:10-13. DOI: 10.1302/2058-5241.4.180029

Purpose The purpose of this study was to compare, in terms of blood loss and implant alignment, a new generation of smart extramedullary (EM) cutting guides with the conventional intramedullary (IM) guide for total knee arthroplasty (TKA). The hypothesis was that the EM system would result in less blood loss and fewer days of hospitalization, while ensuring equal or higher accuracy in the alignment of the femoral implant. Methods Thirty-six patients were enrolled for the present study: 18 patients underwent TKA using the EM guide and for the other 18 patients the IM guide was used. Preoperative and postoperative X-rays were acquired. The preoperative and postoperative hemoglobin values were compared. Lastly, length of hospital stay was recorded. Results The hemoglobin difference was significantly lower in the EM group. The alignment of the prosthetic femoral implant in the two groups was comparable but all patients in the EM cohort had a final alignment within 3 degrees of range on the frontal view, while 22% of the patients in the IM cohort had a final alignment exceeding 3 degrees of range. The mean hospitalization duration showed no significant difference between groups, though EM group showed 1.6 days less compared with IM group. Conclusions The inertial-based EM guide system could be useful for decreasing blood loss compared with conventional guide. This device tended to have better results even in terms of accuracy, but this difference was not significant. Level of Evidence This is a level II, prospective cohort study.

Purpose: To quantitatively evaluate the biomechanical sealing function of an intact labrum and the effect of labral–chondral separation, cerclage suture labral repair, vertical mattress suture repair and partial labrectomy on distraction load and hip joint centre (HJC) displacement. Methods: Eight fresh-frozen cadaveric hips were tested using a navigation system for intra-operative kinematic analysis. A six-axis load cell was used to measure the manually applied force when performing the tests: hip pivoting movement and distraction. The HJC displacement that occurred during the distraction test has been evaluated in correspondence of seven different values of applied force. During the pivoting motion, the maximum value of HJC displacement was evaluated. Five different conditions were tested: labrum intact, labral–chondral separation, vertical mattress suture repair, cerclage suture repair, and partial labrectomy. Results: With regard to HJC displacement using at fixed value of force, the paired sample t test underscored the statistically significant differences (p < 0.05) for each of the five tested conditions among themselves. Only the comparison of intact versus labral–chondral separation was not significantly different. During pivoting motion, a statistically significantly greater displacement was identified after labrectomy when compared with the cerclage suture repair (p = 0.03) and vertical mattress repair (p < 0.01) in medial–lateral direction. Along proximal—distal direction, a significant lower displacement after labrectomy was identified when compared to the cerclage suture repair (p = 0.03). Performing the pivoting motion at the extreme ranges of motion demonstrated a higher value of displacement after labrectomy when compared with all the previously tested conditions. Conclusions: These results suggest that labral repair is important in the function of the hip and that the vertical mattress suture technique may be better than the cerclage suture repair.

The hypothesis was that an alteration of different surgical variables of ACL reconstruction would produce significant changes in post-operative static laxity of knee joint. Joint laxity was acquired by a surgical navigation system for 17 patients just after graft fixation during single-bundle reconstruction with extra-articular lateral tenodesis. The analysed laxity parameters were: internal/external rotation at 30° (IE30) and 90° (IE90) of flexion, varus/valgus rotation at 0° (VV0) and 30° (VV30) of flexion and anterior/posterior displacement at 30° (AP30) and 90° (AP90) of flexion. As surgical variables, the angles between the tibial tunnel and the three planes were defined as well as the lengths of the tunnel and the relationship between native footprints and tunnels. The same analysis was performed for the femoral side. All surgical variables were combined in a multivariate analysis to assess for predictive factors between them and post-operative laxities values. To quantify the performance of each multivariate model, the correlation ratio (η 2) and the corresponding P value (*P

Unicompartmental Knee Replacement Long Term Results With All-Poly Tibial Component At A Mean Follow-Up Of 98 Months.

PURPOSE: Although traditionally not indicated for the treatment of osteoarthritis (OA), regenerative procedures are becoming a focus of increased interest due to their potential to provide pain relief and alter the progression of degenerative diseases. The purpose of this study was to assess whether a combined biomechanical and biological approach could offer good results in unicompartmental OA, thus delaying the need for unicompartmental arthroplasty in patients too young or refusing metal resurfacing. METHODS: Forty-three patients (mean age = 40.1 ± 11 years, 33 men and 10 women, mean BMI = 25 ± 3) affected by unicompartmental OA (Kellegren-Lawrence score = 3) in stable joints were enrolled and treated consecutively. Fifteen patients were treated with osteotomy and osteochondral biomimetic scaffold implant (3 of them also with meniscal substitution), 11 with osteotomy and meniscal scaffold implant, 9 with osteotomy and meniscal allograft implant, and 8 with both cartilage and meniscal reconstruction, depending on the specific joint compartment main requirements. Clinical evaluation was performed at 3-year (2-4) median follow-up using the following scoring systems: IKDC subjective and objective, VAS for pain, and Tegner scores. Failures, adverse events, and complications were also reported. RESULTS: The IKDC subjective score improved from 47.3 to 79.6 at the final evaluation (p < 0.0005), VAS improved from 6.1 to 2.3 (p < 0.0005), and also sport activity level evaluated with the Tegner score showed a significant improvement, from 2 (1-5) to 4 (3-10; p < 0.0005), even if without achieving the pre-injury level (6, p = 0.001). A further subanalysis confirmed the positive outcome obtained in all the treatment subgroups and showed a higher clinical improvement in patients under the age of 40 years (IKDC subjective 84.4 ± 13.2 vs 76.5 ± 17.3; p = 0.03). CONCLUSION: This integrated biological and biomechanical approach produced a marked improvement at short-medium follow-up in patients affected by unicompartmental OA. Even though a good outcome was achieved at all ages, patients under the age of 40 years presented a greater clinical and subjective improvement. Longer follow-up studies are needed to show results over time and confirm this approach as an effective alternative to unicompartmental implants.

The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique.

recent years, research studies into sports injuries have provided healthcare professionals with a better understanding of their etiology and natural history. On this basis, novel concepts in the diagnosis and management of these conditions are now being explored. This timely book offers a complete guide to the latest knowledge on the diagnosis and treatment of the full range of possible sports injuries. Individual sections are devoted to biomechanics, injury prevention, and the still emerging treatment role of growth factors, which foster more rapid tissue healing. Sports injuries of each body region are then examined in detail, with special attention to diagnostic issues and the most modern treatment techniques. In addition, pediatric sports injuries, extreme sports injuries, the role of physiotherapy, and future developments are extensively discussed. All who are involved in the care of patients with sports injuries will find this textbook to be an invaluable, comprehensive, and up-to-date reference.

Soft Tissue Balancing in Primary Total Knee Arthroplasty is proposed as a practical text for the man- agement of soft tissue balancing, presenting step-by-step descriptions of surgical technique. The text was intended to be a pragmatic reference for students, residents, fellows and attending surgeons engaged in the treatment of patients who have undergone knee replacement surgery. This book uses “how to” approach for many of the complex issues confronting us in total knee arthroplasty, written by some expert authors. It is devoted to issues relating to primary total knee arthroplasty – from simple to the most complex. The first and second chapters include the primary technique in knee arthroplasty outlining tips and pearls dur- ing the surgical procedure. Some of the chapters emphasize principles of primary in cruciate retaining and posterior stabilized implants underlining the differences in soft tissue balancing and showing the use of navigation system. The last chapters show “how to” perform the soft tissue balancing in different deformi- ties, such as varus and valgus, flexed and stiff knees. Last, but not least, the final chapter draws attention in extensor mechanism issues. We feel glad to have received the support of so many well-know master surgeons who have contributed to the text. We are grateful to all of them and are proud to have been able to present their combined ex- perience in the proceeding book. It is a true honour for us to have collaborated with outstanding friends, colleagues and mentors in publishing this textbook. As editors, we have each learned a great deal from the authors who have contributed to this text. We expect that their efforts will be equally valuable to you.

in recent years, research studies into sports injuries have provided healthcare professionals with a better understanding of their etiology and natural history. On this basis, novel concepts in the diagnosis and management of these conditions are now being explored. This timely book offers a complete guide to the latest knowledge on the diagnosis and treatment of the full range of possible sports injuries. Individual sections are devoted to biomechanics, injury prevention, and the still emerging treatment role of growth factors, which foster more rapid tissue healing. Sports injuries of each body region are then examined in detail, with special attention to diagnostic issues and the most modern treatment techniques. In addition, pediatric sports injuries, extreme sports injuries, the role of physiotherapy, and future developments are extensively discussed. All who are involved in the care of patients with sports injuries will find this textbook to be an invaluable, comprehensive, and up-to-date reference.

Le meniscectomie parziali artroscopiche hanno mostrato migliori risultati clinici rispetto alla rimozione completa del menisco, ma a lungo termine un numero consistente di questi pazienti subiscono l'effetto degenerativo della perdita della cartilagine meniscale. Infatti è estremamente importante preservare il menisco per quanto possibile, al fine di evitare la progressiva degenerazione del ginocchio. Durante gli anni ’80 Stone, Steadman e Rodkey hanno sviluppato un nuovo scaffold in collagene per sostituire il menisco in caso di rotture parziali/subtotali irreparabili: il CMI (Collagen Meniscus Implant). Dopo 13 anni di buoni risultati nell’impianto del CMI mediale, nel 2006 abbiamo iniziato uno studio postmarketing per valutare l'efficacia e la sicurezza di uno scaffold meniscale equivalente appositamente costruito per riparare il menisco laterale (CMI laterale). In questo articolo descriviamo le indicazioni per l'impianto di un dispositivo CMI, l'evoluzione della tecnica chirurgica (da una tecnica di sutura artroscopia “in-out” ad una “all-inside”) in questi 13 anni di esperienza insieme ad una breve relazione sui nostri risultati clinici.

E' estremamente importante preservare il menisco quanto più possibile per evitare la progressione della degenerazione articolare del ginocchio. In effetti, un numero considerevole di pazienti soffre a causa degli effetti in seguito ad una meniscectomia artroscopica anche parziale.Stone, Steadman e Rodkey hanno sviluppato un nuovo tipo di scaffold in collagene I per sostituire il menisco in caso di rotture parziali/subtotali irreparabili: il CMI (Collagen Meniscus Implant). Dopo 13 anni di buoni risultati nell’uso del CMI mediale, nel 2006 abbiamo iniziato uno studio multicentrico europeo per valutarne l'efficacia e l'efficacia di uno scaffol meniscale equivalente appositamente progettato per riparare i difetti parziali/subtotati del menisco laterale (Lateral CMI). In questo articolo si descrivono le indicazioni per l’impianto di uno scaffol meniscale collagenico, l'evoluzione della tecnica chirurgica (da una tecnica di sutura artroscopica “in-out” ad una “all-inside”) nei nostri 13 anni di esperienza e una breve relazione sui nostri risultati clinici.