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Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

We propose to study a group of patients with primary bone sarcoma of the pelvis treated with limb salvage surgery and analyze overall survival, local recurrence rates and functional outcomes. A retrospective review was performed, and all patients diagnosed with pelvic primary bone sarcomas between 1990 and 2012 were analyzed. Patients treated with limb salvage surgery and with a minimum of 12-month follow-up for patients alive were included. The overall survival and the local recurrence rate were calculated for the assessment of oncological results. The associations with gender, age, histological grade, type of surgery, margins chemotherapy response and use of navigation were examined. Fifty-two patients were included in the study. The mean age was 37 years (range 10–82), and mean follow-up was 44 months (range 8–189). Forty-five (86 %) tumors were histologically classified as high-grade sarcomas, four (8 %) as low-grade sarcomas and three (6 %) as dedifferentiated sarcomas. Cancer-specific overall survival was 37.5 % for 5 years and 31 % for 10 years. Local recurrence rate was 30 %. High-grade tumors and chemotherapy necrosis below 90 % were negative prognosis factor. Postoperative complication rate was 34.5 % (n:18), being deep infection the most prevalent (n:13). Reconstruction of the pelvis after an oncology resection for primary pelvic sarcomas increased the incidence of complication significantly (p

Most authors believe the ACL does not spontaneously heal after a complete rupture. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities.We therefore asked whether (1) a complete ACL rupture in patients can spontaneously heal without the use of a specific rehabilitation program or bracing and (2) patients are able to return to their athletic activity after spontaneous ACL healing.We retrospectively reviewed 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Average age at injury was 31 years (range, 23-41 years). All patients were athletically active before injury. Surgery was indicated in all patients but for various reasons postponed. We obtained International Knee Documentation Committee scores, Lysholm-Gillquist scores, and MRI. The minimum followup was 25 months (mean, 30 months; range, 25-36 months).At last followup, the mean Lysholm-Gillquist score was 97. According to the International Knee Documentation Committee evaluation, 10 knees were normal and four nearly normal. All knees regained end point with a negative pivot shift test; MRI at followup showed an end-to-end continuous ACL with homogeneous signal. All patients returned to their former activity level. However, after the study period, two patients had a rerupture of the ACL (2.5 years after the first lesion).Our observations indicate an acutely injured ACL may eventually spontaneously heal without using an extension brace, allowing return to athletic activity.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Transepiphyseal tumor resection is a common surgical procedure in patients with malignant bone tumors. The aim of this study is to develop and validate a computer-assisted method for selecting the most appropriate allograft from a cadaver bone bank. Fifty tibiae and femora were 3D reconstructed from computed tomography (CT) images. A transepiphyseal resection was applied to all of them in a virtual environment. A tool was developed and evaluated that compares each metaphyseal piece against all other bones in the data bank. This is done through a template matching process, where the template is extracted from the contralateral healthy bone of the same patient. The method was validated using surface distance metrics and statistical tests comparing it against manual methods. The developed algorithm was able to accurately detect the bone segment that best matches the patient's anatomy. The automatic method showed improvement over the manual counterpart. The proposed method also substantially reduced computation time when compared to state-of-the-art methods as well as the manual selection. Our findings suggest that the accuracy, robustness, and speed of the developed method are suitable for clinical trials and that it can be readily applied for preoperative allograft selection.

The objective of the study was to analyze a group of patients with low grade parosteal osteosarcoma treated with limb salvage surgery and reconstructed with bone allograft. A retrospective review from our oncologic data base between 1980 and 2010 was done and all patients with diagnosis of low grade parosteal osteosarcoma, treated with limb salvage surgery and reconstructed with allograft were included. Twenty-two patients were included for the analysis. The mean age was 32±11 years (10-59) y the mean follow-up 93±69 months (8-237). Ten year overall survival of the series was 91% (95% CI: 79-100). Four patients developed local recurrence, 2 of them histological classified after the resection dedifferentiated parosteal osteosarcoma. Two patients developed distant recurrence, being the lung the only site of metastasis. Ten year limb salvage reconstruction survival was 65% (95% CI: 44-86). Long term survival rate in low grade parosteal osteosarcoma is over 90%. Surgical resection wide margin should be the elective treatment and biological limb salvage reconstruction is a good alternative.

Hydatid disease is caused by the parasitic tapeworm Echinococcus granulosus. Osseous involvement accounts for 0.5% to 4% of cases in humans. Patients usually are from endemic zones and are initially asymptomatic, presenting with pain and edema at a later stage of disease. However, large lesions may present initially as pathologic fractures. Standard radiographs usually show expansive osteolytic lesions associated with initial cortical thinning, with compromise of the metaphysis or epiphysis, and may involve the diaphysis. The finding of periosteal reaction, osteocondensation, calcification, and clear delimitation of the lesions excludes the diagnosis of osseous hydatidosis. However, there are no specific radiographic signs in the affected bone. There is no generally accepted treatment algorithm for osseous hydatid disease. The usual treatment is surgical resection of the affected bone, followed by antihelmintic therapy. Some patients can be treated with intralesional procedures, such as curettage and allograft or polymethyl methacrylate cement. However, in some advanced cases, such as those with pathologic fractures or recurrences, wide resection may be needed. Several reconstructive alternatives have been reported, such as megaprosthesis, massive allograft, or alloprosthesis composite. The authors retrospectively reviewed 2 cases of femoral hydatidosis treated with wide resection and reconstruction with massive bone allograft. One patient had 5 years of follow-up, and the other had 9 years. No signs of relapse or complications were recorded, and functional outcomes evaluated with the Musculoskeletal Tumor Society scale showed excellent results. These 2 cases support the use of a massive bone allograft as a valid alternative to reconstruction after extensive bone resection for hydatidic disease. [ Orthopedics. 2 015; 38(10):e943–e946.]

The aim of this work is to assess and analyze the discrepancies introduced in the reconstruction of an entire tumoral bone slice from multiple field acquisitions of a large microscopy slide. The reconstruction tends to preserve the original structural information and its error is estimated by comparing the reconstructed images of eight samples against single pictures of these samples. This comparison is held using the Structural Similarity index. The measurements show that smaller samples yield better results. The detected errors are introduced by the insufficiently corrected optical distortion caused by the camera lens, which tends to accumulate along the sample. Nevertheless, the maximum error encountered does not exceed 0.39 mm, which is smaller than the maximum tolerable error for the intended application, stated in 1 mm.

Osteoarticular allograft is one possible treatment in wide surgical resections with large defects. Performing best osteoarticular allograft selection is of great relevance for optimal exploitation of the bone databank, good surgery outcome and patient's recovery. Current approaches are, however, very time consuming hindering these points in practice. We present a validation study of a software able to perform automatic bone measurements used to automatically assess the distal femur sizes across a databank. 170 distal femur surfaces were reconstructed from CT data and measured manually using a size measure protocol taking into account the transepicondyler distance (A), anterior-posterior distance in medial condyle (B) and anterior-posterior distance in lateral condyle (C). Intra- and inter-observer studies were conducted and regarded as ground truth measurements. Manual and automatic measures were compared. For the automatic measurements, the correlation coefficients between observer one and automatic method, were of 0.99 for A measure and 0.96 for B and C measures. The average time needed to perform the measurements was of 16 h for both manual measurements, and of 3 min for the automatic method. Results demonstrate the high reliability and, most importantly, high repeatability of the proposed approach, and considerable speed-up on the planning.

Tumor excision is the primary treatment of aggressive or recurrent benign bone tumors and malignant bone sarcomas. This requires a surgical resection with the potential for large residual osseous defects that could be reconstructed using fresh frozen allografts. Virtual bone banks enable the creation of databases allowing a 3D pre-surgery evaluation of such allgorafts, based on segmentation of DICOM-CT images. This study demonstrates the usefulness of patient specific 3D models for an accurate host-donor allograft match. We describe one way to select the best match according to size and shape. The results suggest that a robust and reliable technique has been established. Since it is difficult to plan an allograft on a distal femur deformed by the tumor, we propose to plan the surgery on the contralateral side. Our results support this limb symmetry hypothesis. The use of this measurement protocol enables accurate selection of allografts from a contralateral healthy femur 3D CT model achieving the best match possible considering the geometry of available allograft candidate femur specimens.

Diagnosis of localized pigmented villonodular synovitis is clinically difficult, and plain radiographs are usually normal. This article presents five patients with localized pigmented villonodular synovitis of the knee. Symptoms suggested a meniscal lesion in three patients and a loose body in two. Magnetic resonance imaging performed prior to arthroscopic resection revealed a preoperative diagnosis of a tumor in all five patients. Magnetic resonance imaging is a valuable clinical tool for the assessment of intra-articular soft-tissue tumors of the knee that may otherwise be misdiagnosed.

To describe the clinical, MRI, intraoperative, and histological features of mucoid degeneration of the anterior cruciate ligament (ACL).This study included 10 patients (average age 47 years, range 19-69 years) who underwent surgery due to clinical diagnoses of mucoid degeneration of the ACL. All patients underwent preoperative magnetic resonance imaging (MRI) and were arthroscopically treated.All 10 patients reported preoperative posterior knee pain. MRI indicated a thickened ACL with increased signal on all sequences. Postoperatively, only six of 10 patients were confirmed by biopsy to have a mucoid degeneration of the ACL. An associated intraosseous tibial cyst or ganglion was observed only in patients with a definitive diagnosis of mucoid degeneration.Mucoid degeneration of the ACL can be suspected in patients with posterior knee pain associated with a thickened ACL. Associated findings such as an intraosseous tibial or ganglion cyst help to rule out differential diagnosis.

The purpose of this study was to determine if the cartilage from loose osteochondral fragments remains viable. Five patients with OCD of the knee who had undergone surgical treatment (arthroscopic reduction and internal fixation of the loose body) were included. The average age of patients was 13 years (range 10-14 years). Cartilage samples were obtained from the loose body fragments before reattachment was performed (study group) and from the healthy native cartilage (intercondyle area, control group) from each of the five patients. Tissue viability was assessed using live-dead assay in both groups. All five loose osteochondral fragments showed similar viability to the healthy native cartilage group, with 88% cell viability (95% CI 50-100) in loose body fragments versus 92% viability (95% CI 50-100) from healthy cartilage. This study showed that cartilage from detached OCD fragments remains viable before reattachment is performed.

Six massive femoral allografts followed up for 22 to 36 years are described. Three were intercalary, two were osteoarticular and one was a total femoral replacement. Their functional rating according to the Musculoskeletal Tumor Society System (Enneking 1987) averaged 82% (56 to 100). The radiographic score averaged 75% (48 to 100). Four allografts had suffered fractures, but three of these had later united to give good final scores. Our study shows that massive femoral allografts can function well for as long as 36 years.

Techniques for the reconstruction of knee ligaments must restore the injured knee to a satisfactory level of performance. For this, a precise anatomic reconstruction is necessary. Many arthroscopic techniques for reconstruction of the posterior cruciate ligament (PCL) have been reported to restore the normal anatomy of the intact PCL using a double-bundle reconstruction with a Y-shaped tendon graft (2 femoral tunnel and 1 tibial tunnel). However, this procedure is sometimes difficult because the graft must be tightened in different grades of flexion to obtain complete strength of both bundles. We thought that double-bundle PCL reconstruction using double-double tunnels (2 femoral and 2 tibial tunnels) would allow an anatomic reconstruction, restoring better knee biomechanics, and probably improving patient outcome.

The results of bone-allograft reconstruction after the resection of giant-cell tumor close to the knee were reviewed in fifty-two patients (fifty-five allografts), who had been followed for a mean of seven years (range, two to twenty-four years). One giant-cell tumor was graded as stage 1; twenty, as stage 2; and thirty-one, as stage 3. Three reconstructions were repeated transplants that were done after the failure of a previous transplant. Ten allograft reconstructions were intercalary and were combined with an arthrodesis of the knee, and forty-five were osteoarticular. Major complications included infection (after three reconstructions), resorption of the graft (six), collapse of the articular surface (two), fracture (two), and recurrence (one). According to the criteria described by Mankin et al. for functional analysis, forty-two (76 per cent) of the extremities had a result that was considered to be excellent or good. Radiographic evaluation according to the system of the Musculoskeletal Tumor Society showed a mean score of 72 per cent for osteoarticular reconstructions, and of 86 per cent for intercalary reconstructions.

Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). The overall allograft survival rate, as calculated with the Kaplan–Meier method, at 5 and 10 years was 79 % (95 % CI 64–93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. IV.