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Background The medial patellofemoral ligament (MPFL) is considered the primary soft tissue restrain to lateral translation of the patella during the first 15–30 degrees of knee flexion. The primary restraint thereafter is the slope of the lateral wall of the trochlea. A plenty of procedures are described in literature for MPFL reconstruction with different types of graft, angle of knee flexion for fixation and rehabilitation protocols. In this study we used MPFL reconstruction with doubled autologous gracilis tendon with the Schottle’s technique. The aim of our study is to evaluate outcomes at medium-long term follow up of MPFL reconstruction. Methods Patients who underwent arthroscopic MPFL reconstruction for recurrent patellar dislocation were followed up for a minimum of 2 to 10 years. Patient-reported outcomes including the Kujala, Visual Analogue Scale (VAS) score were collected preoperatively and postoperatively. Clinical complications such as loss of ROM, recurrent sub-luxation or dislocation were recorded. Results A total of 38 patients with recurrent patellar dislocation were treated with MPFL reconstruction and data were available for final follow up (mean 72.3 months, SD 33.6). Mean age at time of surgery was 23.4 (SD 7.8). Mean number of dislocations before surgery was 7.1 (SD 10.5). Recurrent dislocations were not observed in any of the patients treated at last follow-up. Significant clinical improvements were also noted with Kujala and VAS score. Patellar tilt angle decreased significantly from pre to post-operative. Conclusion Our study demonstrated that MPFL reconstruction with patellar suture anchors fixation using autologous gracilis tendon is an effective, safe and reliable method for treating recurrent patellar dislocation.

Background Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of knee arthrodesis by circular external fixation performed in the treatment of TKA failure in which revision arthroplasty was not indicated. Methods The study involved 19 patients who underwent knee arthrodesis by the Ilizarov method. Clinical and functional assessments were performed, including Knee Society Score (KSS). A postoperative clinical and radiographic evaluation was conducted every three months until the end of the treatment. Postoperative complications and eventual leg shortening were recorded. Results KSS results showed a significant improvement with respect to the preoperative condition. Of the 16 patients in the final follow-up, 15 patients (93.7%) achieved complete bone fusion. Major complications occurred in patients treated for septic failure of TKA and most occurred in patients over 75 years of age; the mean final leg shortening was four centimeters. Conclusion In our experience, the Ilizarov method is effective for performing a knee arthrodesis in the case of extensive bone loss. At the same time, it is possible to correct the associated leg deformities or limb length difference. In addition, only the Ilizarov method provides a mechanical stimulus for bone formation and improves the quality of the bone and of the microcirculation, which enhances the host response against infection. Despite these attributes, knee arthrodesis by the Ilizarov method must be considered a ‘salvage procedure’ in cases of severe outcomes from knee surgery in which revision arthroplasty is not indicated.

Purpose: Graft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the “Allografts for Anterior Cruciate Ligament Reconstruction” consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making. Methods: In March 2017, a formal consensus process was developed using a modified Delphi technique method, involving a steering group (9 participants), a rating group (28 participants) and a peer-review group (31 participants). Nine statements were generated and then debated during a SIGASCOT consensus meeting. A manuscript has been then developed to report methodology and results of the consensus process and finally approved by all steering group members. Results: A different level of consensus has been reached among the topics selected. Strong agreement has been reported in considering harvesting, treatment and conservation methods relevant for clinical results, and in considering biological integration longer in allograft compared to autograft. Relative agreement has been reported in using allograft as the first-line graft for revision ACL-R, in considering biological integration a crucial aspect for rehabilitation protocol set-up, and in recommending a delayed return to sport when using allograft. Relative disagreement has been reported in using allograft as the first-line graft for primary ACL-R in patients over 50, and in not considering clinical results of allograft superior to autograft. Strong disagreement has been reported in using allograft as the first-line graft for primary ACL-R and for skeletally immature patients. Conclusions: Results of this consensus do not represent a guideline for surgeons, but could be used as starting point for an international discussion on use of allografts in ACL-R. Level of evidence: IV, consensus of experts.

Bony defect of the humeral head associated with anterior glenohumeral instability is called Hill-Sachs lesion. These defects occur when the postero-lateral aspect of the dislocated humeral head impacts against the glenoid rim. The term engaging Hill-Sachs lesion describes a defect in the humeral head large enough such that the edge would drop over the glenoid rim in external rotation. The new concept of glenoid track could explain the risk of engagement and dislocation of a Hill-Sachs lesion.

Purpose: simple tenotomy in the treatment of long head biceps (LHB) lesion offers good results, as well as tenotomy/tenodesis. Materials and methods: we prospectively evaluated 252 patients, divided into 3 groups, treated with rotator cuff repair associated with LHB tenotomy or 2 different types of tenodesis in cases where there had been a partial lesion of the LHB or instability of the bicipital groove. We ascertained whether there was residual pain and the presence of the “Popeye sign” in the post-operative stage. Results: patients who underwent tenotomy alone achieved an improvement on the Visual Analogue Scale (VAS), Simple Shoulder Test (SST) and modified UCLA shoulder rating compared to patients who underwent LHB tenodesis. A positive Popeye sign is poorly perceived by patients. Conclusion: we considered the LHB tenotomy as treatment of choice for the rotator cuff surgical repair when there was an evident LHB lesion.