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Background: Extracorporeal shockwave treatment has shown mixed short-term results for plantar fasciitis. However, the long-term results are not available. Hypothesis: Long-term results of shockwave treatment are comparable with short-term results. [...]

This study analyzed 14 patients with 17 broken intramedullary nails for the treatment of femoral fractures. Average distance from the fracture site was 7.9 cm in cases in which nail breakage occurred at the junction between the cylindrical and cloverleaf portions and 6.4 cm in cases in which nail breakage occurred at the screw hole. Eleven patients with 14 broken nails were treated with exchange nailing and bone grafting, 2 were treated with plating and bone grafting, and 1 was treated with extracorporeal shock wave therapy. Nonunion or delayed union is the main cause of nail breakage. Exchange nailing with bone grafting is a safe and effective method of treatment for a broken intramedullary nail with nonunion. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the effect of plasmid cytomegalovirus (pCMV)-bone morphogenetic protein 2 (BMP-2) gene therapy on the healing of the tendon-bone interface after anterior cruciate ligament (ACL) reconstruction in rabbits., Methods: The pCMV-BMP-2 was synthesized from full-length human BMP-2 complementary deoxyribonucleic acid, followed by cloning into pCMV Script vector (Clontech Laboratories, Inc., San Jose, CA), and was delivered by a xenogeneic (rat kidney) cell line. The ACL was reconstructed by the transfer of extensor digital tendon in the proximal tibia. In the study group the pCMV-BMP-2 gene-transfected normal rat kidney cells mixed with calcium alginate gel were placed at the tendon-bone interface, whereas no pCMV-BMP-2 was used in the control group. The evaluations included radiography, bone mineral density, magnetic resonance imaging, biomechanical study, histologic examination, and immunohistochemical analysis., Results: Bone mineral density showed no significant difference between the groups (P > .05). Magnetic resonance imaging showed significantly better contact between tendon and bone in the study group compared with the control group (P < .0001). In the biomechanical study, significantly higher failure load and maximal graft tension were noted in the study group compared with the control group (P = .034). The modes of graft failure were rupture of the tendon proper in 78% and graft pullout from the bone tunnel in 22% of specimens in the study group versus graft rupture in 22% and graft pullout in 78% in the control group (P = .018). On histologic examination, the study group showed significantly better integration between tendon and bone, as well as more bone tissue around the tendon graft, than the control group (P = .0004). On immunohistochemical analysis, the study group showed significantly higher expressions of von Willebrand factor, vascular endothelial growth factor, proliferation cell nuclear antigen, and BMP-2 than the control group (P < .05)., Conclusions: The pCMV-BMP-2 gene therapy significantly improved the healing of tendon to bone and promoted angiogenesis and osteogenesis at the tendon-bone interface after ACL reconstruction in the rabbit model., Clinical Relevance: Application of pCMV-BMP-2 gene therapy may be an effective adjunct therapy in ACL reconstruction., (Copyright (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The definition of gastrocneumus and soleus deep-vein thrombosis (DVT) remains controversial. The purpose of this study was to evaluate the clinical significance of muscular deep-vein thrombosis after total knee arthroplasty (TKA)., Methods: This study consisted of 359 consecutive patients undergoing TKA evaluated for DVT by ascending venography. Venographies were performed 5 to 7 days after surgery. Those patients showing positive DVT underwent a follow-up venographic study at 3 months. The evaluation parameters included clinical symptoms, late DVT, thrombus propagation and pulmonary embolism. The data from patients with isolated muscular DVT were compared statistically with those patients with DVT of the leg veins and combined DVT., Results: Of 359 patients, 175 (49%) developed venographic DVT including 160 with distal and 15 with proximal DVT. Of the 160 cases with distal DVT, 83 (52%) involved the gastroneumus and soleus muscular veins. Of these 83 cases, 38 (46%) were isolated muscular DVT and 45 (54%) involved muscular branches and major leg veins including the anterior and posterior tibial and peroneal veins. Patients with isolated muscular DVT showed comparable rates of clinical symptoms, late DVT, thrombus propagation and no pulmonary embolism compared with patients with DVT in the major leg veins (p = 0.874, 0.398 and 1.000) and patients with combined DVT (p = 0.155, 0.592 and 1.000)., Conclusion: The clinical significance of isolated muscular DVT is comparable to that of the major leg veins and combined DVT. Muscular DVT in the calf is considered a significant clinical entity and should be treated accordingly.

Despite good early functional results, the posterior laxity of the knee is not completely eliminated after posterior cruciate ligament (PCL) reconstruction. The PCL can retain the normal tension only when the injured ligament is maintained anatomically. This article describes a technique of PCL reconstruction using hamstring tendon graft with PCL remnant augmentation. The harvested hamstring tendons were quadrupled, sized, and pretensioned before use. The PCL remnants and the synovium were preserved. Minimal debridement was performed to gain access to the insertion sites. The tibia and femoral tunnels were created with graft size-matched reamers. The graft was transfixed at 70 degrees of knee flexion with a 15-lb anterior drawer force on the proximal tibia. This surgical technique has several advantages. The hamstring graft acts as an independent PCL reconstruction and maintains the PCL remnant tension. The PCL remnants and synovium may be beneficial to ligament healing and postoperative rehabilitation. The procedure is technically feasible and cosmetically acceptable. The selection of autograft precludes the risks of allograft and artificial ligament. The short-term results are encouraging, but long-term results are needed to confirm the value of this technique for PCL reconstruction.

Background: In this study, we reviewed the results of conventional osteosynthesis combined with strut onlay allografts and autogenous bone grafts as the treatment for nonunion of the femur., Methods: We conducted a retrospective study of 18 patients with nonunion of the femur treated with internal fixation (eight 95 degree fixed-angled blade plates, 7 intramedullary nails, 2 dynamic hip compression plates and screws, and 1 condylar buttress plate) and autogenous bone grafts and cortical strut allografts. There were 1.8 operations on average before surgery. The average time from the initial treatment of the fracture or osteotomy to surgery was 32.5 months. The average follow-up was 32.2 months., Results: All 18 nonunions had healed by the time of follow-up. Positive intraoperative cultures (Staphylococcus epidermidis) in 2 patients were resolved by parenteral antibiotics with no additional treatment. Removal of implants was required in 5 patients because of screw irritation or bony union. One concomitant quadricepsplasty as well as 2 excisions of a protruding graft were required because of restricted knee motion or impingement., Conclusions: For difficult nonunions of the femur in the current study, strict adherence to the principles of the treatment of nonunion and the addition of strut allografts to enhance stability and repair potential proved to be a good alternative.