Revision of anterior cruciate ligament (ACL) reconstruction presents numerous challenges not encountered in the primary setting and therefore requires thorough preoperative planning. Addressing tunnel widening is the primary concern, and therefore the appropriate graft choice is pivotal. Quadriceps tendon autograft recently has gained popularity for its dimensions and the possibility to harvest a bone block from the patella that can fill potential tunnel bone defects. Adjunctive procedures to isolated ACL reconstruction such as lateral extra-articular tenodesis (LET) may help in sharing the loads with the neoligament, with recent findings recommending LET in the revision setting. The technique presented in this Technical Note describes a 1-stage revision ACL combined with LET using a quadriceps tendon autograft with a bone plug.
Background Oxidized zirconium (OxZr) femoral component for total knee arthroplasty (TKA) have been introduced in an attempt to reduce polyethylene wear and secondary osteolysis and improve longevity of implants. Questions/Purposes We reviewed clinical studies in literature evaluating OxZr femoral component for TKA. The aim of this review was to evaluate the clinical outcome and survival rate of TKA with an OxZr femoral component. Methods A review of the existing literature was undertaken to collect data on the OxZr femoral component in order to provide a better understanding of its performance. Of 34 studies published in the literature, 8 met the eligibility criteria and were included in the final analysis. Results Findings indicated that the mean Knee Society knee score improved in all series from preoperative to postoperative evaluation. The postoperative Knee Society knee score reported range from 84 to 95 and mean postoperative Knee Society functional score range from 74 to 90. The revision rate with this implant is low with up to 12.6 years of follow-up, with three revisions in total. The survival rate ranged from 100–98.7% at 5–7 years to 97.8% at 10 years. Conclusions Excellent clinical outcome and high survival rate has been demonstrated for OxZr femoral component in TKA. No adverse reaction has been described for this new material.
Anterior cruciate ligament reconstruction (ACLR) with cortical fixation adjustable-loop devices are associated with high potential risk of button malpositioning or interposition of the soft tissue between lateral femoral cortex and the button. Surgeons usually use X-rays to check and avoid button malposition and soft tissue interposition. Arthroscopic visualization of button position through the lateral gutter has been described. With this technique, it is possible for identification and correction of femoral button malalignment in the setting of soft tissue interposition and it could avoid the use of post-operative X-ray.A total of 193 ACLR were included and patients were randomized into two groups. The first series (Group A) of 112 patients who sustained an ACLR with post-operative X-ray to assess the position of the femoral button and the second series (Group B) of 81 patients who sustained an ACLR with an arthroscopic exploration of the button followed by post-operative X-ray.On the post-operative radiographs, tissue interposition between the button and femoral cortex was found in nine cases of 112 in Group A (8%) and in zero case of 81 in Group B (0%). In six cases (7,4%) in Group B, there was a soft tissue interposition between the button and femoral cortex as visualized by arthroscopic confirmation and before post-operative X-ray; in all these cases, the soft tissue was removed, and the button was in contact with the bone in all X-ray made in the Group B.This technique allows for identification and correction of femoral button malalignment in the setting of soft tissue interposition and reduces the use of post-operative X-ray.
Abstract Background We created a Survey for Italian orthopaedics surgeons on how they approach leg length discrepancy (LLD) when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow literature recommendations during clinical practice. Methods The Survey was composed of 25 questions divided in 4 sections: surgeon’s profile, preoperative and intraoperative evaluation, postoperative management. In this paper we report absolute and relative frequencies of answers to section 4 “postoperative management”. Then regarding the treatment of residual LLD we reported if trauma surgeons (TR) and experts in reconstructive surgery (RS) had higher odds ratio (OR) to give the “literature based” answers than orthopaedics physicians (OP) Results Only four questions received more than 70% of agreement on one of the answers. The OR to give the “literature based” answer taking OP as reference was 1.57 for TR and 1.72 for RS for 10 mm LLD at first follow up (FU) and 1.23 TR and 1.32 RS when 20 mm. When 10 mm LLD at 3 months FU the OR was 0.88 TR and 1.15 RS. The OR for treatment of LLD after the first examination of a new patient was 2.16 TR and 1.85 RS. Conclusions LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition, treatment of LLD during clinical practice often differs from literature recommendations.
Abstract Background Semi‐active robot‐assisted total hip arthroplasty (THA) has two options to measure the leg length discrepancy (LLD) and combined offset (CO), the ‘enhanced’ femoral workflow and the so‐called ‘express’ simplified workflow. The purpose of this study was to determine the precision and accuracy of intraoperative LLD and CO measurement with express workflow robotic THA. Methods Between February 2018 and December 2019, 30 patients underwent an express workflow robot‐assisted primary THA for intraoperative LLD and CO measurements. Postoperative radiographs were used for LLD and CO measurement. In order to examine the accuracy of the robotic system assessment, the absolute difference between the robotic assessments and radiographic evaluations was calculated. Results Intraoperative robotic measurements reported a mean error of 0.2–0.6 mm for each registration, with no significant difference between them ( p = 0.311). The average absolute discrepancies between the robotic and radiographic assessments in the LLD and CO measurements were 1.3 ± 1.5 mm ( p = 0.17) and 1.1 ± 0.9 mm ( p = 0.11), respectively, while the Pearson's correlation coefficients were 0.69 and 0.71. Conclusions An external marker without a femoral array inserted into a screw positioned in the greater trochanter would be an easier and faster method to measure LLD and CO. Our study showed that the measured values of LLD and CO obtained by intraoperative express workflow robot‐assisted THA system were precise and accurate.
