Background

Jumper's knee is the result of violent and repeated contractions of quadriceps muscle caused by rapid acceleration and deceleration, jumping and kicking that load on patellar tendon stressing its mechanical resistance. The porpose of this retrospective study is to analyze the results, after the debridment of the patellar tendon and the patellar apex abrasion performed by arthroscopy, at a mean follow-up of seven years.

Purpose: Many surgical techniques have been described for the treatment of pathological fractures due to aggressive unicameral bone cysts in order to varying rates of success and incomplete healing or recurrence. Many Authors suggested curettage and bone grafting as effective treatment in case of active lesion in children 8 – 12 years old, adjacent to the physis with width of the lesion exceeds that of the adjacent physis and recurrence or persistence. Due to invasive nature of operation this method non is preferred by several Authors : we preferred minimally invasive treatment consisting closed reduction and flexible with titanium rod (Nancy)intramedullary fixation for low operative morbidity whether for the fracture or for the cyst; in case of recurrence of the cyst the closed curettage of the cyst with arthroscopic technique can be applied successful.

Methods: Between 2002–2004 40 aggressive unicameral cysts were observed as pathologic fractures in patients between 5–15 years old in these cases there was a significant loss of bone stock. The site of involvement was in 33 patients the metadiaphysis of humerus, in 7 the femur; radiograms reveal expanding lesion in metaphyseal-diaphyseal site with cortex tinned from its inner surface and erosion with infraction with displacement. The parents were informed about contextual presence of two lesions: the fracture and cyst. The proposed internal fixation with Nancy titanium rods heals the first and might heal the second lesion ; in case of failure this method do not exclude another possibility of treatment as arthroscopic curettage. The Nancy flexible intramedullary fixation was performed with retrograde access 3 0 4 mm. diameter. Two nails with “ Eiffel Tower” construction were inserted by two miniportals 1 centimetres far from the physis. Follow up of treated lesion was made with periodic x rays performed every 45 days.

Results: In 36 patients after a 2-year period of observation the cyst has completely or incompletely healed but with a sufficient bone stock in the remainder four cases the arthroscopic procedure was performed. Curettage of cystic wall by trimmer blade and multiple miniportals 4,5 millimetres is the best way to treat all the cyst. In all the cases we used the standard optical cannula 30°.

Conclusions: In conclusion minimally invasive treatment by Nancy rods and artrhoscopy can be effective because assure high incidence of favourable results by decompression-scaffolding of the lesions, the patient quickly recover natural life and school attendance.

The Authors report the early results of endoscopic curettage with bone grafting to treat aneurysmal bone cysts. Four patients with aneurysmal bone cysts (one located in the femur and three in the humerus) received curettage with homologous bank bone grafting by endoscopy. In one case we used homologous bank bone in chips with osteoconductive properties and in three cases we used homologous bank bone in paste with osteo-inductive properties. The follow-up showed complete improvement in pain, new bone formation and remodelling at 2 years. Even if we do not yet have final results about recurrence, these early data encourage us to continue this study so that a longer follow-up will confirm the benefits of this procedure.

The authors report the results of the use of autologous growth factors in a patient affected by systemic sclerodermia. Two total hip prostheses were implanted in this woman. Because of the delayed wound healing in this patient, either because of the long-term corticosteroid therapy or the basic connective dissease, she decided not to have surgery. Some time later the patient decided positively for surgery, as her condition was becoming serious. Therefore, as part of a pre-operative protocol, she discontinued corticosteroids for 8 months beforehand and increased pharmacological therapy to improve blood perfusion in soft tissues. During surgery, we injected in the periprosthetic zone and in both sides of the surgical wound. Our patient had a normal period of healing and after 2 weeks the result was so good that we were able to remove the skin suture easily.