We performed a clinical, instrumental and radiographic study on a highly homogeneous series of 100 consecutive patients with unilateral ACL lesion at 7 years of minimum follow up, alternatively assigned to a single bundle reconstruction using patellar tendon (PT) or to a double bundle reconstruction using hamstrings (DB). Mean Tegner score was 4,8 for PT and 6,5 for DB (p=0,0005). Time for sport resumption was 6,6 months for PT and 3,8 months for DB (p=0,0052). There were no significative differences between the two groups regarding range of motion and functional subjective self-evaluation. Mean anterior displacement at instrumental evaluation performed with KT2000 showed no significative differences between the two groups. Objective clinical evaluation with IKDC was superior for DB group (A=86,5%; B=13,5%) respect to PT group (A=18,7%; B=75%; C=6,3%) (p<
0,0001). We found no differences regarding anterior knee pain between and Ahlback radiographic score the two groups and we have observed no recurrence of instability after surgical treatment. Double bundle ACL reconstruction with hamstrings has showed higher results respect to single bundle ACL reconstruction with patellar tendon in terms of Tegner score, IKDC, time for sport resumption.
Arthroscopic selective resurfacing of the knee may be considered a treatment option for selected patients with focal articular damage. From more than 2 years in IX Division of Rizzoli Orthopaedics Institute(Bologna- Italy) we use, in selected cases with only one articular compartment damaged, an innovative resurfacing prosthesis. We mad a new design of focal resurfacing (MAIOR) that is possible to implant with arthroscopic technique and that realize both mini-invasive and mini-traumatic surgery. The fixation method of the MAIOR allows higher osteointegration by biomaterials and hydrossiapatite of new generation that permit a press-fit fixation of the implant. The new philosophy of this implant consist of early focal treatment with low compromise of bone. Many surgeons, in case of focal articular damage, prefer to attend to made an unique definitive surgical operation when the degenerative changes are more severe. This new implant permit to substitute, also in arthroscopic technique, only the articular damage and to avoid to attend a more important and diffuse articualr damage. It is an uncemented, focal resurfacing prosthesis that requires minimal bone sacrifice and utilizes a minimal invasive surgical (MIS) approach with or without arthroscopic assistance. In a prospective and consecutive study, 78 patients were followed up at least for 12 months. Subjective pain and joint function were assessed using Visual analogue scale (VAS) and Knee society scores respectively. The preliminary results are interesting and encouraging with subjective evaluation equal to 85% of normal knee. Significant reduction of pain and improvement in joint function was observed. Although, long term study will determine the real performance of the prosthesis, trend seems to be positive.
We undertook a prospective controlled clinical trial of 109 patients to determine whether postoperative blood salvage in patients undergoing total hip or knee arthroplasty decreased the need for transfusion with banked blood. The average amount of blood collected in our series was 493 ml, most of which was collected in the first four postoperative hours. In patients undergoing bilateral total knee arthroplasty, there was a 54% reduction in banked blood utilisation. None of our patients developed adverse effects from the reinfused material. The cost of collecting and processing wound drainage using the Haemolite cell washer was $175 per patient, regardless of the volume processed, compared to $125 for a unit of banked blood. By reducing the requirement for homologous transfusion, blood salvage diminishes the risks of transmission of HIV and hepatitis viruses. In those cases where the equivalent of two units of blood are reinfused, blood salvage saves money. However, due to the small amounts of blood collected in unilateral hip or knee arthroplasty, we do not recommend its routine application in these cases.