Aim of study is to verify feasibility of peroneal tendoscopy and to clarify the histological structure of peroneal vincula, so formulating a hypothesis regarding their functional role.

Peroneal tendons possess a vascular supply through mesotendineal structures (vincula), previously related to trophic role and healing response; aim of study is to verify feasibility of tendoscopy in evaluating peroneal tendon and vincula and to clarify histological structure of vincula and presence of nervous tissue, so formulating a hypothesis regarding their functional role.

Cadaver study was performed on 8 fresh-frozen ankles, verifying accessibility of endoscope to tendon and vincula; samples from cadaveric vincula were taken; 5 peroneal vincula biopsies were obtained from 5 patients affected by ankle instability, undergoing tendoscopy for chronic lateral ankle pain. Tendoscopy was performed for persistent pain at the posterior margin of lateral malleolus after at least 4 months of nonoperative treatment. Biopsies were taken from center of pathologic vincula.

Patients biopsies and cadaveric samples were analyzed with light microscopy and immunohistochemistry (anti-humanS100antibody)

Peroneal tendons are accessible by endoscope along whole common sheath; vincula were found in all cadaveric specimens; intraoperative finding of vincula lesion (thickening/scarring) was found in all patients biopsies. Histology and immunohistochemistry revealed presence of nervous fibers inside the intimate structure of peroneal vincula both in cadaveric specimens and in patients biopsies.

Tendoscopy as a useful tool in visualizing the entire length of peroneal tendons, allowing the surgeon to diagnose and treat different peroneal disorders.

Although literature provides no data about innervations of peroneal vincula, presence of free nervous fibers inside vincula structure is consistent with a proprioceptive role of the vinculum in peroneal tendon physiology.

Moreover, our findings in patients biopsies suggest lesion of peroneal vinculum is a nociceptive source and an important element leading, synergistically with other soft tissues (i.e. joint capsule, lateral ligaments) injuries, to proprioception impairment in clinical pictures of chronic ankle instability. So selective excision of degenerated areas of vincula can be justified as accessory procedure in treatment of chronic lateral pain in patients affected by chronic ankle instability.

Aims: Peroneal tendons possess a vascular supply through a mesotendineal structure named vinculum; vincula are identifiable with tendoscopy and are supposed to play a role in tendon healing response, due to prominent vascularity; aim of the study is to verify the feasibility of tendoscopy in evaluating peroneal tendons, to clarify the histological structure of peroneal vincula and to investigate the presence of nervous tissue, so formulating a hypothesis regarding the functional role of vincula.

Methods: cadaver study was performed on 8 fresh-frozen ankles; dissection were conducted to verify accessibility of endoscope, proximity with superficial peroneal nerve and presence of vincula; samples of vincula were obtained; light microscopy and immunohisto-chemistry (anti-human S100 antibody) were performed, describing structure of vincula and identifying peripheral nerve fibers.

5 peroneal vincula biopsies were analyzed from patients affected by ankle instability and undergoing tendoscopy for peroneal tenosynovitis.

Results: peroneal tendons are accessible along the whole common tendon sheath and a discrete distance between the endoscope and the superficial peroneal nerve is present in all specimens; a membranous mesotendineal structure was found in all specimens between both tendons and tendon sheath; macroscopic inspection revealed the presence of a vessel network, arising from the sheath toward the tendon; light microscopy of cadaver samples confirmed the presence of multiple vessel branches crossing the entire structure of the vinculum and identified nervous structures close to the vessels, resembling a neurovascular bundle; immunohistochemical analysis revealed nerve fibers in each specimen;tendoscopy in patients affected by ankle instability showed lesions of the vincula and histology from intraoperative biopsies showed presence of nerve fibers.

Conclusions: tendoscopy is a useful tool to visualize peroneal tendons and to diagnose and treat different disorders; although literature provides no data about innervations of peroneal vincula, the study shows nervous fibers consistently present inside the intimate structure of vinculum; besides its function in repair and healing processes, this suggests a proprioceptive role of the vinculum in peroneal tendon physiology and lesion of vinculum could be an important element acting synergistically with joint capsule and surrounding tissues lesions and ultimately leading to clinical pictures of ankle instability.

The purpose of this study is to identify the optimal amount of knee flexion required to drill the femoral tunnel in ACL reconstruction using the transtibial technique in order to ensure the correct alignment between the femoral tunnel and the interference screw.

Methods: Twenty (10 × 2) fresh-frozen cadaveric knees were used. The native ACL was resected and its tibial attachment was identified. The angle of the tibial tunnel was set at 55° using an Arthrex tibial guide. The extra-articular tibial tunnel entry point was located at the anterior border of the superficial MCL. The intra-articular exit point of the guide wire was digitized with a digital camera and referenced to anatomical landmarks (the anterior border of the PCL, the lateral aspect of the medial spine and the anterior horn of the lateral meniscus). The femoral tunnels were made using the transtibial technique and a 5mm femoral guide to insert guidewires at 70, 80, and 90 degrees of knee flexion (groups a, b, c respectively). The angles of divergence between the longitudinal axis of the femoral tunnel and the interference screw (placed through an anteromedial portal at 120° of knee flexion) were then measured.

Results: The degrees of divergence were: 5° ± 2° for group a, 12° ± 4 for group b, and 15° ± 3° for group c.

Conclusions: Optimal femoral tunnel and interference screw alignment is achieved using the transtibial technique when the femoral tunnel is drilled with the knee in 70 degrees of flexion and the screw is inserted at 120 degrees of knee flexion.

This study identifies a mathematical formula for the optimal amount of knee flexion required to drill the femoral tunnel in ACL reconstruction using the transtibial technique in order to ensure the correct alignement between the femoral tunnel and the interference screw.

The ABG stem (Anatomique Benoist Girard, How-medica) was realized of titanium alloy (TA6V) and it was designed to provide anchoring only at the femour’s metaphyseal portion. The long-term stability is achived by osteointegration of the implant at the metaphyseal region, which is coated with hydroxyapatite (HA) crystals. The plasma-sprayed HA coating has a tickness of 60 μm for the stem.

The current study presents radiographic outcomes of more than one hundred primary uncemented HA stems with a long-term follow-up. One hundred and eleven ABG hip arthroplasties were evaluated with a mean follow-up of 9.8 years. The radiographical findings have been classified observing Engh’s stability criteria according to Gruen’s subdivision of the periprosthetic femoral zones.

Dividing the hips into two different groups (in the first one the prosthesis implanted 11, 12 or 13 years ago and in the second one the prosthesis with a maximum age of 10 years) it’s possible to see as in the first group the radiolucent lines are quite reduced. Among the older prosthesis the percentage of radiolucent lines is 3.1% in zones 3 and 5 and 18.8% in zone 4. For what concerns the younger ones the percentage are 10.1% (zone 3), 21.5% (zone 4) and 15.2% (zone 5).

We believe that there is a load transfer from the metaphyseal to the metadiaphyseal portion of the femur without a worsening of the clinical outcomes. The absence of reactive lines and lucencies around the proximal HA-coated portion of the stem supports an excellent circumferential bony ingrowth in the metaphyseal area of the proximal femur. According to these percentages we can say that there’s less presence of radiolucency in the oldest prosthesis and it could be possible to argue that radiolucent lines tend to reduce along the time. This is probably due to the increase of the strength of the stem anchorage.