A prospective study was done to assess the outcome of MPFL reconstruction for patellar instability using quadriceps graft. MPFL reconstruction was done using superficial strip of quadriceps by an anteromedial incision and attached close to medial epicondyle of femur. There were 15 knees in thirteen patients with a mean age of 23.4 years. All patients had MPFL reconstruction and 5 had tibial tuberosity transfers. With a mean follow-up of 39.4 (12–57) months, the mean pre-op Kujala scores improved from 47.8 to 87.2. The mean Lysholm scores improved from 54.2 to 86.8. None of the patients had patella re-dislocations. MPFL reconstruction with quadriceps graft appears to be effective producing good results in patients with patellar instability.

The purpose of this study is to present a series of soft tissue sarcomas requiring complex vascular reconstructions, and to describe their management and outcomes. Soft tissue sarcomas are rare mesodermal malignancies accounting for approximately 1% of all cancers diagnosed annually. Sarcomas involving the pelvis and extremities are of particular interest to the orthopaedic surgeon. Tumours that encase and invade large calibre vascular structures present a major surgical challenge in terms of safety of excision with acceptability of surgical margins. Technical advances in the fields of both orthopaedic and vascular surgery have resulted in a trend towards limb salvage with vascular reconstruction in preference to amputation. Limb-salvage surgery is now feasible due to the variety of reconstructive options available to the surgeon. Nevertheless, surgery with concomitant vascular reconstruction is associated with higher rates of complications including infection and amputation. We present a case series of soft tissue sarcomas with vascular compromise, requiring resection and vascular reconstruction. We treated four patients (n = 4, three females, and one male) with soft tissue masses, which were found to involve local vascular structures. Histology revealed leiomyosarcoma (n = 2) and alveolar soft part sarcomas (n = 2). Both synthetic graft and autogenous graft (long saphenous vein) techniques were utilised. Arterial reconstruction was undertaken in all cases. Venous reconstruction was performed in one case. One patient required graft thrombectomy at one month post-operatively for thrombosis. We present a series of complex tumour cases with concomitant vascular reconstructions drawn from our institution's experience as a national tertiary referral sarcoma service

BACKGROUND. Acetabular defects are encountered in both primary total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) and in revision THA. The purpose of this study was to evaluate the clinical and radiographic results of one method of acetabular reconstruction for THA using a hydroxyapatite (HA) block with either an autogenous graft or allograft of impacted morsellized bone in conjunction with a cemented socket. METHODS. Fourteen hips in 14 patients (all female; average age, 64 years) were treated with the above technique in primary (11 DDH) or revision THA (three loosened sockets). All patients were followed clinically in a prospective fashion, and radiographs were analyzed retrospectively. One initial patient had 16-year follow-up, whereas the remaining 13 patients had follow-up between four and 5.5 years. RESULTS. No acetabular components were revised, including the socket of 16-year postoperative case which remains rigidly fixed and supported by the graft and HA block with only mild polyethylene wear and minor osteolysis. The mean Japanese Orthopaedic Association (JOA) score for the hips improved from 37 points preoperatively to 90 points postoperatively. CONCLUSIONS. The authors report very good results of acetabular reconstruction with the use of these biomaterials in conjunction with impaction morsellized bone graft in THA. Osteointegration and good clinical outcome were achieved in all of cases. However longer-term outcome should be the subject of further investigation, as the majority of these patients had only mid-term follow-up of 4 to 5.5 years

Acute osteomyelitis of the radius or ulna in children is rare and may be associated with complications including pathological fracture, growth disturbance and cosmetic problems. Purpose:. To highlight the outcome of acute pyogenic osteomyelitis of the forearm bones in children. Methods:. Eleven children were treated for osteomyelitis of the radius (6) and ulna (5) over 15 years. Staphylococcus aureus was cultured following initial incision and drainage. Two had signs of compartment syndrome. Late complications included gap defects of 2–6 cm (radius 1 and ulna 2). Larger defects with physeal involvement were seen in the distal ulna (4) proximal radius (1) and whole radius (1). The late clinical features included pseudarthrosis (9), distal radioulnar instability (3), radial head dislocation (3) and “radial clubhand” type deformity (1). Treatment:. Gap defects <2 cm were filled with autogenous grafts (3). Segmented iliac crest grafts threaded over a K wire were used in 1 patient with an 8 cm gap defect. Radio-ulnar synostosis was performed in 4 cases. The carpus was centralized onto the ulna in 1 child. Results:. Reconstructive grafts healed by 6–12 weeks. Residual elbow contracture <30° occurred in 3 children. Ten children had improved grip strength and stability of the wrist and elbow and forearm length was decreased by 2–5 cm. The child with a radial clubhand deformity had severe shortening and stiffness of the hand. Conclusion:. Osteomyelitis of the forearm bones can be missed and present late. Complications include disproportionate growth, proximal or distal radio-ulnar instability and radial clubhand type deformity. Treatment is challenging requiring reconstruction of gap defects. Radio-ulnar synostosis is a useful salvage procedure to improve function and cosmesis

Treatment of segmental bone loss remains a major challenge in orthopaedic surgery. This study evaluated the healing potential of a series of highly porous tissue engineering scaffolds with the current clinical gold standard. We compare healing of collagen-glycosaminoglycan (CG) and collagen micro-hydroxyapatite (CHA) scaffolds, with and without recombinant bone morphogenetic protein-2 (BMP2), with autogenous bone graft (ABG) in the healing of a 15mm rabbit radius defect, which were filled with either CG scaffold, CHA scaffold, CG-BMP2, CHA-BMP2 or ABG. Serial radiographs and micro-computed tomography (µCT) at six week radiographs demonstrated complete defect bridging with callus using CHA and CG-BMP2 while the CHA-BMP2 was already in an advanced state of healing with cortical remodeling. By sixteen weeks CHA, CG-BMP2 and ABG all had advanced healing with cortical remodeling while CHA-BMP2 had complete anatomic healing. Quantitative histomorphometry values demonstrated similarly high healing levels of healing in CHA, CG-BMP2 and ABG with highest overall values in the CHA-BMP2 group. Thus, treatment of a critical sized, weight bearing, rabbit radius defect with a CHA scaffold can result in full cortical bridging with medullary cavity development. In addition, a CHA-BMP2 combination can result in fully mature, anatomic healing. The use of an off-the-shelf CHA scaffold for direct surgical placement into a defect site may be an effective bone graft substitute in the treatment of skeletal defects. The ease of manufacture, storage and peri-operative preparation may offer an alternative to traditional strategies, as well as to more recent BMP2 devices. This study provides clear evidence that CHA scaffolds can perform as well as autogenous bone grafts and supports their use as a viable alternative. Where the use of BMP2 may be desirable, these materials provide an ideal delivery mechanism and using a very low (near physiological) dose, healing superior to autogenous graft may be achieved

The purpose of this study was to evaluate the results of selective anatomic augmentation of partial anterior cruciate (ACL) ligament tears in 36 consecutive patients with mean 3years follow-up. Our hypothesis is that this selective augmentation of partial ACL tears could restore knee stability and function. In a consecutive series of 314 ACL reconstructions, 40 patients in which intact ACL fibers remained in the location corresponding to the anteromedial or posterolateral bundle were diagnosed perioperatively. All patients underwent selective augmentation of the torn bundle, while keeping the remaining fibers intact using autogenous hamstring graft. 38 patients (28 males, 10 females) were available with minimum 3 year follow- up. 26 cases had AM bundle tears and 12 cases had PL bundle tears respectively. Patients were assessed with International Knee Documentation Committee (IKDC) 2000 Knee Evaluation Form, Lysholm score; instrumented knee testing was performed with the arthrometer (KT 2000). Statistical analysis was performed to compare the preoperative and postoperative objective evaluation. At 3 year follow-up, 12 (31.6%) patients were graded A, 25 (65.8%) graded B and 1 C (2.6%) at IKDC objective evaluation. Lysholm's score and mean side to side instrumental laxity improved significantly. The results of anatomic single bundle augmentation in partial ACL tears are encouraging with excellent side to side laxity

Introduction:. Lateralization of reversed shoulder arthroplasty provides improvement in range of motion and decreases inferior scapular notching. The purpose of this study was to verify if the autologous cancelous bone graft harvested from the humeral head does heal constantly in a large cohort of patients followed for a long time. Methods:. Cohort of 92 consecutive patients operated between 2006 and 2010 with a BIORSA for definitive shoulder pseudoparalysis, secondary to cuff tear arthropathy (CTA) or massive, irreparable cuff tear (MCT). The autogenous cancelous graft was harvested from humeral head in all cases. Eight patients were lost for follow up, and four died before 2 years. The remaining 80 patients underwent clinical, radiographic and CT assessment at a minimum FU of 24 months. Mean age was 73 years. Three independent observers evaluated notching, partial or total glenoid or humeral loosening and viability of the graft. Constant-Murley score, range of motion and subjective shoulder value (SSV) were recorded. The mean follow up was 39 months (range 24–74 months). Results:. The bone graft did healed completely in 96% of the cases (77/80); the thickness of the graft remained stable through the years. There were two cases of glenoid loosening: one nonunion of the graft at the scapular side was due to an important superior tilt of the glenosphere; one failure of fixation at the baseplate side was related to a low-grade infection. Another patient had a partial radiolucent line between graft and native glenoid located only above the central peg. No other radiolucent line around peg, screws or baseplate was found. Inferior scapula notching was observed in 19% of the cases (mainly grade 1 and 2). Each parameters of Constant score improved, and the mean SSV increased from 27% to 78%. Conclusion:. This study shows that: (1) autologous cancellous bone graft, harvested from the humeral head, does heal to the native glenoid despite the advanced age of the patients; and (2) BIO-RSA allows improvement of shoulder function (mobility, pain, strength, subjective value) with a low rate of scapular notching

Purpose. Patients with anterior cruciate ligament (ACL) deficiency and symptomatic medial compartment osteoarthritis (OA) present a challenge in management. These are often younger than typical primary OA patients and aspire to remain athletically active beyond simple ADLs. Combined ACL reconstruction and valgus tibial osteotomy (ACLHTO) is a well documented surgical option for patients deemed wither too young or too active for total knee arthroplasty. Unicompartmental knee arthroplasty (UKA) is an established surgical treatment for symptomatic medial osteoarthritis of the knee refractory to conservative management. A commonly cited contraindications is symptomatic ACL deficiency because of previous reports detailing premature failure through loosening of the tibial component. Improved results and endoscopic ACL reconstructive procedures have led to an enticing concept of combining ACL reconstruction with medial unicompartmental knee arthroplasty (ACLUKR) for those ACL-deficient medial osteoarthritic (OA) knees. We sought to compare the outcomes in 2 cohorts of patients who underwent either ACLHTO or ACLUKR for this clinical problem. Method. Patients presenting with symptomatic bone on bone medial compartment OA and concomitant ACL deficiency (clinical or asymptomatic) were evaluated for surgery after exhausting non operative management. Patients who were under 40 or had plans to return to high impact loading sports and/or who had more moderate OA were offered combined ACL – medial opening wedge tibia osteotomy as a surgical procedure of choice. Patients were considered for combined ACL Oxford replacement if they were primarily seeking pain relief and were not engaged or aspiring to return to high impact or pivoting sports. All cases but one were concurrent ACL with either HTO or UKR with autogenous hamstring grafts used in all but 2 cases. Results. Thirty of 34 consecutive cases were available for follow-up for a rate of 88%. The median ages for 14 cases of ACLUKR was 51 (range 43 60) whereas 16 patients with ACLHTO had median age 43.4 (range 32 −59). Median FU was 4.65 yrs with minimum 2 year follow up (range 2–8.3). Three of the cases were revision ACL cases all from previous Gore-Tex reconstructions. All but the first patient had concomitant ACL and Oxford unicompartmental knee replacement at 1 surgical sitting and are the subject of this report. The first patient had an autogenous patella bone tendon bone graft performed 6 months prior to the UKA. There were similar change scores for patients in both groups. For ACLUKR, WOMAC pain improvements from 48.1 10.2 SD preoperatively to 79.0 17 SD postop. For ACLHTO, WOMAC improvements from 55.1 13.2 SD preoperatively to 85.0 17 SD postop. To date there have been no cases of infection or bearing dislocation in the ACLUKR group. One patient in the ACLHTO group was revised to TKR for ongoing pain and postoperative flexion contracture. Patient activities ranged from ambulation to vigorous hiking, tennis, and downhill skiing in the UKR group whereas a few in the ACLHTO group were also running mid distances. Overall satisfaction was similar in both groups. Conclusion. ACL reconstruction can safely be combined with medial UKR. The procedure has been used in younger patients with a view toward bone preservation while anticipating need for future revision. Both cohorts showed similar improvements and can be considered. The choice should be geared toward patient athletic demand. While short term results are encouraging though longer term data are necessary to thoroughly evaluate the role of this procedure in patients with medial compartment osteoarthritis and ACL deficiency