INTRODUCTION

The purpose of this study is to report results from a prospective multicenter study of a bioresorbable type I collagen scaffold used to replace tissue loss following irreparable lateral meniscus injuries.

Introduction: The Collagen Meniscus Implant (CMI) has been shown to be effective for the replacement of lost medial meniscus tissue; however, no such device has been available for treatment of similar injuries to the lateral meniscus. Loss of the lateral meniscus results in a rapidly increased rate of knee degeneration compared to similar medial injuries. The purpose of this study was to determine if a CMI developed for use in treatment of lateral meniscus deficiencies is as safe and effective as has been reported for the medial CMI.

Methods: Prospectively, 60 patients (12–65 years of age) were enrolled at 7 sites between March 2006 and October 2007. Patients had irreparable lateral meniscus tears requiring partial meniscectomy. The knee had to be ligamentously stable and in neutral alignment and with no untreated Grade IV cartilage damage. Patients gave informed consent and agreed to comply with postoperative assessments and standardized rehabilitation. The surgical technique involved insertion of the dry implant into the lateral compartment of the knee joint. Fixation of the implant to the host meniscus rim was accomplished with either an all-inside suture technique or a hybrid all-inside/inside-out technique. Clinical evaluations and patient self-assessments were conducted preoperatively and at defined intervals through 2 years postoperatively. Procedure specific intraoperative parameters, radiographic evaluations, and adverse events were documented. Data collection was monitored by a third party according to GCP regulations.

Results: 49 patients received a lateral CMI. Currently, 24 patients have 1-year follow-up and 13 patients have been followed approximately 2 years; the mean follow-up is 22 months. Follow-up included assessments of changes in Lysholm, pain, Tegner and patient satisfaction. All patients showed clinical improvement from the preoperative to the 1 year postoperative time points. Four patients experienced adverse events which required an additional arthroscopic procedure between 4 and 16 months and included removal of implant remnants, synovectomy and debridement.

Conclusions: These preliminary results appear to suggest that implantation of lateral CMI leads to improved clinical outcomes in pain, function, self-assessment and activity levels. Frequency and type of adverse events are comparable to those for suture repair reported in the literature. Based on results reported for the medical CMI, we anticipate that these lateral CMI patients will have improved long-term results compared to partial lateral meniscectomy.

Electrical stimulation techniques are utilised in orthopedics field for the treatment of pseudoarthroses; the more widespread methods are the inductive system with Pulsed Electromagnetic Fields (PEMFs). We report the results of a retrospective study, between February 1987 to February 2002, of 57 patients with pseudoarthroses of tibia (22 treated with PEMFs against 35 without this treatment). The objectives of the study have been to know the influence, the consolidation percentage and the influence of electrical simulation.

The average age was 38 years (14–89); the average follow-up 3,2 years. 17 fractures were open and 40 fractures were closed. All the fractures were affect the tibia shaft, in 19 cases extended to the articulation. For the admission to the study had not united after at less 6 month. All the patients were treated with surgery to the pseudoarthroses (looking nail in 54 cases, fixation extern in 2 cases and osteotomy to fibula in one case). Statistical analysis utilised was the SPSS program.

The results were statistically significantly (p< 0,05) in:

The consolidation with the PEMFs increase compared without this method (91% vs 83%).

Experience supports its role as a successful method of treatment for ununited fractures of the tibia.

We studied nutritional deficits, using as markers the levels of transferrin, retinol-binding protein, and prealbumin, in 20 women with osteoporotic hip fractures (type II), 40 women with vertebral fractures (type I), and two groups of age-matched control subjects. The concentrations of all three nutritional markers were lower in the two groups of patients than in their matched controls, and in type-I as compared with type-II osteoporosis. In the osteoporotic patients, simple linear regression showed a significant correlation between the variables which we studied (r2 ranged from 0.5 to 0.7; p < 0.001), the best correlation being between prealbumin and retinol-binding protein in type-II osteoporosis. Our results suggest that there is a more marked nutritional deficit in type-II than in type-I osteoporosis.