Purpose: The purpose of this study was to review the clinical results of a series of 108 children treated artroscopically for symptomatic discoid lateral menisci.

Methods: The medical records of more than 100 consecutive patients who underwent arthroscopic treatment for symptomatic discoid meniscus between 1990 and 2005 were reviewed.

Results: The mean patient age was 8.7 years (range, 2,5 to 14 years), with 55% female and 45% male patients. The mean duration of symptoms before surgery was 20 months (range, 2 to 48 months), with 95% having pain and 38% having mechanical impingment. All patients were treated arthroscopically. Partial or subtotal arthroscopic meniscectomy was performed. Operative classification of the menisci revealed 64 complete, 18 Wrisberg type and 26 incomplete discoid menisci, with meniscal tears being present in 48 knees (45%). At final follow-up, all patients exhibited full knee flexion beyond 135 degrees. Three patients reported residual knee pain, and four reported intermittent mechanical symptoms. At final follow-up, 3 years minimum, according to Ikeuchi clinical score more than 50 % of the patients were considered very good and 25 % good. Only 8 patients felt that their activity level remained partially limited.

Conclusions: Our results show the middle-term efficacy of arthroscopic partial or subtotal meniscectomy in cases of symptomatic lateral discoid menisci. Arthroscopic partial meniscectomy is preferrable only when the posterior attachment of the discoid meniscus is stable. A total meniscectomy is indicated for the Wrisberg-ligament type of discoid meniscus and when the meniscus is completely degenerated. This to our knowledge is the largest series of discoid lateral menisci arthroscopically treated.

Level of evidence: Level IV, therapeutic case series.

Reconstruction following internal hemipelvectomy for bone tumors remains a major surgical challenge. Most of the cases are considered not suitable for reconstruction because of high complication occurrence. Allografts coupled with standard prosthesis is a reliable method of reconstruction.

26 patients received a McMinn stemmed cup (Link, Germany) after periacetabular tumor resection from February 1999 to 2006. In 18 patients the reconstruction followed resection of the acetabular area while in other 8 an extrarticular resection of the proximal femur was performed. In 21 cases a stemmed acetabular cup were associated with massive bone allograft. There were 13 female and 13 male with a mean age of 41 years (13 to 70). Average follow-up was 45 months (7 to 105).

Six patients were affected by local recurrence of the tumour and five underwent hindquarter amputation. In 4 of them the index surgery followed a previous recurrence of the tumour. Finally 6 patients died for related causes within 2 years. All the other 20 have been followed clinically and radiographically for a minimum of 24 months.

Deep infection occurred in one case, there were no cases of dislocation. Radiolucency at the prosthesis-bone interface was observed in 3 cases, 2 patients had proximal migration < of 20 mm. Only one patient was treated for aseptic loosening because of incorrect initial position of the implant. The iliac osteotomy was consolidated in all cases, while a delayed union was frequently observed in the pubic osteotomy, however without compromise the stability of implant. Functional result were evaluated according to the MSTS system and this showed 65% of excellent or good clinical results.

The procedure requires appropriate patient selection, accurate preoperative planning, meticulous selection and preparation of allograft. Usually artificial ligaments are applied to reduce hip instability, however, this type of reconstruction do not require complex fixation, thus reducing surgical time and early complications.

Purpose: Ultrastructural analysis of PT graft for ACL single bundle reconstruction.

Materials and methods: Arthroscopical biopsies for new meniscal lesions at 6-12-24mm-5-10 ys. All cases with IKDC normal/nearly normal and KT2000 excellent/good.

Samples prepared with Karnowsky fixing and urani-lacetate solution. Fibril diameter and transversal area measured by LEICA QUIN in 5 cuts randomly selected for each sample.

Results: 6 months biopsy showed severe P.T. modifications, with a decrease of larger fibrils, substituted with smaller one with plenty of extra cellular matrix. Oxitalan fibers, macrophagic cells and tenocytes were observed. At 12 months compact fascicles of small fibrils (50–60 nm) divided the larger one, similar to a normal tendon. At 24 months graft modifications were increased with wide compact fasciclesvariously oriented. At 5 and 10 years the modifications were similar to those observed at 2 years, with the graft not completely transformed in native ACL structure.

Discussion: The results showed that PT graft used for ACL single bundle reconstruction certainly undergoes a neoligamentization process up to two years. At longer follow-up the foresaw complete remodelling in a normal ACL was not observed. Heterogeneous fibrils presence suggests incomplete ligamentization or its impossible complete realization in single bundle ACL reconstructions.

Introduction: In the last years matrix autologous chondrocyte transplantation becomes a possible solution in the treatment of chondral lesions. We develop an arthroscopic procedure for chondrocyte implant on hyaluronian-based scaffold.

Material and methods: Thirty-five patients treated using this technique achieved 3 years follow up. All the patients were clinically evaluated using IKDC score and with MRI or TC scan. In some Patients we performed a second look arthroscopy and histological evaluation.

Results: IKDC objective score improved after 12 months in all patients and the results were confirmed at 24 and 36 months of follow-up. The improving was obtained also according to IKDC subjective score. A second look arthroscopy showed healing of the defect with regenerated cartilage. The histological evaluation has demonstrated in 80% the hyaline type of new cartilage.

Conclusions: This matrix autologous chondrocyte transplantation procedure avoids the use of periosteal flap, simplify the surgical procedure and permit to perform the arthroscopic implant reducing the morbidity of the procedure. The preliminary clinical and histological results at 3 years follow-up are encouraging.

Introduction: Total meniscectomy can cause cartilage degeneration and osteoarthritis. The healing capacity of the meniscus is limited. Bioengineered meniscus can be a valid therapeutic option. Within the framework of the European Project MENISCUS, a pilot animal study was conducted to evaluate surgical technique, critical defect size, implant ingrowth and postoperative mobilization using a meniscus replacement device.

Materials and Method: Six sheep were operated on their right stifle joints. 3 sheep received a total meniscus replacement with a 3D biomaterial fixed with sutures. Additionally, controls without implant were operated. The sheep were sacrificed and evaluated clinically and histologically after 6 weeks.

Results: All implants showed excellent adhesion to the capsule and a good ingrowth at the periphery and the horns. Tissue formation was confirmed histologically.

Conclusions: Tissue ingrowth of the implant was demonstrated. The promising results concerning tissue formation and its meniscus like properties will have to be confirmed in future long-term studies.