Implant materials impregnated with antibiotics have long been used to manage the dead space created by debridement surgery in patients with osteomyelitis. To present our preliminary results and in vivo response of patients to PerOssal used to treat bone infection in the form of long bone chronic osteomyelitis. PerOssal is a new osteoconductive bone substitution material for bone filling which consists of an entirely synthetically produced, nanocrystalline hydroxyapatite and calcium sulfate. It can be used effectively as a local antibiotic carrier for the reconstruction of infected bone defects. We have treated 19 patients with long bone osteomyelitis (15 tibial, 4 femoral) with PerOssal impregnated with the appropriate antibiotic which was used following radical debridement surgery. In all cases we did not rely solely on the mechanical stability that it may provide but we supported the bone when necessary. Postoperative observations were focused on primary wound healing and clinical eradication of infection. We had: 15 eradication of infection, 2 recurrences, in terms of re-infection by different species or amputation, and 2 on-going cases. Declining wound leakage and delayed wound healing was present in 5 cases where PerOssal was used either intramedullarily but not sealed or extraosseously in relatively large amounts. We have so far good results with respect to infection control. PerOssal seems to perform better when used in contained defects whereas extraosseous use seems to predispose to prolonged leakage and compromised wound healing or breakdown. The mechanical stability that it provides remains under consideration.
Evaluation of transtibial aiming of the femoral tunnel at its anatomical position in arthroscopical ACL reconstruction. 43 ACL reconstructions with hamstrings’ graft were studied. First, the femoral tunnel was drilled through the anteromedial portal at 09.30–10.00 (14.00–14.30 resp.) and then the tibial tunnel (av. anteroposterior angle: 63,5°, sagittal: 64,2°) at the same diameter with simoultaneous radiological documentation. Then, with a femoral aiming device, we tried to put a K-wire at the center of the drilled femoral tunnel. Fotographic documentation took place. In 20 cases the diameter of the tunnels was 7mm, in 11, 7,5mm, in 7, 8mm, in 3, 8,5mm and in 1, 9mm. Evaluation of all radiological and photographic material from 2 observers followed, according to the deviation of the transtibial K-wire from the center of the femoral tunnel. 38 ACL reconstructions were evaluated. It was shown that in 11 cases the transtibial K-wire was in the femoral tunnel (28,9%) (in 7 with a diameter of 7mm., in 2 with 7,5mm. and in 2 with 8mm.). The K-wire was in 23 cases (60,5%) at the perimeter or out of the femoral tunnel (in 11, with a diameter of 7mm., in 8 with 7,5mm., in 4 with 8mm., in 3 with 8,5mm. and in 1 with 9mm.). There was no correlation with the angles of the tibial tunnel or the age of the patients. Transtibial aiming of the femoral tunnel at its anatomical position is very difficult and there is no correlation of the transtibial deviation with the diameter of the tibial tunnel.
The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair with the FasT-Fix repair system. Type of study: Prospective case series. Methods: 83 meniscal repairs with the FasT-Fix meniscal repair system in 80 patients with a mean age of 29 years were performed between 2004 and 2008. Concurrent anterior cruciate ligament (ACL) reconstruction was performed in 70% of the cases. All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation included also the Lyscholm knee score, and KT-1000 arthrometry. Results: The average follow-up was 38 months (range, 10–61 months). Six of 83 repaired menisci (7.23%) were considered failures according to our criteria. Therefore, the success rate was 92.77%. Time required for meniscal repair averaged 15 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. 92% had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in one of them. Analysis showed that, age, length of tear, simultaneous ACL reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. Conclusions: Our results, shows that arthroscopic meniscal repair with the FasT-Fix repair system provides a high rate of meniscus healing and offers reduction of both the risk of serious neurovascular complications and operative time.
