Antonino Sanfilippo

Effect of suturing the femoral portion of a four-strand graft during an ACL reconstruction

PurposeA suture passed along the part of the graft that will be inserted into the femoral tunnel is widely used by surgeons, because it could prevent the graft sliding on the femoral fixation device during pulling from the tibial side. The aim of this study was to evaluate the biomechanical effects of suturing the intratunnel femoral part of the graft during an anterior cruciate ligament (ACL) reconstruction.MethodsBovine digital extensor tendons and tibias were harvested from 20 fresh-frozen mature bovine knees ranging in age from 18 to 24xa0months. Quadruple-strand bovine tendons were passed through the tibial tunnel and secured distally with a bioabsorbable interference screw. In one half of all grafts (Nxa0=xa010), the looped-over part of the graft was sutured in a whipstitch technique over a distance of 30xa0mm (Group 1). In one half of all grafts (Nxa0=xa010), the looped-over part was left free from any suture (Group 2). The grafts were preconditioned at 50xa0N for 10xa0min, followed by cyclic loading at 1xa0Hz between 50xa0N and 250xa0N for 1,000 cycles. Load-to-failure test was then carried out at a rate of 1xa0mm/s.ResultsThere was no statistically significant difference between mean stiffness at pullout and yield load between the two groups. In all specimens on Group 1, failure occurred following to partial breaking and then slipping of the tendons between the screw and the tunnel. Concerning Group 2, in six cases failure occurred as described for Group 1 specimens. In the remaining four cases, failure occurred entirely through the ligament mid-substance.ConclusionsSuturing in a whipstitch fashion the femoral portion of the graft doesn’t affect the mechanical proprieties of the ACL graft. When suspension fixation device is used, suturing the looped-over part of the graft could be helpful in order to provide equal tension in all of the strands of the graft at time of tibial fixation.

The treatment of wrist fractures with Epibloc system.

BACKGROUNDnFractures of the distal extremity of the radius are the most common bone lesions of the superior extremity of the body, representing 17% of the fractures treated in First Aid facilities. The restoration of anatomical relationships in the radiocarpal joint is considered to be a prerequisite for good functional recovery. There are numerous methods of treatment of these fractures. The Epibloc system is a percutaneous endomedullary synthesis alternative to the plaster cast in wrist fracture treatment.nnnMATERIALS AND METHODSnThe authors describe their experience with 81 fractures (63 type A2-3 fractures and 18 type C1) of the wrist treated with the Epibloc System (ES). The results were evaluated clinically, functionally and radiographically on the 7th, 14th, 35th, 90th day. The Gartland and Werley score modified by Sarmiento was used for the functional assessment of the wrist injuriesnnnRESULTSnTwenty-nine patients (35.8%) had excellent results, 43 (53.1%) had good results. Forty-seven of the patients (58%) had a ROM of 100% of normal, with a dorsiflexion-palmar flexion (DF-PF) arc of 120 degrees or more. Seven (8.6 %) of the patients developed Sudecks osteodystrophy. A very moderate or moderate malunion was observed in 19 cases (23.4%nnnCONCLUSIONn1. The ES is a surgical technique for the treatment of numerous wrist fractures. These fractures can result in excellent mobility as well as a low rate of complications and secondary loss of reduction. 2. This method enables early functional recovery with low incidence of rigidity and algodystrophy. 3. This technique is best indicated for AO type A2-3 and type C1. 4. The ES is inadequate for patients with severe osteopaenia and markedly comminuted intra-articular fractures.

BENEFICIAL EFFECT OF PROBIOTICS ADMINISTRATION IN INFLAMMATORY BOWEL DISEASE AND RELATED SPONDYLOARTHROPATHY: A PROSPECTIVE STUDY

Background: Therapeutic treatment for inflammatory bowel disease (IBD) may follow different approaches, systemic as well as local, especially when the target is the osteoarticular apparatus. Although some clinical trials have suggested benefits from probiotics administration in IBD, there is still a great deal of controversy on their use. The aim of this study was to further investigate the effects of probiotics in patients with IBD and related spondyloarthropathy. Material/Methods: Fifty-nine patients affected by IBD with extra-intestinal involvement where evaluated from 2006 to 2010. Twenty-eight patients received administration of a standard therapy with mesalazine and 31 where treated with the same therapy plus probiotic supplement. Results: Comparative analysis performed between the 2 groups showed a better clinical response and a reduction of occasional corticosteroids administration in patients receiving probiotic administration. Conclusions: This prospective study supports the beneficial effects of probiotic administration in improving the clinical response to standard therapy and in reducing the need for corticosteroids use. Large randomized trials would provide reliable and conclusive results in this field.

Femoro-acetabular impingement. Classification, diagnosis and treatment.

The success of a total hip arthoplasty is linked to a long survival, and this one is obtained reducing the surfaces wearing. Polyethylene material was introduced by Sir John Charnley in the 60’s and has been until now the cartilage most similar material regarding the Young modulus, despite metal and ceramic ones. It has been also characterized by a good wear, especially nowadays the highly cross-linked polyethylene technology has been developed. In the last years, research has been oriented to already used materials improvement such as metals and metal alloys (steel, titanium, CrCo, tantalum), to study and product dense and bioactive ceramics (alumina), to study and product polymeric and composite materials. The physical properties of some polymers have shown to be very similar to those of the normal cartilage. Considering that the most relevant impairment in an arthritic hip regard the articular cartilage, it’s easy to figure out the importance of regaining the cartilage function in anatomical THA surgery. Years of study and laboratory tests have led to the production of a new acetabulum module made of PCU (polycarbonate urethane), which would play a buffer/plug role, as the normal cartilage of a healthy hip does. The emerging buffer characteristics consist of the mentioned optimum modulus of elasticity which results moreover as a shock absorber, and the optimum microelastodynamic lubrication which reduce the friction coefficient. The buffer is presented as an acetabular cup to be inserted in a metal back (titanium coated CrCoMo) press-fit implanted. It can also be implanted directly in contact with the acetabular bone, previous the thin residual cartilage layer removal, allowing a more anatomical surgery and a bone stock sparing. PCU buffer is intended to be a new way of thinking total hip arthroplasty, nevertheless the acquired experience is actually confined among few Centers and further laboratory tests are going to be concluded. The path has drawn, it has just to be covered!