Giancarlo Puddu

Open wedge high tibial osteotomy

Osteotomy is a classic operation in the treatment of unicompartmental osteoarthrosis of the knee. It has often been presented as a possible alternative to prosthetic joint replacement, but the indications depend on the stage and articular diffusion of the degenerative changes and on the patient’s profile and are very different in most cases from the indications for unicompartmental or total knee replacement. A relatively new technique of high tibial osteotomy will be illustrated in this article with careful step-by-step presentation of all the details of the operation. Compared to the Coventry lateral closing wedge osteotomy, this technique turns upside down the method of correction of the varus deformity and adds a wedge medially. It is based on a special dedicated system of instruments and plates developed by Puddu et al in the early 1990s.

Which osteotomy for a valgus knee

A valgus knee is a disabling condition that can affect patients of all ages. Antivalgus osteotomy of the knee is the treatment of choice to correct the valgus, to eliminate pain in the young or middle age patient, and to avoid or delay a total knee replacement. A distal femoral lateral opening wedge procedure appears to be one of the choices for medium or large corrections and is particularly easy and precise if compared to the medial femoral closing wedge osteotomy. However, if the deformity is minimal, a tibial medial closing wedge osteotomy can be done with a faster healing and a short recovery time.

Osteotomies: the surgical treatment of the valgus knee.

Lateral compartment arthrosis from congenital valgus or the result of previous lateral meniscectomy can be a disabling condition. Realignment osteotomy, which may avoid or delay the need for a total knee replacement, is appropriate for young or middle-aged patients suffering from a painful valgus knee. Medium or large corrections can be managed with distal femoral lateral opening wedge osteotomy while minimal deformities are best treated with medial closing wedge tibial osteotomy.

Femoral antivalgus opening wedge osteotomy

Abstract Valgus painful knee is a disabling condition, especially in athletes. To correct this kind of deformity, femoralosteotomy is the most popular surgical procedure among the techniques described in the literature. The authors herein propose a technique of opening wedge osteotomy based on a new system of plates fixation. Furthermore, some special dedicated instruments have been developed that greatly facilitate the performance of the operation. The indications and the limits of osteotomies are briefly considered before introducing the surgical technique, which is described step by step and is well illustrated with many intraoperative pictures. Some principles of rehabilitation conclude the article.

Microvasculature of the human medial meniscus: Operative findings

The purpose of our study was to weigh the probability of a successful meniscus repair on the basis of the microvasculature of the human medial meniscus. In a series of 105 patients who underwent an anterior cruciate ligament reconstruction between January 1985 and December 1986, we chose the 40 patients who had a subtotal medial meniscectomy (38%) to study the microvasculature of the human medial meniscus adequately; the other patients had either an intact meniscus (23%), a meniscus repair (29%), or an already removed meniscus (10%). Forty medial menisci, from 40 male patients with an average age of 27 years, having an anterolateral and/or anteromedial chronic knee laxity and an associated meniscal pathology, were subdivided into two groups: (a) 20 tears restricted to the posterior horn, and (b) 20 bucket-handle tears observed under light microscopy. Meaningful capillary plexuses penetrating into the meniscal stroma were found in 18 of 40 menisci (45%). They were easier to identify in posterior horn tears (55%) than in bucket-handle tears (35%), and were found especially in younger patients (22 years on the average). Therefore, we encourage meniscus repairs even in chronic tears, particularly in younger patients and in posterior-horn tears.

Arthroscopic placement of the interference screw for anterior cruciate ligament reconstruction.

This article describes a simple technique to check arthroscopically the position of the interference screw in bone patellar tendon bone reconstruction of the anterior cruciate ligament. With this simple and inexpensive method we can be sure that the bone plug in the tunnel has a rigid fixation and that the screw does not damage that graft.

Iliotibial band friction syndrome

The iliotibial band friction syndrome (ITBF) is a common knee overuse tendon injury in athletes. Long distance runners and cyclists are the two most involved categories. A combination of extrinsic factors and intrinsic factors is believed to predispose athletes to the syndrome. Lateral pain of the knee is the dominant symptom. The history and an accurate clinical examination allow to correctly diagnose this affliction, distinguishing it from other causes of knee pain. The choice treatment must be always conservative, based on rest from sports activities and medical and physical therapy. Only when conservative treatment fails is surgical therapy indicated. Here we propose an easy surgical technique with encouraging whose results.

Rehabilitation After Posterior Cruciate Ligament Injuries

The nonoperative or surgical management of posterior cruciate ligament (PCL) tears is still very much a matter for discussion. In fact, the symptoms are slight in most cases, while the quality of the results offered by surgery is uncertain. The clinical progress of the natural history of the lesion is not clear [1 – 10]. Insufficient understanding of modern rehabilitation practices after nonsurgical and surgical treatment is another cause of poor clinical and functional results.

Unusual Complications in Knee Surgery from Around the World: Case Reports

The bone—patellar tendon—bone graft is considered the gold standard in anterior cruciate ligament (ACL) reconstruction.1 The advantages of taking the central third of the patellar tendon are its grip force and the bone-to-bone fixation that favors a faster healing.2 Patellar tendon grafts can result in the following complications: patellofemoral pain, patellar tendinitis and patellar fracture, as well as extensor mechanism weakness.3 The morbidity rate of the patellar graft is currently a very controversial topic, but the English-language literature still considers the use of the central third of the patellar tendon the gold standard.