Libor Paša

Treatment of deep cartilage defects of the knee using autologous chondrograft transplantation and by abrasive techniques - a randomized controlled study

Abstract Aim of the study: To compare outcomes of surgical treatment of deep cartilage defects of the knee in a group of patients treated by autologous chondrograft transplantation versus patients treated by abrasive techniques. Materials and methods: An original method of chondrograft preparation based on cultivated autologous chondrocytes in a three-dimensional carrier-fibrin glue (Tissucol, Baxter, Austria) has been described. Preclinical tests in human cadavres and porcine models have established the possibility of chondrograft use in humans. Of the 50 patients included in the study, 25 patients (50%) underwent autologous chondrograft transplantation (group I) and 25 patients (50%) were treated using abrasive techniques according to Johnson (group II). These two groups were similar with respect to age, size of defect, depth and localization, and presence of concomitant knee injuries. The Lysholm knee and IKDC (International Knee Documentation Committee) subjective scores were used to evaluate the results. Results: The preoperative value of the Lysholm knee score for patients in group I was 47.60 points; 5 months after surgery 77.20 points; and 12 months after surgery 86.48 points. The values for the Lysholm knee score for patients in group II preoperatively, 5 months postop, and 12 months postop were 52.60, 69.20, and 74.48 respectively. Results 12 months after surgery were significantly better in group I as compared to group II (p < 0.001). The preoperative value of the IKDC subjective score in group I was 41.28 points; 5 months after surgery 67.00 points; and 12 months after surgery 76.48 points. The values for the IKDC subjective score in group II preoperatively, 5 months postop, and 12 months postop were 45.00, 62.28, and 68.08 respectively. Results 12 months after surgery were significantly better in group I when compared to group II (p < 0.05). Conclusions: The results obtained in this study have confirmed the better outcome in patients treated with autologous chondrograft transplantation. This original method was found to be just as effective as abrasive techniques. We recommend its use in clinical practice.

Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures.

Objectives: To reduce the complication rate associated with open reduction and internal fixation of displaced intraarticular calcaneal fractures through extensile approaches, a locking nail system (C-Nail) was developed for internal fixation. Design: Prospective case–control study. Setting: Two level I trauma centers (university hospital) and 1 large regional hospital in the Czech Republic and Germany. Patients: One hundred three patients (89 male and 14 female; mean age, 45.6 years) with 106 calcaneal fractures were treated between February 2011 and October 2013. Intervention: In all 106 cases, the stainless steel C-Nail with a length of 65 mm, a diameter of 8 mm, and 7 locking options was used for internal fixation. Previous reduction of the posterior facet was performed in 15 cases percutaneously, assisted by arthroscopy and fluoroscopy, and in 91 cases by a sinus tarsi approach. The reduced joint surface was fixed by 1 or 2 compression screws. All other fragments were fixed after reduction and temporary K-wire fixation with the C-Nail introduced percutaneously through the tuberosity and 5 to 6 interlocking screws. The latter were introduced into the sustentacular, the tuberosity, and the anterior process fragments with an aiming device consisting of 3 arms. Main Outcome Measures: Patients were assessed for complications, restoration of Böhler angle, posterior facet reduction with postoperative computed tomography, and weight-bearing radiographs at 6 months. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale after 6 and 12 months for all patients. Results: Wound edge necrosis was seen in 2 cases (1.9%), and soft tissue infection was observed in 1 case (0.9%). Böhler angle improved from 7.3 degree preoperatively to 28.7 degree at 6 months. The posterior facet step-off was reduced from 5.3 mm preoperatively to 0.7 mm postoperatively. The average AOFAS score averaged 89.5 at 6-month and 92.6 at 12-month follow-up. Conclusions: The C-Nail is a new locking system for treatment of displaced intraarticular calcaneal fractures combining a primary stability with reduced soft tissue complications. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Genotypic versus phenotypic methods in the detection of Listeria monocytogenes prosthetic joint infection.

A rare case of a severe prosthetic joint infection in a 71-year-old immunocompetent woman is presented. Listeria monocytogenes was identified in two consecutive samples using broad-range PCR and sequencing, whereas cultivation remained negative for the first sample and streptococci of a non-group A streptococci, non-group B streptococci type were detected for the second one. This report demonstrates that the phenotypic approach may lead to misidentification of L. monocytogenes in a routine clinical setting. Molecular methods of pathogen detection might be useful when a rare and/or unexpected micro-organism is present or the sample is collected during antibiotic treatment.

Biomechanical assessment of the reconstruction of the anterolateral ligament during anterior cruciate ligament surgery

Background: Rotational instability after the anterior cruciate ligament (ACL) injury and subsequent reconstruction may be caused by the rupture of the anterolateral structures of the knee, specifically the anterolateral ligament (ALL). There are more techniques to improve the rotational stability of the knee. The objective of this randomised cohort study was: (1) To evaluate the knee rotational stability after the single-bundle ACL reconstruction (SB) with addition of the ALL reconstruction and to compare it with the double-bundle ACL reconstruction technique (DB). (2) To analyse when the ALL is necessary to reconstruct. Methods and findings: 60 patients underwent the ACL reconstruction with the average age of 29.5 years. In thirty patient’s knees the ACL was replaced with quadriceps muscle graft using the SB technique in combination with the ALL reconstruction by the gracilis graft (ALL group). With another thirty patients the ACL was reconstructed performing DB technique with the use of hamstring tendons (DB group). The rotational stability was studied before and after the reconstruction of the ACL in time “zero” using the computer navigation system. In the ALL group, the rotational stability was also analysed after the ALL reconstruction. Before the surgery, the mean internal rotational instability (IR) was 18.7° in DB group and 19.1° in ALL groups. After the DB reconstruction, IR stability improved to 10.4°. After the ACL reconstruction in the ALL group, the IR stability was 13.3°. When the ALL was added, the IR stability improved up to 9.8°. In cases where IR stability achieved 12° after the ACL reconstruction, the addition of the ALL reconstruction would not further significantly improve the IR stability. Conclusions: The SB reconstruction of the ACL using the quadriceps muscle graft in combination with the ALL reconstruction restores the IR stability of the knee to same extent as DB reconstruction does. If the IR stability after the SB reconstruction achieves 12°, the ALL reconstruction is no longer necessary