Mattia Fabbri

Biomechanical comparison of four coupled fixation systems for ACL reconstruction with bone socket or full-tunnel on the tibial side

BACKGROUND To compare in an animal model the biomechanical properties of four coupled fixation devices currently used in ACL reconstruction. Three out of four devices used a full tibial tunnel with an interference screw, while the other one system used a tibial socket and an adjustable loop suspension device. The null hypothesis is that there are no biomechanical differences between all the techniques tested. METHODS Thirty two femur-graft-tibia complexes were mounted on a tensile machine using bovine digital extensor tendons, porcine knees and four different fixation device combinations: After a preconditioning with a tensile load of 90N for five minutes, 1000cycles between 0 and 150N were applied to the complex before the final pulled to failure. Stiffness and strength were evaluated at the final pullout, as was the displacement (slippage) at one, 100, 500, and 1000cycles. RESULTS The multiple mean comparison led to a significant difference for the case of stiffness, with worse results in group C compared to group A (p=0.037). Conversely, no differences were found in UFL and slippage between all groups (p>0.05). CONCLUSION All the tested systems demonstrated in an animal model sufficient properties for a safe postoperative rehabilitation both for strength and for stiffness and slippage under cyclic loading.

The Fascia Lata Anterolateral Tenodesis Technique

A technique for anatomic reconstruction of the anterolateral complex addressing anterolateral rotatory instability both in primary anterior cruciate ligament reconstruction and in revision cases is presented. The extra-articular reconstruction is performed with a pedicle strip of iliotibial tract, fixed on the anatomic origin and insertion points of the anterolateral ligament of the knee in a double-bundle V-shaped fashion.

Salter–Harris type III and IV displaced fracture of the hallux in young gymnasts: A series of four cases at 1-year follow-up

The purpose of this study was to describe four exceptional cases of Salter-Harris type III and IV fractures of the proximal phalanx of the hallux in young high-level gymnasts. All gymnasts underwent the same mechanism of injury of hyperadduction, which indicates a role of the abductor hallucis muscle in the genesis and displacement of these fractures. An open reduction and internal fixation was performed to achieve an anatomical reduction and avoid chronic disability. At 1-year follow-up, all patients had an excellent American Orthopaedic Foot and Ankle Society (AOFAS) score (100 points), and there was no shortening or angulation of the first ray and no evidence of degenerative joint disease on X-ray. Moreover, all the gymnasts had returned to pre-injury levels of sporting activity. To our knowledge, there are no previous studies that address these types of injuries and how they are handled in gymnasts.

Isokinetic flexion strength recovery after ACL reconstruction: a comparison between all inside graft-link technique and full tibial tunnel technique

ABSTRACT Introduction: Recently, a new minimally invasive single bundle technique for anatomic ACL reconstruction has been described, called the ‘All-Inside graft-link technique’. One of the advantages of this procedure is the reduced morbidity at the donor site as the graft choice is the quadrupled semitendinosus, thus sparing the gracilis tendon. The aim of this study was to evaluate isokinetic flexion strength recovery in patients who underwent a gracilis sparing technique compared to those with a full-tibial tunnel technique using a doubled gracilis and semitendinosus tendons (DGST) graft. Methods: Patients were divided into two groups: Group A (22 patients) who underwent ACL reconstruction performed with an All-Inside graft-link technique; Group B (22 patients) who underwent ACL reconstruction with an Out-In technique and DGST graft. At a mean follow-up of 13 months, quadriceps and hamstring isokinetic peak torque deficits were recorded. Results: In group A, the mean side to side peak torque flexion difference between the operated and non-operated limbs was −3% and the mean torque at 30° was −7.5% at high angular velocity (180°/sec); the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1% at low angular velocity (60°/sec). In group B, the mean side to side peak flexion torque was −3.5% and the mean torque at 30° was −7.6% at high angular velocity (180°/sec); the mean peak flexion torque was −7.2% and the mean torque at 30° was −11% at low angular velocity (60°/sec). A statistically significant difference was found between the two groups at lower angular velocity both for the mean peak flexion torque and the mean torque at 30° (p = 0.009), with better results in the study group. Discussion/conclusion: Gracilis sparing technique is a minimally invasive technique for ACL reconstruction and yielded a significantly better flexion strength recovery at lower angular velocity compared to a full tibial tunnel technique with DGST for ACL reconstruction.

Chest pain caused by multiple exostoses of the ribs: A case report and a review of literature

The aim of this paper is to report an exceptional case of multiple internal exostoses of the ribs in a young patient affected by multiple hereditary exostoses (MHE) coming to our observation for chest pain as the only symptom of an intra-thoracic localization. A 16 years old patient with familiar history of MHE came to our observation complaining a left-sided chest pain. This pain had increased in the last months with no correlation to a traumatic event. The computed tomography (CT) scan revealed the presence of three exostoses located on the left third, fourth and sixth ribs, all protruding into the thoracic cavity, directly in contact with visceral pleura. Moreover, the apex of the one located on the sixth rib revealed to be only 12 mm away from pericardium. Patient underwent video-assisted thoracoscopy with an additional 4-cm mini toracotomy approach. At the last 1-year follow-up, patient was very satisfied and no signs of recurrence or major complication had occured. In conclusion, chest pain could be the only symptom of an intra-thoracic exostoses localization, possibly leading to serious complications. Thoracic localization in MHE must be suspected when patients complain chest pain. A chest CT scan is indicated to confirm exostoses and to clarify relationship with surrounding structures. Video-assisted thoracoscopic surgery can be considered a valuable option for exostoses removal, alone or in addiction to a mini-thoracotomy approach, in order to reduce thoracotomy morbidity.

Anterolateral ligament reconstruction with autologous grafting: A biomechanical study.

Background To evaluate the reliability of the Iliotibial band compared to gracilis tendon as a graft to be used in anterolateral ligament reconstruction. Methods Gracilis tendon and a strip of Iliotibial band compared were harvested from 8 fresh human cadaveric knees. The gracilis tendon was prepared to obtain a graft of 10 cm in length (Group 1). Iliotibial band compared was prepared to obtain a graft of 10 cm in length and 0.5 cm in width from the middle portion (Group 2). All the specimens were fixed on a servo hydraulic tensile machine with dedicated cryo‐clamp. The loading protocol, used to compare the previously published results of ultimate failure load and Stiffness of the anterolateral ligament (Group 3), included a cyclic preconditioning between 10 and 25 N at 0.1 Hz for 10 cycles and then a load to failure test at 20 mm/min. Findings Gracilis tendon showed higher Ultimante Failure Load and stiffness when compared to a strip of Iliotibial band. Gracilis tendon and a strip of Iliotibial band compared showed higher Ultimante Failure Load and stiffness when compared with native anterolateral ligament as reported by Kennedy. Interpretation Both grafts tested in the present studies are suitable for an anatomical anterolateral ligament reconstruction. HighlightsGracilis and Iliotibial‐band are the most used graft for the ALL reconstruction.Gracilis and Iliotibial‐band showed higher UFl than native ALL.Gracilis and Iliotibial‐band showed higher stiffness than native ALL.Gracilis and Iliotibial‐band are suitable graft for ALL reconstruction.

Partial tendon tear as unusual cause of trigger finger: a case report.

Abstract We report a case of post-traumatic trigger finger due to a partial longitudinal tear of the flexor digitorum superficialis. The suspect came from the clinical history and the young age of the patient. It was successfully treated with tendon flap suture and pulley A1 release.