Aims

The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years.

Introduction and Objectives: patellar tendinopaty (or jumper’s knee) is a frequent problem that affects active young adults. In some cases the different conservative treatment options are innefective and surgical treatment is considered. The purpouse of this study is to determine if repeated intratendinous inyections of platelet rich plasma (PRP) are effective for the treatment of these refractary cases.

Materials and Methods: Eight consecutive patients (4 males and 4 females, mean age 24+/−5,9) who presented refractary patellar tendinopathies were included. All patients had presented symptoms for at least 6 months and had recieved treatmet for at least 3 months. All patients had been subjected to activity limitation, physical therapy, NSAID’s and laser and ultrasound therapy. In 3 cases corticosteroid inyections had been used. The subjects were assesed before treatment and 3 months and one year later with a Visual Analoge pain Scale (0 to 100mm, VAS), the Victorian Institute of Sport Assessment Patellar tendinopathy assesment scale(VISA-P) and the Lysholm score. Treatment consisted of 3 infiltrations (one week apart) of 3 cm3 of PRP extracted from their own blood with the GPS^® system (Biomet, Warsaw, Indiana, U.S.A). The PRP was infiltrated at the level of the tender tendon and inmediately behind the tendon at the proximal tendinous insertion and 1 cm distal to it through a single cutaneous puncture.

Results: Of the 8 patients, 7 presented a significant increase (more than 20 points) in the VISA-P score and 1 did not present any noticeable improvement. No complications related to the injections were observed. The VISA-P score increased from a pretreatment mean of 29 +/− 10.7 to 79 +/− 10.7 at one year (significant differences, p< 0.001). A similar decrease was observed in the VAS pain score (pretreatment values of 75+/−28 to one year values of 21+/−19). There were not significat differences in the Lysholm score.

Conclusions: PRP seems to be a possible alternative to surgical treatment in refractary patellar tendinopathy.

Introduction: tibial plateau fractures are a therapeutic challenge that are increasingly being dealt with arthroscopically assisted surgical treatment. About 40% of cases associate a meniscal lesion. Meniscal repair is a challenging technique in this setting but has an increased importance due to the intrinsic role as cartilage protector of the meniscus. Although suture in the course of the reconstructive procedure is more technically demanding and time consuming the biological surrounding of the repair is optimal (extensive intraarticular bleeding, prolonged non weight-bearing, presence of bone marrow elements, acute repair).

The objective of this study is to determine the outcomes of meniscal suture in this group of patients.

Material and methods: Between 1999 and 2007 sixty one tibial plateau fractures were operated with arthroscopic assistance in our institution. Of these, 25 presented meniscal injuries and 16 of these were repaired. Repair criteria were: no age limit was established and all types of ruptures (even radial or bird-beak lesions) were repaired if technically possible. 14 external menisci and 2 internal menisci were repaired. Morphologically 15 were longitudinal ruptures in the red-red zone and one was a bird beak rupture. Suture was performed using a combination of repair techniques including outside-inside (seven cases), inside-outside (two cases) and all-inside (14 cases). Functional results were evaluated with the following scales: Rasmussen, Honkonen, ICDK, Lysholm, SF-36 and Knee Society scores. Evaluation of the meniscal repair was performed either by M.R.I. of the knee (obtained in six cases) or arthroscopic revision of the meniscal repair (during surgery for implant removal in 9 cases). In one case the patient required a TKA not related to the meniscal lesion and the meniscus was revised during the procedure.

Results: All cases were available for follow up a minimum of 12 months after surgery (mean 2.6 +/−1.4 years). Functional results were excellent or good in 14 of 16 cases. One poor result was related to meniscal symptoms and requiered arthrocopic meniscectomy, the other poor result was due to arhtrofibrosis. Direct visual revision of the suture (either arthroscopically [9 cases] or during open surgery [one case]) allowed for the diagnosis the symptomatic failure of the repair and of complete healing in the rest of cases (9). MRI showed complete repair in four cases, partial repair in one and failure in one; all being asymptomatic.

Conclusions: this technique seems to offer good results with complete healing observed in 81% of cases and partial healing in 6%; symptomatic failure of the repair was observed only in 6% of the cases. In meniscal injuries related to this type of fracture, repair should be always considered as the biological environment seems to facilitate success in the repair.

Objectives: tibial plateau fractures are a therapeutic challenge for the trauma surgeon. Arthroscopically assisted surgical treatment (AT) is an option in these fractures that is used more and more frequently even in more complex lesions. The objective of this study is to determine if, at a minimum 1 year follow up, arthroscopic treatment is comparable to open treatment (OT) in respect to radiologic and functional outcomes.

Materials and Methods: We have prospectively reviewed our first 50 arthroscopic cases and compared them with 50 open surgery cases examined retrospectively. The cases in the second group were selected from a database of 87 patients and were matched for Schätzker type, degree of displacement, age and sex with cases of the first group. In each group there were 50 patients (33 male/17 female; mean age: 45,4 years in the AT group and 43,6 years in the OT group). Of the 50 cases in each group, ten were Schätzker I tibial plateau fractures, sixteen were type II, seven type III, eleven type IV, three type V and three type VI. In the AT group all fractures were reduced and fixated with cannulated screws under direct arthroscopic control and in 6 cases a percutaneous plate was added. In the OT group all fractures were reduced and fixated with cannulated screws under direct vision (n=41) or radiologic control (n=9) and in 37 cases a plate was added. Associated lesions were identified and treated accordingly in both groups. Results were evaluated with the following scales: Rasmussen, Honkonen, ICDK, Lysholm, SF-36 and Knee Society scores.

Results: All cases were available for follow up a minimum of 12 months after surgery (2.6 +/−1.4 years in AT and 3.7+/−1.5 years in OC). The patients in the AT group had lower hospital stances (p< 0.05) and lesser postoperative wound complications (zero versus 3). Radiological reduction and alignment was considered excellent or good in 92% of AT cases and 88% of OT cases. Knee society scores were 191+/−18 in AT and 176+/−21 in OT. Lysholm scale scores were 85+/−20 in AT and 72+/−21 in OT. Rasmussen scale scores were 29+/−2.2 in AT and 26+/−3.9 in OT. Most of the differences between both groups was related to range of motion but pain scores were similar.

Conclusions: Arthroscopically assisted treatment of tibial plateau fractures seems to offer better results than open surgery with less hospital stay, lesser postoperative complications and clearly improved range of motion. It can be considered an adequate alternative to traditional open reduction and fixation even in complex fractures.

Introduction and purpose: Many techniques for the treatment of metatarsalgia have been described. Weil’s osteotomy causes loss of movement of the metatarsophalangeal (MTP) joint. Some authors associate this deficiency with a hypertrophic soft tissue scar on the dorsal part of the MTP joint. The purpose of this study is to assess the results of distal osteotomy of the small metatarsals carried out by means of a mini-invasive (MIS) technique.

Materials and methods: We retrospectively reviewed 43 feet, 111 osteotomies performed between 2002 and 2006. The mean age of the patients was 51.8 years. In 45.45% of cases there were associated hallux pathological conditions and in 57.5% there were alterations of the smaller toes. Patients underwent clinical and functional assessment. Radiologically it was possible to determine the metatarsal formula, the rate of consolidation and metatarsal shortening.

Results: The follow-up period was 15 months. From the functional and cosmetic point of view 97% of the patients considered their results were excellent or good. Radiologically there was an average shortening of 2.88 mm; in 20% of cases there was a change to a more physiological metatarsal formula and union was achieved in all cases without significant delays. Complications seen: one case of cellulitis and 3 transfer metatarsalgias.

Conclusions: MIS seems an appropriate surgical technique for the treatment of metatarsalgias of the smaller toes associated or not with forefoot surgery. Good clinical and cosmetic outcomes are seen in more than 95% of cases.

Introduction and purpose: Achilles tendon tears with a surgical indication can be approached by means of either a standard open surgery or an alternative technique, namely a percutaneous suture of the tendon rupture. This study compares the functional results and complications of both techniques in order to assess the differences between them. The purpose of the paper is to determine whether percutaneous sutures are a valid option for the treatment of these kinds of lesions.

Materials and methods: A prospective randomized study was carried out of two groups of patients. One included 26 patients where the Achilles tendon tear was repaired by means of a percutaneous suture; the other was a control group where the classical open surgery technique was used. The mean patient age was 41 years. 92% were male. 54% of lesions were on the left side. A comparison was made of functional results and of the complications which appeared in both groups.

Results: Both groups were homogeneous regarding age, laterality and relevant antecedents. Functional results and the complications’ rate were similar in both groups.

Conclusions: Although the percutaneous suture is not a widespread technique, the study shows it as a valid alternative for the treatment of Achilles tendon ruptures since it leads to a level of function similar to that of open surgery.