1,720,983 research outputs found
Regarding “Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt. A Cost-Effectiveness Model”
No full textWe read with great interest the paper “Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model” by Makhni et al.1 The surgical treatment of anterior glenohumeral insta- bility is a common worldwide issue as well as the management of failed operations. For both primary and revision cases, bone-block procedures and soft tissue repairs have been proposed. The authors have perfectly shown the social costs of these 2 operations and their cost-effectiveness. In Europe, the cost of surgical pro- cedures is even more relevant in daily practice. In Italy, all patients have the right of being assisted by the public health system due to the fact of paying taxes. The health system reimburses the hospitals and the subsi- dized private hospitals for their activity according to the diagnosis-related group (DRG). This is based on patients’ pathologies and on the interventions the physicians perform and accounts for hospitalization, implantable materials, and physicians.
The reimbursement for primary or revision open stabilization is 4,303V (code 8182, DRG224) (open), whereas the reimbursement for the same procedure under arthroscopy is 1,333V (code 8182þ8021, DRG232). The same reimbursement is given for revi- sion surgeries. However, the costs for these 2 operations are completely different.
The DRG of an arthroscopic Bankart repair covers 2 nights of hospitalization (as decided by the health sys- tem) (600V), implanted materials (480V for burr and shaver, 290V for a radiofrequency system, 2,000V for 4 absorbable anchors, and 88V for 2 cannulas) (data from Mitek Italy), occupation of the operating room (300V for 60 minutes), and various other costs (100V, which includes drugs, irrigation bags, sutures, surgical drapes). In case of associated remplissage, 2 additional anchors (1,080V) and 1/2 hour of operating room (150V) must be considered. The total cost is 3,858V with additional 1,230V in case of remplissage, whereas the DRG covers only 1,333V.
The DRG of an open Latarjet covers implanted materials (40V for 2 malleolar screws and washers) and occupation of the operating room (225V for 45 mi- nutes). Drugs and hospitalization are the same as Bankart repair (600V). The total cost is 965V, whereas the cost that the DRG covers is 4,303V.
The cost for imaging analysis (150V for a computed tomography scan), physician consultation (300V for 3 consultations), and postoperative physical therapy (400V for 10 sessions) is not included in the DRG reimbursement but has been calculated (850V) as a comparison with the study by Makhni et al.
The total cost for an arthroscopic soft tissue repair varies from 4,708V to 5,938V all included (in the study by Makhni et al., it is 15,287). The functional outcomes of both bone-block procedures (either open or arthroscopic) and soft tissue repairs are extremely satisfying.2 However, they greatly differ in terms of costs for the public health system. Open Latarjet is much more convenient in terms of costs/DRG reimbursement (all costs account for one-fourth of the expected reim- bursement) than arthroscopic soft tissue repairs (all costs exceed almost 4 times the expected reimburse- ment). The problem of expected expenses of surgical procedures has great relevance in some European countries. In fact, a policy of cost reduction has been introduced and could therefore influence surgeons’ decision making, favoring open procedures over arthroscopy
Lewinnek zone not “the be-all and end-all” functional planning for acetabular component positioning in total hip arthroplasty
No full textBackground: Proper positioning of a total hip arthroplasty (THA) plays a crucial role in the success and long-term survivorship of the implant. Cup positioning within the Lewinnek Safe Zone (LSZ) does not, however, avoid implant dislocation. Thus, the concept of a functional cup position has been introduced. The purpose of this study was to assess the discrepancy between LSZ and the acetabular cup position suggested by the patient’s specific functional planning. The hypothesis was that a mismatch does exist. Methods: One hundred consecutive patients with primary hip osteoarthritis undergoing primary THA with a personalized functional preoperative planning and patient-specific cup implantation system were enrolled. Anatomical and spino-pelvic functional parameters were recorded and, for each patient, a “safe cup orientation” was suggested. The suggested functional safe zone was compared to the LSZ. Results: The mean suggested inclination was 39° ± 3° (range 32°–45°). The mean suggested anteversion was 21° ± 3° (range 12°–28°). The patient’s functional acetabular inclination (AI) corresponded to the LSZ in one of the 100 patients, whereas the acetabular anteversion (AV) was outside the LSZ in 8 of the 100 patients. The mean pelvic tilt while standing and sitting were 0.5° ± 7° (range 21°–45°) and −6° ± 16.7° (range −63°–33°), respectively. The mean pelvic incidence was 52° ± 9.7° (range 33°–83°). Conclusion: When a functional patient’s specific preoperative planning is performed, the LZS does not correspond to the patient’s functional safe zone in about 8% of patients. The concept of a universal safe zone should be revisited, and a functional personalized safe zone may have to be more widely considered
Anterolateral ligament reconstruction with autologous grafting: a biomechanical study
No full textTo 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 10cm in length (Group 1). Iliotibial band compared was prepared to obtain a graft of 10cm in length and 0.5cm 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 25N at 0.1Hz for 10cycles and then a load to failure test at 20mm/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.
Copyright © 2017. Published by Elsevier Ltd.
KEYWORDS:
Anterolateral ligament; Biomechanics; Gracilis tendon; Ileotibial ban
Evaluation of the accuracy of a patient-specific instrumentation
Full text linkPatient-specific instruments (PSI) has been introduced with the aim to reduce the overall costs of the implants, minimizing the size and number of instruments required, and also reducing surgery time. The aim of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability and accuracy of patient specific instrument system in total knee arthroplasty (TKA). A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications. Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%. PSI seem not to be able to result in the same degree of accuracy as for the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers
Isokinetic flexion strength recovery after ACL reconstruction. a comparison between all inside graft-link technique and full tibial tunnel technique
No full textIntroduction: 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
Correction to: "Single-use peripheral" vs "conventional" reaming in total hip arthroplasty: how to respect native centre of rotation and acetabular offset? A CT study
No full textAbstract
Purpose The respect of native hip offset represents a mainstay for satisfying results in total hip arthroplasty (THA). Histori- cally, a great interest has been focused on restoration of femoral offset, while only in recent years, acetabular offset (AO) has been considered. The purpose of the current study was to compare the “single-use peripheral” reaming technique with the “conventional” one for the maintenance of the native COR of the hip and AO in patients undergoing to primary THA. Methods Eighty patients affected from primary hip osteoarthritis were prospectively enrolled in the study and were divided in two groups (Group A “single-use peripheral” and Group B “conventional” reaming technique). Pre- and post-operatively, AO, acetabular floor distance (AFd) and acetabular version (AV) were assessed through a CT scan. A comparison between groups for the radiological parameters, surgical time and complications was performed.
Results The demographic data were similar in both groups. The complications rate and the AV did not differ statistically between groups. Group A presented a statistically significant shorter surgical time and lower variation between pre- and post-operative AO and AFd. Statistical significance was defined as p < 0.05.
Conclusions The “single-use peripheral” reaming technique demonstrated to be more reliable in reproducing the native COR and AO of patients undergoing to primary THA than the “conventional” one. The operative time was significantly reduced, and it may lead to a reduction in the infection risk even though it was not observed in the current study. Further research could be useful to validate such findings and to assess clinical impact and long-term survival of the implant
Regarding "Rupture of the Patellar Tendon after Platelet-Rich Plasma Treatment: A Case Report"
No full textWe are grateful for sending us the comment of Malanga et al. about our publication “Rupture of the Patellar Tendon After Platelet-Rich
Plasma Treatment: A Case Report”.
Regarding their observation about the size of the needle, we would like to specify that to the best of our knowledge, the size of the needle has never had a documented effect on the efficacy/risk of any type of infiltrative treatment.
Secondly, regarding the number of PRP treatments performed, we would like to point out that various protocols report multiple numbers of infiltrations; it is commonly reported in the medical literature that multiple infiltrations are performed in case of chronic tendinopathies not limiting to just a single administration of PRP1,2.
Moreover, regarding the leukocyte count argument, the preparation we performed was rich in leukocytes (corresponding to a concentration three times higher than baseline), and the kit carried about four to five times the baseline platelet concentration.
It is known that the treatment of chronic tendinopathies with leukocyte-rich PRP is commonly performed, and there is no scientific evidence to demonstrate its inferiority compared to treatments with leukocyte-poor PRP 3,4.
Our final consideration concerns the purpose of the case-report; as it is well known, these are reports of sporadic and obviously rare cases that acquire clinical relevance only if other authors report further similar cases. Our beliefs lay with the recent scientific literature regarding the efficacy of PRP in the treatment of chronic tendinopathies.
This is also proven by our case report, in which the athlete taken into consideration returned to carry out his sporting activity with considerably lower amounts of painful symptoms soon after the treatment.
It was certainly not our intention to prove nor identify a precise cause/effect relationship between the rupture of the patellar tendon and the infiltration with leukocyte-rich PRP.
Our aim of the publication was to demonstrate not that the PRP is ineffective or harmful but simply that it does not guarantee a protective effect on possible future injuries.
However, we thank Malanga et al. for the attention given to our publication
Computer-assisted surgery: A teacher of TKAs.
No full textAbstract
INTRODUCTION: The hypothesis of this study is that computer-aided navigation experience could improve the ability to better place components in the coronal plane and to improve visual/spatial awareness based on the ability of navigation to provide instant feedback. The purpose of this study is to demonstrate the educational role of the navigation system to obtain a better alignment of the prosthetic components with standard instrumentation after a computer-aided navigation experience.
MATERIALS AND METHODS: One hundred fifty patients were operated by the same surgeon, with more than 5years experience with TKA. They were equally divided in three groups: group A (operated with non-navigated technique by surgeon without computer-assisted experience); group B (operated with computer-assisted surgery by the same surgeon); group C (operated with non-navigated technique by the same surgeon after the computer-navigated experience). We evaluated by full-length weight-bearing radiographs the overall alignment of the lower limb in the coronal plane. The optimum placement of the components was considered when the angle was within the limits of ±3° varus/valgus on the coronal x-rays. Comparison between groups was done using one-way ANOVA followed by post hoc Bonferroni test and Pearson chi-square statistics for proportions of optimum placement (P<0.05).
RESULTS: In the group A 34 patients (68%) had the optimum placement on the coronal x-rays; in the group B they were 46 (92%) and in the group 41 (82%). The difference is statistically significant in comparing group A and Group B (<0.001), group A and group C (P=0.04), but not for group B and C (P=0.2).
CONCLUSION: We believe that the navigation system has an educational role to improve the ability of surgeon of positioning prosthetic components precisely in the coronal plane
Saucerization and suture of symptomatic bilateral medial discoid meniscus in a 13 years old male football player: a case report and literature review
Full text linkINTRODUCTION: Medial discoid meniscus is estimated to occur in 0.06% to 0.3% of the population, being bilateral medial discoid menisci. The current tendency to be very conservative in treating meniscal lesions should be applied to the discoid meniscus, too, so that the cauterization and suture of a torn discoid meniscus are gaining support. CASE PRESENTATION: We present the case of a 13-years-old Caucasian male competitive football player with a diagnosis of bilateral medial discoid menisci. Arthroscopy of the left symptomatic knee found an incomplete medial discoid meniscus, with an atypical hypertrophic posterior horn and root with a lack of rear tibial attachments. Saucerization to obtain a standard semilunar shape plus outside-in sutures to repair the horizontal tear and stabilize the meniscus’s peripheral rim was performed. The asymptomatic right knee was treated conservatively. After seven months, complete resolution of the symptoms in the left knee and no worsening of symptoms in the right knee was reported. CONCLUSION: Bilateral discoid medial meniscus is a rare abnormality involving active young patients. The conservative treatment is the preferred option in asymptomatic patients. Sauceriziation and eventual repair represent the suggested surgical treatment in symptomatic cases
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