ObjectiveTo collect and analyze the 2-year follow-up clinical and MRI results of patients treated with an arthroscopic technique of collagen membrane-based meniscus repair.Design53 consecutive patients with combined (horizontal and radial or longitudinal component) and complex meniscal tears (tear extended through avascular zones or/and composed with two or more morphological tear pattern) were treated with an “all-inside” arthroscopic suture of meniscus and wrapping with a collagen membrane (Chondro-Gide) technique with bone marrow blood injection. The IKDC 2000 subjective score, IKDC 2000 clinical evaluation score, Lysholm score and Barret clinical criteria of meniscal healing were recorded. All patients were examinated by MRI 2 years postoperatively, using modified WORMS criteria for meniscal integrity.ResultsThe 2 year follow-up was achieved in 50 cases. Of these, 2 patients were excluded from the evaluation due to incomplete data and 2 patients underwent partial meniscectomy and were classified as failures. In 46 patients (86.8% of the intended to treat cases), a statistically significant improvement in IKDC 2000 subjective, Lysholm scores and IKDC 2000 clinical assessment between preoperative and the 2-year follow-up time points were obsereved. Barret criteria demonstrated an improved clinical outcome between pre- and post-operative values. MRI revealed a non-homogeneous signal without meniscal tear (WORMS grade 1) in 76% of the operated menisci (13% WORMS grade 2).ConclusionsThe 2-year follow-up data demonstrate that this technique is safe and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. Level of evidence IV
PurposeBone marrow mesenchymal stem cells were introduced into clinical practice due to their ability to differentiate into many types of cells. Autologous matrix-induced chondrogenesis (AMIC) combines the microfracture method with matrix-based techniques that utilizes a collagen membrane to serve as a scaffold for new bone marrow mesenchymal stem cells, allowing effective reconstruction of even large fragments of a damaged cartilage surface.MethodsAll-arthroscopic technique to repair knee cartilage defects using the AMIC technique, which includes the use of a collagen matrix (porcine collagen type I and III) and fibrin glue—technique presentation.ConclusionThis technical note introduces an all-arthroscopic AMIC technique to reconstruct extensive cartilage defects (without bone defects). The technique may be used for treatment of all location of knee cartilage lesions.Level of evidenceV.
Objective: Intraoperative fluoroscopy is a valuable tool for visualizing underlying bone and surgical tool positions in orthopedic procedures. Disadvantages of this technology include the need for continued radiation exposure for visual control, and cumbersome means of alignment. The purpose of this article was to highlight a new concept for a computer-assisted freehand navigation system that uses single intraoperatively acquired fluoroscopic images as a basis for real-time navigation of surgical tools. Materials and Methods: Optoelectronic markers are placed on surgical tools, a patient reference, and the fluoroscope to track their position in space. Projection properties of the fluoroscope are acquired through an initial precalibration procedure using a tracked radiopaque phantom grid. Corrections are applied to compensate for both the fluoroscope's image intensifier distortions and the mechanical bending of the C-arm frame. This enables real-time simulation of surgical tool positions simultaneously in several single-shot fluoroscopic images. In addition, through optoelectronically tracked digitization of a target viewpoint, the fluoroscope can be numerically aligned at precise angles relative to the patient without any X-ray exposure.Results: This article shows the feasibility of this technology through its use in cadaver trials to perform the difficult task of distal locking of femoral nails. Comp Aid Surg 4:65-76 (
A pilot surgery showed that fracture reduction can benefit from the developed computer-assisted method. An in-vitro study on computer-assisted measurement of femoral antetorsion demonstrated the high degree of precision of this technique.
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