No abstract

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment -other than an antibiotic protocol -would be required when facing a case of positive culture of a graft piece after its implantation.

Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. Three remain alive with no evidence of disease at 5, 7 and 8 years follow-up respectively. Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative. RÉSUMÉ Les métastases osseuses chez les patients atteints d'ostéosarcome sont rares et n'apparaissent que tardivement dans l'évolution de la maladie. Nous rapportons notre expérience avec 8 patients, 4 ayant uniquement des métastases osseuses et 4 des métastases multiples. Ceux qui présentaient une seule métastase ont été traité comme une tumeur primitive avec chimiothérapie néoadjuvante et chirurgie. Trois d'entre eux sont encore vivants sans évidence de maladie après 5, 7 et 8 ans de suivi. L'histologie et la réponse à la chimiothérapie néoadjuvante ont été similaires tant pour la lésion primaire que pour les métastases. Les patients avec métastases multiples ont été traité avec des mesures palliatives. Aucun d'eux n'a survécu. On peut conclure que la résection de ces métastases après chimiothérapie néoadjuvante peut être utilisée avec une intention curative en cas de métastase osseuse unique.

Although the natural history of spondylolisthesis is poorly described, we know that it is rare to see the condition in children before they are 5 or 6 years old. Treatment in these patients may be confusing because there is very little literature on the subject, and most papers are case reports. We present a series of eight pre-school patients (mean age 3.5 years; range 9 months to 5 years) with spondylolisthesis with an average follow up of 11.5 years (range 9-14 years). In our experience, general guidelines for treatment as given by Wiltse and Jackson are useful in patients younger than 5 years. Nowadays we have to keep strict control of these patients due to their important capacity for growth that increases the possibility of further slippage.