Transmyocardial laser revascularization: early results and 1-year follow-up

BACKGROUND: Transmyocardial revascularization using a high-energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. METHODS: From December 1994 to September 1997, 102 patients underwent isolated transmyocardial revascularization. The mean age was 56.7 +/- 9.2 years and 92.15% were men. Mean preoperative angina class and ejection fraction were 2.6 +/- 0.7 and 44.7% +/- 10.5%, respectively. Diabetes was present in 49.01% of patients, 32.3% had history of previous myocardial infarction, and 12.7% had undergone a previous coronary artery bypass graft procedure. An average number of 23 +/- 8 channels were created in each patient using an 800-W CO2 laser. RESULTS: The early mortality was 14.7% and univariate predictors of mortality were age more than 55 years, female sex, creatine kinase more than 1,600 IU, absence of intercoronary collaterals, and mean pulmonary artery pressure greater than 21 mm Hg. At 1-year follow-up there was significant improvement in angina class and effort tolerance but no significant change in left ventricular ejection fraction. CONCLUSIONS: We conclude that transmyocardial revascularization provides symptomatic benefit and improves exercise tolerance in a group of patients suffering from disabling angina not amenable to other modes of treatment. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effects is uncertain and patency of laser channels is controversial, but laser-induced neoangiogenesis is being looked on as a possible explanation.     

The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up

Introduction and hypothesis  

The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence.     

Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up

The authors carried out a prospective study on 96 patients they treated in Kenya for chronic osteomyelitis from 2000 to 2009. All the patients received orthopedic surgery and antibiotic therapy, when possible based on the antibiotic sensitivity test. Among the 90 patients with at least 12 months’ follow-up, 11 had osteomyelitis relapse (12.2%) and recovery rate was therefore 87.8% with no resulting disability. Risk factors for osteomyelitis relapse were investigated and previous treatment with beta-lactamines, predisposing to onset of methycillin-resistant Staphylococcus aureus (MRSA) infections (P = 0.03, OR = 5.74), and onset of osteomyelitis in the metaepiphyseal region (P < 0.0001) resulted statistically significant. Aim of the study was to evaluate the validity of our treatment of chronic osteomyelitis in Kenya on the basis of outcome.     

5-year follow-up after sentinel node mapping for breast cancer demonstrates better than expected treatment outcomes

We conducted this study to provide one of the initial assessments of treatment outcomes for breast cancer patients evaluated with sentinel node mapping. All patients diagnosed with breast carcinoma, evaluated with sentinel node mapping, and followed for 5 years were divided into three groups depending on sentinel node(s) status. Group I (node negative) included 91 patients, 77 with invasive cancer, and 7 lost to follow-up. Of the remaining 70 patients, 3 (4.3%) suffered a distant recurrence and died, 1 developed an in-breast recurrence, and 9 (12.9%) developed a contralateral cancer during the study. Group II (IHC positive) included 28 patients. One (3.6%) developed a distant recurrence and died of breast cancer, and one developed a contralateral cancer during follow. Group III (H&E positive) included 36 patients with 1 lost to follow-up. Five patients (14.3%) died of breast cancer and two (5.7%) developed contralateral carcinomas during follow-up. The most striking observation was a lower than expected rate of distant recurrences in these patients followed for 5 years after a diagnosis of breast cancer and staging with sentinel node mapping. The ability to identify subtle nodal metastasis and design appropriate systemic therapeutic strategies may explain this finding.     

Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up

The high incidence of recurrent tendon tears after repair of massive cuff lesions is prompting the research of materials aimed at mechanically or biologically reinforcing the tendon. Among the materials studied upto now, the extracellular matrix (ECM) scaffolds of human origin have proved to be the safest and most efficient, but the current laws about grafts and transplants preclude their use in Europe. In order to overcome this condition in 2006, we started a project regarding the production of an ECM scaffold of human origin which could be implanted in Europe too. In 2009, the clinical study began with the implantation of dermal matrix scaffolds in 7 middle-aged patients affected with large/massive cuff lesions and tendon degeneration. Out of 5 cases, followed for at least 1 year in which the scaffold was employed as an augmentation device, there were 3 patients with complete healing, 1 partial re-tear, and 1 total recurrence. The absence of adverse inflammatory or septic complications allows to continue this line of research with a prospective controlled study in order to define the real advantages and correct indications offered by scaffold application.     

Arthroscopic meniscectomy. Technique, problems, complications, and follow-up results

After gaining experience in 1,000 diagnostic arthoscopies arthroscopic surgery has been performed in 300 patients between 1979 and 1982, including 100 cases of meniscectomy. A report is given on the technique, problems, complications, and early follow-up results. A select approach to endoscopic surgery has been chosen for the treatment of different meniscus lesions. A combination of motorized instruments and modified manual Gillquist technique has been applied. The legholder is of great help for arthroscopic surgery of posterior horn lesion, especially in tight knees. There were only few problems with endoscopic meniscectomy. The reason for performing arthrotomy in eight cases was the lack of a suitable legholder and inaccurate placement of the instruments in the early stages of our experience. Hospital stay was generally 3-5 days. Postoperative pain was markedly reduced. The majority of those patients with a meniscus lesion as the exclusive abnormality in their knee joint experienced a rapid recovery and returned to work within 2 weeks after surgery. After surgery there was a moderate swelling of the knee joint in 40% of our patients. The swelling diminished rapidly within the 1st week after surgery.     

Treatment of type II endoleak with a transcatheter transcaval approach: results at 1-year follow-up

PURPOSE: This study assessed the feasibility and mid-term outcomes in the treatment of type II endoleak using transcatheter transcaval embolization (TTE). METHODS: During an 8-month period, 12 patients underwent TTE. After direct transcaval puncture of the aneurysm sac, embolization was performed by injecting thrombin and placing coils. Systemic and intrasac pressures were recorded throughout the entire procedure. Computed tomography (CT) scans were performed at 24 hours, 30 days, 6 months, and 1 year after TTE to evaluate endoleaks and changes in sac diameter. Technical success was defined as the feasibility of the procedure; clinical success was defined as no evidence of leaks during the follow-up evaluation. RESULTS: TTE was feasible in 11 of 12 patients (technical success 92%). The mean systemic pressure was 117 mm Hg. The mean intrasac pressure before embolization was 75 mm Hg (range, 39 to 125 mm Hg), 16.5 mm Hg (range, 7 to 40 mm Hg) in 10 patients after embolization, and it increased in one patient. CT scans at 24 hours showed stable contrast medium inside the sac in 10 patients. Only minor complications were observed during follow-up. At the 1-year follow-up, no recurrence of leaks was noted, and sac diameter was reduced in 10 of 11 patients. As a result, TTE clinical success was obtained in 10 (83%) of 12 patients. CONCLUSION: TTE appears to be a feasible technique for the complete exclusion of type II endoleaks. Technical and clinical successes are comparable with other treatment strategies, and TTE should be considered an alternative to direct translumbar puncture of the aneurysm sac.     

Arthroscopic meniscectomy for discoid lateral meniscus in children and adolescents: 10-year follow-up.

Seventeen adolescents underwent arthroscopic lateral meniscectomy for discoid lateral meniscus. The average age at surgery was 13.6 years (range: 5-18 years). The main preoperative symptom was pain in 16 knees and extension loss in 1 knee. At arthroscopy, 10 menisci were complete, 4 were incomplete, and 3 were Wrisberg type. Arthroscopic total meniscectomy was performed in the 3 Wrisberg types, 2 complete types, and 1 incomplete type. The remaining menisci underwent partial meniscectomy. The average follow-up was 10 years (range: 5-15 years). According to the Ikeuchi rating system, 12 knees were rated as excellent (no symptoms and full range of motion), 4 were rated as good (occasional pain), and 1 was rated as fair (patellofemoral pain in an obese patient). Radiographic evaluation showed development of minor osteophytes in the lateral compartment of 8 knees and <50% narrowing of the lateral joint space in 11 knees. No correlation was found between meniscal type, type of meniscectomy (partial or total), and clinical and radiographic results. Arthroscopic lateral meniscectomy for discoid lateral meniscus in adolescents was effective in relieving symptoms during a 10-year follow-up period. Longer follow-up is needed to ascertain the significance of the radiographic changes seen in this study.     

Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course

The long-term results after arthroscopic partial meniscectomy of 119 patients with a mean follow-up of 12 years are presented in this study. The same series of patients had an earlier follow-up 4 years postoperatively. Thus, an evaluation of the actual long-term course and not only a single result after partial meniscectomy is presented. Arthroscopic partial meniscectomy is shown to be the definitive means of therapy for meniscal lesion of the knee joint; 91.7% of patients had an excellent or good result 4 years after surgery, and 78.1% rated excellent or good 12 years after surgery. Full recovery regarding ability to work and sports activity level was achieved in a very high percentage of patients. Early results were mostly representative and did not change significantly during the long-term course for the isolated meniscal lesion. The factor with the highest impact on long- term results was damage to the articular cartilage, which did not influence knee function for several years after surgery but became increasingly symptomatic over time after 5 years and more. Only 62% of patients with additional cartilage damage rated excellent and good 12 years after surgery, in contrast with 94.8% good and excellent results in patients with isolated meniscal tears. Similar observations were made for the untreated rupture of the anterior cruciate ligament.Arthroscopy 1998 Mar;14(2):136-42     

Vaginal wall retropubic urethropexy: Results at 1-year follow-up

The authors objectively evaluated a vaginal retropubic urethropexy for treatment of potential genuine stress urinary incontinence in patients undergoing surgical correction of severe uterovaginal prolapse. Fifteen women were evaluated preoperatively, with a history and physical examination, cystourethroscopy, urethral pressure profilometry, pressure-voiding studies and multichannel cystometry. Eleven women agreed to a follow-up physical examination and 10 agreed to multichannel urodynamics 1 year postoperatively. Five of the 11 patients were noted to have objective stress loss, but only 2 of these reported subjective incontinence. The maximal urethral closure pressure preoperatively was 38±12 cmH₂O, and 1 year postoperatively it was 46±17 cmH₂O, which was not statistically significant. The functional urethral length was 1.9±0.7 cm preoperatively and 1.8±0.5 cm 1 year postoperatively, which was also not statistically significant. The Q-tip test went from 68±23° preoperatively to 39±19° 1 year postoperatively. This was statistically but not clinically significant. This procedure was not proved to be effective in correcting potential GSI, and cannot therefore be recommended.     

Modular cementless cup for total hip arthroplasty: results at 4-year follow-up

The aim is to perform the assessment of a modular cementless acetabular cup with a tapered internal design for all bearing couplings. In 190 unselected consecutive patients, 207 total hip arthroplasties were implanted. The implants were clinically and radiographically evaluated. Follow-up was 49.7 ± 8.1 months. The average Harris hip score improved from 55.5 ± 5.7 to 94.7 ± 3.4 (P < 0.05). All cups were well-positioned and stable. The Kaplan–Maier cumulative survivorship was 98.5 ± 0.8%. No significant differences have been noted in dividing patients according to the different liner materials (P < 0.005). The study, whose rationale is the novelty of this kind of implant, suggests the efficacy of the Delta-PF acetabular cup.     

Long-term follow-up results of total or partial meniscectomy and untreated anterior cruciate ligament rupture

Summary A group of 94 male and 12 female patients who all suffered from ACL ruptures had a follow-up examination after a period of 14 to 21 years (m = 17.2 years). Each of them had undergone a primary arthrotomy with total or partial meniscectomy. In none of the cases, however, had operative repair of the ACL rupture been performed. The most frequent concomitant injury was a torn medial meniscus which occurred in 74.5% of the cases whereas a damaged lateral meniscus was found in 17.0% of the cases only. Chondromalacia of tibia, femur or patella was observed in 42.5% of the cases. Over 60% of the patients resumed their former sports activities, although in nearly 30% of these cases at a lower level whereas one third of the patients had to practice some other sport or were even forced to give up sports completely. 61.3% still complained about instability of the knee joint, 73.6% of the patients with partial or total meniscectomy had developed osteoarthritis of grade III and IV.     

Discovery Elbow System: clinical and radiological results after 2- to 10-year follow-up

Background

Discovery Elbow System (DES) is a semi-constrained prosthesis, mainly used for patients with rheumatoid arthritis (RA).

Methods

Records from 79 patients with RA (90 DES arthroplasties) were reviewed; 47 patients with 55 DES elbows were re-examined. Range of motion (ROM) of both elbows, upper limb function, and quality of life (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Mayo Elbow Performance Score [MEPS], and the RAND 36-Item Health Survey [RAND-36]) were assessed. Cementing quality was assessed, and radiolucent lines measured from plain radiographs. Mean follow-up was 64 (range 24–123) months.

Results

Pre-operatively to post-operatively, mean elbow flexion improved from 120° to 146° (p < 0.001) and mean extension lag improved from 29° to 24° (p = 0.02), respectively. At follow-up, mean supination was 66°, mean pronation was 69°, and mean grip strength was 14 kg. Grip strength and ROM (except supination) were similar between the DES elbow and contralateral un-operated elbow. Mean post-operative MEPS was 93 points (excellent, n = 38; good, n = 14; fair, n = 2; and poor, n = 1). Mean DASH score was 43 points. The RAND-36 showed that physical functioning, physical role functioning, bodily pain, and general health were lower than the Finnish reference values. Primary cementing was challenging, and radiolucent lines appeared during follow-up. Four prostheses were revised because of aseptic loosening (n = 3) and periprosthetic fracture (n = 1).

Conclusion

DES provides significant improvement in patient’s flexion–extension arc. Cementing of the elbow prosthesis was challenging; radiolucent lines appeared during the 5-year follow-up, but their clinical relevance remains unclear. First-generation locking screws may loosen over time.

Level of evidence

Level IV.

     

Endoscopic single-bundle posterior cruciate ligament reconstruction: results at minimum 2-year follow-up

Purpose:The goal of this study was to evaluate the clinical outcome of single-bundle posterior cruciate ligament (PCL) reconstruction with retention of the PCL remnant and hamstring tendon autograft with interference screw fixation in patients with isolated PCL laxity.Type of Study:Prospective case series with minimum 2-year follow-up evaluation.Methods:Thirty-one patients for whom conservative management had failed underwent surgery using a 4-strand hamstring tendon autograft with interference screw fixation. The median time from injury to reconstructive surgery was 9 months (range, 4 to 120 months). At a minimum of 2 years after surgery, patients were assessed with the International Knee Documentation Committee (IKDC) Knee Ligament evaluation, Lysholm knee score, and KT-1000 instrumented testing.Results:Before surgery, the median Lysholm knee score was 64 (95% confidence interval, 51 to 67). No patient rated knee function as normal, and all patients showed at least grade 2 posterior drawer laxity. At review, the median Lysholm knee score was 94 (95% confidence interval, 83 to 94), 56% rated the knee as normal and only one patient was found to exhibit grade 2 laxity on posterior drawer testing. Before injury, 94% of patients participated in moderate or strenuous activity. This figure fell to 26% after injury and had increased to 63% at review.Conclusions:Endoscopic reconstruction of PCL laxity using single-bundle 4-strand hamstring tendon autograft, without removal of the PCL stump, provides a significant reduction in knee symptoms and allows 63% of patients to return to moderate or strenuous activity. This is an effective procedure for symptomatic patients who have isolated PCL laxity and for whom conservative management has failed.     

Meniscus repair: considerations in treatment and update of clinical results

The meniscus plays an important role in the function of the knee. Preservation of the meniscus is preferred if possible when considering treatment of a meniscus tear. A thorough understanding of the anatomy of the meniscus, the structure, the mechanics, and other factors of meniscal healing are critical when evaluating the torn meniscus for a reparative procedure. Many options for meniscus repair exist for the orthopaedist. Options such as open repair or arthroscopically-assisted inside-out techniques have long-term favorable results. The all-inside techniques are attractive because of the decrease in operative time and ease of the technique. Short-term results are positive for the all-inside technique; however, good long-term data on these techniques are lacking. Few well-designed prospective studies exist on any of the meniscus repair techniques. Future directions include the potential use of growth factors and gene therapy to augment meniscus repair.