PurposeLong-term outcomes of anterior cruciate ligament (ACL) reconstruction are good or excellent; however, 0.7%–20% of patients suffer from recurrent instability due to graft failure. The purpose of this paper was to analyse failure aetiology and the possibilities of revision surgical strategies, with a description of our experience. We obtained optimal and good results in most of our patients.Materials and MethodsWe retrospectively reviewed 42 patients who underwent revision surgery (43 revisions) due to relapsing instability after ACL reconstruction between 2006 and 2015. We used allografts in 39 cases and autografts in 4 cases.ResultsThe 85.7% of the patients obtained optimal results (normal knee; group A) and the 7.2% obtained good results (nearly normal knee; group B) according to the International Knee Documentation Committee score. The most frequent failure causes were traumatic events, non-anatomic tunnel placement, and lack of graft incorporation.ConclusionsA correct revision surgery requires accurate patient evaluation and knee imaging. Preoperative planning starts with the identification of the cause of failure of the primary reconstruction. Then, the most suitable procedure should be determined for each case. It is also important to accurately inform the patient of all the complexity of an ACL revision surgery even if it is a procedure with high rates of excellent and good outcomes.

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Background. This placebo-controlled, double-blind study evaluated the short-term effects of betamethasone valerate (BMV) 2.25mg medicated plaster in patients with chronic lateral elbow tendinopathy (LET). Methods. Adult outpatients with LET and on-movement pain intensity ≥50 mm at a 0-100mm visual analogue scale (VAS) were randomised to receive BMV (N=101) or placebo (N=98), 12 hours/day for 4 weeks. Pain decrease from baseline to Day 28 was the primary endpoint. Other endpoints were: patient-rated tennis elbow evaluation (PRTEE), use of rescue paracetamol, tolerability at the application site. Results. Decrease in mean pain VAS from baseline to Day 28 was significantly higher with BMV vs. placebo: the difference between groups (intent-to-treat) was-8.57 mm (95% CI:-16.19 to-0.95 mm; p=0.028). Higher pain decreases in the BMV group over placebo were reported weekly during each control visit and daily in patients' measurements on diaries. Treatment with BMV also led to higher decreases vs. placebo in PRTEE total, pain and functional disability score. Use of paracetamol was minimal. BMV plaster was well tolerated for general and local adverse events. Conclusions. BMV 2.25mg plaster was superior to placebo and well tolerated in patients with painful chronic LET.

Osteosynthesis with LISS system (less invasive stabilization system) is a new technology and this conception of stabilization of long bone fragments is a new step in the development of AO philosophy. Indications to application of this system are distal metaepiphysis and diaphysis femur fractures, supra- and transcondylar fractures in polytrauma, fractures in osteoporosis as well as fractures after total knee replacement. During the last 3 years 35 patients were operated on by that technique. The follow-up period ranged from 6 months to 3 years. Assessment of outcomes was performed using data of clinical examination and evaluation of radiograms with modified Neer-Grantham-Shelton scale. In patients who were operated on I year ago the total score varied from 70 to 80 (maximum - 100). Advantages of this technology as compared to the traditional methods of osteosynthesis are the following: limited operative trauma, less blood loss, shortening of surgery duration, preservation of tissue physiology as well as absence of the necessity to use cement and bone auto- and allografts. Disadvantages include the difficulty for reposition prior to fixation and impossibility of correction in postoperative period as well as early weight-bearing load.