Purpose: the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods: thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frogleg and Lequesne views. The patients' clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results: the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic followup was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5-82.5) to a mean of 85.6 postoperatively (range: 45.1-100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment.Conclusions: a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of camtype impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence: Level IV, therapeutic case series.

OUTSIDE-IN TECHNIQUE IN MENISCAL ISOLATED TEARS AND WITH RECONSTRUCTION OF LCAWe have investigated the outcome of the outside-in suture technique in a 28 patients. Seventeen patients had isolated meniscal tears (Group A), and 11 had meniscal tears with anterior cruciate ligament rupture (Group B). All patients were clinically evaluated, before surgery and postoperatively. By statistical comparison of clinical outcomes of the two groups, we found better results in Group B than in Group A, showing a significant difference. We believe the critical factor leading to a better outcome of the suture can be attributed to the haemarthrosis generated during the ACL repair. IntroduzioneLe lesioni meniscali possono essere di tipo traumatico o degenerativo. Nel tempo sono state proposte numerose classificazioni per le lesioni meniscali. È molto utile e versatile quella proposta da O'Connor che è basata sull'orientamento e l'aspetto delle lesioni all'esame artroscopico [1]: lesioni longitudinali, orizzontali, radiali, oblique e complesse (lesioni a flap, degenerazioni meniscali). Le lesioni longitudinali avvengono generalmente nella parte periferica del menisco, a causa della maggiore concentrazione di fibre collagene circonferenziali. Queste lesioni sono più comuni a livello del corpo posteriore del menisco e avanzano in direzione longitudinale lungo il piano della direzione delle fibre del collagene. Le lesioni sono tipiche dei pazienti giovani e attivi che esercitano sforzi considerevoli. Nelle lesioni longitudinali il paziente può avvertire un "blocco" del ginocchio che, invece di essere un vero e proprio blocco meccanico, è l'espressione della tensione del frammento anomalo mobile che crea dolore e quindi spasmo muscolare [2]. Le lesioni a manico di secchio sono longitudinali estese, in cui la maggior parte dell'estremità libera del menisco si può sublussare fra il condilo femorale e il piatto tibiale o nella gola [2]. Le lesioni radiali, come quelle longitudinali, avvengono sul piano verticale. La sede più comune è la parte laterale del margine libero del menisco laterale. Le lesioni radiali si manifestano vicino l'estremità libera a causa della maggiore concentrazione di fasci di collagene orientati radialmente e a causa dell'assottigliamento delle fibre longitudinali circonferenziali. Se la lesione rimane contenuta, tende a essere asintomatica poiché non sviluppa tensione nelle vicinanze delle terminazioni nervose periferiche. Se la lesione si estende più perifericamente, le terminazioni periferiche sono poste sotto tensione e provocando la sintomatologia dolorosa [3]. Le lesioni orizzontali sono rotture degenerative che interessano la porzione intramurale del menisco. Iniziano in prossimità del margine libero del menisco e si sviluppano con orientamento orizzontale nel piano dei fasci di fibre; si ritiene che siano la conseguenza di forze di taglio generate dalla compressione assiale del menisco. Sono spesso il risultato di un cambiamento degenerativo che si sviluppa a seguito di un trauma minimo e sono molto frequent...

Patellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. In the reported case, an adolescent girl, aged 15 years, affected by left patellofemoral instability, underwent surgery with a double technique comprising tibial tubercle distalization and medial patellofemoral ligament reconstruction. In case of patella alta associated with patellofemoral instability, surgical treatment should focus on medial patellofemoral ligament repair and on recurrent instability prevention. P atellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. This pathologic condition is usually associated with patella alta (increase of Caton-Deschamps index [normal value (n.v.) In the reported case, an adolescent girl, aged 15 years, affected by patellofemoral instability, underwent surgery with a double technique comprising TT distalization and medial patellofemoral ligament (MPFL) reconstruction (Video 1). The patient came to our attention after the third episode of left patellar dislocation; a radiographic control obtained in the emergency department showed a patellar avulsion at the MPFL insertion level. On the basis of clinical and imaging examination findings (radiography, magnetic resonance imaging, computed tomography [CT] scan), we decided to perform surgical treatment 2 (Fig 1). Surgical TechniqueThe patient is placed in the supine position on the operating table and examined under anesthesia for the assessment of patellar kinematics during passive knee flexion before inflation of the tourniquet. A lateral thigh post helps to stabilize the femur during the wide range of motion required for the procedure. A tourniquet is placed high on the thigh and inflated with the knee flexed to limit its effect on muscle balance. We suggest placing a fluoroscopy device on the opposite side.A medial parapatellar approach is performed, extending distally to the entire length of the anterior TT. Dissection is performed to expose the attachment of the patellar tendon to the TT (Video 1).The edges of the patellar tendon and the entire tibial tuberosity are drawn with a suitable marker to perform measurements of their lengths (Fig 2). The length of the tibial crest fragment (at the distal edge of the TT) to be removed is measured in a similar manner to obtain the amount of TT distalization required, as decided during preoperative planning. The length of the distal tibial crest fragment excised determines the correction of patellar height (Video 1).The line of the next TT osteotomy is then marked by electrocautery, with care taken to leave the pes anserinus intact. The semitendinosus tendon (ST) graft is harvested. With the surgeon taking advantage of the surgical incision, the pes anserinus is well identified. A longitudinal incision of the sartorius fascia is made along the medial edge of the pes anserinus and is extended proximally in a reverse-L shape. The flap thus obtained is