PurposeComparing the MRI features of the grafts between a group of patients treated with an over‐the‐top anterior cruciate ligament reconstruction technique that preserves the hamstring attachment and a control group with a classical reconstruction technique. MethodsPatients were assigned to a standard reconstruction technique or an Over‐the‐top plus lateral plasty technique. All patients underwent preoperative, 4‐months and 18‐months MRI; together with a clinical evaluation with KOOS and KT1000 laxity assessment. MRI study involved different parameters: the “Graft” was evaluated with the continuity, Howell Grading system, presence of liquid and signal noise quotient. The “Tibial Tunnel” was evaluated with the signal noise quotient, presence of edema or liquid and tunnel widening. All points assigned to each parameter formed a composite score ranging from 0–10. Tunnel and graft positioning were evaluated. ResultsAt 18‐month 20 MRIs (10 each group) were available, demographics were not significantly different between groups. The non‐detached group showed significantly less liquid within the graft at 4‐months (p = 0.008) and 18‐months (p = 0.028), the tunnel was significantly smaller (p < 0.05) and less enlarged at both follow‐ups (p < 0.05), signal noise quotient of the intra‐tunnel graft was lower at 18‐months (p < 0.05). The total score of the non‐detached group saw a significant improvement at 4‐months (p = 0.006) that remained stable at 18‐months (n.s.). ConclusionsHamstring grafts, which tibial insertions were preserved, showed better MRI features at 4‐and 18‐months follow‐up, especially in terms of liquid effusion, tunnel enlargement and signal noise quotient. Level of evidenceIV.

Purpose The goal of this study was to compare the risk of periprosthetic infection of a consecutive cohort of primary varusvalgus constrained (VVC) total knee arthroplasties (TKAs), with a matched 1:1 cohort of primary posterior-stabilized (PS) TKAs. Methods 74 primary VVC TKAs performed in 66 patients were identiied and matched 1:1 with a cohort of 74 primary PS TKAs performed in 73 patients. At last follow up, patients were clinically evaluated using the Knee Society Score (KSS). Kaplan-Meier survival curves were generated to analyze survivorship using as endpoints revision for any reason, revision for periprosthetic infection and revision for mechanical failure after excluding periprosthetic infection. A multivariate logistic regression analysis was constructed to determine whether revision surgery for periprosthetic infection was inluenced by patients' gender, age, surgical time and reasons for TKA (primary vs secondary osteoarthritis). Results Demographic data were not signiicantly diferent between the two groups as regard patients' age, gender, body mass index, Charlson Comorbidity Index, reasons for replacement, and length of follow-up. Surgical time was greater in the VVC group (95.7 ± 22.5 min vs 88.6 ± 17.1 min, respectively, p = 0.032). Postoperative KSS, range of motion and radiographic data did not difer signiicantly between the two groups. Overall revision rate and revision rate for mechanical failure after 5 years of follow-up was not statistically diferent between the two groups. Considering only the revision rate due to periprosthetic infection, the risk was higher in patients with primary VVC implants (p = 0.013). The surgical time was the only factor that signiicantly afected the risk of revision for periprosthetic infection (OR 1.0636, CI 95% 1.0209-1.1081, p = 0.0032), whereas patients' gender, age and reason for TKA had no inluence. Conclusions Patients and surgeons should be aware of the higher risk of periprosthetic knee infection using a VVC prosthesis. However, the present study supports the use of VVC implants in cases of diicult knee replacements, since comparable clinical outcomes and overall revision rate was found after at least 5 years of follow up. Level of evidence Retrospective cohort study, Level III.

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The use of tricalcium phosphate (TCP) as a bone substitute is gaining increasing interest to treat severe acetabular bone defects in revision total hip arthroplasty (rTHA). The aim of this study was to investigate the evidence regarding the efficacy of this material. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the modified Coleman Methodology Score (mCMS) for all studies. A total of eight clinical studies (230 patients) were identified: six on TCP used as biphasic ceramics composed of TCP and hydroxyapatite (HA), and two as pure-phase ceramics consisting of TCP. The literature analysis showed eight retrospective case series, of which only two were comparative studies. The mCMS showed an overall poor methodology (mean score 39.5). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results. A total of 11 cases that underwent rTHA with a pure-phase ceramic presented satisfactory clinical and radiological outcomes at initial short-term follow-up. Further studies at long-term follow-up, involving a larger number of patients, are needed before drawing more definitive conclusions on the potential of TCP for the treatment of patients who undergo rTHA.