Abstract:

The indications for joint arthroscopy continue to expand rapidly as technology advances. Surgeons and patients alike are realizing a progression of benefits related to lower morbidity associated with arthroscopic procedures supplanting open surgeries. However, it is important in each new application to critically evaluate the operative expertise, theoretical advantages, and actual outcome data before deciding the relative benefit of an arthroscopic procedure versus an open one. This is especially true for shoulder surgery because of the complex and restricted anatomical spaces available for insertion of an arthroscope. Additionally, orthopaedic surgeons are just now developing a clear understanding of the pathology of the glenohumeral joint and subacromial space, and the indications for intervention in these areas. Although the practice of shoulder arthroscopy is still in an early stage of development, it was actually first described by Burman in 1931. In his cadaveric studies, with instruments that look remarkably similar to ours today, he describes both the portal placements and the glenohumeral anatomy in some detail. It was Burman's opinion that the shoulder was the easiest and most consistent of all joints to visualize.

Authors:

Daniel D. Buss, M.D., Kim S. Schaap, M.D.

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Abstract:

When a surgical reconstruction is necessary for a patient with an anterior cruciate ligament (ACL) injury, autologus tissue from either a bone-patellar tendon-bone or hamstring tendon grafts is preferable. There are relative and absolute contraindications for the use of either tissue, in addition to the surgeon's own preference. For example, a patient with Erlos-Danlos ligamentous laxity is not a candidate for a hamstring ACL reconstruction.

Authors:

Pierce E. Scranton, Jr., M.D., Leo Pinczewski, F.R.C.S.

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Abstract:

There are no medical or surgical treatments able to repair traumatic paraplegia. Experiments done by connecting the above-the-lesion with the below-the-lesion cord by means of PNS grafts have always failed. The grafts are reinhabited by regrowing axons of the first motoneurons which however are not able to progress into the distal spinal cord. At the present state of knowledge no surgical treatment can cure paraplegia. Thousands of researchers are working all over the world in many different types of research ranging from molecular biology to embriology, and from biochemistry to pharmacology and surgery. None of these experiments have proved to be practically effective.

Authors:

Giorgio A. Brunelli, M.D., Giovanni R. Brunelli, M.D.

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Abstract:

Iirect bone-metal contact is considered the ideal condition in order to obtain stability of orthopaedic non cemented implants. To acheive this result various implant shapes and surfaces were proposed.

Authors:

Giovanni Zatti, M.D., Luca Andrini, M.D., Paolo Cherubino, M.D.

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Abstract:

Reconstruction of the knee joint with an appropriate prosthetic component that accomplishes the alleviation of pain and the restoration of joint function represents the goal of primary and revision TKA. Revision TKA procedures present a variety of complicating factors not found in primary TKA cases.

Authors:

Adolph V. Lombardi, Jr., M.D., F.A.C.S., Thomas H. Mallory, M.D., F.A.C.S., Robert W. Eberle, Joanne B. Adams, B.F.A.

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Abstract:

Nonunions and delayed unions have been classically defined by Bassett as an arrest of the fracture healing process at an intermediary stage of repair, at which time the fracture gap is bridged by fibrocartilage. It is estimated that approximately 10-20 % oflong bone fractures in the United States will result in delayed unions when compared to the average rate of healing for the location and type of fracture. Many of these will go on to a nonunion if biological or biomechanical factors are not optimized to enhance healing. Additional commorbities such as smoking, ethanol abuse, malnutrition, malabsorption and altered neurologic conditions can contribute to delayed unions or norrun io ns.v" Even despite appropriate and aggressive early management of long bone fractures, a certain percentage still lack progression of healing and go on to nonunion. Classical surgical management of nonunions includes obtaininjr fracture stabilization with ORIF techniques and bone grafting, with reported clinical successes ranging from 50_80%. Those that fail to achieve union despite classical management are indeed recalcitrant nonunions.

Authors:

Joseph A. Longo, III, M.D.

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