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Purpose: The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable focus on the use of non-metallic implants. The aim of this study was to determine the differences in clinical outcomes, including the rates of complications and re-operations following the surgical management of patellar fractures with metallic versus non-metallic implants., Methods: The systematic review was conducted in accordance with PRISMA guidelines. Two investigators independently applied the search strategy to PubMed, SCOPUS, Google Scholar, and Cochrane databases, limited to publications between 1st January 2000 to 30st September 2021. The search strategy identified studies in which there was a comparison between the clinical outcome of the metallic and non-metallic fixation. Meta-analysis was conducted according to the Cochrane Collaboration and Quality of Reporting of Meta-Analysis (QUORUM) guidelines., Results: A total of 19 studies were selected for the systematic review and seven studies for the meta-analysis. Two hundred ninety-sixt patients formed the pooled study population for the meta-analysis. The outcomes evaluated in the meta-analysis were range of motion (ROM), complications, and re-operation rates. There was no significant difference between groups regarding ROM, but the risk ratio (RR) of re-operation (RR 0.19, 95% CI [0.09-0.41]) and complications (RR 0.30, 95% CI [0.17-0.55]) was significantly in favor of fixation with non-metallic implants., Conclusion: The use of non-metallic implants for fixation of patella fractures was associated with significantly lower risk of complications and re-operations than fixation with metallic implants, without any difference between groups with respect to the final range of motion or functional outcome measures., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Unlabelled: Small variations within normal range of radiographic parameters, except ulnar variance and volar tilt, do not influence the final functional outcome in distal radius fractures., Introduction: There are many reports in the literature on the relationship between radiographic variables and their influence on the final outcome of distal radius fractures. Most authors report that a good functional result depends on anatomical restoration of the articular surface and extra-articular alignment. The aim of this study was to verify if it is really necessary to restore anatomic radiographic parameters to obtain satisfactory functional outcome in distal radius fractures treated with volar plate., Materials and Methods: We retrospectively evaluated 51 patients treated with volar locked plate for articular unstable distal radius fractures from December 2006 to March 2009. Each fracture was evaluated according to the AO classification. The average follow-up was 40.5 months. Radiological measurements were performed considering radial height, radial inclination, volar tilt and ulnar variance, both preoperatively and postoperatively, to estimate the correction value. We examined range of motion (ROM), grip strength with a Jamar(®) dynamometer and Disabilities of the Arm, Shoulder and Hand (DASH) score. The τ Student test was performed for statistical analysis., Results: The persistence of articular step-off was assessed in 35.3% of patients. Normal radial inclination (21-25°) was restored in 74.5% of patients (range 15-27.5°). Normal radial height (10-13 mm) was restored in 66.6% of patients (range 6.8-17.3mm). Normal volar tilt (7-15°) was achieved in 90.2% of patients (range 3-17°). Normal ulnar variance (0.7-1.5mm) was restored in 86.3% of patients (range 0.7-4.1mm). There was a statistically significant difference between the preoperative and postoperative radiographic values (p<0.01). The majority of patients showed complete recovery of ROM, with no statistically significant difference (p>0.05) in extension, flexion, supination and pronation compared with the contralateral hand. Eight patients who had postoperative volar tilt and/or ulnar variance out of range had a statistically significant difference (p<0.05) in ROM compared with the non-operated side. At final follow-up, all patients had a statistically significant difference (p<0.05) in grip strength compared with the contralateral side, even with good strength values. The mean DASH score was 12.2 (range 0-61)., Discussion and Conclusion: Our experience suggests that ulnar variance and volar tilt are the most important radiographic parameters to be restored to obtain good functional outcome in distal radius fracture. Small variations of other radiographic parameters seem to not affect the final outcome at minimum 3 years' follow-up., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: The use of available mechanical methods to measure anterior tibial translation (ATT) in anterior cruciate ligament (ACL)-deficient knees are limited by size and costs. This study evaluated the performance of a portable device based on a downloadable electronic smartphone application to measure ATT in ACL-deficient knees., Methods: A specific smartphone application (SmartJoint) was developed for this purpose. Two independent observers nonsequentially measured the amount of ATT during execution of a maximum manual Lachman test in 35 patients with an ACL-deficient knee using KT 1000 and SmartJoint on both involved and uninvolved knees. As each examiner performed the test three times on each knee, a total of 840 measurements were collected. Statistical analysis compared intertest, interobserver and intra-observer reliability using the interclass correlation coefficient (ICC). An ICC > 0.75 indicates excellent reproducibility among measurements., Results: Mean amount of ATT on uninvolved knees was 6.1 mm [standard deviation (SD = 2)] with the KT 1000 and 6.4 mm (SD = 2) with SmartJoint. Mean side-to-side difference was 8.1 mm. (SD = 4) with KT 1000 and 8.3 mm (SD = 3) with SmartJoint. Intertest reliability between the two methods yielded an ICC 0.797 [95 % confidence interval (CI) 0.717-0.857] for the uninvolved knee and of 0.987 (CI 0.981-0.991) for the involved knee. Interobserver ICC for SmartJoint and KT 1000 was 0.957 (CI 0.927-0.976) for the uninvolved knee and 0.992 (CI 0.986-0.996) for the involved knee and 0.973 (CI 0.954-0.985) for the uninvolved knee and 0.989 (CI 0.981-0.994) for involved knee, respectively., Conclusion: The performance of SmartJoint is comparable and highly correlated with measurements obtained from KT 1000. SmartJoint may provide a truly portable, noninvasive, accurate, reliable, inexpensive and widely accessible method to characterize ATT in ACL-deficient knee.

Purpose: The aim of this study was to compare clinical and arthrometrical results of a series of patients older than 40 years with those of younger patients following anterior cruciate ligament (ACL) reconstruction. The hypothesis of this study was that certain biological and biomechanical factors related to middle-aged patients, ACL reconstruction would provide different results compared with younger patients., Methods: Thirty-six patients >40 years operated for ACL reconstruction between 2002 and 2010 were selected for this retrospective study, and results were compared with patients in two other age groups (<30 years and 30-40 years). At a minimum follow-up of two years, patients were reviewed and clinically examined subjectively and objectively according to Tegner, International Knee Documentation Committee (IKDC) classification and Lysholm evaluation scales. An arthrometric evaluation with KT-1000 was also performed., Results: No statistically significant difference was found among the three different age groups at the subjective and objective evaluations. However, the KT-1000 arthrometric study showed a statistically significant mean side-to-side difference at 30 lb with 1.8 mm [standard deviation (SD) 2.4] for patients >40 years, 2.7 mm (SD 1.8) for patients aged 30-40 years and 2.6 mm (SD 1.8) for patients <30 years., Conclusions: Our results seem to show that ACL reconstruction is a safe and valid option for patients of all age groups, even for those >40 years. Moreover, in that group, greater knee stability was found when compared with the younger patient groups.