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Monteggia fracture-dislocation is a complex injury of the superior arm, both because it usually interests growing individuals with difficulties in the choice of treatment and because its frequent complications in the elbow articulation. Chronic anterior dislocation of the radial head is a frequent complication after a Monteggia's fracture. The present study describes a 20-year-old boy who previously had a Monteggia fracture-dislocation treated with Kirshner wire ostheosynthesis. He underwent surgery 20 days after plaster-cast removal, because of irreducible radial head dislocation. An open reduction and a reconstruction of the anular ligament was performed using the Mitek suture anchor Spiralok and an Orthocord wire. The patient was radiographically and clinically investigated three and six months after surgery, with good results, even if a longer follow-up is advisable to judge objectively the results. Suture anchors are good devices, largely accepted in arthroscopic surgery. This versatile device is really useful to solve problems also in osteoarticular traumatology treated in an open manner, and many other applications of suture anchors could be discovered in the future.

Chemokines are inflammatory proteins acting via G-protein coupled chemokine receptors that trigger different signaling pathways. Monocyte chemoattractant protein-1 (CCL2/MCP-1) and regulated on activation, normal T expressed and secreted (CCL5/RANTES) are the two major members of the CC chemokine beta subfamily. The roles of RANTES and MCP-1 are emerging in regulating the recruitment of inflammatory cells into tissue during inflammation. The inhibition of MCP-1 and RANTES with corresponding antibodies or other inhibitors may provide benefits in different clinical scenarios including cancer, inflammation, CNS disorders, parasitic disease, autoimmune and heart diseases. RANTES and MCP-1 may represent targets for diagnostic procedures and therapeutic intervention, and may be useful as a prognostic factor in the above diseases.

In the last years there has been a notable improvement in cruciate ligaments reconstructions, due to an evolution of the surgical technique arthroscopic assisted, to a gain of fixation system, to a better choice of the tendons and to an improvement of the operative technique to harvest them. In our experience alternatives are three and the choice depends on the patient peculiarities and on the surgeon habit: 1) Bone - Patellar Tendon - Bone (BPTB); 2) Doubled Gracilis and Semitendinosus Tendons (DGST); 3) Quadriceps Tendon (QT). Our preference, considering the different indications, is for the first two; nevertheless we use the central third of the quadriceps tendon only in particular cases (other techniques failures, revisions, necessity to use more harvests for associated multiple injuries). We describe the harvesting of the grafts that we perform in different surgical phases depending on the tendon choice: the BPTB harvest is done after a diagnostic arthroscopy to confirm the instability and after the tunnel drillings, otherwise the hamstring harvest is done immediately after the diagnostic phase to have more time to tension it, on the mastergraft (workstation).

Aim. The aim of this study is to analyze our experience on 30 patients with TUBS (Traumatic, Unidirectional, Bankart, Surgery), treated with arthroscopic capsulo-plasty using anchors Bioknotless according to Thai's Technique. Methods. From January 2001 to December 2003 we arthroscopically treated 30 patients with post-traumatic instability of the shoulder. The intervention foresees the following steps: evaluation of the capsular lesion; decortication of the anterior glenoid surface; execution of 3 holes; anchors introduction; application of an immobilizzation for 4 weeks. Results. We clinically appraised the patients through the Constant test with a minimum of 12 to a maximum of 24-month follow-up (average 18 months). The middle value of the Constant score was of 85 compared to the pre-operative value of 55.5. Only one case of relapse was observed. Conclusions. Over the time, thanks to the refinement of surgical techniques, to better knowledge of the role of the propioception in the mechanism of shoulder joint feedback, to a greater knowledge of the articular pathology and to the increased confidence of the surgeons with the arthroscopic technique, many authors are underlining the superimposing role of inherent data of recurrences between arthroscopic and open treatment. We believe that a careful preoperative and intraoperative selection of the patient can sensitively reduce the risks of arthroscopic capsulo-plasty recurrences; excluding patients with bony-Bankart> of 25% and with glenoid inverted pear. We can conclude that the use of these anchors, that do not foresee the execution of the knot, allows a reduction of surgical time, and above all, a good anchorage and capsular shift. Despite the facility of such technique in comparison to others described in Literature, we believe that a long learning curve is essential.

In the wiev of the profound and continuous ethical changes tha have occurred in the doctor-patient relation and with special focus on the self-determination of treatment, the authors suggest a methodological approach to the problem of professional responsibility of arthroscopy specialist. In addition, stress is also laid on the professional responsibility in artroscopic treatment, considering deontologic and technical aspects, analysing the matters regarding the definition of the nature of the juridical shop related to this professional performance and estimating its civil implications. The authors discuss this liability, analysing the matters regarding the definition of the nature of the "specialistic error" related to this professional performance. They also, highlight the importance of informed consence, offering hints for discussion on the preliminary information given to the patient in order to acquire a correct consent and to obtain his ivolvement in the decision-making process: the patient conscious of his rights, is always more involved in therapeutic decisions. In addition the authors define the necessary and correct parameters of informations to obtain a valid and complete consent as to justify a specialistic treatement as arthroscopy. Against this backgroud, on the basic aspects taken from medical-legal and specialised literature, they suggest indications for a correct professional practice.