SICOT J. 2025;11:11. doi: 10.1051/sicotj/2025008. Epub 2025 Feb 27.

ABSTRACT

INTRODUCTION: This biomechanical study evaluated the effect of screw reinsertion with a locking plate on fixation strength and the stability of osteosynthesis in medial tibial plateau fractures using porcine bone.

MATERIALS AND METHODS: Thirty porcine tibiae were divided into three groups: group A (underwent biomechanical testing after medial tibial fixation with a large fragment T-shaped locking plate), group B (underwent plate fixation, followed by the removal of all screws and plates and refixation with the same screws and plates using the same holes before biomechanical testing), and group C (underwent biomechanical testing once after plate fixation, followed by the removal of all screws and plates, refixation with the same screws and plates using the same holes, and then biomechanical testing). The translation pattern of the constructs in each group was examined using cyclic loading tests. The changes in the joint gap and step-off after 2000 cycles were compared among the three groups.

RESULTS: Significant differences in displacement were observed at 10-100 cycles (group A: -0.01 ± 0.04 mm, group B: -0.02 ± 0.04 mm, group C: -0.13 ± 0.15 mm, P = 0.021). However, no significant differences were found in other displacement and translation measurements among the groups. Regarding the gap and step-off among groups, significant differences were observed in anterior and posterior gap changes. Despite the statistical significance, the absolute displacement values were small, suggesting minimal clinical relevance. These findings indicate that reinserting screws and plates into the same hole may not substantially compromise overall fixation strength.

CONCLUSION: Screw reinsertion in the same holes after removal did not significantly compromise the stability of osteosynthesis in this biomechanical model. These findings suggest that reinsertion may be a viable option in revision surgery.

PMID:40014800 | PMC:PMC11867604 | DOI:10.1051/sicotj/2025008

SICOT J. 2025;11:10. doi: 10.1051/sicotj/2025004. Epub 2025 Feb 20.

NO ABSTRACT

PMID:39977647 | PMC:PMC11841981 | DOI:10.1051/sicotj/2025004

SICOT J. 2025;11:9. doi: 10.1051/sicotj/2025003. Epub 2025 Feb 20.

ABSTRACT

There are many variables that influence the decision-making process in the treatment of rotator cuff calcifications. The stage of the deposit, prognostic factors, previous failed treatments, pain level, and functional disability must all be considered. The tendency for spontaneous resolution is an important reason to always exhaust conservative treatment, being non-invasive options the first line of treatment. The emergence of focused shock wave therapy offered a powerful tool for the non-invasive management of rotator cuff calcifications. High-energy focused shock waves have a high degree of recommendation for the treatment of rotator cuff calcifications, supported by meta-analyses and systematic reviews. If non-invasive techniques fail, there is the possibility of moving to a minimally invasive procedure such as ultrasound-guided barbotage. Finally, classic invasive techniques are also a frequent indication, including open surgery and arthroscopy. As each treatment has advantages and disadvantages, the most advisable strategy is to progress from the least invasive therapeutic methods to the most invasive ones without losing sight of the clinical stage of the disease and the general context of each patient.

PMID:39977646 | PMC:PMC11841982 | DOI:10.1051/sicotj/2025003

SICOT J. 2025;11:8. doi: 10.1051/sicotj/2025002. Epub 2025 Feb 10.

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) rupture is a common knee injury, and with advancements in knee arthroscopy, ACL reconstruction has become common. Techniques like single-double bundle and femoral tunnel drilling via transtibial or anteromedial portal approaches are available. This study evaluates the accuracy of femoral tunnel placement via these approaches in single-bundle ACL reconstruction.

MATERIALS AND METHODS: Forty-three ACL reconstructions using hamstring grafts were analyzed. Initially, femoral tunnels were drilled via the anteromedial portal from 09:30 to 10:00 (14:00 to 14:30 for left knees). Tibial tunnels (mean anteroposterior angle: 63.5°, sagittal: 64.2°) were then created with the same diameter, accompanied by radiological documentation. A femoral aiming device was used to place a K-wire at the center of the femoral tunnel, recorded photographically. Tunnel diameters included 7 mm (20 cases), 7.5 mm (11 cases), 8 mm (7 cases), 8.5 mm (3 cases), and 9 mm (1 case). Two observers evaluated all radiological and photographic data, focusing on the deviation of the transtibial K-wire from the femoral tunnel center.

RESULTS: Of 38 evaluated cases, the transtibial K-wire was within the femoral tunnel in 11 cases (28.9%) - 7 cases with 7 mm, 2 cases each with 7.5 mm and 8 mm diameters. In 23 cases (60.5%), the K-wire was at the perimeter or outside the femoral tunnel - 11 cases with 7 mm, 8 with 7.5 mm, 4 with 8 mm, 3 with 8.5 mm, and 1 with 9 mm diameters.

CONCLUSION: Transtibial aiming for anatomical femoral tunnel positioning is challenging. No significant correlation was found between the transtibial deviation and the tibial tunnel diameter.

PMID:39927689 | PMC:PMC11809194 | DOI:10.1051/sicotj/2025002

SICOT J. 2025;11:7. doi: 10.1051/sicotj/2025001. Epub 2025 Feb 10.

ABSTRACT

BACKGROUND: Functional knee positioning (FKP) represents an innovative personalized approach for total knee arthroplasty (TKA) that reconstructs a three-dimensional alignment based on the optimal balance of soft tissue and bony structures, but it has mostly been described for varus knee deformity.

SURGICAL TECHNIQUE: Valgus deformities present specific challenges due to altered bone remodeling and soft tissue imbalances. Using robotic assistance, FKP enables precise intraoperative assessment and correction of compartmental gaps, accommodating each individual's unique anatomy and laxities. The distal femoral cut is calibrated for 9 mm resection at the intact medial femoral condyle and adjusted on the lateral side to accommodate bone wear, while the tibial plateau resection aims for 8 mm from the medial side and 4-6 mm from the lateral side. Intraoperative evaluations of mediolateral laxities are performed at extension and 90° flexion. Adjustments are made to femoral and tibial cuts to balance gaps, aiming for 0 mm in posterior stabilized implants and minimal discrepancies in cruciate-retaining designs with lateral gap looser in flexion.

DISCUSSION: FKP emphasizes soft tissue-driven adjustments with the use of robotic platforms. Hence, intact soft tissue envelope of the knee is essential. This technique holds significant promise for managing valgus deformities in TKA, but further research is needed to evaluate its functional outcomes.

PMID:39927688 | PMC:PMC11809196 | DOI:10.1051/sicotj/2025001