Background: A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. We therefore performed a systematic review of contemporary literature to examine the effect of iliac crest bone grafting on postoperative outcomes of these patients. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results. Methods: The US National Library of Medicine (PubMed/MEDLINE), the Cochrane Database of Systematic Reviews, and EMBASE were searched between January 2008 and December 2019 for relevant publications. Results: Following the application of the inclusion-exclusion criteria, nine articles were found eligible for our analysis. In total, 261 patients (mean age range, 25.5–37.5 years; mean follow-up range, 20.6–42 months) were included in the studies of the current review. The mean modified Coleman score was 48.6 (range 37–65), indicating an overall low-to-moderate methodological quality. In the short term, the overall all-cause reoperation rate was 6.1%, while the rate of recurrent instability was 4.8%. The graft non-union rate was 2.2%, while the rate of osteolysis, graft fracture, and infection was 0.4%, 0.9%, and 1.7%, respectively. Finally, hardware-related complications, such as screw breakage or symptomatic mechanical irritation around the screw insertion, occurred in 3.9% of the patients. Conclusions: Iliac crest bone block techniques in contemporary practice are safe and effective in the short-term (< 4 years) follow-up for the management of anterior shoulder instability with substantial glenoid bone deficiency. However, further studies of higher quality and longer follow-up are required to establish the therapeutic value of these techniques as well as to clarify whether there are differences in the outcomes of arthroscopic and open iliac crest bone block procedures.

Proprioception is a specialized sensory modality encompassing the movement of the joint and its position in space, and it involves the conversion of mechanical deformation of tissues into neural signals. Mechanoreceptors are specialized nerve structures able to transmit mechanical deformation through electrical signals to dorsal root ganglion sensory neurons and are abundant in the muscles, tendons and ligaments of the knee joint. They are believed to play an important role in knee proprioception and dynamic knee stability. Proprioception should always be taken into consideration for successful reconstruction of the cruciate-deficient knee and for pain and function management in the arthritic knee. Advances in histological methods of detection are numerous and continue to highlight the presence and role of mechanoreceptors after ligament reconstruction, depending on choice of graft. In this review, we present the current knowledge of anterior and posterior cruciate ligaments and grafts mechanoreceptors, and their role in proprioception of knee joint, focusing on each type of mechanoreceptors.

Recently, four different operative techniques, referring to the primary anterior cruciate ligament (ACL) repair, were described. These are the dynamic intraligamentary stabilization (DIS) with Ligamys™, the Bridge-enhanced repair (BEAR), the use of internal brace, and the refixation with suture anchors. The purpose of this study was to assess the already-published, clinical, and pre-clinical results of those techniques. A literature review was conducted and implemented by three independent researchers. Inclusion criteria were clinical or cadaveric or animal studies about patients suffering from ACL rupture, who were treated with one of those four different arthroscopic techniques of primary ACL repair. There were 10 clinical trials dealing with the different techniques of primary ACL repair and 12 cadaveric or animal studies. The majority of the published clinical trials investigated the dynamic intraligamentary stabilization (DIS), while only four studies referred to the three other surgical techniques. Most of the clinical trials suggested that primary ACL repair should be done during the first 14–21 days after a proximal ACL rupture and not later. Further clinical evidence is needed for the techniques of bridge-enhanced ACL repair, internal brace, and suture anchors ACL refixation in order to support the animal and cadaveric biomechanical studies. Till now, the existing clinical trials were not enough to establish the use of those techniques in the ACL-ruptured patients. On the contrary, the Dynamic intraligamentary stabilization with Ligamys™ device demonstrated very promising results in different types of clinical studies.

The effects of repair of isolated anterior horn meniscus lesions have not been thoroughly described in the literature. We aimed to evaluate outcomes with subjective clinical scores and imaging modalities after repair of isolated anterior horn tears, at 24 months’ follow-up. Records of all patients that opted for surgical repair of isolated, anterior horn tears of the medial and lateral meniscus were retrospectively reviewed, between 2016 and 2018. All patients were treated with arthroscopic outside-in technique by the same surgeon. Preoperative and postoperative clinical files were accessed to recover records of preoperative symptomatology, patient-reported scores [International Knee Documentation Committee (IKDC) rating, Lysholm score and Tegner activity level], preoperative and postoperative MRI data and time from injury to surgery. Mean age of eight patients was 25.25 years (range 18-37 years). Diagnostic preoperative MRI revealed isolated anterior horn tear of the lateral meniscus and medial meniscus in five patients and an isolated anterior horn tear of the medial meniscus in three patients. Mean time from injury to surgical repair was 23.75 days (range 7-43). We considered seven out of eight repairs to be successfully healed. At 24 months’ follow-up: Mean Lysholm score was 92.25 (range 89-95), Tegner activity scale score was 6.5 (range 5-8) and IKDC score was 91.78 (range 87.8-94.4). All scores significantly improved compared to preoperative values (p<0.001). Outside-in is a reliable technique to repair meniscal anterior horn tears, both medially and laterally, with high healing rates and patient satisfaction in young, active patients.

Purpose: Clinically-oriented anatomy education has been proposed as an effective strategy in anatomy curricula. We aimed to explore the level of extent the literature supports the fact that case-based learning (CBL) can play a significant role in anatomy education. Materials and methods: We searched PubMed, Scopus, Education Resources Information Center (ERIC), and Cochrane database to find articles with the purpose to explore the educational outcomes of case-based anatomy learning. We extracted from each paper authors, type of study (comparative or not), number of participants, level of outcome according to the Kirkpatrick hierarchy, outcomes of CBL concerning the acquisition of anatomical knowledge, and the participants’ perceived enjoyment, motivation, and aid to anatomy learning. Results: Nine articles were included. Three of them evaluated the acquisition of anatomical knowledge, while six papers evaluated the participants’ perceptions. All studies showed positive outcomes regarding the students’ anatomy examination performances, reported confidence, enjoyment, motivation, and ability of CBL to facilitate anatomy learning. Conclusion: Although the existing research has mainly evaluated students’ perceptions, the outcomes of CBL in anatomy education encourage more extensive use of this method in anatomy curricula. Further research is expected to shed more light on the role that CBL can play in modern anatomy education and to clarify if it can replace or supplement didactic teaching.