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Journal of Orthopaedics Oct 2024Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to... (Review)
Review
INTRODUCTION
Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to determine if joint hypermobility leads to an increased risk of patellar instability, and to evaluate outcomes of treatment for patellar instability in those who exhibit hypermobility.
METHODS
Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included.
RESULTS
We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p < 0.001).Five studies found surgical intervention aimed at correcting patellar dislocation in patients with idiopathic hypermobility led to satisfactory outcomes. There was conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following medial patellofemoral ligament reconstruction (MPFLR) in two studies. In addition, this procedure had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS), with hypermobility associated with a higher failure rate (p = 0.03). One study showed the type of graft used made no difference in outcome scores or re-dislocation rates (p > 0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69).
CONCLUSION
Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required.
PubMed: 38784948
DOI: 10.1016/j.jor.2024.05.009 -
Orthopaedic Journal of Sports Medicine May 2024Netball is a popular sport worldwide, particularly for women. However, its nature puts players at high risk for anterior cruciate ligament (ACL) injury.
BACKGROUND
Netball is a popular sport worldwide, particularly for women. However, its nature puts players at high risk for anterior cruciate ligament (ACL) injury.
PURPOSE
To determine (1) the prevalence of ACL graft rupture and contralateral ACL (CACL) rupture in Australian female netballers after ACL reconstruction (ACLR) and (2) the rate of return to sports (RTS) and psychological readiness.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A patient database identified 332 consecutive female netball players who underwent ACLR with hamstring tendon autografts performed by 2 surgeons between 2007 and 2015. Patients were retrospectively surveyed at a minimum of 7 years postoperatively-including details of a second ACL injury to either knee, RTS, and psychological readiness per the ACL-Return to Sport After Injury (ACL-RSI) score. Multivariate regression assessed the association between selected variables and repeat ACL injury.
RESULTS
A total of 267 patients (80%) were included with a mean follow-up of 8.4 years (range, 7-15 years). ACL graft rupture and CACL rupture occurred in 11 (4%) and 27 (10%) patients, respectively, at 7 years postoperatively. The ACL graft had a survival rate of 99%, 97%, 97%, and 96% at 1, 2, 5, and 7 years after surgery, respectively. The native CACL had a survival rate of 100%, 99%, 94%, and 90% at 1, 2, 5, and 7 years, respectively. Adolescents had a 4.5 times greater hazard for ACL graft rupture (95% CI, 1.4-14.6; = .014) and a 2.5 times greater hazard for CACL rupture (95% CI, 1.2-5.5; = .021) compared with adults. CACL injury was also associated with a return to level 1-including jumping, hard pivoting, and cutting-sports (hazard ratio, 10.3 [95% CI, 1.4-77.1]; = .023). Most (62%) participants returned to netball, with those with higher ACL-RSI scores more likely to RTS.
CONCLUSION
The prevalence of repeat ACL injury was higher in the contralateral knee (10%) than the ACL-reconstructed knee (4%) at 7 years postoperatively. ACLR was a suitable option for female netballers who sustained an ACL rupture with low long-term rates of graft rupture. Repeat ACL injuries to either knee were more common in adolescents and those who returned to cutting and pivoting sports.
PubMed: 38784789
DOI: 10.1177/23259671241247488 -
Annals of Plastic Surgery May 2024The closure of scalp wounds presents with reconstructive challenges due to the poor tissue elasticity. It is not uncommon to require skin grafts for definitive closure,...
BACKGROUND
The closure of scalp wounds presents with reconstructive challenges due to the poor tissue elasticity. It is not uncommon to require skin grafts for definitive closure, even when large flaps are employed. Herein, we present a novel method for the direct closure of small- to medium-sized wounds defects. It is a modified bilateral rhomboid flap, which enables tension-free closure in many areas of scalp.
METHODS
All patients treated with this technique between January 2018 and January 2023 were reviewed. Demographics, complications, and outcomes were reviewed.
RESULTS
One hundred forty patients have been operated with this technique. All have been cases of skin tumors. The full flap survival was 97.14%, and they did not present any major local complications, avoiding in all cases the use of skin autografts. Four patients (2.86%) had partial necrosis in the edges of the flap, all managed with topical wound care with good healing and no need of secondary procedures.
CONCLUSIONS
This flap is safe and easy to perform when there is skin laxity in the scalp. It can save many skin grafts, simplifying the closure of this area, which can be a first-choice technique on scalp reconstruction.
PubMed: 38775257
DOI: 10.1097/SAP.0000000000003970 -
Orthopaedic Journal of Sports Medicine May 2024Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular...
BACKGROUND
Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular tenodesis (LET) on anteroposterior translation is unclear.
PURPOSE/HYPOTHESIS
This study aimed to evaluate the reduction in radiographic static anterior tibial translation (SATT) and dynamic anterior tibial translation (DATT) after LET as an adjunctive procedure to ACLR. It was hypothesized that adding a LET procedure would have no effect on postoperative SATT and DATT.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Patients who underwent primary ACLR with hamstring tendon autografts between 2020 and 2022 were reviewed, and those who underwent ACLR and LET as an anterolateral associate procedure were paired 1 to 1 with those who underwent isolated ACLR (control) based on age, sex, preoperative SATT, and posterior tibial slope (PTS). The indications for LET were age <18 years and anterolateral rotary instability (grade ≥2 pivot shift). A previously validated technique was used to measure SATT, DATT, and PTS on lateral weightbearing and lateral stress knee radiographs. Preoperative and 9-month postoperative radiographs were compared between the 2 groups.
RESULTS
A total of 72 patients were included in the analysis (n = 36 patients in each group). The inter- and intraobserver reliability of the SATT, DATT, and PTS measurements was excellent (intraclass correlation coefficients, 0.88-0.99). The mean pre- and postoperative SATT in the ACLR+LET group was 2.44 ± 2.90 mm and 2.44 ± 2.38 mm, respectively, compared with 2.60 ± 2.99 mm and 2.12 ± 2.74 mm, respectively, in the control group. The mean pre- and postoperative reduction in side-to-side DATT in the ACLR+LET group was 5.44 ± 4.65 mm and 1.13 ± 2.95 mm, respectively, compared with 5.03 ± 3.66 mm and 2 ± 3.12 mm, respectively, in the control group. There was no pre- to postoperative difference in SATT ( = .51). However, the side-to-side DATT was reduced by 3.66 ± 3.37 mm postoperatively ( < .001), without significant differences between groups ( = .24).
CONCLUSION
Including a LET procedure for patients undergoing ACLR did not reduce SATT; that is, it did not decrease the amount of tibial translation due to physiological axial load.
PubMed: 38774385
DOI: 10.1177/23259671241246111 -
Biomaterials Advances Jul 2024Large bone defects, particularly those exceeding the critical size, present a clinical challenge due to the limited regenerative capacity of bone tissue. Traditional...
Large bone defects, particularly those exceeding the critical size, present a clinical challenge due to the limited regenerative capacity of bone tissue. Traditional treatments like autografts and allografts are constrained by donor availability, immune rejection, and mechanical performance. This study aimed to develop an effective solution by designing gradient gyroid scaffolds with titania (TiO) surface modification for the repair of large segmental bone defects. The scaffolds were engineered to balance mechanical strength with the necessary internal space to promote new bone formation and nutrient exchange. A gradient design of the scaffold was optimized through Finite Element Analysis (FEA) and Computational Fluid Dynamics (CFD) simulations to enhance fluid flow and cell adhesion. In vivo studies in rabbits demonstrated that the G@TiO scaffold, featuring a gradient structure and TiO surface modification, exhibited superior healing capabilities compared to the homogeneous structure and TiO surface modification (H@TiO) and gradient structure (G) scaffolds. At 12 weeks post-operation, in a bone defect representing nearly 30 % of the total length of the radius, the implantation of the G@TiO scaffold achieved a 27 % bone volume to tissue volume (BV/TV) ratio, demonstrating excellent osseointegration. The TiO surface modification provided photothermal antibacterial effects, enhancing the scaffold's biocompatibility and potential for infection prevention. These findings suggest that the gradient gyroid scaffold with TiO surface modification is a promising candidate for treating large segmental bone defects, offering a combination of mechanical strength, bioactivity, and infection resistance.
Topics: Titanium; Animals; Rabbits; Tissue Scaffolds; Surface Properties; Alloys; Bone Regeneration; Osseointegration; Bone and Bones; Tissue Engineering; Finite Element Analysis; Biocompatible Materials
PubMed: 38772133
DOI: 10.1016/j.bioadv.2024.213899 -
International Journal of Ophthalmology 2024To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine...
AIM
To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation.
METHODS
Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability.
RESULTS
Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min 18.15±2.20min, =0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) 3.00min (2.21-4.15), <0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) 2 (1-4), <0.001]. Postoperative symptoms at 6mo were comparable between the groups (=0.487), with no recurrence.
CONCLUSION
ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.
PubMed: 38766334
DOI: 10.18240/ijo.2024.05.07 -
Computers in Biology and Medicine Jun 2024In young patients, aortic valve disease is often treated by placement of a pulmonary autograft (PA) which adapts to its new environment through growth and remodeling. To...
OBJECTIVE
In young patients, aortic valve disease is often treated by placement of a pulmonary autograft (PA) which adapts to its new environment through growth and remodeling. To better understand the hemodynamic forces acting on the highly distensible PA in the acute phase after surgery, we developed a fluid-structure interaction (FSI) framework and comprehensively compared hemodynamics and wall shear-stress (WSS) metrics with a computational fluid dynamic (CFD) simulation.
METHODS
The FSI framework couples a prestressed non-linear hyperelastic arterial tissue model with a fluid model using the in-house coupling code CoCoNuT. Geometry, material parameters and boundary conditions are based on in-vivo measurements. Hemodynamics, time-averaged WSS (TAWSS), oscillatory shear index (OSI) and topological shear variation index (TSVI) are evaluated qualitatively and quantitatively for 3 different sheeps.
RESULTS
Despite systolic-to-diastolic volumetric changes of the PA in the order of 20 %, the point-by-point correlation of TAWSS and OSI obtained through CFD and FSI remains high (r > 0.9, p < 0.01) for TAWSS and (r > 0.8, p < 0.01) for OSI). Instantaneous WSS divergence patterns qualitatively preserve similarities, but large deformations of the PA leads to a decrease of the correlation between FSI and CFD resolved TSVI (r < 0.7, p < 0.01). Moderate co-localization between FSI and CFD is observed for low thresholds of TAWSS and high thresholds of OSI and TSVI.
CONCLUSION
FSI might be warranted if we were to use the TSVI as a mechano-biological driver for growth and remodeling of PA due to varying intra-vascular flow structures and near wall hemodynamics because of the large expansion of the PA.
Topics: Models, Cardiovascular; Hemodynamics; Pulmonary Artery; Hydrodynamics; Animals; Humans; Computer Simulation; Pulmonary Valve; Autografts; Stress, Mechanical
PubMed: 38761502
DOI: 10.1016/j.compbiomed.2024.108604 -
European Journal of Orthopaedic Surgery... May 2024The hamstring tendon (HT) autograft is currently the most widely utilised autograft option for anterior cruciate ligament (ACL) reconstruction. However, recent studies...
Comparative effectiveness of peroneus longus tendon (PLT) autografts versus hamstring tendon (HT) autografts in anterior cruciate ligament reconstruction: a comprehensive systematic review and meta analysis.
The hamstring tendon (HT) autograft is currently the most widely utilised autograft option for anterior cruciate ligament (ACL) reconstruction. However, recent studies endorse the peroneus longus tendon (PLT) autograft as a viable alternative. To evaluate this, we systematically reviewed randomised controlled trials (RCTs) to compare the efficacy of PLT against HT autografts. Our search encompassed Cochrane, Embase, OVID, PubMed, and Scopus databases for RCTs comparing outcomes of PLT and HT autografts in ACL reconstruction. Primary outcomes included Lysholm and International Knee Documentation Committee (IKDC) scores, while secondary outcomes involved American Orthopaedic Foot and Ankle Society (AOFAS) scores, graft diameters and donor-site complications. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration) and heterogeneity was assessed with I statistics. 683 patients from 6 RCTs were included, with 338 (49.5%) patients treated with PLT autografts. Follow-up ranged from 12 to 30 months. Despite lower preoperative Lysholm scores in the PLT group, no significant differences were observed at 6 and 12 months. Although preoperative and 6-month IKDC scores were lower in the PLT group, no significant differences were found at 12 and 24 months. AOFAS scores showed no significant preoperative difference, but slightly lower scores were noted in the PLT group at 12 or 24 months. There was no significant difference in graft diameter, while donor-site complications were fewer in the PLT group. In summary, the PLT autograft is a promising and non-inferior alternative to the HT autograft, demonstrating equivalent outcomes in patient-reported knee and ankle metrics, comparable graft diameters and fewer donor-site complications.
PubMed: 38755499
DOI: 10.1007/s00590-024-03984-w -
Archives of Orthopaedic and Trauma... Jun 2024Only a few anatomic studies have described an isolated rectus femoris tendon autograft for anterior cruciate ligament (ACL) reconstruction. This study aims to...
INTRODUCTION
Only a few anatomic studies have described an isolated rectus femoris tendon autograft for anterior cruciate ligament (ACL) reconstruction. This study aims to demonstrate a new surgical technique utilising the rectus femoris tendon for ACL reconstruction. This study hypothesises that the rectus tendon autograft will yield satisfying postoperative outcomes in terms of stability, with minimal complications at the harvest site.
METHODS
This retrospective study investigated the outcomes of 28 revision ACL reconstructions using a rectus tendon autograft with a mean follow-up of 41.7 (range, 24.0-64.8) months. A 3 cm longitudinal incision was used to harvest the rectus tendon with an open tendon stripper. Intraoperative collected data included the length of the tendon and thickness of a 4-fold graft. Further outcome parameters include anterior cruciate ligament stability and range of motion. Additionally, postoperative complications, especially donor site morbidity, were documented in type and frequency.
RESULTS
The mean tendon length measured 32.4 cm (range, 30-35 cm). After preparing a 4-fold graft, the mean diameter was 9.2 mm (range, 8.0-10 mm) at the tibial and 9.0 mm (range, 7.5-10 mm) at the femoral end. Stability evaluated by the Lachman test improved significantly from 2 (Interquartile range (IQR), 2-3) preoperatively to 0 (IQR, 0-1) postoperatively (p < .001). Rerupture of the anterior cruciate ligament graft was observed in 2 patients (7.1%). Four patients showed a persistent extension deficit of about 5 degrees postoperatively. Two of them underwent revision surgery due to a Cyclops lesion. Only one patient complained of prolonged pain at the harvest site (3.6%).
CONCLUSION
The 4-fold rectus tendon represents a novel autograft technique in revision ACL reconstruction. This study provides evidence of appropriate graft dimensions and satisfying postoperative outcomes regarding stability. The technique is associated with a low complication rate at the harvest site.
STUDY DESIGN
Case series; Level of evidence, IV.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Retrospective Studies; Adult; Male; Female; Tendons; Reoperation; Autografts; Young Adult; Transplantation, Autologous; Quadriceps Muscle; Adolescent; Middle Aged; Anterior Cruciate Ligament Injuries
PubMed: 38753014
DOI: 10.1007/s00402-024-05268-8 -
BMJ Case Reports May 2024We present two cases which underwent complex ocular surface reconstruction to achieve a stable ocular surface. Conjunctival autograft (CAG) procedure was required more...
We present two cases which underwent complex ocular surface reconstruction to achieve a stable ocular surface. Conjunctival autograft (CAG) procedure was required more than once, in addition to simple limbal epithelial transplantation to address extensive symblepharon in the eyes with total unilateral limbal stem cell deficiency secondary to acid ocular burns. These cases demonstrate that multiple CAGs may be harvested from the contralateral unaffected eye to correct recurrent symblepharon without any donor site complications if the correct surgical technique is adopted.
Topics: Humans; Burns, Chemical; Eye Burns; Conjunctiva; Autografts; Male; Adult; Female; Transplantation, Autologous; Conjunctival Diseases; Limbus Corneae; Recurrence
PubMed: 38749513
DOI: 10.1136/bcr-2023-256344