-
BMC Surgery Jun 2024We describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results.
PURPOSE
We describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results.
METHODS
The semitendinosus and gracilis tendons are braided into 5 strands and the ACL femoral tunnel and tibial tunnel are created. The graft is passed through the tunnel with the use of a traction suture and the tibial end is fixed with absorbable interference screws at 30° of knee flexion. The ACL graft traction suture is used as an anterolateral reconstruction structure to pass through the proximal exit of the ACL femoral tunnel and then through the depth of the iliotibial bundle to the anterior to Gerdy's tubercle, a bony tunnel is created from the anterior to Gerdy's tubercle to the goose foot, and the traction suture is passed through this bony tunnel to form a Loop structure at 20° of knee flexion. Between March 2021 and May 2022 IKDC score, Lysholm score, and Tegner score were performed preoperatively and 6-12 months postoperatively in 24 consecutive patients who met the indications for this procedure and underwent surgery. The patient's maximum flexion angle, the circumference of the thigh, and the stress X-ray between the operated and healthy knee were measured.
RESULTS
Patients showed significant improvement in IKDC score, Lysholm score and Tegner score at a mean follow-up of 7 months postoperatively compared to preoperatively. No significant increase in anterior tibial displacement was found between the patient's operated side and the healthy side.
CONCLUSION
The Loop technique ACLR combined with ALSA can be used in patients with an ACL tear combined with a high degree of positive pivot shift. The patient's subjective perception was significantly improved from the preoperative period and knee stability was restored.
LEVEL OF EVIDENCE
IV, therapeutic study.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Adult; Male; Female; Anterior Cruciate Ligament Injuries; Treatment Outcome; Young Adult; Follow-Up Studies; Suture Techniques; Range of Motion, Articular; Middle Aged; Tendons; Tibia; Adolescent
PubMed: 38877438
DOI: 10.1186/s12893-024-02439-7 -
Cureus May 2024Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two...
Functional Outcome of Single-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction using Peroneus Longus Graft and Hamstring Graft: An Open-Label, Randomized, Comparative Study.
Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two distinct graft sources: peroneus longus (PL) graft and hamstring graft. The choice of graft material in ACL reconstruction is crucial for optimal postoperative results, and this study aims to contribute valuable insights into the comparative efficacy of these two graft types. Method This open-label randomized comparative study involved a carefully selected cohort of patients undergoing single-bundle arthroscopic ACL reconstruction. Participants were randomly assigned to either the PL graft group or the hamstring graft group. Surgical procedures were conducted using standardized techniques, and postoperative rehabilitation protocols were closely monitored. Functional outcomes, including range of motion, stability, and patient-reported measures, were assessed at predefined intervals to ensure comprehensive data collection. Results The study underscores significant demographic and clinical factors in ACL reconstruction outcomes. Participants were predominantly aged 17-30 years (58.33%) with a mean age of 29.27 years and exhibited a male predominance (80.56%). Common complaints included knee pain and instability, primarily due to falls from bikes (55.56%) or sports-related trauma (44.44%). Notably, PL grafts demonstrated advantages over hamstring grafts, with longer mean length (10.11 mm vs. 8.77 mm, p=0.0001) and shorter operation times. Visual analog scale (VAS), International Knee Documentation Committee (IKDC), and Tegner Lysholm scores show no significant differences between grafts over the period of time. There is no notable foot eversion weakness or significant donor site morbidity after the PL graft harvest. Hamstring graft cases exhibit a higher incidence of altered sensation and muscle atrophy, suggesting the potential benefits of PL grafts for improved surgical outcomes. Conclusions Graft comparisons favored PL grafts due to longer length, and functional outcome assessments between the two graft types. However, foot and ankle strength assessments revealed fluctuations in strength recovery with PL grafts, highlighting the need for tailored rehabilitation. Thigh circumference variations suggested potential muscle atrophy in the hamstring graft group, along with reported paresthesia in the ipsilateral proximal leg. In conclusion, PL grafts offer potential advantages for ACL surgery, but ongoing monitoring and specialized rehabilitation are crucial.
PubMed: 38872693
DOI: 10.7759/cureus.60239 -
The Knee Jun 2024Gel-based autologous chondrocyte implantation (GACI) enables a simpler and more effective delivery of chondrocytes with reproducible three-dimensional structural...
BACKGROUND
Gel-based autologous chondrocyte implantation (GACI) enables a simpler and more effective delivery of chondrocytes with reproducible three-dimensional structural restoration of the articular cartilage surface. There is limited documentation of medium-term outcomes. This study assessed safety and effectiveness of GACI for treatment of cartilage defects of the knee.
METHODS
This multicentric retrospective study was conducted across eight hospitals in India. Patients who had undergone GACI (CARTIGROW®) between 2008 and 2014 for the treatment of focal articular cartilage defects of the knee (mean defect size 4.5 ± 5.8 cm) in limbs with normal alignment were analyzed. Primary outcomes were changes in Lysholm Knee Scoring Scale score, and Knee Outcome Sports Activity Scale (SAS).
RESULTS
A total of 107 patients (110 knee joints) with mean age 31.0 ± 10.5 years were included. The mean follow-up was 9.8 ± 1.5 years (range 7.85-13.43). Majority had osteochondritis dissecans (n = 51; 46.4%). The mean Lysholm Knee Scoring Scale score (81.23 ± 13.21 vs. 51.32 ± 17.89; p < 0.0001) and SAS score (80.93 ± 8.26 vs. 28.11 ± 12.28; p < 0.0001) improved significantly at follow-up as compared to pre-operative. Magnetic Resonance Observation of Cartilage Repair Tissue score in 39 patients at minimum 2 years follow-up was 84.5 ± 4.3. Among 30 patients who were playing sports before treatment, 17 patients (56.7%) could return to the same or higher level of sports post-transplantation. No major intra-operative or post-operative complications were noted. Four patients warranted revision surgery.
CONCLUSION
GACI is an effective treatment option for large focal articular cartilage defects of the knee with a low complication rate and revision rate and significant improvement in functional scores.
PubMed: 38870617
DOI: 10.1016/j.knee.2024.05.006 -
Arthroscopy : the Journal of... Jun 2024
PubMed: 38864804
DOI: 10.1016/j.arthro.2024.04.007 -
Scientific Reports Jun 2024In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this...
In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this study is to investigate the optimal immobilization position for conservative treatment of different types of PHFs. We hypothesized that the optimal position minimizing the deforming force in PHFs depends on the fracture components involved. PHF models involving either the surgical neck (SN) or greater tuberosity (GT) were created using 12 fresh-frozen cadaveric shoulders. In the SN model, the deforming forces on the pectoralis major muscle were measured in full adduction by increasing external rotation. In the GT model, the deforming force of the supraspinatus muscle was measured in neutral rotation by decreasing abduction, and the deforming force of the infraspinatus muscle was measured in full adduction by increasing internal rotation, respectively. In the SN model, the deforming force of the pectoralis major muscle increased significantly with external rotation from full internal rotation to neutral rotation (P = 0.006), indicating that the arm should be placed in full internal rotation. In the GT model, the deforming force of the supraspinatus muscle increased significantly with adduction from 45° of abduction to full adduction (P = 0.006); the deforming force of the infraspinatus muscle increased significantly with internal rotation from neutral rotation to full internal rotation (P = 0.006). These findings should be considered when placing the arm in abduction and neutral rotation so as to minimize the deforming force by either the supra or infraspinatus muscle. In conservative treatment for PHFs, the affected arm should be placed in a position that minimizes the deforming force on the fracture components involved.
Topics: Humans; Shoulder Fractures; Cadaver; Biomechanical Phenomena; Aged; Male; Female; Conservative Treatment; Aged, 80 and over; Immobilization; Middle Aged; Range of Motion, Articular
PubMed: 38862648
DOI: 10.1038/s41598-024-64326-8 -
Computer Methods and Programs in... Jun 2024Degenerative meniscus tissue has been associated with a lower elastic modulus and can lead to the development of arthrosis. Safe intraoperative measurement of in vivo...
BACKGROUND AND OBJECTIVE
Degenerative meniscus tissue has been associated with a lower elastic modulus and can lead to the development of arthrosis. Safe intraoperative measurement of in vivo elastic modulus of the human meniscus could contribute to a better understanding of meniscus health, and for developing surgical simulators where novice surgeons can learn to distinguish healthy from degenerative meniscus tissue. Such measurement can also support intraoperative decision-making by providing a quantitative measure of the meniscus health condition. The objective of this study is to demonstrate a method for intraoperative identification of meniscus elastic modulus during arthroscopic probing using an adaptive observer method.
METHODS
Ex vivo arthroscopic examinations were performed on five cadaveric knees to estimate the elastic modulus of the anterior, mid-body, and posterior regions of lateral and medial menisci. Real-time intraoperative force-displacement data was obtained and utilized for modulus estimation through an adaptive observer method. For the validation of arthroscopic elastic moduli, an inverse parameter identification approach using optimization, based on biomechanical indentation tests and finite element analyses, was employed. Experimental force-displacement data in various anatomical locations were measured through indentation. An iterative optimization algorithm was employed to optimize elastic moduli and Poisson's ratios by comparing experimental force values at maximum displacement with the corresponding force values from linear elastic region-specific finite element models. Finally, the estimated elastic modulus values obtained from ex vivo arthroscopy were compared against optimized values using a paired t-test.
RESULTS
The elastic moduli obtained from ex vivo arthroscopy and optimization showcased subject specificity in material properties. Additionally, the results emphasized anatomical and regional specificity within the menisci. The anterior region of the medial menisci exhibited the highest elastic modulus among the anatomical locations studied (9.97±3.20MPa from arthroscopy and 5.05±1.97MPa from finite element-based inverse parameter identification). The paired t-test results indicated no statistically significant difference between the elastic moduli obtained from arthroscopy and inverse parameter identification, suggesting the feasibility of stiffness estimation using arthroscopic examination.
CONCLUSIONS
This study has demonstrated the feasibility of intraoperative identification of patient-specific elastic modulus for meniscus tissue during arthroscopy.
PubMed: 38861877
DOI: 10.1016/j.cmpb.2024.108269 -
Radiology Advances May 2024Medial meniscus root tears often lead to knee osteoarthritis. The extent of meniscal tissue changes beyond the localized root tear is unknown.
BACKGROUND
Medial meniscus root tears often lead to knee osteoarthritis. The extent of meniscal tissue changes beyond the localized root tear is unknown.
PURPOSE
To evaluate if 7 Tesla 3D T2*-mapping can detect intrasubstance meniscal degeneration in patients with arthroscopically verified medial meniscus posterior root tears (MMPRTs), and assess if tissue changes extend beyond the immediate site of the posterior root tear detected on surface examination by arthroscopy.
METHODS
In this prospective study we acquired 7 T knee MRIs from patients with MMPRTs and asymptomatic controls. Using a linear mixed model, we compared T2* values between patients and controls, and across different meniscal regions. Patients underwent arthroscopic assessment before MMPRT repair. Changes in pain levels before and after repair were calculated using Knee Injury & Osteoarthritis Outcome Score (KOOS). Pain changes and meniscal extrusion were correlated with T2* using Pearson correlation ().
RESULTS
Twenty patients (mean age 53 ± 8; 16 females) demonstrated significantly higher T2* values across the medial meniscus (anterior horn, posterior body and posterior horn: all <.001; anterior body: =.007), and lateral meniscus anterior (=.024) and posterior (<.001) horns when compared to the corresponding regions in ten matched controls (mean age 53 ± 12; 8 females). Elevated T2* values were inversely correlated with the change in pain levels before and after repair. All patients had medial meniscal extrusion of ≥2 mm. Arthroscopy did not reveal surface abnormalities in 70% of patients (14 out of 20).
CONCLUSIONS
Elevated T2* values across both medial and lateral menisci indicate that degenerative changes in patients with MMPRTs extend beyond the immediate vicinity of the posterior root tear. This suggests more widespread meniscal degeneration, often undetected by surface examinations in arthroscopy.
PubMed: 38855428
DOI: 10.1093/radadv/umae005 -
Journal of Orthopaedic Surgery and... Jun 2024Arthroscopic tuberoplasty is an optional technique for managing irreparable rotator cuff tears. However, there is a lack of studies investigating the resistance force...
BACKGROUND
Arthroscopic tuberoplasty is an optional technique for managing irreparable rotator cuff tears. However, there is a lack of studies investigating the resistance force during shoulder abduction in cases of irreparable rotator cuff tears and tuberoplasty.
HYPOTHESES
In shoulders with irreparable rotator cuff tears, impingement between the greater tuberosity (GT) and acromion increases the resistance force during dynamic shoulder abduction. Tuberoplasty is hypothesized to reduce this resistance force by mitigating impingement.
STUDY DESIGN
Controlled laboratory study.
METHODS
Eight cadaveric shoulders, with a mean age of 67.75 years (range, 63-72 years), were utilized. The testing sequence included intact rotator cuff condition, irreparable rotator cuff tears (IRCTs), burnishing tuberoplasty, and prosthesis tuberoplasty. Burnishing tuberoplasty refers to the process wherein osteophytes on the GT are removed using a bur, and the GT is subsequently trimmed to create a rounded surface that maintains continuity with the humeral head. Deltoid forces and actuator distances were recorded. The relationship between deltoid forces and actuator distance was graphically represented in an ascending curve. Data were collected at five points within each motion cycle, corresponding to actuator distances of 20 mm, 30 mm, 40 mm, 50 mm, and 60 mm.
RESULTS
In the intact rotator cuff condition, resistance forces at the five points were 34.25 ± 7.73 N, 53.75 ± 7.44 N, 82.50 ± 14.88 N, 136.25 ± 30.21 N, and 203.75 ± 30.68 N. In the IRCT testing cycle, resistance forces were 46.13 ± 7.72 N, 63.75 ± 10.61 N, 101.25 ± 9.91 N, 152.5 ± 21.21 N, and 231.25 ± 40.16 N. Burnishing tuberoplasty resulted in resistance forces of 32.25 ± 3.54 N, 51.25 ± 3.54 N, 75.00 ± 10.69 N, 115.00 ± 10.69 N, and 183.75 ± 25.04 N. Prosthesis tuberoplasty showed resistance forces of 29.88 ± 1.55 N, 49.88 ± 1.36 N, 73.75 ± 7.44 N, 112.50 ± 7.07 N, and 182.50 ± 19.09 N. Both forms of tuberoplasty significantly reduced resistance force compared to IRCTs. Prosthesis tuberoplasty further decreased resistance force due to a smooth surface, although the difference was not significant compared to burnishing tuberoplasty.
CONCLUSION
Tuberoplasty effectively reduces resistance force during dynamic shoulder abduction in irreparable rotator cuff tears. Prosthesis tuberoplasty does not offer a significant advantage over burnishing tuberoplasty in reducing resistance force.
CLINICAL RELEVANCE
Tuberoplasty has the potential to decrease impingement, subsequently reducing resistance force during dynamic shoulder abduction, which may be beneficial in addressing conditions like pseudoparalysis.
Topics: Humans; Rotator Cuff Injuries; Middle Aged; Aged; Biomechanical Phenomena; Cadaver; Male; Female; Shoulder Joint; Rotator Cuff; Arthroscopy; Range of Motion, Articular; Shoulder Impingement Syndrome
PubMed: 38849918
DOI: 10.1186/s13018-024-04740-w -
Journal of Experimental Orthopaedics Jul 2024Septic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary...
PURPOSE
Septic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy.
METHODS
A systematic review and meta-analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all-cause complications, length of inpatient stay and mortality secondary outcomes.
RESULTS
A total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72-1.02], = 36%). Eligible studies found in favour of arthroscopy for all-cause complication rate (risk ratio 0.75 [95% CI: 0.6-0.93], = 84%) and length of stay in hospital (mean difference -1.98 days [95% CI: -3.43 to -0.53], = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52-2.63], = 57%).
CONCLUSION
Our analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All-cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates.
LEVEL OF EVIDENCE
Level III.
PubMed: 38846377
DOI: 10.1002/jeo2.12041 -
Cureus May 2024Anterior cruciate ligament (ACL) tears represent common occurrences in sports, particularly posing significant risks to young athletes. The diagnostic methods for ACL...
Nonsurgical Rehabilitation Perspectives for a Type I Salter-Harris Fracture With Lipohemarthrosis and Concomitant Grade II Anterior Cruciate Ligament (ACL) Tear in a Volleyball Athlete: A Case Report.
Anterior cruciate ligament (ACL) tears represent common occurrences in sports, particularly posing significant risks to young athletes. The diagnostic methods for ACL injury include magnetic resonance imaging (MRI), arthroscopy, and physical examination. Management of this injury can be done both operative and nonoperatively. Pediatric growth plate fractures are classified under the Salter-Harris classification. A 13-year-old male athlete sustained a knee injury during a volleyball match. While landing from a jump after a smash, the athlete directly landed on the ground on his right knee. After this, he reported discomfort and severe anterior knee pain. Due to immobility and pain, he was taken to the emergency unit. Upon radiographic examination, a Salter-Harris Classification Type I fracture was found, indicating epiphyseal slip and separation through the physis of the right proximal tibia medially. An MRI imaging was done to check the integrity of the ACL after the swelling had subsided post-15 days of injury. An MRI identified a bony contusion on the medial tibial plateau, extending to the physeal plate with a Grade II ACL tear. The concurrent occurrence of ACL injury and growth plate injury presents a significant concern. Hence, a referral for physical therapy rehabilitation was given. Our findings highlight the importance of prompt initiation of physical rehabilitation following such injuries. Where non-surgical rehabilitation strategies play a crucial role in managing these cases while focusing on restoring knee stability, promoting healing of the growth plate, and facilitating a safe return to sport. Tailored rehabilitation, including therapeutic exercises, neuromuscular training, and proprioceptive training, is essential for optimizing outcomes and preventing long-term complications. The case underscores the importance of a multidisciplinary approach in managing the complex knee injury of this young athlete.
PubMed: 38846221
DOI: 10.7759/cureus.59758