Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

Purpose The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL. Study design Cross-sectional study, Level of evidence III. Methods In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05). Results 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78). Conclusion Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.

Đánh giá kết quả phẫu thuật tái tạo hai dây chằng chéo khớp gối một thì bằng gân tự thân với kỹ thuật nội soi

Mục tiêu: Đánh giá kết quả tái tạo hai dây chằng chéo khớp gối 1 thì qua nội soi. Đối tượng và phương pháp: Nghiên cứu tiến cứu với 52 bệnh nhân (31 nam và 21 nữ) được tái tạo hai dây chằng chéo khớp gối từ tháng 8 năm 2008 đến tháng 2 năm 2019. Thời gian theo dõi tối thiểu 1 năm sau phẫu thuật (từ 12 đến 92 tháng). Kết quả: Đánh giá kết quả sau phẫu thuật ít nhất 1 năm theo các thang điểm IKDC và Lysholm. Theo phân loại theo IKDC-2000, tại thời điểm theo dõi có 5 bệnh nhân xếp loại A, 32 bệnh nhân xếp loại B, 15 bệnh nhân xếp loại C so với 52 loại D thời điểm trước phẫu thuật. Theo thang điểm của Lyshom, điểm trung bình tại thời điểm theo dõi là 86,9 ± 9,5 điểm so với trước mổ là 43,6 ± 9,3 (cụ thể có 5 rất tốt, 33 tốt, 14 bệnh nhân kết quả trung bình. Kết luận: Phẫu thuật tái tạo hai dây chằng chéo khớp gối tuy bệnh nhân không thể phục hồi hoàn toàn như trước khi bị chấn thương nhưng hầu hết bệnh nhân phục hồi chức năng ổn định và đã cải thiện đáng kể chức năng khớp gối so với tình trạng trước phẫu thuật của họ.

Ultrasound-assisted Endoscopic Evacuation of Recurrent Calf Hematoma Following Anterior Cruciate Ligament Reconstruction. Case Study

Hematoma of the calf is a rare complication following anterior cruciate ligament reconstruction (ACLR). The golden standard method of its treatment is puncture and aspiration. More advanced procedures are needed in difficult cases, such as prolonged he­ma­tomas. Among the novel management choices is endoscopy with ultrasound guidance. The aim of the study was to present the management of a post-surgical hematoma of the calf using endoscopic and ultrasound-assisted surgery. A 48-year-old patient un­der­went arthroscopic ACLR grafted with hamstrings tendons (semitendinosus and gracilis). Due to a hematoma developing at the donor site, he experienced edema and paresthesiae of the calf and foot that enhanced over time. An open reoperation failed and symptoms recurred. A second reoperation was performed as an endoscopic and ultrasound-assisted mini-invasive procedure. Re­sults were assessed postoperatively using the IKDC 2000 and Lysholm questionnaires. An evident increase in IKDC 2000 Score (from 14.9 points after open surgery to 77.0 one week after endoscopic treatment) and Lysholm Scale (26 points after first surgery and 84 one week after endoscopic surgery) was observed after the mini-invasive procedure. Edema and paresthesiae of the affect­ed limb completely disappeared four weeks after endoscopy. No complications of the novel procedure were found. Accordingly, en­doscopic and ultrasound-assisted evacuation of a prolonged calf hematoma appears an effective minimally-invasive and tar­geted procedure.

Composite Xenohybrid Bovine Bone-Derived Scaffold as Bone Substitute for the Treatment of Tibial Plateau Fractures

Introduction: Tibial plateau fractures represent a common challenge for orthopaedic surgeons, sometimes representing complex cases to manage, where augmentation using bone grafts is required for stabilisation. Autologous iliac bone graft (AIBG) is the current gold standard for bone grafting. In order to overcome limitations related to the procedure, alternative strategies, like allogenic and xenogeneic bone substitutes have been investigated. Here, within the framework of an observational clinical study, we report clinical and radiological outcomes of patients treated for tibial plateau fractures with a composite xenohybrid bone graft, aiming at assessing clinical and radiological outcomes. Materials and Methods: We performed a cohort retrospective study of patients treated for tibial plateau fractures from May 2017 to January 2018. Thirty-four patients, i.e. 100% of those having received the bone graft under investigation for tibial plateaux fracture treatment, met the inclusion criteria and were enrolled in the study. Patients were assessed at 2 weeks, and then at a 1-, 3-, and 6-months, and 1-year follow-up. At each evaluation patients filled a visual analogue scale (VAS) for the level of pain during the day life activities and underwent physical exam and anteroposterior and lateral projection radiographs of the knee. At 1 year the Tegner Lysholm Scoring Scale, International Knee Document Committee 2000 (IKDC 2000), and Short Form (36) Health Survey (SF-36) were administered. Results: At 1-year, mean VAS decreased from 6.33 ± 1.40 to 1 ± 0.79 (P < 0.0001); Tegner Lysholm Scoring Scale was 89 ± 4.10 and mean IKDC 2000 was 78.67 ± 3.31. No infections, neurovascular complications or adverse effects related to implants were reported during the clinical exams at follow-up. Mean ROM was 124 ± 6°. Radiographs did not show defects of consolidation or progressive post-surgical subsidence and demonstrated a good grade of integration of the implant. Conclusions: Clinical and radiological outcomes, and scores of questionnaires, were good. The xenograft has demonstrated to be a safe biomaterial, with satisfactory mechanical and biological performances in the mid-term period. It also showed a high grade of osteointegration and remodelling.

Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique

Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System. The outcome was evaluated both clinically and with three separate outcome systems (IKDC 2000, KOOS, Lysholm) at one and a mean four year follow-up. We demonstrated excellent clinical results in all patients. At four years, all scoring systems demonstrated statistically significant improvement when compared to the preoperative status. Our study suggests that the AO Hook Fixation System is an alternative method of surgical intervention with comparable medium term results with other existing modes of fixation and the added biomechanical advantage of the absence of distracting forces during hardware removal.

Single-Legged Hop Tests as Predictors of Self-Reported Knee Function in Nonoperatively Treated Individuals With Anterior Cruciate Ligament Injury

Background: Previous studies have found significant predictors for functional outcome after anterior cruciate ligament (ACL) reconstruction; however, studies examining predictors for functional outcome in nonoperatively treated individuals are lacking. Hypothesis: Single-legged hop tests predict self-reported knee function (International Knee Documentation Committee [IKDC] 2000) in nonoperatively treated ACL-injured individuals 1 year after baseline testing. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Ninety-one nonoperatively treated patients with an ACL injury were tested using 4 single-legged hop tests on average 74 ± 30 days after injury in a prospective cohort study. Eighty-one patients (89%) completed the IKDC 2000 1 year later. Patients with an IKDC 2000 score equal to or higher than the age- and gender-specific 15th percentile score from previously published data on an uninjured population were classified as having self-reported function within normal ranges. Logistic regression analyses were performed to identify predictors of self-reported knee function. The area under the curve (AUC) from receiver operating characteristic curves was used as a measure of discriminative accuracy. Optimal limb symmetry index (LSI) cutoff for the best single-legged hop test was defined as the LSI with the highest product of sensitivity and specificity. Results: Single hop for distance symmetry indexes predicted self-reported knee function at the 1-year follow-up ( P = .036). Combinations of any 2 hop tests (AUC = 0.64-0.71) did not give a higher discriminative accuracy than the single hop alone (AUC = 0.71). A cutoff of 88% (LSI) for the single hop revealed a sensitivity of 71.4% and a specificity of 71.7%. Conclusion: The single hop for distance (LSI) significantly predicted self-reported knee function after 1 year in nonoperatively treated ACL-injured patients. Combinations of 2 single-legged hop tests did not lead to higher discriminative accuracy than the single hop alone.

Lesão do ligamento cruzado anterior (LCA) do joelho em população indígena do estado do Amazonas, Brasil

Em agosto de 2003, foram estudados 151 indígenas (88 homens e 63 mulheres) da etnia Ticuna, que se localiza nas proximidades da cidade de Tabatinga, Amazonas. Foi determinada a ocorrência de lesão do ligamento cruzado anterior (LCA), mediante um protocolo de exame físico baseado no "International Knee Documentation Committee" - IKDC 2000. Cerca de 14% dos homens sofreu lesão do LCA, contra 3% das mulheres, e 88% da população examinada apresentou alinhamento dos joelhos em varo. O expressivo índice de lesão encontrado se deve a questões culturais, provavelmente à prática do futebol, sendo o isolamento geográfico o fator decisivo para a falta de diagnóstico e tratamento dos indígenas.

Ocorrência de entorse e lesões do joelho em jogadores de futebol da cidade de Manaus, Amazonas

Foram estudados 50 jogadores de dois times profissionais e 47 jogadoras de três times amadores de futebol do Estado do Amazonas, todos da primeira divisão e sediados em Manaus. Foi determinada a ocorrência de entorse do joelho e lesões decorrentes, mediante uma entrevista sobre a história de entorse do joelho, além de avaliação subjetiva e exame físico, segundo o International Knee Documentation Committee (IKDC 2000). Entre os jogadores, 16 (32%) haviam referido entorse do joelho, sendo 14 (28%) unilateral e 2 (4%) bilateral. Entre as jogadoras, 11 (23%) haviam referido entorse do joelho, sendo 9 (19%) unilateral e 2 (4%) bilateral. Dez (63%) dos jogadores com entorse sofreram lesões ligamentares ou meniscais, dos quais 7 atletas submeteram-se à cirurgia, sendo 6 meniscectomias e 2 reconstruções do ligamento cruzado anterior. Não encontramos lesões do joelho entre as jogadoras de futebol examinadas. O tempo médio de afastamento dos atletas foi em torno de 3,5 meses em ambos os sexos, sendo que entre os jogadores o tempo médio de retorno foi quase 3 vezes maior naqueles que sofreram lesões ligamentares ou meniscais. A média da pontuação do IKDC subjetivo foi no sexo masculino de 95 pontos e de 96 pontos no sexo feminino.