Arthroscopic-assisted Anterior Cruciate Ligament Research Articles

Press-Fit-Hybrid Technique for Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons

Arthroscopic-assisted anterior cruciate ligament reconstruction follows standardized protocols. Multiple fixation techniques are known. Discussion has been raised about osseus fixation and integration. To improve a biological osseous fixation of the anterior cruciate ligament transplant, a Press-Fit-Hybrid technique has been developed. The basic principle is to recycle bony cylinders obtained from the femoral and tibial tunnel to fix the transplant in the femoral and tibial tunnel. In addition to the biological advantage, there are additional economic benefits, such as no extra fixation material is necessary compared with common fixation techniques, and the overall surgical procedure requires minimal effort.

A STUDY OF FUNCTIONAL OUTCOME OF ACL RECONSTRUCTION WITH ANATOMICAL HAMSTRING TENDON AUTOGRAFT

Background: The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. Anterior Cruciate Ligament (ACL) reconstruction is an established and widely practiced surgical procedure with proven efcacy and a low morbidity prole. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with anatomical hamstring grafts are availability of a greater sectional area and unaffected integrity of the extensor mechanism. Moreover tensile strength of quadrupled anatomical hamstring is found to be even better than a normal ACL. The rate of complications like extension loss, anterior knee pain and surgical site infections was also lower than other procedures. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial xation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture xation methods like the interference screws allows for early rm xation and heal with tight bone-tendon interface. To evalua Objectives: te functional outcome of arthroscopy assisted ACL reconstruction with anatomical hamstring tendon graft using Endobutton and Bioabsorbable interference screw and tibial disc. The Methodology: study results included 30 patients admitted with clinical and radiological deciency of ACL during October 2021 to December 2022, in Department of Orthopaedics, SMIMER Hospital, Surat. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction with anatomical hamstring tendon graft using Endobutton and Bioabsorbable interference screw and tibial disc in terms of range of motion, postoperative knee stability, graft site morbidity, subjective knee functions and prospective assessment of functional outcome using Tegner Lysholm knee scoring system. All the patients included in the s Results: tudy were 23 male and 2 female patient. The analysis of the studied cases revealed that the most common affected age group was between 18 to 24 years .. Majority of patients were operated more than 6 months after injury. Sports/BPET (Battle Physical Efciency Test) injuries was the most common mode of injury. The mean size of graft used was 8.2±0.39.Post-operatively at 3, 6, 12month follow up,1 case (4%) had a positive Pivot shift test with a "Glide" (Grade-I), whereas remaining 24 cases (96%) had a negative Pivot shift test. None of the patients had grade III laxity. The mean postoperative Lysholm score improved from preoperative score of 66±5.2 to 88.70±5.54. The overall satisfactory result (excellent + good) at follow up was 95%. All the patients had returned to preinjury level of activity. ACL injuries are common in younger age group individuals. S Conclusion: ports related injury and RTA are the most common modes of injury. Arthroscopy assisted ACL reconstruction using Anatomical hamstring tendon autograft provides a stable knee, reduces postoperative morbidity and enables early rehabilitation. Graft xation using endobutton and and Bioabsorbable interference screw will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs. It allows the patients to return to preinjury level of activity, allows the patient to squat, sit crossed leg and climb stairs without difculty. Degeneration of the articular surfaces rarely occurs and the re-operation rates are minimal.

The tibial insertion of the hamstring can be considered to be preserved during anterior cruciate ligament reconstruction.

BackgroundHamstring as a graft was very common in anterior cruciate ligament reconstruction surgery. Usually the hamstring muscles needed to be taken out and then woven to be used.AimIn order to investigate whether it was beneficial for patients to preserve the transpedicular insertion of hamstring when using the hamstring as a graft for anterior cruciate ligament reconstruction.MethodsThis was a retrospective study. Patients with anterior cruciate ligament injury who underwent surgery in a large hospital from January 2015 to May 2021 were included in the study. These patients underwent anterior cruciate ligament reconstruction assisted by arthroscopic. Autologous hamstring muscles were used as grafts. The tibial insertion of the hamstring were preserved during the operation were included in the observation group. The remaining patients were included in the control group. The knee joint function and operation of the two groups were compared.ResultsA total of 97 patients were included in the study. There was no statistical difference between the two groups in general data including gender, age and surgical side. All the patients’ operations were successfully completed there was no significant difference in the operation time between the two groups. All patients were followed up for at least 1 year. No patients had complications such as wound infection and graft failure at the last follow-up. There was no significant difference between the two groups in Lysholm score and IKDC score before operation. Similarly, there was no significant difference between the two groups in Lysholm score and IKDC score 3 months after operation. However, the Lysholm score and IKDC score of the two groups 1 year after operation were statistically different, and the patients in the observation group had higher Lysholm score and IKDC score. After comparing the MRI images of the knee of the two groups 3 months after operation through the MRI evaluation system, compared with the patients in the control group, the patients in the observation group have higher scores, and the difference was statistically significant.ConclusionIn the knee arthroscopic assisted anterior cruciate ligament reconstruction using the hamstring as a graft, the tibial insertion of the hamstring can be preserved, which can make the patient have better function after the operation. This kind of operation leads to the increase of operation time and operation risk.

Poster 256: The "N+10 Rule" to Avoid Graft Tunnel Mismatch in Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction Using Independent Femoral Tunnel Drilling

Objectives: To determine the amount of tibial graft tunnel mismatch during application of the “N+10” rule in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) graft using independent femoral tunnel drilling.To compare actual (measured) tibial tunnel length and desired (calculated) tibial tunnel length when using the “N+10” rule for independent femoral tunnel drilling. Methods:Twenty paired knees from 10 fresh frozen cadaveric specimens (5 female and 5 male specimens) underwent arthroscopic assisted bone-patellar tendon-bone ACL reconstruction using independent femoral tunnel drilling with either a hyperflexion accessory anteromedial portal (n=10) or flexible reamer technique (n=10). The prepared patellar tendon graft bone blocks were trimmed to 10 x 20mm for all specimens and the intertendinous distance (N) between the bone blocks was measured. The “N+10 Rule” was used to set the angle of the ACL tibial tunnel guide to the appropriate degree setting for drilling. The amount of excursion or recession of the tibial bone plug in relation to the anterior tibial cortical aperture was measured in both flexion and extension. A +/-6mm threshold was used to assess this strategy based on prior biomechanical aperture fixation studies. As a secondary outcome, the intraarticular distance (IAD) and the actual tibial tunnel length (TTL) were measured and compared to the planned TTL based on the equation: IAD + TTL = N + 20 (size of bone plug in millimeters)Results:The average BTB ACL intertendinous distance (N) was 47.5mm (SD =5.5mm). The average measured IAD was 27.2mm (SD=3.0mm). Using the “N+10 Rule”, the average mismatch of the tibial tunnel was 4.9mm (SD=3.6mm) and 3.8mm (SD=3.5mm) in flexion and extension, respectively. Both values fall within the +/- 6mm threshold. When comparing the actual measured tibial tunnel length (TTL) to the desired TTL, there was an average difference of 5.4mm (SD=3.9mm)Conclusions:The “N+10” rule resulted in an acceptable average mismatch in both flexion and extension using the threshold of +/- 6mm for 20 cadaveric knees. Measured actual TTL compared to the desired calculated TTL were acceptable 61% of the time using the same threshold. The “N+10” is a simple and effective intraoperative strategy for achieving desired tibial tunnel length to avoid excessive graft tunnel mismatch.Figure 1:Derived formula for calculating ideal tibial tunnel length (TTL) using intraarticular distance (IAD), and the known values of the intertendinous distance (N) and lengths of the bone blocks (20mm).Figure 2:Intraoperative photo of BTB ACL graft measuring intertendinous distance between the bone plugs (N=55mm). Following the "N+10" ruleFigure 3:Intraoperative photo of tibial ACL guide measurement of tibial tunnel length at 50mm with guide set to 65 degrees.Figure 4:Intraoperative photo of the ACL tibial tunnel guide positioned on the anatomic tibial footprint set to 65 degrees (N=55mm). Using this setting for the guide, the tibial tunnel measured 50mm as seen in the zoomed in photo, as per the formula.

Clinical effects of arthroscopy-assisted anterior cruciate ligament tibial eminence avulsion fracture compared with traditional open surgery:a Meta-analysis

To systematically evaluate the clinical efficacy of arthroscopy and traditional incision in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL). From July 2010 to July 2020, clinical comparative trial about arthroscopy and traditional incision in the treatment of ACL tibial avulsion fracture was conducted by using computer-based databases, including Embase, Pubmed, Central, Cinahl, PQDT, CNKI, Weipu, Wanfang, Cochrane Library, CBM. Literature screening and data extraction were carried out according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by improved Jadad score and Ottawa Newcastle scale (NOS). The operation time, hospital stay, fracture healing time, knee range of motion, postoperative excellent and good rate, complication rate, Lysholm score, International Knee Documentation Committee (IKDC) score and Tegner score were statistically analyzed by Review Manager 5.3 software. Finally, 16 literatures were included, including 1 randomized controlled trial and 15 non randomized controlled trials, with a total of 822 patients (405 in arthroscopy group and 417 in traditional incision group). Meta analysis showed that the operation time [MD=-9.03, 95% CI(-14.36, -3.70), P<0.001], hospital stay [MD=-5.81, 95%CI(-9.32, -2.31), P=0.001] and fracture healing time [MD=-14.61, 95% CI(-17.93, -11.28), P<0.001] in the arthroscopy group were better than those in the traditional incision group. The incidence of complications in arthroscopy group was lower than that in traditional incision group[OR=0.15, 95%CI(0.07, 0.33), P<0.001]. The postoperative excellent and good rate[OR=4.39, 95%CI (1.96, 9.82), P<0.001], knee mobility[MD=6.78, 95%CI(2.79, 10.77), P<0.001], Lysholm score[MD=11.63, 95%CI(4.91, 18.36), P<0.001], IKDC score[MD=7.83, 95%CI(6.09, 9.57), P<0.001] and Tegner score[MD=0.60, 95%CI(0.31, 0.89), P<0.001] in the arthroscopic group were higher than those in the traditional incision group. Compared with the traditional open reduction and internal fixation, arthroscopic surgery in patients with ACL tibial avulsion fracture can shorten the operation time, hospital stay and fracture healing time, reduce the incidence of postoperative complications, and obtain good postoperative knee function. It can be recommended as one of the first choice for patients with ACL tibial avulsion fracture.

Assessment of an Intra-Articular Drain in Arthroscopy-Assisted Anterior Cruciate Ligament Reconstruction.

IntroductionThe use of a drain after various types of arthroscopic surgeries has long been debated. Whether a drain offers an advantage in terms of pain, swelling, and functional outcome after arthroscopy-assisted reconstruction of the anterior cruciate ligament (ACL) needs to be investigated. This study was designed to assess the validity of the use of an intra-articular drain after routine arthroscopic ACL reconstruction and to assess the various complications associated with its use.Material and methodsForty-four patients (group I included patients for whom an intra-articular drain was used and group II included patients for whom an intra-articular drain was not used) diagnosed with ACL injury were included in the study. The patients in group I had a drain placed inside the joint, while those in group II had a drain placed outside the joint cavity but the drain placement was such that there remained no patient or observer bias.ResultsOutcome assessment was performed on days one, two, and three followed by weeks one, four, and eight, and six months after surgery by determining a visual analog pain (VAS) score. The assessment was also done for the range of motion (ROM) in terms of loss of flexion and extension with a hand-held goniometer, knee hemarthrosis, and thigh circumference. Although there was a difference in both the groups in terms of the above-mentioned parameters in the early post-operative period, the difference becomes insignificant at the final follow-up at six months.ConclusionFrom this study, we conclude that putting an intra-articular drain after ACL reconstruction offers no advantage in terms of functional outcome in the long term.

Intraoperative Scrub Nurse Handoffs Are Associated with Increased Operative Times for Lower Extremity Orthopaedic Sports Procedures

PurposeThe purpose of this study was to evaluate the effect of intraoperative scrub nurse handoffs on surgical times for arthroscopically-assisted anterior cruciate ligament (ACL) reconstructions and hip arthroscopies.MethodsA retrospective chart review was done at a major, urban academic medical center for all patients who underwent arthroscopically-assisted ACL reconstructions and hip arthroscopies for femoroacetabular impingement syndrome between May 2014 and May 2020. All ACL reconstructions were performed by 1 of 6 sports medicine fellowship–trained surgeons, and all hip arthroscopies were performed by a single surgeon. Operative times, number of scrub nurse handoffs, surgeon, patient demographics, and procedure-specific information were recorded. The association between patient characteristics and the number of handoffs, as well as the association between patient characteristics and operative times, stratified by scrub nurse handoffs, were calculated. A multivariable linear regression was performed to assess the association between intra-operative handoffs and operative times.ResultsEight hundred twenty ACL reconstructions and 269 hip arthroscopies were identified. Multivariable linear regression demonstrated increasing intraoperative scrub nurse handoffs were associated with increased operative times for all patients. For ACL reconstructions, when including all possible covariates, 1 scrub nurse handoff increased operative times by 21.1 minutes (95% confidence interval [CI]: 15.36 to 26.89; P < .001), and 2+ handoffs increased operative times by 34.2 minutes (95% CI: 26.28 to 42.15; P < .001). For hip arthroscopies, 1 scrub nurse handoff increased operative times by 7.0 minutes (95% CI: 0.31 to 13.74; P = .04).ConclusionAlthough a causal link cannot be made, intraoperative scrub nurse handoffs were associated with statistically significant increase in operative times for both ACL reconstructions and hip arthroscopies.Level of EvidenceLevel III, retrospective cohort study.

FUNCTIONAL OUTCOME OF ARTHROSCOPE ASSISTED RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT USING BONE-PATELLAR TENDON-BONE GRAFT

Objective: To evaluate arthroscopic assisted Anterior Cruciate Ligament (ACL) reconstruction using Bone-Patellar Tendon-Bone (BPTB) graft using anteromedial approach to drill the femoral tunnel followed by accelerated ACL rehabilitation protocol in terms of Lysholm score. Study Design: Prospective comparative study. Place And Duration Of Study: The study was conducted in Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar from May 2018 to April 2019. Methodology: This study was an analysis of prospectively collected data of patients who had undergone Anterior Cruciate Ligament reconstruction. All patients below the age of 35 years presenting with Anterior Cruciate Ligament Grade 3 tear were assessed objectively and subjectively using Lysholm score pre and post operatively. Manual laxity of knee was assessed with anterior drawer and Lachman test; and being compared with normal contralateral knee. Rotational instability was assessed by pivot shift test. Results: Nineteen patients, all males, were included in this study with the mean age of 26.7 ± 4.68 years. All patients underwent arthroscopic assisted Anterior Cruciate Ligament reconstruction with uneventful recovery. Every patient had his pre and post-operative Lysholm scoring done. Mean pre-operative Lysholm score was 53.89± 3.81. Patients were followed up at 5 months and at 9 months and their mean Lysholm scores were 84.74 ± 6.31 and 92.47 ± 3.04 respectively with the p-value of &lt;0.001. Only 2 patients had residual Grade I Lachman laxity and none of the patients had any rotational instability. Conclusion: Arthroscopic assisted Anterior Cruciate Ligament reconstruction using Bone-Patellar Tendon-Bone graft followed by accelerated Anterior Cruciate Ligament rehabilitation protocol led to signicant improvement of Lysholm score.

Minimally invasive treatment of portal pseudoaneurysm in a haemophiliac after knee arthroscopy

The formation of a pseudoaneurysm or ‘false’ aneurysm is a rare vascular complication of arthroscopic surgery. Its occurrence is even more uncommon in the background of a clotting disorder. We present a case of a recreational athlete with a history of haemophilia, who developed a pseudoaneurysm over an arthroscopic portal site following arthroscopic-assisted anterior cruciate ligament reconstruction. The lesion was treated successfully with image-guided thrombin injection. We discuss the association between haemophilia and pseudoaneurym formation as well as prevention methods and treatment options.

A descriptive study of arthroscopy assisted anterior cruciate ligament reconstruction and evaluation of its functional outcome using Lysholm score

With the new advancements in the technology being used in orthopedic surgeries like arthroscopic reconstruction of joint injuries, the surgical outcome has improved a lot over the period of time. Arthroscopic reconstruction of the ACL ligament is one of the most commonly performed knee surgeries nowadays. The first arthroscopically assisted ACL reconstruction was performed in 1980 using an artificial ligament made out of carbon fiber supplemented with an extra-articular lateral substitution. Later in the first decade of twenty first century, anterior cruciate ligament reconstruction using Hamstring tendon autograft showed excellent self-reported and objective results. It was proved further that the outcome measures which favored Semitendinosus and Gracilis autografts included anterior knee pain, kneeling pain and extension loss. Long term studies have shown to have equal success rates with quadrupled Hamstring tendon graft or bone patellar tendon bone graft. We conducted this study to evaluate the anterior cruciate ligament injuries, their arthroscopic surgical reconstruction and their functional outcome using Lysholm score over a period of 6 months follow up. 52 Patients admitted in the Orthopedic department of the hospital with ACL injuries were included in the study. 36% of the population had ACL injury due to RTA, 33% of the population had ACL injury due to fall and 31% of the population had ACL injury due to sports injury. 55.8% of the patients underwent surgery within 4 months of the injury. 29% of the patients had associated injuries, while 6% had complications post-op. Mean Lysholm score showed significant improvement post-operatively on evaluation at 6 weeks, 3 months and 6 months. 73.1% patients underwent ACL reconstruction, 15.4% had ACL reconstruction with Meniscal Debridement while rest 11.5% underwent ACL reconstruction with Meniscal Repair.

Comparative analysis of the functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft fixed with bio absorbable interference screw against titanium interference screw

INTRODUCTION: Knee injuries are more common in the modern era due to increase in road traffic accidents and more involvement in sports related activities by common people. Anterior cruciate ligament is the most commonly injured ligament around knee joint. Anterior cruciate ligament has a pivot role in function and stability of the knee joint, being the primary stabilizer preventing the anterior translation of tibia over femur. Arthroscopic anterior cruciate ligament reconstruction has become the gold standard in the management of these injuries. AIM OF THE STUDY: To do comparative analysis of the functional outcome of Arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft with endobutton as femoral fixation device and bioabsorbable interference screw against titanium interference screw as tibial fixation devices respectively. MATERIALS & METHODS: This study is a retrospective and prospective study of 60 patients treated with arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as the femoral fixation device and titanium interference screw (no=30) and bioabsorbable interference screw (no=30) as tibial fixation device respectively between May 2012 and November 2013 at Institute of orthopaedics and traumatology, Rajiv Gandhi Government General Hospital, Chennai. Minimum age of the patient was 20 years and maximum age was 55 years with mean age of 31. Study group included 51 male patients and 9 female patients. Minimum duration after injury was 5 weeks and maximum duration since injury was 15 months. Minimum period of follow up was 6 months and maximum was 1.5 years. Of the 60 patients, 30 patients underwent arthroscopic assisted anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as femoral fixation device and tiatanium interference screw as tibial fixation device. Remaining 30 patients underwent arthroscopic assisted anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as femoral fixation device and bioabsorbable interference screw as tibial fixation device. All patients were operated under spinal aneasthesia. Except for 2 patients, postopearative period was uneventful for others. RESULTS: All patients are evaluated with Lysholm and Gillquist scoring at the end of 6 months. The maximum score achieved was 100 and minimum score was 56. Two patients in titanium interference group and one patient in bioabsorbable interference screw group lost to followup. Statistical analysis was studied using Yate’s corrected Chi-Square test. No significant differences were identified between the two screw typeswith respect to Lysholm and Gillquist scoring. The complication rates were also similar in the two groups. CONCLUSION: The clinical results associated with titanium interference screw and bioabsorbable interference screw are statistically similar. The complication rates associated with the two screws were also similar. The results of this comparative analysis support the hypothesis that there are no significant differences in the outcomes associated with tiaanium screws compared with bioabsorbable screws for ACL reconstruction.

Effect of drains on dynamic proprioception after arthroscopically assisted anterior cruciate ligament reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Decrease in proprioception and kinesthesia occurs after ACL injury. Changes occurring within the joint following injury affect normal recruitment and firing patterns of the surrounding musculature. There are little data in the literature with reference to drain use after arthroscopic procedures on the knee or ACL reconstruction. The objective of the study was to determine the effect of postoperative drain use on proprioception after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study, 54 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or non-drain group. Outcome Assessment was done at 1 month, 3, 6 and 12 months after the surgery in which patients were assessed using Star excursion balance test by measuring excursion distances in each of the 8 directions.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Excursion distances in eight directions showed more increment in drainage tube (DT) group compared to no DT group. However it was found to be statistically significant only for posteromedial (p =0.018) and medial directions (p &amp;lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Postoperative drain should be used after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft for improving the deficits in dynamic posture control.&lt;/p&gt;

Effect of drainage tube on knee function after arthroscopically assisted anterior cruciate ligament reconstruction

Background: There is a paucity of literature evaluating the use of intra-articular drains after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction and their effects on knee function. Objective: The aim of this study is to determine the effect of postoperative drain use on knee function after ACL reconstruction with quadrupled hamstring graft. Materials and Methods: In this study, 44 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or nondrain group. Outcome assessment was done on postoperative day 4, day 10, 1 month, 3, 6, and 12 months after the surgery in which patients were asked to complete a visual analog pain scale. They were assessed for a range of motion (ROM) in flexion and extension with a universal goniometer, knee effusion, and knee stability by Lachman's test. Results: Both treatment and control groups showed no statistical significant difference in flexion of the knee through the ROM (P = 0.116). The percentage reduction in knee effusion was found to be statistically significant at 4 th (P < 0.001), 10 th (P < 0.001) 16, and 1 month (P = 0.012) in between treatment and control group. The overall pain difference between the two groups was not found to be statistically significant (P = 0.198). Conclusion: Clinically, the drain group showed faster pain relief, lesser effusion, and early return to motion compared to the no-drain group but was not statistically significant.

Return to Sports and Functional Outcome after Primary Anterior Cruciate Ligament Reconstruction in Jamaica

Objective: The aim of this study was to assess the function and number of patients who returned to sports after undergoing primary anterior cruciate ligament reconstruction. Methods: The study consisted of two arms, a retrospective and a prospective arm. For the retrospective arm, the medical records of patients who underwent primary anterior cruciate ligament reconstruction between January 1, 2005 and December 31, 2010 were reviewed. For the prospective arm: patients seen between January 1st, 2011 and December 31st, 2011 were reviewed. The subjects were then contacted and evaluated by the Tegner-Lysholm Score, the International Knee Documentation Committee (IKDC) score, clinical knee examination and KT-1000 arthrometer. The patient’s ability to return to sports was documented. The data was analyzed using EXCEL 2008 and SPSS version 20 for Mac. Results: Seventy three (73) patients were identified, of which 46 were included in the study. Thirty two (32) patients participated in competitive sports. Majority of the patients were males (32/46), average age was 27 years (range 16 -51) at the time of surgery. All patients underwent single bundle arthroscopic-assisted anterior cruciate ligament reconstruction with ipsilateral patella bone-tendon bone autograft. After surgery 36 (78%) patients returned to sports. The majority of patients had good knee-impairment function. Patients took approximately 9 months (range 2-19) to return to sports. 24 (66%) patients returned to their pre-injury level and 12 (34%) patients returned to a lower level. Ten (10) patients did not return to sports. Fear of re-injury was the most common reason. Conclusion: Despite good short and long-term knee outcome scores, athletes were still fearful of re-injury and this prevented them from returning to their previous level of sports.

Effect of drainage tube on muscle strength &amp; knee function after arthroscopically assisted anterior cruciate ligament reconstruction

Background: There is a paucity of literature evaluating the use of intra-articular drains after arthroscopic procedures. The aim of this study is to determine the effect of postoperative drain use on muscle strength and knee function after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft. Method: 44 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or non-drain group. All arthroscopic ACL reconstructions using a four strands hamstrings graft as auto graft were included in the trial. Assessment was done on postoperative day 4, day10, 1 month, 3, 6 and 12 months after the surgery in which patients were asked to complete a visual analogue pain scale, were assessed for range of motion, knee effusion, measurement of quadriceps and hamstrings using dynamometer. Result: Comparison of quadriceps strength between the two groups showed no statistical significant difference at 30 degrees. (p <0.167) and 90 degrees (0.115) of knee flexion. Statistically significant difference was seen at 60 degrees knee flexion. (p = 0.036). Both groups showed no statistical significant difference in knee flexion. (p = 0.116) The reduction in knee effusion was found to be statistically significant at 4th (p <0.001), 10th (p <0.001)16 and one month (p = 0.012) ) in between treatment and control group. The overall pain difference between the two groups was not found to be statistically significant. (p = 0.198) Conclusion: This study showed that following surgery, clinically the increment in the muscle strength was more in the drain group compared to the no drain group but was statistically significant only for quadriceps at 60 degree flexion in drain group. Clinically the drain group showed faster pain relief, lesser effusion and early return to motion compared to the no drain group.

One-incision versus two-incision techniques for arthroscopically-assisted anterior cruciate ligament reconstruction in adults

One-incision versus two-incision techniques for arthroscopically-assisted anterior cruciate ligament reconstruction in adults

Electrophysiological Assessment of Injury to the Infra-patellar Branch(es) of the Saphenous Nerve during Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Auto-grafts: Vertical versus Oblique Harvest Site Incisions

BackgroundIt was suggested that the direction of incision for medial hamstring tendons harvesting influences the incidence of injury to the infrapatellar branch of the saphenous nerve (IPBSN), a common complication following arthroscopically-assisted anterior cruciate ligament reconstruction (ACLR).ObjectivesThe main purpose of current study was to compare the incidence of IPBSN injury between vertical and oblique incisions utilizing electrophysiological evaluation.Patients and MethodsThere were 60 patients underwent arthroscopically-assisted ACLR assigned to two equal vertical or oblique incision groups, randomly. One year postoperatively, the patients were electrophysiologically examined to detect whether IPBSN is injured. The Lysholm score was completed. The patients' satisfaction with surgical outcomes determined utilizing visual analogue scale (VAS). Finally, two groups were compared and the effect of IPBSN injury on function and satisfaction was investigated.ResultsThe incidence of IPBSN injury was higher in the vertical group (4 patients vs. 10 patients), but the difference was not statistically significant. The mean of Lysholm and VAS scores were the same. Also, the mean of Lysholm score was the same in patients with and without IPBSN injury. However, patients without IPBSN injury were more satisfied (8.9 ± 9 vs. 7.4 ± 1.1; P < 0.001).ConclusionsIPBSN injury is a common complication following arthroscopically-assisted ACLR and, if not significant, oblique direction of the incision is associated with decreased incidence of the injury. IPBSN injury has no effect on the function but because of the disturbance with patients' satisfaction, authors believe the oblique incision is preferable to avoid the nerve injury during medial hamstring tendons harvesting.

Irreducible dislocation of the knee joint

Posterolateral knee dislocations are very rare and generally irreducible by closed reduction. It is due to interposition of various portions of medial capsule-ligamentous structure in the knee joint space. In such cases, open reduction is recommended. Only a few cases have been reported in the literature. This article presents an unusual case of irreducible knee dislocation, in which the medial femoral condyle buttonholed through the medial retinaculum and capsular structure. Closed reduction attempt was unsuccessful. Open joint reduction was performed. Direct repair of the medial collateral ligament and retinaculum, and arthroscopic assisted posterior cruciate ligament reconstruction were also performed. Arthroscopic-assisted anterior cruciate ligament reconstruction was carried out in staged operation.

Navigated Anterior Cruciate Ligament Reconstruction: Radiographic Validation of a Nonimage-based System

The authors compared the intraoperative navigated measurements of the location of the tibial and femoral tunnels during arthroscopic-assisted anterior cruciate ligament reconstruction to the postoperative measurements performed on standard plain radiographs in 56 patients. The position of the center of the tibial and femoral tunnels was measured intraoperatively with the OrthoPilot (B. Braun Aesculap, Tuttlingen, Germany) and postoperatively on plain anteroposterior and lateral radiographs. The center of the tibial tunnel was located at 43% of the mediolateral tibial dimension intraoperatively and at 41% of the mediolateral tibial dimension postoperatively (P=.14). The center of the tibial tunnel tibial was located at 40% of the anteroposterior tibial dimension intraoperatively and at 35% of the anteroposterior tibial dimension postoperatively (P=.01). The center of the femoral tunnel was located at 85% of the anteroposterior femoral dimension intraoperatively and at 76% of the anteroposterior femoral dimension postoperatively (P<.001). A significant correlation was found between intraoperative navigated and postoperative radiographic measurements only at the femur. Good agreement existed between all navigated and radiographic measurements. The OrthoPilot navigation system allows an accurate measurement of the location of the tibial and femoral tunnels during anterior cruciate ligament reconstruction.

Paper 199: Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Fresh-Frozen Bone-Patellar-Tendon-Bone Allografts: 15-year Follow-up

To evaluate the long-term outcomes following arthroscopic assisted anterior cruciate ligament (ACL) reconstruction using fresh-frozen bone-patellar-tendon-bone (BPTB) allografts. Between 1991 and 1992 38 patients underwent ACL reconstruction using a BPTB allograft by a single surgeon. The same technique was used in all operations, which consisted of the 1-incision endoscopic approach. Of these patients 31 were available for full evaluation. Evaluation included: history, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner score, physical examination, functional knee ligament testing and the International Knee Documentation Committee standard evaluation form (IKDC).Degenerative joint disease on radiographs was scored as prescribed in the x-ray section of the IKDC evaluation form. The average age of the 38 patients at the time of operation was 29.2 (range 13-46) and the mean duration to follow-up was 14.5 years (range 13-16). Three patients were lost to follow-up. 29 reoperations were performed in 17 patients. Reoperations consisted of removal of the fixation material (11 patients), meniscectomy (5 patients), cyclops (2 patients), high tibial osteotomy (2 patients) or revision of the ACL (4 patients, of whom one had a total knee prosthesis afterwards), total knee prosthesis (1 patient and one was expecting one in the near future) and a diagnostic arthroscopy (4 patients). 31 of the 38 patients were available for full examination (3 patients lost to follow-up, 3 patients with a revision surgery and one with a total knee prosthesis). The mean scores for the KOOS subscales were 88.7 for Pain (± 20.7), 79.3 for Symptom (± 20.0), 90.5 for ADL (± 18.5), 72.3 for Sport/Rec (± 32.3) and 75.2 for QOL (±26.2). The mean Tegner score was 4.2 (± 2.2). Using the IKDC evaluation score 3 patients were classified as normal (group A), 11 as nearly normal (group B), 12 as abnormal (group C) and 5 as severely abnormal (group D). 24 patients showed none or mild degenerative joint disease (group A and B). 2 patients showed moderate (group C) and 5 patients severe (group D) degenerative joint disease. Only 14 patients (45.2%) were classified as normal or nearly normal using the IKDC evaluation score. More than half of the patients (54.8%) required one or more re-operations and 7 patients (22.6%) showed moderate or severe degenerative joint disease.