Thigh Atrophy Research Articles

Peroneus Longus Tendon Autografts have Better Graft Diameter, Less Morbidity, and Enhanced Muscle Recuperation than Hamstring Tendon in ACL Reconstruction.

Recently the peroneus longus tendon (PLT) gained popularity in anterior cruciate ligament (ACL) reconstruction and has been utilized with satisfactory outcomes. However, there are concerns regarding donor site morbidity. This study aims to compare the functional outcome of ACL reconstruction using hamstring (HT) and PLT autografts and evaluate the donor site morbidity. Patients who underwent ACL reconstruction were allocated to two groups (HT and PLT). Graft diameter was measured intraoperatively. Knee functional outcome was evaluated with IKDC and Tegner-Lysholm scores preoperatively, and postoperatively after 3 months, 6 months, and 1 year. Donor site morbidities were assessed with thigh circumference measurements, subjective evaluation of sensory disturbances, and ankle scoring with AOFAS and FADI scores. At 1-year follow-up, the PLT group showed comparable IKDC (p = 0.925) and Tegner-Lysholm (p = 0.600) scores with those of the HT group. The mean graft diameter in the PLT group (7.93 ± 0.52mm) was larger compared with the HT group (7.43 ± 0.50mm) (p < 0.001). The incidence of thigh atrophy (HT-16.7%, PLT-10%) and sensory disturbances (HT-73.3%, PLT-10%) was greater in the HT group. There was no significant ankle donor site morbidity in the PLT group (AOFAS-98.67 ± 3.45, FADI-99.23 ± 1.69). ACL reconstruction with PLT had comparable functional outcome with that of HT at 1 year. However, PLT demonstrated larger graft diameter, less donor site morbidity, and enhanced muscle recovery without significantly affecting the ankle function. PLT can be safely used as an acceptable alternative graft choice harvested from outside the knee for ACL reconstruction.

Comparison of AO, Schatzker, and three-column classification systems in tibial plateau fractures: Impact on functional outcomes.

This study aimed to compare the AO, Schatzker, and Three-Column classification systems for tibial plateau fractures, focusing on their prognostic and functional outcome prediction and influence on clinical decisions across different trauma types. In this retrospective study, we examined 49 patients (36 males, 11 females; mean age: 40.6±11.8 years; range, 19 to 67 years) with tibial plateau fractures between January 2011 and January 2017. The fractures were classified using the AO, Schatzker, and three-column systems. The main outcome measurements included functional scores (Knee Injury and Osteoarthritis Outcome Score [KOOS], Hospital for Special Surgery [HSS]), range of motion (ROM), duration of hospitalization, thigh atrophy, operation time, and the development of osteoarthritis. The impact of smoking was also assessed. According to the AO classification, type B fractures obtained higher KOOS and HSS scores compared to type C fractures (p=0.013 and p=0.007, respectively). According to the Schatzker classification low-energy fractures achieved higher KOOS and HSS scores than high-energy fractures (p=0.013 and p=0.026, respectively). One-column fractures had higher KOOS and HSS scores compared to two-column and three-column fractures (p=0.007 and p=0.001, respectively). Two-column fractures had a lower ROM compared to other column fractures (p=0.022). Shorter hospital stays were recorded for Schatzker low-energy fractures (p=0.016), whereas higher thigh atrophy was found in Schatzker high-energy fractures (p=0.022) and AO type C fractures (p=0.018). Longer operation times were observed in AO type C fractures (p=0.037) and Schatzker high-energy fractures (p=0.017). According to the Kellgren-Lawrence classification, AO type C fractures and three-column fractures yielded worse outcomes (p=0.039 and p=0.001, respectively). Smoking had a negative impact on functional KOOS and HSS scores across all groups (p=0.022 and p=0.001, respectively). This study highlights the predictive value of the AO, Schatzker, and Three-Column classification systems in determining functional outcomes and clinical data in tibial plateau fractures. Each system provides unique insights into different outcomes, suggesting their concurrent application may yield a more comprehensive prognosis.

E30 Sequelae of Juvenile Idiopathic Arthritis in a 20-year-old young woman

Abstract Background The long-term effects of Juvenile Idiopathic Arthritis are still largely unknown in our context. We set out to describe the long-term complications of a patient known to have Juvenile Idiopathic Arthritis who underwent follow up into adulthood. Methods Retrospective chart review Results We report a case of a female patient, now 20 years’ old who was diagnosed with Juvenile Idiopathic Arthritis since the age of 8 years. The patient initially received symptomatic treatment with paracetamol and non-steroidal anti-inflammatory drugs administered during flare-ups. After 12 years of follow up, she has failure to thrive (BMI 15.43 kg/m2) and delayed secondary sexual characteristics (menarche at 17, poorly developed chest). Other sequelae include bilateral boutonniere deformation of the 2nd and 3rd fingers, camel back deformity of the wrists, flexion contractures of the elbows, and bilateral coxopathy. She has tenderness and limited range of motion of shoulders, knees and ankles with bilateral thigh atrophy. She has a tender cervical spine painful and limited movement (C7-wall at 4.5 cm, tragus-acromion at 9 cm on the right and on the left). Conclusion This case highlights the importance of early control of the disease to mitigate against sequelae with negative impact on the academic and social life of the patient. The implication to policy, practice, research and advocacy The case illustrates the consequences of sub-optimal management of chronic inflammatory rheumatism in Africa, especially among children, due to lack of expertise and resources across the continent. Ethics We have no conflict of interest

Plating versus Ilizarov Technique for Complex Tibial Plateau Fractures: A Comparative Study on Functional Outcome and Patient Satisfaction

Objective To compare clinical and functional outcomes and complications of open reduction internal fixation (ORIF) by plating and Ilizarov technique in complex tibial plateau fractures. Methods This study is a randomized clinical trial accompanying 56 patients having Schatzker type V and VI tibial plateau fractures. We divided patients into two groups for management. Group I; open reduction internal fixation and Group II; ilizarov technique. We conducted study at the orthopedics department, Jinnah Post-Graduate Medical Center, Karachi, from April-2018 to Oct-2020. The endpoint was to assess patients’ satisfaction and clinical and functional outcomes up to an 18-month follow-up. Results The etiology of tibial fracture was mainly road traffic accident (RTA); 17 (70.9%) in ORIF versus 23 (71.8%) in the Ilizarov group. According to clinical outcomes, excellent extension lag was achieved in 100% of patients in both groups. Most patients had excellent knee flexion, thigh atrophy and instability outcomes (54.1% vs 59.37%, 87.5% vs 81.2% and 83.3% vs. 87.5%). The functional outcome assessment was done and recorded for 18 months of follow-up. There was no significant difference in normal walking, stair climbing, squatting, jumping and duck walking between the groups. The overall rate of complications was similar; 11 (45.8%) in ORIF versus 17 (53.12%) in the illizarov group (p=0.78). Conclusion Our study concludes that there is an excellent clinical and functional outcome found in both procedures as both are safe and effective procedures with fewer complications Keywords Complex Tibial Plateau Fractures, ORIF, Ilizarov Technique

Wasted leg syndrome: An atypical slowly-progressive form of lower motor neuron disease

We describe four male patients with wasted-leg syndrome, with predominant asymmetric thigh atrophy and weakness that stabilized after a period of slow progression (follow-up 7–18 years). Two patients had an Indian ethnic background and two were Portuguese, without known Indian ancestry. Other mimicking disorders were excluded, but one Indian patient was later diagnosed with CADASIL. Electromyography (EMG) revealed severe chronic neurogenic changes in proximal leg muscles, and mild changes in distal leg muscles, but EMG of the upper limbs was normal. Upper motor neuron signs were absent clinically and on transcranial magnetic stimulation. This seems to represent a variant of the common wasted-leg syndrome presentation.

80 Case series of juvenile scleroderma at Aga Khan University Hospital, Nairobi

BackgroundJuvenile scleroderma includes a range of conditions presenting with skin fibrosis. It’s classified into two major categories, localized and systemic. Juvenile localized scleroderma (morphea) is limited to the skin and forms majority of pediatric presentations (>95%). Though rare, juvenile systemic sclerosis involves the skin and other internal organs and is associated with a poorer prognosis.ObjectiveTo characterize the clinical profile of two cases of scleroderma at Aga Khan university hospital, Nairobi.MethodsRetrospective review of medical records of two patients with Juvenile scleroderma managed at Aga Khan university hospital, Nairobi.ResultsThe first patient was a 7-year-old boy presenting with joint pains for 2 months, restricted activities and limping. He also had a non-itchy lesion on the right thigh for about 6 years. On examination, there was an 8 by 18 cm, flat, shiny skin lesion with ill-defined margins and skin thickening around it. There were 2 punched out scars from previous skin biopsy sites with latest biopsy showing atrophic epidermis, dermal collagen homogenization with thick sclerosed fibers in keeping with morphea. Pulmonary function tests revealed mild restrictive lung disease. There were no other systems involved on further evaluation. He was started on weekly methotrexate, daily prednisone, daily folic acid and omeprazole to be followed up in clinic.The second case is a 5-year-old girl who presented with 3-year history of inability to walk. Physical examination revealed areas of skin hypopigmentation and hyperpigmentation on the neck and back with active lesions on the left flank and posterior right leg. She had left lower limb atrophy and extreme wasting of thigh and calf muscles, a contracture of the left knee, ankle and limb length discrepancy. Her investigations revealed positive rheumatoid factor, positive antinuclear antibody (ANA), microcytic hypochromic anaemia and skin biopsy with features of morphea. She received six courses of high dose methyl prednisone over six months, weekly methotrexate, daily folic acid, daily prednisone that was tapered off gradually, calcium supplementation and iron supplementation. In addition, she received isoniazid for tuberculosis prophylaxis with pyridoxine. Her management was multidisciplinary involving orthopedics, physiotherapy, occupational therapy, and dieticians. She developed a new skin lesion on the left forearm about five months after initiation of treatment but no worsening of symptoms or other new lesions thereafter.ConclusionJuvenile scleroderma though rare has a high risk of misdiagnosis with delay in initiation of treatment. It is associated with significant morbidity and early diagnosis, treatment and follow up is imperative for good outcomes.

COMPARISON OF SURGICAL RESULTS OF RETROGRADE INTRAMEDULLARY NAILING AND FIXING WITH PLATE SCREW IN SUPRACONDYLAR FEMUR FRACTURES

Amaç&#x0D; Erişkinlerde görülen suprakondiler femur kırıkları eklem&#x0D; yüzeyini ilgilendiren veya ilgilendirmeyen kırıklar&#x0D; olup farklı cerrahi tespit seçenekleri bulunmasına&#x0D; rağmen, tedavisi kolay olmayan bir kırık çeşididir. Bu&#x0D; kırıklarda yapılan plak uygulamalarında geniş insizyonlar&#x0D; sebebiyle yumuşak doku ve periost canlılığı&#x0D; korunamayıp kaynamama gibi sonuçlarla karşılaşıldığından&#x0D; dolayı cerrahlar tarafından retrograd intramedullar&#x0D; çivileme metoduna bir yönelim meydana&#x0D; gelmiştir.&#x0D; Gereç ve Yöntem&#x0D; Çalışmamızda retrograd intrameduller çivileme ve&#x0D; plak ile tespit edilen iki grup hastada karşılaştırma yapıldı.&#x0D; 2005-2016 tarihleri arasında kliniğimizde tedavi&#x0D; olan 20 hasta çalışmaya dahil edildi, bu hastaların 11’i&#x0D; plak ile 9’u ise retrograd çivi ile tedavi edildi. Bu hastalarda&#x0D; subjektif memnuniyet derecesi ameliyat sonrası&#x0D; VAS, HSS, Neer skorları, artroz gelişimi, kuadriseps&#x0D; kası gücü, uyluk atrofisi ve kısalık açısından araştırıldı&#x0D; ve karşılaştırıldı.&#x0D; Bulgular&#x0D; Yapılan karşılaştırmalarda her iki tedavi grubu arasında&#x0D; memnuniyet derecesi postoperatif VAS, HSS,&#x0D; Neer skorları, artroz gelişimi, kuadriseps kası gücü,&#x0D; uyluk kas atrofisi ve kısalık açısından istatiksel olarak&#x0D; anlamlı bir fark saptanmadı.&#x0D; Sonuç&#x0D; Suprakondiler femur kırıklarında plak-vida ile tedavi&#x0D; ve retrograd çivileme yöntemleri güvenilir tedavi yöntemleridirler,&#x0D; her iki yöntemin avantaj ve dezavantajları&#x0D; mevcut olup uzun vadede değerlendirildiğinde her&#x0D; iki yönteminde suprakondiler femur kırıkları tedavisinde&#x0D; başarılı olduğunu söyleyebiliriz.

Osteoid Osteoma of The Lesser Trochanter in Children

The purpose of this editorial is to perform an extensive review of the pediatric literature about the diagnosis and treatment of osteoid osteoma localized in the region of the lesser trochanter, to indicate that it may appear with atypical clinical and/or imaging findings, and to present two illustrative cases, with thigh atrophy and cortical erosion, respectively.

The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Meniscal Repair or Chondral Restoration Surgery in Active Duty Military: A Randomized Controlled Trial.

Recently, blood flow restriction (BFR) training has gained popularity as an alternative to high-load resistance training for improving muscle strength and hypertrophy. Previous BFR studies have reported positive treatment effects; however, clinical benefits to using BFR following meniscal repair or chondral surgery are unknown. The purpose of this study was to determine the effect of resistance exercises with BFR training versus exercises alone on self-reported knee function, thigh circumference, and knee flexor/extensor strength postmeniscal or cartilage surgery. Single-blinded randomized controlled trial in an outpatient military hospital setting. Twenty participants were randomized into 2 groups: BFR group (n = 11) and control group (n = 9). Participants completed 12weeks of postoperative thigh strengthening. The BFR group performed each exercise with the addition of BFR. Both groups continued with the prescribed exercises without BFR from 12weeks until discharged from therapy. Thigh circumference and self-reported knee function were measured at 1, 6, 12, and 24weeks postoperatively along with knee extensor and flexor strength at 12 and 24weeks. Change scores between time points were calculated for knee function. Limb symmetry indices (LSI) were computed for thigh circumference and knee strength variables. Seventeen participants were included in the final analyses (BFR = 8 and control = 9) due to COVID-19 restrictions. There were no interactions or main effects for group. Time main effects were established for change in knee function scores, thigh circumference LSI, and knee extensor strength LSI. However, knee flexor strength LSI had no main effect for time. The outcomes of this trial suggest that resistance exercises with and without BFR training may result in similar changes to function, thigh atrophy, and knee extensor strength postmeniscus repair/chondral restoration, though further study with larger sample sizes is needed.

Benign monomelic amyotrophy of lower limb in a cohort of chinese patients.

BackgroundBenign monomelic amyotrophy of lower limb (BMALL) is a neurogenic syndrome representing an unclear field. Further studies might be helpful to elucidate uncertainties regarding causation, outcome, and the risk of progression to amyotrophic lateral sclerosis (ALS).MethodsAccording to the inclusion and exclusion criteria, 37 patients with BMALL were retrospectively collected in three neuromuscular centers from January 2012 to October 2018. The detailed medical data were summarized. Multiple laboratory tests were examined. Routine electrophysiological examinations, muscle MRI of lower limbs, and muscle biopsy were conducted.ResultsThe cohort included 24 male and 13 female cases with median age of onset 47 years. Muscle MRI revealed that the distribution of involved muscles matched with the extent of fat infiltration, so the pattern muscle atrophy can be divided into the following four types: six patients with thigh atrophy (type I), 14 patients with leg atrophy (type II); 10 patients with disproportionate atrophy in both thigh and leg (type III); and seven patients with well‐proportionate atrophy in both thigh and leg (type IV). Electrophysiological findings showed neurogenic pattern, spontaneous activity, and abnormal H reflex, which suggested a disorder of spinal anterior horn cell in the patients with types I‐III. However, no electrophysiological abnormalities were found in the patients with type IV. Muscle pathology varied from almost normal pattern to advanced neurogenic pattern in nine biopsied patients. Follow‐up showed that two patients with type II developed to ALS four years later, and all patients with type IV were in stable condition without any complaints.ConclusionMuscle MRI was useful to exactly localize the distribution of involved muscles in BMALL patients. The distribution of atrophic muscles can be roughly divided into four types based on the MRI features. The classification of distributing types might be as an indicator for the prognosis of BMALL.

Does radiological evaluation of endobutton positioning in the sagittal plane affect clinical functional results in single-bundle anterior cruciate ligament reconstruction?

Sports injuries are increasing today due to the increased interest in sports. The most common injured knee ligament is the anterior cruciate ligament (ACL) in sport injuries. Accordingly, surgical treatment of the ACL is performed frequently. In this study, it was aimed to retrospectively evaluate whether the location of an endobutton on lateral knee radiography was effective on knee functional scores in patients who underwent ACL reconstruction. One hundred thirty patients who underwent ACL reconstruction between January 2015 and February 2019 were identified. The patients were divided into three groups according to the location of the endobutton on lateral radiographs taken in the postoperative period. Group 1 patients were classified as anterior, group 2 as middle, and group 3 as posterior according to the location of the endobutton. Functional scoring, physical examination tests, comparative thigh diameter measurements, and single-leg hop tests were compared between the groups. It was evaluated as to whether there was a statistically significant difference between the groups. There were 38 patients in group 1, 63 patients in group 2, and 29 patients in group 3. The mean age was 29.1 in group 1, 29.1 in group 2, and 29.7 in group 3. The mean follow-up period of the patients was 18.4months in group 1, 19.1months in group 2, and 21.4months in group 3. The average Lysholm score was 92.9 in group 1, 93.3 in group 2, and 91.7 in group 3. The mean modified Cincinnati scores were 27.0, 27.1, and 26.6, respectively, in the groups. The mean IKDC score of the subjective knee assessments was 92.5, 92.8, and 91, respectively, according to the groups. The average thigh atrophy value was 1cm, 1cm, and 1.2cm, respectively, in the groups. In the single-leg hop test, 34 patients in group 1 jump to over 85% of the distance compared with the intact side, while 58 patients in group 2, and 23 patients in group 3 were successfully able to jump this distance. The effect of the placement of the endobutton in the anterior, middle or posterior was not statistically significant on functional scores and physical examination results. In patients with endobuttons in the middle, functional scores were found better than in those with anterior or posterior placement. No statistically significant differences were found in clinical functional results when comparing patients' endobutton location on femur. For this reason, surgical time should not be extended using unnecessary extra effort to change the orientation of the exit hole during surgery.

Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR).

Introduction:Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction.Material and Methods:Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association.Results:A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels.Conclusion:Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.

Results of quadratus femoris muscle pedicle bone grafting (Meyers' procedure) in the management of ununited femoral neck fractures.

Femoral neck fractures in young patients are associated with increase complication risk. The objective of this study was to evaluate the results of quadratus femoris muscle pedicle grafting in the treatment of ununited femoral neck fractures. This study includes 16 patients with ununited femoral neck fractures treated with quadratus femoris muscle pedicle graft. 7 patients had neglected femoral neck fractures while 9 had ununited femoral neck fractures after fixation. Quadratus femoris muscle with 2 × 1 × 1 cm (length-width-height) bone in its insertion was elevated and placed in the posterior cortex of the femoral neck with additional cancellous graft from the posterior iliac bone. The graft was fixed with 3.5-mm cortical screws. The average follow-up period was 96 weeks and the radiological union occurred at an average of 7 months. The femoral inclination of all patients was 128.5° ± 3.9° with an average 7 (range 0-35) mm thigh atrophy in the last follow-up visit. Only 1 patient (6%) had avascular necrosis of the femoral head and was treated with hip arthroplasty. Quadratus femoris muscle pedicle grafting provides better stability and blood supply in ununited femoral neck fractures. Achieving fracture union provides better clinical and functional results in the treatment of femoral neck fractures.

Gonoarthrosis in former athletes treated which regenerative therapy and therapeutic exercise program

Osteoarthritis, or wear and tear of the knee joint, is a cause of sports trauma, affecting a large number of the population of former athletes in the province. The therapeutic alternative to gonoarthrosis exatlets implanted with regenerative therapy and rehabilitative exercises is applied to this sports-practicing population with balls. The assessment of variables, in responses to treatment implemented in the exathletes, was carried out over 6 months, where bilateral thigh atrophy prevailed over unilateral atrophy, to lesser degree atrophy of the affected thighs was presented after treatment with the applied therapeutic exercise program. 71.4% showed recovery of muscle strength with grade 5 (normal) muscle notes for the muscle group of knee flexor poplites, and 85.7% with grade 5 (normal) muscle notes for the femoral or crural quadriceps muscle group, which are involved in the extension of the knees. With the application of this exercise alternative in former athletes with gonoarthrosis treated with regenerative therapy, more than 70% showed recovery of the variables studied.

Is Cyclic Exercise Performed before Tibial Fixation Effective on Grafts during Anterior Cruciate Ligament Reconstruction?

Objectives:The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients who underwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, compared with the patients who underwent ACL reconstructions with or without cyclic exercise.Methods:Between March 2016 and May 2018, 59 patients with at least eight months’ follow-up of an ACL reconstruction were identified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did not undergo cyclic exercise were evaluated and compared.Results:The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scores in Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm in Group 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12 patients in Group 2 were able to hop this distance successfully.Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective knee assessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). No significant difference was found in other examinations and tests.Conclusion:Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise should be added to the operative procedure.

Medial Patellofemoral Ligament Reconstruction in Traumatic Patellar Dislocation without Patellar Fixation.

Acute traumatic patellar dislocation is a common injury, and spontaneous reduction may occur at the time of injury or may be reduced at the field of the accident by someone. It may be associated with osteochondral fractures and rupture of medial patellar stabilizers leading to recurrent patellar instability. The aim of this prospective study was to evaluate the outcomes of medial patellofemoral (PF) ligament (MPFL) reconstruction in recurrent traumatic patellar dislocation. Forty-five patients presented with PF instability as a result of traumatic rupture MPFL with normal patellar tracking underwent MPFL reconstruction without patellar fixation hardware through two parallel transpatellar tunnels and one screw in femoral tunnel. All patients were evaluated clinically preoperatively and at a minimum follow-up of 24 months, and International Knee Documentation Committee (IKDC) and Kujala scores were used to assess the clinical results. All patients were available for evaluation at a minimum of 24 months (up to 36 months). The mean age of these patients at the time of surgery was 22.82 years (range: 18-34 years). All patients gave history of trauma of their knees. Mean IKDC scale showed significant improvement as it rose from 47.17 preoperatively to 77.94 postoperatively, and mean Kujala score rose from 53.88 preoperatively to 86.24 postoperatively (p < 0.001). No recurrence of dislocation was recorded. Only three patients had mild atrophy of thigh and one patient had some difficulty in jumping. Reconstruction of MPFL by this method provides good clinical result in the treatment of PF instability by using autologous graft (semitendinosus and gracilis). Less hardware were used with less complications.

Does anterolateral ligament rupture affect functional outcomes in patients who underwent an anterior cruciate ligament reconstruction?

BackgroundStudies have shown that the anterolateral ligament contributes to knee stability. This study aims to compare the results of postoperative physical examinations, knee joint stability tests, and functional assessment tests of patients with intact anterolateral (AL) ligaments and patients with ruptured anterolateral (AL) ligaments. Material and methodThis study consisted of 101 patients, with at least a 12-month follow-up period, who underwent an anterior cruciate ligament reconstruction between 2010 and 2016, and whose AL ligaments were evaluated by the radiologist with the preoperative and postoperative magnetic resonance images (MRI). Of these patients, 41 had intact AL ligament (Group 1) in MRI and other 60 had ruptured AL ligament (Group 2). Groups were compared according to postoperative physical examinations, knee joint stability tests, and functional assessment tests. ResultsThe average Lysholm score of Group 1 was 94.9 (range: 81–100), and the score of Group 2 was 87.2 (range: 74–100). The modified Cincinnati score of Group 1 was 28.7 (24–30), while the score of Group 2 was 25.6 (21–30). The average IKDC subjective knee evaluation score of Group 1 was 91.9 (range: 83–100), and the score of Group 2 was 86.6 (range: 75–100). The average thigh atrophy value was 1.5 centimeters (cm) in Group 1 and 2.4 cm in Group 2. Thirty-three patients in Group 1 were able to jump over 85% of the distance in single-legged hop test compared to the intact side, while 16 patients in Group 2 were able to jump over this distance successfully.As a result of the analysis, it was determined that the Lysholm activity scoring results, the Modified Cincinnati scoring results, IKDC subjective knee evaluation results, two-cycle IKDC activity scale results, comparison of thigh diameters and the single-legged hop tests of two groups showed a statistically significant difference, and the results of the patients with intact AL ligaments who underwent an ACL reconstruction were found to be better (p < 0.05). No significant difference was found in other examinations and tests. ConclusionSince the rupture of the AL ligament has negative effects on functional outcomes, we think that the reconstruction of the AL ligament in the same session with the ACL reconstruction or later will have a positive effect on functional outcomes.

Disability among Patients with Patellofemoral Pain Syndrome and Instability among Patients with Anterior Knee Pain

Anterior knee pain is commonly occurring problem and it is mostly connected with middle aged people, who are involving strenuous activities and in young individuals involving in sports activities due to patellar instability. The individual with over using and repeated trauma leads to developing anterior knee pain. The purpose of my study is to determine the proportion of Patellofemoral pain with malalignment and without malalignment and instability among patients with anterior knee pain. The rational of this study is to determine the proportion of PFPS. By doing this study I will help the clinicians for correct decision making. A case series study was done in different settings of Lahore and Multan. Convenience sampling technique was done to collect data from individuals. A well-structured Kujala score questionnaire was used to collect data from different patients regarding age gender, limp, support, walking, stairs, squatting, Running, jumping, prolonged sitting with knee flexed, pain, swelling, abnormal painful kneecap movements, atrophy of thigh and flexion deficiency. Anterior knee pain is frequently found in females with ratio of 62 percent. The Kujala score was used to determine the disability. If the score is high than there is low disability and vice versa. The range I have found in my study is 85 with mean 61, minimum 10, maximum 95 and standard deviation 1.79. Thekujala score range 85 shows that individual having anterior knee pain is not related to some malalignment problems it may be due to other nonmalalignment reasons. The patients who have score are in the range of 85 having no difficulty in performing their daily activities. This study have concluded that anterior knee pain is commonly problem now a days. But it’s not mainly due to some malalignment and instability problems. It would be due to some other reasons which lead to developing anterior knee pain. This is mostly in individuals with age between 40 to 50 age groups.

Open versus arthroscopic anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials

Background: The purpose of this paper was to determine if significant differences exist between open and arthroscopic anterior cruciate ligament reconstruction (ACLR). We have hypothesized that patients would experience less pain, fewer complications, and fewer reoperations after arthroscopic ACLR. Methods: A systematic review of multiple medical databases was performed. Randomized controlled trials with a minimum of 6 mo follow-up were included. Study quality was analyzed using the Modified Coleman Methodology Score (MCMS) and Jadad Scale. Results: Three studies met the inclusion criteria (212 subjects; 212 knees). The MCMS rating was fair at 60.7±1.5, and the mean Jadad score was fair at 2.7±1.5. One study reported long-term outcomes (mean 12 yr) of 53 patients (25 open, 28 arthroscopic) and noted no differences in pain, strength, functional testing, or prevalence of osteoarthritis between groups. Two studies reported short-term outcomes of a combined 125 patients (58 open, 67 arthroscopic) with an average follow-up of 6 mo. In these studies, there were no differences in operative time, Lysholm scores, knee range of motion, laxity, complications, or reoperations between groups. Immediate postoperative analgesic use was higher in the open group. Average thigh atrophy ranged from 1.5 to 2.8 cm in the open group and 1.4 to 1.5 cm in the arthroscopic group. Conclusions: Based on the examined studies, there are no differences in operative time, knee range of motion, laxity, Lysholm scores, complications, or reoperations between open and arthroscopic ACLR techniques. Immediate postoperative pain appears decreased in patients undergoing arthroscopic ACLR.

Total ruptures of the extensor apparatus of the knee

ObjectiveThis was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures. MethodsThe sample included 190 patients and 198 total ruptures of the knee extensor apparatus. All patients were evaluated by the same examiner after a minimum one-year follow-up. ResultsTendinous ruptures occurred most frequently in men, in younger patients, and had better clinical and functional outcomes when compared with patella fractures; however, the former presented higher levels of thigh atrophy. Patella fractures occurred most frequently in women and in older patients and caused most frequently caused residual pain, muscle weakness, and limitations in daily activities. Comminuted fractures were related to high-energy trauma, lower clinical and functional outcomes, and higher levels of residual pain and osteosynthesis failure. Early removal of osteosynthesis material was related to better outcomes. Regarding the tendinous ruptures, over half of the patients presented risk conditions for tendinous degeneration; a longer delay until surgery was related to lower Kujala scores. ConclusionThe surgical repair of bilateral ruptures of the knee extensor apparatus resulted in satisfactory clinical and functional outcomes, which were better for tendinous ruptures when compared with patella fractures. However, these lesions are associated with non-negligible levels of residual pain, muscle weakness, atrophy, and other complications.