Graft Reconstruction Research Articles

Similarities in the kinematics of autografts and hybrid grafts for anterior cruciate ligament reconstruction: Minimum 2years of follow-up.

To compare the clinical results of anterior cruciate ligament reconstruction (ACLR) with autografts and that with hybrid grafts of the same diameter. This study retrospectively included 102 patients who underwent ACLR from August 2017 to July 2019. According to graft type, the patients were divided into an autograft group (58 patients) and a hybrid graft group (44 patients). All grafts were 8.0mm in diameter. The failure rate, knee kinematics with 6 degrees of freedom (DOFs), signal/noise quotient (SNQ), the Lachman test, pivot-shift test, Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score were compared in each group after a minimum 2-year follow-up. There was no significant difference in the failure rate between the autograft group (1.72%) and the hybrid graft group (2.27%) (P>0.999). The SNQ values of the autograft group (16.42±5.29 and 18.52±5.30) at the middle and proximal sites were lower than those of the hybrid graft group (12.13±5.62 and 16.35±4.64; P=0.020 and P<0.001, respectively). In the autograft group, the results of range of motion at 6 DOFs and tibiofemoral kinematics at 5 DOFs (except internal-external rotation) were similar to those of the hybrid graft group (P>0.05). The Lysholm score, Tegner activity score, IKDC score, Lachman test, and pivot-shift test showed no differences between the two groups (P>0.05). Autograft in ACLR has better graft maturity than hybrid grafts, but their kinematic characteristics are similar. ChiCTR2000037869.

Diverse Applications of Saphenous Vein Graft in Oral and Maxillofacial Reconstruction.

The greater saphenous vein (GSV) is widely used as an autologous graft in reconstructive surgeries, particularly in coronary artery bypass grafting and peripheral vascular interventions. This study explores the applicability of the GSV as a valuable graft option in oral and maxillofacial reconstructions, focusing on complex head and neck cases. Given the unique anatomic challenges of these areas, including proximity to vital structures and the need for extensive tissue resection, the GSV serves as an effective conduit in reconstructive strategies. This article provides a detailed overview of the typical GSV harvesting technique and presents case studies demonstrating the diverse applications of GSV grafts, including mandibular defect reconstruction, replacement of the internal jugular vein after radical neck dissection, and maxillary reconstruction after oncologic resection. The discussion addresses common anatomic and technical considerations, such as variable GSV diameters, vessel size mismatches, and donor site morbidity. A number of advanced anastomotic techniques is evaluated to address graft-recipient vessel discrepancies, ensuring optimal outcomes. Emphasizing careful patient evaluation and precise surgical techniques, this study concludes that the GSV is a reliable autogenous graft option, extending its versatility to challenging head and neck reconstructions. Preoperative anatomic assessment through Doppler analysis, patient consultation, and meticulous graft handling are essential to optimize graft function and minimize complications.

Comparison of Tissue-Engineered Dermis with Micronized Adipose Tissue and Artificial Dermis for Facial Reconstruction Following Skin Cancer Resection

Our group has previously demonstrated that tissue-engineered dermis containing cultured fibroblasts or adipose-derived stromal vascular fraction cells is superior to artificial dermis in terms of scar quality for covering facial defects. However, using these cells for clinical applications requires Food and Drug Administration approval and involves complex procedures for cell culture or isolation. This retrospective study aimed to compare effects of tissue-engineered dermis containing micronized adipose tissue (MAT) and artificial dermis for facial reconstruction. Tissue-engineered dermis consisting of MAT seeded on artificial dermis was applied in 30 cases, while artificial dermis without MAT was grafted in 35 cases. Healing time and severities of scar contraction, color mismatch, and landmark distortion at one year after healing were evaluated. Wounds in the tissue-engineered dermis group re-epithelialized in 30.0 ± 4.3 days compared to 34.3 ± 5.4 days in the artificial dermis group (p &lt; 0.05). The average dE2000 score in color mismatch analysis was 4.9 ± 1.7 in the tissue-engineered dermis group and 5.1 ± 1.7 in the artificial dermis group (p = 0.57). The extent of scar contraction was 16.2 ± 12.3% in the tissue-engineered dermis group and 23.2 ± 12.8% in the artificial dermis group (p &lt; 0.05). The average severity grade of landmark distortion was 0.20 ± 0.50 in the tissue-engineered dermis group and 0.50 ± 0.71 in the artificial dermis group (p &lt; 0.05). These findings indicate that tissue-engineered dermis grafts containing MAT are superior to artificial dermis grafts for facial reconstruction in terms of healing time, scar contraction, and landmark distortion severity. However, there was no significant difference in color mismatch between the two groups.

Beyond One-Size-Fits-All: Pioneering a Zone-Based Strategy in Digital Nerve Autografting.

Digital nerve injuries significantly affect hand function and quality of life, necessitating effective reconstruction strategies. Autologous nerve grafting remains the gold standard due to its superior biocompatibility, despite recent advancements in nerve conduits and allogenic grafts. This study aims to propose a novel zone-based strategy for donor nerve selection to improve outcomes in digital nerve reconstruction. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, searching PubMed, Embase, Cochrane Library, and Web of Science for articles published from January 2004 to December 2023. Inclusion criteria included studies involving adult human subjects undergoing autologous nerve grafting for digital nerve reconstruction, with sensory recovery and donor site morbidity as primary outcome measures. Additionally, an anatomical study comparing donor nerves to digital nerves was included. Five studies met the inclusion criteria: 4 clinical studies and 1 anatomical study. Analysis of the 4 included clinical studies showed that the posterior interosseous nerve had the lowest donor site morbidity (6.25%), while the lateral antebrachial cutaneous nerve (LABCN) demonstrated the best sensory recovery outcomes (mean 2-point discrimination of 5.92 mm, with 100% of patients achieving good to excellent recovery). The sural nerve exhibited acceptable donor site morbidity (15%) but showed the lowest sensory recovery outcomes (mean 2-point discrimination of 10.8 mm, with only 46% of patients reporting good to very good recovery). The anatomical study indicated that the LABCN had the closest match in cross-sectional area and fascicle count to most zones of the digital nerve, supporting its suitability as a graft source. Although there are many nerve reconstruction techniques available, autologous nerve grafting remains the gold standard. Based on the analysis of five studies, this review proposes a new zone-based approach for donor nerve selection, emphasizing matching donor nerves to specific injury zones. This tailored strategy can potentially optimize both functional recovery and donor site morbidity, moving beyond the one-size-fits-all paradigm. The posterior interosseous nerve, LABCN, and SN each provide unique benefits depending on the zone of injury, suggesting that this approach may lead to improved patient outcomes. Future research is needed to validate this framework.

Aneurysmal Bone Cyst of the Jaws: A Retrospective Analysis of 19 Cases.

To analyse the clinical, radiographic, and pathological characteristics of aneurysmal bone cyst of the jaws (JABCs), and to provide reference for clinical diagnosis and treatment. A retrospective study was conducted on 19 patients with JABC diagnosed from 2018 to 2022. Of the 19 JABC patients (5 males, 14 females, aged 7-53 years, mean 23.7), 94.7% of the lesions were in the mandible, with only 5.3% in the maxilla. Painless swelling was the most common symptom. CT typically showed bone expansion with either a unilocular or multilocular appearance and visible intracystic septa. MRI revealed characteristic 'fluid-fluid' levels within the lesion. Microscopically, most cases were unilocular or multilocular; 10.5% were cystic-solid, and USP6 gene disruption was detected in 44.4% of tested cases (4/9). All the cases were treated surgically, ranging from curettage to extensive excision. The follow-up data of 16 patients were obtained, most of them had a good prognosis, with one patient relapsed 9 months after surgery. JABC commonly occurs in the mandible, with a higher incidence in women. Swelling is the most common symptom. Radiographic findings were mostly unilocular or multilocular lesions with clear boundaries, and the characteristic multiple 'fluid-fluid' level could be used as an important basis for diagnosis. Smaller lesions can achieve good therapeutic effects through curettage, while larger ones often require radical excision followed by autologous bone graft reconstruction simultaneously. Prognosis is favourable in most cases. JABC are rare but clinically significant, requiring accurate diagnosis and timely treatment. This study analyses 19 cases, highlighting their diverse clinical, imaging, and histological features. Early detection and personalized treatment, including surgery, are crucial to prevent recurrence and preserve function. Long-term follow-up is essential for monitoring outcomes. These findings enhance the understanding of JABC, guiding clinicians in management for better patient outcomes.

Masquelet Inspired in Vivo Engineered Extracellular Matrix as Functional Periosteum for Bone Defect Repair and Reconstruction.

The Masquelet technique that combines a foreign body reaction (FBR)-induced vascularized tissue membrane with staged bone grafting for reconstruction of segmental bone defect has gained wide attention in Orthopedic surgery. The success of Masquelet hinges on its ability to promote formation of a "periosteum-like" FBR-induced membrane at the bone defect site. Inspired by Masquelet's technique, here a novel approach is devised to create periosteum mimetics from decellularized extracellular matrix (dECM), engineered in vivo through FBR, for reconstruction of segmental bone defects. The approach involved 3D printing of polylactic acid (PLA) template with desired pattern/architecture, followed by subcutaneous implantation of the template to form tissue, and depolymerization and decellularization to generate dECM with interconnected channels. The dECM matrices produces from the same mice (autologous) or from different mice (allogenic) are used as a functional periosteum for repair of structural bone allograft in a murine segmental bone defect model. This study shows that autologous dECM performed better than allogenic dECM, further permitting local delivery of low dose BMP-2 to enhance allograft incorporation. The success of this current approach can establish a new line of versatile, patient-specific, and periosteum-like autologous dECM for bone regeneration, offering personalized therapeutics to patients with impaired healing.

The Use of Coronoid Process as a Free Graft for Condylar Reconstruction in a Patient With Condylar Osteoma: A Condylar Reconstruction Technical Note (Technical Strategy).

Osteoma is a rare, asymptomatic, and slowly growing benign tumor of bone. Upon reviewing the literature, only 21 cases were previously reported in the mandibular condyle. A 19-year-old male patient presented to the Department of Oral and Maxillofacial Surgery of Ain Shams University complaining of hypomobility and facial asymmetry involving the lower jaw. He stated that he was involved in a road traffic accident (RTA) and sustained a traumatic injury to the head a few years ago. Upon examination, it was noticed that the chin deviated to the right side with some discomfort during function. Computed tomography scans revealed the presence of a hyperdense mass medial to the right condylar pole. Condylectomy was carried out using a preauricular approach. A diagnosis of osteoma was confirmed histopathologically. The defect was reconstructed using the coronoid process as an autogenous-free graft.

Outpatient surgical management of head and neck keratinocyte cancers in a regional centre: an updated analysis of costs and outcomes.

Australia has the highest global incidence of keratinocyte cancer. Surgically managing keratinocyte cancers in regional Australia presents geographic and economic challenges, which necessitate cost-effective resource allocation. Previous work has outlined the cost benefit for outpatient day surgical excision of head and neck skin lesions that can be closed primarily. We expand on this analysis with the inclusion of graft and local flap reconstructions. A retrospective analysis was completed in a single regional centre across 24 months from July 2022 to June 2024. Patient demographics, lesion characteristics, margin status, cost comparison, and complication rates were recorded. There were 256 excisions for proven or suspected keratinocyte cancers. Basal cell carcinomas comprised 73.1% of lesions, squamous cell carcinoma for 21.9% of lesions, and intra-epidermal carcinoma for 5.1%. Lesion defects were closed primarily in 63.8% while 23.0% underwent full thickness graft reconstruction and 13.2% required local flaps. Involved margins were reported in 8.1% of excisions. Follow-up wound review was undertaken in primary care for 26.1% of all lesion excisions. Average indicative costs were three-to-four times higher for procedures performed in theatre compared to the outpatient setting, and these savings were greatest for graft and local flap reconstructions. There were 20 recorded complications including 16 partial or complete graft failures and one partial flap failure. This study demonstrates further cost effectiveness for graft and local flap reconstruction of head and neck skin excisions under local anaesthetic in the regional outpatient setting, while maintaining low complication and incomplete excision rates.

Development of Prevascularized Synthetic Block Graft for Maxillofacial Reconstruction.

Cranio-maxillofacial bone reconstruction, especially for large defects, remains challenging. Synthetic biomimetic materials are emerging as alternatives to autogenous grafts. Tissue engineering aims to create natural tissue-mimicking materials, with calcium phosphate-based scaffolds showing promise for bone regeneration applications. This study developed a porous calcium metaphosphate (CMP) scaffold with physicochemical properties mimicking natural bone, aiming to create a prevascularized synthetic bone graft. The scaffold, fabricated using sintered monocalcium phosphate with poly (vinyl alcohol) as a porogen, exhibited pore sizes ranging from 0 to 400 μm, with the highest frequency between 80 and 100 μm. The co-culture of endothelial cells (ECs) with human alveolar osteoblasts (aHOBs) on the scaffold led to the formation of tube-like structures and intrinsic VEGF release, reaching 10,455.6 pg/mL This level approached the optimal dose for vascular formation. Conversely, the co-culture with mesenchymal stem cells did not yield similar results. Combining ECs and aHOBs in the CMP scaffold offers a promising approach to developing prevascularized grafts for cranio-maxillofacial reconstruction. This innovative strategy can potentially enhance vascularization in large tissue-engineered constructs, addressing a critical limitation in current bone regeneration techniques. The prevascularized synthetic bone graft developed in this study could significantly improve the success rate of maxillofacial reconstructions, offering a viable alternative to autogenous grafts.

Case Care of Breast Cancer with Latissimus Dorsi Muscle Flap Graft and Breast Reconstruction

Case Care of Breast Cancer with Latissimus Dorsi Muscle Flap Graft and Breast Reconstruction

Combination of Vascularized and Non-vascularized Fibula Free Flap With Dermofat Graft for Maxilla and Mandibula Reconstruction After Malignant Spindle Cell Tumor Resection.

The spindle cell tumor is a variant of sarcomatoid carcinoma that mostly affects the oral cavity. Bone involvement in this tumor leads to a wide excision, which sometimes requires resection of both the maxilla and mandible. The maxilla and mandible are important bones that function to form the 3-dimensional dimensions of the facial bones. The fibular bone can be selected to replace the facial bone because of its strong structure with a skin paddle, long pedicle, and proper bone shape. The authors present the case of a 24-year-old female who underwent maxillectomy and total hemimandibulectomy after a spindle cell tumor resection. The free fibular flap was harvested and divided into several segments to close the mandible and maxilla. However, the vascularized bone was insufficient; thus, non-vascularized bone was used in combination to reconstruct the maxilla. Six months after bone reconstruction, a dermofat graft was placed to fill the cheek structure. During the 6 months of follow-up, the vascularized and non-vascularized fibular bones were well arranged. Intraoral placement of a skin paddle covering the maxilla and mandible was viable. Both functional and esthetic outcomes were attained in patients with high satisfaction rates. Although there are many reconstruction options for patients with post-wide tumor excision, the fibula free flap remains the main choice as a replacement for facial bones because it has a strong and firm bone structure that can resemble facial bones; thus, a non-vascularized bone graft can be used in combination to cover the defects.

Hemostatic Net Sutures: A New Solution to an Old Problem

Objective: The use of hemostatic net sutures, known for their efficacy in reducing hematoma formation in rhytidoplasty, is emerging as a promising technique for skin graft fixation. This research focuses on evaluating the effectiveness of hemostatic net sutures in securing full-thickness skin grafts, aiming to improve graft uptake and minimize complications.Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi, From July 2022 to December 2023.Methods: We conducted a prospective study at a single institution, involving 30 patients who underwent full-thickness skin grafting in the head and neck region and required hemostatic suturing over a period of 1.5 years. Results: The study encompassed 30 full-thickness skin graft reconstructions, with a follow-up period extending up to three weeks. A notable graft take rate of 90% was observed, with half of the cases achieving 100% adherence. The average time for the procedure was approximately 26.7 minutes across an average defect area of 58 cm². Major hematoma formation was observed in only 3% of the cases, with no significant influence of age, sex, or defect area on the graft take rate.Conclusion: Hemostatic net suturing demonstrates its efficacy in ensuring adequate graft adherence while simultaneously minimizing tissue manipulation, reducing surgical time, and lowering complication rates.

Omniflow prosthesis for treatment prosthetic graft infection of the aorto-iliac and femoropopliteal level on the infrarenal aortic segment and lower extremity.

To report outcomes after the use of the Omniflow II biosynthetic graft (LeMaitre Vascular, Il, USA) for vascular reconstruction in patients with prosthetic infection at the aorto-iliac and femoropopliteal level. Within a six-year period, all consecutive patients with aorto-iliac and femoro-popliteal graft infection treated by resection of the infected graft material, extensive local debridement and reconstruction using Omniflow II biosynthetic graft were retrospectively analzyed. Patient characteristics, intraoperative details, postoperative outcomes, and infection details were assessed. Overall 18 patients were operated in the study period. The anatomical localization of the index surgery was the abdominal aorta n=3 (17%), iliac arteries n=5 (27%) and lower extremities (thigh) n=10 (56%). Previous surgery included 8 (44%) reconstructions with alloplastic and 10 (55.6%) reconstructions with bovine xenopericardium. An obturator rerouting for the aorto-iliac level was used in 8 patients (44 %), a femoro-femoral cross-over routing was used in 7 patients (39%) and a femoro-popliteal routing was used in 3 patients (17%). Overall, 3 patients (17%) expired in-hospital. Five (28%) patients required secondary wound closure. Operative revision due to bleeding was performed in three patients. During follow-up (mean 41.4 ± 25.7 months), one patient received a stent angioplasty to maintain graft patency. We observed one reinfection (6%), treated by explanation of the prosthesis and no further revascularization was performed. Secondary graft patency was 100% and one reintervention at the level of the foramen obturatum was needed. The concept of using the Omniflow II biosynthetic graft for vascular reconstruction in patients with prosthetic infection at the aorto-iliac and femoro-popliteal level shows very promising mid-term results. Graft patency is high and reinfection rate is low.

Comparison between artificial dermis with split-thickness skin graft and full-thickness skin graft for reconstruction of joint-involved burn wounds: A retrospective review from a tertiary burn centre.

We aimed to compare the scar quality and recovery rate of joint activity for patients with joint-involved burn injuries receiving either artificial dermis (AD) with split-thickness skin graft (STSG) or full-thickness skin graft (FTSG) for reconstruction. The primary outcomes were %skin graft (SG) take. Secondary outcomes included complications such as the infection rate and donor site morbidity, 12-month scar quality evaluated using the Vancouver scar scale (VSS), recovery rate of joint activity and incidence of scar contracture requiring further revision. Twenty-eight patients between 1 August 2021, and 1 August 2023, were enrolled. Twelve patients received AD-STSG while the other 16 patients underwent FTSG for reconstruction. The median %SG take was 95.0% (interquartile range [IQR] 6.3%) and 96.0% (IQR 10.0%) for the AD-STSG and FTSG groups (p = 0.71). The FTSG group had significantly better 12-month scar quality (median VSS 4.0 [IQR 1.3] vs. 6.0 [IQR1.5], p < 0.01) and recovery rate of joint activity (median 82.5% [IQT 15.0%] vs. 70.0% [IQR 7.5%], p < 0.01) compared with AD-STSG group. However, two patients in the FTSG group (12.5%) suffered partial wound dehiscence of the donor site, whereas no patients experienced donor site morbidity in the AD-STSG group (p = 0.49). The incidence of scar contracture requiring further revision was 25.0% (3/12) in the AD-STSG group and 12.5% (2/16) in the FTSG group (p = 0.62). In conclusion, AD-STSG could be an alternative treatment over FTSG for larger joint-involved burn wounds (>200 cm2) owing to lesser donor site morbidity with admissible cosmetic outcomes and functional recovery.

A young female patient with severe traumatic hemifacial degloving avulsion injury successfully managed with reconstruction and full thickness skin graft: case report

Introduction and importance: Road traffic accidents can result in severe ocular injuries, jeopardizing vision. High-speed collisions may lead to facial avulsion and degloving injuries, which pose risks such as airway compromise, bleeding, soft tissue loss, disfigurement, and post-traumatic impairments that necessitate prompt reconstruction. Case presentation: A 24-year-old woman sustained injuries in a motorcycle accident, which resulted in a left hemifacial avulsion, a degloving injury, and the loss of her left brow. Additionally, she lost the lower eyelid on the left side and a portion of the left maxilla near the medial canthus. Despite these injuries, the movements of her left eye remained normal. Clinical discussion: The primary objectives of periorbital reconstruction are to restore the patient’s vision with minimal discomfort while ensuring stable coverage for orbital protection and achieving functional reconstruction of the defect. Although there are various surgical reconstruction techniques available, skin grafting and regional flap reconstruction methods are the most commonly employed. Conclusion: The patient expressed satisfaction with the outcome and reported improved social comfort. After a one-year follow-up, both the patient’s facial functions and vision were found to be normal.

Minimizing Unnecessary Harvesting of an Extremely Thin Gracilis Tendon During ACL Reconstruction by Referencing the Diameter of the Doubled Semitendinosus Tendon Alone

Background: The incidence of anterior cruciate ligament reconstruction (ACLR) graft failure is inversely related to the diameter of the ACLR graft. When the diameter of a 4-stranded hamstring tendon graft with a doubled semitendinosus and doubled gracilis tendon (ST×2 + G×2) configuration is &lt;8 mm, the gracilis tendon is often thin. Hypothesis: (1) The diameter of the doubled semitendinosus tendon (ST×2) alone would be able to predict the probability of a 4-stranded ACLR graft having a diameter of ≥8 mm, and (2) there would be a specific cutoff value for the ST×2 diameter such that the addition of a doubled gracilis tendon (G×2) will not result in a 4-stranded graft with a ≥8-mm diameter. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were patients who had undergone 4-stranded hamstring ACLR between 2008 and 2018. Patients were excluded if the diameter measurements of the tendons or ACLR graft were missing. A receiver operating characteristic (ROC) analysis was performed to assess the predictability of ST×2 on an ACLR graft with a diameter of ≥8 mm. The effect of including G×2 on the final graft size was reported. Results: A total of 314 patients were included, and the mean diameters of ST×2 and G×2 were 6.5 ± 0.8 mm and 5.0 ± 0.7 mm, respectively. There was a moderate to strong correlation between the diameter of ST×2 and that of G×2 (men: r = 0.678; women: r = 0.654; P &lt; .001 for both). An ST×2 with a diameter &lt;6 mm predicted a 4-stranded ACLR graft of &lt;8 mm (area under the ROC = 0.917; P &lt; .001). When ST×2 was &lt;6 mm, the addition of a G×2 did not result in the ACLR graft's having a diameter of ≥8 mm, regardless of patient sex or G×2 diameter. Conclusion: When the diameter of the doubled semitendinosus was &lt;6 mm, the addition of the doubled gracilis was unlikely to produce a 4-stranded ACLR graft with a diameter of ≥8 mm. Surgeons should consider alternative methods such as tripling or quadrupling the semitendinosus tendon to increase the size of the ACLR graft, rather than routinely harvesting the gracilis tendon.

Lateral Femoral Notch Sign Presence, Location, and Depth Are Not Associated with Primary Anterior Cruciate Ligament Reconstruction Failure: A Retrospective Case-Control Study.

The purpose of this study is to assess the relationship between the presence, depth, and location of the lateral femoral notch sign (LFNS) on preoperative MRI and the risk of ACL reconstruction (ACLR) graft failure, as well as secondary return to sport (RTS) endpoints. Patients with primary ACLR failure between 2012 and 2021 with a minimum of a 2-year follow-up were identified and matched to patients without primary ACLR failure by sex, age, and BMI. Patients with incomplete medical records or concomitant lateral extra-articular tenodesis or anterolateral ligament reconstruction were excluded. The LFNS presence, depth and location were recorded from patients' preoperative MRI. Intraoperative data, concomitant injuries, ACLR failure, and return to sport (RTS) were collected. Of the 253 included patients, 158(62.5%) were male, the mean age was 22 ± 9.1 years old, and the mean body mass index (BMI) was 25.7 ± 5.7 kg/m2. 87(34.4%) had a LFNS on preoperative MRI. There was no difference in the prevalence of the LFNS between patients with primary ACLR failure (42(32.1%)) and without primary ACLR failure (45(36.9%)) (OR 1.24, 95% CI 0.74 to 2.08; P=0.42). Among patients with the LFNS, there was no difference in mean depth between those with and without primary ACLR failure, or when stratifying depth by 1.0-1.5mm, 1.5-2.0mm, and >2.0mm. The mean location of the LFNS from Blumensaat line did not differ between patients with or without primary ACLR failure, and RTS rate, level, and time were comparable between patients with and without the LFNS. There was no significant difference in the presence, depth or location of LFNS in patients with and without primary ACLR failure. Presence of the LFNS is not associated with additional risk of primary ACLR failure, and clinical outcomes were comparable in patients with and without the LFNS. Retrospective case-control study; IV.

Cross-Bridge Free Vascularized Fibular Graft for Reconstruction of Extensive Traumatic Tibial Defects

Abstract Background The cross-bridge free flap technique has been described for salvage of cases of traumatic lower limb defects when adequate recipient vessels in the same limb are lacking. While previous accounts mainly focused on utilizing muscle, myocutaneous, or perforator skin flaps, this study presents a series of cross-bridge free vascularized fibular transfer for reconstruction of traumatic tibial defects with extensive soft tissue loss. Methods The study included 22 cases with an average age at surgery of 24 ± 8 years and an average tibial bone defect of 14.2 ± 3.3 cm. In this technique, the fibula was inset into the tibial defect and vascularization was performed using the posterior tibial artery of the contralateral leg through a radial forearm flap. The two legs were coimmobilized using Hoffmann external fixator and subsequently separated after 6 weeks. Results All flaps survived. Follow-up averaged 44.4 months. Union occurred in all cases within an average of 4.5 ± 1.9 months and Full weight-bearing was achieved at an average of 9.0 ± 2 months. Stress fractures occurred in eight patients (36.3%) after an average of 12 months. Mean graft hypertrophy at the final follow-up was 67.6%. Six patients showed an average limb length discrepancy of 4.2 cm. Two patients required corrective osteotomy, one ankle fusion, and another Achilles tendon lengthening. Functionally, 20 patients were able to walk without crutches. Conclusion The cross-bridge free vascularized fibular graft is a viable option for reconstruction of complex and extensive tibial defects when no other reconstructive options are available.

Mineralized tissue loss at the femoral ACL enthesis in young male ACL-injured patients.

Primary anterior cruciate ligament (ACL) reconstruction graft failure remains a significant health concern in young patients. Despite the high incidence of poor graft integration in these patients and the resulting high failure rate, little consideration has been given to the quality of the bone into which the graft is anchored at reconstruction. Therefore, we investigated post ACL injury mineralized tissue changes in the ACL femoral entheses of young males and compared them to changes previously reported for young females. ACL femoral entheses and adjacent bone specimens were harvested from the injured knees of 51 young males during primary ACL reconstructive surgery and from 10 non-injured male cadaveric donors. The specimens were imaged via nano-computed tomography and analyzed for volumetric bone mineral density (vBMD) and architectural changes. Male femoral ACL explant specimens had significantly lower cortical vBMD (p < 0.001), lower relative bone volume (BV/TV, p = 0.027) and greater cortical bone porosity (Ct.Po, p = 0.027) but similar trabecular bone parameters (p's > 0.05) to those of control specimens from male cadaveric donors. Cortical and trabecular bone loss increased significantly with time from ACL injury to reconstructive surgery (p's < 0.05). While cortical loss occurred in both males and females, significant trabecular loss occurred only in females (p = 0.009). Femoral entheseal bone loss occurs in males following ACL injury. This bone loss increases with time following ACL injury, with cortical bone loss occurring sooner after injury than trabecular bone loss. The effects of ACL injury and time from injury to surgery on trabecular bone microarchitecture differed between male and female patients. N/A.

Anterior Knee Pain after Bone Patellar Tendon Bone Graft for Arthroscopic-Assisted Anterior Cruciate Ligament Reconstruction

Objective: To determine the change in frequency and intensity of anterior knee pain after a bone patellar tendon bone graft for arthroscopic-assisted anterior cruciate ligament reconstruction after 06 months. Study Design: Longitudinal study. Place and Duration of Study: Department of Orthopedics Combined Military Hospital, Rawalpindi Pakistan, from Jul 2019 to Jun 2021. Methodology: We studied 100 patients who underwent Anterior Cruciate Ligament reconstruction and met our inclusion criteria. A Visual Analogue Scale pain score was used to assess anterior knee pain in this group. They were reevaluated at four weeks, eight weeks, and twenty-four weeks. Results: The data of 100 patients (mean age of 29.2±6.71 years) who underwent Anterior Cruciate Ligament reconstruction surgery and followed prescribed rehabilitation protocol was analysed. The VAS scores of all patients at 04 weeks, 08 weeks and 24 weeks were evaluated. The incidence of severe anterior knee pain was 3 patients (3%) at 04 weeks and 1 patient (1%) at 6 months. The frequency of patients in the moderate pain category was 13(13%), 06(06%) and 04(04%) at the 04, 08 and 24 weeks, respectively. At the four-week follow-up, 44 patients (44%) were pain-free, increasing to 70 patients (70%) at the six-month follow-up. Conclusion: At six months following Anterior Cruciate Ligament repair with bone patellar tendon bone graft, there was a significant reduction in the intensity of anterior knee discomfort in patients.