Hamstring Graft Research Articles

Retrospective Study on the Risk of Nerve Injury After Distal Biceps Tendon Repair Using Cortical Button.

Distal biceps tendon ruptures are relatively rare injuries that typically require surgical intervention to restore flexion and supination strength. Concerns have been raised regarding the risk of nerve injuries, particularly the posterior interosseous nerve (PIN), associated with the use of cortical buttons in distal biceps repair. This study aimed to estimate the incidence of PIN injury as well as injuries to the lateral cutaneous nerve of the forearm and superficial branch of the radial nerve following distal biceps repair using cortical buttons. A retrospective review was conducted on all patients who underwent distal biceps repair with cortical buttons at a district general hospital between January 2014 and May 2022. Patient data, including age, gender, time from injury to surgery, type of procedure, and postoperative nerve injuries, were collected. The incidence of nerve injuries was analyzed, and the outcomes were assessed during postoperative follow-up visits. Ninety-six male patients were included in the study, with an average age of 45.6 years. The average time from injury to surgery was 22.6 days. All patients underwent primary repairexcept for two patients who underwent reconstruction with hamstring grafts. None of the patients experienced a PIN injury. However, 16 patients (16.7%) developed lateral cutaneous nerve injuries of the forearm, and three patients (3.1%) had superficial radial nerve injuries. Our study, encompassing a large cohort of patients over an eight-year period, demonstrates the safety of distal biceps repair using cortical buttons with regard to PIN nerve injury. However, there were incidences of lateral cutaneous nerve of the forearm and superficial radial nerve injuries, consistent with previous studies.

Both Adjustable and Fixed Loop Hamstring Tendon Graft Fixation Have Similar Clinical and Patient-Reported Outcomes in Anterior Cruciate Ligament Reconstruction

PurposeThis study aims to compare the outcomes of fixed-loop device (FLD) vs adjustable-loop device (ALD) graft fixation with up to 2-year follow-up in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) in a predominantly Asian setting. MethodsProspectively collected outcome measures as well as clinical records of patients who underwent primary ACLR using either FLD or ALD fixation of hamstring tendon autograft performed by a single surgeon were reviewed. The surgeon in this study used a fixed-loop device from 2018 to 2019 and then changed to adjustable loop from 2019 to 2020. Suspensory fixation was performed on the femoral side, and aperture (interference screw) fixation was performed on the tibial side. Outcome measures included knee range of motion, KT-1000 arthrometer testing, Lysholm knee score, and Tegner activity scale. Patients were assessed preoperatively and postoperatively at regular intervals of 6, 12, and 24 months. ResultsA total of 105 patients were identified. Forty-six were excluded due to incomplete follow-up data, so 59 patients with full 2-year follow-up were included in the final study group. Both groups (FLD vs ALD) were similar in demographics except for age (P = .042). Out of 105, there were 59 patients remaining in the study group with 2-year follow-up data. No significant differences were observed between the 2 groups at all respective testing intervals. ConclusionsFLDs and ALDs for suspensory fixation of hamstring tendon autograft in ACLR had similar clinical outcomes with a minimum of 2-year follow up. There is no evidence of graft loosening from loop lengthening. Level of EvidenceLevel III, retrospective comparative trial.

Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented with Ligament Augmentation and Reconstruction Systems (LARS) or Synthetic Meshwork of LARS Compared with Four-Strand Hamstring Tendon Grafts Alone, a Prospective, Randomized Clinical Study with 2- to 8-Year Follow-Up.

To compare the long-term outcomes of anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft alone (hamstring group) or with synthetics (Ligament Augmentation and Reconstruction System, LARS group) or synthetic meshwork of LARS (meshwork group). Patients who underwent ACL reconstruction using four-strand hamstring tendon grafts (hamstring group), autologous hamstrings augmented with the LARS (LARS group), or synthetic meshwork of LARS (meshwork group) were selected in this prospective randomized clinical study. Patient-reported outcome measures (PROMs) were obtained preoperatively; at 6, 12, and 18months postoperatively; and at final follow-up between 3 and 8years. Second-look arthroscopic findings were used to evaluate graft morphology based on graft tension, graft tear, and synovial coverage. A total of 141 consecutive patients underwent ACL reconstruction, 47 patients in each group, and 21 patients were lost to follow-up during the study period. At the 6-month follow-up, the IKDC scores and Lysholm scores were significantly better in the LARS group (P < 0.05). At the 6- and 12-month follow-ups, the KOS-ADLS, KOOS-activities of daily living and quality of life, NSARS scores, GRC scores, Tegner scores, and ACL-RSI scores were significantly better in the LARS group (P < 0.05). For the LARS group, hamstring group, and meshwork group, the cumulative failure rates were 8.5%, 12.8%, and 4.3%, respectively. Malposition of the femoral tunnel was significantly associated with cumulative failure (P < 0.05). There was no difference between the groups in other outcomes at any other time, including radiographic and arthroscopic outcomes. ACL reconstruction using autologous hamstring augmented with LARS resulted in significantly better clinical scores with a faster return to sports and comparative side-to-side differences in graft laxity by 6 and 12months follow-up. Despite these findings, no statistically significant differences were seen among the three patient groups in terms of objective outcomes and clinical scores at the 18-month, 3-year and 8-year follow-ups. Additionally, a malpositioned femoral tunnel was associated with graft failure.

Cohort study of short-term outcomes after ACL-reconstruction using autograft with internal brace reinforcement versus isolated autograft demonstrating no significant difference

BackgroundThe gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten recovery. Few studies have examined these techniques, in particular when compared to non-augmented grafts. This study assesses the short-term outcome of ACL-R using augmented and non-augmented hamstring tendon autografts. MethodsThis was a retrospective cohort study comparing augmented and non-augmented ACL-R. All procedures were performed in a single centre using the same technique. The Knee injury and Osteoarthritis Outcome Score [KOOS] was used to assess patient-reported outcomes. ResultsThere were 70 patients in the augmented and 111 patients in the control group. Mean graft diameter in the augmented group was 8.82 mm versus 8.44 mm in the non-augmented. Six strand graft was achievable in 73.5% of the augmented group compared to 33% in the non-augmented group. Two graft failures were reported in the non-augmented group and none in the augmented group. Patient satisfaction rates were higher in the augmented group. There was a statistically insignificant improvement in the postoperative KOOS in the augmented group compared to the non-augmented group (p 0.6). Irrespective of augmentation status, no correlation was found between the functional score and age, or femoral tunnel width. ConclusionNo statistically significant difference was demonstrated in the short-term functional outcome of ACL reconstruction using an augmented or non-augmented hamstring graft. Augmented ACL-R may achieve superior graft diameters, failure rates and patient reported outcomes when compared to nonaugmented ACL-R. Prospective trials are needed to examine this further.

Comparison of “ligamentization” process between preserved insertion hamstring tendon autograft and bone-patellar tendon-bone autograft

BackgroundLigamentization is a complex process and effect of preservation of hamstring tendon graft insertion on this process is not well studied. Present study was conducted to analyze and compare the ligamentization of semitendinosus gracilis graft with preserved tibial insertion (STGPI) and bone-patellar tendon-bone (BPTB) autografts. MethodsA total of 50 sportspeople who underwent ACL reconstruction using either BPTB (group A; n = 25) or STGPI (group B; n = 25) autografts were included in the study. Contrast enhanced MRI was done at 8 months and 14 months post-ACL reconstruction to evaluate the ligamentization using Signal noise quotient (SNQ), graft intensity and enhancement index. Clinical outcomes (Lysholm score) and knee laxity were also assessed at 8 months and 14 months. Results18/23 (78%) patients in group A and 14/23 (61%) patients in group B had hyperintense graft signal at 8 months (n.s.) and at 14 months, 1/23 patients in group A and none of the patients in group B had hyperintense graft. SNQ at 8 months was 3.6 ± 2 and 3.7 ± 2 in group A and B respectively (n.s.) and at 14 months, SNQ was 2.5 ± 1.5 in group A and 2.4 ± 1.3 in group B (n.s.). Enhancement index at 8 months was 1.5 ± 0.3 and 1.2 ± 0.3 in group A and B respectively (p = 0.0001). Enhancement index at 14 months was 1.21 ± 0.2 in group A and 1.07 ± 0.2 in group B (p = 0.003). Functional outcomes and knee laxity were comparable in both the groups at 8 and 14 months (n.s.). ConclusionBoth the grafts i.e. BPTB and STGPI are similar in terms of rate and extent of ligamentization. Clinical outcomes and knee laxity are also comparable between two grafts.

Midterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch)

Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the mid-term outcomes following rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (TEAR patch) with the hypothesis, that outcomes would be reasonable and complication rates low. This is a retrospective case series study of patients who underwent open RCR using a TEAR patch from June, 2015 to March, 2019. evidence of cuff tear arthropathy, advanced fatty infiltration, moderate to severe arthropathy and workers compensation board or litigation involved. Clinical outcome measures: Constant score (CS), Disabilities of Arm, Shoulder and Hand score (DASH), Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), range of motion (ROM) and manual muscle test (MMT) for forward elevation, abduction, external and internal rotation, patient satisfaction, willingness to do the operation again. Radiographic outcome measures: MRI, ultrasound and radiographs: Graft integrity and acromiohumeral distance (AHD). 44 patients were followed (89%) for ≥ 2 years (45 shoulders, mean age 60.3 years (48-76), mean follow-up 4.3 years (2-6)). All clinical outcome measures (CS, DASH, SST, SSV, ROM, and MMT) demonstrated significant improvement except active external and internal rotation. At 2 years follow-up, the mean patient satisfaction was high (12.2 out of 15 points) and 33 of 38 patients (73.3%) would do the operation again. A perfect graft integration was observed in n=30 (66.7%) a small gap in n=7 (15.6%), a retear in n=3 (7%) and a complete failure of the tendon patch in n=5 (11%) patients. Graft integrity was strongly correlated with the postoperative AHD (r=0.599 , p=0.001 ) and the gain in AHD (r=0.599 , p=0.001) but not with ROM or PROM's or patient satisfaction. Four patients required revision surgeries (three due to deep infection and one for poor function and pain). Mid-term clinical and radiographic outcomes following RCR with graft bridging using a TEAR patch were reasonable. The procedure resulted in improved shoulder function and a high level of patient satisfaction. The revision rate is acceptable in view of the specific patient group and treatment alternatives. The described technique of the TEAR patch can be a valuable alternative to existing methods and a novel autograft source for rotator cuff surgeries that need bridging of a tendon defect.

Minimally Invasive Bone-Patellar Tendon-Bone Graft Harvest Is Associated With Less Frequent Anterior Knee Pain at Rest Than Hamstring Graft Harvest After Anterior Cruciate Ligament Reconstruction at the 1-Year Follow-Up

To compare the incidence of postoperative anterior knee pain at rest and during "knee walking" in patients who had anterior cruciate ligament reconstruction (ACLR) surgery with hamstring tendon (HT) grafts versus bone-patellar tendon-bone (BPTB) grafts harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects. Adult patients who had undergone an ACLR and had completed a questionnaire enquiring about anterior knee symptoms at a minimum of 1 year postoperatively were identified. Two groups were compared: 1) patients who had received a BPTB graft harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects, and 2) patients who had received a HT graft. A total of 142 adult patients were included: 88 had a BPTB graft and 54 had a HT graft. The prevalence of anterior knee pain at rest was 10% in the BPTB group and 28% in the HT group (P= .006). Overall, knee walking scores were worse in the BPTB group when compared to the HG group, but the difference in the proportions of patients who found it impossible to knee-walk was not statistically significant (17% vs 6%; P= .069). Our results showed that pain at rest was less in the BTPB group compared to the HT group contradicting historic literature. In addition, there was no statistically significant difference between the 2 grafts when comparing the proportion of patients who found it "impossible" to knee-walk. Level III, retrospective comparative study.

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

PurposeThe aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis.MethodsThe study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study.ResultsOverall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with κ = 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found.ConclusionThis study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis.Level of evidenceIV.

Manual and Device-Assisted Hamstring Autograft Tensioning Yield Similar Outcomes following ACL Reconstruction.

A prospective comparative study was conducted between September 2015 and May 2017. Sixty-four patients (mean age 29.3 years, range 14-45) with isolated ACL injuries (and who would be subjected to ACL reconstruction with a quadruple hamstring tendon graft) were divided into two groups. In Group A (n = 29), common tension was applied manually to both grafts. In Group B (n = 35), specific tension was applied to the grafts with the use of a tensioner device (ConMed Linvatec SE™ (Stress Equalization) Graft Tensioning System). A total of 60 N was applied to the semitendinosus, and 40 N was applied to the gracilis. Clinical outcomes were assessed at 6, 12, and 24 months. There were no significant differences between the baseline demographic and clinical data among the patients of the two groups (all p > 0.05). The patients were followed up for a minimum of 24 months (mean ± SD). There were no significant differences in the side-to-side anterior knee laxity, the IKDC, the Lysholm Knee, and the Tegner Activity Scale scores for up to 24 months after operation. The pivot shift test was negative in all cases, and no graft failure was reported at a 2-year follow-up. No significant differences were found with respect to postoperative anterior knee laxity, clinical outcomes, activity level, and patient satisfaction between the application of manual tension and the use of the graft-tensioning system during tibial fixation while performing anatomic single-bundle ACL reconstruction with a quadruple hamstring tendon graft. Further high-quality clinical studies are required to elucidate whether device-assisted tension is superior to manual tension.

Characterizing focal muscle signal on MRI in flexor-pronator muscles' status post ulnar collateral ligament reconstruction.

Focal high signal is commonly seen about the flexor pronator mass on MRI in some patients after ulnar collateral ligament (UCL) reconstruction of the elbow. The etiology of this high signal is unclear and not described in literature. The hypothesis is that the edema we see on post-operative MRI is related to palmaris longus graft harvest rather than secondary to other causes of muscle edema such as denervation or muscle strain. An IRB waiver-approved, retrospective search of our radiology database was conducted using the keywords "ucl," "elbow," and "reconstruction" between 1/01/2012 and 1/01/2022, with search parameters set as MRI for exam type. The images were reviewed to evaluate for high signal at the flexor pronator mass by a junior and a senior musculoskeletal radiologist. The surgical notes were then reviewed in electronic medical record system to see which graft was used for the UCL reconstruction. The cohort comprised of 33 patients (1 female/32males, 14-51 years old) who had undergone UCL reconstructions. Four patients were excluded from the study secondary to the surgical note not specifying which graft was used. The surgical and imaging dates were also recorded with the largest time gap of 7 years between the surgery and imaging. Seventeen of the 29 patients had palmaris longus harvested from the ipsilateral arm, 1 patient had palmaris longus harvested from the contralateral arm, 2 patients had an internal brace, and 9 patients had a hamstring graft. Seventeen out of 17 (100%) patients with ipsilateral palmaris longus graft demonstrated focal edema at the flexor pronator mass while 0/12 of the patients without the palmaris longus graft showed the focal edema seen by its counterparts. High signal which is commonly seen at the flexor pronator mass in patient status most UCL reconstruction of the elbow is secondary to the palmaris longus harvest rather than other etiologies such as muscle strain, retear, or trauma.

Poster 332: Return to Sport, Post-Operative Performance Testing, and Re-injury Rates Among Athletes Treated with Hamstring, Quadriceps, and Patellar Tendon Autograft ACL Reconstruction

Objectives: Anterior Cruciate Ligament (ACL) tears are a common sporting injury and optimal graft choice is of concern for both patients and surgeons. Few comparative studies have evaluated return to sport and reinjury rates across graft types. The purpose of the present study was to evaluate return to sport rates and reinjuries among hamstring tendon (HT), quadriceps tendon (QT), and patellar tendon (BPTB) ACL reconstructions. Methods: Recreational and competitive athletes ages 13-24 from 2010-2022 that underwent primary or revision ACL reconstruction were included. There were 837 total athletes comprised of 341 HT, 358 BPTB, and 138 QT autografts, of which 729 were primary and 108 were revision surgeries. Return to sport (RTS) rates, RTS testing results, clearance time, and reinjury rates were collected. RTS testing data included isokinetic testing of quadricep and hamstring strength and functional movement screening. A Kruskal-Wallis test was used to detect differences among continuous variables. A GLIMMIX procedure was completed for multivariate analysis to detect differences between groups after adjusting for age and activity level. Chi-square statistics and Fisher’s exact test were used for categorical variables. Odds ratio, adjusted odds ratio, and 95% confidence intervals were provided by logistic regression. All statistical analyses were performed using SAS 9.4 (Cary, NC). Statistical significance was measured at p&lt;0.05. Results: The median ages were 18 for HT and BPTB and 17 for QT (p= 0.0001). Females comprised 50.73% of HT grafts, 42.86% of BPTB grafts, and 41.30% of QT grafts. Return to previous level of play was observed in 118/130 (90.77%) HT, 124/136 (91.18%) BPTB, and 39/52 (75.00%) of QT grafts (p=0.0045); BPTB remained statistically more likely to return to previous level of play than QT after adjusting for age and activity level. RTS testing was completed in 28/341 (8.21%) HT, 142/358 (39.66%) BPTB, and 80/138 (57.97%) QT grafts (p&lt;0.001); after adjusting for age and activity level, the results remained significant. Median isokinetic quadriceps testing at 300 degrees per second was 92% for 26 HT athletes, 83% for 134 BPTB athletes, and 87% for 77 QT athletes (p= 0.0006); results remained significant following age and activity level adjustment. Median isokinetic hamstring testing at 60 degrees per second was 89% for 24 HT athletes, 101% for 135 BPTB athletes, and 100% for 79 QT athletes (p=0.0007); results remained significant after adjustment for age and activity level. The median single- leg hop ratio was 98% for 5 HT athletes, 85% for 12 BPTB athletes, and 96% for 14 QT athletes (p=0.044); after adjusting for age and activity level, results remained significant. Time to be cleared for RTS was 25.89 weeks for 179 HT athletes, 34.75 weeks for 186 BPTB athletes, and 35.74 weeks for 75 QT athletes (p &lt;0.0001) with the results remaining statistically significant following adjustment for age and activity level. ACL retear rates were 12.02% for HT, 3.07% for BPTB, and 5.07% for QT (p&lt;0.0001) with hamstring grafts remaining significantly more likely to suffer an ACL retear than BPTB grafts after adjusting for age and activity level. Conclusions: After adjusting for age and activity level, BPTB ACL autografts demonstrated a lower reinjury risk when compared to HT autografts. When comparing QT and BPTB, return to sport testing 6-9 months post-op was superior in the QT group; however, BPTB patients were more likely to return to sport. This data can help influence surgeon and patient shared decision-making models in athletes with ACL injuries.

STUDY OF THE INFLUENCE OF THE POSITION OF THE TENDON GRAFT HAMSTRING MUSCLE ON THE STABILITY OF THE KNEE JOINT UNDER THE CONDITIONS OF PLASTICITY OF THE STRUCTURES OF THE POSTEROLATERAL ANGLE

Damage to the posterolateral angle of the knee joint is an injury that occurs occasionally and can be isolated or combined with tears of the posterior or anterior cruciate ligaments. The key link of damage to the posterior lateral corner is the rupture of the tendon of the hamstring muscle, mained stabilizer of excess external rotation lower legs. Objective. Determine the optimal fixation position tendon graft on the posterior surface of the tibia subject to recovery of the hamstring muscle which ensuring the greatest stability of the lower leg during external rotation. Methods. Models of the knee joint were built with different attachment points of the popliteal graft muscle in the ANSYS software environment. The criteria for evaluating the effectiveness of selecting the fixation point of the transplant were chosen as the degree of movement of the finite parts elements of the model. Results. The smallest movements in all directions received in the case when the transplant fixed as far as possible outwards and upwards, near the joint surface. Maximum — in the direction of the coordinate axes, as well as full movement were recorded for the control model, in the absence of the hamstring tendon The nature of the distribution of displacement fields in all models p graft and control were identical. Biggest there were additional displacements in the direction of the x axis (outward). on the front border of the platform, and the largest negative (so far redins) on the back. The largest additional shifts to the sides the y (front) axes are fixed at the leftmost limit and the largest negative (back) — to the rightю Conclusions. In view of the stability of the lower leg during rotational loading, the most effective is fixation of the hamstring graft on the back surface of the fibula is as late as possible and closer to its cardiac surface, finished in this case, the dimensions are found to be the smallest in all directions. The greatest displacement in all directions obtained in the control model for less tendon hamstring muscle.

Functional outcome of arthroscopic anterior cruciate ligament reconstruction with hamstring graft

Introduction Incidence of anterior cruciate ligament (ACL) injuries is increasing owing to increased participation in sports. We are presenting our case series in which we have done ACL reconstruction (ACLR) with autologous hamstring graft. Basic idea for this project was to increase the awareness regarding timely management of ACL injury and good to excellent outcome of this minimal invasive technique. Materials and Methods In this retrospective study, we included 10 patients who underwent arthroscopic transportal single bundle ACLR using hamstring autograft, between January 2019 to December 2021 in Isra university hospital Hyderabad. Patients were followed routinely and outcome was recorded with the help of Lysholm knee scoring questionnaire at 6 months and 12 months post procedure. Results Mean age of the patients was 28.2 years (22 to 35 years) (Table-1). Average duration between injury to surgical intervention was 12.3 months (6 to 26 months). Final outcome was excellent in 3 patients (60%), good in 6 patients (30%) and fair in one patient (10%). Conclusion Injury to ACL is a critical event for any individual. Its timely management is important not only to return the patient back to pre-injury activity level but also to prevent delayed consequences of ACL tear. Our study and the literature review shows satisfactory results of arthroscopic ACLR. Finally, one should follow the basic principles of arthroscopic surgical technique of ACLR along with postoperative supervised physiotherapy rehabilitation protocol to get the desired results.

Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study

BackgroundPersistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR.MethodsPatients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers.ResultsA total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05).ConclusionIn this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.

Anterior Cruciate Ligament Arthroscopic Ligamentoplasty Using the Four-Strand Hamstring Technique.

In this study, we looked at the clinical outcomes of individuals who had a symptomatic torn anterior cruciate ligament and had their anterior cruciate ligament repaired using a four-strand hamstring (4SHS) tendon autograft at least two years later. This is a retrospective study of 34 cases of anterior cruciate ligament arthroscopic reconstruction using the four-strand hamstring graft, collected from Traumatology and Orthopedics at Cheikh Khalifa Hospital in Casablanca, Morocco between January 2017 and January 2021. Different surgeons performed the operations. Physical findings and functional scores were recorded before the follow-up physical examination and surgery; thus, knee radiographs have been evaluated. A six-month rehabilitation program was devised following surgery. The average age of the patients was 30 years, with a male predominance of 94%. Thirty patients (88%) reported negative pivot shift tests and the Lachman test. The average Lysholm score enhanced from 59.3before surgery to 85.29at the time of the assessment. Three patients (8.82%)with a positive pivot shift test had no background of extra knee damage. In comparison to the appearance on the preoperative radiographs, no proof of progressive degenerative deterioration was found on the follow-up radiographs. All of the patients, however, had tunnel extension. The tibial tunnel grew on average by 18%, while the femoral tunnel grew on average by 30%. In 88% of patients assessed at least two years after surgery, ligamentoplasty of the anterior cruciate ligament using the four-strand hamstring graft eradicated anterior tibial subluxation. The failure rate was overall 10%. The functional knee scores had greatly improved at the time of the follow-up.

Diagnostic Accuracy of Fine Needle Aspiration Cytology for Evaluation of Breast Lump Compared to Trucut Biopsy

Background: The primary issue after isolated intra-articular anterior cruciate ligament (ACL) surgery is the continuation of pivot shift. By limiting rotational laxity, the lateral extra-articular tenodesis (LET) treatment added to the ACL surgery improves knee stability. This study's objective was to assess the long-term clinical and radiological results of ACL restoration coupled with LET utilizing a continuous hamstring graft as the first operation. Method and Analysis: Four years postoperatively, 20 patients were examined. Collecting subjective outcome ratings (IKDC, Lysholm, KOOS, and Tegner). A clinical and radiological evaluation was conducted. The anteroposterior laxity of the knees was assessed using a rollimeter. Using SPSS version 23, the statistical analysis was conducted. The mean and standard deviation of quantitative data were used to summarize the data. Fischer's exact test was used to compare qualitative characteristics, whereas Student's t-test was used to compare mean values. A p value of 0.05 or less was regarded as significant. Result: The mean IKDC subjective score was 83.1, the mean Lysholm score was 89.02 and 75% of patients had exceptional or excellent scores. In 85% of patients, there was no pivot shift, and 60% of patients had a definitive endpoint on the Lachman test. Conclusion: The addition of primary LET to ACL restoration enhances rotational laxity control over time without raising the risk of complications.

Anatomic Posterolateral Corner Reconstruction With Single Graft Tibial Socket Fixation

Introduction: The posterolateral corner (PLC) is comprised of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Injuries to the PLC are associated with significant morbidity and functional limitation, most frequently manifested through a varus thrust gait. In the previous 2 decades, advances have been made in understanding the importance of the PLC and as a result, many techniques have been developed to address its reconstruction. Material and Methods: The Laprade technique is a previously described anatomic reconstruction of the PLC. We propose some modifications to this technique, which involve dissection of the posterolateral tibia to allow direct protection of the popliteal neurovascular bundle while establishing tibial fixation. A single hamstring graft is utilized for the reconstruction, is routed through the fibular tunnel and subsequently secured with the use of a dual-expanding tenodesis anchor, placed in a tibial socket removing the need for a tibial tunnel. Conclusion: The present study describes a novel anatomic technique that allows for improved protection of neurovascular structures, better control of graft tensioning and tunnel management, and the judicious use of a single tendon autograft while maintaining the described benefits of the anatomic Laprade technique.

Comparison of an Anterior Cruciate Ligament's Functional Outcomes Peroneus Longus Graft Reconstruction as an Option to the Hamstring Tendon Graft

Background: The utilization of peroneus longus graft for the main ACL reconstruction had not been considered since the advent of arthroscopic surgery of anterior cruciate ligament (ACL). There is not much written about it. Therefore, the purpose of this study is for comparison of functional results, morbidity of donor site, knee stability, and evaluation of the muscle of thigh worsening in the patients having the injury of ACL who underwent reconstruction of the arthroscopic single-bundle utilizing the PLT and the HT, respectively. Methods: The crass sectional and survey designed was used to meet the study objectives. The population was Prior to surgery and rehabilitation, all patients who were included were randomly assigned to the HT and PLT groups The 194 individuals whose admitted for the arthroscopic single-bundle ACLR who had symptoms of symptomatic ACL insufficiency and was between the ages of 16 and 50 and of either gender was divided into two groups (hamstring tendon and peroneus longus). Preoperative measurements were taken as well as ones at six months and a year after surgery for functional, clinical knee evaluation, morbidity of donor site, and the thigh circumference. In both groups, the identical post-operative rehabilitation regimen was used. Results: The criteria of inclusion were met by 174 patients. The scores of postoperative, preoperative 6-months, and the 1-year post-operative for hamstring and groups of PL in the IKDC where p = 0.3 and score of the Lysholm knee where p = 0.28 did not differ significantly from each other. The thigh muscle wasting was significantly reduced in group of PLT so at the last follow-up where the p &lt; 0.001, while it was not significantly different in the HT group (mean for the AOFAS was 99.05 ± 3.56 and 99.80 ± 0.70, respectively). Practical implication: This study is for comparison of functional results, morbidity of donor site, knee stability, and evaluation of the muscle of thigh worsening in the patients having the injury of ACL who underwent reconstruction of the arthroscopic single-bundle utilizing the PLT and the HT, respectively. Given that there was no discernible donor site morbidity and improved recovery of the thigh muscle atrophy (better reactivity to the rehabilitation than the HT group), it was an effective and secure autograft choice for routine ACL restoration. Conclusion: Similar knee stability and functional results were seen in both groups, and there was no clear donor site morbidity. Additionally, these patients recovered from the withering of their thigh muscles more quickly after receiving physiotherapy. Therefore, we can suggest that a PL graft may be a reliable, practical, and efficient alternative to the standard arthroscopic single-bundle replacement. Keywords: Hamstring tendon, hamstring tendon grafts, anterior cruciate ligament reconstruction, hamstring tendons, anterior cruciate ligament

Metal hypersensitivity causing implant migration after anterior cruciate ligament reconstruction

A young female in her early twenties was diagnosed with Anterior cruciate ligament (ACL) deficiency. Operative intervention was advised with ACL reconstruction using a hamstring graft. The procedure was uneventful, and she was discharged on the second day. She was improving as per expectations. Six months later, the patient came with complaints of a discharging sinus which was located at the site of the tibial entry wound which healed with conservative therapy. However, she developed a similar discharge from the same site after one year of surgery. Radiographs showed migration of the implants away from the bone and towards the skin on the femoral and tibial side. The tibial implant was seen lying just beneath the skin through the discharging sinus. Finally, it was decided to remove the implants surgically. After implant removal, regular dressing was done, and the sinuses healed well without any further complications.&#x0D;

Predictors of lower knee function improvement two years after anterior cruciate ligament reconstruction

ABSTRACT Objectives The extent to which knee functions improve after anterior cruciate ligament reconstruction (ACLR) varies. This study aimed to determine the factors that affect lower knee function improvement after two years of ACLR. Methods The study included 159 patients who underwent ACLR in the Indonesian ACL community between August 2018 and April 2020. The concomitant injury and graft types of ACLR were determined using patients’ pre-surgical MRI and medical records. The five subscales of the knee injury and osteoarthritis outcome score (KOOS) were used to evaluate the patient at baseline, first year, and second year following ACLR. A linear mixed-effect model (LMEM) was used to predict the longitudinal improvement models for the five-subscales KOOS score after ACLR. Results The LMEM predicted lower KOOS subscales scores improvements by 0.5 for QOL, 0.1 for symptom, ADL, and QOL, and 0.2 for sports/recreation, respectively, for a one score increase of age and time from injury to surgery. Male patients had higher KOOS subscale scores with the improvement of pain, symptom, and ADL by 5.7, 5.9, and 6.3 compared to female patients, respectively, while patients with patellar tendon grafts had lower improvement of KOOS score pain by 6.5 compared to hamstring tendon grafts. Conclusion As the age and time from injury to surgery increased, the KOOS subscales scores of QOL and symptoms, ADL, sports/recreation, and QOL decreased. Male patients reported higher KOOS subscales scores for pain, symptoms, and ADL, while patients with patella tendon grafts had a lower improvement in pain score.