Postoperative IKDC Research Articles

Arthroscopic ACL repair with suture tape augmentation: clinical, functional, and gait analysis outcomes at minimum 3-year follow-up.

Recent advancements in surgical techniques have led to renewed interest in ACL repair, particularly for acute, proximal tears. Suture tape augmentation (STA) has emerged as a promising technique to support ACL healing while preserving native tissue and potentially improving outcomes. This study aims to evaluate the outcomes of ACL repair with STA in patients with acute, proximal ACL tears. We retrospectively reviewed patients who underwent ACL repair with STA between June 2018 and October 2020. Inclusion criteria were acute (< 6weeks) ACL rupture, Sherman type I tears, and minimum follow-up of 3years. Exclusion criteria included mid-substance or distal ACL tears and previous knee surgeries. Clinical evaluation involved stability tests, PROMs, and gait analysis using Prokin WalkerView. Second-look arthroscopy and histological analysis were conducted on a subset of patients. Twelve consecutive patients (7 males and 5 females) with a mean age of 27.4 ± 7.9years and mean BMI of 23.3 ± 1.6kg/m2were included. Time to operation was 19.5 ± 8.7days. Mean follow-up duration was 53.2 ± 9.4months. One patient experienced a traumatic re-rupture. One had a contralateral ACL tear and one experienced hardware irritation. Clinical tests were negative for instability in all patients. Post-operative IKDC, Lysholm, and FJS-12 scores showed significant improvement (p < 0.001). All patients (100%) achieved minimal clinically important difference for all PROMs. Walking gait analysis revealed high symmetry indices for range of motion (93.50%) and step length (95.80%) with near symmetrical loading. Second-look arthroscopy showed intact repairs with healthy tissue morphology and integration. Histology revealed increased cellularity, high nuclear density, and preservation of vascular and neural components indicated by CD34 and S-100 markers. Arthroscopic ACL repair with STA provides favourable clinical, functional, and histological outcomes with low re-rupture rates when performed on acute, proximal ACL tears. This technique demonstrates fair-to-good PROMs, functional stability, and near-normal gait parameters.

Repair Fails More Frequently Than Reconstruction in Acute Posterolateral Corner Knee Injuries: A Systematic Review of Outcomes Following Surgical Management.

To synthesize the current literature on PLC reconstruction and repair, focusing on a comparison of surgical techniques and outcomes based on injury chronicity in the setting of sports-related ligament tears. A systematic review of the literature including queries of the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in March of 2024. Studies were included if they were of level IV evidence or greater, reported PLC reconstruction or repair outcomes, and had a minimum 2-year follow-up. Patient demographics, injury type, time from injury to surgery, surgical technique, subjective patient outcomes, objective physical exam findings, and complications were obtained. Postoperative physical exam findings of varus and posterolateral rotatory stability and reoperation for instability were used to determine surgical success or failure. Means and ranges were recorded for continuous variables. Forest plots were generated for failure rates by subgroup and an I-squared statistic was used as a measure of heterogeneity. Except for 3 studies, injuries were considered acute when treated within 3 weeks of injury. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) for cohort studies and the National Institute of Health (NIH) Quality Assessment Tool for case series studies. Twenty-nine of the sixty-three reviewed studies (791 patients) met inclusion criteria. Two of the studies were level II, eleven level III, and sixteen level IV evidence. Mean patient age ranged from 19 to 69.1 years. Mean time from injury to surgery ranged from 8.1 to 19 days (acute) and 7.2 weeks to 70.2 months (chronic). Mean postoperative Lysholm scores ranged from 80.8 to 97.0 (acute) and 76.5 to 94.5 (chronic). Mean postoperative IKDC scores ranged from 59.8 to 87.3 (acute) and 64 to 91.9 (chronic). Within the acute PLC group, 114 (59.3%) patients were treated with isolated repair and the remaining 78 (40.7%) were treated with reconstruction. Within this group, failure rates, defined by varus stress examination or reoperation, ranged from 0 to 40%. More specifically , reconstruction failure rates ranged from 0 to 15%, whereas repair failure rates ranged from 0 to 40%. All 602 chronic PLC patients were treated with reconstruction and the failure rate ranged from 0 to 27%, with a single outlier study of two patients reporting a 50% failure rate. The findings of this review suggest that repair of PLC injuries in the acute setting may fail at higher rates than reconstruction. Additionally, chronic PLC injuries are predominantly treated with reconstruction and experience greater variability in their rates of success compared to acute injuries. High-quality, well-controlled studies are needed to determine optimal management of both acute and chronic PLC injuries.

Functional Outcomes in ACL Reconstruction: A Randomized Controlled Trial Comparing All-Inside and Transportal Techniques.

The two techniques to fix a torn ACL are the Transportal and All-Inside Techniques. However, the argument about which method is better for functional outcomes keeps going on. The aim was to look at how well these two treatments worked and their effects. We hypothesized that All-Inside and Transportal ACL reconstruction procedures would yield similar functional results. The study included 45 patients with ACL insufficiency from AIIMS, Raipur, India. Half of each ACL approach was represented by 22 AI and 23 TP participants, randomly assigned to each group. Preoperative and post-operative VAS, IKDC, and range of motion were determined at 1, 3, and 6 months. The study used IBM SPSS v20 for Data Analysis, comparing two groups using a t-test. P < 0.05 was fixed for Statistical significance. The study was dominated by young males (86.7%, 18-30 years), mainly students (44.4%). Comparable IKDC scores over time (P = 0.628); significant VAS score difference (P = 0.001). A similar movement range (P = 0.153) was observed. AI group had slightly smaller grafts (non-significant, P = 0.235). Similar Lachmann Grade distributions pre- and post-surgery; no significant post-operative complication in either group. When comparing the methods' functionalities, no statistically significant gaps emerged. All-Inside approach preserves bone and gracilis tendon, reduces post-operative pain, and strengthens knee flexors. Although, early rehabilitation favors all inside, both methods are equally effective over time. In comparison to the traditional Transportal Technique, All Inside has a greater learning curve and costs more.

MCL pie crusting for concomitant medial meniscal surgery does not appear to adversely influence primary ACL reconstruction functional outcomes

ObjectivesMedial collateral ligament “pie-crusting” (MCLPC), selective release of the superficial MCL, has been shown to improve the arthroscopic access to the posterior horn of the medial meniscus without adversely affecting the outcomes of isolated meniscal surgery. However, whether MCL PC, to address concomitant meniscal lesions during anterior cruciate ligament reconstruction (ACLR) surgery, adversely affects ACLR outcomes is unknown. The aim of this study was to assess whether patients who had undergone MCLPC at the time of ACLR had similar post outcomes to patients undergoing isolated ACLR. Methods55 consecutive patients (33 male and 22 female), with minimum 2-year follow-up, who had undergone MCLPC with concomitant primary ACLR (PC group) were retrospectively matched on the basis of age, sex and follow-up with 55 patients who underwent isolated primary ACLR. Post-operative outcome measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, Tegner activity score, the EuroQol five-dimension health questionnaire and EuroQol visual analogue scale. ResultsThe two groups’ median postoperative EQ 5D-VAS, EQ 5D-index and Tegner scores were similar. The difference between pre-operative and post-operative KOOS scores was similar for the two group for all subscales except the ADL subscale which was higher in the MCLPC group (24, IQR ​= ​6–32) than in the isolated ACLR group (5, IQR ​= ​0–9.74). The median post op IKDC score was 84 in the MCLPC group and compared with 90 in the isolated ACLR group. However, the difference between pre-operative and post-operative IKDC scores was higher in patients in the MCLPC group (40, IQR ​= ​25–49) than in the isolated ACLR group (32, IQR ​= ​19.6–46.8). ConclusionsMCLPC, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes. Level of evidenceIV.

Comparison of Clinical and Radiological Outcomes With Body Mass Index After Medial Patellofemoral Ligament Reconstruction.

Medial patellofemoral ligament (MPFL) reconstruction is a commonly employed surgical approach for recurrent patellar dislocation. However, the impact of elevated body mass index (BMI) on postoperative complication rates remains controversial. To compare the clinical, radiographic, and functional outcomes of patients with normal BMI (18.5-24.9 kg/m2) and those with elevated BMI (≥25 kg/m2) who underwent MPFL reconstruction for recurrent acquired lateral traumatic patellar dislocation. Cohort Study; Level of evidence, 3. A total of 70 patients who underwent MPFL reconstruction for recurrent patellar dislocation were included in this study. Patients with recurrent patellar dislocation were categorized into 2 groups based on their BMI: the normal BMI group and the elevated BMI group. Functional scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner, and Kujala scores) and radiological measurements (patellar tilt angle, patellofemoral trochlear congruence, lateral patellofemoral angle, and lateral patellar displacement) were evaluated both preoperatively and at the last follow-up. The occurrence of postoperative complications at the last follow-up was also recorded. Differences in functional scores and radiological parameters before and after surgery were analyzed with paired-samples t tests or Wilcoxon signed-rank tests. Comparisons between groups were conducted using independent-samples t tests or the Kolmogorov-Smirnov test. In the normal BMI group, there were 13 male patients and 27 female patients, with a mean follow-up duration of 26.15 ± 13.16 months. The mean age in this group was 21.93 ± 7.94 years. The elevated BMI group consisted of 12 male patients and 18 female patients, with a mean follow-up duration of 27.50 ± 15.79 months and a mean age of 23.30 ± 8.43 years. At the final follow-up, the incidence of surgical failure (patellar redislocation or subluxation and necessitating secondary surgery) was significantly higher in the elevated BMI group (6 out of 30 patients; 20.0%) compared with the normal BMI group (1 out of 40 patients; 2.5%) (P < .05). Both groups demonstrated significant improvement in postoperative Lysholm, IKDC, Tegner, and Kujala scores compared with the preoperative period (P < .05). Notably, the normal BMI group had significantly higher preoperative Lysholm and Tegner scores compared with the elevated BMI group (P < .05). Furthermore, the elevated BMI group exhibited less improvement in Tegner and Kujala scores compared with the normal BMI group (P < .05). Postoperative radiological parameters in both groups returned to the normal range (P < .05). There were no statistically significant differences between the 2 groups in terms of radiological parameters and their corresponding differences. Our study demonstrated statistically significant increases in postoperative clinical scores for both groups, although the intergroup differences varied. Specifically, patients with elevated BMI demonstrated poorer preoperative Lysholm and Tegner scores. The postoperative improvement in radiological parameters was equally good between the 2 groups.

Failure rate of isolated medial meniscus repair in the stable knee: Systematic review and meta-analysis.

The present meta-analysis aims to determine the outcomes and failure rates for medial meniscus repairs in patients with stable knees. A literature search was conducted using PubMed and Scopus with the terms '(medial meniscus OR medial meniscal) AND (repair)'. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included 93 articles assessed for eligibility. The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analyses and case reports. In total, 10 studies with 595 patients were included. Degenerative tears or studies reporting meniscus repair outcomes on root repairs, revision or primary anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. All studies included revision surgery and/or clinical symptoms as failure definitions. The overall medial meniscal repair failure rate was 26% with a 95% confidence interval (CI) [15%-37%]. The mean time to failure from isolated medial meniscus repair surgery was 27.7 months with 95% CI [18.5-36.9 months]. The postoperative Lysholm and IKDC scores were reported in three articles. At the final follow-up, the mean postoperative Lysholm and IKDC scores were 92.3 with 95% CI [84.5-100] and 88.6 with 95% CI [83.5-93.8], respectively. The current meta-analysis revealed an overall failure rate of 26% in the case of medial meniscus repair in a stable knee. For these reasons, the patient should be aware of the substantial risk of revision surgery (one out of four cases). Medial meniscus repair in a stable knee yielded good clinical results. II.

Good mid- to long-term outcomes after meniscus bucket-handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction.

To evaluate mid- to long-term clinical outcomes after arthroscopic bucket-handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty-five patients with an average follow-up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post-operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. The failure rate was 9%. Medial BHMT repair showed superior post-operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post-operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow-up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post-operative outcome measures was observed but did not reach statistical significance for most items. Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow-up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level IV (retrospective case series).

Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes

PurposeMeniscal wrapping is a fully arthroscopic technique that involves enhanced meniscal repair with a tissue-engineered collagen matrix wrapping. This study aims to investigate the feasibility of using the meniscal wrapping technique for the treatment of chronic or complex meniscal tears. The primary objective is to assess its failure rate. The secondary objectives are to analyse complication rate, functional outcomes and overall patient satisfaction.MethodsThis retrospective case series study included patients who sustained chronic and complex tears undergoing meniscal wrapping with autologous liquid bone marrow injection. Failure rate was considered if the patient underwent partial or complete meniscectomy or knee replacement during the follow-up, while other unexpected knee reoperations were considered as complications. Clinical outcomes were evaluated through the IKDC score, Tegner Activity Score and Short Assessment of Patient Satisfaction.ResultsTwenty-one patients were included (15 non-acute bucket-handle tears, three non-acute horizontal tears and three non-acute complex injuries). The failure rate was 9.5% at 33 months. The rate of other unplanned reoperations was 14.3%, but none of these complications were apparently directly related to the wrapping technique. The average postoperative IKDC was 73.3/100. No statistically significant difference was encountered between preinjury and postoperative Tegner Activity Score. The mean overall patient satisfaction was 88.3/100.ConclusionsMeniscal wrapping can be safely used as an adjunctive technique to meniscal repair in such difficult-to-treat cases to preserve the meniscus. The technique achieves a low failure rate and promising results of knee function, and patient satisfaction.

Comparison of effectiveness of intraoperative subperiosteal versus periarticular analgesic cocktail injection for post operative analgesia in patients undergoing total knee arthroplasty

Background: Early postoperative pain management is pivotal in patients undergoing Total knee arthroplasty. The advantage of Local infiltration analgesia is its ability to provide control of pain without interfering with motor strength of the lower extremity, thereby allowing early mobilization of patients. This study compares the effectiveness of local analgesic cocktail injection given through subperiosteal vs. periarticular routes. Methods: The study included 30 patients admitted for primary total knee arthroplasty. They were grouped into two groups based on different injection sites. Group A included patients who received subperiosteal injection and Group B included patients who received periarticular injection, under spinal anaesthesia. The difference in pain among the two groups, using VAS at 12, 24, 48, and 72 hrs postoperatively, postoperative range of movements, and Functional outcome using IKDC score at the end of 6 months were assessed and compared between the two groups. Results: The mean VAS scores at 12, 24, 48, and 72 hrs were 0.87±0.35, 1.47±0.52, 1.80±0.41, 1.07±0.46 in subperiosteal group and 2.00±0.53, 2.47±0.52, 2.80±0.56, 1.93±0.59 in periarticular group. The 6 months postoperative IKDC scores were 51.34±0.41 and 51.04±0.61 respectively. Conclusions: Subperiosteal cocktail injection can significantly reduce the postoperative pain and result in early recovery of range of movements, compared with periarticular cocktail injection in patients undergoing Total knee arthroplasty. But the long-term functional outcomes were comparable among both the groups.

Higher conversion rate to knee arthroplasty in female patients following medial open-wedge high tibial osteotomy.

Most studies about medial open-wedge high tibial osteotomy (HTO) reported outcomes without focusing on gender differences. Therefore, the study compared the long-term survival rate and postoperative subjective knee function after HTO in female versus male patients with symptomatic medial compartment knee osteoarthritis. The data of three cohorts with long-term outcomes were analysed (n = 245; 32% females; age: 49 ± 7 years; Kellgren Lawrence Grade I 6.1%, II 32.7%, III 42.4%; IV 18.8%). The minimum follow-up was at least 6 years or an earlier conversion to total knee arthroplasty (TKA). The gender-specific survival rate after HTO was calculated after 5 and 10 years and compared using Kaplan-Meier analysis and the logrank test. Baseline characteristics and subjective knee function (International Knee Documentation Committee [IKDC]/Lysholm) were analysed between both genders. Forty of 78 (51.3%) women and 41 of 167 men (24.5%) underwent TKA. HTO survival in females was significantly lower (p = 0.0010). The 5- and 10-year survival rates were 85.9% and 62.6% for females and 93.4% and 77.7% for males. In females and males, from preoperative to the last follow-up, the IKDC (43 ± 15 to 58 ± 17; 47 ± 14 to 67 ± 18) and the Lysholm (42 ± 18 to 72 ± 18; 55 ± 22 to 77 ± 23) improved significantly (all p < 0.0001). Females had significantly lower preoperative and postoperative IKDC (p = 0.0438; p = 0.0035) and Lysholm scores (p = 0.0002; p = 0.0323). But the absolute improvements of the IKDC and Lysholm were not significantly different between genders. Females had higher conversion rates to TKA and lower knee function at the last follow-up. However, preoperative knee function was lower in females and the absolute improvement following HTO was similar for both genders. In general, females benefit from HTO to treat medial knee arthritis, and TKA could be postponed for half of female patients for more than 10 years. However, surgeons must be aware of the described inferior outcomes in females for realistic patient expectation management. Level II.

FUNCTIONAL OUTCOME AMONG PATIENTS WITH ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH ENDO-BUTTON AT GHURKI TRUST TEACHING HOSPITAL POST 6 MONTHS-A SINGLE CENTERED SURVEY

Background of the Study: To assess the functional outcome among patients with arthroscopic ACL reconstruction with endo-button at Ghurki Trust Teaching Hospital post 6 months. Methodology: A single centered survey was conducted on 67 patients with arthroscopic AC Ligament reconstruction using Hamstring auto-graft (Semitendinosus-Gracilis tendons) after 6 months and evaluated for functional outcome. The data was collected from Ghurki Trust Teaching Hospital. The sampling procedure utilized was non-probability sampling. Functional outcome was assessed using subjective form of IKDC score. Data was analyzed using SPSS version 23. Results: Out of 67 patients, all were male. The pre-operative subjective IKDC scoring was less than 30 and post-operative mean IKDC scoring is 73.92. On the basis of findings of study, significant improvement was observed after ACL reconstruction post 6 months. Conclusion: ACL reconstruction shows significant improvement in knee function and significant recovery of preoperative functional status. Keywords: Anterior cruciate ligament reconstruction, international knee documentation score, functional outcome, arthroscopy, endobutton, hamstring tendon, ligament injury

Poster 241: Outcomes of Trochleoplasty for Recurrent Patellar Dislocation in Adolescents with Open Physes

Objectives: Patellofemoral dislocation, the most severe presentation on the spectrum of patellar instability, is most common in adolescent populations. Trochlear dysplasia is an integral component of the disorder, and procedures aimed at correcting instability by addressing this dysplasia are often necessary. A theoretical risk of injury to the distal femoral physis exists in these surgeries. At our institution, a thick-flap sulcus deepening technique is used to re-shape the trochlear groove. The risk of injury to the physis in this procedure is not clearly delineated in the current literature. We investigated the outcomes in adolescent patients undergoing this procedure, hypothesizing that patients with open distal femoral physes and less than 2 years of remaining growth can safely and successfully undergo thick-flap sulcus deepening trochleoplasty. Methods: Seventeen adolescents (21 knees) with open physes underwent thick-flap trochleoplasty at our institution. Preoperative radiographs were used to evaluate leg axis and patella alta. Preoperative MRI was used to determine trochlear dysplasia (sulcus depth, spur height, patellofemoral index) and tibial tuberosity to trochlear groove distance (TTTG) distance. Preoperative and postoperative AP and lateral radiographs were used to evaluate and compare the lateral distal femoral angle (LDFA) and Blumensaat’s angle (BA). Preoperative and postoperative IKDC and Kujala outcome scores were measured to evaluate clinical improvement. Results: Median age at time of operation was 14.9 years for girls and 15.5 for boys. Mean follow up was 5.4 years from surgery. At two-year follow up, growth plates were closed in all but one knee. No clinical differences to the leg length or alignment were appreciated. There was no statistically significant change in lateral distal femoral angle (mean change 0.74 degrees, p = 0.1074). There was a statistically significant change in Blumensaat’s angle (mean change 0.89 degrees, p = 0.0477). Mean Kujala score improved significantly from 60.19 preoperatively to 90.36 postoperatively, p= 0.0008. Mean IKDC score improved significantly from 59.37 preoperatively to 87.21 postoperatively, p = 0.00064. There was recurrent instability in one knee, requiring revision surgery with distal femur and Fulkerson osteotomies. Conclusions: Adolescent patients nearing skeletal maturity can safely and successfully undergo thick- flap sulcus deepening trochleoplasty for patellar instability resulting from trochlear dysplasia. At follow- up, there was no clinical evidence of growth disturbances, and postoperative imaging demonstrated less than 1 degree difference in LDFA and BA at skeletal maturity, which are unlikely to be of clinical significance. These findings should be interpreted very carefully, as specific patient selection, trochleoplasty expertise, and extreme caution are still necessary to prevent iatrogenic injury to the distal femoral physis.

Repair of meniscus root tear - Is there a difference between medial meniscus root repair and lateral meniscus root repair? A systematic review and meta-analysis.

Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing small-scale retrospective case-control studies suggested that the outcomes were different between medial and lateral meniscus root repair. This meta-analysis aims to study whether such discrepancies exist via a systematic review of the available evidence in the literature. Studies evaluating the outcomes of surgical repair of posterior meniscus root tears, with reassessment MRI or second-look arthroscopy, were identified through a systematic search of PubMed, Embase, and Cochrane Library. The degree of meniscus extrusion, healing status of the repaired meniscus root, and functional outcome scores after repair were the outcomes of interest. Among the 732 studies identified, 20 studies were included in this systematic review. 624 knees and 122 knees underwent MMPRT and LMPRT repair, respectively. The amount of meniscus extrusion following MMPRT repair was 3.8 ± 1.7mm, which was significantly larger than the 0.9 ± 1.2mm observed after LMPRT repair (p < 0.001). Significantly better healing outcomes were observed on reassessment MRI after LMPRT repair (p < 0.001). The postoperative Lysholm score and IKDC score was also significantly better after LMPRT than MMPRT repair (p < 0.001). LMPRT repairs resulted in significantly less meniscus extrusion, substantially better healing outcomes on MRI, and superior Lysholm/IKDC scores, when compared to MMPRT repair. This is the first meta-analysis we are aware of that systematically reviews the differences in the clinical, radiographic, and arthroscopic results of MMPRT and LMPRT repair.

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials.

In recent years, various clinical trials have focused on treating knee osteoarthritis (KOA) with multiple injections of platelet-rich plasma (PRP). However, compared with the multiple hyaluronic acid (m-HA) injections, the clinical efficacy of multiple PRP (m-PRP) injections for KOA still remains controversial among these studies. Therefore, we aimed to compare the clinical effectiveness of m-PRP injections with m-HA injections in the treatment of KOA in this systematic review. Relevant clinical trials were searched via bibliographic databases, including Medline, PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, to compare the m-PRP and m-HA injections in the treatment of KOA. Finally, fourteen randomized controlled trials, including 1512 patients, showed the postoperative VAS, WOMAC, IKDC, or EQ-VAS scores and were enrolled in this systematic review. Compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was lower in the VAS scores at 3-month (WMD = -0.25; 95%CI, -0.40 to -0.10, p = 0.0009) and 12-month (WMD = -0.64; 95%CI, -0.79 to -0.49, p < 0.00001) follow-ups. In addition, the group of intra-articular m-PRP injections was also lower in the WOMAC scores at 1-month (WMD = -1.23; 95%CI, -2.17 to -0.29, p = 0.01), 3-month (WMD = -5.34; 95%CI, -10.41 to -0.27, p = 0.04), 6-month (WMD = -11.02; 95%CI, -18.09 to -3.95, p = 0.002), and 12-month (WMD = -7.69; 95%CI, -12.86 to -2.52, p = 0.004) follow-ups. Furthermore, compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was higher in the IKDC scores at 3-month (WMD = 7.45; 95%CI, 2.50 to 12.40, p = 0.003) and 6-month (WMD = 5.06; 95%CI, 1.94 to 8.18, p = 0.001) follow-ups. However, the long-term adverse side of m-PRP injections for KOA still needs more large-scale trials and long-term follow-ups.

Pre- and Post-Operative Hamstring Autograft ACL Reconstruction Isokinetic Knee Strength Assessments of Recreational Athletes.

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries with a high incidence among people with high physical activity levels. Therefore, ACL reconstruction (ACLR) is one of the most common surgical procedures performed in sports medicine. This study aims to compare the pre- and 6-month post-operative isokinetic knee strengths in healthy (HK) and ACL knees of patients who underwent semitendinous/gracilis (ST/G) ACLR. Materials and Methods: A retrospective cohort of 21 recreational athletes who underwent ST/G ACLR by the same surgeon were evaluated. The pre- and 6-month post-operative isokinetic knee extension (Ex) and flexion (Flx) strengths of the HK and ACLR patients were evaluated in a series consisting of three different angular velocities (60, 180 and 240°/s). Of all the findings, peak torque (PT) and hamstring/quadriceps (H/Q) parameters were evaluated. Results: There was a significant improvement in post-operative Lysholm, Tegner and IKDC scores compared to pre-operative scores (p < 0.05). There were significant differences in pre-operative and post-operative knee Ex and Flx strengths at angular velocities of 60°, 180° and 240°/s in both the ACLR and HK groups (p < 0.001). There was no significance at 240°/s Flx for ACLR (p > 0.05). As for H/Q ratios, there was a significant difference between pre- and post-operative values only at 60°/s angular velocity in both ACLR and HC (p < 0.005). Conclusions: The pre-operative and 6-month post-operative results of the ST/G ACLR showed that there was a high level of recovery, particularly in quadriceps strength, while the increase in strength was less in the hamstring. The significance observed at 60°/s in H/Q ratios was within normal ranges. It can be argued that the ST/G ACLR method is feasible for people with high physical activity levels and for athletes.

Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement.

Biomechanical studies support the use of suture tape reinforcement for limiting graft elongation and increasing strength in knee ligament reconstructions. To compare posterior cruciate ligament (PCL) laxity, complication and reoperation rates, and patient-reported outcomes (PROs) after all-inside single-bundle PCL reconstruction (PCLR) with versus without independent suture tape reinforcement. Cohort study; Level of evidence, 3. A retrospective cohort study of consecutive patients who underwent primary, all-inside allograft single-bundle PCLR with and without independent suture tape reinforcement at a single academic institution from 2012 to 2019. Medical records were reviewed for patient characteristics, additional injuries, and concomitant procedures. PRO scores (including the International Knee Documentation Committee [IKDC], Tegner activity scale, and Lysholm scores), bilateral comparison kneeling radiographs, and physical examination findings were collected at a minimum of 2 years postoperatively. Included were 50 patients: 19 with suture tape reinforcement (mean age 30.6 ± 2.9 years) and 31 without suture tape reinforcement (control group; mean age 26.2 ± 1.6 years). One PCLR graft in the suture tape group failed. Posterior drawer examination revealed grade 1+ laxity in 4 of 19 (21%) of the suture tape cohort versus 6 of 31 (19%) of the control cohort (P > .999). Bilateral kneeling radiographs showed similar side-to-side differences in laxity between the groups (suture tape vs control: mean, 1.9 ± 0.4 vs 2.6 ± 0.6 mm; P = .361). There were no statistically significant differences between the groups in postoperative IKDC (suture tape vs control: 79.3 vs 79.6; P = .779), Lysholm (87.5 vs 84.3; P = .828), or Tegner activity (5.6 vs 5.7; P = .562) scores. All-inside single-bundle PCLR with and without independent suture tape reinforcement demonstrated low rates of graft failure, complications, and reoperations, with satisfactory PROs at a minimum 2-year follow-up. Radiographic posterior tibial translation was comparable between the 2 groups.

Concomitant Patellar Tendon Tear (PTT) with Cruciate and/ Collateral ligament injury (Multi- Ligamentous Knee Injury –MLKI) and new pathoanatomical -Ganga PTT classification aids to strategize treatment options

IntroductionConcomitant patellar tendon (PT) tear with cruciate or multi-ligament knee injuries (MLKI) following high-velocity injury requires a systematic approach. MethodsThe study is a retrospective case series of patients (2008–2019) with concomitant PT ligament injury with cruciate or collateral ligament injury (MLKI), including bony avulsion injuries. Isolated cruciate and MLKI without patellar tendon tears are excluded. N = 32 patients (1 female and 31 male) are divided into two groups, Group 1 (11 patients) with PT tear and ACL tear and group 2 (21 patients) with PT tear and MLKIs. Patients were taken up for a single stage in types 1,2,3 and staged repair with reconstruction for types 4,5 of our new classification. All the patients are followed up regularly, and IKDC and Lyshom's score and objective radiological stress x-rays taken at each follow-up ResultsIncidence of PTT combined injuries among all knee ligament injuries is 0.57%. The mean age was 35.09+/-11.96 SD(group1) and 36.55+/-11.89 SD(group2). The average follow-up was 34.45 months +/- 12.86SD (group 1) and 35.3 months +/- 15.75 SD (group2). Mean post-operative Lysholm score and IKDC score of group 1 and group 2 improvement was statistically significant p-value <=0.01. The mean post-operative ROM of the two groups were 132.73 (SD 6.46) (Group 1) and 111.75 (15.75) (Group 2) and was a statistically significant p-value <0.01. Residual lag of 30° seen in all patients improved by 3rd month in group 1 and 6th month in group 2. Knee stiffness is seen in 2 patients and superficial infection in 2 patients. ConclusionPTT combined injuries are rare and occurs due to direct impact injuries. Single-stage PT repair with ACL reconstruction gives adequate stability, and extensor lag is eminent and needs supervised rehabilitation. PT with MLKI is a challenging scenario that can be performed in single-stage/multiple stages, depending on the injuries, surgical expertise, and institutional facilities. Newer simplified classification aids surgeons in planning a treatment strategy.

Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients

BackgroundTibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done. MethodsA prospective, randomized, interventional study was conducted from December 2019 to January 2022 for comparing the clinical outcome of arthroscopic pull through suture fixation and arthroscopic antegrade cancellous screw fixation in skeletally mature individuals. Ninety patients (45 in each group) were randomly assigned and treated with the above two methods. A comprehensive clinical analysis was done after nine months of surgery for assessment of functional outcome, ligament laxity, range of motion, and complications if any. Results65.55% of anterior tibial eminence fractures were caused by road traffic accidents followed by sports injuries (28.88%). The postoperative mean subjective IKDC score in the suture group was 91.36 and for the screw fixation group was 85.71 (p = 0.001). After nine months of surgery, the mean LKS was 91.96 in patients treated with suture fixation and 86.00 in patients treated with screw fixation (p = 0.001). Pivot shift grading was grade 3 in one patient of the suture group and in three patients of the screw group (p = 0.319). Seven patients who had screw fixation required re-surgery for removal of the implant; however, no such complication was seen in the suture fixation group. ConclusionArthroscopic pull-through suture fixation of tibial avulsion of ACL in skeletally mature patients seems to be a superior intervention over arthroscopic screw fixation with the benefits of better clinical and functional outcomes and decreased chances of re-surgery.

Comparative study of superficial medial collateral ligament reconstruction combined with posterior oblique ligament reconstruction or posteromedial capsule advance in grade III injuries of the medial compartment in a complex knee injury scenario

BackgroundThe purpose of this study was to compare the combined reconstruction of the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL) with the reconstruction of the sMCL associated with the advancement of the posteromedial capsule in a complex knee injury scenario. We hypothesized that both techniques would present similar knee stability and failure rates. MethodsThis is a retrospective case–control study designed to compare the results of the two reported techniques for grade III MCL instability. Patients undergoing MCL reconstruction associated with anterior cruciate ligament, posterior cruciate ligament, or both, from 2010 to 2019, were included. The following parameters were evaluated: demographic data, type of graft, time from injury to surgery, associated meniscus injuries, follow up time, mechanism of trauma, postoperative objective IKDC, subjective IKDC and Lysholm scales, range of motion, reconstruction failure and complications. ResultsSeventy-eight patients were evaluated, 37 of whom underwent reconstruction of the sMCL and POL, and 41 of whom underwent reconstruction of the sMCL with advancement of posteromedial structures. There was no difference in any preoperative variable. Patients undergoing reconstruction of the sMCL + advancement had greater loss of flexion (Group 1 3.4 ± 4.6 vs Group 2 8.4 ± 7.9; P = 0.002) and more individuals with flexion loss greater than 10° (Group 1, seven patients (18.9%) vs Group 2, 17 patients (41.5%); P = 0.031). Postoperative knee stability, failures and complications were similar between groups. ConclusionBoth techniques presented good functional results and low rates of complications. However, the advancement technique showed greater flexion loss, which should be considered when choosing the best surgical option.

Comparative study on arthroscopic double posterior medial approach versus open surgery for acute simple posterior cruciate ligament tibial avulsion fracture

To compare difference in clnical efficacy between arthroscopic double posterior internal approach and incisional surgery for acute simple posterior cruciate ligament tibial avulsion fractures. Totally 52 patients with acute simple posterior cruciate ligament tibial avulsion fractures treated from June 2016 to June 2020 were retrospectively analyzed and divided into two groups according to different surgical protocols, 27 patients in arthroscopic group were treated with arthroscopic double posterior internal approach, including 16 males and 11 females, aged from 19 to 52 years old, with an average age of (34.9±9.2) years old;25 patients in open reduction group were treated with posterior medial knee incision, including 14 males and 11 females, aged from 18 to 54 years old , with an average age of(33.7±8.4) years old. Operation time, incision length, intraoperative bleeding, hospitalization days, hospitalization cost, fracture healing, complications, postoperative Lysholm score and IKDC score at 12 months were observed and compared between two groups. All patients in both groups were completed opertaion successfully without vascular or nerve injury, and 52 patients were followed up from 6 to 24 months with an average of (15.0±1.7) months. Operation time and hospitalization cost in arthroscopic group were significantly greater than those in open reduction group(P<0.05);intraoperative bleeding, incision length, and hospitalization days in arthroscopic group were less than those in open reduction group(P<0.05);preoperative Lysholm score in arthroscopic group and open reduction group were 49.1±2.3 and 48.9±1.1 respectively, and improved to 95.9±1.7 and 86.4±1.2 at 12 months after operation respectively(P<0.05);preoperative IKDC scores in arthroscopic group and open reduction group were 47.6±4.1 and 48.1±3.9 respectively, and improved to 96.9±1.5 and 87.1±1.4 at 12 months after operation(P<0.05). Arthroscopic double posterior internal approach for acute simple posterior cruciate ligament tibial stop avulsion fracture has satisfactory early results and better efficacy than traditional open surgery, which has advantages of less trauma, faster recovery and easier operation.