Preinjury Activity Level Research Articles

Return to Sport After Anterior Cruciate Ligament Reconstruction in a Cohort of Division I NCAA Athletes From a Single Institution.

Background:Anterior cruciate ligament (ACL) tears are common in collegiate athletes. The rate of return to the preinjury level of sport activities after ACL reconstruction continues to evolve.Purpose/Hypothesis:The purpose was to determine the return-to-sport rate after ACL reconstruction in a cohort of National Collegiate Athletic Association Division I athletes in different sports. It was hypothesized that, with intensive supervision of rehabilitation, the return-to-sport rate would be optimal.Study Design:Case series; Level of evidence, 4.Methods:We retrospectively reviewed the records of 75 collegiate athletes from a single institution who had undergone unilateral or bilateral ACL reconstruction between 2001 and 2013 and participated in an extensive supervised rehabilitation program. Prospectively collected athlete data as well as data about preinjury exposure, associated lesions, surgical technique, time lost to injury, number of games missed, time to return to full sport activity or retire, and subsequent surgical procedures were extracted from the medical and athletic trainer records.Results:The 75 patients (40 male, 35 female; mean age, 20.1 years) underwent 81 reconstruction procedures (73 primary, 8 revision). The mean follow-up was 19.3 months. The overall return-to-sport rate was 92%. After reconstruction, 9 athletes (12%) retired from collegiate sports, but 3 of them returned to sport activities after graduation. Overall, 8 athletes (11%) experienced an ACL graft retear.Conclusion:The return-to-sport rate in our National Collegiate Athletic Association Division I athletes compared favorably with that reported in other studies in the literature. The strict follow-up by the surgeon, together with the high-profile, almost daily technical and psychological support given mainly by the athletic trainers during the recovery period, may have contributed to preparing the athletes for a competitive rate of return to sport at their preinjury level.

Traditional Modified Broström vs Suture Tape Ligament Augmentation.

The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB. Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm. Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST (P < .001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL (P = .14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group (P = .12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group (P = .144). Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity. Level II, prospective comparative study.

Decreased motion with normal strength after Latarjet procedure has minimal impact on return to activity.

The Latarjet procedure can affect the range of motion (ROM) and strength of the shoulder, which determine the time to return to the preinjury level of activity. This study prospectively assessed whether the Latarjet procedure leads to a decrease in range of motion and muscle strength, affecting the time to return to the previous level of activity. Fifty-one consecutive patients who underwent the Latarjet procedure for recurrent dislocation of the shoulder were included prospectively. The ROM, strength, Walch-Duplay score, and Rowe score were measured every 3months for 1 year and then every 6months for 2 years. Radiological assessments were performed to confirm the graft location, union, and the humeral head position in abduction and external rotation (ER). Out of 51 patients, 49 completed all follow-ups. The median age was 27years (17-45years), and the dominant side was involved in 36 patients. The median number of dislocations was 11 (5-50). Twelve patients were sleep dislocators. There was a significant loss (p < 0.0001) of abduction, forward flexion (FF), ER, and internal rotation (IR) in the affected shoulder compared to the contralateral shoulder. Recovery plateaued at 12months. There was near complete recovery of muscle strength after the Latarjet procedure, and the difference between the affected and contralateral shoulders was not significant (n.s.). The modified Rowe score was excellent in 44 (90%) patients, and the Walch-Duplay score was excellent in 43 patients (88%) at 24months. Suboptimal results were associated with non-compliance with rehabilitation in two (4%) patients and neglected unreduced dislocation in one (2%) patient. The coracoid graft position was below the equator in 44 patients (90%). Forty-six patients (94%) could return to the previous level of activity. The Latarjet procedure results in a restricted ROM of the shoulder, but there is no loss of muscle strength. III.

Clinical Outcome of Neer Type II Lateral End Clavicle Fractures With Coracoclavicular Ligament Disruption Treated With Pre-Contoured Locking Plate and Endobutton.

IntroductionMany surgical techniques have been described for the treatment of Neer type II lateral end clavicle fractures like open reduction and internal fixation with hook plate, tension band wiring, coracoclavicular screw fixation, and distal clavicle locking plate. However, most of these operative procedures are associated with high perioperative complications ranging from hardware prominence, hardware failure, screw and plate pull-out, and infection. As the lateral end clavicle fractures has both vertical and horizontal stress forces, any technique counteracting both the forces should result in a better clinical outcome. Therefore, this study was conducted to assess the functional and radiological outcome of type II lateral end clavicle fracture treated using pre-contoured locking plate along with coracoclavicular reconstruction with endobutton and fiberwire.MethodsThirty-two consecutive patients with Neer type II fractures of the lateral end of clavicle were treated surgically using pre-contoured locking plate and coracoclavicular reconstruction with endobutton and fiberwire between May 2014 and December 2016. Clinical outcome was assessed using the University of California Los Angeles (UCLA) shoulder score and Constant Murley score. The coracoclavicular distance was also recorded. These were compared to the unaffected side at one-year follow-up.ResultsThe bony union was achieved in all cases. There were no major complications in any of the patients. All the patients were able to return to their preinjury level of activity. The UCLA score, the Constant Murley score, and coracoclavicular distance did not vary significantly at a one-year interval when compared to the normal shoulder.ConclusionOpen reduction and internal fixation of Neer type II lateral end clavicle fractures using pre-contoured locking distal clavicle plate along with coracoclavicular reconstruction with endobutton and No. 2 fiberwire provide an excellent functional and radiological outcome.

Vitamin D deficiency in athletes and its impact on outcome of Anterior Cruciate Ligament surgery.

Vitamin D deficiency is a worldwide pandemic problem. With vitamin D having some role in exercise-induced inflammation, skeletal muscle mass and endurance, we studied its effect on functional outcome of athletes' post-Anterior Cruciate Ligament (ACL) reconstruction. A total of 153 patients who underwent primary ACL reconstruction were enrolled in the study. All patients were screened for vitamin D levels preoperatively. Patients were divided into 3 groups on basis of vitamin D levels; Group 1 patients had < 20ng/ml, group 2 patients 20-30ng/ml and group 3 > 30ng/ml. All patients were followed up for a minimum of 2years. A total of 153 patients were enrolled in study. The average age of the patients was 24.12 ± 2.12years in group 1, 25.24 ± 3.20years in group 2 and 24.74 ± 2.86 in group 3. The mean follow-up of patients was 2.8 ± 1.2years. At 2years, the mean Lysholm score was 96.12, 96.49 and 97.0, respectively (p = 0.75); mean WOMAC score was 3.33, 3.38 and 3.20, respectively (p = 0.91); mean difference between the pre-injury and post-surgery Tegner level of sports activity at 2years follow-up was 0.78, 0.78 and 0.85, respectively (P = 0.51) and graft failure rate was 5.88%, 1.96% and 1.96%, respectively (p = 0.43). Vitamin D has no effect on functional outcome and graft rupture rates in patients' post-primary ACL reconstruction. Prospective Cohort Study (Level III).

Current preoperative physiotherapy management strategies for patients awaiting Anterior Cruciate Ligament Reconstruction (ACLR): A worldwide survey of physiotherapy practice

BackgroundAnterior cruciate ligament ruptures are the most common ligament injury to the knee with surgical reconstruction considered standard treatment. This study aimed to explore the current physiotherapy management strategies used during the preoperative phase of rehabilitation for patients awaiting anterior cruciate ligament reconstruction (ACLR). MethodsAn anonymous survey was disseminated online via Twitter and the ‘interactive Chartered Society of Physiotherapy’ message board. Practising physiotherapists who treated at least one patient prior to ACLR in the past year were invited to take part. Responses were collected over a 4-week period in March 2020. Data were analysed using descriptive statistics. ResultsIn total, 183 respondents replied; 122 completed the full survey. Responses were collected from 20 countries across 3 settings, NHS/public health services, private and sports.Most respondents reported prescribing exercises, advice and education to patients during prehabilitation. Up to 40% also utilised passive treatments including manual therapy, taping/bracing and electrotherapy. The frequency of recommended exercise completion and length of treatment varied.Most respondents (n = 103/84.4%) felt that many patients waiting for ACLR did not receive prehabilitation. Many physiotherapists reported that patients expressed concerns regarding their readiness for surgery (n = 61/50%) and return to preinjury levels of physical activity (n = 112/91.8%). Almost all respondents would discuss non-operative management with patients (n = 112/91.8%) if they had returned to their preinjury level of physical activity before their ACLR. ConclusionOverall, this survey provides some insight as to how physiotherapists manage patients awaiting ACLR. Areas of uncertainty in physiotherapy practice have also been highlighted that require further high-quality research.

Primary Partial Transphyseal Anterior Cruciate Ligament Reconstruction in Children with Open Physes

The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients is increasing, with ACL reconstruction preferred as it has been shown to have chondroprotective benefits in this population. Due to concerns with growth disturbances following ACL reconstruction in skeletally immature patients, results of various physical-sparing, partial-transphyseal, or complete-transphyseal techniques have been explored. Currently, there is no consensus on the most effective ACL reconstruction technique in skeletally immature patients. Therefore, the purpose of this study was to report the outcomes of a partial-transphyseal, over-the-top (OTT) ACL reconstruction in a cohort of skeletally immature patients. All patients with radiographic evidence of open tibial and femoral physes that underwent primary ACL reconstruction using the partial-transphyseal OTT technique between 2009-2018 at a single tertiary-care institution were retrospectively reviewed. Patient demographics, physical examination findings, graft ruptures, return to sport, and Tegner activity levels were analyzed. Statistical significance was defined as p <0.05. Overall, 22 males and 2 females (25 knees) with a mean age of 13.0 years (Standard Deviation [SD], 1.7 years) were included in the study. The mean postoperative follow-up was 2.1 years (SD, 1.7 years). There were four cases of ACL graft rupture (16%). All patients successfully returned to unrestricted sport at an average time of 7.3 months. Preinjury and postoperative Tegner activity levels were documented in 22 knees, of which 21/22 (95%) returned to the same or higher level. There were no documented cases of clinically significant longitudinal or angular growth disturbance. Partial transphyseal ACL reconstruction using a transphyseal tibial tunnel and an extra-articular, OTT position on the femur in skeletally immature affords minimal risk of growth disturbance with a graft rupture rate of 16% and a 95% return to sport at the same or higher level.

CLINICAL OUTCOMES AFTER TWO-STAGE BICRUCIATE KNEE LIGAMENT RECONSTRUCTION.

ABSTRACTObjective: To correlate clinical and intraoperative findings with the postoperative evaluation of two-stage bicruciate knee ligament reconstruction. Methods: The study was conducted with 25 patients (20 men and 05 women) with mean age of 32.3 years, mean body mass index (BMI) of 26.2, and mean lesion duration of 18.3 months. The treatment consisted of an Inlay reconstruction of the posterior cruciate ligament (PCL) followed by the anterior cruciate ligament (ACL) reconstruction, at least 3 months after the first surgical procedure. Four patients required additional procedures: patellar tendon (02), medial collateral ligament (MCL) (02). Results: With an average follow-up of 24.8 months, 60% of the patients scored zero or + at the posterior drawer test, while 40% scored ++; 60% of patients were evaluated as good/excellent according to the Lysholm scale. Only one patient reached the pre-injury Tegner activity level. Injury duration had a negative influence on functional limitation, vitality, and mental health (SF-36). Conclusion: Although two-stage bicruciate knee ligament reconstruction improved knee stability and self-assessment, 96% of patients did not recover their pre-injury state. In the 36-item short form survey (SF-36), injury duration was inversely correlated with self-assessment of functional capacity, physical limitation, vitality, and mental health. Level of Evidence II, retrospective study.

Factors associated with fear of re-injury in physically active individuals after an anterior cruciate ligament reconstruction

Objectives: Fear of re-injury is a psychological consequence of an anterior cruciate ligament (ACL) injury. For physically active individuals, fear of re-injury is a frequent cause for not returning to their preinjury physical activity level after ACL reconstruction. The aim of this study is to investigate fear of re-injury, and factors associated with its increase in physically active individuals who had an ACL reconstruction. Methods: A cross-sectional study was conducted in our institute. An online survey was sent to participants. The survey focused on sports participation and included two instruments, the International Knee Documentation Committee (IKDC) and an 11-item version of the Tampa Scale for Kinesiophobia (TSK-11). Results: In total, 103 individuals participated in this study. The mean age was 35 years, males constituted 98% and the mean body mass index (BMI) was 27.8 kg/m2. The mean post-surgery follow-up period was 5.1 years, and around 59.2% of the sample returned to sports. Soccer was the most frequent (73.8%) sport practiced. The mean TSK-11 was 27.9. Age, BMI, concomitant knee injury, time from injury to surgery, follow-up period, and sport type were not correlated with fear of re-injury. However, sports participation frequency, returning to sports, and IKDC scores were significantly correlated with fear of re-injury. Conclusion: Fear of re-injury after an ACL reconstruction is affected by the frequency of sports participation, resuming activity after injury and knee function. Optimizing these factors may improve the psychological outcomes after an ACL reconstruction.

American Academy of Sports Physical Therapy Platform Presentation Abstracts SPL1–SPL82

American Academy of Sports Physical Therapy Platform Presentation Abstracts SPL1–SPL82

Study of functional outcome of arthroscopic ACL reconstruction using hamstring tendon autograft

Introduction: The most common ligament injured in knee is anterior cruciate ligament. This ligament is related to stability, prevention of excessive rotation and forward motion of knee. Accurate reconstruction should be done to achieve excellent functional outcome. Objectives: The main aim was to assess the functional outcome of arthroscopic ACL reconstruction using hamstring tendon auto graft. Also the study intended to describe early weight bearing and early mobilisation and rapid rehabilitation for good clinical recovery after surgery. Methodology: The study was done among 40 subjects who were between 18yrs to 50yrs, with ACL deficient knees, associated menisci injuries. The subjects excluded were having severe co-morbidities, multi ligament injuries and previously operated knee. The Patients were assessed with the IKDC score and single hop test preoperatively and after 6 months. Results: In the study 1 subject didn’t return to pre injury activity level and other 39 came back to pre injury activity level. In the study IKDC score and single hop test after 6 months showed a higher mean in comparison to pre operative evaluation. Conclusion: The technique of ACL reconstruction offers a normal or near normal function and pre and post operative outcome is improved by IKDC score or single hop test

SURGICAL MANAGEMENT OF MENICOCAPSULAR SEPARATION OF THE KNEE JOINT

Background: Meniscocapsular separations are longitudinal tears at the meniscocapsular junction of the posterior horn of the medial meniscus. They are commonly associated with the ACL-deficient knee, both in the acute and chronic setting, with their incidence increasing in time from injury. Meniscocapsular separations are difficult to diagnose preoperatively, and one must have a high index of suspicion in the setting of a chronic ACL tear. Objective: To highlighten a special entity of meniscal injuries “meniscocapsular separation”. Patients and Methods: This study included 10 patients with meniscocapsular separation treated between November 2014 and May 2019. All were involved in sporting trauma. Age was between 18 - 40 years. All cases had a minimum 6 months follow-up. All cases had an M.R.I. All patients had medial meniscal tears. During arthroscopy, complete separation of the meniscus at the capsular junction was reported. Reduction was done followed by using the shaver for edge abrasion. An all inside suture technique had been used to repair the meniscus. The Lysholm knee score and International Knee Documentation Committee (IKDC) were recorded to assess functional outcome, and had been recorded before surgery and 6 months after surgery. Results: Full range of motion was gradually restored. Minimal tenderness was noticed at site of sutures. Four patients had returned to pre-injury activity level. Lysholm knee score improved gradually from preoperatively to final follow-up 6 months later. Conclusion: Meniscocapsular separation presented as a bucket-handle tear. Vigorous twisting and locking should raise suspicion. M.R.I. may be misleading. Reduction and multiple suture placements from posterior to anterior allowed healing and prevented further displacement.

Midterm results of modified coracoclavicular ligament repair using suture anchors for acute acromioclavicular joint dislocation

Purpose The aim was to prospectively gauge the clinical and functional patient outcomes of modified coracoclavicular ligament repair and stabilization using suture anchors and disc reduction in management of acute acromioclavicular joint (ACJ) dislocation at a minimum 2 years of follow-up. Study design This was a case series, and the level of evidence was IV. Patients and methods This study was carried out on 30 consecutive patients who had acute ACJ dislocation Rockwood types III–V in the period between June 2009 and March 2014. Average follow-up was 34.7 (25–75) months. This study was conducted in two tertiary centers: Suez Canal University Hospitals and El-Galaa Military Hospital. All patients were operated within 1 month of injury using an anchor with loaded sutures that was inserted into the dorsal part of coracoid base. The ends of the sutures were then passed through clavicular holes placed at coracoclavicular ligament attachment, and each suture strand was separately tied. Outcome measures Patients were evaluated postoperatively for persistence of good reduction, complications, range of motion, and return to preinjury activity level. Visual analog scale was used to assess postoperative pain. The functional outcomes of the shoulder were evaluated by Disabilities of the Arm, Shoulder, and Hand and Constant shoulder scores. Results A total of 28 patients (93.33%) returned to work and resumed sports activities. The mean Constant score was 88.2 points. The mean Disabilities of the Arm, Shoulder, and Hand score was 12.2 points. Conclusion Treatment of acute ACJ dislocation with coracoacromial ligament repair and stabilization using suture anchors and disc reduction is technically simple and showed encouraging midterm clinical results with a low complication rate.

Outcomes of Surgical Repair Versus Primary Tenodesis for Proximal Rectus Femoris Avulsion Injuries in Professional Athletes

Background: Surgical repair of proximal rectus femoris avulsion injuries is associated with prolonged periods of rehabilitation and highly variable risk of injury recurrence. Surgical tenodesis of these injuries is often reserved for recurrent injuries or revision surgery. To our knowledge, the outcomes of proximal rectus femoris avulsion injuries treated with surgical repair versus primary tenodesis have not been previously reported. Hypothesis: Primary tenodesis of proximal rectus femoris avulsion injuries is associated with reduced risk of injury recurrence as compared with surgical repair. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 25 patients (22 male and 3 female) who underwent surgical repair versus 30 patients (26 male and 4 female) who received primary tenodesis for proximal rectus femoris avulsion injuries. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.9 months (range, 24.0-31.7 months) from date of surgery. Results: All patients returned to their preinjury levels of sporting activity. Primary tenodesis was associated with earlier return to preinjury level of sporting function as compared with surgical repair (mean ± SD, 12.4 ± 1.6 vs 15.8 ± 2.2 weeks; P < .001) and reduced risk of recurrence (0% vs 16%; P < .001). At 1-year follow-up, there was no difference in surgical repair versus primary tenodesis relating to patient satisfaction scores (12 very satisfied and 13 satisfied vs 16 very satisfied and 14 satisfied; P = .70), isometric quadriceps strength (95.6% ± 2.8% vs 95.2% ± 6.3%; P = .31), Tegner scores (median [interquartile range], 9 [8-9] vs 9 [8-9]; P = .54), and lower extremity functional scores (73 [72-76] vs 74 [72-75]; P = .41). High patient satisfaction, quadriceps muscle strength, and functional outcome scores were maintained and remained comparable between treatment groups at 2-year follow-up. Conclusion: Primary tenodesis was associated with reduced time for return to preinjury level of sporting function and decreased risk of injury recurrence when compared with surgical repair for proximal rectus femoris avulsion injuries. There were no differences in patient satisfaction, functional outcome scores, and quadriceps muscle strength between the treatment groups at 1- and 2-year follow-up.

Single-Bundle Versus Double-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction: Comparison of Long-Term Functional Outcomes.

ObjectiveTo compare long-term functional results of ACL reconstruction with a single bundle (SB) and double bundle (DB).MethodsSixty patients who underwent ACL reconstructions from January 2007 to December 2008 were retrospectively evaluated (30 SB and 30 DB ACL reconstructions). Clinical and functional outcomes were measured pre- and postoperatively in terms of anterior drawer test, Lachman’s test, pivot shift test, KT1000 side-to-side difference, range of motion, International Knee Documentation Committee Scoring, Lysholm knee scoring scale (LKS), and Tegner activity level scale. The period of follow-up was 10 years.ResultsClinical outcome measured showed that anterior drawer test result were equally normal for both groups (93.3%; p > 0.995); however, the Lachman test was 76.7% in the DB group and 56.7% in the SB group (p > 0.100), the pivot shift was 83% in the DB group and 50% in the SB group (p < 0.001), and KT1000 was 76.7% in the DB group and 56.7% in the SB group (p > 0.100). Regarding the functional outcome, it favored the DB group of patients, with the LKS being statistically significant (p < 0.007) and the Tegner activity level scale p-value being <0.001ConclusionsDB ACL reconstruction produces better rotational stability and gives superior functional outcome in terms of return to pre-injury activity level in comparison to SB reconstruction. DB ACL reconstruction using hamstring tendon autograft produces better functional results at 10 years follow-up.

Surgical repair for luxation of the superficial digital flexor tendon using a temporary restraining pin.

(1) To report the clinical features of luxation of the superficial digital flexor tendon in dogs and (2) to report the outcome and complications of a novel surgical technique where postoperative immobilisation was not used. Medical records from one Swedish veterinary hospital were retrospectively reviewed for cases of superficial digital flexor tendon treated by the author, between July 2007 and August 2019, where a temporary restraining pin was used as part of the surgical repair. Twenty-three procedures were performed in 19 dogs. Fourteen of the dogs were Shetland Sheepdogs with five other breeds represented. Lateral luxation occurred in all but one case. Minor complications occurred in eight cases (35%). Major complications requiring unplanned surgery occurred in three cases (13%). All cases ultimately returned to their pre-injury level of activity. The use of a temporary restraining pin is useful in the surgical repair of superficial digital flexor tendon luxation. All cases were successfully treated without using post-operative immobilisation of the tarsal joint. Plain radiography is unreliable in the identification of morphological defects of the calcaneus.

Similar functional outcomes of arthroscopic reconstruction in patients with isolated Posterior Cruciate Ligament (PCL) and combined Anterior Cruciate Ligament (ACL) and PCL tears

BackgroundPosterior Cruciate Ligament (PCL) injuries seldom occur in isolation and majority occurs in conjugation with other ligament injuries. Posterior Cruciate Ligament (PCL) reconstruction continues to be taken into consideration as a complicated surgical procedure, with heterogeneity in literature regarding clinical and functional outcomes in isolated PCL and combined ACL and PCL injuries. MethodsThe retrospective evaluation of patients with isolated PCL reconstruction (group 1) and combined Anterior Cruciate Ligament (ACL) and PCL reconstruction (group 2) was performed. A total of 66 patients with either isolated PCL or combined ACL and PCL reconstruction surgeries that met the inclusion criteria, were included in the study. These patients were assessed for functional outcome scores including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lysholm score, International Knee Documentation Committee (IKDC) and Tegner activity score at a minimum follow-up of 5 years. ResultsThe mean follow-up of patients was 82.09 ± 12.43 months in group 1 and 79.36 ± 11.24 months in group 2, with a total of 29 patients in group 1 and 21 patients in group 2. Both the groups were found to be comparable in terms of age, gender, duration of injury and pre-injury Tegner activity level. Post-surgical functional outcome scores (WOMAC score, Lysholm score and Tegner score) were found to be comparable between 2 groups at a mean follow-up of 5 years. Further, 22 patients in group 1 and 16 patients in group 2 had normal or near normal objective IKDC outcome scores at a mean follow-up of 5 years. ConclusionsNo differences were observed in functional outcome scores (WOMAC score, Lysholm score, Tegner score and IKDC score) between isolated reconstructed PCL and combined ACL and PCL reconstructed patients.

Study of clinical outcome following arthroscopic anterior Crucitate ligament reconstruction using autologous quadruple hamstrings graft

Study of clinical outcome following arthroscopic anterior Crucitate ligament reconstruction using autologous quadruple hamstrings graft - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/2395-1362.2018.0066, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Clinical outcome of tibial spine ACL avulsion fracture in adults treated with suture bridge fixation

Introduction: Anterior cruciate ligament avulsion from the tibia with a bony fragment of the tibial spine is an uncommon injury of the knee joint. These are predominantly seen in children and young adults. Arthroscopic reduction and fixation of the tibial avulsion fracture is a technically demanding procedure as restoring the ACL length and tension during fixation is important to ensure stability of the knee while maintaining range of motion and minimal knee laxity. The purpose of the study was to evaluate the outcome of Arthroscopic Suture bridge fixation of tibial spine anterior cruciate ligament avulsion fractures. Materials and Methods: We followed up seven patients prospectively after Arthroscopic suture bridge fixation. The patients were assessed with clinical examination, Tegner Lysholm and IKDC (International Knee Documentation Committee) knee scores. The study group consisted of 5 males and 2 females with a mean age of 24.28 years (Range 18 years to 32 years). Mean follow-up time was 28.7 months (range 24 to 36 months). The study included 4 type II and 3 type III Meyer and McKeever fractures. Results: At follow-up the mean Tegner lysholm score was 91.28. The best results were seen in younger patients. Younger patients had significantly better score for IKDC functional and final scores. Conclusion: Displaced tibial spine avulsion fractures can be successfully treated in younger and older patients using arthroscopic suture bridge fixation with most patients returning back to preinjury levels of activity. Keywords: Arthroscopy, Tibial fractures, Avulsion, Anterior cruciate ligament injuries, Fracture fixation internal.

Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction: Clinical Outcomes and Return to Activity at Mean 6-Year Follow-Up

To report clinical and functional outcomes including return to preinjury activity level following arthroscopic-assisted coracoclavicular (CC) ligament reconstruction (AA-CCR) and to determine associations between return to preinjury activity level, radiographic outcomes, and patient-reported outcomes following AA-CCR. A institutional registry review of all AA-CCR using free tendon grafts from 2007 to 2016 was performed. Clinical assessment included Single Assessment Numeric Evaluation (SANE) score and return to preinjury activity level at final follow-up. Treatment failure was defined as (1) revision acromioclavicular stabilization surgery, (2) unable to return to preinjury activity level, or (3) radiographic loss of reduction (RLOR, >25% CC distance compared with contralateral side). SANE scores, return to activity, and RLOR were compared between patients within each category of treatment failure, by grade of injury, and whether concomitant pathology was treated. There were 88 patients (89.8% male) with mean age of 39.6 years and minimum 2-year clinical follow-up (mean 6.1 years). Most injuries were Rockwood grade V (63.6%). Mean postoperative SANE score was 86.3 ± 17.5. Treatment failure occurred in 17.1%: 8.0% were unable to return to activity, 5.7% had RLOR, and 3.4% underwent revision surgery due to traumatic reinjury. SANE score was lower among patients who were unable to return to activity compared with those with RLOR and compared with nonfailures (P= .0002). There were no differences in revision surgery rates, return to activity, or SANE scores according to Rockwood grade or if concomitant pathology was treated. AA-CCR with free tendon grafts resulted in good clinical outcomes and a high rate of return to preinjury activity level. RLOR did not correlate with return to preinjury activity level. Concomitant pathology that required treatment did not adversely affect outcomes. Return to preinjury activity level may be a more clinically relevant outcome measure than radiographic maintenance of acromioclavicular joint reduction. IV (Case Series).