Tegner Lysholm Knee Scoring Research Articles

Functional outcome of an arthroscopic anatomical single bundle anterior Cruciate Ligament (ACL) reconstruction using Semi-tendinosus graft with fixation using Endo-button on femoral side and Suture Disc on Tibial side- A prospective clinical study

<p class="abstract"><strong>Background:</strong> Injury to the anterior cruciate ligament (ACL) is one of the most frequent injuries of the knee during different sports activities. Arthroscopic surgical reconstruction is the current standard of care for treatment of ACL injuries in young and active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Hamstring tendon is most favoured graft for ACL reconstruction. We wanted to study the outcomes particular method of fixation for fixing the hamstring tendon.</p><p class="abstract"><strong>Methods:</strong> In this study 30 patient with ACL injury were treated arthroscopically for the fixation of graft in bone tunnel we use endobutton for femur and suture disc for tibia as suspensor implant and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> The preoperative activity level could be maintained in 70% of the patients. The Lysholm score showed very good and good results in 80%. Functional and stability results in about 70% of the patients.</p><strong>Conclusions:</strong>This surgical technique can be recommended for the active patient with ACL deficiency. The functional outcome of anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon autograft using Endobutton and suture disc is good. This method of fixation will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs completely.

Functional outcome of bony PCL avulsions fixed with Mini open technique

Introduction: To evaluate the functional outcome in bony Posterior Cruciate Ligament (PCL) avulsion fractures treated with open reduction and internal fixation through Mini open technique. The approach is safe, and simple with a slight modification and technical tips. Material and Methods: Twenty four patients (19 males and 5 females) were included in the study. Fixation was done through a modified mini open technique using 4 mm cannulated cancellous screws. The minimum follow up considered in study was one year. Functional outcome was assessed using clinical examination, Tegner Lysholm knee score and stress radiography. Results: The mean Tegner Lysholm scores at the time of 1 year follow up was 91.66. The PCL laxity assessed clinically by posterior drawer test on stress radiography was grade I in 3 cases and nil in rest of 21 at 8 weeks follow-up. All the patients had achieved bony union of tibial avulsion fractures at the time of last follow up. Conclusion: Bony PCL avulsion fractures treated by Mini open technique with open reduction and internal fixation achieved good to excellent results and can prevent significant late onset disability.

Functional evaluation of fixation for PCL bony avulsion fractures using Burk and Schaffer’s approach

Background: Posterior cruciate ligament (PCL) is the chief posterior stabilizer of the knee In literature, surgical indications for PCL injuries treatment remains debatable, but in PCL bony avulsion, surgical reinsertion of the avulsed fragment is a recommended procedure. Objective: This study was aimed to evaluate efficacy of Burk Schaffer’s approach for fixation of tibial avulsion of PCL and to abstract the outcome of bony PCL avulsion fractures treated with cancellous screw fixation and their complications if any. Study Design: This was a prospective study conducted in 34 patients of isolated PCL avulsion fracture. Material and Methods: This study had 34 patients with age ranging from 28 to 50 yrs. It included 47.06% RTA, 26.47% sports trauma and 26.47% domestic injuries. All patients were evaluated by X-rays, MRI and CT preoperatively. Standard Burks Schaffer’s approach was used in all cases. All patients were assessed radiologically for union, Tegner Lysholm Knee Scoring Scale and IKDC score and objective PDT manual examination for a period of 2 years after surgery were done. 67.65% achieved union in 12 weeks and 26.47% achieved union by 16 weeks, Delayed union was found in 5.88% beyond 16 weeks although none needed revision or reconstruction. Average pre-operative Lysholm score of 40 improved to 88 postoperatively. Average IKDC score preoperative was 33 which meliorated to 83 after treatment. Conclusion: Improvised approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw is one of the excellent techniques for tibial avulsion of posterior cruciate ligament (PCL). The isolated PCL avulsion fractures treated with fixation have good Lysholm and IKDC scores, although objective laxity is present in significant number of cases without subjective disability. The isolated PCL injuries have good results if managed surgically

Functional outcome of anterior cruciate ligament reconstruction with quadruple hamstring tendon graft using EndoButton and bioabsorbable interference screw: minimum 2-year follow-up

<p class="abstract"><strong>Background:</strong> Anterior cruciate ligament (ACL) is the most common ligament to be torn in the knee joint and ACL reconstruction (ACLR) is one of the most commonly performed surgery in orthopaedics nowadays. This study evaluated short term results of anterior cruciate ligament reconstruction with quadruple hamstring tendon (QHT) graft using EndoButton for femoral fixation and Bio absorbable interference screw for tibial fixation.</p><p class="abstract"><strong>Methods:</strong> Out of the<strong> </strong>68 patients who underwent single-bundle ACLR with QHT graft using EndoButton for femoral fixation and Bio absorbable interference screw for tibial fixation, 60 patients were followed up for a minimum period of 2 years. Patients were followed up at regular intervals and evaluation was done using the anterior drawer test, Lachman test, pivot-shift test, modified Cincinnati rating system and Tegner-Lysholm knee scoring scale.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was improvement in the Lachman test and pivot-shift test at 2 year follow-up, from grade 2 (n=47) or grade 3 (n=6) to grade 1 (n=17) or grade 0 (n=42) and from grade 1 (n=38) or grade 2 (n=12) to grade 1 (n=14) or 0 (n=45), respectively. The mean Modified Cincinnati score and Tegner-Lysholm knee score improved from 59.57 to 99.03 and 64.45 to 98.87 respectively at 2 year follow-up. Complications occurred in 3 patients, a re-rupture due to trauma at 1 year after surgery, development of a cyclops lesion with restricted range of motion and a superficial infection at the graft harvest site.</p><p><strong>Conclusions:</strong> The two year follow-up results of ACLR with QHT graft using EndoButton for femoral fixation and bioabsorbable interference screw for tibial fixation are satisfactory and comparable with other modalities of graft fixation.</p>

The effect and safety of highly standardized Ginger (Zingiber officinale) and Echinacea (Echinacea angustifolia) extract supplementation on inflammation and chronic pain in NSAIDs poor responders. A pilot study in subjects with knee arthrosis

The study aimed to evaluate the effect of Zingiber officinale and Echinacea angustifolia extract supplementation (25 mg of ginger and 5 mg of Echinacea) for 30 days on inflammation and chronic pain in knee osteoarthritis (OA). Consecutive nonsteroidal anti-inflammatory-drugs (NSAIDs) poor responders with chronic inflammation and pain due to knee arthrosis were assessed (15 subjects, age: 67.2 ± 7.9, body mass index: 30.6 ± 7.1, men/women:2/13). The primary endpoint was to determine pain improvement from baseline to Day 30 by Tegner Lysholm Knee Scoring. The secondary endpoints were the assessment of Visual Analog Scale for Pain, health-related quality of life, by the ShortForm36 (SF-36), anthropometric parameters, hydration. After supplementation, a significant improvement of 12.27 points was observed for Lysholm scale score (p < 0.05), SF-36 (p < 0.05), and a decrease in −0.52 cm in knee circumference (left) (p < 0.01). This pilot study provides feasibility and safety data for the use of highly standardised ginger and Echinacea extract supplementation in people with knee OA.

A comparison of functional outcome between bioabsorbable interference screw and endobutton fixation on femur in arthroscopic anterior cruciate Ligament reconstruction

Introduction: Arthroscopic Anterior Cruciate Ligament [ACL] reconstruction is very commonly done procedure in recent times {1}. The graft fixation methods vary from aperture fixation [Interference screws] to suspensory fixation methods [Endobutton]. This is a Prospective non randomised clinical study of arthroscopic ACL reconstruction comparing the functional results between aperture fixation and suspensory fixation. Material and methods: Two groups of 10 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 1 year follow up evaluation were included in the study. The aperture fixation group underwent bioabsorbable interference screw fixation at both femoral and tibial tunnels. The suspensory fixation group underwent endobutton fixation on the femoral side and biointerference screw on tibial side. Both group patients were examined prior to surgery and at 3 months, 6 months and 1 year. They were compared for functional outcome with Tegner Lysholm knee score. Observation and results: There was significant improvement in functional outcome in both the groups for base and at 3 months, also for 3 months and 6 months but for 6 months to 1 year Group 2 is almost significant. Conclusion: In our prospective study of comparison of functional outcomes between aperture fixation and suspensory fixation on femur in arthroscopic ACL reconstruction which were evaluated by using Tegner Lysholm knee score over a period of 1 year, suspensory fixation was found to be better. However, further long term studies involving large series of cases would throw more light on this information.

Rehabilitation in Patients with Anterior Cruciate Ligament Reconstruction Using Auxiliary Platelet-Rich Plasma Therapy

Abstract Background: The main target after successful AnteriorCruciate Ligament (ACL) reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma) may improve clinical outcomes. Objective: The aim of our study was to evaluate two consecutive series of patients who underwent ACL reconstruction, one with PRP treatment and one without it. Material and method: Two groups of consecutive patients underwent arthroscopic ACL reconstruction, using the SemiT and BPTB techniques. Postoperatively all patients included in this study followed the same standardized rehabilitation protocol. In addition, patients in the first group received three intraarticular PRP injections as auxiliary therapy. Injections were performed at week two, four and six. The patients were evaluated at enrolment and every four and twelve weeks using the Tegner Lysholm Knee Scoring Scale (Scoring Scale: poor &lt;65/ fair 65-83 / good 84-90 / excellent &gt; 90). Each patient was operated on and evaluated afterwards by the same team of surgeons. Results: At 12 weeks interval, Group A had a higher mean clinical score than Group B (94.67 vs 92.50) although marginally not statistically significant (p=0.0503, 95% CI: −4.336 to 0.002911). Regarding pain in patients from Group A compared with patients from Group B, we saw a statistically significant difference at 4 weeks interval (16.90 vs. 18.89, p=0.0370, 95% CI: 0.1260 to 3.842) and no significant difference at 12 weeks interval (21.19 vs. 21.94, p=0.3744, 95%CI: −0.9452 to 2.453). In terms of swelling points scored between the two groups, there was no statistically significant difference at 4 week interval (5.048 vs. 4.00, p=0.1979, 95% CI: −2.667 to 0.5714) but there is a significant difference in favor of patients from Group A at 12 weeks interval (8.475 vs. 5.556, p=0.0002, 95% CI: −4.323 to −1.159). Conclusions: In the short term, the local treatment showed improvement on the overall clinical status of the patients (less pain, improved mobility, less swelling) undergoing rehabilitation after ACL reconstruction, although further studies are required.

Partial Anterior Cruciate Ligament Knee Reconstruction with Accelerated Anterior Cruciate Ligament Rehabilitation

Objectives:The primary purpose of this study is to determine whether or not a partial Anterior Cruciate Ligament (ACL) reconstruction with accelerated rehabilitation produced similar outcomes to that of the conventional ACL reconstruction with its traditional rehabilitation program timeframe. An improved understanding of these outcomes can change the way partial ACL injuries are treated surgically and return patients back to their chosen activities quicker without compromising their graft.Methods:Level III, therapeutic, retrospective study. Participants who were two years post partial ACL reconstruction with accelerated rehabilitation by were contacted. They filled out IKDC, Modified Cincinatti and Tegner Lysholm knee score questionnaires and were measured using a KT-1000 arthrometer for side-to-side instrumented laxity >2 mm as well as indicating if there partial ACL reconstruction had re-ruptured, requiring further surgical intervention.Results:All three measurements in this study, including re-rupture rates, side – to – side instrumental laxity and satisfaction scores via questionnaires, were statistically significant, thus showing a partial ACL reconstruction with accelerated rehabilitation is a viable choice for the treatment of a patient with a partial ACL tear of his knee.Conclusion:Partial ACL reconstruction with accelerated rehabilitation is a viable choice for the treatment of a patient with a partial ACL tear of his knee.

Testing the feasibility and safety of the Nintendo Wii gaming console in orthopedic rehabilitation: a pilot randomized controlled study.

IntroductionThe Nintendo Wii game console is already used as an additional training device for e.g. neurological wards. Still there are limited data available regarding orthopedic rehabilitation. The authors’ objective was to examine whether the Nintendo Wii is an appropriate and safe tool in rehabilitation after orthopedic knee surgery.Material and methodsA prospective, randomized, controlled study comparing standard physiotherapy vs. standard physiotherapy plus game console training (Wii group) in patients having anterior cruciate ligament (ACL) repair or knee arthroplasty was conducted. The subjects of the Wii group (n = 17; mean age: 54 ±19 years) performed simple knee exercises daily under the supervision of a physiotherapist in addition to the normal rehabilitation program. The patients of the control group (n = 13; 52 ±18 years) were treated with physiotherapy only. The participants of both groups completed a questionnaire including the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System and the Tegner Lysholm Knee Score prior to the operation, before discharge from hospital and four weeks after treatment.ResultsThere was no significant difference in the score results between the Wii and the control group (p > 0.05).ConclusionsWe demonstrated that physiotherapy using the Nintendo Wii gaming console after ACL reconstruction and knee arthroplasty does not negatively influence outcome. Because training with the Wii device was highly accepted by patients, we see an opportunity whereby additional training with a gaming console for a longer period of time could lead to even better results, regarding the training motivation and the outcome after orthopedic surgery.

Our Experience in Treatment of Patients with Acute Traumatic Lateral Patellar Dislocation

Treatment results for 38 patients aged 18-45 years with acute traumatic lateral patellar dislocation are presented. In 2 months after arthroscopic intervention 3 intraarticular injections of synovial fluid substitute were performed to all patients. Results were assessed by IKDS questionnaires and Tegner Lysholm Knee Scoring Scale in 2 (prior to injections), 6 and 9 months after operation. Mean point by IKDC scale made up 38±2.1 before surgery, 56±3.5 in two months, 73±3.7 in 6 and 85±3.4 in 9 months (p

Clinical outcome after implant-free ACL reconstruction with hamstring tendon graft

To assess the outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with quadruple hamstring tendon graft using all press-fit technique with bone plugs near the native insertion of the ACL. This prospective study included 50 consecutive active patients. There were 47 males and 3 females. The mean age was 30 years (range 17–44). The mean follow-up was 24 months (range 12–48). Patients were evaluated using subjective as well as objective International Knee Documentation Committee (IKDC) assessment forms, Tegner Lysholm knee score. Instrumental testing included digital rolimeter as well as the KT-1000 testing. Assessment using IKDC scoring revealed that 95 % of the patients had normal or nearly normal knee (IKDC score of A/B). Postoperative level of activity was excellent in 82 % of patients. The mean side-to-side difference using the digital rolimeter measurements was 1.3 mm (range 0.1–5.5 mm). The mean side-to-side difference using the KT 1000 measurements was 1.4 mm (range 0–5 mm). On pivot shift test, we have 97 % of our patients with either equal pivot shift tests on both sides or just a glide. The mean preoperative Tegner Lysholm score was 52 (41–90) while the mean postoperative score was 92 (range 67–100). We found no graft displacement on follow-up radiographs. This study showed that arthroscopic ACL reconstruction with quadruple hamstring tendon graft using all press-fit technique with bone plugs is a reliable, cost-effective technique with fast bone-to-bone healing, and ease for revision surgery.

The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction.

To evaluate knee proprioception in patients with anterior cruciate ligament (ACL) injuries and to assess the effectiveness of an exercise program consisting mainly of proprioception exercises addressing pain, proprioception, and functional status following ACL reconstruction. Twenty male patients, diagnosed with unilateral ACL injury and scheduled for reconstruction, participated in the study along with 16 age- and sex-matched healthy volunteers. Arthroscopic reconstruction of the ACL using autologous hamstring tendon was performed in every case by the same surgeon. After the operation, a six-month rehabilitation program was initiated. Knee proprioception, pain, and functional status were evaluated before and six months after the reconstruction. An isokinetic dynamometer was used to evaluate proprioception and a visual analog scale (VAS) and the Tegner Lysholm Knee Scoring Scale were used to evaluate pain and functional status respectively. Preoperative proprioception loss was detected on the patients' injured side when compared to the uninjured side and to healthy volunteers (p = 0.00). A significant improvement was found in pain severity, proprioception, and functional capacity after the postoperative six-month rehabilitation program (p = 0.00). Preoperative proprioception loss was detected in ACL-injured patients. The rehabilitation program predominantly consisting of proprioception exercises provided considerable improvement on knee proprioception and functional status.

Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis.

Injury to subchondral bone is associated with knee pain and osteoarthritis (OA). A percutaneous calcium phosphate injection is a novel approach in which subchondral bone marrow edema lesions are percutaneously injected with calcium phosphate. In theory, calcium phosphate provides structural support while it is gradually replaced by bone. However, little clinical evidence supports the efficacy of percutaneous calcium phosphate injections. We asked: (1) Does percutaneous calcium phosphate injection improve validated patient-reported outcome measures? (2) What proportion of patients experience failure of treatment (defined as a low score on the Tegner Lysholm Knee Scoring Scale)? (3) Is there a relationship between outcome and age, sex, BMI, and preoperative grade of OA? Between September 2012 and January 2014, we treated 33 patients with percutaneous calcium phosphate injections. Twenty-five satisfied our study inclusion criteria; of those, three patients were lost to followup and 22 (88%; 13 men, nine women) with a median age of 53.5 years (range, 38-70 years) were available for retrospective chart review and telephone evaluation at a minimum of 6 months (median, 12 months; range, 6-24 months). Our general indications for this procedure were the presence of subchondral bone marrow edema lesions observed on MR images involving weightbearing regions of the knee associated with localized pain on weightbearing and palpation and failure to respond to conservative therapy (> 3 months). Patients with pain secondary to extensive nondegenerative meniscal tears with a flipped displaced component at the level of bone marrow edema lesions, or with mechanical axis deviation greater than 8° were excluded. All patients had Grades III or IV chondral lesions (modified Outerbridge grading system for chondromalacia) overlying MRI-identified subchondral bone marrow edema lesions. Percutaneous calcium phosphate injection was performed on the medial tibial condyle (15 patients), the medial femoral condyle (five patients), and the lateral femoral condyle (two patients). Concomitant partial meniscectomy was performed in 18 patients. Preoperative and postoperative scores from the Knee Injury and Arthritis Outcome Score (KOOS) and the Tegner Lysholm Knee Scoring Scale were analyzed. For patients available for followup, the outcome scores improved after treatment. The KOOS improved from a mean of 39.5 ± 21.8 to 71.3 ± 23 (95% CI, 18.6-45.2; p < 0.001) and the Tegner and Lysholm score from 48 ± 15.1 to 77.5 ± 20.6 (95% CI, 18.8-40.2; p < 0.001). However, seven of the 22 patients had poor clinical outcomes as assessed by the Tegner Lysholm Knee Scoring Scale, whereas three had fair results, five had good results, and seven had excellent results. The postoperative Tegner Lysholm score was inversely related to the preoperative Kellgren-Lawrence OA grade (R(2) = 0.292; F (1.20) = 9.645; p = 0.006). We found no relationship between outcome scores and age, sex, or BMI. In a study that would have been expected to present a best-case analysis (short-term followup, loss to followup of patients with potentially unsatisfactory results, and use of invasive cotreatments including arthroscopic débridements), we found that percutaneous calcium phosphate injection in patients with symptomatic bone marrow edema lesions of the knee and advanced OA yielded poor results in a concerning proportion of our patients. Based on these results, we advise against the use of percutaneous calcium phosphate injections for patients with advanced osteoarthritic changes. Level IV, therapeutic study.

Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes?

Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was -1.1 (-2.1 to -0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%. There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to work in the PRP group (100% [six of six]) compared with the non-PRP group (100% [nine of nine]) or in the patients who returned to their regular sports/activities in the PRP group (71% [five of seven]) compared with the non-PRP group (78% [seven of nine]; p = 0.75). Patients who sustain meniscus injuries should be counseled at the time of injury about the outcomes after meniscus repair. With our limited study group, outcomes after meniscus repair with and without PRP appear similar in terms of reoperation rate. However, given the lack of power and nature of the study, modest size differences in outcome may not have been detected. Future larger prospective studies are needed to definitively determine whether PRP should be used with meniscal repair. Additionally, studies are needed to determine if PRP and other biologics may benefit complex tear types. Level III, therapeutic study.

A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study.

The incidence of an anterior cruciate ligament (ACL) tear is highest in female patients; however, it is not apparent whether graft choice affects clinical results. The aim of this prospective randomised study was to evaluate clinical results of an ACL reconstruction using patellar tendon [bone-patellar tendon-bone (BTB)] or hamstring graft (HS) in female patients. Inclusion criteria were traumatic instability, no signs of osteoarthritis, no previous instability and no contralateral knee instability. Inclusion criteria were met in 150 patients, mean age 26(17-47)years. Patients were randomised into two groups of 75 patients according to graft type; all had the same rehabilitation protocol. Tegner Lysholm knee score and stability were evaluated pre-operatively and one and twoyears postoperatively. The difference between groups was statistically evaluated using unpaired t test. Of the 150 patients, all completed oneyear follow-up; three were lost to follow-up at twoyears. There was no significant difference in functional scores and knee stability between groups. The HS group had significantly less anterior knee pain in the first sixmonths postoperatively. ACL reconstruction significantly improves clinical results and stability of the knee. Difference in Lysholm score and stability between groups was not significant. Neither group showed higher tendency to graft failure within twoyears. Graft choice for reconstruction in female patients should be surgeon specific and individualised, as both grafts studied achieved comparable results.

Patellar Tendinopathy

Background:Calcific deposits (CaDs) may be related to chronic postoperative pain and may affect function after patellar tendon surgery.Study Design:Cross-sectional.Hypothesis:We hypothesized that patients with CaDs (+CaDs) would rate lower than those without (−CaDs) on measures of knee function and quality of life.Methods:Patients completed the Tegner Lysholm Knee Scoring Scale (Lysholm), Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC), and the Tegner Activity Level Scale. Sixteen postsurgical and 16 age-matched controls were tested. Patients +CaDs were 5.6 years older than those patients −CaDs and had 4.2 years of longer elapse since surgery. Bilateral patellar tendons were examined for CaDs with musculoskeletal ultrasound imaging. One-way analysis of variance was used to determine if differences existed among patients +CaDs and −CaDs and healthy controls. Hierarchical logistic regressions were used to determine which variables best predicted the presence of CaDs.Results:CaDs were found in 44% (7 of 16) of postsurgical patients, who scored lower than controls on all dimensions of the Lysholm, KOOS, and IKDC. Patients +CaD had lower KOOS scores than controls (symptoms, activities of daily living, and quality of life). Age and time since surgery were both moderately related to the presence of CaDs, and both correctly predicted 71% of patients +CaDs.Conclusion:Calcific deposits were found in the patellar tendon of 44% of postsurgical patients, who rated themselves lower on all subjective measures of knee function and quality of life following surgery. Age is an important factor for developing CaDs postsurgery.Clinical Relevance:Calcific deposits may be present in patellar tendons following surgery, but their direct role in functional or clinical limitations remains unknown.

The treatment of acquired patella baja with proximalize the tibial tuberosity

Acquired patella baja may result in decreased range of motion of the knee, extensor lag, and anterior knee pain. The aim of the study was to evaluate the efficacy of tibial tubercle osteotomy with proximal displacement. Between 1998 and 2011, a proximalization of the tibial tuberosity was performed in 15 patients (15 knees) with patella baja diagnosed using the Blackburne-Peel ratio. Clinical outcomes included the Tegner Lysholm knee scoring scales, the WOMAC questionnaire, the short form-12 (SF-12), and a visual analogue score (VAS) pain scale. Fifteen proximalizations of the tibial tuberosity were performed, with a mean follow-up period of 64 months (5-160). The mean patient age was 59 years (41-86 years). The mean preoperative Blackburne-Peel ratio of 0.4 (0.1-0.6) was improved to a mean of 1.0 (0.8-1.2) post-operatively, which was associated with significant improvements in the Lysholm knee scoring scale from 13.3 ± 13.0 to 86.7 ± 10.4 points (p < 0.0001). Quality of life, as measured using the SF-12 outcome, also improved significantly (p < 0.0001), as did all WOMAC questionnaire score subscales (p < 0.0001). The VAS preoperative status for pain improved from 8.3 ± 2.0 to 1.5 ± 1.8. No patient had delayed or non-union of the osteotomy site. A series of patients with patella baja, treated with proximalization of the tibial tuberosity, achieved satisfactory outcomes in terms of pain relief and improved function, without major complication.

Difference in Graft Maturity of the Reconstructed Anterior Cruciate Ligament 2 Years Postoperatively

Background: Currently, there is an ongoing debate regarding the optimal graft choice between autograft and allograft tendons in reconstruction of the anterior cruciate ligament (ACL). It has been reported that allograft tendons have a slower onset and rate of revascularization compared with autograft tendons. Hypothesis: Allograft tendons might have inferior graft maturity compared with autograft tendons in ACL reconstruction at 2 years postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 52 participants with ACL reconstruction were recruited in this study, including 30 using allograft tendons and 22 using autograft tendons. All of them had unilateral ACL reconstruction and were followed up using 3.0-T magnetic resonance imaging (MRI) at least 2 years postoperatively. Clinical examination was performed on the same day when the MRI examination was performed, including subjective functional examinations (International Knee Documentation Committee [IKDC] and Tegner Lysholm Knee Scoring Scale [TLKS]) and physical examinations (anterior drawer test and Lachman test). Four measurements based on MRI were focused on graft orientation (including tibial tunnel position and graft angles), the edematous condition of the graft, intra-articular graft width at different sites, and signal intensity of the ACL graft using the signal/noise quotient (SNQ) from a region of interest analysis. Differences in each measurement were compared between the allograft group and the autograft group. Results: All the participants returned to normal sports activities at the follow-up time point, as all of them acquired full functional strength and stability. There was no significant difference between the autograft and the allograft group with respect to IKDC or TLKS score. The knees in both of the groups were confirmed stable by physical examination before MRI. On MRI measurements, the allograft group displayed no significant difference in graft orientation compared with the autograft group (P > .05). Moreover, there was also no significant difference between allograft group and autograft group in graft width of the distal site (P > .05), middle site (P > .05), and proximal site (P > .05). However, the mean SNQ value of the allograft group was significantly higher than that of the autograft group in the distal site (6.54 ± 6.58 vs 2.98 ± 5.48; P = .0173), the middle site (7.21 ± 6.31 vs 3.56 ± 4.62; P = .0149), and the proximal site (6.61 ± 8.08 vs 2.45 ± 8.12; P = .0018). Conclusion: The allograft group had a significantly higher SNQ value compared with the autograft group in this study, indicating that allograft tendons might have inferior graft maturity than autograft tendons in ACL reconstruction at 2 years postoperatively.

Simultaneous Anterior and Posterior Synovectomies for Treating Diffuse Pigmented Villonodular Synovitis

The current treatment methods for diffuse intraarticular or extraarticular type pigmented villonodular synovitis (PVNS) include arthroscopic synovectomy or staged anterior and posterior open synovectomies. However, it is unclear whether simultaneous anterior and posterior synovectomies achieve local control and recovery of function. We therefore determined the recurrence rate and function in patients with diffuse PVNS treated with anterior and posterior synovectomies and adjuvant radiotherapy. We retrospectively reviewed all 19 patients with diffuse PVNS involving the knee treated with anterior and posterior synovectomies and adjuvant radiotherapy between January 2001 and November 2007. From the records, we determined local recurrence and Tegner-Lysholm scores. The minimum followup was 42months (median, 98months; range, 42-143months). Postoperative MRI revealed residual tumor in five of the 19 patients, although three had no disease progression during followup and had knee scores of 86 to 90. Two patients had recurrences at 6 and 9months with knee scores of 88 at 42months and 90 at 68months. The mean Tegner-Lysholm knee score improved from 59 to 93 points. Mean maximum extension and flexion angles improved from 11° to 2° and from 76° to 127°, respectively. Compared with the literature, simultaneous anterior and posterior synovectomies associated with postoperative radiotherapy provided rates of residual or recurrent tumor and knee function recovery comparable to that with staged synovectomies reported in the literature. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Review of single stage revision ACL reconstruction

s / International Journal of Surgery 10 (2012) S53–S109 S56 ABSTRACTS 0174: REVIEW OF SINGLE STAGE REVISION ACL RECONSTRUCTION Young-seok Cho, Peter Kempshall, Rhidian Morgan-Jones. Cardiff and Vale Orthopaedic Centre, Cardiff, UK Aim: To review single stage revision ACL reconstruction. Method: Between January 2002 and January 2011, 34 patients were identified as having had revision ACL reconstruction at a single stage under a single surgeon. The case notes were retrospectively reviewed and patients were contacted by telephone interview where patient reported outcome measures were recorded in the form of Tegner Activity Scale, Tegner Lysholm Knee Scoring Scale, Cardiff ACL Satisfaction Index and EQ5D Euroqol. Results: 20 patients were contactable (59%), with the average follow-up of 3.8 years [range 1-10 years]. None of the revisions had failed. The mean Tegner score was 84.4 [range 45-100], which correlated well with the EQ5D Euroqol. One patient had proceeded to TKR at 6 years but the graft was functioning at the time of surgery. Eight of the revisions used bone patella tendon bone (BPTB) as a graft material. Fixation was possible in all but one case where a femoral post and suspensory fixation was required. Tegner score was higher in revisions using hamstrings [n1⁄48, mean 83.4] than BPTB [n1⁄411, mean 82.6]. Conclusions: Single stage revision ACL reconstruction can yield good results, where hamstring and BPTB grafts yield similar results on functional outcome scores. 0178: CAN PATIENTS REMEMBER THEIR PRESENTING SYMPTOMS SIX MONTHS AFTER SURGERY? Rachel L. O'Connell, Liza Osagie, S.Z. Nawaz, Rohit Gupta. Ashford and St Peters NHS Foundation Trust, Surrey, UK Aims: The Oxford Shoulder Score (OSS) is a validated score of shoulder symptoms, little work has explored patients' recollection of pre-operative symptoms. The aim of this study was to determine howwell patients recall pre-operative symptoms. Methods: Fifty patients who underwent shoulder surgery at least 6 months previously and had completed OSS pre-operatively were contacted. Patients were asked to complete the OSS questionnaire in terms of their pre-operative symptoms. Kappa coefficient was used to calculate agreement between pre and post-operative answers. Results: 41 patients completed the questionnaire, mean age was 53 years, 23 males and 19 females. Comparison of pre-operative and recall data on the four questions relating to pain showed ‘poor' agreement for one and ‘moderate' agreement for three (kappa 0.128, 0.454, 0.491, 0.502). Comparison of the eight questions relating to activities of daily living (ADL) showed one ‘poor', four ‘moderate', two ‘fair' and one ‘good' agreement. Pre-operative and post-operative OSS averaged 35.6 and 38 respectively (Paired t-test, p<0.001). Conclusion: There is considerable disagreement between patients' original and recalled scores. Our study demonstrates the limitations of using recalled data to determine pre-operative symptoms when verifying efficacy of shoulder surgery. This illustrates the importance of pre-operative scoring when assessing post-operatively. 0184: DELAY IN DIAGNOSIS OF ACL INJURY: IS IT STILL A PROBLEM? Medhat Alaker, Nicholas Greville Farrar, Stephen Duckett. Leighton