Tegner Lysholm Score Research Articles

Functional Outcomes of Nuts-in-Jelly Mosaicplasty.

Interspace defects after osteochondral autograft transfer (OATS) are filled only with fibrocartilage. Attempts have been made to address these issues in OATS with procedures like mega OATS and Hexagonal Osteochondral Graft System. We have described the functional outcomes of a hybrid technique combining a regeneration and a restoration modality to address the interspace defect in OATS. Consecutive cases of full-thickness focal chondral defects of the knee were treated using the nuts-in-jelly mosaicplasty technique. Patients with less than 1cm lesions, ligament insufficiency, and alignment abnormalities were excluded. Bone marrow aspirate concentrate (BMAC) with fibrin glue has been used to fill the defect remaining after the osteochondral cylinders are transferred, resulting in a configuration like nuts dispersed in a jelly. We had a total of 12 cases-4 cases of osteochondritis dessicans (OCD) and 8 cases of traumatic chondral defects. The mean age of the patients was 32years (range 19 - 44years). 4 were female patients. The available cartilage was fixed in all the OCD cases. The remaining defect was filled with one or two osteochondral cylinders and the BMAC-fibrin glue or only with BMAC-fibrin glue. In traumatic defect cases, the space remaining after the OATS cylinder transfer was filled with BMAC-fibrin glue. The mean follow-up period was 3years (range 2 - 5years). All cases had good to excellent Tegner-Lysholm scores with a mean score of 92 (range 85 - 96). Nuts in jelly mosaicplasty may address the issue of fibrous cartilage formation after OATS in the interspace. Further prospective comparative studies are necessary to validate the findings of this study.

Enhancing stability and outcomes in young Indian footballers: The synergistic effect of anterior cruciate ligament reconstruction with lateral extra-articular tenodesis – A prospective observational cohort study

Objectives: Anterior cruciate ligament (ACL) tears are frequently seen injuries in young footballers that can contribute to chronic knee instability, meniscal injuries, and increased risk of early-onset osteoarthritis if not properly treated. Materials and Methods: This study evaluated the clinical findings of combined ACL reconstruction and lateral extra-articular tenodesis (LET) in 22 male footballers aged 20–30. ACL reconstruction was carried out using hamstring autografts and LET was done utilizing a modified Lemaire procedure with iliotibial band autograft. Clinical findings were studied preoperatively and at six months and one year postoperatively utilizing the International Knee Documentation Committee (IKDC) and Tegner–Lysholm scores. Results: Mean IKDC and Tegner-Lysholm scores were similar or slightly improved at six months compared to pre-operative baselines and further increased at one year follow-up, with the improvements being statistically significant. There are no cases of graft failure occurred. Conclusion: A combination of ACL reconstruction and LET is a safe and effective treatment for ACL tears in young footballers, which can restore knee stability and allow them to go back to sports. Adding LET to ACL reconstruction may help lower the likelihood of graft failure in this high-risk population.

Randomized Controlled Study Comparing Hamstring Graft and Peroneus Longus Tendon Graft in Arthroscopic ACL Reconstruction.

Graft choice for anterior cruciate ligament reconstruction (ACLR) has been evolving. The peroneus longus tendon (PLT) has been seen as a suitable choice for ACLR, providing comparable results to those of hamstring tendon (HT) autograft, but its clinical relevance in terms of return to sports, to our knowledge, has not been studied. One hundred and twenty patients who sustained an isolated ACL injury were enrolled and underwent ACLR using tripled or quadrupled PLT autograft (if graft thickness exceeded 10 mm then tripled) or quadrupled HT autograft. Patients were followed for 24 months. Functional scores (International Knee Documentation Committee [IKDC] and Tegner-Lysholm scores) were assessed preoperatively and at 3, 6, 12, and 24-month post-operatively. Graft diameter and graft harvesting time were measured intraoperatively. Donor-site morbidity was evaluated using subjective evaluation. Time to return to sports in both groups was compared. The mean diameter of the PLT autograft was significantly larger than that of the HT autograft, and the mean graft harvesting time was less (P < 0.001). Patients in the PLT group returned to sports a mean of 36 days earlier than those in the HT group (P < 0.001) and had a lower rate of donor-site morbidity, and better patient-reported outcomes at the knee (P < 0.001). There was a significant difference between the groups in IKDC and Tegner-Lysholm scores at the 24-month follow-up. Despite some donor site complications, such as numbness and infection, both PLT and HT grafts offer acceptable knee stability. However, PLT grafts seem to provide superior subjective functional outcomes based on patient-reported scores. More research is needed to further establish these findings and optimize graft choices for individual patients.

Evaluation of the peroneus longus tendon as an autologous graft in knee surgery

Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 0.02, 98.69± 0.08, 99.92± 0.07, and 99.92± 0.07 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results.

Evaluation of the peroneus longus tendon as an autologous graft in knee surgery

Objectives Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. Methods A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Results Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 1.02, 98.69± 1.08, 99.92± 0.27, and 99.92± 0.27 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). Conclusion The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results.

Evaluating the Efficacy of Peroneus Longus Tendon as an Autograft for Anterior Cruciate Ligament Reconstruction in Indian Female Patients: A Prospective Cohort Study.

Background Anterior cruciate ligament (ACL) injuries are prevalent, especially among active individuals, and are increasingly observed even in Indian women who are not active in sports. ACL reconstruction (ACLR) is commonly performed using various graft options, but optimal choices for women remain debated. The aim of our study was to examine the use of the peroneus longus tendon as an autograft for ACLR in Indian female patients. Materials and methods A prospective cohort study was carried out on 44 non-athlete female patients who met the inclusion criteria. The study evaluates functional outcomes using the International Knee Documentation Committee (IKDC), Lysholm-Tegner, and American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well as knee stability through clinical tests, over a one-year postoperative period. Results The study demonstrates significant improvements in knee function, with substantial increases in IKDC and Lysholm-Tegner scores from preoperative levels (p-value < 0.01), and effective restoration of knee stability, as shown by improved Lachman, Anterior Drawer, and Pivot Shift test results. Moreover, the peroneus longus graft had minimal impact on ankle morbidity, as indicated by consistent AOFAS scores before and after surgery. Conclusion The study highlights the peroneus longus tendon as a viable graft option for ACLR in symptomatic Indian female patients who were not active in sports, offering both mechanical strength and favorable functional outcomes without affecting the ankle strength or the function.

Continuous suture all-inside meniscal repair technique produces excellent functional outcomes and return to play rates with a low rate of failure.

The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner-Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair. Data were collected for 37 patients. Mean age was 25.8years, 81%, were male, median time to theatre was 169days, mean follow-up time was 2.9years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner-Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner-Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04). In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner-Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique.

Peroneus Longus Tendon Autografts have Better Graft Diameter, Less Morbidity, and Enhanced Muscle Recuperation than Hamstring Tendon in ACL Reconstruction.

Recently the peroneus longus tendon (PLT) gained popularity in anterior cruciate ligament (ACL) reconstruction and has been utilized with satisfactory outcomes. However, there are concerns regarding donor site morbidity. This study aims to compare the functional outcome of ACL reconstruction using hamstring (HT) and PLT autografts and evaluate the donor site morbidity. Patients who underwent ACL reconstruction were allocated to two groups (HT and PLT). Graft diameter was measured intraoperatively. Knee functional outcome was evaluated with IKDC and Tegner-Lysholm scores preoperatively, and postoperatively after 3 months, 6 months, and 1 year. Donor site morbidities were assessed with thigh circumference measurements, subjective evaluation of sensory disturbances, and ankle scoring with AOFAS and FADI scores. At 1-year follow-up, the PLT group showed comparable IKDC (p = 0.925) and Tegner-Lysholm (p = 0.600) scores with those of the HT group. The mean graft diameter in the PLT group (7.93 ± 0.52mm) was larger compared with the HT group (7.43 ± 0.50mm) (p < 0.001). The incidence of thigh atrophy (HT-16.7%, PLT-10%) and sensory disturbances (HT-73.3%, PLT-10%) was greater in the HT group. There was no significant ankle donor site morbidity in the PLT group (AOFAS-98.67 ± 3.45, FADI-99.23 ± 1.69). ACL reconstruction with PLT had comparable functional outcome with that of HT at 1 year. However, PLT demonstrated larger graft diameter, less donor site morbidity, and enhanced muscle recovery without significantly affecting the ankle function. PLT can be safely used as an acceptable alternative graft choice harvested from outside the knee for ACL reconstruction.

Clinical outcomes of primary anterior cruciate ligament reconstruction using six-strand hamstring autograft

Objectives: Quadrupled and five-strand hamstring tendon (HT) autografts are commonly used in anterior cruciate ligament reconstruction (ACLR), but there is significant variability in graft diameter. The six-strand HT autograft has been introduced to increase graft diameter in patients with undersized HT grafts and may achieve better clinical outcomes. None of the studies has reported clinical outcomes following this technique in Indian patients. We investigated clinical outcomes in patients who underwent primary ACLR using a six-strand HT autograft technique with a minimum six-month follow-up. Materials and Methods: Fifty-five patients who underwent primary ACLR using six-strand HT autografts with interference screw fixation were included in the study. These patients were followed up at three and six months for the evaluation of clinical outcomes. Subjective evaluations included the TegnerLysholm score, anterior cruciate ligament-quality-of-life (ACL-QOL) score, and International Knee Documentation Committee (IKDC) subjective score. Laxity assessments of the knees were performed using the Lachman test and the pivot-shift test. Functional evaluation of the patients was performed with an overall IKDC objective score. Results: The mean IKDC subjective score was significantly improved at three-month (63.42 ± 5.38) and six-month (82.82 ± 7.49) follow-up after surgery (P &lt; 0.05) when compared with pre-operative scores (50.55 ± 1.84). A similar finding was also noted with the Tegner-Lysholm score and ACL-QOL score in our study. All patients have achieved normal to near-normal functional outcomes at six months in our study without any major complications. The most commonly found complication was paresthesia (21.80%) in the present study. Conclusion: In the primary ACLR, six-strand hamstring autograft achieves similar clinical outcomes and complications as reported with four-strand or five-strand HT autografts. However, the percentages of patients who achieved normal to near-normal outcomes were higher in the present study (100%) as compared to earlier reported data using four-strand or five-strand HT autografts (~85%). The six-strand graft technique is a useful means of increasing graft diameter when faced with an undersized hamstring graft.

Functional Outcome of Single-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction using Peroneus Longus Graft and Hamstring Graft: An Open-Label, Randomized, Comparative Study.

Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two distinct graft sources: peroneus longus (PL) graft and hamstring graft. The choice of graft material in ACL reconstruction is crucial for optimal postoperative results, and this study aims to contribute valuable insights into the comparative efficacy of these two graft types. Method This open-label randomized comparative study involved a carefully selected cohort of patients undergoing single-bundle arthroscopic ACL reconstruction. Participants were randomly assigned to either the PLgraft group or the hamstring graft group. Surgical procedures were conducted using standardized techniques, and postoperative rehabilitation protocols were closely monitored. Functional outcomes, including range of motion, stability, and patient-reported measures, were assessed at predefined intervals to ensure comprehensive data collection. Results The study underscores significant demographic and clinical factors in ACL reconstruction outcomes. Participants were predominantly aged 17-30 years (58.33%) with a mean age of 29.27 years and exhibited a male predominance (80.56%). Common complaints included knee pain and instability, primarily due to falls from bikes (55.56%) or sports-related trauma (44.44%). Notably, PL grafts demonstrated advantages over hamstring grafts, with longer mean length (10.11 mm vs. 8.77 mm, p=0.0001) and shorter operation times. Visual analog scale (VAS), International Knee Documentation Committee(IKDC), and Tegner Lysholm scores show no significant differences between grafts over the period of time. There is no notable foot eversion weakness or significant donor site morbidity after the PL graft harvest.Hamstring graft cases exhibit a higher incidence of altered sensation and muscle atrophy, suggesting the potential benefits of PL grafts for improved surgical outcomes. Conclusions Graft comparisonsfavored PL grafts due to longer length, and functional outcome assessments between the two graft types. However, foot and anklestrength assessments revealed fluctuations in strength recovery with PL grafts, highlighting the need for tailored rehabilitation. Thigh circumference variations suggested potentialmuscle atrophy in the hamstring graft group, along with reported paresthesia in theipsilateral proximal leg. In conclusion, PL grafts offer potential advantages for ACL surgery, but ongoing monitoring and specialized rehabilitation are crucial.

Functional Outcome of Arthroscopic Suture Pull-Out Fixation in Tibial Spine Avulsion of Anterior Cruciate Ligament.

Tibial spine avulsion of the anterior cruciate ligament is a rare intraarticular injury of the knee. In this condition, the tibial attachment site of the anterior cruciate ligament is detached from the knee. The mechanism of the injury is hyperextension of the knee and rotation with valgus force. There are so many treatment options. This study aims to find out the functional outcome of Arthroscopic Suture pull-out fixation in this injury. This is a retrospective study done from August 15, 2019, to August 14, 2022. The outcome was analyzed by comparing the preoperative and 12-month postoperative International Knee Documentation Committee Score, Tegner Lysholm Score, Knee Range of motion, and Visual Analog Scale Score. Twenty-two patients were included with a mean age of 18.95 (13-31). Among them 15(68.2%) were male and 7(31.8%) were female. Arthroscopic suture pull-out fixation was done in all the cases. The knee range of motion was improved from preoperatively 35.00±7.86 to 135.68±3.50 at the final follow-up. The Tegner Lysholm score was improved from preoperatively 34.68±1.28 to 94.54±2.97 at the final follow-up. Preoperatively the VAS score was 8.04±1.27 which improved to 0.60±0.50 at the final follow-up. The IKDC score was 23.86±1.42 preoperatively which improved to 92.72±3.28 at the final follow-up with p-value < 0.001 Conclusions: Arthroscopic Suture pull-out fixation of tibial spine avulsion of the Anterior cruciate ligament is a good technique that restores the functions of the knee and has an excellent outcome Keywords: Anterior cruciate ligament; suture pull-out fixation; tibial spine avulsion.

Dorsal Hook Plating of Patella Fractures With Immediate Range of Motion Results in Reliable Fixation, Low Implant Removal Rates, and Satisfactory Clinical Outcomes.

To evaluate radiographic and clinical patient-reported outcomes following dorsal hook plating of displaced patella fractures with permittance of immediate postoperative active closed chain range of motion. Retrospective review of prospectively collected data. Urban academic level 1 trauma center. Adult patients with displaced patella fractures (OTA/AO 34C1-3) who underwent dorsal plating with immediate range of motion between 2018 and 2023. Numerical Rating Scale for Pain, Knee Outcome Score (KOS-ADL), Tegner-Lysholm score, radiographic union, and wound complications were collected. Sixty-one patients were included (47 female) with an average age of 63 years (SD 14.7, range 22-86 years). The mean BMI was 24.2 (SD 3.6, range 16.6-33.3). There were 13 34-C2 and 48 34-C3 fractures. All but 2 patients (96.7%) achieved bony union after the index procedure. 89% (n = 54) of patients completed outcome surveys with at least 6-month follow-up. Six patients (9.8%) underwent removal of plate implant at a mean of 15.1 months postoperatively. The mean KOS-ADL score was 91.4, the mean Tegner-Lysholm score was 78.1, and the mean NRS was 2.7. Dorsal hook plating offers secure fixation to allow early range of motion, reliable fixation with low nonunion and implant failure rates, low implant removal rates, and satisfactory patient-reported outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

“Push and Park” Microdrilling Technique for Chondral Lesions of the Patella: A Technical Note

Abstract Background: The most used treatment modality for chondral lesions of the patella, particularly when the lesion is &lt;2 cm2, is microdrilling. However, reduced working space and mobility of the patella make this procedure technically difficult. To bypass this technical difficulty, we describe a simple technique of “Push and park” for microdrilling of the chondral lesions of the patella. Materials and Methods: Patients operated on by this technique in 2021 were followed for 1 year. Patients operated for magnetic resonance imaging-proven International Cartilage Repair Society grade III and IV patellofemoral chondral lesions (PFCLs) that are localized and &lt;2 cm2 with or without other concomitant knee pathologies were included. The functional outcomes were evaluated using the Tegner Lysholm score and Kujala score. Results: Twenty-one patients were included in the study. Of these, 7 cases had isolated PFCL, 8 cases had associated medial meniscal posterior horn root tears, and the remaining 6 cases had anterior cruciate ligament injuries. The mean follow-up period was 14 (±2) months. The average age was 41 (±7) years. We had 12 female and 9 male patients. The Tegner Lysholm and Kujala scores improved significantly in all the patients at 1-year postsurgery (P = 0.035 and P = 0.026, respectively). Conclusion: We have described a simple and reproducible technique for microdrilling of difficult-to-access patellar lesions. When used appropriately, the technique can be a cost-effective method of managing the chondral lesions of the patella.

Functional and Radiological Outcome of Meniscal Repair and Conservative Management for Medial Meniscal Root Tear - A Prospective Comparative Study.

To sustain hoop stress, prevent extrusion, and maintaining the function of the meniscus, the posterior root attachment point of the medial meniscus is essential. The purpose of this study is to determine the functional and radiological outcome of conservative therapy and meniscal repair for medial meniscal root tears. Prospective evaluations were performed on forty individuals who confirmed a diagnosis of Medial meniscus root tear (MMRT). Among the 40 patients, 20 underwent arthroscopic meniscal repair and 20 underwent conservative management and followed up a period of 2 years. Functional outcome between two groups was measured using Tegner Lysholm score and IKDC score. Radiological outcome was measured using X-rays (medial joint space width, joint space narrowing, K-L grade). Both group showed improvement in Lysholm score and IKDC. When comparing the clinical outcomes between both the groups, Group A showed significantly better outcome (P = 0.02). About 60% of patients in Group A and all patients in Group B showed K-L grade progression. Of the patients in Group A, 5% had significant K-L grade progression and 10% had severe joint space constriction. Of the patients in Group B, 80% had significant K-L grade progression and 25% had severe joint space constriction. Meniscal repair had considerably superior outcomes for radiologic parameters than conservative care (P < 0.01) when we examined the final results of Groups A and B. The MMRT repair group had better functional and radiological outcome than the conservative treatment group. Although treatment did not entirely stop the advancement of arthrosis, meniscal repair decreased the rate of arthritic changes when compared to the conservative group.

Functional Outcomes of Anatomic Single Bundle Primary ACL Reconstruction with Peroneus Longus Tendon (Without a Peroneal Tenodesis) Versus Hamstring Autografts.

There is a paucity of comparative studies on the Peroneus longus tendon versus conventional hamstring autograft use in primary single-bundle ACL reconstruction. To date, there are no studies that reported donor ankle functional outcomes when a peroneus longus graft is harvested without performing a tenodesis to peroneus brevis. A single-center retrospective comparative study was undertaken to evaluate the functional outcomes (IKDC & Tegner-Lysholm scores) of primary isolated single bundle anatomic ACL Reconstruction with Peroneus Longus tendon (PL group) versus Hamstring (HT group) autografts. Further, an evaluation of donor ankle morbidity using the AOFAS score for the PL group and persistent anteromedial thigh pain and paraesthesia around the knee for the HT group was also performed. 30 patients were evaluated in each group. The mean graft diameter was 8.61 +/- 0.66mm (HT) & 9.6 +/- 0.84mm (PL) and the mean graft length was 7.39cm (HT) & 7.86cm (PL) respectively. The mean IKDC scores were 58.2 (Pre-op) & 89.52 (1 year) for the HT group and 61.8 (Pre-op) & 90.9 (1 year) for the PL group respectively. The mean Tegner-Lysholm scores were 69.83 (Pre-op) & 91.96 (1 year) for the HT group and 70.66 (Pre-op) & 92.36 (1 year) for the PL group respectively.10% of the HT group had residual anteromedial thigh pain & 6.7% had paraesthesia at one-year follow-up. In the PL group, the mean AOFAS score was 96.37 +/- 2.49 at the end of one year. Two cases (6.66%) reported paraesthesia around the harvested site. Peroneus longus tendon appears to be a better autograft choice than hamstrings for primary ACL reconstruction. Further, without a peroneal tenodesis, the functional outcomes of the donor ankle remained excellent.

A comparative analysis of suture-augmented and standard hamstring autograft single-bundle ACL reconstruction outcomes: short-term functional benefits without long-term impact

BackgroundAugmentation of the biologic graft with nonabsorbable suture material during anterior cruciate ligament reconstruction (ACLR) is a relatively new technique to enhance its biomechanical properties and add additional support to the critical process of healing. We aimed to compare the short-term functional patient-reported outcome measures (PROMs) and complication rates of patients treated with either standard single-bundle four-strand hamstring ACLR or added suture augmentation (SA).MethodsPatients undergoing arthroscopic ACLR between February 2015-January 2017 and in the standard ACLR group, and between February 2017-September 2019 in the SA-ACLR group operated by adding a no.5 FiberWire® (Arthrex, Naples, FL, USA) braided suture to the hamstring autograft, were retrospectively reviewed and the PROMs were compared. Patients were followed up for a 24-month period and PROMs were assessed by the International Knee Documentation Committee (IKDC) Subjective Knee Form and Tegner-Lysholm knee score. Patients’ demographic and clinical characteristics, and postoperative complications including graft retear requiring revision surgery, deep vein thrombois, and surgical site infection were recorded and analyzed.ResultsWe included 79 patients with mean age of 31.6 ± 8.3 years in the standard ACLR group, and 90 patients with mean oge of 30.5 ± 7.6 in the SA-ACLR group. There was no statistically significant difference between the two groups in terms of age, sex, body mass index, and medical comorbidities. The values of the IKDC scores increased to 75.8 ± 18.9 in the standard ACLR group, and 85.6 ± 12.6 in the SA-ACLR group, 24 months after the operation (P < 0.05). The 24-month postoperative Tegner-Lysholm scores escalated to 79.3 ± 21.0 in the standard ACLR group and 91.0 ± 13.7 in the SA-ACLR group (P < 0.05). Four (5.1%) patients in the standard ACLR group and 4 (4.4%) in the SA-ACLR group experienced graft retear requiring revision surgery (P > 0.05). Incidence of surgical site infection and deep vein thrombosis showed no significant differences between the two groups, 24 months after ACLR.ConclusionSA-ACLR is associated with improved short-term functional PROMs compared to the standard hamstring ACLR. Although SA did not reduce the retear rate, and infection and DVT rates did not differ between study groups, superior improvement of PROMs in SA approach, leverages this method for ACLR.

Inter-fragmentary compression using cannulated cancellous screws augmented with modified tension band wiring in transverse patella fractures

The classical Kirschner wires and tension band wiring technique, described by the AO foundation, has been the most widely used method for transverse patella fractures. In this study, we have adopted what we perceive to be an improved technique, the cannulated cancellous screws with modified tension band wiring. 20 patients with transverse patella fractures were included in our prospective single-blinded randomized control study with a duration of 3 years. All patients were operated on with modified tension band wiring with a 4 mm cannulated cancellous screw. Functional evaluation was made using the Tegner lysholm knee scoring scale. Roentgenograms were taken in AP and Lateral views to look for signs of radiological union and interfragmentary gap. The post-operative interfragmentary gap between fracture fragments with 65% of patients having a 0 mm gap, 25% of patients having a 1 mm gap, 5% of patients having a 2 mm gap, and 5% of patients having a 3 mm gap. The mean duration for the radiological union was 10 weeks. Mean Tegner lysholm score at 6 months was 88±4.7. We concluded that modified tension band wiring with cannulated cancellous screw is a safe, reliable, and better alternative method of fixation for transverse patella fractures with excellent union rate, range of motion, and functional outcome.

Fixation method can affect posterior tibial slope in opening-wedge high tibial osteotomy: a retrospective study

BackgroundPosterior tibial slope (PTS) alterations following open-wedge high tibial osteotomy (OWHTO) can cause instability and excessive tibial translation in the sagittal plane. These changes can be influenced by the type of fixation. This study aims to compare PTS changes between patients undergoing OWHTO with Puddu plate or TomoFix plate fixation.MethodsIn this retrospective cohort study, we included 104 knees from 85 patients undergoing OWHTO, with a mean age of 41.98 ± 9.95 years; 51.8% of the participants were male. Seventy-two knees were fixed with Puddu plates, while 32 knees were fixed with TomoFix plates. PTS changes, demographic factors, Cincinnati Knee Rating Score (CKRS), Tegner-Lysholm score (TLS), length of stay (LOS), and complications were evaluated. PTS changes were measured preoperatively, immediately postoperatively, and at the 6-month follow-up.ResultsDemographic factors were similar between the Puddu plate and TomoFix groups. There were no significant differences in preoperative, postoperative, or follow-up PTS measurements between the two groups. PTS changes were not significant in the TomoFix group postoperatively or at follow-up. However, the Puddu plate group showed a significant increase in PTS both postoperatively (P = 0.027) and at follow-up (P = 0.014). CKRS, TLS, LOS, and complications did not significantly differ between the groups.ConclusionWhile overall PTS changes did not significantly differ between the Puddu Plate and TomoFix Plate groups, analyzing changes within each group revealed distinct results. TomoFix fixation exhibited nonsignificant PTS changes, while Puddu plate fixation resulted in a significant increase in PTS after surgery and at the 6-month follow-up. Our findings suggest that the choice of fixation may influence PTS changes after OWHTO.Level of Evidence: Level III.

Association Between Posterior Tibial Slope and Clinical Outcomes After Isolated Anterior Cruciate Ligament Reconstructions.

Background Increased posterior tibial slope (PTS)is an important risk factor for non-traumatic graft failure and revision surgery after anterior cruciate ligament reconstruction. If a tibial posterior slope is an important factor for graft failure after anterior cruciate ligament reconstruction, does it affect clinical outcomes? This study aimed to evaluate the association between PTS and clinical outcomes after anterior cruciate ligament reconstruction. Material and methods Patients undergoing arthroscopic anterior cruciate ligament reconstruction with hamstring tendons in the clinic were evaluated retrospectively. Inclusion criteria were: patients with at least an 18-month follow-up period who were evaluated with the Tegner Lysholm scoring system, aged between 18 and 40 years, with only an anterior cruciate ligament rupture. PTSs were measured from the lateral radiographs of the knees. The patients were divided into two groups with a PTS of 10° or less. Results The mean Tegner Lysholm score was 86.8 ± 8.9. The mean PTS was 9.7° ± 1.5°. In total, 14 and 15 patients had a PTS of above 10° and below 10°, respectively. The mean age and follow-up time of patients were 28.5 ± 5.3 years and 24.6 ± 7.2 months in the group with a PTS of above 10° and 30.2 ± 5.3 years and 24.2 ± 5.18 months in the group with a PTS of below 10°, respectively. Tegner Lysholm scores were 88.2 ± 8.8 and 85.6 ± 9.1 in the group with values above 10° and below 10°, respectively. Statistically, there was no significant difference between the clinical outcomes of both groups. Conclusion PTS does not affect the clinical outcomes of patients who underwent arthroscopic anterior cruciate ligament reconstruction in the early period.

Earlier Return to Sports, Reduced Donor-Site Morbidity with Doubled Peroneus Longus Versus Quadrupled Hamstring Tendon Autograft in ACL Reconstruction.

Graft choice for anterior cruciate ligament reconstruction (ACLR) has been evolving. The peroneus longus tendon (PLT) has been seen as a suitable choice for ACLR, providing comparable results to those of hamstring tendon (HT) autograft, but its clinical relevance in terms of return to sports, to our knowledge, has not been studied. Two hundred and thirty-two patients who sustained an isolated ACL injury were enrolled and underwent ACLR using doubled PLT autograft or quadrupled HT autograft; 158 were followed for 24 months. Functional scores (International Knee Documentation Committee [IKDC] and Tegner-Lysholm scores) were assessed preoperatively and at 3,6, 12, and 24 months postoperatively. Graft diameter and graft harvesting time were measured intraoperatively. Donor-site morbidity was evaluated using subjective evaluation. Time to return to sports in both groups was compared. The mean diameter of PLT autograft was significantly larger than that of HT autograft, and the mean graft-harvesting time was less (p < 0.001). Patients in the PLT group returned to sports a mean of 34 days earlier than those in the HT group (p < 0.001) and had a lower rate of donor-site morbidity and, at 6 months, better patient-reported outcomes at the knee (p < 0.001). There were no significant differences between the groups in the rate of graft rupture or in IKDC and Tegner-Lysholm scores at the 24-month follow-up. PLT is a suitable autograft for ACLR in terms of graft diameter and graft-harvesting time and may offer athletes an earlier return to sports related to better outcomes at 6 months of follow-up. HT autograft was associated with increased thigh weakness. Both grafts, however, performed similarly at 24 months postoperatively. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.