Reconstruction of the Lateral Ankle Ligaments with Bone-Patellar Tendon Graft in Patients with Chronic Ankle Instability

2002 ◽  
Vol 30 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Kazuya Sugimoto ◽  
Yoshinori Takakura ◽  
Tsukasa Kumai ◽  
Makoto Iwai ◽  
Yasuhito Tanaka
Keyword(s):  
Patellar Tendon ◽  
Clinical Condition ◽  
Case Series ◽  
Tendon Graft ◽  
Long Term Results ◽  
Patellar Tendon Graft ◽  
Chronic Instability ◽  
Lateral Ankle Ligaments ◽  
Bone Patellar Tendon

Background Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency. Hypothesis Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot. Study Design Case series. Methods Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients’ clinical condition before the operation and at final follow-up. Results Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4° ± 5.5° to 4.9° ± 2.6°, and the average anterior drawer sign was improved from 9.1 ± 2.6 mm to 5.8 ± 1.6 mm. Conclusion In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.

scholarly journals Return to Sport After Bone–Patellar Tendon–Bone Autograft ACL Reconstruction in High School–Aged Athletes

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110115
Author(s):  
Ryan C. Rauck ◽  
John M. Apostolakos ◽  
Benedict U. Nwachukwu ◽  
Brandon L. Schneider ◽  
Riley J. Williams ◽  
...  
Keyword(s):  
High School ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Sport ◽  
Acl Injuries ◽  
Reconstructed Knee ◽  
Bone Patellar Tendon

Background: Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations. Purpose/Hypothesis: To evaluate outcomes after bone–patellar tendon–bone (BTB) autograft ACLR in competitive high school–aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low. Study Design: Case series; Level of evidence, 4. Methods: An institutional ACL registry was utilized to identify competitive high school–aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS. Results: A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis. Conclusion: BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school–aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport.

COMPARATIVE STUDY OF ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING BONE PATELLAR TENDON BONE GRAFT AND HAMSTRING GRAFT

2019 ◽  
pp. 1-5
Author(s):  
Shivananda S. ◽  
Nikhil Das ◽  
Anudeep. N. Naik ◽  
Jai Aditya Jhamb* ◽  
Anil K Nair
Keyword(s):  
Bone Graft ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Medical Science ◽  
Tendon Graft ◽  
Hamstring Graft ◽  
Patellar Tendon Graft ◽  
Bone Patellar Tendon

INTRODUCTION: ACL reconstruction is probably the most common procedure of the knee in adults in recent times, and the choice of graft to be used for it is the most important decision to be made during the surgery.Although several methods of ACL reconstruction exist,the 2 most common procedures done are BTB reconstruction using an autograft of the middle third of the patellar tendon and reconstruction using a (HT) graft. PURPOSE: The purpose of this study was to evaluate the midterm functional outcome of ACL reconstruction using the bone-patellar tendon-bone graft and hamstring graft. MATERIALS AND METHODS: The study was conducted in the Department of Orthopaedics,Kempegowda institute of medical science and research centre.A total of 40 cases were operated out of whom 20 were operated using arthroscopic ACL reconstruction using Hamstring graft and other 20 underwent ACLR using Patellar tendon graft.Patients in our study were assessed by IKDC,Tegners and Lysholm operative scores. RESULTS- The mean age of the patients in our study was around 29 years. Around 70% of our patients were operated within 6 months from the time of injury after achieving complete flexion. Evaluation using IKDC, Lyshom and tegner scoring system showed hamstring graft having statistical significance when compared with BPTB graft, but the difference between the groups was not clinically appreciable. CONCLUSIONS: ACL reconstruction by either hamstring tendon graft or bone patellar tendon graft gives equally satisfactory results.But complications in the form of anterior knee pain were noted in BPTB group

scholarly journals Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712199491
Author(s):  
Alberto Grassi ◽  
Gian Andrea Lucidi ◽  
Giuseppe Filardo ◽  
Piero Agostinone ◽  
Luca Macchiarola ◽  
...  
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Final Analysis ◽  
Activity Level ◽  
Long Term Results ◽  
Level Of Evidence ◽  
Unicompartmental Knee Arthroplasties ◽  
Tegner Score

Background: The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated. Purpose: To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4, Methods: This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure. Results: Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure. Conclusion: Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up.

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

2015 ◽  
Vol 8 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Grzegorz Brzezicki ◽  
Dennis J Rivet ◽  
John Reavey-Cantwell
Keyword(s):  
Skull Base ◽  
Treatment Option ◽  
Case Series ◽  
Endovascular Intervention ◽  
Long Term Results ◽  
Complete Revascularization ◽  
Intraoperative Complication ◽  
Pipeline Embolization Device ◽  
High Cervical

BackgroundMost cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication.ObjectivesTo report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature.MethodsWe retrospectively reviewed all cases of high cervical and skull base dissections treated with a PED at our institution. Patient clinical characteristics, presentation, procedural and follow-up imaging, and clinical course were analyzed to evaluate for procedure complications, dissection revascularization success, pseudoaneurysm obliteration, and clinical outcome.ResultsThis is a retrospective case series including 11 patients with 13 carotid dissections treated in our center. There were nine traumatic and four spontaneous dissections. The most common presentation was cerebrovascular accident/transient ischemic attack (CVA/TIA; 5 patients) and headache/face pain (4 patients). Eleven dissections were associated with pseudoaneurysms. Three patients failed medical management with anticoagulation, although flow-limiting stenosis was the main indication for endovascular intervention. Up to three PEDs per vessel were deployed. Angioplasty was used in 10 cases. Complete revascularization (<10% residual stenosis) was achieved in 91% of vessels and 50% of pseudoaneurysms were completely or near completely obliterated immediately after PED(s) deployment. Proximal iatrogenic dissection was the only intraoperative complication. Follow-up imaging was available for nine treated vessels and demonstrated patent PEDs without significant in-stent stenosis up to 9 months after intervention. 75% of pseudoaneurysms were completely obliterated at follow-up. One PED partially collapsed but had no neurological consequences. There were no new CVA/TIAs.ConclusionsOur initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

scholarly journals MRI Evaluation of Patella Alignment Before and After Anatomical Reconstruction of ACL Undergoing Unified Rehabilitation Programme Introduced by CMC Physical Therapy Team

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Dariusz Straszewski ◽  
Marcin Plenzler ◽  
Joanna Szczepaniak ◽  
Robert Śmigielski ◽  
Beata Ciszkowska-Łysoń ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Muscle Activation ◽  
Weight Bearing ◽  
Tendon Graft ◽  
Rehabilitation Programme ◽  
Anatomical Reconstruction ◽  
Patella Baja ◽  
Functional Rehabilitation ◽  
Patellar Tendon Graft ◽  
The Impact

Objectives: The aim of the study was to asses the impact of the functional rehabilitation on patella alignment with MRI imaging in patients who underwent the ACL reconstruction. The surgical approach with the use of patellar tendon graft is known to carry the risk of lowering patella height (patella baja), which, in turn, may lead to accelerated cartilage wear in patellofemoral joint. Methods: 30 patients after the anatomical reconstruction of ACL took part in this study (23 male, and 7 female, mean age = 28 ± 10,6 years). During the procedure a patellar tendon graft was used. The Insali-Salvati ratio measured with MRI (images taken pre-procedural, and 9 months after the surgery) was used for the assessment of patellar alignment. The measurements were taken by one radiology specialist on MRI scans in sagittal view in PD sequence. During the examination, patellar joint was in flexion (approx.10 degrees). As the point of reference for patella’s position ISR ratio was in the range of 0.8 - 1.2. All patients were operated on by the same team of surgeons and underwent an unified rehabilitation programme led by a team of selected physiotherapists. The main features of the programme were: an early muscle activation (second day after the procedure); mobilisation of the patella and tissues of the anterior compartment of the knee; weight bearing co-contraction exercises, and the sensomotoric training of the entire kinetic chain of the lower limb. The data recorded was statistically analysed using the Wilcoxon signed-rank test in order to establish parameters’ changes within the study group.. Results: The mean ISR value before the procedure was 0.84 (± 0,1), whereas 9 months after the surgery it was 0.85 (± 0,1). The results’ analysis did not show any statistically significant changes between ISR values. Nine months after the procedure patella baja has not been observed in any of the evaluated patients. Conclusion: The functional rehabilitation programme designed by the CMC team had no negative impact on patella alignment, as no patella baja, which is a common complication after these kinds of surgeries, has been observed. The applied functional rehabilitation programme enabled patients to keep the proper patella alignment, similar to the alignment recorded before the surgery.

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