scholarly journals Stiff Knee After Ligament Reconstruction

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0011
Author(s):  
Pham The Hien
Keyword(s):  
Epidural Anaesthesia ◽  
Ligament Reconstruction ◽  
Fibrous Tissue ◽  
Scar Tissue ◽  
Ligament Injury ◽  
Manipulation Under Anesthesia ◽  
Treatment And Prevention ◽  
Cyclops Lesion ◽  
Stiff Knee ◽  
Multiligament Injury

Stiff knee is a difficult complication after surgery and ligament injury. There are many reasons which cause stiff knees and we should undestand them for the best treatment and prevention. Here we present cases of stiff knees after multiligament injury. They were indicated operations by ligament reconstruction or avulsion reattachment. After that, the stiff knees recurred although the patients also had 5 - 6 months of rehabilitation. Via arthroscopy, we found a scar tissue in the suprapatellar compartment, a fiber around the patella, an adhension femur - tibia at the notch, a scar tissue at the notch, and a cyclops lesion. We used the shaver and cautery to cut the fibrous tissue and release the patella and ligaments at the notch. Then, manipulation under anesthesia (MUA) was indicated. After all, the patients had the combined spinal and epidural anaesthesia (CSE) for 5 days. It is a better way to reduce pain and let the patients exercise earlier.

Extreme stiff knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection

The Knee ◽  
2021 ◽  
Vol 30 ◽  
pp. 35-40
Author(s):  
Konstantinos Tilkeridis ◽  
Dimitrios Diamantidis ◽  
Anthimos Keskinis ◽  
Konstantinos Paraskevopoulos ◽  
Christos Chatzipapas ◽  
...  
Keyword(s):  
Botulinum Neurotoxin ◽  
Manipulation Under Anesthesia ◽  
Stiff Knee

Graft Failure, Revision ACLR, and Reoperation Rates After ACLR With Quadriceps Tendon Versus Hamstring Tendon Autografts: A Registry Study With Review of 475 Patients

2021 ◽  
pp. 036354652110151
Author(s):  
Malte Schmücker ◽  
Jørgen Haraszuk ◽  
Per Hölmich ◽  
Kristoffer W. Barfod
Keyword(s):  
Graft Failure ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Significant Trend ◽  
Meniscal Injury ◽  
Registry Study ◽  
Cyclops Lesion

Background: It has been indicated that anterior cruciate ligament reconstruction (ACLR) with a quadriceps tendon (QT) graft has a higher risk of revision compared with ACLR performed with a hamstring tendon (HT) graft. Purpose/Hypothesis: To investigate whether ACLR with QT graft had a higher risk of graft failure, revision ACLR, or reoperation compared with HT graft in a high-volume center. We hypothesized that there would be no between-group differences. Study Design: Cohort study; Level of evidence, 3. Methods: This was a registry study with review of medical records. Our study cohort consisted of patients who underwent primary ACLR with either QT or HT graft performed at Copenhagen University Hospital Hvidovre between January 2015 and December 2018. The cohort was identified from the Danish Knee Ligament Reconstruction Registry and linked to the Danish National Patient Registry to identify all hospital contacts after ACLR. The outcome variables were graft failure (rerupture or >3-mm side-to-side difference in anteroposterior [AP] laxity), revision ACLR, reoperation due to cyclops lesion, reoperation due to meniscal injury, and reoperation due to any reason. AP laxity and pivot shift were assessed at 1 year. Kaplan-Meier estimates were used to evaluate the rates of events at 2 years, and comparison was performed with Cox regression analysis. Results: A total of 475 patients (252 HT, 223 QT) were included. The rate of graft failure at 2 years was 9.4% for the QT group and 11.1% for the HT group ( P = .46). For the QT and HT groups, respectively, the rate of revision ACLR was 2.3% and 1.6% ( P = .60), the rate of reoperation due to cyclops lesion was 5.0% and 2.4% ( P = .13), and the rate of reoperation due to meniscal injury was 4.3% and 7.1% ( P = .16). The rate of reoperation due to any reason was 20.5% and 23.6% ( P = .37). At 1-year follow-up, AP laxity was 1.4 mm for QT and 1.5 mm for HT ( P = .51), and the proportion of patients with a positive pivot shift was 29-30% for both groups. Conclusion: QT and HT grafts yielded similar rates of graft failure, revision ACLR, and reoperation at 2 years of follow-up after ACLR. Graft failure was found in 9% to 11% of patients. Patients with QT ACLR showed a non–statistically significant trend of higher risk for reoperation due to cyclops lesion, and those with HT showed a non–statistically significant trend of higher risk for reoperation due to meniscal injury.

Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft

2007 ◽  
Vol 35 (9) ◽  
pp. 1521-1527 ◽  
Author(s):  
Benjamin R. Coobs ◽  
Robert F. LaPrade ◽  
Chad J. Griffith ◽  
Bradley J. Nelson
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament ◽  
Normal Stability ◽  
Semitendinosus Graft

Background The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated. Purpose To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability. Study Design Controlled laboratory study. Methods Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N·m varus moment and 5 N·m external and internal rotation torques at 0°, 15°, 30°, 60°, and 90° of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system. Results After sectioning, we found significant increases in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, and 30° of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0° and 30° of knee flexion. Conclusion An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury. Clinical Significance An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.

scholarly journals Limited evidence for graft selection in pediatric ACL reconstruction: a narrative review

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Gianni De Petrillo ◽  
Thierry Pauyo ◽  
Corinna C. Franklin ◽  
Ross S. Chafetz ◽  
Marie-Lyne Nault ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Iliotibial Band ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Graft Selection

AbstractAnterior cruciate ligament reconstruction is the preferred treatment to anterior cruciate ligament injury. With the increase in anterior cruciate ligament injuries in both adults and skeletally immature patients comes the need for individualized anterior cruciate ligament reconstruction graft selection whether it is the type of graft (auto vs. allograft) or the harvesting site (hamstrings, iliotibial band, quadriceps, patella). Several factors need to be considered preoperatively in order to optimize the patients’ recovery and restore anterior cruciate ligament strength and function. These include age and bone maturity, preoperative knee flexor/extensor strength, sport participation, patient’s needs and anatomical characteristics. This paper aims at bringing evidence supporting the use of a personalized approach in graft selection for faster and more efficient return to sport and propose a theoretical framework to support the approach.

scholarly journals Clinical and morphological features of scar tissue of the uterus.

2019 ◽  
Vol 23 (1) ◽  
pp. 98-103
Author(s):  
N.P. Goncharuk ◽  
N.R. Kovyda ◽  
O.O. Dyadyk ◽  
Y.S. Radkevich
Keyword(s):  
Smooth Muscle ◽  
Muscle Fibers ◽  
Fibrous Tissue ◽  
Significant Proportion ◽  
Scar Tissue ◽  
Vaginal Birth ◽  
Pathological Changes ◽  
Smooth Muscle Tissue ◽  
Uterine Scar ◽  
Group 1

One of the key issues for increase uterine scars is the rapid and unwarranted Caesarean sections (CS) as in the world same in Ukraine. One of the way to reduce CS is delivery truth vaginal births in women with previous surgical intervention on the uterus or after CS. The ability of scar on the uterus is the main criterion for an attempt to vaginal birth. Objectivе — to analyze the structural changes of the scar tissue of the uterus. Pathomorphological examination was fragments of uterus scar. The material was fixed in a 10% solution of neutral colored formalin (pH 7.4) carried out according to the standard procedure, poured into paraffin. From the paraffin blocks on the rotary microtome of HM 325, serial histological sections were made in a thickness of 4–5 microns, which were stained with hematoxylin and eosin. Scar tissue was additionally stained for Van Gieson, according to Masson. Fragments of scar tissue were subjected to an immunohistochemical study (IGHS) using monoclonal antibodies (MATs) to CD31 to assess the degree of vascularization vascular component and α-SMA for assessing the condition smooth muscle tissue. Having conducted a comprehensive pathomorphological study in two groups, one can state that in group 1 the pathomorphological picture of the changes in the scar was minimal and confirmed by the retained proportions between the fibrous tissue and the smooth muscle fibers, as well as their characteristic location. Muscle fibers with minimal pathological changes, developed by compensatory changes from the side of the vascular complex. These data were confirmed by conducting IGHS from MAT to CD31, which gives a pronounced positive response in the endothelial layer of the vascular wall, forming continuous cell chains. IGHS from MAT to α-SMA exhibits pronounced homogeneous intensive expression, indicating minimal pathological changes in muscle fibers. These figures make it possible to talk about the ability of uterine scar in 61% in group 1, as opposed to in group 2, this result was only 41%. As a result of a comprehensive clinical and morphological study, it was found that the majority of women in group 1, according to the morphological and histological characteristics, had a capable scar on the uterus, that is, potentially could be considered as a reserve for vaginal birth in women with uterine scar after the previous CS. In the second group, a significant proportion of women confirmed the correlation of regenerative and degenerative changes in the tissues of postoperative scar, indicating prevalence of fibro-sclerotic changes and insufficient vascularization, that is, it states the validity of operational resolution.

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