scholarly journals ACL Repair of Femoral Osseous Avulsion in a 13-Year-Old Using Suture Pullout Technique

2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110302
Author(s):  
Andrew Moore ◽  
Jess Rames ◽  
Kathy McGurk ◽  
Harris Slone
Keyword(s):  
Physical Examination ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Surgical Indications ◽  
Postoperative Rehabilitation ◽  
Rare Injury ◽  
Avulsion Fractures ◽  
Bony Avulsion ◽  
Osseous Avulsion

Background: The incidence of pediatric anterior cruciate ligament (ACL) injuries has been increasing over the past 20 years, with the majority comprised of mid substance tears or tibial eminence avulsion fractures. Pediatric femoral sided osseous avulsion is rarely reported in orthopedic literature and specific surgical indications and contraindications, as well as recommended surgical techniques and postoperative rehabilitation protocols, are underdefined. Indications: The surgical indications for femoral-sided repair of ACL osseous avulsion includes a displaced osseous fragment and ligamentous laxity on physical examination. There was no concomitant midsubstance tear necessitating reconstruction. Technique Description: Two sutures piercing the proximal ligamentous bony junction of the ACL were fed through 2.4-mm transphyseal tunnels and secured with cortical button and backup fixation with a 3.9-mm swivel lock anchor in the proximal lateral femoral metaphysis. The patient was immobilized in a hinged-knee brace locked in extension during ambulation and limited to 90 degrees of flexion while nonweightbearing for the first 6 weeks after surgery. Standard ACL protocol was followed thereafter. Results: Successful fixation and restoration of ligamentous tension and impingement-free range of motion were achieved without complication. There was stable Lachman, negative pivot shift, 125 degrees of knee flexion, and evidence of early healing at 3 months follow-up. Discussion/Conclusion: This report demonstrates successful reduction and fixation of proximal bony avulsion of the ACL. Although this patient exhibits stable physical examination and undisturbed growth at early follow-up, more research is required to establish treatment and rehabilitation guidelines for this rare injury.

scholarly journals Retear rates after rotator cuff surgery: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Arianna Carnevale ◽  
Ilaria Piergentili ◽  
Alessandra Berton ◽  
Vincenzo Candela ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Fatty Infiltration ◽  
Surgical Techniques ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Factors Influencing ◽  
Main Factors ◽  
Tear Size

Abstract Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

Arthroscopy Mini-plate Fixation with the Posterior Trans-septal Portal for Treating Posterior Cruciate Ligament Tibial Avulsion Fractures

2020 ◽  
Author(s):  
Chunlei Wang ◽  
Haisen Zhang ◽  
Longjie Li ◽  
Si Chen ◽  
Chang Liu
Keyword(s):  
Posterior Cruciate Ligament ◽  
Plate Fixation ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Fracture Site ◽  
Avulsion Fractures ◽  
Conventional Open Surgery ◽  
Mini Plate ◽  
Pcl Avulsion

Abstract Background Posterior cruciate ligament (PCL) avulsion fractures are rare and difficult to treat. The present work aimed to examine the effect of an innovative arthroscopy method for the treatment of PCL tibial avulsion fractures using mini-plate reduction and fixation through two tibial tunnels and the posterior trans-septal portal.Methods Totally 19 patients (median age, 33 years; range, 23–43 years) with PCL tibial avulsion fractures who underwent treatment with an arthroscopic suture bridge method were retrospectively assessed. Knee function pre-operation and at last follow up was assessed via Lysholm and Tegner scores. A KT-2000 arthrometer was employed for determining knee stability, the range of motion (ROM), and side-to-side differences. Plain radiography and International Knee Documentation Committee (IKDC) exams were performed for patient evaluation.Results No patient was switched to conventional open surgery due to difficult intraoperative procedures. Mean post-surgical Lysholm and Tegner scores (P < 0.001) were significantly improved in comparison with presurgical values. KT-2000 examination revealed markedly reduced side-to-side differences at last follow-up than observed preoperatively (1.2 ± 0.6 VS. 9.3 ± 2.2; P < 0.001). Radiography at the final follow up revealed solid union at the fracture site in the totality of 19 cases.Conclusions This new arthroscopy mini-plate fixation and posterior trans-septal method for posterior cruciate ligament tibial avulsion fractures resulted in good clinico-radiological outcomes, with adequate stability and fracture site healing. It could be employed to repair avulsion fragments of various sizes.Level of evidence IV

scholarly journals Clinical outcome of arthroscopic management of isolated posterior cruciate ligament injuries

2016 ◽  
Vol 2 (4) ◽  
pp. 411
Author(s):  
Suresh Perumal ◽  
Sadem Amer ◽  
Prakash Ayyadurai ◽  
Arumugam Sivaraman
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Hamstring Tendon ◽  
Lysholm Score ◽  
Radiographic Evaluation ◽  
Pcl Reconstruction ◽  
Avulsion Fractures ◽  
Arthroscopic Management

<p class="abstract"><strong>Background:</strong> Isolated posterior cruciate ligament<strong> (</strong>PCL) injuries are considered as benign and treated conservatively. But studies have shown the long term outcomes of these patients are poor. Aim of this study is to determine the functional outcomes, efficacy, and complication of isolated PCL injuries treated by arthroscopic PCL reconstruction or fixation.</p><p class="abstract"><strong>Methods:</strong> 24 patients, each with an isolated PCL injury, (17 with complete PCL tear and 7 with PCL avulsion fracture) were enrolled in this prospective study. Patients with complete tear underwent PCL reconstruction with hamstring tendon autograft and patients with displaced avulsion fractures underwent arthroscopic fixation with suture bridge technique. Average age at time of surgery was 33 years. Average time from injury to surgery was 1 month. Average follow-up period was 18 months. Patients underwent regular follow-up postoperatively with clinical and radiographic evaluation. Follow-up examinations comprised the Lysholm knee score, the International Knee Documentation Committee (IKDC) score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean preoperative Lysholm score for 24 knees was 41; mean postoperative Lysholm score was 90. Eighteen of 24 patients had excellent results, and 4 patients had good results and 2 patients have fare result at final assessment. IKDC ratings showed significant improvements on subsequent follow ups. In final IKDC ratings, 21 patients were assessed as normal or near normal (grade A or B).</p><p class="abstract"><strong>Conclusions:</strong> The short-term follow-up, analytical results showed good function after arthroscopic management in isolated PCL injuries. Hence we recommend surgical intervention in isolated PCL injuries.</p>

Arthroscopic Two-Point Suture Bridge Fixation Technique for the Treatment of Anterior Cruciate Ligament Tibial Avulsion Fractures

2021 ◽  
Vol 11 (10) ◽  
pp. 1977-1982
Author(s):  
Dong Zheng ◽  
Jianjian Yin ◽  
Long Han ◽  
Jianchao Gui
Keyword(s):  
Anterior Cruciate Ligament ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Suture Fixation ◽  
Fixation Technique ◽  
Avulsion Fractures ◽  
Anterior Drawer ◽  
Kt 1000 ◽  
Anterior Cruciate

This study aimed to present and evaluate a new arthroscopic technique that uses two-point suture fixation for anterior cruciate ligament (ACL) tibial avulsion fractures. A total of 15 patients diagnosed with ACL tibial avulsion fracture underwent arthroscopic suture fixation from November 2018 to October 2019 and were treated using two-point suture fixation. The patients were followed up and evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, Tegner activity level scales, anterior drawer testing, and KT-1000 arthrometer testing. The mean follow-up period was 18 months (12 to 24). All patients had a negative Lachman test and anterior drawer test at final follow-up and showed the radiological union of avulsion fracture at 12-week postoperative radiograph. The Lysholm score improved significantly postoperatively with a mean score of 94.26±3.63 (87 to 98; p < 0.001). The Tegner score improved significantly postoperatively from 3.61 ±1.37 to 7.14±1.51 (P < 0.001). The KT-1000 measured value decreased significantly postoperatively from 7.3±1.5 to 1.4 ±1.2 (P < 0.001). The IKDC category was abnormal or severely abnormal preoperatively, and all patients improved to normal or nearly normal at final follow-up. Arthroscopic treatment using the two-point suture fixation technique is effective for ACL avulsion fracture and can restore the function and stability of the knee joint.

Management of Posterior Cruciate Ligament Tibial Avulsion Injuries: A Systematic Review

2017 ◽  
Vol 46 (3) ◽  
pp. 734-742 ◽  
Author(s):  
Perry O. Hooper ◽  
Chris Silko ◽  
Tennison L. Malcolm ◽  
Lutul D. Farrow
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Posterior Cruciate Ligament ◽  
English Language ◽  
Cruciate Ligament ◽  
Open Group ◽  
Treatment Modalities ◽  
Avulsion Fractures ◽  
Bony Avulsion ◽  
Patient Reported

Background: Tibial-sided avulsion injuries of the posterior cruciate ligament (PCL) generally require surgical intervention. No consensus exists concerning the optimal surgical treatment approach for these injuries. Purpose: To perform a systematic review investigating the open and arthroscopic surgical treatment modalities, outcomes, and complications of PCL tibial-sided bony avulsions. Study Design: Systematic review; Level of evidence, 4. Methods: The authors performed a systematic review of the literature utilizing PubMed and EMBASE from 1975 to present outlining open versus arthroscopic surgical repair of PCL bony avulsion injuries and comparing subjective and objective postoperative patient-reported outcomes, including Tegner, IKDC (International Knee Documentation Committee), and Lysholm scoring systems, as well as rates of patient complications. The quest was performed in June 2016, and searched terms included posterior cruciate ligament, PCL, bony, avulsion(s), tibial-sided, open, and arthroscopic. Inclusion criteria included English-language studies involving surgical fixation strategies for PCL tibial-sided bony avulsions. Exclusion criteria included non-English language, case studies/case series, and subject matter not pertaining to PCL bony avulsions. Results: Twenty-eight articles comprising 637 patients met the criteria and were included in the final review. PCL injuries with a tibial-sided avulsion were the result of motor vehicle accidents in 68.4% of patients, with 59.0% of these injuries resulting from motorcycle accidents. The arthroscopic group had better IKDC grade A scores (78.9%), indicating a normal knee postoperatively, as compared with the open group (65.9%). The postoperative Lysholm scores were similar between the groups, with a mean of 95.0 in the arthroscopic group and 92.8 in the open group. The arthroscopic group also reported 100% return to preinjury level of activity, compared with 86.2% in the open group. The most common complication in both groups was arthrofibrosis, which was reported more often in the arthroscopic group (0%-35%) versus the open treatment group (0%-25%). Conclusion: In patients with displaced tibial-sided PCL avulsion fractures treated operatively, surgical approaches render similar outcomes and risks. While the arthroscopic group had somewhat higher subjective and objective knee outcome scores, it demonstrated a slightly higher rate of arthrofibrosis. The clear advantage of the arthroscopic approach is that concomitant intra-articular injuries seen on preoperative magnetic resonance imaging, such as meniscal tears or osteochondral loose fragments, can be addressed at the time of the index operation.

scholarly journals Evaluation of Single-Bundle versus Double-Bundle PCL Reconstructions with More Than 10-Year Follow-Up

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Masataka Deie ◽  
Nobuo Adachi ◽  
Atsuo Nakamae ◽  
Kobun Takazawa ◽  
Mitsuo Ochi
Keyword(s):  
Evaluation Method ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Surgical Techniques ◽  
Double Bundle ◽  
Single Bundle ◽  
Bundle Versus ◽  
Significant Difference ◽  
The Mean

Background. Posterior cruciate ligament (PCL) injuries are not rare in acute knee injuries, and several recent anatomical studies of the PCL and reconstructive surgical techniques have generated improved patient results. Now, we have evaluated PCL reconstructions performed by either the single-bundle or double-bundle technique in a patient group followed up retrospectively for more than 10 years.Methods. PCL reconstructions were conducted using the single-bundle (27 cases) or double-bundle (13 cases) method from 1999 to 2002. The mean age at surgery was 34 years in the single-bundle group and 32 years in the double-bundle group. The mean follow-up period was 12.5 years. Patients were evaluated by Lysholm scoring, the gravity sag view, and knee arthrometry.Results. The Lysholm score after surgery was89.1±5.6points for the single-bundle group and91.9±4.5points for the double-bundle group. There was no significant difference between the methods in the side-to-side differences by gravity sag view or knee arthrometer evaluation, although several cases in both groups showed a side-to-side difference exceeding 5 mm by the latter evaluation method.Conclusions. We found no significant difference between single- and double-bundle PCL reconstructions during more than 10 years of follow-up.

scholarly journals Early Outcomes in Anterior Cruciate Ligament Reconstruction: Full Tibial tunnel technique compared to all-inside technique

2019 ◽  
Vol 69 (12) ◽  
pp. 3753-3755
Author(s):  
Octav Marius Russu ◽  
Emilian Ciorcila ◽  
Andrei Marian Feier ◽  
Radu Fleaca ◽  
Sandor Gyorgy Zuh ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Tibial Tunnel ◽  
Surgical Techniques ◽  
Assessment Tools ◽  
Significant Difference ◽  
Tunnel Technique

The all-inside technique for ACL reconstruction uses the semitendinous muscle tendon as a graft, and postoperative pain is slightly reduced. Through the full tibial tunnel technique, better anatomical graft placement is obtained with promising results, yet there are only few scientific articles comparing the two techniques. The main objective is evaluation of results after ACL reconstruction by comparing the clinical results of the two surgical techniques. A prospective study was conducted that included 63 eligible patients according to pre-established criteria. The technique used was randomly indicated to each patient. Demographics and clinical examination results were collected and subsequently stored. The assessment tools used were the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analogue Scale (VAS) with a 6-month follow-up period. The statistical analysis was performed for preoperative follow-up scores, at 3 and 6 months. All patients were operated by the same surgical team under spinal anesthesia with nerve block and tourniquet applied.In regards to IKDC and KOOS scores, the difference between the two interventions was not statistically significant (p = .579 and p = .710). Postoperative pain was slightly reduced in patients in the all-inside\ group but without any statistical significance compared to full-tibial tunnel technique(p = .259). There were no graft ruptures or late postoperative complications. Regarding IKDC, KOOS and VAS evaluating tools, there is no statistically significant difference between the two evaluated methods for ACL reconstruction, all-inside and full tibial tunnel at 3 months and 6 months after surgery.

Die pediatrische vordere Kreuzbandläsion – Eminetia intercondylaris-Fraktur

2021 ◽  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Procedure ◽  
Cruciate Ligament ◽  
Avulsion Fractures ◽  
Bony Avulsion ◽  
Arthroscopically Assisted ◽  
Grade Ii ◽  
Anterior Cruciate ◽  
Arthroscopically Assisted Reduction

Ligamentous structures are more robust than bone. Therefore, avulsion fractures are more common in children. This principle is seen in bony avulsion fractures of the anterior cruciate ligament in children. Diagnostics include conventional radiographs as well as an MRI to evaluate further intra-articular injuries. The fracture rarely occurs; however, it usually requires arthroscopically assisted reduction and fixation. The indication is given if at least a grade II fracture is evident radiologically. The injury, as well as the surgical procedure, carries the risk of growth damage and arthrofibrosis.

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