scholarly journals Complications of surgical reconstruction of multiligament injuries of the knee joint: diagnosis, prevention and treatment

2021 ◽  
Vol 6 (10) ◽  
pp. 973-981
Author(s):  
E. Carlos Rodríguez-Merchán ◽  
Hortensia De la Corte-Rodríguez ◽  
Carlos A. Encinas-Ullán ◽  
Primitivo Gómez-Cardero
Keyword(s):  
Knee Joint ◽  
Revision Surgery ◽  
Functional Outcomes ◽  
Early Recognition ◽  
Common Peroneal Nerve ◽  
High Energy ◽  
Surgical Reconstruction ◽  
Fluid Extravasation ◽  
Peroneal Nerve Injury

The main complications of surgical reconstruction of multiligament injuries of the knee joint are residual or recurrent instability, arthrofibrosis, popliteal artery injury, common peroneal nerve injury, compartment syndrome, fluid extravasation, symptomatic heterotopic ossification, wound problems and infection, deep venous thrombosis, and revision surgery. Careful surgical planning and execution of the primary surgical reconstruction of multiligament injuries of the knee joint can minimize the risk of the aforementioned complications. Careful postoperative follow-up is required to detect complications. Early recognition and prompt treatment are of paramount importance. To obtain good results in the revision surgery of failed multiligamentary knee reconstructions, it is crucial to perform a thorough and exhaustive evaluation to detect all the causes of failure. Addressing all associated injuries during revision surgery will lead to the best possible subjective and objective results, although functional outcomes are often modest. However, advanced age and high-energy injuries have been associated with the poorest functional outcomes after revision surgery of failed multiligament injuries of the knee joint. Cite this article: EFORT Open Rev 2021;6:973-981. DOI: 10.1302/2058-5241.6.210057

Iatrogenic common peroneal nerve injury during harvesting of semitendinosus tendon for anterior cruciate ligament reconstruction

2021 ◽  
Vol 14 (4) ◽  
pp. e240736
Author(s):  
Raf Mens ◽  
Albert van Houten ◽  
Roy Bernardus Gerardus Brokelman ◽  
Roy Hoogeslag
Keyword(s):  
Anterior Cruciate Ligament ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Cruciate Ligament ◽  
Common Peroneal Nerve ◽  
Peroneal Nerve Injury ◽  
The Common ◽  
Anterior Cruciate ◽  
Incision Technique

We present a case of iatrogenic injury to the common peroneal nerve (CPN) occurring due to harvesting of a hamstring graft, using a posterior mini-incision technique. A twitch of the foot was noted on retraction of the tendon stripper. After clinically diagnosing a CPN palsy proximal to the knee, the patient was referred to a neurosurgeon within 24 hours. An electromyography (EMG) was not obtained since it cannot accurately differentiate between partial and complete nerve injury in the first week after injury. Because the nerve might have been transacted by the tendon stripper, surgical exploration within 72 hours after injury was indicated. An intraneural haematoma was found and neurolysis was performed to decompress the nerve. Functioning of the anterior cruciate ligament was satisfactory during follow-up. Complete return of motor function of the CPN was observed at 1-year follow-up, with some remaining hypoaesthesia.

Functional Outcomes of Revision Osteosynthesis after Failure of Surgical Treatment of Patellar Fractures

2019 ◽  
Vol 34 (01) ◽  
pp. 080-086 ◽  
Author(s):  
Elena Caroline Müller ◽  
Karl-Heinz Frosch
Keyword(s):  
Revision Surgery ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Fracture Dislocation ◽  
Anatomic Reconstruction ◽  
Secondary Fracture ◽  
Complete Extension ◽  
Early Revision ◽  
Patellar Fractures

AbstractPatellar fractures account for approximately 1% of all skeletal fractures. These fractures are rare; however, because of the crucial function of the patella in the extensor mechanism of the knee, they may lead to serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study was to assess the functional outcomes of patients after revision surgery in cases of secondary fracture dislocation or persistent articular incongruity. This study included 16 patients with a mean age of 51.8 years (range: 16–85 years) with a mean follow-up of 35.1 months. According to the AO/OTA classification, 15 patients had a C-type fracture, including 10 patients with C3 fracture. Thirteen patients were initially treated with tension band wiring via K-wires or cannulated screws. Revision surgery was performed because of persistent articular incongruity in five patients and secondary fracture dislocation or refracture in 11 patients. We analyzed pain (visual analog scale [0–10]), satisfaction, range of motion (ROM), Böstman's score, Lysholm's score, and knee injury and osteoarthritis outcome score (KOOS) after revision surgery and could extract follow-up data from 15 patients. Mean pain score at rest was 0.57 (range: 0–3.5) and on exertion 2.79 (range: 0–8). The measurement of the ROM of the affected knee compared with that of the opposite knee revealed complete extension. Mean flexion was 123 degrees, in the corresponding knee it was 136 degrees (p = 0.05). The mean postoperative Böstman's and Lysholm's scores were 25.11 (good, maximum: 30) and 78.67 (moderate, maximum: 100), respectively. KOOS was as follows: symptoms, 66.8 points; pain, 77.55 points; activity of daily living (ADL), 75.67 points; and quality of life, 56.25 points. The results of this study suggested that early revision surgery after failure of primary osteosynthesis with secondary anatomic reconstruction and good radiological results leads to satisfactory functional outcomes with persistent functional deficits.

scholarly journals Management of Failed Proximal Biceps Surgery: Clinical Outcomes After Revision to Subpectoral Biceps Tenodesis

2019 ◽  
Vol 48 (2) ◽  
pp. 460-465 ◽  
Author(s):  
David D. Savin ◽  
Brian R. Waterman ◽  
Shelby Sumner ◽  
Catherine Richardson ◽  
John Newgren ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Revision Surgery ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Persistent Pain ◽  
Functional Score ◽  
Biceps Tenodesis ◽  
Patient Reported ◽  
Subpectoral Biceps Tenodesis

Background: The preferred surgical technique to manage biceps–superior labral pathology is often debated, and rates of revision and persistence of pain vary widely according to surgical technique and patient characteristics. Purpose: To evaluate the clinical and functional outcomes of patients undergoing revision subpectoral tenodesis after failed primary tenodesis or tenotomy of the long head of the biceps. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing revision biceps management by the senior surgeon between 2006 and 2016 and with a minimum 24-month follow-up were retrospectively identified. Patients being treated with concomitant rotator cuff repair or capsular release were excluded. Patient characteristic variables were recorded. Patient-reported outcomes including the functional score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons were obtained, and range of motion, strength, and complications were quantified. Results: In total, 25 patients with revision biceps tenodesis were identified at a mean follow-up of 76.5 ± 31.5 months. The average age was 44.4 ± 14.3 years, and the surgical indications included failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and patient dissatisfaction after tenotomy (8%). There was a significant improvement in the VAS score ( P < .001), SANE ( P = .001), SST ( P = .035), functional score ( P < .001), and forward elevation ( P = .028), whereas postoperative strength ( P = .440), abduction ( P = .100), and external rotation ( P = .745) improvement failed to achieve statistical significance after revision surgery. There was no difference in postoperative outcome measures between modes of failures, concomitant procedures, and sex. Twenty-two (88%) patients reported high satisfaction and stated they would have this revision surgery again. The overall complication rate was 48%, with half of these reporting pain of >3 on a scale of 10 and 4% of patients requiring additional surgeries. Conclusion: The current study demonstrates high patient satisfaction (88%) and significant improvement in functional outcomes with revision biceps tenodesis, a mini-open subpectoral technique, after previous failed tenodesis or tenotomy. Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. Patients should be counseled on the high complication rate (48%), with persistent pain being the most common complaint.

Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis

2020 ◽  
Vol 45 (7) ◽  
pp. 679-686 ◽  
Author(s):  
Marc Olivier Gauci ◽  
Thomas Waitzenegger ◽  
Pierre-Emmanuel Chammas ◽  
Bertrand Coulet ◽  
Cyril Lazerges ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Revision Surgery ◽  
Functional Outcomes ◽  
Type I ◽  
Type Ii ◽  
Level Of Evidence ◽  
Wrist Motion

We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion. Level of evidence: III

scholarly journals Failure Rates in Contact versus Non-Contact Athletes Following Arthroscopic Inferior Capsular Shift at 10-Year Follow-Up (237)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0034
Author(s):  
Kevin Plancher ◽  
Thomas Evely ◽  
Stephanie Petterson
Keyword(s):  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Functional Outcomes ◽  
External Rotation ◽  
Return To Sport ◽  
Suture Anchors ◽  
Recurrence Rates ◽  
Capsular Shift

Objectives: Arthroscopic Bankart repair has become the surgical procedure of choice for many in the United States, over the Latarjet in Europe, for first time anterior shoulder instability with minimal bone loss, less than 20%. However, high recurrence rates in contact athletes have led many to proceed with open type procedures. Our purpose was to compare failure rates and functional outcomes of the arthroscopic inferior capsular shift in contact and non-contact athletes. We hypothesized that contact and non-contact athletes would exhibit excellent functional outcomes and return to sport with low recurrence rates. Methods: A consecutive series of 69 shoulders in 61 contact and non-contact athletes underwent an arthroscopic inferior capsular shift with ≥3 suture anchors by a single surgeon (1999-2018). Thirty shoulders in 26 contact athletes (6 women; 25.3±8.1 years) and 39 shoulders in 35 non-contact athletes (7 women; 34.8±10.0 years) were included. Inclusion criteria were complete anterior inferior labral detachment (6 unit hours) and ≥2-year follow-up. Exclusion criteria included multidirectional instability, engaging Hill Sachs lesion or glenoid bone loss >30%. A modified 3-portal technique utilizing the outside-in method was employed. A conservative rehabilitation program was followed with return to sport no sooner than 3 months in non-contact, 4-5 months in contact, and 9 months in throwing athletes. Functional outcomes were measured using Constant Scores, American Shoulder and Elbow Surgeons (ASES) Score, Western Ontario Shoulder Instability Index (WOSI), Melbourne Instability Shoulder Scale (MISS), and Rowe. Forward elevation, external rotation at side and 90° abduction and internal rotation range of motion (ROM) were measured. Independent samples t-tests were used to assess differences in outcomes between contact and non-contact athletes (Bonferroni correction: p<0.006). Results: Follow-up was 11.0±3.5 years (range 2-16 years) in contact athletes and 12.2±4.3 years (range 2-21 years) in non-contact athletes (p=0.264). Contact athletes were significantly younger than non-contact athletes (p<0.0001). An average of 3.9±1.7 and 3.1±1.0 suture anchors were used in contact and non-contact groups, respectively (p=0.348). There were no significant differences in post-operative functional scores (all p>0.053) or shoulder ROM (all p>0.034) between groups. Forward flexion was 163.75±16.8° pre-operatively and 168.89±13.0° post-operatively in contact athletes (p=0.212) and 162.5±13.7° preoperatively and 170±7.7° post-operatively in non-contact athletes (p=0.005). External rotation at the side was 59.04±19.4° pre-operatively and 67.9±18.6° value post-operatively in contact athletes (p=0.094) and 52.94±25.1° pre-operatively and 62.83±14.3° post-operatively in non-contact athletes (p=0.062). External rotation at 90° abduction was 92.61±20.1° pre-operatively and 93.39±12.9° post-operatively in contact athletes (p=0.867) and 88.33±21.1° pre-operatively and 87.5±8.1° post-operatively in non-contact athletes (p=0.842).Internal rotation behind the back was to an average of T11 pre-operatively and T9 post-operatively in contact athletes (p=0.004) and L1 pre-operatively and T9 post-operatively in non-contact athletes (p=0.001).In contact and non-contact athletes, respectively, Rowe scores were 65.35±17.6 and 51.25±13.2 preoperatively and 89.22±17.6 and 96.25±12.4 post-operatively (p=0.002 and p<0.001); Constant Scores were 75.69±12.6 and 61.67±11.3 pre-operatively 85.79±19.6 and 89.71±13.6 post-operatively; ASES scores were 80.40±15.3 and 62.14±22.2 pre-operatively and 93.91±9.9 and 86.06±20.7 post-operatively (p<0.001 and p<0.001); MISS scores were 59.36±12.4 and 48.39±15.5 preoperatively and 88.20±13.5 and 75.75±19.7 post-operatively (p<0.001 and p<0.001); WOSI was 3.50±1.3 and 4.55±1.4 pre-operatively and 1.70±3.0 and 2.94±2.7 post-operatively (p=0.101 and p=0.066). Overall recurrence rate was 4.3% (3/69). Two contact athletes (2/30; 6.7%) and one non-contact athlete (1/39; 2.6%) experienced a traumatic recurrent instability event requiring revision surgery (p=0.439). These three patients underwent a revision arthroscopic inferior capsular shift with an additional 3-4 plication sutures and returned to pre-injury sports including hockey, football, skiing, and tennis without recurrence of instability at greater than 7 years following the revision surgery. Conclusions: Modified arthroscopic inferior capsular shift utilizing ≥3 suture anchors with plication sutures returns contact and non-contact athletes to sports with excellent functional outcomes, low recurrence rates (3/69), and full unrestricted ROM. While loss of ROM is a concern, particularly in overhead athletes, ROM was successfully restored in all patients, most notably in external rotation at 90° abduction. We recommend a modified arthroscopic inferior capsular shift with plication sutures as the primary procedure in all athletes with anterior instability with less than 30% bone loss excluding those with high Beighton scores rather than a Latarjet.

scholarly journals Positive Microbiological Findings at the Site of Presumed Aseptic Revision Arthroplasty Surgery of the Hip and Knee Joint: Is a Surgical Revision Always Necessary?

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Konstantinos Anagnostakos ◽  
Andreas Thiery ◽  
Christof Meyer ◽  
Ismail Sahan
Keyword(s):  
Knee Joint ◽  
Antibiotic Therapy ◽  
Revision Surgery ◽  
Normal Values ◽  
Revision Arthroplasty ◽  
Systemic Antibiotic ◽  
Systemic Antibiotic Therapy ◽  
Aseptic Revision ◽  
Arthroplasty Surgery

Little is known about patients that undergo presumed aseptic revision arthroplasty surgery of the hip and knee joint and having positive microbiological findings of the intraoperatively taken tissue samples. 228 “aseptic” operations were retrospectively analyzed from prospectively collected data with regard to the following parameters: demographic data; reasons for primary and revision surgery, respectively; time between primary and revision surgery; preoperative laboratory findings; microbiological and histopathological findings; type and length of systemic antibiotic therapy; clinical outcome; and follow-up. Identification of microorganisms was present in 8.8% of the cases (9.3% of the hip and 7.8% of the knee cases). Preoperatively, the median CRP value was 8.4 mg/l (normal values 0-5.0 mg/l) and the median WBC count 8,100×106/l (normal values 3,700‐10,100×106/l). The most common identified organism was methicillin-resistant Staphylococcus epidermidis in 30%, followed by viridans streptococci in 15% of the cases. In 7 cases, the microbiological findings were interpreted as a contamination, and no antibiotic therapy was administered. In the other cases, a systemic antibiotic therapy was applied for a time period between 2 weeks and 3 months. 68.4% of the patients did not have any infectious complications at a median follow-up of 20 (3-42) months. The present study indicates that more than 2/3 of the cases with positive microbiological findings at the site of presumed aseptic revision arthroplasty surgery of the hip and knee joint can be successfully treated conservatively and they do not require any further surgical therapy.

scholarly journals Comparison of Radiographic and Clinical Outcomes following Treatment of Talar Osteochondral Lesions with Micronized Cartilage Extracellular Matrix Mixed with Bone Marrow Aspirate Concentrate vs Microfracture

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
Mark C. Drakos ◽  
Taylor N. Cabe ◽  
Carolyn Sofka ◽  
Peter Fabricant ◽  
Jonathan Deland
Keyword(s):  
Extracellular Matrix ◽  
Revision Surgery ◽  
Functional Outcomes ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Group Iii ◽  
Group I ◽  
Cartilage Extracellular Matrix

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Historically, microfracture has been the standard surgical treatment for talar osteochondral lesions (OLTs); however, it is associated with unsatisfactory long-term results due to the formation of biomechanically inferior reparative fibrocartilage as opposed to normal hyaline-like cartilage. Thus, the optimal treatment for OLTs remains contested. Application of micronized allogenic cartilage extracellular matrix (ECM) as an adjuvant therapy during the treatment of OLTs offers a promising option that could be administered arthroscopically to improve the quality of reparative tissue. The purpose of this study is to provide a case-control series comparing radiographic and functional outcomes following treatment of OLTs with an adjuvant mixture of micronized allogenic cartilage ECM and bone marrow aspirate concentrate (BMAC) to those achieved following standard microfracture with or without BMAC. Methods: 194 patients (average age 37) with a minimum 1-year follow-up who were treated for an OLT by a fellowship-trained foot and ankle surgeon were screened for inclusion. 107 patients who received mixed micronized cartilage ECM and BMAC (Group I), 40 who were treated by microfracture augmented with BMAC (Group II), and 47 patients who were treated with traditional microfracture alone (Group III) were identified. Preoperative lesion size, lesion location, and concurrent injuries were recorded retrospectively. Foot and Ankle Outcome Scores (FAOS) were completed preoperatively and postoperatively through the prospective Registry database at the authors’ institution. Outcomes were assessed radiographically at a minimum of 6 months postoperatively by a trained radiologist using the MOCART scoring system. Linear regression modeling was used to assess differences in MOCART scores, post-operative FAOS scores, pre-to-postoperative change in FAOS, and the rate of revision surgery between groups I, II, and III. Results: The average MOCART score for Group I was 62.39, (average follow-up 16.13 months; n = 46), 58.8 (26.82 months; n =25) for Group II and, 55.36 (43.12 months; n=14) for Group III patients (p=0.57). The rate of revision surgery for OLTs treated using adjuvant micronized cartilage ECM was 5% and was significantly lower when compared to a 22.7% rate of revision surgery following microfracture with or without BMAC (p<0.001). Finally, when controlling for lesion size, changes in pre-to-postoperative FAOS Pain and Sports Activities were significantly different amongst the 3 treatment groups (p=0.05). Group I had the greatest improvement in Pain. Conclusion: Micronized allogenic cartilage extracellular matrix serves as an adjunctive therapy that may help improve patients’ radiographic and functional outcomes following treatment of OLTs when compared to outcomes following traditional microfracture. Specifically, use of adjunctive ECM appears to have better postop FAOS Pain scores when controlled for lesion size when compared to microfracture. There is a lower rate of revision surgery with the use of allogenic cartilage ECM in the short to intermediate term when compared with microfracture.

scholarly journals Solving the enigma of posterolateral tibial plateau fractures, the clue protocol

2021 ◽  
Vol 87 (1) ◽  
pp. 125-136
Author(s):  
Radwan G Metwaly ◽  
Zeiad M Zakaria ◽  
Mohamed A Elgebeily ◽  
Hany El Zahlawy
Keyword(s):  
Tibial Plateau ◽  
Soft Tissue Injuries ◽  
Common Peroneal Nerve ◽  
Functional Results ◽  
Deep Infection ◽  
Tibial Plateau Fractures ◽  
Academic Center ◽  
Peroneal Nerve Injury ◽  
Arthroscopically Assisted

The study aim is to evaluate functional and radio- logical outcomes following a suggested protocol based on the four-column classification for management of posterolateral column tibial plateau fractures. A prospective cohort study was performed in level I academic center on 42 patients with mean age of 36 years (22-59). Eleven patients had isolated posterolateral column fractures whereas 31 patients had associated columns fractures. According to the suggested protocol, all cases of isolated posterolateral column fracture started treatment via arthroscopic evaluation of soft tissue injuries (menisci and liga- ments), arthroscopically assisted reduction and inter- nal fixation by rafting screws followed by ORIF if plating was needed. If associated with other columns fractures, columns were fixed sequentially in an anti-clockwise direction starting from anteromedial column. Average follow up was 26 months. Mean time to union was 16.3 (12-22) weeks. No radiological evidence of loss of coronal or sagittal alignment was detected at final follow up. Five patients had an average depression of 5 millimeters that did not need further intervention at this short-term follow up. Mean KOOS was 81 (72- 88). The average knee range of motion was (0° - 127°). One patient had temporary common peroneal nerve injury, one patient had deep infection and two had superficial wound infection. implementing the suggested protocol gives good to excellent radiological and functional results as regard posterolateral tibial plateau fracture. A larger study group with longer follow up is needed.

scholarly journals Functional Outcomes After Isolated and Combined Posterior Cruciate Ligament Reconstruction in a Military Population

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987513 ◽  
Author(s):  
Christopher J. Tucker ◽  
Eric J. Cotter ◽  
Brian R. Waterman ◽  
Kelly G. Kilcoyne ◽  
Kenneth L. Cameron ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Revision Surgery ◽  
Physical Disability ◽  
Military Service ◽  
Cruciate Ligament ◽  
Surgical Reconstruction ◽  
Complication Rates ◽  
Military Population ◽  
Physically Active

Background: The rates of return to full activity, persistent disability, complications, and surgical revisions after operative management of posterior cruciate ligament (PCL) tears in a physically active population have not been reported. Purpose: To evaluate the clinical outcomes of active military patients with symptomatic PCL tears who underwent surgical reconstruction and compare outcomes between isolated PCL and multiligament injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Individuals undergoing surgical reconstruction of the PCL (Current Procedural Terminology code 29889) were isolated from the Military Health System Management Analysis and Reporting Tool between fiscal years 2005 and 2010. Demographic variables and rates of postoperative complications, activity limitations, rates of revision surgery, physical disability ratings, and ultimate medical discharge were recorded from the electronic medical record and US Army Physical Disability Agency database. Results: A total of 182 patients underwent 193 surgeries, including 118 isolated PCL reconstructions and 75 multiligament knee reconstructions, with an average follow-up of 19.5 months. There were 174 primary procedures and 19 revision reconstructions. The mean ± SD patient age was 28.4 ± 7.2 years, with males comprising 96.2% of patients. The overall surgical complication rate was 12.4%, with a significantly higher rate in multiligament knee reconstructions compared with isolated PCL reconstructions (18.7% vs 8.5%; P = .045). Overall, 35.1% of patients were discharged from military service due to disability. Rates of discharge were significantly higher in those undergoing surgery at lower volume institutions (those that performed <2 PCL reconstructions per year during the study period) than those at higher volume institutions (41.1% vs 26%; P = .040). The overall revision rate was 10.9%, with no significant difference between the isolated PCL and multiligament knee reconstructions. Of the 103 patients with primary isolated PCL reconstructions, 35% underwent medical discharge for persistent knee complaints, and 12.6% required revision PCL reconstruction. The overall failure rate for primary isolated PCL reconstructions, which includes both revision surgery and knee-related medical discharge from military service, was 42.7%. Conclusion: In a physically active, military population, nearly one-third of patients were unable to return to previous level of military function, and 12.6% required revision at short-term follow-up due to persistent instability. Perioperative complication rates were significantly higher among patients with multiligament knee reconstructions.

scholarly journals The Assessment of the Reduction Algorithm in the Treatment for “Logsplitter” Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Kangquan Shou ◽  
Richa Adhikary ◽  
Liang Zou ◽  
Hao Yao ◽  
Huarui Yang ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Functional Outcomes ◽  
High Energy ◽  
Fracture Dislocation ◽  
Posttraumatic Arthritis ◽  
Reduction Algorithm ◽  
Anatomical Reduction ◽  
Clear Space ◽  
Radiographic Parameters

As a rare and exceptional injury with significant syndesmotic disruption, the outcome of Logsplitter injury remains poor and unfavorable. In this study, we retrospectively investigated the relationship between the intraoperative reduction quality and the prognosis such as the posttraumatic osteoarthritis to help surgeons achieve better functional outcomes for this high-energy transsyndesmotic ankle fracture dislocation. From January 2015 to February 2019, 31 patients (average 37.6±9.4 years with 19 male and 12 female) diagnosed with the Logsplitter injury were treated by ORIF procedure and enrolled in our study. Particularly, nine vital radiographic parameters including medial clear space, talocrural angle, superior clear space, tibiofibular clear space, tibiofibular overlap, talar tilt, coin sign, tibial medial malleolus angle, and fibular lateral malleolus angle were measured from a postoperative film (AP and mortise view). Next, we compared the clinical outcome by using range of ankle motion, AOFAS scores, Burwell-Charnley score system, and Kellergen-Lawrence criteria from the patients who obtained the intraoperative anatomical reduction with those who failed. Our results showed that AOFAS score with all the patients was 79.33±5.82 at the final follow-up. 14 (45.1%) of 31 patients were observed with radiographic posttraumatic arthritis of the ankle joint with an average Kellgren-Lawrence score of 1.75±1.6 at final follow-up. Most importantly, our results proved that there were significant differences between the patients eligible for anatomical reduction quality with those who failed with regard to OA rate (33.3% vs. 85.7%, P=0.003) and AOFAS scores (75.33±6.53 vs. 66.89±4.28, P=0.037) at the final follow-up. Furthermore, the functional outcome after the operation showed an increased range of motion of the ankle joint of the patients obtained anatomical reduction compared with those who failed (P<0.05). In this study, the significant discrepancy with regard to the functional outcomes was observed between the acceptable and unacceptable radiographic parameters, indicating that the quality of intraoperative reduction is scientifically significant and thus can be utilized as the major factor to predict the clinical outcomes for Logsplitter injuries. Moreover, this reduction algorithm arising from our study can also be applied to other ankle fractures and dislocation involving syndesmotic complex.

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