Computed tomographic evaluation of bone tunnel enlargement following single bundle anterior cruciate ligament reconstruction with hamstring autograft

<p class="abstract">The purpose of this study is to evaluate tibial and femoral tunnel diameter following single bundle anterior cruciate ligament (ACL) reconstruction and correlation between tunnel enlargement and clinical outcome. Twelve patients who underwent primary arthroscopic single bundle ACL reconstruction with hamstring graft were included in prospective case series. Preoperative clinical evaluation was performed using international knee documentation committee (IKDC) subjective score and grade, Tegner knee score and Lysholm knee score. Computed tomography (CT) evaluation of the femoral and tibial tunnels were done on post-operative day (POD) 1 and at a mean follow up of 9 months (range 7-12 months) and were compared with functional scores. Our study shows significant tibial and femoral tunnel enlargement on CT scan at 9 months (range 7-12 months) postoperatively. All the clinical evaluation scales showed improvement postoperatively. The mean average femoral tunnel diameter increased significantly (p&lt;0.001) from 8.17±0.57 to 9.08±0.660 (10%) and tibial tunnel diameter increased significantly (p&lt;0.001) from 8.08±0.669 to 9.07±0.601 (11%) postoperatively at a mean follow up of 9 months (range 7-12 months). No statistically significant difference between tunnel enlargement and clinical values were found. In our current prospective CT based study, we conclude use of extracortical fixation of femoral tunnel with stronger fixation of the tibial tunnel, tunnel orientation and anatomic fixation close to the joint line along with less aggressive rehabilitation protocol with use of extension knee brace may result in minimization of tunnel widening with quadrupled hamstring autograft.</p>

Bone-on-Bone Contact on Radiograph is not a Prerequisite for Successful Outcome in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty—A 10-Year Follow-Up Study

Introduction Patients without bone-on-bone osteoarthritis are excluded from mobile-bearing unicompartmental knee arthroplasty due to higher revision rates and poorer outcomes. However, we do not know if the same indication applies to fixed-bearing unicompartmental knee arthroplasty implants. Our study aims to compare functional outcomes and revision rates in patients with and without bone-on-bone arthritis undergoing fixed-bearing medial unicompartmental knee arthroplasty. Materials and Methods We reviewed 153 fixed-bearing medial unicompartmental knee arthroplasties in a single institution. Patients were divided into four groups based on joint space remaining measured on preoperative radiographs. Group 1 included knees with bone-on-bone contact; group 2 included knees with less than 2 mm joint space; group 3 included knees with 2 to 4 mm joint space; group 4 included knees with more than 4 mm joint space. Patients were followed up for 10 years postoperatively and assessed using the Oxford Knee Score, the Functional Score and Knee Score from the Knee Society Clinical Rating Score, and the Short Form 36 Health Survey. Results There was no difference in terms of demographic data and preoperative scores. Postoperative Knee Society Functional Score was found to be lower in group 1 as compared with the other groups. There was no difference between the four groups of patients in terms of Knee Society Knee Score, Oxford Knee Score, and Physical Component Summary and Mental Component Summary Scores from the Short Form 36 Health Survey. There was no difference in terms of survivorship free from all-cause revision at a minimum of 10 years' follow-up. Conclusion Symptomatic patients with varying degrees of arthritis on preoperative radiographs had comparable clinical outcomes. We conclude that symptomatic patients with clinical and radiographic evidence of medial compartment osteoarthritis of any grade can benefit from a fixed-bearing medial unicompartmental knee arthroplasty.

The Functional Impact of Home-based Self-rehabilitation Following Arthroscopic Root Repair

Purpose: COVID-19 pandemic makes outdoors rehabilitation a potential hazard. Patient education to perform simple home-based exercises seems to be an interesting and sometimes a mandatory option. This study provides a comparison between the conventional and home-based virtual rehabilitation after surgical repair of medial meniscus root tears. Methods: All patients who underwent MPRT repair with a modified trans-tibial pull-out technique from March 2019 to March 2021 were evaluated. Those who underwent surgery after December 2019 were trained to perform self-rehabilitation. The rest had undergone outdoors specialized rehabilitation according to a unified protocol and these were used as a historical control group. All patients were followed up for a minimum of 2 year after surgery. Final Lysholm scores were utilized to compare functional outcomes. Results: Forty-three consecutive patients with medial meniscal root tears were studied. Thirty-nine (90.7%) were women and 4 (9.3%) were men. The mean age of participants was 53.2 ±8.1 years. The total Lysholm knee score, and all its items were significantly improved in both groups at a two-year follow-up (p<0.05), except the “Using cane or crutches” item (p=0.065). Nevertheless, the final Lysholm knee score improvement was higher in patients who performed outdoors specialized rehabilitation and in patients with shorter time-to-surgery.Conclusion: Regardless of age and gender, home-based rehabilitation after meniscal root repair with the modified trans-tibial pull-out technique improved the patients’ function at a two-year follow-up. Nonetheless, this effect was still significantly lower than that of the outdoors specialized rehabilitation. Future work is required to clarify basic protocols for home-based tele-rehabilitation programs and determine clinical, radiological and functional results.Level of evidence: Level IV, therapeutic, historically controlled study

Analysis of the Early Clinical Effect of Simultaneous Ipsilateral Total Hip and Knee Arthroplasty in the Treatment of End-stage Hemophilic Arthritis

ObjectiveTo evaluate the clinical efficacy of simultaneous ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the treatment of advanced hemophilic arthritis. Methodthe clinical data of 8 patients with advanced hemophilic arthritis, with ages of 31.6±6.2 years (ranging from 25-38 years, who underwent ipsilateral THA and TKA at the ** Hospital from January 2018 to May 2021 were retrospectively analyzed. There were 6 cases of hemophilia A and 2 cases of hemophilia B. The preoperative level of coagulation factor VIII was 1.8(±1.3)%，activated partial prothrombin time (aPTT) was 131.2 (±35.3) s. A comparison of the Harris score before and 0.3-1 year after operation was performed to evaluate hip function, American hospital for special surgery (HSS) knee score and American Knee society score (KSS) score. ResultDuring the follow-up period of 1.4 (± 1.1) years, no intra-articular bleeding and skin dehiscence were found in the early postoperative period, and no joint infection, bleeding, prosthesis loosening and sinking were found in the last follow-up visit. The Harris score increased from 16.8 (± 4.4) preoperatively to 77.6 (± 7.1) postoperatively, HSS knee score increased from 41.8 (± 4.2) preoperatively to 76.0 (± 5.8) postoperatively, the clinical KSS increased from 35.6 (± 10.8) preoperatively to 79.2 (± 6.9) postoperatively. The KSS increased from 22.8 (± 8.4) preoperatively to 72.0 (± 5.9) postoperatively at the last follow-up visit. The differences were statistically significant (P < 0.05).ConclusionsIpsilateral THA and TKA in the treatment of advanced hemophilic arthritis can effectively relieve pain, and improve hip and knee joint function, as well as the quality of life, and can thus be recommended as a safe and effective measure for the treatment of advanced hemophilic arthritis.

The use of autologous platelet-rich fibrin matrix combined with meniscal repair in the treatment of parameniscal cyst: clinical results and cyst recurrence after 2-year of follow up

Purpose Parameniscal cysts are associate with horizontal meniscal tears. Arthroscopic meniscal repair and the excision of the cyst by mini-open approach represent a valid treatment. However, the recurrence of cyst is still a current issue. Therefore, biological factors may be considered to promote the biological repair and avoid recurrence. The aim of the present study was to report the clinical results and the rate of recurrence of the cyst after minimum 2-year of follow up in a cohort of patients treated by meniscal repair and autologous platelet-rich fibrin matrix augment. Methods Patients with lateral parameniscal cyst undergoing arthroscopic meniscal repair and autologous platelet-rich fibrin matrix augment between 2016 and 2019 were retrospectively reviewed in March 2021. Inclusion criteria were absence of prior surgery on the affected knee with minimum 2-year of follow-up. Exclusion criteria were concomitant ligament lesions, rheumatic diseases and knee osteoarthritis. After reviewing the database, each selected patient was contacted and asked to participate in the study; at the follow-up evaluation all patient signed an informed consent. Tegner-Lysholm knee score, IKDC and NRS were collected before surgery and at follow-up. Results This study included 15 patients (8 male) with mean age of 32.8 years old. No recurrence of the cysts was observed. The Tegner-Lysholm knee score and IKDC subjective scores increased respectively from 41.3 ± 5.4 and 37.6 ± 5.1 at baseline to 92.3 ± 4.6 and 89.4 ± 2.6 at the final follow up. Concerning pain relief, the Numeric Pain Rating Scale (NRS) displayed a significant improvement reaching at the follow up a score of 1,3 ± 1.1 in comparison to 6.8 ± 0.9 at the baseline. Conclusion Surgical management of symptomatic lateral parameniscal cyst with cyst excision, autologous PRP membrane application and meniscus repair demonstrated excellent subjective clinical outcome with any cyst reoccurrence. Level of evidence III, retrospective cohort study.

Fractures of the distal femur in elderly patients: retrospective analysis of a case series treated with single or double plate

Introduction: We evaluated the radiologic and clinical outcomes of a lateral incision single plate with and a single-incision double plating in elderly patients with osteoporotic distal femoral fractures.Materials and Methods: We performed a retrospective study of 82 cases of distal femoral fractures from May 2004 to June 2018. Group A consisted of 42 patients who underwent single-plate fixation. Group B consisted of 40 patients who underwent double-plate fixation. The mean patient age was 77 years (67–87 years) and 76 years (64–86 years) in groups A and B, respectively. All patients were evaluated for procedure duration, time to union, range of knee motion, Lysholm knee score, and presence of complications.Results: The average procedure time was 81 min (66–92 min) and 110 min (95–120 min) in groups A and B, respectively(p=0.33). One case in group B required bone grafting after 5 months. The average time to union was 14 weeks (9–19 weeks) and 12.2 weeks (8–19 weeks) (p=0.63), and the mean range of knee motion was 105° (90–125°) and 110.7° (90°–130°) (p=0.37) in groups A and B, respectively. There was no significant statistical difference between the two groups in the Lysholm knee score(p=0.44) and knee society score(p=0.53).Conclusion: The clinical and radiological outcomes were similar in the 2 groups. In elderly patients, double plate fixation for distal femoral fractures is an useful method for several advantages such as adequate exposure, easy manipulation, anatomical reduction and stable fixation.

Role of ultrasound guided injection of platelet rich plasma (PRP) in knee osteoarthritis patients

Background Multiple promising researches were done regarding using platelet rich plasma (PRP) injection aiming at establishing new minimally invasive treatment option for knee OA and avoiding surgical procedures hazards which could be an option in advanced cases. Thus, our study will be directed towards ultrasound guided injecting of PRP trying to confirm the efficacy of the procedure as a therapeutic option. Objective The study aims to assess of the role of ultrasound guided PRP injection in cases of knee osteoarthritis and follow up of the symptoms outcome. Methods and material Twenty patients with different knee osteoarthritis grades were injected with PRP under ultrasound guidance and the symptoms outcome were followed up by using visual analogue scale (VAS), WOMAC osteoarthritis index, OXFORD knee score, LYSHOLM knee scoring scale at periods of , and weeks post procedure. Results A total of patients were included with the age ranging from - years old, the mean was . years old (SD ± . ). Among them patients ( ) were females and patients ( ) were males. There was statistically significant difference between the different knee pain scoring scales , and weeks after the procedure compared to before injection, where according to VAS score the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with mean reduction ratio of . % after months. The extent of the difference over the periods through WOMAC in knee osteoarthritis patients was . . ,. . and . . after , and weeks respectively, compared to . . before the procedure with a mean reduction ratio of . % after months. While according to OXFORD knee score, the patient’s scores were . . before the procedure Vs . . , . . and . . at , and weeks after injection with symptoms mean reduction ratio of . %. According to LYSHOLM knee scoring scale, the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with months mean reduction ratio of . %. Conclusion PRP injection in symptomatic knee osteoarthritis patients cause statistically significant improvement of the symptoms.