No significant improvement in neuromuscular proprioception and increased reliance on visual compensation 6 months after ACL reconstruction

Purpose To determine the contributions of proprioceptive and visual feedbacks for postural control at 6 months following ACLR, and to determine their associations with knee laxity, isokinetic tests and clinical scores. Study design Level IV, Case series. Methods Fifty volunteers who received ACLR between May 2015 and January 2017 were prospectively enrolled, and at 6 months following ACLR, postural stability was assessed. Somatosensory ratios (somatic proprioception), and visual ratios (visual compensation), were calculated to evaluate the use of sensory inputs for postural control. Univariable regression analyses were performed to determine associations of somatosensory and visual ratios with knee laxity, isokinetic tests and clinical scores. Results At 6 months following ACLR, the somatosensory ratio did not change, while the visual ratio decreased significantly from 5.73 ± 4.13 to 3.07 ± 1.96 (p = 0.002), indicating greater reliance on visual cues to maintain balance. Univariable analyses revealed that the somatosensory ratio was significantly lower for patients who performed aquatic therapy (β = -0.50; p = 0.045), but was not associated with knee laxity, muscle strength or clinical scores. An increased visual ratio was associated with patients who received hamstrings tendon autografts (β = 1.32; p = 0.049), but was not associated with knee laxity, muscle strength or clinical scores. Conclusion At 6 months following ACLR, visual ratios decreased significantly, while somatosensory ratios did not change. This may suggest that there is little or no improvement in neuromuscular proprioception and therefore greater reliance on visual cues to maintain balance. The clinical relevance of this study is that posturography can provide useful information to help research following ACLR and to predict successful return to play.

CLINICAL COMPARISON BETWEEN FEMORAL TRANSFIXATION AND BIOSCREW FIXATION USING HAMSTRING TENDON GRAFT FOR ACL RECONSTRUCTION AT ORTHOPAEDICS DEPARTMENT OF JLNMCH, BHAGALPUR, BIHAR

Background: One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. Thereis no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically. Methods: 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In groupA; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter. Results: At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laitytests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score. Conclusions: Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests,instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels.

Treatment of Chronic Patellar Tendon Rupture with Hamstrings Tendon Autograft

We describe a new simple reconstruction for neglected chronic ruptures of patellar tendon using ipsilateral hamstrings tendon autograft. This has been validated in thirteen patients with mean follow up six years resulting in favorable outcome. Thirteen patients with mean age 58.2 years (range 30–64 years) presented with chronic patellar tendon rupture. They all underwent patellar tendon reconstruction using ipsilateral hamstrings tendon autograft. The average time from injury was 10 months (range 3–20 months). The cause of rupture was fall from height or after TKA and the preoperative Lysholm score was 65 (range 50–80). Postoperatively with a mean follow up of six years (range 5–7 years), all patients had a stable knee with mean flexion of 123°, extension lag 0°, and Insall-Salvati index 1.2. Quadriceps power was regained in 8 cases to 5/5 and in 5 cases to 4/5. No complications were inspected. The postoperative Lysholm score was 93 (range 89–95). Patellar tendon reconstruction using ipsilateral hamstrings as free autograft, consists an effective treatment option for chronic neglected patellar tendon ruptures. Our technique has favorable clinical outcome, complications are not expected, and consist a simple and anatomic reconstruction with a powerful graft, without the requirement for allograft or implants.

Comparison of Short-Term Biodex Results after Anatomic ACL Reconstruction Between Three Autografts

Objectives: Recent literature has suggested residual quadriceps weakness up to 12 months after anterior cruciate ligament reconstruction (ACLR), especially with quadriceps tendon autograft. These studies, though, have not directly compared different autograft options. The primary objective of this study was to compare short-term quadriceps and hamstring muscle strength between individuals undergoing primary ACLR with quadriceps tendon (QT), bone-patellar tendon-bone (BPTB), or hamstrings tendon (HS) autograft. The secondary objective was to assess how patients performed relative to common clinical strength thresholds used for return to activity decisions. We hypothesized that QT autografts would have poorer quadriceps strength symmetry at 5-8 months as compared to HS and BPTB, but there would be no significant difference at 9-15 months among all three groups. Methods: Patients who underwent anatomic primary ACLR with autograft at one institution from 2010-2015 were retrospectively reviewed. Isometric quadriceps and hamstrings strength measurements were routinely obtained between 5-8 months and 9-15 months postoperatively in these patients. To normalize strength outcomes between participants, we created a quadriceps (QI) and hamstring (HI) strength indices by expressing the ACLR limb strength as a percentage of the uninvolved limb strength. Values less than 100% indicated a strength deficit, while values greater than 100% indicated greater strength in the ACLR limb. Patients could be cleared to run if strength symmetry exceeded 80% and cleared to play if quadriceps strength symmetry exceeded 90%. Results: A total of 73 patients were identified with 5-8 month follow up, and 52 patients with 9-15 month data (Table 1). The QT group had significantly lower QI at 5-8 months (69.5 ± 17.4) as compared to the BPTB (82.8 ± 14.6, p = 0.01) and HS (86.0 ± 18.6, p < 0.01) groups. Similarly, the HS group demonstrated a significantly lower HI at 5-8 months (79.5 ± 14.6) compared to the BPTB group (98.0 ± 17.5, p < 0.01). However, there was no significant difference when compared to the QT group (88.4 ± 17.4, p = 0.06). At 5-8 months, more patients with HS autograft met criteria to return to run and play (84% and 26%, respectively) compared to QT (26% and 13%, respectively). In the 9-15 month analysis, the HS group had a significantly lower HI (84.2 ± 23.1) compared to the QT group (99.8 ± 20.1, p = 0.03), but no difference was noted when compared to the BPTB (99.6 ± 17.6, p = 0.08) group. There was no significant difference in quadriceps strength symmetry between the QT (83.3 ± 20.7), BPTB (97.0 ± 13.8), and HS (90.0 ± 17.5) groups at 9-15 months (p = 0.13). Additionally, there was no significant difference in percent of patients that met return to play and return to run thresholds between groups at 9-15 months. Conclusion: In conclusion, patients undergoing ACLR with QT demonstrated clinically meaningful quadriceps asymmetry, and patients reconstructed with HS had significant hamstring asymmetry at 5-8 months and 9-15 months postoperatively. Additionally, significantly fewer patients in the QT group met criteria to return to play and run at 5-8 months than the BPTB and HS groups. No significant difference was found at 9-15 months in regards to QI and return to play and run criteria between all three groups. These data suggest a longer time to return to play and specific rehabilitation protocols that emphasize quadriceps strengthening may be necessary due to residual quadriceps weakness after ACLR with QT. [Table: see text]

Clinical comparison between femoral transfixation and bioscrew fixation using hamstring tendon graft for ACL reconstruction

<p class="abstract"><strong>Background:</strong> One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. There is no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically.</p><p class="abstract"><strong>Methods:</strong> 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In group A; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laity tests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score.</p><p><strong>Conclusions:</strong> Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests, instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels. </p>