A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation

Purpose Suspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II). Materials and methods This was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery. Results Postoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9). Conclusion ACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results. Level of evidence 1.

Femoral Positioning of the Anterolateral Ligament Graft With and Without Ultrasound Location of the Lateral Epicondyle

Background: In anterior cruciate ligament (ACL) reconstruction with anterolateral ligament (ALL) reconstruction, precise positioning of the ALL graft on the femur and tibia is key to achieve rotational control. The lateral femoral epicondyle is often used as a reference point for positioning of the ALL graft and can be located by palpation or with ultrasound guidance. Purpose: To compare the ALL graft positioning on the femoral side between an ultrasound-guided technique and a palpation technique for the location of the lateral epicondyle. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 120 patients receiving a primary combined ACL and ALL reconstruction between June and December 2019 were included. The location of the lateral epicondyle was determined by palpation in the palpation group (n = 60) and with preoperative ultrasound guidance in the ultrasound group (n = 60). Groups were comparable in age, sex, body mass index (BMI), and operated side. The planned positioning of the femoral ALL graft was proximal and posterior to the lateral epicondyle. The effective positioning of the femoral ALL graft was evaluated on postoperative lateral radiographs. The primary outcome was location of the graft in a 10-mm quadrant posterior and proximal to the lateral epicondyle. Results were analyzed in 2 subgroups according to BMI. Results: All 60 anterolateral grafts (100%) in the ultrasound group were positioned in a 10-mm quadrant posterior and proximal to the lateral epicondyle, as opposed to 52 (87%) in the palpation group ( P = .006). Errors in graft positioning with palpation occurred in overweight patients (BMI >25) as well as nonoverweight patients ( P = .3). Conclusion: Femoral positioning of the ALL graft posterior and proximal to the lateral epicondyle is more reproducible with ultrasound guidance when compared with palpation alone, regardless of BMI.

Unusual apical femoral head deformity treated by hip arthroscopy and tunnel drilling through femoral head: a case report

Femoro-acetabular impingement (FAI), is the result of an abnormal morphology of the hip joint. On the femoral side, asphericity of the head can be highlighted by an alpha angle measurement >50° on computed tomography or MRI. However, some particular cephalic asphericities can make it difficult to measure the alpha angle, leading to a diagnostic pitfall. While in the classic cam effect, the deformity is peripheral and can be treated by arthroscopic femoroplasty, an apical head deformity remains a therapeutic challenge. We present the case of a 17-year-old male patient with a femoral head deformity, corresponding to an ISHA zone 6 overhang, significantly improved in everyday and sports life by arthroscopic trapdoor technique to resect the focal central deformity while enabling concomitant treatment of central compartment pathology, in this case, a hypertrophic ligamentum teres and femoral head chondral flap. Etiology of this femoral head deformity remains uncertain but could be a particular cam deformity, sequelae to pediatric disease or instability with repeated traction of the ligament teres on the femoral head apical insertion during cephalic growth.

Medial Pelvic Migration of the Lag Screw after Intramedullary Nailing for Trochanteric Femoral Fracture

Internal fixation with intramedullary nails has gained popularity for the treatment of trochanteric femoral fractures, which are common injuries in older individuals. The most common complications are lag screws cut-out from the femoral head and femoral fracture at the distal tip of the nail. Herein, we report a rare complication of postoperative medial pelvic migration of the lag screw with no trauma. The patient was subsequently treated by lag screw removal via laparoscopy. This case suggests that optimal fracture reduction, adequate position of the lag screw, and careful attention to set screw insertion are important to prevent complications. Additionally, laparoscopic surgery might be able to remove the lag screw more safely than removal from the femoral side.

Neglected Total Hip Dislocation

Background: Dislocation of total hip arthroplasty (THA) needs prompt intervention and reduction either closed or open. It is unusual to left THA dislocated. Hence in this study, the outcomes of neglected prosthesis after THA were determined. Methods: In this case series study, 15 neglected cases of total hips which had been left unreduced for long time (more than 3 months) were assessed. Cause of postponing reduction, femoral side and acetabular side defects, approach and type of revised prosthesis, Harris hip score (HHS), and other complications were studied. Results: The results in this study demonstrated that financial issues were the cause of delayed attempt for treatment in 5 cases and the other 10 cases had delay for treatment, because they searched for a specialist to accept performing an operating on them. There were some acetabular side and femoral side defects. By Paprosky classification, in femoral side, there were 6 defects: four type 2, one type 3A, and one 3B. In acetabular side, there were 10 defects (three type 1, one type 2a, three type 2b, one type 3a, and two type 3b). In one developmental dysplasia of the hip (DDH) case, previous osteotomy site was revised (distal segment rotated and then refixed) Conclusion: Totally, according to the obtained results, it may be concluded that outcomes were relatively good in neglected prosthesis cases after THA. However, recognition of high-risk cases and reduction of delay time may improve the outcomes.

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.

Influence of extension stem length and diameter on clinical and radiographic outcomes of revision total knee arthroplasty

Background Extension stems provide stability to revision total knee arthroplasty (RTKA). Little is known regarding the relationship between stem characteristics and RTKA stability. We aimed to identify the relationship between canal filling ratio (CFR) and aseptic loosening following RTKA. Methods We retrospectively reviewed demographics, radiographic parameters, and outcomes associated with RTKA performed between 2008 and 2013 in a tertiary hospital. The inclusion criteria were: revision for aseptic loosening, hybrid fixation, minor bone defect, Zimmer® LCCK prosthesis, and follow-up > 24 months. Using the modified Knee Society radiographic scoring system, radiographic prosthesis loosening was defined as a radiolucent line (RLL) score ≥ 9 on the femoral side or ≥ 10 on the tibial side. We utilized receiver operating characteristic (ROC) curve analysis to evaluate the cutoff value for stem length and diameter in terms of prosthesis loosening or not. Furthermore, CFR-related parameters were analyzed with logistic regression to clarify their relationships with prosthesis loosening. Results Prosthesis loosening was detected in 17 of 65 patients included. On logistic regression analysis, male sex and severity of the tibial bone defect were associated with loosening. On multivariate analysis, male sex and bone defect severity were associated with loosening on the femoral side, while malalignment was associated with loosening on the tibial side. Protective factors included femoral CFR > 0.85, CFR > 0.7 for > 2 cm, and CFR > 0.7 for > 4 cm, as well as tibial CFR > 0.85. Conclusions To minimize loosening post-RTKA, femoral CFR > 0.7 for > 2 cm and tibial CFR > 0.85 are recommended. Risk factors may include male sex, bone defect severity, and malalignment.