The aim of the this study was to determine the effect of the knee flexion angle (KFA) during tibial anterior cruciate ligament (ACL) graft fixation on patient reported outcomes, graft stability, extension loss and re-operation following anatomic single-bundle ACL reconstruction. All 169 included patients (mean age 28.5 years, 65% male) were treated with anatomic single bundle ACL reconstruction using patellar tendon autograft and randomized to tibial fixation of the ACL graft at either 0o (n=85) or 30o (n=84). The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) two years following surgery. Secondary outcomes were the Marx Activity Scale (MAS), the rate of re-operation, and physical exam findings at one year including KT-1000 and side to side differences in knee extension. The follow-up rate was 82% (n=139) for the primary outcome. Graft failure rate at two years was 1% (n=2, 1 per group). ACL tibial graft fixation at 0o or 30o did not have a significant effect on KOOS scores at two years following ACLR. Patients whose graft was fixed at a knee flexion angle of 0o had greater scores on the Marx Activity Scale (mean 9.6 [95%CI 8.5-10.6] versus 8.0 [95%CI 6.9-9.1, p=0.04) and a greater proportion of patients who achieved the minimal clinical important difference (MCID) for the KOOS pain subscale (94% vs 81%, p=0.04). There was no significant difference in knee extension loss, KT-1000 measurements or re-operation between the two groups. In the setting of anatomic single-bundle ACLR using patellar tendon autograft and anteromedial portal femoral drilling, there was no difference in KOOS scores among patients fixed at 0o and 30o. Patient fixed in full extension did demonstrate higher activity scores at 2 years following surgery and a greater likelihood of achieving the MCID for KOOS pain.
Introduction Leg length inequalities (LLIs) are a common finding in every orthopaedic practice. They can be classified into anatomical and functional LLIs. LLIs can e.g. cause gait and balance disabilities, low back pain and functional scoliosis of the spine. In patients with a total hip replacement a higher rate of aseptic loosening of the prosthesis was found when LLIs were present (Gurney 2002). Until today LLIs are treated statically by wooden blocs, which are placed under the shorter extremity, until the pelvis is levelled. However, the correction of LLIs should also be evaluated dynamically to examine the influence of correction onto the spine and pelvis during gait. Therefore, we seek to evaluate in this pilot study the influence of simulated LLIs on spine and pelvis during gait. Methods A total of 30 healthy subjects (17 females & 13 males) with an average age of 24.4 years were measured in this study. First, LLIs (1 to 4 cm) were simulated with the subjects standing on a simulation platform, which height could be controlled, as previously described (Betsch 2012). In addition, a specially designed sandal with different insole heights (1 to 4 cm) was used to simulate LLIs under dynamic condition while subjects were walking on a treadmill. Changes in pelvic position and spinal posture caused by the LLIS were measured using a rasterstereographic system (Formetric 4D motion, Diers International GmbH, Germany). All data were checked for Gaussian distribution by the Chi square test. Student t-tests were used to check for differences between the LLIs. The level of significance was set at p
The Essex-Lopresti injury (ELI) of the forearm
is a rare and serious condition which is often overlooked, leading
to a poor outcome. The purpose of this retrospective case study was to establish
whether early surgery can give good medium-term results. From a group of 295 patients with a fracture of the radial head,
12 patients were diagnosed with ELI on MRI which confirmed injury
to the interosseous membrane (IOM) and ligament (IOL). They were
treated by reduction and temporary Kirschner (K)-wire stabilisation
of the distal radioulnar joint (DRUJ). In addition, eight patients
had a radial head replacement, and two a radial head reconstruction. All patients were examined clinically and radiologically 59 months
(25 to 90) after surgery when the mean Mayo Modified Wrist Score
(MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores
(MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder
and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome. In case of a high index of suspicion for ELI in patients with
a radial head fracture, we recommend the following: confirmation
of IOM and IOL injury with an early MRI scan; early surgery with
reduction and temporary K-wire stabilisation of the DRUJ; preservation
of the radial head if at all possible or replacement if not, and
functional bracing in supination. This will increase the prospect
of a good result, and avoid the complications of a missed diagnosis
and the difficulties of late treatment. Cite this article:
