Medial patellofemoral ligament reconstruction with gracilis autograft for recurrent patellar instability: a case report

The medial patellofemoral ligament (MPFL) is the primary passive restraint in pathologic lateral translation of the patella. Recurrent patellar instability is com­mon, and multiple procedures have been described for its treatment. Chronic instability of the patellofemoral joint and recurrent dislocation may lead to progres­sive cartilage damage and severe arthritis if not treated adequately. A 17-years-old female presented with a one-year history of knee pain in his left knee. The apprehension test is positive; there is pain and muscle defensive contraction of lateral patellar dislocation with 20°-30° of knee flexion. MRI revealed flattened trochlear joint surface proximally and the concavity is less pronounced distally. The inclination angle is less than 11 degrees and trochlear facet asymmetry can be seen on axial view. Patient undergone medial patellofemoral ligament reconstruction with gracilis autograft and six months postoperatively, the patient was followed up using WOMAC score and showed good result. WOMAC score was 96.2% indicating no significant pain, joint stiffness, or any difficulty on physical activity. After the operation, the patient is able to perform regular daily activities without any complaints. This study has shown that treatment of recurrent patellar instability with medial patellofemoral ligament reconstruction using gracilis autograft resulted in satisfactory functional outcome based on WOMAC score

The relationship between tourniquet time and Il-6, D-Dimer and visual analogue scale in total knee arthroplasty

Background: The use of tourniquet during TKA aside from having several advantages, is also accompanied by several risks. This study was performed to prove the relation between the duration of tourniquet application to inflammatory response, pro-thrombotic condition, and pain response of the patients undergoing TKA procedures.Methods: This study is a cross-sectional analytical experimental research. A femoral tourniquet was applied to 34 primary osteoarthritis (OA) patients undergoing the standard procedure of TKA and the duration of tourniquet application data was noted and collected. Pain assessment was performed by using Visual Analogue Scale (VAS), whereas blood samples are taken from the patients and IL-6 cytokine and D-dimer levels were identified at 12 hours and 24 hours post-operatively. Statistical analysis (Pearson correlation) was performed to see the correlation of tourniquet duration to the VAS, IL-6, and D-dimer serum level at 12 hours and 24 hours post-operatively.Results: The result of this study showed a positive correlation between the duration of tourniquet use with IL-6 at 12 hours post operation (r=0.359) and 24 hours post operation (r=0.658); with D-dimer at 12 hours post operation (r=0.491) and 24 hours post operation (r=0.483); and with VAS at 12 hours post operation (r=0.647) and 24 hours post operation (r=0.507) with p<0,05. A positive correlation was found between tourniquet time and IL-6, D-dimer and VAS.Conclusions: The duration of tourniquet cut-off time of more than 122.5 minutes elevates IL-6 and D-Dimer which increases the risk for SIRS and DVT