Effect of medial patellofemoral ligament reconstruction method on patellofemoral contact pressures and kinematics.

Background: There remains a lack of evidence regarding the optimal method when reconstructing the medial patellofemoral ligament (MPFL) and whether some graft constructs can be more forgiving to surgical errors, such as overtensioning or tunnel malpositioning, than others. Hypothesis: The null hypothesis was that there would not be a significant difference between reconstruction methods (eg, graft type and fixation) in the adverse biomechanical effects (eg, patellar maltracking or elevated articular contact pressure) resulting from surgical errors such as tunnel malpositioning or graft overtensioning. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen cadaveric knees were placed on a customized testing rig, where the femur was fixed but the tibia could be moved freely from 0\ub0 to 90\ub0 of flexion. Individual quadriceps heads and the iliotibial tract were separated and loaded to 205 N of tension using a weighted pulley system. Patellofemoral contact pressures and patellar tracking were measured at 0\ub0, 10\ub0, 20\ub0, 30\ub0, 60\ub0, and 90\ub0 of flexion using pressure-sensitive film inserted between the patella and trochlea, in conjunction with an optical tracking system. The MPFL was transected and then reconstructed in a randomized order using a (1) double-strand gracilis tendon, (2) quadriceps tendon, and (3) tensor fasciae latae allograft. Pressure maps and tracking measurements were recorded for each reconstruction method in 2 N and 10 N of tension and with the graft positioned in the anatomic, proximal, and distal femoral tunnel positions. Statistical analysis was undertaken using repeated-measures analyses of variance, Bonferroni post hoc analyses, and paired t tests. Results: Anatomically placed grafts during MPFL reconstruction tensioned to 2 N resulted in the restoration of intact medial joint contact pressures and patellar tracking for all 3 graft types investigated (P >.050). However, femoral tunnels positioned proximal or distal to the anatomic origin resulted in significant increases in the mean medial joint contact pressure, medial patellar tilt, and medial patellar translation during knee flexion or extension, respectively (P <.050), regardless of graft type, as did tensioning to 10 N. Conclusion: The importance of the surgical technique, specifically correct femoral tunnel positioning and graft tensioning, in restoring normal patellofemoral joint (PFJ) kinematics and articular cartilage contact stresses is evident, and the type of MPFL graft appeared less important. Clinical Relevance: The correct femoral tunnel position and graft tension for restoring normal PFJ kinematics and articular cartilage contact stresses appear to be more important than graft selection during MPFL reconstruction. These findings emphasize the importance of the surgical technique when undertaking this procedure

The Videoinsight\uae method: improving rehabilitation following anterior cruciate ligament reconstruction-a preliminary study.

The purpose of this randomized double blind controlled study was to investigate if the vision of contemporary art video according to the Videoinsight(\uae) method could produce better short-term clinical and subjective outcomes after anterior cruciate ligament (ACL) reconstruction. METHODS: One-hundred and six patients treated with single-bundle ACL reconstruction plus extra-articular tenodesis were enrolled in this study and randomly assigned to Group A (53 patients) and Group B (53 patients). Group A received one art video that was established to produce positive and therapeutic "insight", while Group B received one art video with an "insight" unfavourable to the psychological recovery. All patients were instructed to watch the video 3 times a week for the first 2 months during the execution of the same rehabilitative protocol. Patients were evaluated pre-operatively and 3 months after surgery with Tegner, subjective International Knee Documentation Committee (IKDC), physical and mental SF-36 scores and Tampa Scale of Kinesiophobia (TSK). Time to crutches discharge was collected at final follow-up as well. RESULTS: Five patients were lost to follow-up and 101 patients (Group A: 51 patients; Group B: 50 patients) were available at mean 3.0 \ub1 0.2 months follow-up. Age at surgery was 33.0 \ub1 17.0 years. The two groups were homogeneous regarding pre-operative demographic data, meniscal lesions and clinical outcomes. Significant improvements were observed in Group A compared to Group B at final follow-up for subjective IKDC (82.0 \ub1 13.8 vs. 71.0 \ub1 19.7, p = 0.0470), TKS (28.1 \ub1 6.0 vs. 32.0 \ub1 5.8, p = 0.0141) and time to crutches discharge (20.9 \ub1 5.0 vs. 26.5 \ub1 8.2 days, p = 0.0012). A positive significant correlation between TSK and time to crutches discharge (r = 0.35, p = 0.0121) was observed. CONCLUSIONS: The Videoinsight(\uae) method combined to adequate rehabilitatio

Double ACL Reconstruction Failure In A Young Soccer Player In Treatment With Retinoids

Isotretinoin is a vitamin A derivative commonly used for the treatment of severe acne. Although being effective, long-term or excessive use of isotretinoin has some toxic or side effects on the musculoskeletal system. The most frequent effects are arthralgia, myalgia with hyperostosis, reduced bone mineralization and calcifications in ligaments and tendons, tendinopathies and periosteal proliferations [1]. Excess of vitamin A intake has been shown to result in bone reabsorption via increasing the number and size of osteoclasts and decreasing osteoid surface. Retinoid- induced side effects on the musculoskeletal system can occur during both shortand long-term administration [2]. To date literature on retinoids effects on tendons is scarce [3] and to the best of authors\u2019 knowledge studies on soft tissues integration in patients treated with vitamin A derivates were never conducted. We present the case of a double anterior cruciate ligament (ACL) reconstruction failure in a young amateur soccer player patient in treatment for severe cystic acne with isotretinoin

ACL, PCL, Collaterals and Meniscus

Since the launch of this course format during the 10th EFORT Congress in Vienna in 2009, the EFORT Comprehensive Review Course (CRC) has been a huge success and sold out months ahead of time. Created during Pierre Hoffmeyer\u2019s time as President of EFORT, the CRC aims to provide the knowledge and skills required by every specialist, and to broaden the participant\u2019s orthopaedic horizon. This course provides up-to-date presentations in five major areas: Lower extremity Upper extremity Spine Pediatrics Basic science The CRC usually takes place parallel to the Annual Congress. Therefore, registration for this course comes in addition to the Congress\u2019 registration

Anatomic double-bundle anterior cruciate ligament reconstruction leaving hamstrings tibial insertion intact: technical note.

his article describes an anatomic, double-bundle, arthroscopic anterior cruciate ligament reconstruction technique with hamstrings using second-generation out-in retrograde femoral drills, second-generation cortical femoral suspensory fixation devices with adjustable graft loop length, standard out-in tibial drills, and titanium low-profile tibial staples. Grafts choice is autologous gracilis and semitendinosus tendons. They are harvested through the single minimally invasive tibial incision maintaining their tibial insertion. Sutures are tightened at the free proximal tendon ends to obtain a sufficient strength to traction. The grafts are reflected in two separate loops and linked to femoral adjustable TightRope graft loops. With this method, grafts length can be customized to the anatomy of every knee and their tension can be increased even after graft fixation. The preservation of tendons tibial insertion could improve the neoligamentization process, acting as a tenodesis

The influence of ACL reconstruction on post-operative rotational laxity: do the patients with higher values maintain higher values after the surgery?

none6nonec. signorelli; n. lopomo; g. marcheggiani muccioli; m. marcacci; s. zaffagnini; t. bonanzingac. signorelli; n. lopomo; g. marcheggiani muccioli; m. marcacci; s. zaffagnini; t. bonanzing

Management of Combined Anterior Cruciate Ligament-Posterolateral Corner Tears: A Systematic Review.

BACKGROUND: A consensus on the treatment of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) injuries is still lacking. PURPOSE: To review the available literature on the management of these combined lesions to investigate the influence that injuries of knee posterolateral structures play in the outcome of an ACL lesion. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "posterolateral corner," "plc," "posterolateral instability," "posterolateral injury," "anterior cruciate ligament," and "acl." RESULTS: A total of 6 studies involving 95 patients were included. For those with PLC lesions, 14 patients were treated nonoperatively, 9 underwent an early anatomic repair, while the remaining 72 underwent a reconstruction. In all 95 patients, an ACL reconstruction was performed. Sixty-seven of the 72 patients who underwent a PLC reconstruction were assessed for anteroposterior laxity, with a mean side-to-side difference of 1.5 \ub1 1.1 mm. Evaluated by the objective International Knee Documentation Committee (IKDC) Knee Form, 88% of the patients who underwent a PLC reconstruction were graded as good/excellent (A/B). The 9 patients who underwent an early surgical repair of the PLC lesion were evaluated by means of the objective IKDC score, with 3 patients (33%) graded as good/excellent (A/B), and by means of a clinical evaluation, with 5 of 9 patients (56%) graded as 1+ for varus laxity. For the 14 patients who were managed nonoperatively for PLC injuries, the only clinical score available was the subjective IKDC score, with a mean value of 80.5 (87.8 for the 6 patients with type A PLC injuries and 75.0 for type B PLC injuries). CONCLUSION: There is a paucity of literature focused on the management of combined ACL and PLC injuries. Combined ACL and PLC reconstruction seems to be the most effective approach to these combined lesions. However, future work is needed to explore the long-term outcome of the different treatment options

Does pre-operative laxity influence anterior cruciate ligament reconstruction outcomes? A quantitative analysis with a navigation system.

none6noneT.Bonazinga; G.M. Marcheggiani Muccioli; N. Lopomo; C. Signorelli; S. Zaffagnini; M. MarcacciT.Bonazinga; G.M. Marcheggiani Muccioli; N. Lopomo; C. Signorelli; S. Zaffagnini; M. Marcacc