Characteristics of Patellofemoral Measurement in Indonesian Population Using Magnetic Resonance Imaging

BACKGROUND: The patellofemoral join is a unique complex joint formed by articulation of the patella and the femoral trochlea. Normal measures for patellofemoral parameters have been published. AIM: This study aimed to describe the characteristics of patellofemoral measurements in Indonesian population using magnetic resonance imaging (MRI). METHODS: This descriptive total sampling study was conducted from May 2019 to August 2020. The parameters of the measurements in this study include Insall-Salvati ratio, Caton-Deschamps index, trochlear angle, lateral trochlear inclination, TT (tibia tubercle) – TG (trochlear groove) distance, and trochlear depth. The mean results of the measurements were compared with the normal value measurements that are internationally used. RESULTS: A total of 100 normal knees MRI scan from patients consisting of 54 (54%) males and 46 (46%) females, with an average age of 35.09 ± 12.77 (19–60) years old. The average body mass index (BMI) was 28.07 ± 3.0 (22–34). Based on ethnicity, subjects were mostly Javanese (66%), Sundanese (12%), Madura (4%), Minangkabau (7%), and the others (11%). The mean of Insall-Salvati ratio was 1.09 ± 0.17 (0.49–1.60). The mean of Caton-Deschamps index was 0.97 ± 0.16 (0.62–1.64). The mean of trochlear angle was 138.97° ± 119.7 (122°–160°). The mean of lateral trochlear inclination was 20.37° ± 4.56 (11.0°–30.6°). The mean of TT-TG distance was 13.76 ± 5.86 (4.9–41), and the mean of trochlear depth was 5.18 ± 1.87 (1.05–8.6). Those values were within normal range of international values. There were no significant differences between comparison of males and females. CONCLUSION: The means of Insall-Salvati ratio, Caton-Deschamps index, trochlear angle, lateral trochlear inclination, and TT-TG trochlear depth of the Indonesian people were within the international normal range, and higher than other countries’ published measurements

Evaluation of Quadriceps Strength Post-medial Patellofemoral Ligament Reconstruction Using Quadriceps Tendon Autografts

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon (QT) grafts provides favorable results with minimal complications and can be performed in patients with open epiphyseal plates. Following MPFL reconstruction using QT grafts, the outcomes have been evaluated, but the residual quadriceps strength (QS) has never been evaluated. AIM: We analyzed the knee’s range of motion (ROM), thigh circumference (TC), and QS at donor leg sites compared with those at contralateral healthy sites after MPFL reconstruction. The hypothesis was that there is no morbidity at donor sites. MATERIALS AND METHODS: Patients who underwent MPFL reconstruction using QT autografts between January and December 2017 were recruited. The ROM, TC, and QS were measured 6 months postoperatively. RESULTS: Twenty-one patients (8 men, 14 women; mean age, 28.40 ± 10.78 years [range, 16–45]) were included in the study. The TCs at the donor and contralateral sites (medians: 37 and 37.5 cm, respectively) showed no significant difference (p = 0.64). QS measurements showed means of 182 ± 4.6 N and 190 ± 4.7 N at the donor and contralateral sites, respectively (p = 0.376). There were no ROM deficits. CONCLUSIONS: The ROM, TC, and QS at donor sites were similar to those at contralateral sites. The QT is a suitable graft for MPFL reconstruction

The influence of hamstring autograft diameter on patient-reported functional scoresfollowing anterior cruciate ligament (ACL) reconstruction

Anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft is a common procedure in orthopedic surgery to treat ACL rupture. Graft diameter is very important in successfulness of ACL reconstruction. The purpose of this study was to evaluate the influence of hamstring autograft diameter on patient-reported functional scores following ACL reconstruction. The diameter of grafts were collected retrospectively from medical records of the patients who underwent primary ACL reconstruction with hamstring autograft in the Soeradji Tirtonegoro General Hospital, Klaten, Central Java. The patient-reported functional scores data according to the International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected by phone call interview from the patients after more than six months post-reconstruction. The comparison between graft diameter and patient-reported functional scores was analyzed by independent t test. A p8mm.The result showed significant difference in KOOS and IKDC score between the both groups (p8mm (Group 2) had higher KOOS and IKDC score compared to graft diameter ≤8mm (Group 1) (p8 mm associated with better patient-reported functional scores in 6 monthsfollow-up after ACL reconstruction

Functional Outcomes and Hop Tests Results in Anterior Cruciate Ligament Reconstruction Patients with Adjustable Loop Fixation: 2-Years Follow-up

BACKGROUND: Grafts are ultimately integrated into the bone tunnels by either screws, cross-pins, or cortical suspension devices in anterior cruciate ligament (ACL) reconstruction. Investigation the usage of adjustable loop button is inadequate. AIM: The aim of this study was to identify knee functional outcome and serial hop test in ACL reconstruction with adjustable loop button in 2-years follow-up. METHODS: Chronic isolated ACL ruptured patients were reconstructed with adjustable loop button using peroneus longus autograft. We recorded knee functional outcome score using Tegner-Lysholm score, Modified Cincinnati score, and International Knee Documentation Committee (IKDC) at pre-operative and 2-years follow-up. Serial hop test was assessed at 6 months after surgery. RESULTS: Forty-seven patients fulfilled inclusion criteria with median age 22.0. Evaluation of functional outcome of Tegner-Lysholm score, Modified Cincinnati score, and IKDC showed significant improvement at 2-years follow-up compared to pre-operative. Serial hop test showed excellent result at 6 months after surgery. CONCLUSION: The result of knee functional score (Tegner-Lysholm score, Modified Cincinnati score, and IKDC) and serial hop test in ACL reconstruction with adjustable loop using peroneus longus autograft was excellent at 2-years follow-up. LEVEL OF EVIDENCE: Level 2, Retrospective Cohort Study

Iatrogenic Injury to the Posterolateral Knee During Anterior Cruciate Ligament Reconstruction with Anteromedial Portal Technique

BACKGROUND: Femoral tunnel reaming through anteromedial portal, also known as transportal technique, allows for anatomic femoral tunnel placement in restoring anterior cruciate ligament (ACL) kinematics. This procedure may cause iatrogenic injury to the posterolateral structures of the knee. PURPOSE: This study aims to assess the risk of posterolateral structure injury in ACL reconstruction using transportal technique. METHODS: ACL reconstruction using transportal technique was performed in 20 patients. Clinical and radiological examination was performed preoperatively and 1 month postoperatively. Clinical examination included any pain or paresthesia on posterolateral area of the knee, varus alignment of the knee, abnormal gait, and specific tests for posterolateral stability. Radiological evaluation was plain radiography and stress radiography for posterolateral stability, and magnetic resonance imaging (MRI) for assessing structural damage. RESULTS: Post-operative evaluation showed pain in posterolateral area in five patients, numbness on posterolateral knee in one patient, both pain and numbness in two patients and lateral gastrocnemius muscle injury on MRI in six patients. We did not find varus knee alignment and abnormal gait. Specific tests were negative in post-operative evaluation. Post-operative radiographic imaging did not show the sign of lateral widening. CONCLUSION: Femoral tunnel drilling using transportal technique in ACL reconstruction is safe even it might risk to damage lateral gastrocnemius muscle, according to clinical and MRI findings

Measurements of Patellofemoral Morphology Characteristics in Indonesian Population: an MRI Based Study

Patellar malalignment is the imbalance relationship between patella and trochlea, in which clinical findings most of the time are obscured; hence diagnosis is often challenging. Magnetic resonance imaging (MRI) is the most sensitive tool to detect subtle patellar malalignment features, so diagnosis can be made early. However, there has been no clear consensus on the normal value of patella morphology until today. This study aims to determine patellofemoral morphology values in Indonesian using MRI. This was a retrospective study of 202 patients aged 18-40 years old with knee problems without patellar instability. Patellar morphology parameters including Insal Savati ratio (IS ratio), patellar tilt angle (PTA), sulcus angle (SA) and tibial tubercle-trochlear groove distance    (TT-TG) were evaluated and recorded for statistical analysis. There was no significant correlation between anthropometric values and patellar morphology values. There were significantly higher PTA, SA and TT-TG values in females compared to males. The mean value of the IS ratio in the Asian population using MRI was 0.99 ± 0.14, PTA was 9.09 ± 6.88, SA was 139.20 ± 6.38, and TT-TG distance was 8.00 ± 5.25. Further studies with larger samples and multi-center results are required

Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Adjustable-Loop Femoral Cortical Suspension Devices

BACKGROUND: Incidence of isolated posterior cruciate ligament (PCL) injury is lower than PCL rupture is associated with other knee injuries. Adjustable loop femoral cortical suspension device is commonly used for femoral graft fixation during PCL reconstruction. AIM: This study purpose is to describe the functional outcome of PCL reconstruction using an adjustable loop femoral cortical suspension device. METHODS: This study used prospective design with consecutive sampling. All patients underwent PCL reconstruction with adjustable loop femoral cortical suspension devices using peroneus longus tendon autograft. Patients were evaluated at 6 months after surgery using posterior drawer test and functional outcome scoring system (Lysholm knee score, Cincinnati Score and International Knee Documentation Committee (IKDC) score). RESULTS: 20 patients were enrolled in this study with a mean age of 27.65 ± 9.78. Lysholm knee means the score was improved from 59.80 ± 18.73 pre-operative and 80.55 ± 11.72 post-operative (p < 0.05). Cincinnati mean score was improved from 52.01 ± 20.29 pre-operative to 72.95 ± 15.26 post-operative (p < 0.05). IKDC mean score was improved from 48.36 ± 13.18 at pre-operative to 72.5 ± 13.13 post-operative (p < 0.05). CONCLUSION: PCL reconstruction using adjustable loop femoral cortical suspension device using peroneus longus tendon autograft showed good clinical outcome and knee functional outcome (Lysholm, Cincinnati, and IKDC score) at 6 months follow-up

Role of adipose mesenchymal stem cells and secretome in peripheral nerve regeneration

The use of stem cells is a breakthrough in medical biotechnology which brings regenerative therapy into a new era. Over the past several decades, stem cells had been widely used as regenerative therapy and Mesenchymal Stem Cells (MSCs) had emerged as a promising therapeutic option. Currently stem cells are effective therapeutic agents againts several diseases due to their tissue protective and repair mechanisms. This therapeutic effect is largely due to the biomolecular properties including secretomes. Injury to peripheral nerves has significant health and economic consequences, and no surgical procedure can completely restore sensory and motor function. Stem cell therapy in peripheral nerve injury is an important future intervention to achieve the best clinical outcome improvement. Adipose mesenchymal stem cells (AdMSCs) are multipotent mesenchymal stem cells which are similar to bone marrow-derived mesenchymal stem cells (BM-MSCs). The following review aims to provide an overview of the use of AdMSCs and their secretomes in regenerating peripheral nerves

Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization. AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up. METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively. RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement. CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes

Knee Laxity or Loss of Knee Range of Motion after PCL Reconstruction: A Systematic Review and Meta-Analysis

Background. PCL reconstruction is a successful method for enhancing the patient's quality of life but posterior knee laxity and knee stiffness have still occurred surgery. There is no study to evaluate knee laxity or loss of knee range of motion after surgery. Objectives. To assess the outcomes after PCL reconstruction, we: 1) evaluated the range of motion of the knee, 2) evaluated posterior knee laxity, and 3) determined the factors that influence laxity or the loss of range of motion after surgery. Methods. Articles that met the following criteria were enrolled in this review: 1) articles on peer-reviewed level 1 to 4 studies; 2) articles published in English; 3) articles on PCL reconstruction studies; 4) articles on isolated PCL rupture; 5) articles that describe laxity after surgery and 6) articles that describe the degree of range of motion after surgery. Results. Involving a total of 1711 patients. There was a loss of extension and flexion after PCL reconstruction (9.15% and 28.9%, respectively). Knee laxity was still observed at the final examination in the posterior drawer test, KT 1000/2000 test, and Telos radiographic view (64.8%, 42.8%, and 47.9%, respectively). In the subgroup analysis, there was no significant difference in laxity between allograft group vs autograft group using the KT 1000/2000 measurement (mean difference [MD] = -0.42, 95% confidence interval [-1.41, 0.56], p = 0.40), Single Bundle vs Double Bundle (DB) using the KT 1000/2000 measurement (MD = -0.003, 95% CI [-1.35, 1.29], p < 0.00001), and transtibial vs tibial inlay using the Telos radiograph measurement (MD = 0.03, 95% CI [-0.33, 0.39], p = 0.88), but DB significantly improved knee stability using the Telos radiographic measurement (MD = 0.69, 95% CI [0.29,1.09], p = 0.00008).Conclusion. This study demonstrates that the loss of range of motion or laxity is still a problem after PCL reconstruction