Associations between isolated bundle tear of anterior cruciate ligament, time from injury to surgery, and clinical tests

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Anterior cruciate ligament tear in Hong Kong Chinese patients

Objective: To investigate the associations between patient sex, age, cause of injury, and frequency of meniscus and articular cartilage lesions seen at the time of the anterior cruciate ligament reconstruction. Design: Case series. Setting: University affiliated hospital, Hong Kong. Patients: Medical notes and operating records of 672 Chinese patients who had received anterior cruciate ligament reconstruction between January 1997 and December 2010 were reviewed. Data concerning all knee cartilage and meniscus injuries documented at the time of surgery were analysed. Results: Of the 593 patients, meniscus injuries were identified in 315 (53.1%). Patients older than 30 years were more likely to suffer from meniscal injury compared with those younger than 30 years (60% vs 51%, P=0.043). Longer surgical delay was observed in patients with meniscal lesions compared with those without (median, 12.3 months vs 9.1 months, P=0.021). Overall, 139 cartilage lesions were identified in 109 (18.4%) patients. Patients with cartilage lesions were significantly older than Introduction Anterior cruciate ligament (ACL) tear is one of the commonest sport injuries seen in clinical practice, and such injury is often associated with meniscal and chondral lesions. It is widely believed that early surgery can prevent such lesions in ACL-deficient patients, and probably help avoid the most dreadful complication of early osteoarthritis of the knee.1 Despite multiple studies conducted to evaluate the relationship between intra-articular injuries and ACL tear, such associations among Asians, especially Chinese, have not been extensively studied. Data show that females are more susceptible to ACL injury than their male counterparts,2-4 but lower risk of other intra-articular injuries in females was observed in some studies.5 Furthermore, a those without the lesions (mean, 27.6 years vs 25.1 years, P=0.034). Male patients were more likely to have chondral injuries than female patients (20.1% vs 10.9%, P=0.028). The risk of cartilage lesions was increased by nearly 3 times in the presence of meniscal tear (P<0.0001; odds ratio=2.7; 95% confidence interval, 1.7-4.2). Conclusions: Increased age and surgical delay increased the risk of meniscal tears in patients with anterior cruciate ligament tear. Increased age, male sex, and presence of meniscal tear were associated with an increased frequency of articular lesions after an anterior cruciate ligament tear.published_or_final_versio

Management of traumatic patellar dislocation in a regional hospital in Hong Kong

Introduction: The role of surgery for acute patellar dislocation without osteochondral fractures is controversial. The aim of this study is to report the short-term results of management of patellar dislocation in our institute. Methods: Patients who had patella dislocation seen in our institution from January 2011 to April 2014 were managed according to a standardized management algorithm. Pre-treatment and one-year post-treatment International Knee Documentation Committee (IKDC) score, Tegner activity level scale and presence of apprehension sign were analysed. Results: 41 patients were studied. 20 patients were first time dislocators. 21 patients were recurrent dislocators. Among the first time dislocators, there was significant difference between patients receiving conservative treatment and surgical management. The conservative treatment group had 33% recurrent dislocation rate, whereas there were no recurrent dislocations for the surgery group. However, there was no difference in Tegner activity level scale and apprehension sign before and one year after treatment. Among the recurrent dislocators who received surgery, there was significant difference between patients receiving conservative treatment and surgical management. Recurrent dislocation rate was 71% in the conservative treatment group, whereas there were no recurrent dislocations for the surgery group. There was also significant improvement of IKDC score from 67.7 to 80 (p=0.02), and of apprehension sign from 62% to 0% (p<0.01). Conclusions: A management algorithm for patellar dislocation is described. Surgery is preferable to conservative treatment in treating patients suffering from recurrent patellar dislocations, and may be preferable for patients suffering from acute patellar dislocations.published_or_final_versio

Delay in surgery increases rotational instability in patients suffering from anterior cruciate ligament deficiency

Concurrent Free Papers 5 - Sports: no. 5.3Conference Theme: Defying the Aging Spine: Our Mission ContinuesINTRODUCTION: Rotational stability of knee is contributed by both central (anterior cruciate ligament [ACL]) and peripheral structure. In chronic ACL deficiency, peripheral structures can be stretched out. It is hypothesised that delay in surgery can lead to increased rotational instability. The hypothesis was tested in an ACL reconstruction (ACLR) registry. METHODS: The results of 301 primary ACLR (209 single-bundle and 92 double-bundle) performed between 2007 and 2012 were analysed. The prospective data collected in this registry included …postprin

How accurate is physical examination in diagnosing subacromial impingement?

Concurrent Free Papers 5 - Sports: no. 5.14Conference Theme: Defying the Aging Spine: Our Mission ContinuesINTRODUCTION: Primary subacromial impingement occurs when coracoacromial complex impinges the rotator cuff during movement of shoulder. The study aimed to investigate the accuracy of 5 described impingement signs in predicting a type III acromion found during shoulder arthroscopy. METHODS: A total of 103 shoulder arthroscopies performed by the senior author between July 2008 and June 2013 were recruited. Significant subacromial impingement was defined as a type III ...postprin

Femoral radiographic landmarks for popliteus tendon reconstruction and repair: a new method of reference

Free Papers - Session: Knee Arthroscopy & Sports Medicine: abstract no. 34554The Conference abstracts' website is located at http://www.sicot.org/?id_page=657INTRODUCTION: Though popliteus muscle-tendon complex is one of the most important structures in controlling the posterolateral rotatory stability of the knee, little work has been done concerning the use of femoral radiographic landmarks in repair and reconstruction. The objective of our study is ...postprin

Use of strontium-enriched bioactive bone cement in enhancing tendon osteointegration in a rabbit anterior cruciate ligament reconstruction model

Conference Theme: Defying the Aging Spine: Our Mission ContinuesConcurrent Free Papers 5 - Sports: no. 5.17Introduction: It was hypothesised that strontium led to accelerated healing of strontium-enriched calcium phosphate cement (Sr-CPC)–treated soft tissue tendon graft within the bone tunnel in anterior cruciate ligament (ACL) reconstruction. This hypothesis was tested in a rabbit ACL reconstruction model using Achilles tendon allograft. Methods: A total of 30 bilateral ACL reconstructions were performed in 15 rabbits. The graft on the tested limb was treated with Sr-CPC, while that on the contralateral limb was treated with CPC. Three were sacrificed for histomorphometric analysis respectively at 3, 6, 9, 12, and 24 weeks after the index operation. Histomorphometric analysis of the healing of graft was done by 2 independent observers in 42 histological zones per animal using a scoring system of 0 to 9. The data were analysed by Mann-Whitney U test. Results: Accelerated healing of the graft within bone tunnel was noted in the strontium-treated limb at 3, 6, 9, and 12 weeks after the operation (p < 0.001) when compared with the CPC-treated limb. Complete healing of the graft by Sharpey’s fibre formation at 9 weeks and early evidence of remodelling into normal ACL insertion site at 12 weeks were noted in the SrCPC group. The healing of the graft in the CPC-treated limb was noted 3 to 6 weeks slower than the Sr-CPC group. Conclusion: Strontium is the main contributing factor leading to accelerated healing of Sr-CPC–treated soft tissue tendon graft in a rabbit ACL reconstruction model.postprin

Statistical atlas based registration and planning for ablating bone tumors in minimally invasive interventions

Bone tumor ablation has been a viable treatment in a minimally invasive way compared with surgical resections. In this paper, two key challenges in the computer-Assisted bone tumor ablation have been addressed: 1) establishing the spatial transformation of patient's tumor with respect to a global map of the patient using a minimum number of intra-operative images and 2) optimal treatment planning for large tumors. Statistical atlas is employed to construct the global reference map. The atlas is deformably registered to a pair of intra-operative fluoroscopy images, constructing a patient-specific model, in order to reduce the radiation exposure to the sensitive patients such as pregnant and infants. The optimal treatment planning system incorporates clinical constraints on ablations and trajectories using a multiple objective optimization, which obtains optimal trajectory planning and ablation coverage using integer programming. The proposed system is presented and validated by experiments. © 2012 IEEE.published_or_final_versio

Local Application of Strontium in a Calcium Phosphate Cement System Accelerates Healing of Soft Tissue Tendon Grafts in Anterior Cruciate Ligament Reconstruction: Experiment Using a Rabbit Model

Background: The healing of soft tissue tendon graft within the bone tunnel in anterior cruciate ligament (ACL) reconstruction is known to be slower than that of bone-patellar tendon-bone graft. There are attempts in accelerating the healing of the graft within the bone tunnel. One of the methods is the use of strontium-enriched calcium phosphate bone cement (Sr-CPC). The early result in animal study was encouraging, though it was not known whether the accelerated healing was solely due to the effect of the strontium within the cement, or due to the calcium phosphate cement (CPC) itself. Hypothesis: There would be differences between a strontium-enriched calcium phosphate cement (Sr-CPC) and a conventional calcium phosphate cement (CPC) in terms of the effect on soft tissue tendon graft healing within the bone tunnels in anterior cruciate ligament (ACL) reconstruction. Study Design: Controlled laboratory study. Methods: Thirty single bundle ACL reconstruction procedures were performed in 15 rabbits with the use of an Achilles tendon allograft. The graft on the left limb was coated with Sr-CPC, while that on the right limb was coated with CPC. Three animals were sacrificed for histological and histomorphometric analysis at 3, 6, 9, 12 and 24 weeks post-operation. Results: In the Sr-CPC group, early Sharpey fiber formation was present at 6 weeks post-operation while early remodeling of a graft-fibrocartilage-bone junction was noted at 12weeks. In the CPC group, early Sharpey fiber formation was only found at 9 to 12 weeks post-operation. At 24 weeks, a direct enthesis was found in both groups. According to histomorphometric score, graft healing in the Sr-CPC group took place 3 weeks faster than that in the CPC group at and before 12 weeks, but there was no difference at 24 weeks. Conclusion: The local application of strontium in a CPC system leads to accelerated graft healing within the bone tunnels. Clinical Relevance: The use of Sr-CPC to enhance graft-bone healing may improve the clinical results of ACL reconstruction using soft tissue tendon graft. Keywords: anterior cruciate ligament (ACL); strontium; calcium phosphate cementpostprin

Use of strontium-enriched bioactive bone cement in enhancing tendon osteointegration in a rabbit anterior cruciate ligament reconstruction model

Conference Theme: Defying the Aging Spine: Our Mission ContinuesConcurrent Free Papers 5 - Sports: no. 5.17Introduction: It was hypothesised that strontium led to accelerated healing of strontium-enriched calcium phosphate cement (Sr-CPC)–treated soft tissue tendon graft within the bone tunnel in anterior cruciate ligament (ACL) reconstruction. This hypothesis was tested in a rabbit ACL reconstruction model using Achilles tendon allograft. Methods: A total of 30 bilateral ACL reconstructions were performed in 15 rabbits. The graft on the tested limb was treated with Sr-CPC, while that on the contralateral limb was treated with CPC. Three were sacrificed for histomorphometric analysis respectively at 3, 6, 9, 12, and 24 weeks after the index operation. Histomorphometric analysis of the healing of graft was done by 2 independent observers in 42 histological zones per animal using a scoring system of 0 to 9. The data were analysed by Mann-Whitney U test. Results: Accelerated healing of the graft within bone tunnel was noted in the strontium-treated limb at 3, 6, 9, and 12 weeks after the operation (p < 0.001) when compared with the CPC-treated limb. Complete healing of the graft by Sharpey’s fibre formation at 9 weeks and early evidence of remodelling into normal ACL insertion site at 12 weeks were noted in the SrCPC group. The healing of the graft in the CPC-treated limb was noted 3 to 6 weeks slower than the Sr-CPC group. Conclusion: Strontium is the main contributing factor leading to accelerated healing of Sr-CPC–treated soft tissue tendon graft in a rabbit ACL reconstruction model.postprin