Tibio-femoral attachment site combinations as a determinant for Acl graft impingement

The purpose of this study was to assess graft impingement both qualitatively and quantitatively, with different tibio-femoral combinations. Three tibial [T1-T3] and three femoral [F1-F3] attachment sites resulting in nine different tibio-femoral combinations were studied on 8 fresh frozen cadaveric knees. Bungee cords coated with barium paste were used to simulate the grafts used clinically. Lateral knee radiographs in full extension were done for the cord with each combination. Radiographic impingement was graded according to the following classification: Type [I] no contact with roof. Type [II] contact with roof but no deformation of the cord. Type [III] contact with roof with deformation of the cord. Superlow Fuji films inserted in the femoral notch lying between the roof and the cord with the knee positioned in full extension were used to quantitatively assess graft impingement for each combination. Anterior tibial cord placement consistently led to graft impingement with cord deformation type III radio-graphic classification. Tibial tunnels central in the ACL stump [T2] demonstrated 3 knees classified as type II and 5 as type I. Posterior tibial tunnels [T3] were consistently classified as type I with no contact with the roof. In conclusion, tibial tunnels central in the ACL stump and 7mm anterior to the PCL were non-impinging radiographically, with insignificant contact pressure developing between the roof and graft. It was also apparent that graft impingement was mainly dependent on the tibial rather than the femoral attachment site or combination of both

role of arthroscopy in treatment of resistant frozen shoulder

Frozen shoulder is defined by restriction of active and passive shoulder motion in all planes without a known specific cause. The pathophysiology and time course of the disease is still unclear. It is usually self-limited disorder generally lasting 12-18 months and is divided into three phases: freezing phase then frozen phase followed by thawing phase. Thirty eight patients are included in this study complaing of pain, limitation of motion, functional limitation and sleep disturbance and have been symptomatic for more than eight months and have failed course of conservative non-operative treatment for at least 4 months. The patients are manipulated under general anesthesia in the beach-chair position followed by arthro-scopic examination and debridement of the glenohumeral joint and the subacromial space. The use of arthroscopy allows identification and treatment of associated pathology and increases range of motion through artrosco-pically -guided sectioning of coracohumeral ligament. The overall results are satisfactory in 31 cases [81.5%] which are comparable to the commonly published series

ilioinguinal approach for surgical treatment of acetabular fractures

Between 1998 and 2002, 20 patients [16 males and 4 females, with an average age at time of surgery 44.1 years] with unilateral displaced acetabular fractures were treated surgically through the ilioinguinal approach and followed-up for an average time of 27.3 months [range 13-38 months]. The fracture types were ten anterior column, six associated both columns and two anterior fracture with posterior lip fracture. According to D'Aubigne and Postel scale, excellent and good clinical results were obtained in 13 patients, fair in 5 and poor in 2. The reduction was anatomical in 6 cases, satisfactory in 10 and unsatisfactory in 4 cases. The final radiographic results were considered excellent and good in 13 patients, fair in 6 and poor in 2 according to Matta's grading system. Complications were few, only two cases of superficial wound infection and one patient with permanent lateral cutaneous nerve of thigh injury. There were no reported cases of ectopic ossification in this series