Arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus and gracilis tendon graft. A prospective study

The anterior cruciate ligament [ACL] is an important static stabilizer of the knee that prevents anterior translation of the tibia in relation to the femur. Several graft options exist for reconstruction of the deficient ACL. The semitendinosus/gracilis composite autograft [STG] is used widely for its potential advantages over the Patellar tendon graft. A recent increase in the popularity of the hamstring tendons has been fueled by techniques allowing the hamstring graft to be doubled or even quadrupled, theoretically improving the initial tensile strength and increasing the cross sectional diameter of the graft together with the improvement of fixation methods. This study included 24 patients 21 males [87.5%] and 3 females [12.5%] in the age group between 18 and 38 years [average 24 years]. Inclusion criteria of patients in this study were patients with symptomatic ACL deficiency manifested by repeated episodes of giving way of the affected knee with evident history of significant trauma, positive lachman's test, pivot shift tests and MRI evidence of torn ACL. The Hamstring tendon graft was harvested and prepared as quadrupled graft then sized and pretensioned. The tibial and femoral tunnels were drilled and then the graft was passed through the tunnels and fixed in the femoral tunnel using two biodegradable transfixing pins [Rigidfix] and tibial tunnel fixation was achieved using bioabsorbable interference screw. The results were assessed according to the International Knee Documentation Committee [IKDC] scale. There were 21 patients [87.5%] rated as normal or nearly normal [Grade A or B], while 3 patients [12.5%] were rated as abnormal [Grade C] and none were rated as severely abnormal [Grade D]. The difference between grades A and B [on one side] and grades C and D [on the other side] were statistically significant. There were 20 patients [83.3%] that returned to their pre-injury level of activity. Lachman testing demonstrated that 50% of patients had grade 0 laxity while 41.7% had grade I laxity with firm end point and only 8.3% had grade II laxity with firm end point while 79.2% had absent Pivot shift test. Arthroscopic anterior cruciate ligament reconstruction in ACL-deficient knees using quadrupled Semitendinosus and Gracilis tendon graft produce safe and reproducible results with low incidence of complications as harvest site morbidity, anterior knee pain and quadriceps atrophy

Closed reduction and percutaneous pinning of displaced supracondylar humeral fractures in children

Supracondylar fracture of the distal humerus is the most common elbow fracture in children [60% of elbow fractures]. The peak age for Supracondylar fractures is between 6 and 7 years. This fracture is classified into extension or flexion injuries based on radiologic appearance. Between November 2002 and August 2005 120 child in the age group between 4 years and 13 [with mean age 7.1 years] including 80 boys [67.7%] and 40 girls [33.3%] with left elbow involvement in 71 patients and right elbow in 49 patients with displaced Supracondylar humeral fracture were treated by closed reduction and percutaneous pinning under image intensifler control using crossed pins for fixation [1.6 or 1.8 K-wires].The follow up ranged between 9 and 12 months. The patients are assessed according to both functional [Range of Motion] and Cosmetic factors [Carrying angle] and the overall results were excellent in 89 cases [74.1%], good in 21 cases [17.5%],fair in 2 cases [1.7%] and poor in 8 cases [6.7%] losed Reduction and percutaneous pinning is safe, cost effective and allows direct assessment of the carrying angle of the extended elbow after fracture stabilization

Arthroscopic treatment of recurrent traumatic anterior instability of the shoulder using suture anchors

This study for arthroscopic treatment of recurrent post-traumatic anterior dislocation included 18 patients [17 males and 1 female] ranging between 18 years old and 31 years old [average 23 years]. Fifteen patients had history of recurrent post traumatic shoulder dislocations [range is 2 to 5 dislocations], while 3 patients had history of recurrent subluxation after single dislocation. Patients included are patients with recurrent posttraumatic anterior dislocation and no more than five dislocations, with arthroscopic ally confirmed anterior detachment of the glenoid labrum, and good quality and competence of the inferior glenohumeral ligament and symptomatic subluxation. Beach - chair position and posterior and anterior working portals were used. At least 3 suture anchors [G II Mitek] at 5, 3 and 1 o'clock positions were used to fix the labrum - ligament complex to the glenoid using sliding arthroscopic knots. Using the modified Rowe scoring system for preoperative and postoperative patient evaluation, there was marked improvement in postoperative Rowe score regarding stability, motion, pain and function. The score improved to 35 - 100 points [average 85.8] compared to score range 25 - 45 points [average 32.7 points] preoperatively. This technique is thus effective with results that mimic open repair with less operative morbidity

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

role of arthroscopic acromioplasty in the treatment of chronic impingement syndrome in elderly age group

Twenty five cases of chronic impingement syndrome above 50 years of age whether associated with partial thickness rotator cuff tears or not are included in this study. The most common presenting symptoms are night pain and weakness. The most important signs are impingement sign and impingement injection test. Radiological examination shows Type III and Type II acromion in almost all cases. All these cases had at least three months course of conservative treatment but with no improvement. All cases were assessed using UCLA scoring system. All cases were treated by arthroscopic technique starting with arthroscopic subacromial bursectomy, then release of coracoacromial ligament and then excision of the anterior acromion. Most cases showed marked improvement as regard pain and function score. Twenty one cases had satisfactory results while four cases unsatisfactory results, Thus, arthroscopic acromioplasty proved to be as effective as open technique with better cosmesis, shorter hospital stay and preservation of deltoid attachments