Comparison of Outcomes Between All-Inside SingleBundle and Double-Bundle Anterior Cruciate Ligament Reconstruction: A Retrospective Study

@#Introduction: ACL rupture is the most common type of knee injury. The All-inside ACL reconstruction procedure features some distinguished components including closed-socket tunnels with less bone expulsion, double suspensory fixation, and smaller incisions. We aimed to compare the outcomes between the All-inside Single-bundle and the Double-bundle ACL reconstruction techniques. Materials and methods: This study was a retrospective study which analysed the patient-reported and the clinical outcomes on patients who underwent ACL reconstruction between January and December 2020 at Dr Kariadi General Hospital Semarang, Indonesia. We compared the patientreported and the clinical outcomes at 6- and 12-month follow-ups between the All-inside Single-bundle and the Double-bundle groups. The patient-reported outcomes were determined using the IKDC and Tegner-Lysholm scores while the clinical outcomes included the measurement of Thigh Circumference, Single Hop test, Anterior Drawer test, Lachman test, Range of motion, and the patient’s level of return to sport. Results: A total of 24 subjects were divided into two groups, namely the All-inside Single-bundle and the Double-bundle groups, consisting of 12 subjects in each group. Most of the subjects were male in both groups, including 9 (75%) subjects in the All-inside Single-bundle group, and 11 (91.67%) subjects in the Double-bundle group. The mean age of the subjects were 25.75±7.57 years old in the Allinside Single-bundle group, and 24.5±6.87 years old in the Double-bundle group. In terms of the side of the knee that suffered the most injuries in both groups were the right knees. The result of the patient-reported outcomes using IKDC and Tegner-Lysholm scores showed no statistically significant differences in both groups at 6- and 12-month follow-ups (p=0.864; p=0.293 and p=0.589; p=0.233, respectively). The results of clinical assessments at 6- and 12-month follow-ups also showed no statistically significant differences in both groups. Conclusion: Our study showed no significant differences in the patient-reported and the clinical outcomes between the All-inside Single-bundle and the Double-bundle ACL reconstruction techniques at 6- and 12-month follow-ups.

Injury Frequency in Handball Players: A Descriptive Study of Injury Pattern in São Paulo State Regional Teams

Abstract Aim: To assess the frequency of injuries among male and female handball athletes, identifying injured anatomic parts, injury diagnostics, their severity and type. Methods: The participants were composed of 122 handball players from São Paulo state teams, being 63 male (21.2±5.3 years) and 59 female (19.9±5.3 years) athletes who were interviewed using the "Champion Profile" questionnaire. The injuries were sorted by type: acute or overuse; and severity (major, moderate, slight, minor), given by the period of absence from team activities (training sessions and matches), and our results are presented as descriptive statistics. Results: The majority of injuries was found in the lower limbs, both in female (69.6%) and male (47.4%) players, as well as the knee was the most commonly injured anatomic part, representing 33.7% and 20.8% of the total number of injuries for the respective genders. We found a higher number of major injuries in female (35.8%) and male (20.8%) players when compared to the other severity categories. The acute injuries were more common among the total sample (48%) when compared to overuse injuries (22.7%), while a sprain was the most commonly diagnosed injury. Conclusion: It was observed that Brazilian handball players demonstrated an important number of major and acute injuries, forcing them to abstain from training sessions and matches, which can lead to both team and athlete performance losses. Furthermore, we suggest the inclusion of preventive training to reduce the frequency of injuries in handball athletes.

Results of Anterior Cruciate Ligament Reconstruction Using Autogenous Four-Strand Hamstring Tendon

PURPOSE: This study presented the clinical outcomes at a minimum one year following anterior cruciate ligament (ACL) reconstruction using autogenous four-strand hamstring tendon and measured the strength of the knee flexor and extensor after tendon harvest. MATERIALS AND METHODS: Twenty seven patients who had a symptomatic ACL insufficiency underwent ACL reconstruction using four-strand hamstring autograft from Dec. 2003 to Jun. 2004. The patients were evaluated according to clinical findings (Lachman test, pivot shift test), standard knee scales (Lysholm, IKDC), and KT-1000 manual-maximal side-to-side difference. Functional test including one-leg hop test for distance and vertical jump test was performed and the strength of the knee flexor and extensor was measured using Cybex isokinetic test at last follow-up. RESULTS: At the time of follow-up, the average Lysholm score improved from 63.0 preoperatively to 95.0 and overall IKDC evaluation showed 14 patients was graded as A, 13 as B. There were 18 patients (66.6%) in negative Lachman test and also 25 patients (92.6%) in negative pivot shift test. The average KT-1000 manual-maximal side-to-side difference was 2.1+/-1.2 mm. One-leg hop distance and one-leg vertical jump test showed 12.3% and 22.3% decrement than uninvolved side. On isokinetic cybex test, peak extensor torque was 80.0% and 82.7% and peak flexor torque was 91.2% and 89.4% at the angular velocity of 60 degrees and 180 degrees/sec compared to the contralateral leg. CONCLUSION: ACL reconstruction using autogenous four-strands hamstring tendon seems to be a viable option for restoring stability with good clinical result and less donor site morbidity.

Clinical Diagnosis of Acute ACL Injury of Knee Joint / 대한정형외과학회잡지

PURPOSE: To report and assess the clinical symptoms and signs, which are the most reliable for diagnosis of acute anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: We analyzed 79 patients who were confirmed to have an ACL rupture by arthroscopy from January 1995 to December 1999. The T-test was used for statistical analysis. RESULTS: There is no statistical difference of frequency of the clinical symptoms and signs of the ACL ruptures. The most frequent clinical symptom is pain, and sign is hemarthrosis. The Lachman test is the most sensitive test of acute ACL rupture in our cases. CONCLUSION: To increase the accuracy of clinical diagnosis of ACL injury, repeated and accurate history taking and physical examination including above symptoms and signs are important.

Comparision of Results after ACL Reconstruction between Bioabsorbable Interference Screw and Metallic Interference Screw Fixation

PURPOSE: To analysis clinical results after arthroscopic ACL reconstruction between bioabsorbable interference screw fixation and metallic interference screw fixation. MATERIALS AND METHODS: We evaluated the results of arthroscopic ACL reconstruction with patellar tendon autograft between two groups, of which group 1 is used metallic interference screw, group 2 is used bioabsorbable interference screw. All of 53 patients underwent arthroscopic patellar tendon auto-grafts with one incision technique. A minimum 12 months follow-up is available on 31 patients in group 1 and 22 patients in group 2. The average age was 28.4 years(19 to 47 years) in group 1 and 29.7 years(18 to 55 years) in group 2. The average period, from trauma to operation, was 20.7 months in group 1 and 24.6 months in group 2. The average follow-up period was 24.1 months in group 1 and 13.1 months in group 2. In terms of the results of pivot shift test, Lachman test, anterior drawer test, Lysholm score, Arthrometer(KT-2000), Cybex test, simlpe X-ray and MRI findings of group 1 compared with group 2. RESULTS: At the final follow-up, KT-2000 test showed that average maximum manual side-to-side dif-ference(STSD) was 2.7mm for group 1 and 2.7mm for group 2. Average muscle power of injured quadri-ceps muscle compared with normal leg by Cybex test was average 82% for group 1 and 79% for group 2. Lysholm score was average 90 for group 1 and 89 for group 2. 3 cases of group 1 and 2 cases of group 2 were showed instability in physical examination, but there were no evidence of synovitis of knee joint or rerupture of anterior cruciate ligament in the follow-up MRI. CONCLUSIONS: No statistical difference was found between the bioabsorbable interference screw fixation group and the metallic interference screw fixation group. Short-term data support that bioabsorbable interference screw is a reasonable alternative to metallic interference screw.

The Fate of Untreated ACL Insufficient Knee Joint / 대한정형외과학회잡지

The purpose of this study is to access and describe the status of patients with untreated anterior cruciate ligament ruptures to determine if prediction of functional deterioration in these knees were inevitable. 29 patients with rupture of the anterior cruciate ligament verified arthroscopically were evaluated at an average of 3 years and 8 month after injury. This group of patients was selected by the retrospective review in patients who were treated with traumatic ligament injury of the knee joint. The average age at the injury time was 25.9 years ranged from 16 to 44 years and most of injuries occured during sports activities including 12 cases (4196) occured while the patients were playing football. Meniscal lesions were found in 21 cases(72.4%) of all 29 cases of which were 15 cases in the medial, 4 in the lateral and 2 in both side. Follow up functional average score using the Hospital for Special Surgery Knee was 35.8 which would be fall in the Fair range defined as moderate functional disability and depending on the condition of thigh muscle, the functional score was 38.3 in case of less than 2cm atropy of the thigh on the involved side and 32.6 in case of more than 2cm atrophy. There was statistically significant difference (p < 0.05) of the functional score. Reinjuries of the same knee joint were experienced in 22 cases (76%). Rehabilitation of thigh muscles would play an important part in recovery from the injuries.