Open versus arthroscopic technique for anterior cruciate ligament reconstruction with patellar tendon graft. An early results on post-operative pain, rehabilitation and stability

Anterior cruciate ligament [ACL] reconstruction is a common procedure performed by many surgeons, different grafts have been used but the bone- patellar tendon graft has considered the gold standard for many years. The graft can be inserted either arthroscopically assisted with femoral half tunnel created from the joint, thus avoiding the lateral incision or making two tunnels through a mini-arthrotomy and a lateral femoral incision. A great controversy have been claimed for the advantage and the disadvantage of the two procedure as regards early rehabilitation period and stability. A fourty male patients with ACL deficiency were included in a prospective randomized trial comparing the two procedure with a follow up period of one year. The data obtained preoperatively did not show any significant differences between the two groups. At early follow up there was a differences observed with respect to complications and the progress of rehabilitaion. Evaluation at 12 months postoperatively using Lysholm scoring system revealed good to excellent results in 80% of patients in the first group and 70% in the second one. ACL reconstruction reduced anterior tibial translation of the knee significantly at 6 months follow up with a slight increase of degrees of instability at 12 months in both groups. The arthoroscopic single incision technique did show better results as regards early postoperative pain, swelling, range-of motion or any rehabilitational parameters. We conclude that an arthroscopic single incision technique for ACL reconstruction has an advantage over open mini-arthrotomy two incision technique as regards subjective more than objective parameters

Arthroscopic bankart repair using suture anchors with respect to lesion of the middle glenohumeral ligament

Arthroscopic bankart procedures have been well described, and their results have produced a significant improvement over those of open repair or even those of other arthroscopic capsulorraphy techniques. Although injury to the middle glenohumeral ligament [MGHL] was discribed as a part of an avulsion of the entire anterior capsulolabral complex. A retrospective study was made on 42 patients with symptomatic anterior instability of the glenohumeral joint. The mean age was 24 yaers [20-32]. The instability was confirmed from preoperative history, physical examination, and magnetic resonance imaging which was positive in all patients. The arthroscopic findings showed ill-defined MGHL in 10 patients,and a cord like type in 5 patients a band like shaped ligament had been seen in the rest of the patient, associated injury with an anterior inferior glenoid labaral [AIGL] tear in 8 patients. Arthroscopic repair of glenoid labral tear with respect to MGHL using 2-3 suture anchors with a follow up of 2 - years resulted in decreased pain and improved function in all patients.There was no complication nore recurrence of the symptoms of instabity. 40 patients rated satisfactory on UCLA scale, the 2 patients rated unsatisfactory were complaining impingment, improved with arthroscopic subacromial decompression. Surgical arthroscopic repair of glenoid labral tear and avulsions of MGHL provides satisfactory results in a majority of cases