Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option.

PURPOSE: Failed ACL reconstruction is a common occurrence nowadays due to the increased incidence of ACL surgeries and return to full activities following the surgery. Several challenges might stand in the face of this revision surgery particularly the graft harvest and its suitability to the situation with possible widening of the tunnel and the avoidance of additional morbidity at the contralateral side or anterior knee pain as in patellar tendon harvest. The aim of this study is to evaluate the ipsilateral quadriceps tendon as a source of autograft in revision ACL surgery which constitutes a viable option that can potentially decrease the morbidity of the procedure, and meanwhile provide a graft substitute that can be tailored to suit the dilated tunnels commonly encountered in revision surgery, thus giving the patients a good potential for better functional outcome. METHODS: Revision anterior cruciate ligament reconstruction was done in 30 patients using the ipsilateral quad tendon as a pure soft tissue or with a bony fragment. RESULTS: The mean subjective international Knee Documentation Committee score (IKDC score) at two years follow-up was 65.83 ± 7.20. There is statistically significant improvement of the objective as well as the subjective IKDC scores at the end of follow-up when compared to the preoperative as well as the 6-month evaluation figures. The KT1000 arthrometer recorded a mean of 4.50 ± 1.07. Significant improvement of the limb symmetry index was at two years duration. CONCLUSIONS: The quadriceps tendon can be a solution for several challenges that might appear during the revision ACL surgery with comparable results to other tendons and with minimal morbidity on the function of the harvested muscle tendon.

The relationships between body fatness, leptin, testosterone, and reproductive performance in ram lambs as affected by level and frequency of feeding.

This study was carried out using 24 Najdi ram lambs of approximately 6.5 months old to evaluate the effects of feed restriction and frequency of feeding on hormone concentrations of leptin and testosterone, sexual behavior, and semen traits. Ram lambs were allotted equally into three feeding groups. The first group was used as a control and fed ad libitum. The second and third groups were restricted fed at 0.85 ad libitum and fed either once (R1M) or twice daily (R2M). Sexual behavior and semen evaluation were assessed during the sixth, seventh, and eighth weeks of the study. Blood samples were drawn at 1-hour pre-feeding on days 41, 48, and 55 of the study for the determination of serum leptin and testosterone concentrations. All lambs were slaughtered after 8 weeks of experimentation. Results showed that the restricted-fed groups had lower (P < 0.01) values for slaughter body weight, average daily gain, dry matter intake, internal fat, tail fat, body fat thickness, body wall thickness, and testes weight than the ad libitum group; these corresponding traits did not differ between both restricted-fed treatments. Leptin and testosterone concentrations in restricted-fed rams were (P < 0.01) lower and higher, respectively, than in the ad libitum rams; there were no differences between R1M and R2M groups. The restricted-fed rams had lower (P < 0.01) ejaculation latency time compared with control, whereas the percentage of sexually active rams and sexual desire score were not affected by feeding restriction or frequency of feeding. Sperm motility, progressive motility, and percentage of sperm moving at rapid speed were higher (P < 0.01) in feed-restricted rams than in the ad libitum rams. R1M rams had higher (P < 0.01) value for straightness and lower (P < 0.01) value for curvilinear velocity in comparison with the ad libitum group. Testosterone was correlated positively (P < 0.05) with sperm motility and progressive motility and negatively (P < 0.04) with fat measurements, leptin, and ejaculation latency time. In conclusion, moderate intake restriction can optimize body fatness and testosterone concentrations in rams, which helped to improve some reproductive traits.

Use of fluorogestone acetate sponges or controlled internal drug release for estrus synchronization in ewes: Effects of hormonal profiles and reproductive performance.

This study was carried out using 300 multiparous Najdi ewes during breeding season to compare the effects of fluorogestone acetate (FGA) sponges and controlled internal drug release (CIDR) dispensers to synchronize estrus on reproductive performance and hormonal profiles. Ewes were equally and randomly allotted into group A (FGA) and group B (CIDR); intravaginal progestagen was administered for 14-day period with intramuscular administration of 600-IU eCG at withdrawal time. Estrus was detected using a vasectomized ram starting 12 hours after progestagen withdrawal and repeated every 12 hours up to 84 hours. Blood samples were collected at the time of progestagen withdrawal (0 hour), 24 hours, and 48 hours. Follicle-stimulating hormone, LH, estradiol, and progesterone serum concentrations were measured using commercial ELISA kits and microtitrimetric plates. Timed laparoscopic insemination was performed 48 hours after progestagen withdrawal. Pregnancy and the number of fetuses were diagnosed by ultrasonography on Day 23 after insemination and confirmed on Days 35 and 60. The results revealed that the retention, vaginal discharge, and drawstring breakage rates after progestagen removal were significantly (P ≤ 0.05) higher in the FGA group (94.00, 98.58, and 9.22, respectively) than those in the CIDR group. On the other hand, pregnancy, fertility, twinning rates, and fecundity were significantly (P ≤ 0.05) higher in the CIDR group (77.86, 75.57, 34.34, and 1.02, respectively) than in the FGA group. Estrus responses in FGA and CIDR groups increased gradually to attain their significantly (P ≤ 0.05) higher percentages after 48 hours of progestagen withdrawal (91.49 and 92.37, respectively); thereafter, they decreased. The overall estrus responses and prolificacy did not differ between the FGA and CIDR groups. Follicle-stimulating hormone was significantly higher in the FGA group at 24 and 48 hours after progestagen withdrawal, whereas LH was significantly higher in the CIDR group at 48 hours after progestagen withdrawal. Estradiol and progesterone were significantly higher in the CIDR group at 0, 24, and 48 hours after progestagen withdrawal. These results indicated that although FGA and CIDR devices are efficient in synchronizing estrus in ewes, CIDR provided higher pregnancy, fertility, twinning rates, and fecundity than FGA.

The effect of transfixing the hip with Kirschner wire during the operative treatment of hip dysplasia in children after the walking age.

INTRODUCTION: Transfixing the hip joint during operative treatment of DDH is sometimes necessary. MATERIAL AND METHODS: This study included 30 patients presenting with DDH after the walking age divided into two groups; group 1, the hip joint was transfixed with K-wire. Group 2 no k-wire transfixion. RESULTS: At mean follow up duration of 30 months. Satisfactory results were obtained in 13 patients in group 1, and 14 patients for group 2. The final radiological results for both groups were satisfactory in 14 patients. CONCLUSION: Femoral head transfixing with Kirschner wire has no effect on the final results.

Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft.

BACKGROUND: Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction. METHODS: We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch. CONCLUSION: Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.

The transverse ligament as a landmark for tibial sagittal insertions of the anterior cruciate ligament: a cadaveric study.

PURPOSE: The purpose of this study was to determine the relation between the position of the transverse ligament, the anterior edge of the anterior cruciate ligament (ACL) tibial footprint, and the center of the ACL tibial insertion. We used arthroscopy for localization of the anatomic landmarks, followed by insertions of guide pins under direct visualization, and then the position of these guide pins was checked on plain lateral radiographs. METHODS: The transverse ligament and the anterior aspect of the ACL tibial footprint were identified by arthroscopy in 20 unpaired cadaveric knees (10 left and 10 right). Guide pins were inserted with tibial ACL adapter drill guides under direct observation at the transverse ligament, the anterior aspect of the tibial footprint, and the center of tibial insertion of the ACL. Then, plain lateral radiographs of specimens were taken. The Amis and Jakob line was used to define the attachment of the ACL tibial insertion and the transverse ligament. A sagittal percentage of the location of the insertion point was determined and calculated from the anterior margin of the tibia in the anteroposterior direction. RESULTS: The transverse ligament averaged 21.20% ± 4.1%, the anterior edge of the ACL tibial insertion averaged 21.60% ± 4.0%, and the center of the ACL tibial insertion averaged 40.30% ± 4.8%. There were similar percent variations between the transverse ligament and the anterior edge of the ACL tibial insertion, with no significant difference between them (P = .38). Intraobserver and interobserver reliability was high, with small standard errors of measurement. CONCLUSIONS: This study shows that the transverse ligament coincides with the anterior edge of the ACL tibial footprint in the sagittal plane. CLINICAL RELEVANCE: The transverse ligament can be considered as a new landmark for tibial tunnel positioning during anatomic ACL reconstruction.

Determination of the safe penetration depth during all-inside meniscal repair of the posterior part of the lateral meniscus using the FasT-Fix suture repair system.

PURPOSE: The objective of this study was to determine the safe penetration depth of the FasT-Fix meniscal suture repair system during all-inside repair of the posterior part of the lateral meniscus. METHODS: Thirty-one knees from 17 embalmed and formalin-fixed cadavers (11 women, 6 men) were used. In each case, the circumference of the cadaver knee was measured before dissection. After dissection, 41 Fast-Fix meniscal repair devices were used in different predetermined penetration depths ranging from 8 to 16 mm. In this study, non-involvement of the popliteal neurovascular bundle, common peroneal nerve or the inferior lateral genicular vessels by either needle penetration or affixment by the suture bar anchors was considered to be a safe trial. RESULTS: Out of the 41 FasT-Fix devices used in this study, only one device bent during introduction and was excluded from the study. For the remaining 40 trials, 27 of them were considered safe, while 13 trials were considered unsafe. The ratio of the average penetration depth to the average circumference of the cadaver knee was found to be >0.05 for the unsafe penetrations, and this was statistically significant P < 0.05. Additionally, for the first point, which is more central, there was a trend for the straight needles through the direct lateral approach to be less safe, and this was found to be statistically significant P < 0.05. CONCLUSIONS: Correlating the needle-penetration depth to the measured circumference of the cadaver knee may be an important clinical predictor of safety whereby a ratio of less than 0.05 might be useful as a guide to determine the safe penetration depth of the FasT-Fix suture repair needle during repair of the posterior horn lateral meniscus. Also, it is better to avoid using straight needles through the direct lateral approach during repair of the more central portion of the posterior horn lateral meniscus.

Silencing microRNA-34a inhibits chondrocyte apoptosis in a rat osteoarthritis model in vitro.

OBJECTIVE: miRNAs, which are non-coding RNAs, play a role in the pathogenesis of disease including OA. miRNA (miR)-34a is induced by p53, subsequently leading to cell apoptosis, which is one of the major factors in the pathogenesis of OA. The purpose of this study is to investigate the effect of silencing miR-34a on IL-1ß-induced chondrocyte apoptosis in a rat OA model in vitro. METHODS: Locked nucleotide analogue (LNA)-modified miR-34a-specific anti-sense was transfected into rat chondrocyte monolayer culture. After that, IL-1ß was added to the chondrocytes to create an OA model in vitro. The effect of silencing miR-34a on the prevention of chondrocyte apoptosis was analysed by assessment of the expression levels of Col2a1 and iNOS, also through assessment of cell viability and TUNEL staining. RESULTS: The expression of miR-34a was significantly up-regulated by IL-1ß. Silencing of miR-34a significantly prevented IL-1ß-induced down-regulation of Col2a1, as well as IL-1ß-induced up-regulation of iNOS. Finally, MiR-34a inhibitor could also reduce TUNEL-positive cells. CONCLUSION: Silencing of miR-34a by LNA-modified anti-sense could effectively reduce rat chondrocyte apoptosis induced by IL-1ß. This present study revealed that silencing of miR-34a might develop a novel intervention for OA treatment through the prevention of cartilage degradation.

Repair of a large osteochondral defect in the knee joint using autologous and artificial bone graft combined with motion preserving distraction arthroplasty: a case report.

The biological reconstruction of a large osteochondral defect in the weight-bearing area of the knee joint has long been a challenge to orthopedic surgeons. We present a case of a large posttraumatic defect in the weight-bearing area of knee joint treated with a novel distraction arthroplasty device after reconstruction of the joint surface using combined autologous and artificial bone graft.