Anterior cruciate ligament reconstruction: effect of graft type and gender on early to mid-term clinical outcomes.

INTRODUCTION: Anterior cruciate ligament (ACL) rupture is a debilitating condition and often requires surgery to restore joint stability. Common autografts used for reconstruction include patella tendon and hamstring tendons. The primary aim of this study was to evaluate the early to mid-term clinical outcomes of ACL reconstruction using validated patient-reported outcome measures (PROMs). The secondary aim was to compare clinical outcomes between patella tendon and hamstring tendon autografts. The tertiary aim was to compare clinical outcomes between males and females. METHODS: Patients with an ACL rupture were evaluated before and after surgery using PROM scores which included Lysholm, Tegner, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form-12 Item (SF-12) and EQ-5D-5L. RESULTS: A total of 87 patients were included in the study. All PROM scores significantly improved following surgery (p < 0.001) at a mean follow-up time of 28 months (range 12 to 88 months). The patella tendon subgroup (n = 27) had superior post-operative results as compared to the hamstring tendon subgroup (n = 60) for KOOS sport and recreation (p = 0.005), KOOS quality of life (p = 0.025), KOOS overall (p = 0.026), Tegner (p = 0.046) and IKDC (p = 0.021) scores. There was no significant difference of PROM scores between males (n = 60) and females (n = 27) (p > 0.05). CONCLUSIONS: ACL reconstruction significantly improves clinical outcomes for patients with symptomatic instability consequent to ACL rupture. Overall, patella tendon autograft resulted in better clinical outcomes as compared to hamstring tendon autograft following surgery. Gender did not influence clinical outcome following ACL reconstruction.

Total Hip Arthroplasty in fracture neck of femur: A review of the literature.

Fracture Neck of Femur (FnF) is a major cause of loss of independence, morbidity and mortality in a vulnerable group of elderly patients; as well as a substantial economic burden on healthcare systems across the world. An increasingly ageing population has resulted in a rise in incidence and prevalence of FnF. Over 76,000 patients were admitted with FnF in the United Kingdom in 2018, with the resulting health and social costs estimated to be in excess of £2 billion. It is therefore important that the outcomes of all management options be evaluated to ensure constant improvement as well as allocation of resources as appropriate. It is widely agreed that patients presenting with displaced intracapsular FnF injuries are managed operatively; with options including internal fixation, hemiarthroplasty or Total Hip Arthroplasty (THA). The volume of THA performed for FnF has significantly increased in recent years. However, compliance with national guidelines on FnF patient selection for THA has been shown to be inconsistent. The aim of this study was to review current literature with regards to the use of THA in management of FnF patients. The literature describes managing FnF in ambulant and independent patients by THA with dual-mobility acetabular cup and cemented femoral component via the anterolateral approach. There is scope for further research in assessing the outcomes of different prosthetic femoral head sizes and choice of bearing surfaces (tribiology) used for THA as well as cementation of the acetabular cup component specifically in FnF patients.

Arthroplasty infection rates in fractured neck of femur: single vs dual antibiotic cement.

INTRODUCTION: Mortality rates following hip arthroplasty range between 10% and 40% after 12 months. A higher rate is attributed to postoperative complications, of which surgical site infection is one of the most significant. In an effort to reduce surgical site infection following arthroplasty, antibiotics can be added to the cement used. The primary aim of this study was to determine whether dual antibiotic impregnated cement can reduce the rate of deep surgical site infection in patients following cemented arthroplasty for fractured neck of femur compared with single antibiotic impregnated cement. The secondary aim was to compare the rate of superficial surgical site infection in single compared with dual antibiotic cement. MATERIALS AND METHODS: A total of 206 patients were included. Group 1 included 108 retrospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using single antibiotic impregnated cement. Group 2 included 98 prospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using dual antibiotic impregnated cement. The rates of deep and superficial surgical site infection were investigated. RESULTS: Group 1 had a deep surgical site infection rate of 2.9% (n = 3), Group 2 had a deep surgical site infection rate of 0% (n = 0). Group 1 had a superficial surgical site infection rate of 3.7% (n = 4), Group 2 had a superficial surgical site infection rate of 5.1% (n = 5). CONCLUSION: Dual antibiotic cement reduced the rate of deep surgical site infection compared with conventional single antibiotic cement in arthroplasty for fractured neck of femur. Only a marginal difference in superficial surgical site infection was observed.

Secondary signs on static stress MRI in anterior cruciate ligament rupture.

The MRI diagnosis of ACL rupture based on primary signs has variable rates of diagnostic accuracy. These signs observed on direct visualisation of the ACL include discontinuity of fibres, abnormal ligament contour and increased intrasubstance signal intensity. Secondary radiological signs of ACL rupture are increasingly being used. These indirect ancillary signs include PCL angle, translocation of the tibia relative to the femur and displacement of the posterior horns of the menisci. The aim of this study was to investigate if the application of static stress force to the knee will accentuate the secondary signs of ACL rupture on MRI. One hundred and forty-eight subjects (50 subjects with arthroscopically confirmed ACL rupture, 48 subjects with arthroscopically confirmed intact ACL and 50 subjects with clinically confirmed normal knees) underwent MRI of their knee with the application of specially designed fibreglass leg splints which exert a translational force on the knee joint. Five secondary radiological signs were evaluated and all were found to be significantly accentuated following the application of the splints (p<0.001). The MRI diagnosis of ACL rupture demonstrated a sensitivity of 95.9%, specificity of 91.7% and accuracy of 93.8%. The static stress technique improved the accuracy of diagnosing ACL ruptures on MRI and illustrated the abnormal tibiofemoral kinematics.

Proprioception following partial meniscectomy in stable knees.

PURPOSE: to investigate the proprioceptive function of patients with isolated meniscal tears of the knee before and after arthroscopic partial meniscectomy. METHODS: one hundred subjects (50 patients who underwent a knee arthroscopy and 50 normal controls) were evaluated using single-leg dynamic postural stabilometry. All participants were assessed clinically and radiologically. Knee outcome scores were obtained for all subjects. RESULTS: of the 50 patients arthroscoped, 34 were found to have meniscal tears. Twenty-nine of these patients were reassessed 3 months post-operatively. There was a significant proprioceptive deficit in subjects with meniscal tears when compared to their normal contra-lateral knee (P < 0.001) and the control group (P < 0.001). Partial meniscectomy resulted in a significant improvement in knee outcome scores but not proprioception measurements (n.s.). CONCLUSION: patients with isolated meniscal tears were found to have a significant proprioceptive deficit which persisted following arthroscopic partial meniscectomy despite an otherwise successful clinical outcome.

Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures.

A cohort of 109 consecutive patients with a tibial fracture who underwent continuous compartment pressure monitoring of the anterior compartment of the leg were reviewed and compared to a historical control group of the immediate previous 109 patients who were clinically monitored. Of these patients 33 underwent fasciotomies for acute compartment syndrome in association with tibial diaphyseal fractures. Seventeen patients had continuous compartment pressure monitoring and 16 clinical assessments alone. The fasciotomy rate of patients who underwent continuous compartment pressure monitoring was 15.6%. Patients who were not monitored had a fasciotomy rate of 14.7%. The mean time delay from injury to fasciotomy was 22 h in the monitored group and 23 h in the non-monitored group. Continuous compartment pressure monitoring did not increase the rate of unnecessary fasciotomies. We could not demonstrate a significant difference in terms of clinical outcome and time delay from injury to fasciotomy.