ABSTRACT
Anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury that can significantly impair knee function and stability. The optimal management of ACL injuries remains a topic of ongoing debate, with two primary treatment approaches being surgical reconstruction and adequate rehabilitation. The aim of this study is to compare the knee function and stability outcomes between these two treatment modalities, shedding light on their respective effectiveness. We utilized Scopus, PubMed, Cochrane Database, MEDLINE, and Web of Science from inception until April 20, 2022. We utilized the Cochrane risk of bias tool for quality assessment. The following outcomes were assessed: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee score, Lysholm score, the occurrence of the knee giving way, Tegner score, KT1000, Lachman test, pivot shift test, SF-36 score to assess the quality of life, and incidence of reinjury and reoperation. We included a total of six trials with a population sample size of 691 patients, which were divided into surgical versus non-surgical groups, accounting for 348 and 343 patients, respectively. The pooled estimate demonstrated that the surgical reconstruction was associated with a significant increase in the IKDC score (MD = 7.49 [2.04, 12.94], (P = 0.007)), and KOOS score was significant in the reconstruction cohort (MD = 5.87 [1.64, 10.09], (P = 0.007)). The incidences of reoperation (RR = 0.43 [0.20, 0.91], (P = 0.03)), reinjury (RR = 0.49 [0.27, 0.88], (P = 0.02)), and occurrence of the knee giving way (RR = 0.19 [0.08, 0.49], (P = 0.005)) were significantly decreased in the surgical cohort. There is no significant difference between both cohorts regarding the Lysholm score (1.27 [-1.39, 3.93], (P = 0.35)). The findings of this comprehensive analysis indicate that early reconstruction does not demonstrate clear superiority over rehabilitation alone in terms of knee function, Lysholm score, and Tegner score among patients with ACL rupture. However, early reconstruction does exhibit a substantial reduction in the incidence of reinjury, reoperation, and knee giving way, suggesting potential benefits in terms of stability outcomes. These results underscore the importance of considering individual patient characteristics and preferences in treatment decision-making.
ABSTRACT
Vogt-Koyanagi-Harada (VKH) disease is a T-cell-mediated autoimmune inflammatory disease characterized by granulomatous panuveitis with a variety of other systemic manifestations. A 29-year-old man referred with a two-week history of pain, redness, photophobia, and blurring of vision of the right eye. The patient reported a history of tinnitus and vertigo. Ocular examination revealed that the visual acuity was hand movement oculus dextrus (OD) and 1.0 oculus sinister (OS), slight periocular depigmentation in the right eye, iris bombe in the right eye, sunset glow sign similar to Dalen-Fuchs nodules of multifocal choroiditis in the right eye, reduced fovea reflex/subtle macular edema in the right eye, and normal anterior and posterior segment OS. The patient underwent a series of investigations and treatments, including corticosteroids, cyclosporine, antibiotics, and other local eye drugs. Surgical treatment included scheduling intravitreal ranibizumab for the right eye. Outcomes included improved general health conditions and improved visual condition (visual acuity improved to 0.8 OD). The combined therapy of immunosuppressive drugs with steroids was effective in improving visual impairment.
ABSTRACT
Total traumatic extrusion of the talus is a rare and disabling ankle injury. Treatment may include talar reimplantation or talar body removal, but an optimal treatment protocol has not yet been established. Several case reports showed that disruption of the vascular supply and contamination could lead to major complications, such as infection and avascular necrosis, with the high risk of these complications being associated with both the traumatic ankle injury itself and subsequent talar reimplantation. No report to date has described the revascularization of a completely extruded talus, as shown by serial MRI, a less invasive surgical strategy consisting of immediate reimplantation, early administration of antibiotics, and a short period of cast immobilization followed by early motion exercises. The present study describes complete revascularization and good clinical outcomes in a 30-year-old man who underwent talus reimplantation after isolated total talar extrusion.
