Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Results in Superior Rotational Stability Compared with Isolated Anterior Cruciate Ligament Reconstruction in High Grade Pivoting Sport Patients: A Prospective Randomized Clinical Trial.

The purpose of the current randomized clinical trial (RCT) was to evaluate the clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction and to compare them with those of isolated ACL reconstruction. The hypothesis was that combined ACL and ALL reconstruction will result in superior clinical outcomes in terms of the rotational stability of the knee. This prospective RCT included 57 patients (44 men and 13 women, mean age = 31 ± 7.1 years) who underwent ACL reconstruction either isolated (Group I: 25 patients) or combined with ALL reconstruction (Group II: 32 patients). The evaluation of the patients was done preoperatively and postoperatively at 6 weeks, 12 weeks, 6 months, and 12 months including a clinical examination (Lachman's test, Pivot shift's test, and Rolimeter differential anterior laxity), an objective clinical scores (objective: the International Knee Documentation Committee [IKDC] score) and a subjective clinical scores (subjective: IKDC's score, Lysholm's score, and Tegner's activity score). Postoperative complications of all the patients were recorded. There was a significant difference between the study groups at all follow-up intervals when evaluating the postoperative pivot shift test (p < 0.05) with a superior rotational stability in the group of combined ACL and ALL reconstruction. At the final follow-up evaluation, 36% of the patients from Group I and 6.2% in Group II had a grade I positive pivot shift test (p < 0.05). There was a statistically significant difference between the two groups regarding the number of patients with a grade A IKDC objective score (p < 0.05) at the 6- and 12-month follow-up intervals (p = 0.007). There was a significant difference concerning the IKDC subjective score between the two study groups in favor of the combined ACL and ALL reconstruction group at 12 months postoperatively (p = 0.048). Combined ACL and ALL reconstruction technique was demonstrated to be effective in obtaining a superior control of the rotational knee instability and to improve the clinical objective and subjective outcomes when compared with isolated ACL reconstruction in sports patients with high-grade pivoting shifts.

Superior rotational stability and lower re-ruptures rate after combined anterolateral and anterior cruciate ligament reconstruction compared to isolated anterior cruciate ligament reconstruction: a 2-year prospective randomized clinical trial.

PURPOSE: The purpose of the current prospective randomized clinical trial (RCT) was to compare the clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction with those of isolated ACL reconstruction and evaluate the re-rupture rate between the two study groups. METHODS: This prospective RCT included 58 patients (43 men and 15 women) who underwent ACL reconstruction, either isolated (Group I: 26 patients) or combined with the ALL reconstruction (Group II: 32 patients). Preoperatively, the two groups differed in age and rate of medial meniscal injuries. The patients were evaluated preoperatively and postoperatively during the time points corresponding to 6 (T1) weeks, 12 (T2) weeks, 6 (T3) months, 12 (T4) months, and 24 (T5) months. The evaluation included the clinical examination (comprising Lachman test, Pivot Shift test, Range of Motion, and Rolimeter differential anterior laxity), the objective clinical score (Objective IKDC [The International Knee Documentation Committee] score), and the subjective clinical scores (comprising Subjective IKDC score, Lysholm score, and Tegner activity score). The postoperative complications of all the patients were recorded. RESULTS: Both the groups reported a significant improvement in clinical scores during the final follow-up as compared to the preoperative value (p < 0.05). The only differences between the two groups were observed with respect to the pivot shift test during each follow-up, wherein more patients from group I reported a pivot shift test grade I as compared to group II (p < 0.05). Three patients from group I reported a re-rupture of the operated knee, whereas no patients from group II reported new ruptures (p = 0.041). CONCLUSIONS: Combined ACL and ALL reconstruction has proven to be more effective in obtaining a high grade of rotational knee stability during mid-term follow-up as compared to isolated ACL reconstruction along with a significantly lower rate of re-ruptures. LEVEL OF EVIDENCE: Level I: Randomized Clinical Trial. REGISTRATION: researchregistry5873: www.researchregistry.com.

Romanian medicine, European medicine.

The aim of the present paper is to present the message transmitted by the Presidential Lecture given during the first congress of arthroscopy organised in Romania, in March 2016, by the Romanian Society of Arthroscopy and Sports Trauma (SRATS). The goal was to present the evolution of medical care in Romania over the years, with the remarkable progress made in the first half of the twentieth century and the current status of arthroscopic surgery as seen from the point of view of medical professionals, as well as from a governmental point of view.

Does physiotherapy contribute to the improvement of functional results and of quality of life after primary total hip arthroplasty?

INTRODUCTION: This paper aims to determine whether physiotherapy succeeds in improving the functional results (expressed by the Harris hip score) and the quality of life after primary total hip arthroplasty, especially in very elderly persons. MATERIAL AND METHOD: A prospective study has followed up 100 patients with coxarthrosis, who underwent a primary total hip arthroplasty and who were subject to an early initiation of a recovery treatment, adapted to each individual, focused on regaining functionality and independence and continued at home after discharge from hospital. After 3 months, the Harris hip score was compared with the preoperative one and the quality of life was assessed according to a simplified questionnaire derived from SF-36. RESULTS: The average preoperative Harris hip score was significantly lower in patients aged over 75 years, as compared to the other 3 age groups (under 40 years, between 41 and 60 years and between 61 and 75 years). After 3 months, the average Harris hip score was significantly improved, in comparison to the preoperative one (85.89 as compared to 40.06) and there were no statistically significant differences between the average Harris hip score in all 4 age groups. The quality of life was regarded by patients as being good on average, in all 4 age groups. CONCLUSION: Very elderly people benefit equally with the other age groups from a functional recovery after primary total hip arthroplasty, even if this recovery is initially more difficult and more cautious.

Venous thromboembolism following major orthopedic surgery.

ABSTRACT: Venous thromboembolism (VTE) is an important complication of major orthopedic surgery (total hip arthroplasty-THA, total knee arthroplasty-TKA, hip fracture surgery-FHS) and is associated with significant morbidity and mortality. Despite this, not all patients receive an appropriate prophylaxis, often due to a disproportionate fear of bleeding complications. A challenge in the management of VTE prophylaxis is to balance the benefits of the treatment with the risk of bleeding. In this article, we review the latest guidelines recommendations regarding prevention of postoperative VTE in patients undergoing orthopedic surgery.

Factors that may influence the functional outcome after primary total hip arthroplasty.

AIM: The present paper aims to decipher the multiple factors occurring in patients on the recovery program, in order to obtain an optimal functional outcome after the implantation of a primary total hip prosthesis. MATERIAL AND METHOD: One hundred patients operated with primary total hip prosthesis, consecutively included in this study, underwent an immediate postoperative recovery program, with an integrative aspect, over the entire duration of hospitalization. The program was individualized according to the specific features of the patients, such as gender, age, Body Mass Index (BMI), type of diagnosis that required the prosthesis implantation, type of prosthesis implanted and functional status of the opposite hip, and it was continued at home. At 3 months postoperatively, the Harris hip score (in comparison with the preoperative one) and the quality of life were calculated. RESULTS: At 3 months post-surgery and post-recovery, the average Harris hip score was more than double in comparison with the preoperative one (85.89 as compared to 40.06), and on average the patients considered the quality of life as good. The preoperative Harris hip score had no statistically significant differences in different patient groups, except for the ones aged over 75, for whom it was statistically significantly lower than the score of other age groups. Three months after surgery, the statistically significant differences between different groups of patients disappeared. At 3 months postoperatively, the average perceived quality of life was good. There were statistically significant differences only in obese patients, who considered it to be very good. DISCUSSION: Correlations are sought between different categories of patients and the obtained results, to be compared with the data in specialized literature. CONCLUSIONS: The factors contributing to a good functional outcome after primary total hip arthroplasty are the following: rehabilitation program beginning immediately after surgery, its performance gradually reaching exercises against resistance and its integrative aspect being mainly oriented towards obtaining movement independence and walking recovery, careful adaptation to the specific features of the patient, related to age, weight condition, opposite hip condition and, within each group, related to the physical possibilities of the person submitted to surgery, as well as the continuation of the rehabilitation program at home. Factors such as gender, old age, the cause requiring prosthesis implantation, obesity or unoperated hip with functional impairment are not limitative and do not prevent obtaining satisfactory results.

Cerebral palsy gait, clinical importance.

ABSTRACT: Cerebral palsy refers to a lesion on an immature brain, that determines permanent neurological disorders. Knowing the exact cause of the disease does not alter the treatment management. The etiology is 2-2.5/1000 births and the rate is constant in the last 40-50 years because advances in medical technologies have permitted the survival of smaller and premature new born children. Gait analysis has four directions: kinematics (represents body movements analysis without calculating the forces), kinetics (represents body moments and forces), energy consumption (measured by oximetry), and neuromuscular activity (measured by EMG). Gait analysis can observe specific deviations in a patient, allowing us to be more accurate in motor diagnoses and treatment solutions: surgery intervention, botulinum toxin injection, use of orthosis, physical kinetic therapy, oral medications, baclofen pump.