Bone plug fixation in anterior cruciate ligament reconstruction: A clinical and radiological assessment of graft-tunnel integration.

BACKGROUND: The decision regarding graft choice and fixation in anterior cruciate ligament (ACL) reconstruction remains controversial. Free cylindrical bone plugs have been used successfully as graft fixation method. However, some concerns continue to exist regarding how well these plugs integrate with the bony walls of the tunnel. The aim of this study was to assess osteo-integration of free cylindrical bone plugs and to evaluate its effect on the clinical outcomes of the procedure. METHODS: From January 2015 to December 2017, 30 patients (21-40 years old) with torn ACL were operated on and followed up for 24 months after surgery. All patients were assessed clinically (International Knee Documentation Committee score (IKDC) and Tegner-Lysholm knee scoring system), instrumentally (KT 1000 and Rolimeter), and radiologically (X-ray, computed tomography and magnetic resonance imaging). Young active patients with torn ACL were included while those with previous ligamentous injury and/or surgery were excluded. RESULTS: All bone grafts showed solid bone healing after 6 months of surgery; incorporation was 'good to excellent' (tibial side: 66.6%; femoral side: 86.6%). There was no correlation between age or time interval and graft incorporation. Positive correlation was shown between tibial and femoral graft incorporation within the same patient. Only one patient was abnormal in our final objective IKDC scores (graded C). The mean side-to-side difference with KT 1000 and Rolimeter was 1.9 and 1.8, respectively. CONCLUSION: Free cylindrical bone plugs could be used safely for hamstring tendon graft fixation; it enhances graft tunnel integration within the first 6 months and yields comparable clinical outcomes whilst avoiding the potential hazards of foreign hardware implants.

Role of arthroscopy for the diagnosis and management of post-traumatic hip pain: a prospective study.

The current published literature regarding the role of hip arthroscopy in the diagnosis and management of post-traumatic hip pain is still limited. Therefore, we conducted the present prospective study to determine the value of hip arthroscopy in the diagnosis and management of various causes of hip pain after traumatic conditions. The present study included a prospective cohort of 17 patients with symptomatic post-traumatic hip pain. It was conducted between July 2013 and May 2018. The mean age was 22 (19-29) years and the mean follow-up was 24 (r: 7-36) months. Prior to surgery, every eligible patient underwent assessment of functional status using the Modified Harris Hip Score, Oxford hip score (OHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. All patients underwent arthroscopic management for their diagnosed pathologies. The most commonly encountered diagnosis was labral tear (58.8%), followed by ligamentum teres tear (35.3%) and loose intra-articular fragments (29.4%). In addition, 52.9% of the patients had associated CAM lesion and 11.8% had associated Pincer lesion. The mHSS, OHS and WOMAC score showed significant improvement in the post-operative period (P < 0.001), all the 17 patients had 100% Patient Acceptable Symptomatic State; only one patient did not achieve minimal clinical importance difference. One case underwent labral debridement for failed labral repair (5.8%), another patient developed maralgia paraesthetica (5.8%). In conclusion, hip arthroscopy is a useful and effective minimally invasive procedure for the diagnosis and management of selected patients with post-traumatic hip pain. Moreover, hip arthroscopy was safe technique with no reported serious adverse events.

All-endoscopic management of benign bone lesions; a case series of 26 cases with minimum of 2 years follow-up.

PURPOSE: Assessment of the functional and oncologic outcomes regarding endoscopic curettage of different benign bone tumor types within variable anatomic locations. PATIENTS AND METHODS: During the period between February 2012 and December 2016, 26 patients with symptomatic intra-osseous benign bony lesions were included. The age ranged from 3 up to 49 years (mean 20), of 14 females and 12 males. The follow-up duration ranged from 26 up to 58 months (mean 41). Functional scoring was done according to the Revised Musculoskeletal Tumour Society Rating Scale. Anatomic locations of the lesions included: 6 cases in the proximal tibia, 6 cases in the distal femur, 4 cases in the calcaneus, 3 cases in the proximal humerus, 3 cases in the distal tibia, 2 cases in the talus, 1 case in the proximal femur, and 1 case in the distal fibula. The procedure used 4 mm 30° scope for endoscopy, and high speed burrs 3.5-5 mm for extended curettage. Autogenous bone grafting was done in 5 cases, and adjuvant material (polymethylmethacrylate) was needed in 7 cases. RESULTS: After exclusion of one case that was lost in the follow-up, the remaining 25 cases showed full functional recovery at a period of 8-12 weeks, and improved mean functional scores from 20.2 to 28.6/30 post-operatively, with p value <0.001 which was considered as a statistically significant result. The oncologic outcome showed 24 cases with adequate healing, while 1 case developed recurrence (aneurysmal bone cyst in the proximal tibia) for which, an open revision surgery was performed. Intra-operative fracture occurred in another case with aneurysmal bone cyst of the proximal femur, which was fixed by flexible nails with complete healing. CONCLUSION: Endoscopic curettage of different types of intra-osseous benign bony lesions proved to be an effective treatment modality with promising oncologic outcome, improved functional scores, and fast functional recovery.

Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study.

PURPOSE: This study compared the accessory anteromedial portal (AAMP) and the modified transtibial technique (MTTT)" for single-bundle anterior cruciate ligament (ACL) reconstruction. PATIENTS AND METHODS: Sixty active adult patients with ACL tear were randomly assigned into two equal groups who were treated surgically. One group was operated on using AAMP and the other group through MTTT. Both the groups had the same postoperative course and were followed for 1 year after surgery. The follow-up included Lysholm and International Knee Documentation Committee (IKDC) subjective knee evaluation forms, IKDC objective knee examination form, and radiological evaluation. Results were evaluated and compared with each other. RESULTS: There was no significant difference in subjective effects or clinical examination between the two groups. Regarding radiological angles, the AAMP had more oblique graft orientation in the coronal plane than the MTTT, but both were found to be more slanted than native ACL. Also, the MTTT had succeeded to place the graft and tunnel more obliquity than the traditional non-anatomic TTT and better than the anatomic ranges despite having the graft inclination of the AAMP higher than the MTTT. The complaints from the patients and subjective scoring were found to be positively related to graft stability. Patients with healthier preoperative subjective state had a smoother postoperative period and better outcome. CONCLUSION: This study offers simple modifications to the transtibial technique to allow near anatomic ACL reconstruction with similar results comparable to the AAMP and with fewer complications.

Staged bone grafting for the management of segmental long bone defects caused by trauma or infection using induced-membrane technique.

Treatment of segmental bone defects resulting from trauma or infection is extremely difficult. Bone segment transport with distraction osteogenesis and vascularized fibula transfer are the commonest used methods of treatment. Bone transport has problems with docking site. Vascularized fibula is technically demanding and hypertrophy occurs late. Induced membrane (Masquelet) technique is a relatively recent and simple treatment option consisting of two stages. A biological membrane is formed around cement spacer which is inserted in bone defect. In the second stage, the spacer is carefully removed and the membrane filled with autologous cancellous bone graft. From May 2013 to October 2015, we treated 20 patients with post-traumatic and post-infectious bone defect using Masquelet technique. There were 17 males and 3 females, with an average age of 38 years (range 12-64). The etiology of defect was open fractures in 6 cases (30%), infected non union in 11 cases (55%) and aseptic atrophic nonunion in 3 cases (15%). The mean size of bone defect after debridement was 7.2 cm. Soft tissue defect was present in 3 cases which was reconstructed. In the first stage involves thorough debridement, stabilization of the bone (either external or internal) and insertion of antibiotic cement spacer. 2nd stage was done after 4 to 8 weeks with insertion of morselized cancellous bone graft harvested from iliac bone, then tight closure done. 17 cases (85%) united, 2 cases (10%) of graft resorption and 1 case (5%) of infected graft. The time to union ranged from 4 to 11 months after 2nd stage with mean 7.4 months. In conclusion, induced membrane (Masquelet) technique is a safe, simple and reliable method for treating segmental bone defect. The major complications of this technique include infection and graft resorption.