Reliability and validation of the Dutch Achilles tendon Total Rupture Score.

PURPOSE: Patient-reported outcome measures (PROMs) have become a cornerstone for the evaluation of the effectiveness of treatment. The Achilles tendon Total Rupture Score (ATRS) is a PROM for outcome and assessment of an Achilles tendon rupture. The aim of this study was to translate the ATRS to Dutch and evaluate its reliability and validity in the Dutch population. METHODS: A forward-backward translation procedure was performed according to the guidelines of cross-cultural adaptation process. The Dutch ATRS was evaluated for reliability and validity in patients treated for a total Achilles tendon rupture from 1 January 2012 to 31 December 2014 in one teaching hospital and one academic hospital. Reliability was assessed by the intraclass correlation coefficients (ICC), Cronbach's alpha and minimal detectable change (MDC). We assessed construct validity by calculation of Spearman's rho correlation coefficient with domains of the Foot and Ankle Outcome Score (FAOS), Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A) and Numeric Rating Scale (NRS) for pain in rest and during running. RESULTS: The Dutch ATRS had a good test-retest reliability (ICC = 0.852) and a high internal consistency (Cronbach's alpha = 0.96). MDC was 30.2 at individual level and 3.5 at group level. Construct validity was supported by 75 % of the hypothesized correlations. The Dutch ATRS had a strong correlation with NRS for pain during running (r = -0.746) and all the five subscales of the Dutch FAOS (r = 0.724-0.867). There was a moderate correlation with the VISA-A-NL (r = 0.691) and NRS for pain in rest (r = -0.580). CONCLUSION: The Dutch ATRS shows an adequate reliability and validity and can be used in the Dutch population for measuring the outcome of treatment of a total Achilles tendon rupture and for research purposes. LEVEL OF EVIDENCE: Diagnostic study, Level I.

[Safety regarding invasive procedures in HIV-positive patients]. / Veiligheid rond invasieve ingrepen bij HIV-geïnfecteerde patiënten.

A 46-year-old man and a 58-year-old man, both known for several years with HIV infection, were admitted for operations due to aortic valve insufficiency (aortic valve replacement) and posttraumatic coxarthrosis (total hip replacement) respectively. In accordance with the protocol, preoperative viral infections (HIV, hepatitis B and C) were inventoried, the HIV viral load was lowered medicinally and the operation team informed. During each operation a consultant was present in the operating theatre to provide advice in the case of a needlestick or cut accident. No accidents occurred. Both patients were discharged to home in a good condition.

Comparison of tibial tunnel enlargement after anterior cruciate ligament reconstruction using patellar tendon autograft or allograft.

This retrospective study was designed to compare tibial tunnel enlargement in patients with autograft or allograft anterior cruciate ligament reconstructions. The changes were related to position of the tibial tunnel and clinical outcome. Twenty-six patients with autograft reconstructions and 41 with allograft reconstructions were studied at a mean follow-up of 59 months (range, 41 to 84) after surgery. The average tunnel enlargement on the anteroposterior view was 2.2 mm (SD, 2.5) for autografts and 2.8 mm (SD, 2.1) for allografts. On the lateral view, the tunnel enlargement was 2.6 mm (SD, 2.4) and 3.4 mm (SD, 2.6) for autografts and allografts, respectively. No significant differences were found between the autograft and allograft groups. A trend was found in the correlation between the position of the tibial tunnel and the tunnel enlargement: more anteriorly placed tunnels had more enlargement. The changes in tunnel diameter did not relate to knee functional score or laxity. There was a significant correlation between malposition of the tibial tunnel and poor clinical scores. A significant negative correlation was found between postoperative follow-up time and tunnel enlargement in both groups. We conclude that placement of the tibial tunnel is a determining factor in tibial tunnel enlargement and clinical knee scores after anterior cruciate ligament replacement with an autograft or allograft. Tunnel enlargement tends to be less at a longer postoperative follow-up.

Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft. A prospective study with an average follow up of 4 years.

A prospective study was performed with 36 patients who underwent an anterior cruciate ligament (ACL) reconstruction with the use of a fresh-frozen bone-patellar tendon-bone (BPTB) allograft. A group of 26 patients who underwent the same operation conducted by the same surgeon in the same period but with the use of an autograft BPTB served as controls. The average follow-up was 46 (range 30-64) months in the allograft group and 52 (range 42-74) months in the autograft group. The allograft group consisted of 17 men and 19 women with a mean age of 28 years (mean trauma to reconstruction interval was 55 months). The autograft group consisted of 9 men and 17 women with a mean age of 28 years (mean trauma to reconstruction interval was 30 months). Clinical and functional evaluation was performed according to the IKDC guidelines. Analysis of tibial tunnel placement with respect to the Blumenstaat line on a lateral radiograph with the knee in hyperextension was done in relation to an extension deficit and clinical score. In the autograft group 18 (70%) patients had a normal or nearly normal knee and 8, a fair result. In the allograft group 30 (85%) patients had a normal or nearly normal knee, 5 (13%) patients had a fair result, and one (2%) knee was poor. The difference between the two groups was not significant. The allograft BPTB is a good alternative graft in ACL reconstruction.

Pain after use of the central third of the patellar tendon for cruciate ligament reconstruction. 33 patients followed 2-3 years.

We performed reconstruction of the anterior cruciate ligament in 33 patients using the central third of the patellar tendon. In 20 patients we did an arthroscopically-assisted procedure, while 13 patients had an additional mini-arthrotomy through the gap in the patellar tendon. After 2-3 years the subjective knee function, according to the Lysholm score, was excellent or good in 18 knees and fair or poor in 15 knees, mainly due to anterior knee pain. Although 18 patients complained about anterior knee pain, only 1 patient required further surgery. After the operation the patella had a lower position. A flexion contracture was found in 7 patients, and 13 had heterotopic bone formation at the apex of the patella. Although stability was restored in 31 of the 33 reconstructed knees, anterior knee pain was a frequent complication. There were no correlations between the anterior knee pain and patellar height, flexion contracture or heterotopic bone formation.