ABSTRACT
BACKGROUND: The aim of this study is to evaluate the possible effects of removing the peroneus longus on the ankle and gait parameters, in order to add insufficient hamstring tendons for anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: In this controlled clinical trial, 375 patients with ACL rupture who underwent ACL reconstruction arthroscopically using hamstring tendons in the orthopedic clinics of Isfahan University of Medical Sciences in 2010 and 2011 were selected. Fifteen patients were included because their hamstring tendon diameter was lower than 8 mm and peroneus longus was added. After 6 months, the patients were followed using "Kistler force plate" to detect 3D kinematics and kinetics of the ankles and spatiotemporal walking parameters. RESULTS: There was a significant difference between both operated and non-operated ankles in flexion/extension range of motion (P < 0.05). There was no significant difference between the moments of both ankles in sagittal and coronal planes (P > 0.05), but there was a significant difference between the moments of both ankles in the transverse plane (P = 0.006). There was a significant difference in the force of operated and non-operated ankles in all three planes (P < 0.05). There was no significant difference in the mean values of spatiotemporal gait parameters between operated and non-operated sides (P > 0.05). CONCLUSION: Removing the peroneus longus tendon has no effect on gait parameters and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopedic surgeries.
ABSTRACT
BACKGROUND: Stability of the knee joint is achieved by a complex process in which the anterior cruciate ligament (ACL) plays an important role. The rupture of this ligament is quite frequent especially in athletic young subjects. Various methods have been used to reconstruct the ACL. One of the new methods is to use a graft combined from peroneus longus and hamstring. As there is no evidence regarding this method, it was aimed to evaluate the efficiency of this method. METHOD: Two groups of normal and those with ACL injury, in whom their ACLs were reconstructed with the new method, participated in this study. The kinematic and kinetic parameters during walking on level surface were evaluated by a motion analysis system (Qualysis) and a Kistler force plate. The difference between the parameters of operated and non-operated sides and also between patients and normal subjects was evaluated by use of a two sample t test (p-value was 0.05). RESULTS: The results of this study showed that the pattern and magnitude of the loads transmitted by lower extrimity joints differed between normal and ACL reconstructed subjects. The sound side pattern and magnitude of motion were also influenced by ACL insufficiency. CONCLUSIONS: The results of the current study showed that the reconstructed ACL by use of this method did not have enough performance to restore the function of the leg. As the knee joint is unstable following the use of this method, it is recommended to find a new method of ACL reconstruction to improve the function of this ligament after reconstruction.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction/methods , Gait/physiology , Joint Instability/physiopathology , Muscle, Skeletal/transplantation , Tendons/transplantation , Adult , Anterior Cruciate Ligament Reconstruction/adverse effects , Biomechanical Phenomena , Case-Control Studies , Compressive Strength , Female , Follow-Up Studies , Humans , Knee Injuries/diagnosis , Knee Injuries/surgery , Male , Muscle, Skeletal/surgery , Quadriceps Muscle/surgery , Quadriceps Muscle/transplantation , Reference Values , Risk Assessment , Tendons/surgery , Tensile Strength , Treatment OutcomeABSTRACT
BACKGROUND: Although a variety of strategies have been employed for managing articular cartilage defects in the knee, overall outcomes have not been satisfactory. An alternative option may be autologous chondrocyte transplantation (ACT). However, as this method is still under investigation, here we assessed the efficacy of ACT for human knee defect cartilage repair. METHODS: In a randomized clinical trial study, eleven patients (mean age 31.09 years) were enrolled in the study with full thickness cartilage defects in the knee. Arthroscopically, healthy cartilage was obtained, chondrocytes expanded for 2-3 weeks and ACT performed. Clinical status was evaluated before ACT, 6 and 12 months after ACT using the Brittberg-Peterson functional assessment and modified Cincinnati rating score. Magnetic resonance imaging (MRI) findings were evaluated based on the scoring systems used by Sally Roberts and by Henderson. RESULTS: Modified Cincinnati rating indicated significant improvement of clinical score before ACT compared to 6 (p = 0.000) and 12 (p = 0.000) months after ACT (from 2.73 before ACT to 7.27, 8.36 and 9.5 at 6, 12, and 48 months after ACT, respectively). Brittberg-Peterson functional assessment indicated a decline from 79.27 to 25.82 and 19.27 at 6 and 12 months post ACT. Further, statistical test demonstrated significant differences 6, 12 and 48 months post ACT (p = 0.007). Evaluation of MRI revealed a score of 6.5 for Henderson criteria and a score of 2.5 for Robert criteria. CONCLUSIONS: Our study demonstrated that ACT of the knee provides an excellent treatment for full thickness cartilage defects with outstanding clinical and radiological outcomes.
