Multiligament knee injury with common peroneal nerve palsy in a long jump athlete with 4-year follow-up: A case report.

Introduction: Multiligament knee injuries (MLKIs) are difficult to manage occurrence and are usually associated with poor functional outcomes. Knee dislocations involving both cruciate ligaments are relatively rare compared to other multifilament injuries involving one cruciate ligament and a collateral ligament. Multiple studies have reported the Tegnor score after surgery as 3 or 4. In 44% of cases with posterolateral corner (PLC) injury and biceps femoris tendon rupture or avulsion of the fibular head, a palsy of the common peroneal nerve (CPN) occurs. About half of these cases do not exhibit functional recovery. Case Report: A 20 years old long jump national athlete sustained varus and hyperextension injury leading to a multiligament knee injury (anterior cruciate ligament, posterior cruciate ligament, PLC, and medial collateral ligament) and CPN palsy. After a staged surgical procedure and structured rehabilitation protocol, the athlete was able to return to preinjury level in 18 months. At present, 4 years postoperatively, the patient can walk full weight-bearing with no instability. On the latest follow-up, the Lachman's test is negative, posterior drawer test negative, varus, and valgus stress test negative. Knee ranges of motion 0 to 140 degrees. The patient reported that Tegnor Score was 8. Conclusion: Surgical management of MKLI with CPN palsy can give reasonable functional outcome.

Determinants of regeneration and strength of hamstrings after anterior cruciate ligament reconstruction-fate of hamstring tendon.

BACKGROUND AND AIM: Arthroscopic reconstruction of anterior cruciate ligament (ACL) surgical procedure using hamstring autograft is the most common surgery performed in the arena of sports medicine and arthroscopy. Most studies in literature are ambiguous regarding the fate of hamstrings based on function, regenerative potential, and cross-sectional area (CSA). The aim of this research study is analysis of the fate of hamstring tendons (both semitendinosus and gracilis) during the time course for determinants of regeneration and strength. METHODS: Fifty patients who were operated for unilateral isolated ACL reconstruction from July 2015 to June 2018 were evaluated for the fate of harvested hamstring tendons which included the following: regeneration, cross-sectional area (CSA), strength, and insertion of regenerated hamstrings by isometric torque and isokinetic strength. MRI of knee was performed for both knees concerning the semitendinosus (ST), gracilis (G), Sartorius, biceps femoris, and medial head of gastrocnemius. RESULTS: Eighty-four percent men and 16% women within a mean patient age of 34 ± 4.12 years were evaluated and all 50 (100%) patients demonstrated hamstring regeneration by the MRI measurements at six months and at one year post-ACL reconstruction. The torque of isometric knee flexion measured in 60° was found to be remarkably lower in the ACL-reconstructed lower extremity compared to that of the contralateral limb (87.13 ± 20.18% of BW), at 90° (49.17 ± 15.09% BW), and at 105° (43.91 ± 13.17% BW), respectively (p < 0.01). However, at 30° flexion and 45° flexion, the difference was insignificant (116.48 ± 21.07% BW for 30° and 100.16 ± 25.12% BW for 45°). CONCLUSIONS: It was found that the properties of musculotendinous units of ST and G were significantly transformed after their harvesting for ACL reconstruction and these weaknesses contribute to the flexion deficit of knee in the deeper range of flexion in the operated limb. Therefore, approaches facilitating tendon regeneration and preservation must be warranted.

Impact of medial open-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee.

BACKGROUND: Most populations worldwide, who are used to squatting and sitting cross-legged for their activities of daily living, largely comprise the lower socioeconomic strata, thus making them candidates for exclusion for total knee arthroplasty. Proximal/high tibial osteotomy (HTO) is a preferred strategy for clinically symptomatic osteoarthritis (OA) with genu varum due to painful medial compartment OA which is not amenable to conservative measures. AIM: To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India. METHODS: A total of 65 knees in 56 patients with a mean age of 58.22 ± 5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018. The mean preoperative radiological angle of genu varum was 13.4°. Clinical outcomes were assessed by the range of movement, knee scores, pain scores, and functional scores. Radiographic studies were performed preoperatively and at regular intervals during the follow-up period. RESULTS: All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years. The genu varum angle was overcorrected to approximately four degrees in all patients. There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively. Preoperative knee movements were restored in all patients. No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief. CONCLUSION: Medial open-wedge HTO is a reliable, safe, practical, physiological, and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.