Randomised comparison of pretensioning using cyclical loading and on tendon board for arthroscopic anterior cruciate ligament reconstruction using hamstring autograft.

OBJECTIVE: Pretensioning is usually done using two methods - manual cyclical loading and using tensioner with a tendon board. Both the methods are being used with little knowledge about the superiority of either method. This study was done with the objective of trying to find out the better method. METHODS: A total of 50 patients were selected for the above mentioned study who were randomised into each of the two groups using chit system - In group A patients, cyclical loading was done by twenty times full flexion -extension movements but in group B patients, the graft was placed on a tensioner with 15 pounds tension for 10 minutes. All patients were operated by the same surgeon. The patients were put on a strict rehabilitation protocol. Patients were allowed to bear weight as tolerated. Patients returned for follow up at 6 weeks, 3 months, 6 months and 12 months. At each visit patients were followed with Lysholm's Score and ROLIMETER reading. RESULTS: The ROLIMETER reading and Lysholm's score were seen to improve from preoperative to postoperative period and improved further over time with the progress of the rehabilitation protocol in both the groups. When compared to each other Group A i.e. patients pretensioned with cyclical loading had better Lysholm scores and ROLIMETER readings with the difference being statistically significant at all time periods except at 1 year when the difference between the ROLIMETER readings in the two groups were no more significant, though the difference of the Lysholms score was still found to be statistically significant. CONCLUSION: It was concluded in this study that cyclical loading is a better method of pretensioning in ACL reconstruction than tensioner on tendon board with 15 pounds of tension for 10 minutes.

Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients.

BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series. METHODS: From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years. RESULTS: The mean fracture healing time was 21.4 weeks (range 16-32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%). CONCLUSION: MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.