ABSTRACT
Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro-Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness.
ABSTRACT
INTRODUCTION AND IMPORTANCE: The manifestation of tuberculous mimicry is challenging to diagnose, especially in extrapulmonary Tuberculosis (TB). Pigmented villonodular synovitis (PVNS) may mimic tuberculous arthritis of the knee joint. In young, otherwise healthy-appearing individuals, tuberculous arthritis and PVNS in the knee joint could present as monoarticular involvement, with painful swelling of extended duration and limited movement. The core therapies for tuberculous arthritis and PVNS are different. CASE PRESENTATION: There are two patients. First, male 25 years old presented with a painful mass at the left knee of 3-years duration. The second patient was 14 years old boy who presented with a painful mass at his left knee for ten months before being admitted to the hospital. From the physical examination, plain x-ray, and MRI, both patients are highly suggestive of PVNS. However, the histopathology result and microbial culture showed a tuberculous-specific process. CLINICAL DISCUSSION: Because of its clinical manifestations, X-ray, and MRI features, patients were initially suspected of having the diffuse type of PVNS. An improper diagnosis may be due to atypical clinical presentation, wide use of antibiotics, the low specificity of diagnostic tools, and most of all, the clinician not prioritizing the possibility of tuberculous arthritis. Open biopsy and the result of the microbial culture establish the definitive diagnosis of knee tuberculosis. CONCLUSION: In conclusion, the clinical and radiologic findings in TB gonitis and PVNS are occasionally similar. Therefore TB gonitis should be highly suspicious, especially in endemic areas. Histopathology results and mycobacterial culture need to determine the diagnosis.
