Tibial fixation in anterior cruciate ligament reconstruction.

OBJECTIVE: To determine whether supplementary tibial graft fixation with a staple is routinely necessary for anterior cruciate ligament (ACL) reconstructions. METHODS: We retrospectively reviewed a series of consecutive patients who underwent ACL reconstruction at our institution from April 2012 to July 2013. Patients who fulfilled the inclusion and exclusion criteria were divided into two groups, of which one with tibial fixation of the graft with a biointerference screw alone (biointerference screw group) and the other with tibial fixation of the graft with a biointerference screw and supplementary extra tunnel staple fixation (biointerference screw and staple group). All the surgeries were performed by a single fellowship-trained sports surgeon, using a standardized transportal technique and rehabilitation protocol. Both well-matched groups were evaluated at 1-year follow-up objectively for ligament laxity using instrumented testing with KT-2000 arthrometer and clinical tests as well as subjectively with the validated International Knee Documentation Committee 2000 (IKDC) and Lysholm knee score. All complications were reported. RESULTS: A total of 64 patients (31 in the only biointerference screw group and 33 in the biointerference screw and staple group) were included in the study. At 1 year, there was no significant difference in the objective and subjective outcome assessments between the two groups. However, four patients from the group with supplementary staple experienced symptomatic hardware on kneeling of which two necessitated removal of hardware. CONCLUSION: Our study showed that supplementary tibial graft fixation with a staple is not routinely necessary for ACL reconstructions. It confers no additional benefits when compared with the use of biointerference screw alone for tibial graft fixation but may increase the risks of symptomatic hardware.

Radiographic study of the proximal femur morphology of elderly patients with femoral neck fractures: is there a difference among ethnic groups?

INTRODUCTION: This study aimed to determine ethnic differences in the proximal femur morphology of elderly patients with femoral neck fractures in Singapore. METHODS: We reviewed the medical records of 101 men and 288 women aged 60-109 (mean 76.4) years who underwent hip hemiarthroplasty for femoral neck fractures between 1 June 2010 and 31 December 2015. Patients' age, gender and race were recorded. Plain anteroposterior radiography was used to measure the following: calcar width to canal width ratio of the ipsilateral femur; neck-shaft angle; hip offset; neck length; and neck width of the contralateral proximal femur. RESULTS: Chinese women had slightly larger femoral heads (mean 43.88 mm) as compared to Malay (mean 42.92 mm, p = 0.044) and Indian (mean 42.34 mm, p = 0.025) women. Chinese women also had a significantly lower mean calcar-to-canal width ratio (0.606) as compared to Malay (0.664, p = 0.002) and Indian (0.693, p = 0.004) women. The mean neck-shaft angle of Chinese women was significantly greater than that of Indian women (137.48° vs. 127.00°, p = 0.001). CONCLUSION: We found statistically significant differences in the femoral head sizes and calcar-to-canal width ratios among women of different ethnic groups. There were also differences in neck-shaft angles between Chinese and Indian women, and between Malay and Indian women.