The Correlation Between Graft Size and Graft Failure in Hamstring Autograft Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Previous studies have investigated various factors that contribute to graft failure in hamstring anterior cruciate ligament (ACL) reconstruction. However, there is debate about the potential advantages of increasing graft diameters beyond 8 mm. METHODS: In this retrospective cohort study (level of evidence III), we investigated whether increasing graft sizes beyond 8 mm diameter showed any advantages in reducing the risk of graft failure. We utilized univariate Kaplan-Meier analysis and Cox proportional hazard (PH) regression models to compare the risk of failure in the different patient groups. Mutual adjustment was performed for age, gender, body mass index (BMI), and graft strands. Graft sizes ranging between 8 and 10 mm were assessed for their association with graft failure, alongside examining the impact of graft strands, age, and BMI on graft failure. RESULTS: A total of 487 patients underwent hamstring autograft ACL reconstruction at our hospital between January 2016 and December 2020. Our analysis indicated that among patients undergoing hamstring autograft ACL reconstruction, the risk of graft failure was 1.64 times higher for patients with a graft size between 8.5 and 9 mm (95% CI 0.36-7.43, p=0.483) and 2.19 times higher for patients with a graft size between 9.5 and 10.5 mm (95% CI 0.42-11.31, p=0.384) compared to those with an 8 mm graft. However, there was weak evidence against the null hypothesis.  Conclusion: These findings suggest that there is no benefit to increasing graft sizes past 8 mm and that other factors, like surgical technique, should be considered when assessing the risk of graft failure in patients undergoing ACL reconstruction.

Stand-Alone Tibial Interference Screw Fixation and Tibial Interference Screw Plus Tibial Staple Fixation Produce Comparable Outcomes After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts.

Purpose: To investigate the impact of adding a metal staple alongside the interference screw in tibial side graft fixation during anterior cruciate ligament reconstruction (ACLR). Methods: All patients treated with autograft hamstring ACLR at our institution between January 2017 and December 2021 with a minimum 1-year follow-up were reviewed retrospectively. Patients treated with a stand-alone interference screw for tibial side fixation were compared with those treated with a combination of interference screw and staple. The primary outcome was failure of the reconstructed graft. Secondary outcomes were operative time, complication rate, and reoperation rate. Results: A total of 497 patients met the study's inclusion and exclusion criteria. A combination of staple and interference screw was used in 167 patients (33.6%), whereas a standalone interference screw was used in 330 patients. There was no significant difference between the 2 groups in terms of operative time, complication rate, or failure rate. The mean follow-up was 23.25 (±13.29) months. Conclusions: Our results demonstrate that augmenting the interference screw with a staple for tibial-side fixation in ACLR does not have a significant impact on operative time, reoperation rate, complications, or failure rates. Level of Evidence: Level III, retrospective cohort study.

Open Achilles tendon lacerations.

In contrast to closed Achilles tendon ruptures, open injuries are rarely reported in the literature. This paper provides information about open Achilles tendon wounds that are eventually seen in the Middle East. The reporting unit, Hamad Medical Corporation, is one of the biggest trauma centers in the Gulf area and the major health provider in Qatar. This is a retrospective study including patients admitted and operated for open Achilles tendon injuries between January 2011 and December 2013. Two hundred and five cases of open Achilles tendon lacerations were operated in Hamad General Hospital in this period. Forty-eight cases showed partial injuries, and the remaining are complete tendons cut. In the same period, fifty-one closed ruptured Achilles tendons were operated in the same trauma unit. In the majority of cases, the open injury resulted from a slip in the floor-leveled traditional toilette seats. Local damage to the toilette seats resulted in sharp edges causing the laceration of the heel if the patient was slipping over the wet floor. This occurrence is the cause in the vast majority of the cases. Wounds were located 1-5 cm proximal to tendon insertion. Standard treatment principles were applied. This included thorough irrigation in the emergency room, intravenous antibiotics, surgical debridement and primary repair within 24 h. Patients were kept in the hospital 1-7 days for intravenous antibiotics and possible dressing changes. Postoperatively below knee slabs were applied in the majority of patients and were kept for about 4 weeks followed by gradual weight bearing and range of motion exercises. Outpatients follow up in 1-2 weeks. Further follow-up visits at around 2-, 4-, 8- and 12-week intervals until complete wound healing and satisfactory rehabilitation outcome. Sixteen cases needed a second procedure. A high incidence of Achilles tendon open injuries is reported. This seems to be related to partially damaged floor-level toilettes in the typical Middle-East lavatory. The surgical treatment resulted in excellent outcome in the vast majority of the cases. Low incidence of complications resulted despite dramatic injury pattern.