A Comparison between Modified Robert Jones Bandage and Intermittent Cold Pack in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial.

Background: Modified Robert Jones bandage and intermittent cold pack are commonly used for postoperative care in arthroscopic anterior cruciate ligament reconstruction (ACLR). However, no study has been done to compare the postoperative pain and functional outcome of both methods in ACLR. Objective: To compare the postoperative pain and functional outcome of a modified Robert Jones bandage and intermittent cold pack in ACLR. Material and Method: Forty patients scheduled for ACLR were included. Computer-generated randomization allocated patients into either modified Robert Jones bandage group (MRJ) or intermittent cold pack group (ICT). Visual analog scale and morphine usage were assessed postoperatively. Blinded assessors assessed functional outcome, knee swelling, and patient's satisfaction. Results: There were 19 patients in each group. Two groups were well comparable for the prognostic variables. The postoperative VAS and total morphine usage in both groups were not statistically different. Postoperative knee swelling increment was significantly lower in ICT than MRJ group (p-value = 0.04). The patient's satisfaction and positive quadriceps set test were significantly higher in the ICT group than the MRJ group (p-value <0.01). Conclusion: Intermittent cold pack has not demonstrated the benefit of pain reduction or morphine usage when compared to the modified Robert Jones bandage, but it had significantly less knee swelling, a significantly higher patient's satisfaction and trend to have better functional outcome. We recommend intermittent cold pack for postoperative care in ACLR.

Anteromedial Marginal Fracture of Medial Tibial Plateau without Significant Knee Ligamentous Injury in Hypermobility Patient: a Case Report and Review of Literature.

Anteromedial rim fracture of medial tibial plateau is a rare fracture pattern with only a small number of case reports in the literature. However, it is highly likely that is associated with specific significant soft tissue injuries, especially posterior and posterolateral corner structure, and medial meniscus injury. It is thought this fracture is caused by hyperextension and varus rotation mechanism. The previous reports highlight the typical pattern of severe concomitant knee ligament injury associated with this fracture that always require surgical repair to restore knee stability and function. In this report, we present an unusual case with a history of generalized joint laxity and acute anteromedial marginal fracture of medial tibial plateau without associated significant ligament damage, together with a literature review of this condition. We believe this case report introduces new insights into this unique fracture pattern.