A difference in rotational alignment of the tibio-femoral joint after anterior cruciate ligament reconstruction between the bone-patellar tendon-bone and semitendinosus-gracilis grafts.

BACKGROUND: A question as to the effect of the graft choice on rotational kinematics after anterior cruciate ligament reconstruction remains unclear. The purpose of this study was to determine if there were any differences in rotational alignment of the knee after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) graft compared to that using semitendinosus-gracilis (STG) graft. METHODS: Ten patients with BTB graft and 10 patients with STG graft were assessed at 3 months after ACL reconstruction. We compared the 6 degrees-of-freedom alignment of the tibiofemoral joint in the fully extended position between knees reconstructed with BTB graft and STG graft using the uninvolved knee as a control. FINDINGS: The BTB graft group showed no difference in knee alignment between the ACL reconstructed knee and uninvolved knee, whereas the STG graft group showed greater external rotation in the ACL reconstructed knee than in the uninvolved knee (median values, 8.4° vs 5.8°; p = 0.022). INTERPRETATION: ACL reconstruction with the STG graft leads to increased external tibial rotation. Our findings suggest that clinicians should make an effort to prevent increased external tibial rotation during the rehabilitation process in patients with STG graft.

Gait variability before surgery and at discharge in patients who undergo total knee arthroplasty: a cohort study.

This study aimed to determine gait ability at hospital discharge in patients undergoing total knee arthroplasty (TKA) as an indicator of the risk of falling. Fifty-seven patients undergoing primary TKA for knee osteoarthritis participated in this study. Gait variability measured with accelerometers and physical function including knee range of motion (ROM), quadriceps strength, walking speed, and the Timed Up and Go (TUG) test were evaluated preoperatively and at discharge from the hospital (1 month before and 5 days after surgery). All patients were discharged directly home at 5 days after surgery. Knee flexion of ROM, quadriceps strength, walking speed, and the TUG test results were significantly worse at hospital discharge than preoperatively (p < 0.001). However, gait variability was not significantly different before and after TKA. This result indicated that patients following TKA surgery could walk at hospital discharge as stably as preoperatively regardless of the decrease in physical function, including knee ROM, quadriceps strength, and gait speed after surgery.

Pseudoaneurysm of Lumbar Artery following a Vertebral Biopsy: A Case Report.

A 74-year-old man developed a severe low back pain and a fever. In the initial examinations, a collapse of the L5 anterosuperior vertebral body and narrowing of the L4/5 disc space were identified on radiographs, and the laboratory data showed inflammatory results. A computed tomography (CT) and a magnetic resonance imaging showed collapse of L5. A needle biopsy was performed to make a diagnosis; however, an abdominal pain and a hypotension appeared after the biopsy. An abdominal CT showed a hematoma in the retroperitoneal space, and an angiography revealed a left fourth lumbar artery pseudoaneurysm. The pseudoaneurysm was treated with transcatheter placement of microcoils. Although haemorrhagic complications following needle biopsy are very rare, patients with large amounts of vertebral destruction may have unusual anatomical positions of the lumber artery. Therefore, surgeons should be aware of the possibility of lumbar artery injury during a needle biopsy and take care of prebiopsy plans.

A comparison of bone-patellar tendon-bone and bone-hamstring tendon-bone autografts for anterior cruciate ligament reconstruction.

BACKGROUND: Most of the previous comparative studies between patellar tendon and hamstring tendon anterior cruciate ligament grafts compared grafts of different constructs fixed with different methods. PURPOSE: To compare patellar tendon and hamstring tendon grafts with the same fixation method used to reconstruct the anterior cruciate ligament. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: During the reconstructive procedure, the hamstring tendon graft was prepared as a bone-hamstring-bone graft; both bone-patellar tendon-bone and bone-hamstring-bone grafts were fixed with interference screws. Eighty consecutive patients who underwent anterior cruciate ligament reconstruction were randomly assigned to either bone-patellar tendon-bone or bone-hamstring-bone groups. Follow-up examinations were performed for at least 5 years postoperatively. Seventy-two of the 80 patients (37 patients in the bone-patellar tendon-bone group and 35 in the bone-hamstring-bone group) were evaluated, with a mean follow-up period of 87.0 and 80.8 months, respectively. Follow-up examinations were performed using the International Knee Documentation Committee knee ligament standard and subjective knee forms. RESULTS: The mean KT-1000 arthrometer evaluation results showed no significant difference between the bone-patellar tendon-bone and bone-hamstring-bone groups (1.2 +/- 2.1 mm and 1.7 +/- 1.4 mm, respectively; P = .24). However, symptoms related to graft harvest (anterior kneeling pain) were more frequently observed in the bone-patellar tendon-bone group, and unsatisfactory results were correlated with severe kneeling pain in 3 patients from this group (P = .0056). Significant hamstring muscle weakness without complaint of functional deficit was found in the bone-hamstring-bone group (P = .0045). CONCLUSION: Bone-hamstring-bone grafts were shown to reduce the risk of problems at the graft harvest site compared to bone-patellar tendon-bone grafts, with comparable results in the remaining clinical parameters tested.

Traumatic anterior atlantoaxial subluxation occurring in a professional rugby athlete: case report and review of literature related to atlantoaxial injuries in sports activities.

STUDY DESIGN: This is a case report of traumatic anterior atlantoaxial subluxation occurring in a professional rugby athlete with a literature review. OBJECTIVE: To report a rare case of traumatic anterior atlantoaxial subluxation in a professional rugby athlete. SUMMARY OF BACKGROUND DATA: Atlantoaxial subluxation occurring in a professional athlete is very rare, and only two cases have been reported so far. METHODS: A 26-year-old professional rugby player sustained traumatic anterior atlantoaxial subluxation. The pathomechanism of the injury was hyperflexion. No quadriplegia existed, but severe anterior subluxation was found on functional radiographs and kinematic magnetic resonance imaging. RESULTS: Surgical fixation of C1-C2 was carried out, and no impairment was seen in his daily living, although he did not return to professional rugby. CONCLUSIONS: Anterior atlantoaxial subluxation in sports activities is very rare. The mechanism of this injury is hyperflexion, and the rupture of the transverse ligament is essential. Good prognosis has been reported; however, a return to high-level sports activities is thought to be a contraindication.

MRI-negative rotator cuff tears.

We report two cases of rotator cuff tear in which the T(2)-weighted MRI signal was negative at the first examination, but positive by the second examination without any changes in symptoms. Many authors have reported on correlations between the MRI and operative findings of rotator cuff tears. However, MRI findings, history of symptoms and operative findings in our patients suggest that there was a discrepancy between symptoms and MRI findings dependent on the period from the injury. Operative findings also indicate that intratendinous tears might have occurred first in these patients then progressed to partial or full thickness tears over time. We concluded that physicians should keep rotator cuff pathology in mind even in patients whose MRI findings are negative but symptoms of rotator cuff tear persist.