Variation in Kaplan fiber insertion to the distal femur and surgical implications: A cadaveric anatomical study comparing Asian and Caucasian knees.

BACKGROUND: The iliotibial band together with its attachment to the distal femur, known eponymously as the Kaplan fibers, has been shown to contribute to anterolateral rotatory stability of the knee. However, there remains paucity of data regarding the detailed anatomy of the Kaplan fibers to aid us in anatomical-based surgical reconstruction of these structures. The aim of our study was to identify and compare the presence and quantitative anatomy of the Kaplan fibers in Caucasian and Asian cadavers. METHODS: Twenty paired fresh-frozen Asian and 20 unpaired embalmed Caucasian cadaveric knees were dissected using a standard outside-in technique. The presence, qualitative and quantitative measurements of any distal femoral attachments of the iliotibial band were recorded. Mean values of its dimensions were calculated and compared between the Caucasian and Asian groups. RESULTS: A consistent supracondylar attachment of the iliotibial band was found in all Caucasian knees and in 19 of 20 Asian knees. The fibers were noted to have two variations with regard to their insertion to the distal femur, either as a single limb or as a double limb attachment, averaging between 30 mm and 40 mm from the lateral femoral epicondyle. No statistically significant difference was noted in dimensions of the fibers between the Caucasian and Asian groups. CONCLUSIONS: The Kaplan fibers are a consistent attachment of the iliotibial band at the distal femur in both Caucasian and Asian knees with two different patterns of insertion. Surgical reconstructions should aim to recreate these attachments to be as anatomically based as possible.

Low-Cost Self-Made Arthroscopic Training Camera Is Equally as Effective as Commercial Camera: A Comparison Study.

PURPOSE: To assess the effectiveness of a low-cost self-made arthroscopic camera (LAC) in basic arthroscopic skills training compared with a commercial arthroscopic camera (CAC). METHODS: One hundred fifty-three orthopaedic residents were recruited and randomly assigned to either the LAC or CAC. They were allocated 2 practice sessions, with 20 minutes each, to practice 4 given arthroscopic tasks: task 1, transferring objects; task 2, stacking objects; task 3, probing numbers; and task 4, stretching rubber bands. The time taken for participants to complete the given tasks was recorded in 3 separate tests; before practice, immediately after practice, and after a period of 3 months. A comparison of the time taken between both groups to complete the given tasks in each test was measured as the primary outcome. RESULTS: Significant improvements in time completion were seen in the post-practice test for both groups in all given arthroscopic tasks, each with P < .001. However, there was no significant difference between the groups for task 1 (P = .743), task 2 (P = .940), task 3 (P = .932), task 4 (P = .929), and total (P = .944). The outcomes of the tests (before practice, after practice, and at 3 months) according to repeated measures analysis of variance did not differ significantly between the groups in task 1 (P = .475), task 2 (P = .558), task 3 (P = .850), task 4 (P = .965), and total (P = .865). CONCLUSIONS: The LAC is equally as effective as the CAC in basic arthroscopic skills training with the advantage of being cost-effective. CLINICAL RELEVANCE: In view of the scarcity in commercial arthroscopic devices for trainees, this low-cost device, which trainees can personally own and use, may provide a less expensive and easily available way for trainees to improve their arthroscopic skills. This might also cultivate more interest in arthroscopic surgery among junior surgeons.

Crossing Suture Technique for the Osteochondral Fractures Repair of Patella.

Osteochondral fracture of the patella is a common concomitant injury of the knee, especially in lateral patellar instability, and the importance of early stable fixation with minimal complication and early mobilization should be emphasized. Screws and Kirschner wires both absorbable and nonabsorbable have been the common mode of fixation of these fractures. Nevertheless, these fixation techniques require larger osteochondral fragments and are associated with cartilage abrasion, hardware prominence, synovitis, and foreign body reaction. In contrast, suture fixation can adequately stabilize smaller osteochondral fragments without comminution and prevent some of the possible complications of other techniques of fixation. We created 4 holes in a rectangular pattern on the patella oriented perpendicular to its anteroposterior surface. We used readily available, and affordable, no. 2 Ultrabraid sutures inserted into the holes and looped around the osteochondral fragment, compressing it to the patella. The technique is very simple and is relatively easy to learn. It provides secure fixation and allows early mobilization. And it spares the knee from subsequent surgical procedure for removal of metallic implants.

Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.

A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures.

Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial.

BACKGROUND: A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear. PURPOSE: To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: Twenty-eight patients diagnosed with an acute hamstring injury were randomly allocated to autologous PRP therapy combined with a rehabilitation program or a rehabilitation program only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and pain interference scores over time were examined. RESULTS: Patients in the PRP group achieved full recovery significantly earlier than controls (P = .02). The mean time to return to play was 26.7 ± 7.0 days and 42.5 ± 20.6 days for the PRP and control groups, respectively (t(22) = 2.50, P = .02). [corrected]. Significantly lower pain severity scores were observed in the PRP group throughout the study. However, no significant difference in the pain interference score was found between the 2 groups. CONCLUSION: A single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone.

Platelet-rich plasma (PRP) for acute muscle injury: a systematic review.

INTRODUCTION: Acute muscle injury is one of the commonest injuries that often result in loss of training and competition time. The best management for muscle injury has not been identified. Sports medicine practitioners used several approaches in attempt to accelerate time to recovery from muscle injury. More recently growing interest focussed on autologous blood product injection. METHODS: A literature search was conducted systematically using OvidMEDLINE, PubMed, EMBASE, SPORTDiscus and CINAHL databases to retrieve articles published until December 2012. Controlled trials and controlled laboratory studies comparing different strategies to promote early recovery of muscle injury were included. The methodological quality of studies was assessed. RESULTS: There are limited studies on the effects of PRP therapy for muscle injury. Three in vivo laboratory studies and one pilot human study were reviewed. The laboratory studies reported histological evidence on significant acceleration of muscle healing in animals treated with autologous conditioned serum (ACS), platelet-rich plasma (PRP) and platelet rich fibrin matrix (PRFM). A pilot human study found athletes treated with repeated ACS injection recovers significantly faster than retrospective controls. CONCLUSION: Several in vivo laboratory studies suggest beneficial effects of ACS, PRP and PRFM in accelerating muscle recovery. Evidence to suggest similar effects on humans is however limited, as valuable information from robust human controlled trials is still not available at this moment. Hence, more studies of satisfactory methodological quality with platelet-rich plasma interventions on muscle injury are justified.

Pattern of muscle injuries and predictors of return-to-play duration among Malaysian athletes

<p><b>INTRODUCTION</b>The purpose of this study was to investigate the pattern of muscle injuries and the factors that predict the return-to-play duration among Malaysian athletes.</p><p><b>METHODS</b>This is a retrospective review of the case notes of athletes who attended the National Sports Institute Clinic in Malaysia. The medical records of athletes with muscle injury, diagnosed on clinical assessment and confirmed by diagnostic ultrasonography, were included for final analysis.</p><p><b>RESULTS</b>From June 2006 to December 2009, 397 cases of muscle injury were diagnosed among 360 athletes. The median age of the athletes with muscle injuries was 20.0 years. Muscle injuries were mostly diagnosed among national-level athletes and frequently involved the lower limb, specifically the hamstring muscle group. Nearly all of the athletes (99.2%) were treated conservatively. The median return-to-play duration was 7.4 weeks. Athletes who waited more than one week before seeking medical attention, those with recurrent muscle injuries and female athletes were significantly more likely (p < 0.05) to take more than six weeks before returning to the sport.</p><p><b>CONCLUSION</b>Grade 2 lower limb muscle injury was commonly diagnosed among national-level athletes in this study. The frequency of weekly physiotherapy sessions did not affect the return-to-play duration. Factors such as initial consultation at more than one week post injury, recurrent muscle injuries and female gender were significant predictors of return-to-play duration among Malaysian athletes. These predictive factors should be kept in mind during clinical assessment so as to aid in prognosticating recovery after muscle injury.</p>

Platelet-rich plasma (PRP): an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol (ISCRTN66528592).

BACKGROUND: Muscle injuries are one of the commonest injuries affecting athletes. It often leads to significant pain and disability causing loss of training and competition time. With current treatment, the duration to return-to-play ranges form six weeks to never, depending on injury severity. Recent researches have suggested that autologous platelet-rich plasma (PRP) injection into the injured site may hasten soft tissues healing. To-date, there has been no randomised clinical trials to evaluate the effects of PRP on muscle healing. The aim of this study is to examine the effects of autologous PRP on duration to return-to-play after muscle injury. METHODS AND DESIGN: A randomised, single blind controlled trial will be conducted. Twenty-eight patients aged 18 years and above with a recent grade-2 hamstring injury will be invited to take part. Participants will be randomised to receive either autologous PRP injection with rehabilitation programme, or rehabilitation programme only. Participants will be followed up at day three of study and then weekly for 16 weeks. At each follow up visit, participants will be assessed on readiness to return-to-play using a set of criteria. The primary end-point is when participants have fulfilled the return-to-play criteria or end of 16 weeks.The main outcome measure of this study is the duration to return-to-play after injury. CONCLUSION: This study protocol proposes a rigorous and potential significant evaluation of PRP use for grade-2 hamstring injury. If proven effective such findings could be of great benefit for patients with similar injuries. TRIAL REGISTRATION: Current Controlled Trials ISCRTN66528592.