Comparison of knee flexion isokinetic deficits between seated and prone positions after ACL reconstruction with hamstrings graft: Implications for rehabilitation and return to sports decisions.

OBJECTIVES: Hamstrings grafts are commonly used in ACL reconstruction, however, the effect of graft harvesting on knee flexion strength has not been longitudinally evaluated in functional positions. We hypothesized that greater deficits in knee flexion strength exist in the prone compared to the seated position and these deficits remain as rehabilitation progresses. DESIGN: Case series. METHODS: Forty-two consecutive patients who underwent ACL reconstruction with a hamstrings graft were followed prospectively for 9 months. Isokinetic knee flexion strength at a slow and a fast speed were collected at 3, 4, 6, and 9 months in two different positions: conventional (seated) and functional (0° of hip flexion). RESULTS: Peak torque knee flexion deficits were higher in the prone position compared to the seated position by an average of 6.5% at 60°/s and 9.1% at 180°/s (p<0.001). CONCLUSIONS: Measuring knee flexion strength in prone demonstrates higher deficits than in the conventional seated position. Most athletes would not be cleared to return to sports even at 9 months after surgery with this method.

Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique.

PURPOSE: Several studies have suggested that drilling the femoral tunnel through an anteromedial arthroscopic portal during anterior cruciate ligament reconstruction allows more anatomic placement of the graft. However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring autograft is used. The purpose of the present study is to investigate short-term functional and clinical outcome differences between male patients recovering from anterior cruciate ligament reconstruction with a hamstring autograft using the transtibial femoral tunnel drilling approach versus the anteromedial approach. METHODS: Lysholm score, functional test and isokinetic data were collected at 3 and 6 months after surgery in 51 male patients who received a standardized rehabilitation in a large outpatient facility. Multivariate and univariate analyses of variance were used to assess group, time and interaction effects. RESULTS: All outcomes except isokinetic knee flexion at 180°/s improved from 3 to 6 months for both groups (p ≤ 0.05). The anteromedial approach group had better Lysholm scores at 3 months (p ≤ 0.05) and better performance in the timed lateral movement functional tests at 3 and 6 months (p ≤ 0.05). No other comparisons were significant (n.s). CONCLUSIONS: Both groups had comparable outcomes on most measures. The differences in the Lysholm score and lateral movement functional tests may suggest a quicker return of function and performance for the anteromedial approach group. Clinicians should take into consideration the surgical technique as they progress patients recovering from ACL reconstruction through the different phases of the rehabilitation protocol. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Rotaglide total knee arthroplasty: a long-term follow-up study.

BACKGROUND: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing implants in total knee arthroplasty. The purpose of this study was to determine the clinical results of a mobile-bearing knee implant. METHODS: From 1990 to 1998, 326 primary consecutive mobile-bearing total knee prostheses were implanted in 260 patients who had a mean age and standard deviation of 66.7 ± 6.9 years. Femoral and tibial components were cemented in all knees, and the patella was resurfaced in 199 knees (61%). Patients were evaluated with the use of the Knee Society clinical rating system and radiographic examinations. Complications were noted, and survivorship of the prostheses was determined. RESULTS: The mean follow-up period was 156 ± 27.3 months, with maximum follow-up at eighteen years. The mean Knee Society knee score improved from 32.4 ± 21.2 preoperatively to 92.6 ± 10.0 at the time of the last follow-up (p = 0.00), and the mean Knee Society functional score improved from 39.3 ± 18.7 preoperatively to 66.7 ± 18.6 at the time of the last follow-up (p = 0.00). Mean knee flexion improved from 92.3° ± 14.5° preoperatively to 112.1° ± 13.4° at the time of the last follow-up (p = 0.00). There were twenty-four (7.4%) knees that required revision. In eighteen (5.5%) knees, worn out or broken polyethylene was found and a polyethylene-only exchange was done. Six knees (1.8%) were fully revised. The survival rate was 0.96 (95% confidence interval, 0.93 to 0.98) at ten years and 0.87 (95% confidence interval, 0.79 to 0.93) at eighteen years. CONCLUSIONS: A fully congruent, mobile-bearing total knee prosthesis had excellent survivorship during the ten to eighteen-year follow-up interval.

Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation.

BACKGROUND: There has been great interest in the literature regarding meniscal tears in unstable knees, but there is not as much information available on stable knees. PURPOSE: To report the characteristics of isolated meniscal tears (type and location) in athletes with intact cruciate ligaments. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Arthroscopic surgery was performed on 314 (83.1%) knees in the acute phase ( < 6 weeks) of injury and on 64 (16.9%) knees more than 6 weeks after injury for a total of 364 athletes (378 knees). Cooper's classification was used to classify the meniscal tears according to the type and location. RESULTS: Overall, 262 of 378 tears (69.3%) were located in the medial meniscus and 116 (30.7%) in the lateral meniscus. Vertical tears (77.5%) were significantly more frequent than were horizontal tears (22.5%; chi(2) test, P < .001). A total of 23.2% of tears involved the peripheral zones (zone 0 or 1), and tears that extended into the posterior horn accounted for 75.7%. Regarding the tear shape between male and female athletes, on both sides there were no statistically significant differences in the percentage of horizontal, bucket-handle, longitudinal, or radial tears. CONCLUSION: The characteristics of isolated meniscal tears differ with regard to the sport, sex, and tear location and type from those seen in unstable knees. This knowledge is useful in knee injury management.

Spleen rupture after surgery in Marfan syndrome scoliosis.

Spleen rupture occurred in a 14-year-old girl with Marfan syndrome after posterior spinal instrumented fusion and thoracoplasty for scoliosis. Splenectomy successfully treated this unusual complication of spinal surgery. The etiology, diagnosis, and management of spleen rupture following pediatric spinal surgery are discussed.

The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement.

The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and -) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A- 1017 ml, Group B+ 622 ml and Group B- 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (P<0.001) and demands in blood transfusion P<0.05 as well as a longer operating time (P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.