1.Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus–Gracilis Graft and Semitendinosus–Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons
Soni A ; Gupta RK ; Raghav M ; Masih GD ; Bansal P
Malaysian Orthopaedic Journal 2021;15(No.2):12-17
Introduction: Bone-patellar tendon-bone (BPTB) and
semitendinosus–gracilis (STG) are the commonest grafts
used for ACL reconstruction. However even after having
been debated for years, there is no consensus about the ideal
graft. Moreover, the literature is deficient about STG graft
with preserved tibial insertion (STGPI) which preserves the
proprioception. Our aim is to compare the outcome of BPTB,
free STG and STGPI grafts after ACL reconstruction in
professional sports persons. We compared the outcome in
terms of mechanical stability, functional outcome, return to
sports activity and degenerative changes.
Materials and Methods: Professional sports persons aged
between 16-50 years operated for ACL tear using BPTB, free
STG and STGPI grafts with minimum follow-up of two
years were identified from hospital records. Patients with
associated knee injuries were excluded. Patients, divided in
three groups according to graft used, were compared in terms
of mechanical stability (arthrometric examination KT-1000
score), functional outcome (Lysholm Score), return to sports
activity (Tegner score and difference in thigh circumference)
and degenerative changes (KL grading).
Results: BPTB graft group was found to be better than free
STG and STGPI graft groups in terms of KT-1000 score.
There was no statistically significant difference among the
groups in terms of Lysholm score, Tegner score, difference in
thigh circumference and KL grading.
Conclusion: BPTB graft is better than free STG and STGPI
grafts in terms of knee stability. When compared for patient
reported outcome, return to sports activity, osteoarthritic
changes and graft failure there is no significant difference
among the three types of grafts.
2.Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR)
Gupta R ; Singhal A ; Malhotra A ; Soni A ; Masih GD ; Raghav M
Malaysian Orthopaedic Journal 2020;14(No.3):50-56
Introduction: Few authors have addressed risk factors
related to an ipsilateral graft rupture and contralateral
anterior cruciate ligament (ACL) injury after return to sports
(RTS) following primary ACL reconstruction.
Material and Methods: Patients with ACL re-injury to
either knee after successful primary ACLR were included in
Group I and those with no further re-injury were included in
Group II. Variables including age, gender, side, body mass
index (BMI), thigh atrophy, anterior knee laxity difference
between both knees measured by KT-1000 arthrometer,
mean time of return to sports (RTS), graft type, type of game,
mode of injury, Tegner Activity Score, hormone levels,
femoral tunnel length (FTL), posterior tibial slope (PTS) and
notch width index (NWI) were studied. Binary logistic
regression was used to measure the relative association.
Results: A total of 128 athletes were included with 64 in
each group. Mean age in Group I and II were 24.90 and
26.47 years respectively. Mean follow-up of Group I and
Group II were 24.5 and 20.11 months respectively.
Significant correlation was present between ACL re-injury
and following risk factors; PTS of >10º, KT difference of
>3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50
months P value <0.05). No correlation was found with age,
sex, BMI, type of game, Tegner Activity Score, mode of
injury, NWI, size of graft, FTL and hormone levels.
Conclusion: Possible risk factors include PTS of ≥ 10º, KT
difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of
≥ 2.50cm at 1 year follow-up and RTS <9.5 months after
primary ACLR.
3.Total knee arthroplasty with long tibial stem for tibial stress fractures with knee osteoarthritis: Two birds with one stone.
Satvik N PAI ; Mohan M KUMAR ; Pravin K VANCHI ; Raghav RAVI ; Pradeesh KISWANTH
Chinese Journal of Traumatology 2022;25(6):357-361
PURPOSE:
The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.
METHODS:
Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.
RESULTS:
Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.
CONCLUSION
Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.
Humans
;
Arthroplasty, Replacement, Knee/adverse effects*
;
Osteoarthritis, Knee/surgery*
;
Tibia/surgery*
;
Fractures, Stress/surgery*
;
Tibial Fractures
;
Knee Joint
;
Knee Injuries/surgery*
;
Treatment Outcome