This study showed an overall 16.3% radiological PCE and 1.4% symptomatic PCE incidence when CAFPS were used due to severe osteoporosis. The symptomatic PCE risk was significant when CAFPS were > 7 levels; > 14 fenestrated screws; and > 20-25 cc cement volume is used and this may cause PAP increase and right ventricular dilatation.
Objectives:Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy.Methods:A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia.Results:At the 3 month- follow-up, the patient achieved full symmetric restoration of motion and he had returned to full daily activities. The Tegner Lysholm score was evaluated as 94 (excellent) postoperatively. Functional examination of the left knee reveled 155 of flexion, and full knee extension. The complaint of instability was disappeared. At 9 month-follow-up, clinical findings were unremarkable, with no sign of re-rupture and arthrofibrosis and he returned to his professional dance career.Conclusion:In the literature there is not any consensus regarding the management and rehabilitation intervention for arthrofibrosis in young athletes or professional dancers. The best treatment method is preventing the arthrofibrosis once it has occurred with surgical lysis and aggressive physical therapy. The combined surgical treatment and physiotherapy described in this case report may assist clinicians in the treatment of arthrofibrosis after arthroscopic reconstruction of ACL and PLC injury.
Objectives:Chronic isolated injuries of the posterior cruciate ligament (PCL) are very rare in the literature. PCL injuries are often presented undiagnosed because of the weak signs of the injury compared to the anterior cruciate ligament (ACL) injuries. We report the surgical outcome of arthroscopic reconstruction of the chronic isolated PCL rupture with ipsilateral autologous hamstring tendon in a professional Caucasian dancer.Methods:A 21-year-old male professional Caucasian dancer presented severe instability without any pain in his right knee lasting for one year. The patient did not describe any specific traumatic event but his both knees received repeatitive direct pretibial trauma during hyperflexion of the knee while landing to the floor. At the physical examination, posterior sagging of the tibia was observed on the affected side at 90o of knee flexion and step off test and posterior drawer test were positive preoperatively under general anesthesia. The Tegner Lysholm score was evaluated as 59 (poor). A magnetic resonance image (MRI) revealed the isolated total rupture of PCL. The treatment of choice was arthroscopic single bundle reconstruction of PCL with ipsilateral autologous hamstring tendon. A standard arthroscopic exploration of the joint was performed preoperatively and we didn't observe any meniscal, cartilage or ligamentous lesion. Anteromedial and anterolateral portals were made in order to visualize the posterior cortex of the tibia with a 70 degree scope. Intra-operative fluroscopy was used to confirm proper tunnel position. During postoperatively first week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. Quadriceps musculature and passive range of motion was trained.Results:At the 6 month- follow-up, the patient achieved full symmetric restoration of motion. He had returned to full daily activies. The Tegner Lysholm score was evaluated as 95 (excellent) postoperatively. Functional examination of the right knee reveled 140 of flexion, and full knee extension. No posterior sagging was observed and step off test and posterior drawer test was negative. The complaint of instability was disappeared. At 1-year follow-up, clinical findings were unremarkable, with no sign of re-rupture and he returned to his professional career.Conclusion:Surgical reconstruction technique of the PCL and associated rehabilitation protocols has not yet been fully standardized and much work still has be done optimizing correct treatment of PCL injuries. The arthroscopic reconstruction of chronic isolated PCL instability is a very difficult technique as well as its diagnosis. The reconstruction is very beneficial in the athletes and the patients who are not responding well to the conservative treatment.
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