To assess the ligamentization of the hamstring graft after arthroscopic anatomic single bundle anterior cruciate ligament (ACL) reconstruction using MRI at one year postoperatively. Patients and Methods: 25 patients (22 males and 03 females) underwent arthroscopic anatomic single bundle ACL reconstruction using hamstring tendon autograft. After ACL reconstruction, the ligamentization of the hamstring graft at one year postoperatively was evaluated on MRI by assessing the signal intensity of the graft and the integration of the graft on the tibial side. The graft integration at the level of the tibial tunnel was evaluated by the presence or absence of synovial fluid at the tunnel-graft interface. Results: MRI signal intensity of the ACL grafts was low in 13 (52%) cases, intermediate in 10 (40%) cases, and high in 1 (4%) case. Presence of synovial fluid at the graft interface was observed in 3 (12%) cases. The graft ligamentization was present in 23 (92%) cases, as indicated by the Figueroa score of 3-5. Conclusion:The phenomenon of ligamentization of ACL grafts after anatomical ACL reconstruction occurs within 1 year after surgery. MRI is a good tool to evaluate graft integration and graft ligamentization after ACL reconstruction.
To evaluate the functional results of intramedullary nailing in diaphyseal both bone forearm fractures in children. Patients and Methods: 40 patients (30 males and 10 females) with an age group of 8-14 years were included in the study. Displaced diaphyseal fractures, fractures with loss of reduction (within first week) in casting, segmental fractures, and open fractures (Gustilo & Anderson type 1 & 2) were considered for intramedullary fixation. The fractures were reduced percutaneously by manipulating the fracture fragments & were stabilised by 2-2.5 mm flexible titanium intramedullary nails. Retrograde nailing of radius was done from the dorsal entrance site. Antegrade nailing of ulna was done from the lateral cortex of the olecranon. Patients were followed at two weeks, four weeks, six weeks, eight weeks and then at monthly intervals up to 9 months. Final follow up was done at 9 months and results were assessed clinically using Daruwalla criteria with restoration of forearm rotation. Results: In 31 (77.5%) cases, closed reduction and nailing was achieved using 2 to 2.5 mm flexible titanium nails while in 9 (22.5%) cases open reduction through limited incisions was done. In all patients fracture was united at an average of 8.1 weeks. In all patients, removal of implant was done at 6 months. Excellent results were in seen 38 (95%) patients & good results in 02 (5%) patients using Daruwalla criteria with restoration of forearm rotation. The complication reported were bursa formation in 7 (17.5%) patients, symptomatic prominent hardware in 5 (12.5%) patients, superficial radial nerve injury in 1 patient, wound related problems in 3 patients & refracture in 1 patient. Conclusion: Elastic intramedullary nailing is a safe and reliable method for internal fixation of displaced diaphyseal unstable forearm fractures with good to excellent functional results.
This study was aimed to determine the accuracy of arthroscopic anatomic single bundle anterior cruciate ligament (ACL) reconstruction using MRI at one year postoperatively. Patients and Methods: This prospective study included 40 patients (34 males and 06 females) who underwent arthroscopic anatomic single bundle ACL reconstruction with hamstring tendon autograft using medial portal technique. The patients were evaluated at one year postoperatively by clinical examination and MRI. The MR images were evaluated for graft location, tunnel location, graft signal intensity, graft quality, and graft ligamentization. Results: The ACL was found to be anatomically reconstructed in 37 (92.5%) cases. The mean sagittal inclination angle of ACL graft was 54 degrees (range 48.6 ○ -60 ○ ). The mean coronal inclination angle of ACL graft was 70.5 degrees. The mean center of tibial tunnel was found to be at 42.6% of AP diameter of tibia (range 35-51%). The mean femoral graft angle (FGA) was 50.5 degrees (range 43.5 ○ -57 ○ ). The graft ligamentization was present in 38 (95%) cases. Conclusion: Single bundle ACL reconstruction using medial portal technique results in anatomical location of the graft. MRI is an excellent tool to evaluate the graft and bone tunnel location, graft signal intensity, and graft ligamentization.
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