Background:
Patellar fractures and chondral injuries are serious complications after medial patellofemoral ligament (MPFL) reconstruction. Using a central strip from the quadriceps tendon avoids these complications. Moreover, this technique maintains an anatomical attachment of the tendon at the proximal patella at the position of the native MPFL. The quadriceps strip is biomechanically comparable to the intact MPFL, whereas the hamstring tendon graft is stiffer than the native MPFL.
Methods:
Thirty-four patients were involved in this study. Conservative treatment failed in all after an initial episode of patellar dislocation. Their mean age was 19.4 yr. The mean duration of symptoms was 14.3 mo. The mean follow-up period was 28.7 mo. Their preoperative visual analogue scale (VAS) was 5 and their preoperative Kujala score was 69.5. Mean Caton-Deschamps index was 1.1. Patella alta was found in seven patients. Thirteen patients had trochlear dysplasia. All had MPFL reconstruction using 10-cm long, 10-mm wide, 3 mm thick strip harvested from the central portion of the quadriceps tendon.
Results:
The mean VAS score was significantly reduced from 5 to 1. Mean Kujala score significantly improved from 69.5 to 94.8. The patellar tilt decreased significantly. There was no significant correlation between final Kujala scores and the presence of anatomical predisposing factor. All patients had negative patellar apprehension tests.
Conclusions:
Using a central strip of the quadriceps tendon in the reconstruction of MPFL in patients with recurrent patellar dislocation is an excellent option.
Level of Evidence:
Level IV.
Background:
A combined adductor canal block and sciatic nerve block is an efficient way to obtain postoperative analgesia after total knee replacement that spares the motor power of the femoral nerve. This is a prospective controlled randomized study comparing the efficacy of local infiltrative analgesia (LIA) to a combined adductor canal block and sciatic nerve block (CNB).
Methods:
Seventy-five patients were included and randomized to two groups. The first (34 patients) received ultrasound guided CNB and the second group (41 patients) received LIA.
Results:
There was no significant difference in pain control after 4, 6, or 12 hr postoperatively, and there was no significant difference in pain before or after physiotherapy. Both groups achieved knee flexion to 90 degrees at comparable times. Operative time and length of hospital stay were significantly less in the LIA group. Opiate use was similar in both groups. One patient in the LIA group had transient popliteal artery spasm postoperatively.
Conclusions:
LIA may be comparable in efficacy to combined adductor canal and sciatic nerve block, moreover it is easier and faster to perform.
Background:
Surgical management of grade III acromioclavicular joint dislocation should be considered in patients who have significant deformity, tenting of the skin, or persistent pain despite nonsurgical management, or in patients who have a higher functional demand. Coracoclavicular ligament reconstruction alone may not be sufficient to prevent anteroposterior translation at the acromioclavicular joint despite preventing superior translation. Reconstruction of the acromioclavicular capsule may be necessary for additional joint stability. The aim of this study was to evaluate the necessity of the capsular reconstruction in the treatment of acromioclavicular dislocation.
Methods:
This is a retrospective comparative study between two groups. The first group, 14 patients, had anatomical coracoclavicular ligament reconstruction without capsular reconstruction. The second group, 19 patients, had capsular reconstruction in addition to acromioclavicular ligament reconstruction.
Results:
Pain, American Shoulder and Elbow Surgery, and Constant Shoulder scores were better in the second group. No cases of failure were reported in any group. Loss of reduction occurred in seven patients in first group (50%).
Conclusions:
Reconstruction of the acromioclavicular capsule in surgical treatment of grade III acromioclavicular joint dislocation may play an important role against loss of reduction.
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