Anterior Cruciate Ligament (ACL) is a knee ligament that is very important in maintaining the stability of the knee joint. The incidence of isolated ACL tears remain a common orthopaedic injury with significant increase in the rate of ACL reconstruction over time. Several types of autografts used for ACL reconstruction have some potential occurrence of donor site morbidity, including Bone-Patellar Tendon-Bone (BPTB), hamstring tendon, and quadriceps tendon. Peroneus longus tendon can be an option as a graft donor because it has biomechanical characteristics that are not significantly different from the hamstring tendon. Purpose: The aim of the study was to evaluate the functional outcome and donor site morbidity of anterior cruciate ligament (ACL) reconstruction using peroneus longus tendon autograft. Methods: This study was an observational analytical with retrospective cohort design using medical record. The functional outcomes were assessed with IKDC, Modified Cincinnati, Tegner-Lysholm, and KSS scoring system 12 months after surgery. Donor site morbidity was assessed with AOFAS and FADI scoring system, eversion strength, and plantarflexion strength. Results: Seventy five patients fulfilled the inclusion criteria (59 males and 16 females). Mean of peroneus longus tendon graft diameters were 8.39 ± 0.69 mm (range 6.5-10 mm). Significant increase of functional score (p<0.05) were found 12 months after surgery. Mean score of IKDC was 55.26 ± 12.76 preoperative; 96.69 ± 3.36 postoperative, Modified Cincinnati was 65.45 ± 16.25 preoperative; 93.29 ± 7.04 postoperative, Tegner-Lysholm was 67.80 ± 15.29 preoperative; 89.71 ± 8.35 postoperative, KSS (Knee) was 65.33 ± 19.46 preoperative; 95.17 ± 5.94 postoperative, and KSS (Function) was 76.52 ± 20.25 preoperative; 93.20 ± 10.29 postoperative. Mean score of AOFAS was 98.93 ± 3.11 and FADI was 99.80 ± 0.59 at six months after surgery. The eversion and plantarflexion strength were not significantly different (p>0.05) between donor and contralateral side ankle. There was neurapraxia in 3 (4%) patients at six months postoperative. Conclusion: The peroneus longus tendon can be an ideal source of graft for ACL reconstruction because it has good functional outcome and minimal donor site morbidity.
Highlights
Complex injury and unique anatomic relationships at the sacropelvic region.
Use of modified approach to access the fracture site of the sacrum where dural tear is common.
No complications after surgery.
Alternative treatments for managing complex pelvic and sacral fractures Denis type 2.
IntroductionCombination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment.Case reportReporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae.ConclusionIncomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management.
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