Arthroscopic Physeal Sparing Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis With Semitendinosus and Gracilis Tendons.

Anterior cruciate ligament (ACL) injuries among young patients have increased in recent years. The purpose of this study was to present a physeal-sparing intra- and extra-articular reconstruction using semitendinosus and gracilis tendons autograft. In recent years, the management of these injuries in the pediatric population has become increasingly surgical to restore knee function and reduce the risk of meniscal and chondral injury due to persistent knee instability. However, this is a population at high risk for ACL graft rupture, but it can be lowered by an addition of lateral extra-articular tenodesis (LET). This study shows the pearls and pitfalls of an arthroscopic physeal-sparing ACL reconstruction combined with a concomitant LET using hamstrings autograft.

Return to Soccer After Acute Anterior Cruciate Ligament Primary Repair: A 2-Year Minimum Follow-up Study of 50 Amateur Players.

BACKGROUND: Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. PURPOSE: To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL-Return to Sport After Injury scale, and the Forgotten Joint Score-12. RESULTS: The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P = .017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P = .041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P = .002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P = .044). CONCLUSION: In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old.

Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and "All Suture" Knotless Anchors for Patellar Fixation.

Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.

Clinical, functional and radiological outcomes of the use of fixed angle volar locking plates in corrective distal radius osteotomy for fracture malunion.

BACKGROUND AND AIM: Fractures of the distal radius are a common injury and mal-union can occur in those managed non-operatively. This can cause significant functional limitations along with pain. A corrective osteotomy with the use of a volar locking plate aims to restore articular surface congruency and improve outcomes. We present our local experience with clinical, functional and radiological outcomes of corrective osteotomy using a fixed angle volar locking plate and bone graft for management of distal radius mal-union. METHODS: Retrospective study. All adult patients. Both pre and post operatively clinical range of motion was recorded. Post operative PROMS was measure by DASH, MAYO and SF-12 and pain by means of a VAS measured from 0-10. Mean follow up period was at 15 months. RESULTS: 32 patients underwent the studied procedure. 24F-8F. Mean age: 56. Radiological union of corrective osteotomy: 28 (88%) of patients. 4 patients required further operative treatment to achieve corrective union. No other reported complications post-op. Post-operatively flexion improved by 24 and extension 20. Pronation was improved by 24 and supination 22. Pain was improved from an average VAS pre-operative of 5.6 to 1.6 post-operatively. Mean DASH scored improved from 57.8 to 16.2 post-operatively and MAYO 38.5 to 58.6. The mean post-operative SF-12 score was 46.2 from 31. CONCLUSIONS: In this series of 32 patients (the biggest reported in the literature in our knowledge) a  corrective osteotomy with fixed-angle volar locking plate for mal-united distal radius has shown to improve both clinical-radiological and patient reported outcomes and provide good results of the very few complications' treatments.