The prognosis of iatrogenic saphenous nerve injuries during hamstring tendon harvesting in anterior cruciate ligament reconstruction.

PURPOSE: This study aims to evaluate the long-term outcomes of saphenous nerve (SN) injuries from hamstring tendon harvesting during ACL reconstruction, focusing on clinical results and patient satisfaction after at least two years. Additionally, it investigates the incidence, recovery patterns, and impact of these injuries on functional outcomes, daily activities, and ACL re-rupture rates immediately post-surgery and at final follow-up. MATERIALS AND METHODS: A retrospective review was conducted on patients who had undergone ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The incidence of SN injuries was assessed immediately after surgery and at final follow-up. Additionally, the recovery rate and time were evaluated, and the impact of these injuries on functional outcomes was measured using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. RESULTS: Of the 159 patients analyzed, iatrogenic SN injuries were initially observed in 87 (54.7%) patients post-ACLR. By the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injuries were recorded in 51 (32.1%) patients, affecting various extents of the infrapatellar branch (IPBSN) and the sartorial branch (SBSN) of the saphenous nerve. Patients with persistent SN injuries experienced a significant impact on daily activities and had lower LKS scores compared to those without injuries or with recovered injuries. Furthermore, a higher re-rupture rate was associated with persistent SN injuries. CONCLUSIONS: The study finds that SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits for at least two years postoperatively. These injuries are observed to adversely affect patient satisfaction and functional outcomes and to increase the re-rupture rate.

Relationship between serum vitamin D levels and the prevalence of knee osteoarthritis: A retrospective study on 3424 subjects.

BACKGROUND: The extent of the association between vitamin D deficiency and knee osteoarthritis remains inadequately understood. OBJECTIVE: This study aimed to elucidate the relationship between vitamin D levels and knee osteoarthritis through a cross-sectional analysis. METHODS: This retrospective study involved an analysis of knee radiographs and serum 25-hydroxyvitamin D3 (25-(OH) vitamin D3) levels in a cohort of 3424 individuals (2901 women and 523 men). Knee osteoarthritis severity was evaluated using the Kellgren-Lawrence radiological scoring system. RESULTS: Of the participants, 49.2% (n= 1,683) were diagnosed with knee osteoarthritis. Among these patients, the levels of adjusted 25-(OH) vitamin D3 were significantly lower (p< 0.001). Regression analysis revealed a significant association between vitamin D deficiency and knee osteoarthritis, with an adjusted odds ratio (OR) of 1.7 (95% CI: 1.5-2.0; p< 0.001). Notably, a stronger association was observed between vitamin D deficiency and knee osteoarthritis in women under 65 compared to those aged 65 and above. CONCLUSIONS: The findings of this study indicate a higher prevalence of vitamin D deficiency in patients with knee osteoarthritis. Maintaining adequate serum 25-(OH) vitamin D3 levels may prevent knee osteoarthritis, especially in women below 65.

Is the Akagi Line a Reliable Landmark for Adjusting the Rotational Axis of the Tibial Component in Patients with Patellofemoral Instability?

Purpose: This study aimed to investigate whether the Akagi line is a reliable anatomic landmark for adjusting the rotational axis of the tibial component in patients with patellofemoral (PF) malalignment. Materials and methods: This retrospective case-control study included 86 patients with PF instability and 129 controls. On the superimposed axial CT images, TT-TG, TT-PCL, nTT-TG, nTT-PCL, knee joint rotation, and the angle between the Akagi line and surgical transepicondylar axis (Akagi/sTEA angle) were measured. In addition, a modified Akagi line, drawn 1 cm medial to the patellar tendon attachment, was defined, and the angle between the new Akagi line and sTEA (mAkagi/sTEA angle) was also measured and compared between groups. Results: There were 86 patients (47 females, 39 males) in the case group and 129 patients (56 females, 73 males) in the control group with a mean age of 35.7 ± 17.9 years and 41.1 ± 18.8 years, respectively (p < 0.001). Radiologic variables of PF alignment (TT-TG, TT-PCL, nTT-TG, nTT-PCL, and knee joint rotation) were significantly abnormal in the case group (p < 0.001 for all variables). The Akagi/sTEA angle was significantly higher in the case group, resulting in 89.5% external malrotation of the tibial component (> 10°). However, the tibial component was 96.5% aligned correctly (between 10° external and 3° internal rotation) in the control group. Using the modified Akagi line significantly improved the rotational alignment, and normal tibial rotation increased to 93.3% of the case group. The Akagi/sTEA angle strongly correlated with the knee rotation (rho: 0.735, p: 0.001), TT-TG (rho: 0.715, p: 0.001) and nTT-TG (rho: 0.783, p: 0.001). But the TT-PCL (rho: 0.459, p: 0.001) and nTT-PCL (rho: 0.589, p: 0.001) had a medium correlation. Conclusions: The Akagi line might cause unacceptable external rotation of the tibial component in patients with PF malalignment. The use of the modified Akagi line described in this study may be a solution for the rotational mismatch between femoral and tibial components in TKA. Level of evidence: Level III, retrospective case-control study.

Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison.

PURPOSE: This study aimed to compare the clinical, radiological, aesthetic and economic outcomes of extension pin block technique and extension orthosis in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation (Wehbe and Schneider classification type IB and IC). MATERIALS AND METHODS: Thirty-nine patients (11 women and 28 men; mean age: 40.9±11.5 years) who had mallet fractures were retrospectively reviewed. Twenty-one patients were treated with the extension pin block technique, and the remaining 18 were treated with the extension orthosis. Fracture classification, measurement of articular surface involvement, presence of subluxation, and the fragment displacement were performed according to the Wehbe and Schneider classification. Crawford's criteria, extension lag, distal interphalangeal joint (DIPJ) range of motion, dorsal bump, and visual analog scale were evaluated. Fracture union, articular incongruity, and all other complications were followed and analyzed. The Michigan Hand Questionnaire (MHQ) was used to evaluate the aesthetic perception of the patient's finger. Direct and indirect costs were calculated for each treatment method. RESULTS: At the final follow-up (mean: 18.4±6.2 months), there was no significant difference with respect to clinical outcomes between groups (p=0.335) and pain (p=0.131). Fracture union was achieved in all cases. Both extension lag (p=0.150) and DIPJ flexion (p=0.261) were not different between groups. Dorsal bump was more frequent in the conservative treatment group (p=0.048). Aesthetic scores were similar between groups (p=0.477), but female patients rated significantly lower aesthetic scores than males (p=0.003) regardless of the treatment method. The direct medical (p=0.001), indirect (p=0.009) and cumulative costs (p=0.001) were significantly higher in surgical treatment group. One pin tract infection, one nail dystrophy, and one joint space narrowing were seen in the surgical treatment group versus none in the conservative treatment group (p=0.698). CONCLUSIONS: Conservative treatment does not result in inferior clinical, radiographic and aesthetic outcomes compared to surgical fixation in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation. Extension orthosis which is non-invasive, and cheap, maybe the treatment of choice in closed mallet fractures. LEVEL OF EVIDENCE: IV; Retrospective cohort.