Effect of Soft Tissue Interposition and Postoperative Suspensory Cortical Button Migration on Functional Outcomes and Ligamentization After Single-Bundle ACL Reconstruction.

Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity. Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores (P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M). Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.

Wohlfahrtiimonas chitiniclastica-related soft-tissue infection and osteomyelitis: A rare case report.

Wohlfahrtiimonas chitiniclastica is a rare pathogen that was first isolated from Wohlfahrtia magnifica, a parasitic fly. It is an uncommon, but an emerging human pathogen reported only in Europe and South America. Until today, it has been reported to be a zoonotic pathogen originating from different geographic locations. The present case, a patient suffering from osteomyelitis in Turkey, represents the first report of this pathogen in this country and so far no reports of related osteomyelitis associated with W. chitiniclastica is available. Clin-ical awareness of these emerging human pathogens is crucial for controlling infectious diseases.

Short-Term Outcomes After Treatment of Isolated Hidden Meniscal Ramp Lesions.

Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ruptures. However, isolated ramp lesions without a ruptured ACL have also been reported. Purpose: To evaluate outcomes after type 3 hidden ramp lesions without ACL rupture were treated with all-inside sutures passed through the standard anterior portal. Study Design: Case series, Level of evidence, 4. Methods: Included were 41 patients (26 female; 63.4%) with isolated type 3 ramp lesions who underwent surgery between January 2017 and January 2019. Patients with concomitant lateral meniscal injuries and revision meniscal surgeries were excluded. We retrospectively recorded patient age, sex, and body mass index (BMI), as well as follow-up periods, comorbidities, and postoperative and early midterm complications. The Lysholm, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were compared preoperatively to final follow-up. In addition, patients were classified as having either a sedentary or active lifestyle according to Sedentary Behavior Research Network (SBRN) criteria. The Shapiro-Wilk test was used to evaluate the normality of the data, and the Wilcoxon and Mann-Whitney U tests were used to compare preoperative and postoperative outcome scores. The Spearman test was employed to evaluate the correlation between patient variables. Results: The mean follow-up period was at 37.6 (range, 25-49) months. A total of 17 patients (41.46%) had a sedentary lifestyle based on SBRN criteria. All scores improved significantly from preoperatively to final follow-up (VAS, from 8.43 ± 1.53 to 2.34 ± 2.9; Lysholm, from 47.73 ± 17.02 to 85.37 ± 14.01; and IKDC, from 27.12 ± 14.81 to 85.32 ± 8.78; P < .001 for all). Although no significant relationship was established between patient activity level and postoperative Lysholm and IKDC scores, an inverse correlation was observed between BMI and Lysholm (r =-0.9906) and BMI and IKDC (r =-0.9402). Conclusion: Satisfactory postoperative clinical results were obtained in patients with type 3 ramp lesions not accompanied by ACL rupture who were treated with all-inside suturing through standard anterior portals.