Tubularization of Bone-Tendon-Bone Grafts: Effects on Mechanical Strength and Postoperative Knee Stability in Anterior Cruciate Ligament Reconstruction.

Background and Objectives: The study addresses a significant limitation in applying bone-patellar tendon-bone (BTB) grafts in anterior cruciate ligament (ACL) surgery. By exploring the tubularization of grafts, the study extends the understanding of this surgical technique. The dual approach of the study-focusing on biomechanical properties using an animal model and postoperative outcomes in humans-offers a comprehensive perspective. Materials and Methods: The experimental cohort encompassed ten pairs of fresh porcine bone-tendon-bone grafts. One graft in each pair underwent modification through sutures that transformed the flat graft into a cylindrical structure. Testing determined the force required for the modified graft to rupture mechanically, expressed as N/mm2, compared to conventionally prepared bone-tendon-bone grafts. The second phase of the research involved a prospective randomized clinical trial comprising 120 patients undergoing operative ACL reconstruction. For half the cases, grafts were tubularized using a random selection process. Clinical evaluations preoperatively and 12 months postoperatively employed the Tegner, Lysholm, and IKDC scoring scales for knee assessment. Results: Experiments showed that ligaments made using the tubularized surgical technique have statistically significantly higher values of measured force and higher maximum elongation values than ligaments made using the classical method. The clinical study concluded that there was no significant difference between the two groups of patients in the average score on the Tegner, Lysholm, and IKDC scales before and after surgery. Conclusions: The study results showed that suturing the graft does not negatively affect its biomechanical properties, and tubularization significantly increases the values of force required to cause rupture and the values of maximum elongation during rupture. Given the possibility of the one-year follow-up period being insufficient, future investigations should extend this period to acquire objective functional insights post-surgery.

Segmental Humeral Head Reconstruction in Patients with Chronic Locked Posterior Shoulder Dislocation.

Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25-50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant's scoring scale was used. Results: The average value of Constant's point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant's point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25-50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods.

Prognostic importance of steroid receptor status for disease free and overall survival after surgical resection of isolated liver metastasis in breast cancer patients.

PURPOSE: Breast cancer (BC) is the most common malignancy among women, while isolated operable liver metastases (LMs) from BC are very rare and occur in only 1-5% of the patients. Besides, positive steroid receptor (SR) status for oestrogen and/or progesterone is known as a factor which improves disease free survival (DFS) and overall survival (OS). The primary aim of this study was to examine the impact of SR status on DFS and OS after liver metastasectomy in female patients with primary BC. METHODS: We analyzed 32 medical records of female patients diagnosed and treated for primary BC with LMS as the first and only site of disease progression, at the Institute of Oncology and Radiology of Serbia (IORS), during 2006- 2009. All of them underwent primary BC surgery as well as LMs resection. RESULTS: Patients with metachronous BC and LMs and positive SR status in both BC and LM (BC+/LM+) had a median time from BC to LM occurrence (TTLM) of 36 months, compared to BC+/LM- and BC-/LM- subgroups, whose medians for TTLM were 30.5 and 14.5 months, respectively (p<0.01). For all patients, positive SR status showed high correlation with longer DFS and OS after LM resection (medians according survival analysis for DFS/OS in subgroups BC-/LM-, BC+/LM- and BC+-LM+ were 10/19, 25/45, 50/not reached months respectively; p<0.01 for DFS/ OS). Cox regression analysis confirmed that the subgroup of patients with BC-/LM- had 10.8 and 18.8 higher risk of events for DFS (disease relapse or death) and event for OS (death only), respectively, compared to BC+/LM+ subgroup of patients. CONCLUSION: Positive SR status in BC and LM has a high impact not only on time from BC to LM occurrence, but also on longer DFS and OS after LM resection.

Diazepam diminishes temozolomide efficacy in the treatment of U87 glioblastoma cell line.

AIMS: Many patients with glioblastoma (GBM) suffer from comorbid neurological/psychiatric disorders and, therefore, are treated with psychopharmacological agents. Diazepam (DIA) is widely adopted to treat status epilepticus, alleviate anxiety, and inhibit chemotherapy-associated delayed emesis in GBM patients. Even though temozolomide (TMZ) and DIA could be found as possible combination therapy in clinical practice, there are no reports of their combined effects in GBM. Hence, it may be of interest to investigate whether DIA enhances the antitumor efficacy of TMZ in GBM cells. METHODS: U87 human GBM was used to examine the effects of combined TMZ and DIA on cell viability, and the oxygen consumption within the cells, in order to evaluate mitochondrial bioenergetic response upon the treatment. RESULTS: The cooperative index showed the presence of antagonism between TMZ and DIA, which was confirmed on long-term observation. Moreover, the level of apoptosis after the TMZ treatment was significantly decreased when administered with DIA (p < 0.001). Concomitant use of TMZ and DIA increased the basal cell respiration rate, the oxidative phosphorylation rate, and maximal capacity of mitochondrial electron transport chain, as well as the activities of complexes I and II, vs. TMZ alone (p < 0.001). CONCLUSION: Comparing our results with data reported that DIA elicits cell cycle arrest in the G0/G1 phase and favors senescence reveals that DIA diminishes TMZ efficacy in concomitant use in the treatment of GBM. However, due to its great potency to hinder GBM proliferation and metabolism, it could be considered using DIA as maintenance therapy after TMZ cycles.

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis.

(1) Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth's method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: "Schroth exercise", "idiopathic scoliosis", "Cobb angle", "angle of trunk rotation", and "quality of life". Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. (3) Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = -0.492, p ˂ 0.005); ATR (ES = -0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). (4) Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis.

THE IMPACT OF COMBINED MENISCUS TEAR ON QUALITY OF LIFE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

INTRODUCTION: An anterior cruciate ligament injury represents a significant epidemiological problem worldwide, especially due to involving young, sporty and active working-age population. This study has been conducted in order to compare the quality of life of patients who had isolated anterior cruciate ligament tear and of those who suffered from anassociated meniscal injury. MATERIAL AND METHODS: This study included 185 patients who had undergone reconstruction of the anterior cruciate ligament at the Department of Orthopedic Surgery and Traumatology in Novi Sad from January lst, 2012 to December 31st 2012. The patients vere divided into 2 groups: group AZ consisted of patients who had anterior cruciate ligament reconstruction only, and group B consisted of patients who had partial meniscectomy in addition to the anterior cruciate ligament reconstruction. The follow-up period was 12 months. RESULTS: Distribution of patients by gendei was significantly in favor of men. In our study, 146 patients ~vere male and 39 patients ~vere female. The average age of patients was 26.1 years overall (16-55 years), being 26.9 years tbr men, and 23.3 years for female patients. Out of 185 patients, 110 had an isolated anterior cruciate ligament injury, while 75 suffered both meniscus, internal or external, and anterior cruciate ligament injury. CONCLUSION: The comparison of the quality of life of patients in both groups showed no statistically significant difference. Therefore, we were not able to prove the hypothesis about the superior quality of life of those patients who had suffered from a runnired anterior cruciate linament only.

INFLUENCE OF DIFFERENT LEVELS OF SPORTS ACTIVITIES ON THE QUALITY OF LIFE AFTER THE RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT.

INTRODUCTION: The goal of this study was to examine the nature and presence of influence of different levels of sports activity on the life quality of the patients a year after the reconstruction of anterior cruciate ligament. MATERIAL AND METHODS: The study included 185 patients operated at the Department of Orthopedic Surgery and Traumatology of the Clinical Centre of Vojvodina, who were followed for twelve months. Data were collected using the modified Knee Injury and Osteoarthritis Outcome Score questionnaire which included the Lysholm scale. RESULTS: This study included 146 male and 39 female subjects. The reconstruction of anterior cruciate ligament was equally successful in both gender groups. In relation to different types of sports activity, there were no differences in the overall life quality measured by the questionnaire and its subscales, regardless of the level (professional or recreational). However, regarding the level of sports activities, there were differences among the subjects engaged in sports activities at the national level as compared with those going in for sports activities at the recreational level, and particularly in comparison with physically inactive population. A significant correlation was not found by examining the aforementioned relationship between sports activities. CONCLUSIONS: This study has shown that the overall life quality a year after the reconstruction of the anterior cruciate ligament does not differ in relation to either the gender of the subjects or the type of sports activity, while the level of sports activity does have some influence on the quality of life. Professional athletes have proved to train significantly more intensively after this reconstruction than those going in for sports recreationally.

ASSESSMENT OF QUALITY OF LIFE IN PATIENTS AFTER LOWER LIMB AMPUTATION.

INTRODUCTION: Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. MATERIAL AND METHODS: The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female) with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND) 36--Item Health Survey 1.0 (SF-36) was used to measure the quality of life. RESULTS: The results showed that patients with lower extremity amputation scored lower than the control group on all SF-36 variables (p<0.05). None of the SF-36 variables differed between the genders (p>0.05). Seventeen (61%) patients were with transfemoral, and 11 (39%) with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05). CONCLUSION: The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

Surgical treatment of shoulder rotator cuff injuries.

INTRODUCTION: The rotator cuff is the most important functional structure of the shoulder. The aim of this study was to determine which factors contribute to a rotator cuff injury and to evaluate the results of the surgical treatment at the Department of Orthopedic Surgery and Traumatology in Novi Sad since December 2009 until May 2012. MATERIAL AND METHODS: The study sample consisted of 20 patients who had been operated for a shoulder rotator cuff injury. Their mean age was 56.8 +/- 9.1. RESULTS: According to the Constant Shoulder Score, 75% of the patients had excellent and good results. A statistically significant difference (p < 0.05) was found between Constant Shoulder Score of the operated should and the opposite shoulder as well as between the range of external and internal rotation and abduction. After the surgical treatment, 95% of the patients have no limitations in the activities of daily living and they are satisfied with the results of treatment. CONCLUSION: Surgical treatment of a shoulder rotator cuff injury is reliable, time-tested and provides good clinical results especially in patients who were operated within the first three weeks after the injury.

Causes of anterior cruciate ligament injuries.

In order to prevent anterior cruciate ligament injuries it is necessary to define risk factors and to analyze the most frequent causes of injuries--that being the aim of this study. The study sample consisted of 451 surgically treated patients, including 400 sportsmen (65% of them being active and 35% recreational sportsmen), 29% female and 71% male; of whom 90% were younger than 35. Sports injuries, as the most frequent cause of anterior cruciate ligament injuries, were recorded in 88% of patients (non-contact ones in 78% and contact ones in 22%), injuries occurring in everyday activities in 11% and in traffic in 1%. Among sportsmen, reconstruction of the anterior cruciate ligament was most frequently performed in football players (48%), then in handball players (22%), basketball players (13%), volleyball players (8%), martial arts fighters (4%). However, the injury incidence was the highest among the active basketball players (1 injured among 91 active players). Type of footwear, warming up before the activity, genetic predisposition and everyday therapy did not have a significant influence on getting injured. Anterior cruciate ligament injuries happened three times more often during matches, in the middle and at the end of a match and training session (79%), at landing after the jump or when changing direction of movement (75%) without a contact with other competitors, on dry surfaces (79%), among not so well prepared sportsmen.

[Reconstruction of anterior cruciate ligament by using two different techniques].

INTRODUCTION: Modern literature concerning reconstructions of Anterior Cruciate Ligament is mostly focused on the choice of graft (hamstring or bone-tendon-bone), its placing, tensioning and fixation. The bone-hamstring-bone graft consists of compressed cancellous bone on its ends and it has been developed to achieve a more rigid fixation of the graft. The aim of this study was to compare the postoperative results in surgically treated patients two years after the reconstruction of anterior cruciate ligament. MATERIAL AND METHODS: The study included 55 patients divided into two groups according to the implanted graft: bone-tendon-bone and bone-hamstring-bone graft. The results were assessed by Tegner and Lysholm scoring systems, arthrometric measurements, functional tests and International Knee Documentation Committee standard. RESULTS: The average postoperative results did not show a statistically significant difference (p < 0.05) between the two groups (94 in the bone-tendon-bone group versus 93 in the bone-hamstring-bone group) according to Lysholm scoring system, nor in the arthrometric measurements obtained by Lachman test (2.0:2.1). According to the International Knee Documentation Committee standard, the bone-hamstring-bone group had more excellent results, but also three unsatisfactory ones; so, the bone-tendon-bone group was found to have uniform and better results (100% of excellent and good results vs. 91% in the bone-hamstring-bone group). Better results were also recorded by Tegner scoring system in the bone-tendon-bone group (8.6 vs. 7.1) due to the fact that there were more active athletes and greater preoperative level of activities in this group (3.1 vs. 7.1 in the bone-hamstring group). CONCLUSIONS: The choice of graft is a less important factor in the reconstruction of anterior cruciate ligament than its placing, tensioning and fixation, because a significant difference between groups was recorded only by the International Knee Documentation Committee standard.

The surgical treatment of the recurrent dislocation on the shoulder joint with minimum invasion anterior approach.

Shoulder joint is one of the spherical joints and one of the most movable but also the most unstable joint of locomotive apparatus. The aims of this work are to review and analyse the results of medical treatment of frontal recurrent dislocations on the shoulder with open surgery technique on the Clinic for Orthopaedic Surgery and Traumatology in Novi Sad in the period from 2002 to 2005. Twenty one patients with anterior recurrent dislocations of the the shoulder were operated on, 19 men and 2 women. The average age of those patients was 24.8 (15-40 year-olds). Ten patients had an injury of the left and 11 patients the injury of the right shoulder. There were eight handball players, four fighting skills players; two of them played volleyball and one was a basketball player. Six of them were not sportsmen. The preoperational and post operational mean value of the modified Rowe scale showed a statistically significant difference (P < 0.001). Observing the patients after the operation in the period of 2 years, according to Neer scale, 3 patients (14.28%) had great results (grade over 90), 16 patients (76.19%) had a good result, (75-89), and only two patients (9.52%) had results less than 75. The measuring of the volume of movements after physical treatment in 12 patients (57.14%) has shown the decrease of the outside rotation. Open surgery treatment of the front unstable shoulder joint is reliable and time tested and it gives good clinical results in young sportsmen with undirected unstable, bigger number of dislocations and associated osseous defects.

[Revision anterior cruciate ligament reconstruction due to knee instability].

INTRODUCTION: The primary goal of anterior cruciate ligament reconstruction is to provide stability to the knee and regain full range of motion. Although great improvement has been achieved in surgical techniques and rehabilitation, some patients are not completely satisfied with the results of surgery and a revision anterior cruciate ligament reconstruction is necessary. MATERIAL AND METHODS: Revision arthroscopic anterior cruciate ligament reconstruction was carried out in eleven patients with bone-tendon-bone autografts. The surgery was performed in a standard manner and the graft was taken from the opposite knee. Eight men and three women were evaluated. The mean age of patients was 26 (17-34) years. Repeated instability of the knee was caused by injury in five patients, while six patients were unsatisfied with the position of the graft. RESULTS: The follow up was 4,2 years (2-8) respectively. The mean Lysholm and Gillquist score after operation was 88 (65-90). Preoperative and postoperative tibial shift was 9mm (6-15) and 2mm (0-4), respectively. The preoperative pivot shift test was grade 2 and 3 in all patients. Postoperative pivot shift test was negative in seven patients, in three it was grade 1 and grade 2 in one patient. According to the IKDC scale, preoperative results were abnormal in three patients and in eight they were severly abnormal. Postoperative IKDC score was normal in five patients, in four nearly normal, and in one patient the score was still abnormal. Five patients continued to be active in sports activities, four patients decreased the level of sports activity and two stopped all sports activities. CONCLUSION: Success of revision anterior cruciate ligament reconstruction requires detailed preoperative evaluation of the repeated instability of the knee. The treatment plan is then decided upon. The patients must be preoperativevely informed about the real possibilities of revision surgery. Only a mutual collaboration between the patient, physiatrist and a surgeon is a key for successful treatment and return to previous level of sports activities.

[Treatment of knee flexion contracture in patients with chronic juvenile arthritis--a case report].

INTRODUCTION: Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. CASE REPORT: A 23-year-old female patient with chronic juvenile arthritis since the age of one was admitted for treatment of flexion contractures in both knees, muscle hypotrophy, loss of strength and gait disability. The patient underwent arthroscopic synovectomy. The operation was first performed on the right and after 3 mouths on the left knee. The preoperative range of motion in the right knee was 30 degrees - 70 degrees and in the left 40 degrees - 80 degrees. The patient underwent intensive physical therapy to reduce postoperative swelling of knees and firstly passive and then active kinesitherapy. Nine months after the first surgery and six months after the second, the range of motion in the right knee was 0 degrees - 100 degrees and in the left 0 degrees - 105 degrees. The strength of tested muscles was increased and gait was improved. CONCLUSION: Management and rehabilitation of patients with chronic juvenile arthritis include maintenance or improvement in position and function of joints that is achieved with synovectomy. The results depend on combined interdisciplinary rehabilitation, well-experienced staff and pre- and post-operative physiotherapy as well as kinesitherapy. Arthroscopic synovectomy has many advantages and we believe that it was a better solution than open capsulosynovectomy in this patient with chronic juvenile arthritis of the knee.

[Correlation between radiological and clinical findings after anterior cruciate ligament reconstruction].

INTRODUCTION: In the last two decades, the gold standard for anterior cruciate ligament reconstruction is the bone-patellar tendon-bone graft procedure. Correct position of the bone-patellar tendon-bone graft significantly affects the postoperative knee stability. The aim of this study was to establish if and how clinically measured knee stability is associated with radiographic position of bone-patellar tendon-bone graft in the femoral and tibial bones. MATERIAL AND METHODS: The prospective study included 39 patients, 30 men and 9 women. We analyzed and compared results of clinical and radiographic examinations prior to and 2 years following surgery. RESULTS: The mean arthrometric difference between the anterior tibial movement prior to surgery was 11.2 mm and 2.4 mm (p < 0.05) after surgery. The preoperative Tegner and Lysholm score was 1.49, and postoperative 8.23 (p < 0.05). The preoperative Lysholm-Gillquist scale was 51.56 and postoperative 97.74 (p < 0.05). The International Knee Documentation Committee (IKDC) scores were as follows: grade A in 32 patients (84.6%), grade B in 5 patients (12.8%), and grade C in 1 patient (2.6%). By comparison of IKDC scores and radiographic parameters (M1-M10) of anterior-posterior and profile views, a statistical significance was found only between IKDC and M9 index (sagittal femoral index OR'/RR' x 100). DISCUSSION: By using bone-patellar tendon-bone grafts, it is not possible to entirely achieve anatomical positions. Correct graft position within the bone tunnels is of great significance concerning knee stability after anterior cruciate ligament reconstruction. CONCLUSION: Correlation between radiological and clinical findings after anterior cruciate ligament reconstruction in our 39 patients shows that only the position of the graft affects the clinical outcome. Posterior graft location provides better clinical outcome and knee stability. On the other hand, anterior location is associated with worse postoperative IKDC scores, unstable knee and worse clinical outcome.

[False aneurysm following arthroscopic meniscectomy of the knee]. / Lazna aneurizma posle artroskopske meniscektomije kolena.

INTRODUCTION: Blood vessel injuries during arthroscopic knee surgeries are unusual and rare and comprise less than 1% of all arthroscopic complications. Between 1990 and 2004, at the Department of Orthopedic Surgery and Traumatology, Institute of Surgery, Novi Sad, 2100 arthroscopic knee surgeries were carried out. Only one case of false aneurysm of the geniculate lateral inferior artery was reported. CASE REPORT: A 35-year-old professional waiter injured his left knee while getting up from a kneeling position. He had a typical clinical rupture with an interior meniscus lesion. Knee arthroscopy with resection of the torn part of interior meniscus was performed. Seven days later, we observed a subcutaneous tumefaction, 2 cm in diameter, which was warm, pulsating and painful on palpation. It was located in the region of anterolateral portal. Angiography confirmed the existence of a false aneurysm of lateral geniculate inferior artery. Revision of the wound was performed on the exterior side of the knee. The hematoma was removed and the artery tied A month later, the patient fully recovered and returned to his professional activities. DISCUSSION: Only four injuries, that is false aneurysms of the exterior knee artery after knee arthroscopy, have been described so far. The possibility for this injury to occur lies in the fact the artery lies over and is parallel with the lateral knee joint line, at the very entrance of the anterolateral arthroscopic port. Since the latter is the most often used arthroscopic port to access the knee, the above injury is possible, but it does not minifest clinically. This complication is easily diagnosed by a pulsating tumefaction in the area of arthroscopic port and is confirmed by angiography. These rare blood vessel injuries, do not affect the usage of anterolateral arthroscopic procedure. If the injury does exist,, revision of the wound and artery ligature should be carried out, which does not affect the final treatment results.

[Patellar fracture after reconstruction of the anterior cruciate ligament--case report]. / Prelom patele posle rekonstrukcije prednjeg ukrstenog ligamenta--prikaz slucaja.

INTRODUCTION: The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL) rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002), 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. CASE REPORT: An 18-year-old female patient, a handball player, suffered an acute rupture of anterior cruciate ligament of the left knee, so arthroscopic bone-tendon-bone reconstruction of the anterior cruciate ligament was performed. After adequate skin incision, a bone graft was taken from the patella and upper part of trapezoid tibia, which was 25 mm long, 10 mm wide and 5 mm thick, together with a part of patellar ligament. After the remains of the anterior cruciate ligament had been arthroscopically removed, tunnels were made in tibia and femur and a graft was inserted and fixed with two metal interference screws. Knee stability was tested, and drainage was put in the knee joint. The wound was closed by layers. The quadriceps exercises and passive knee movements started immediately. Full range of movements was accomplished six weeks later when the patient started to walk with full weight-bearing on her operated leg. Three weeks later, (nine weeks after the operation), the patient has accidentally lost her balance and fell. A transverse, dislocated fracture of the left patella was diagnosed and osteosynthesis of the fractured patella with two Kirschner wires and a metallic loop was performed. Postoperatively, full range of movement was allowed. Six months later, the patient felt no pain, there was no swelling, full range of knee movement was achieved, while the Lachman Test was identical in both knees and the pivot shift test was negative. DISCUSSION: Fracture of patella after ACL reconstruction is due to several reasons: size and shape of the graft, technique of its taking, disturbed patellar blood supply, incomplete filling of patella defect after graft taking, and inappropriate postoperative rehabilitation. If a patellar fracture occurs after anterior cruciate ligament reconstruction, the best treatment is firm osteosynthesis, which enables bone healing and immediate continuation of the previously resumed rehabilitation program. However, this complication prolongs the rehabilitation period and slows down return to sports.