Transepicondylar Distance Can Predict Graft and Tunnel Length for Different Pediatric Anterior Cruciate Ligament Reconstruction Techniques: A Magnetic Resonance Imaging Study.

PURPOSE: To find a correlation and mathematical formulas between a linear 2-dimensional (2D) magnetic resonance imaging (MRI) measurement around the knee and the length of the grafts and tunnels required for both all-inside-all-epiphyseal and Kocher-Micheli pediatric anterior cruciate ligament (ACL) reconstruction techniques. METHODS: At time 0 and 30 days after, 2 observers measured: (1) on standard 2D knee MRI, 7 linear distances, representing morphologic measurements, such as transepicondylar distance (TD), and (2) on 3-dimensional (3D) MRI, 5 curved distances, corresponding to Kocher-Micheli and all-epiphyseal ACL reconstruction techniques. Intra- and interobserver reliability was tested for all measurements. The correlation between 2D and 3D measurements was tested. The 2D measurement with highest repeatability and reproducibility and with strongest correlation with 3D measurements was used to extract formulas to calculate the tunnel and graft length for the 2 techniques. RESULTS: Seventy-six MRIs were used. The intra- and interobserver reliability of 2D measurement was high, with TD showing the highest reproducibility and repeatability. 3D measurements also showed good intra and inter-observer reliability. A linear correlation was found between 2D and 3D measurements, with TD showing the strongest correlation. TD was used to extract formulas to calculate graft or tunnel length for Kocher-Micheli and all-epiphyseal ACL reconstruction. All formulas were proven to be accurate. A reference chart was also created to be used in the surgical setting. CONCLUSIONS: With specific formulas, TD can be used to calculate the length of the tunnels, intra-articular portion and graft length for an all-inside all-epiphyseal pediatric ACL reconstruction and the length of the iliotibial band required for the Kocher-Micheli technique. CLINICAL RELEVANCE: The surgeon can use these formulas in pediatric ACL reconstruction preoperative planning, graft harvesting and tunnel drilling.

The use of platelet-rich plasma (PRP) in the treatment of gastrocnemius strains: a retrospective observational study.

The aim of the present retrospective observational study was to evaluate the time of functional recovery following a specific combined therapeutic approach characterized by an active exercise therapy carried out immediately after Platelet-rich plasma (PRP) injections for the treatment of the muscular lesion of the distal musculotendinous junction of the gastrocnemius medial head.Medical records of 31 subjects treated with three PRP intra-lesional ultrasound guided injections and 30 patients treated with the standard therapeutic approach (control group) were analyzed. Both groups followed the same rehabilitation therapy. Patients in the control group were able to start active exercise with a significant delay when compared to the PRP treated subjects: 17 ± 7.2 days and 9 ± 3.8 days (p = 0.0001), respectively. This delay was mainly due to the persistence of pain in the subjects in the control group. The time necessary to return to walk without pain was significantly shorter in the PRP treated group: 24.27 ± 12.36 days versus 52.4 ± 20.03 days in the control group (p < 0.001) as well as the time needed to fully return to practice the previous sport activity: 53.33 ± 27.74 days versus 119.3 ± 43.87 days in the control group (p < 0.001).The present study showed that ultrasound guided delivery of PRP into the site of muscle injury has to be considered a valid therapeutic approach with the potentiality of significantly reduce time and costs for reaching a complete functional recovery.

Minimal Damage to the Supinator Muscle After the Double-Incision Technique for Distal Biceps Tendon Repair.

BACKGROUND: The effect of the double-incision technique on the supinator muscle is unclear. PURPOSE: The aim of this study was to quantify fatty atrophy of the supinator muscle and map the area of muscle damage. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 19 male patients (median age, 43 years) who underwent distal biceps tendon repair were included in the analysis. Patients with a minimum of 12 months of follow-up were included. The following variables were analyzed: range of motion; shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Summary Outcome Determination (SOD) score; and isokinetic peak force and endurance in supination. Quantitative analysis and mapping of fatty infiltration of the supinator muscle were based on the calculation of proton density fat fraction on magnetic resonance imaging scans of both elbows using the IDEAL (Iterative Decomposition of Echoes of Asymmetrical Length) sequence. RESULTS: At an average follow-up of 24 months (range, 12-64 months), the median SOD score was 9.0 (95% CI, 7.8-9.4), and the mean QuickDASH score was 6.7 (95% CI, 0.0-14.1). A difference of 17% in peak torque was measured between repaired and nonrepaired elbows (repaired elbow: 9.7 N·m; nonrepaired elbow: 11.7 N·m; P = .11). Endurance was better in the repaired elbow than the nonrepaired elbow (8.4% vs 14.9% work fatigue, respectively; P = .02). The average fat fraction of the supinator muscle was 19% (95% CI, 16%-21%) in repaired elbows and 14% (95% CI, 13%-16%) in contralateral elbows (P = .04). The increase in fat fraction was located in a limited area between the radius and ulna at the level of the bicipital tuberosity. CONCLUSION: The assessment of the supinator muscle showed a limited increase in fat fraction between the radius and ulna at the level of the bicipital tuberosity. No significant effect on supination strength was highlighted.