Outcome of percutaneous reconstruction of chronic lateral collateral ligament rupture.

PURPOSE: Many techniques have been described for the reconstruction of chronic lateral collateral ligament (LCL) rupture with different autograft options. The advantages of percutaneous LCL reconstruction include small incisions, minimal soft tissue disruption, less postoperative pain, and speedy rehabilitation and recovery. The aim of this study was to report the functional outcome of percutaneous LCL reconstruction and overall patient satisfaction in Africans. METHODS: This prospective and interventional study involving 51 patients with chronic LCL rupture who had percutaneous LCL reconstruction using peroneus longus autograft was conducted between January 2021 and December 2022 in National Orthopaedic Hospital, Dala-Kano, Nigeria. The inclusion criteria were patients between the ages of 18 and 45 years with chronic isolated LCL and not more than 1 injury of knee ligament. Exclusion criteria were active infection, and multi-ligament knee injury requiring 2-staged surgery. The knee functions were assessed preoperatively, 3 months, 6 months, and 12 months postoperatively using the Lysholm scoring system. Patient satisfaction with the outcome of the treatment was assessed using a 5-point Likert scale. Relevant information was recorded into Microsoft Excel sheet and data was analyzed using SPSS version 23.0 for windows. The paired samples t-test was used to compare the clinical outcomes as continuous variables. Statistical significance was considered at p < 0.05. RESULTS: The mean age of the patients was (30.10 ± 5.90) years. The median time from injury to surgery was 7 months (ranging from 3 to 28 months). The mean follow-up period was (14.07 ± 3.13) months. The mean preoperative and 1-year postoperative Lysholm scores were 44.33 ± 12.97 and 97.96 ± 1.23, respectively. CONCLUSION: Percutaneous LCL reconstruction using peroneus longus autograft significantly improves patient knee function and results in excellent patient satisfaction.

Implant factors that might influence components' survival in primary total hip arthroplasty.

Primary total hip arthroplasty (THA) is an invaluable surgical procedure that has revolutionised the treatment of various end-stage hip pathologies. Aseptic loosening of either acetabular cup and/or femoral stem as well as components' dislocation are well-known post-operative complications due to so many factors: environmental, surgeon, patient related, disease related or implant design. The aim of this literature review is to look at some relevant implant designs that might influence acetabular and femoral components' survival for primary cementless THA using revision for aseptic loosening and dislocation as criteria for failure. This may also assist the surgeon in making an informed choice of using appropriate implants to match the demographic and disease-specific need of the patients undergoing the surgical procedure. This review article was performed using an online literature search on relevant publications.

Preoperative percutaneous hamstring tenotomy in a patient with severe flexion deformity undergoing primary total knee replacement: Case report and literature review.

Fixed flexion deformity may accompany severe knee osteoarthritis in patients with long-standing pathology. This makes it difficult to achieve complete knee extension intraoperatively during total knee replacement surgery. Various options of treatment are available including preoperative serial knee extension and casting, intraoperative additional distal femoral resection to increase extension gap, and extensive soft tissue releases. We present this technique of on-table percutaneous medial hamstring tenotomy that we found helpful in achieving complete or near-complete knee extension intraoperatively, thereby minimizing the need for extensive bone resection and soft tissue dissection. An M is a 78-year-old man who presented with inability to walk for a 2-year duration due to pain and deformity of both knees. Complete clinical evaluation revealed the diagnosis of bilateral severe knee osteoarthritis with fixed flexion deformities. Ranges of knee motion were 90°-120° on the right and 80°-125° on the left. On-table percutaneous medial hamstring tenotomy + extension exercise under spinal anesthesia was carried out first and subsequently had posterior stabilized semi-constrained knee replacement. Knee extensions of 160° and 180° were achieved preoperatively after tenotomy and exercise and intraoperatively following distal cuts and soft tissue releases, respectively. This technique may be additive to various attempts at achieving adequate knee extension preoperatively for successful knee replacement. May be further evaluated to assess its effectiveness or otherwise to selected patients with severe flexion contractures undergoing primary total knee replacement.

Résumé Une déformation en flexion fixe peut accompagner une arthrose sévère du genou chez les patients présentant une pathologie de longue date. Cela rend difficile deobtenir une extension complète du genou en peropératoire lors d'une arthroplastie totale du genou. Diverses options de traitement sont disponibles, y compris extension et moulage préopératoires du genou en série, résection fémorale distale supplémentaire peropératoire pour augmenter l'écart d'extension et extension douce libérations de tissus. Nous présentons cette technique de ténotomie percutanée des ischio-jambiers médiaux sur table que nous avons trouvée utile pour obtenir une ou une extension quasi-complète du genou en peropératoire, minimisant ainsi le besoin d'une résection osseuse étendue et d'une dissection des tissus mous. Un Mest un homme de 78 ans qui s'est présenté avec une incapacité à marcher pendant une durée de 2 ans en raison de douleurs et d'une déformation des deux genoux. Clinique complète l'évaluation a révélé le diagnostic d'arthrose sévère bilatérale du genou avec déformations fixes en flexion. Les amplitudes de mouvement du genou étaient de 90° à 120° à droite et 80°­125° à gauche. Une ténotomie percutanée des ischio-jambiers médiaux sur table + exercice d'extension sous rachianesthésie a été réalisée en premier lieu puis a subi une arthroplastie totale du genou semi-contrainte postérieure stabilisée. Extensions du genou de 160° et 180° ont été réalisées en préopératoire après ténotomie et exercice et en peropératoire après des coupes distales et des libérations de tissus mous, respectivement. Cetechnique peut s'ajouter à diverses tentatives pour obtenir une extension adéquate du genou avant l'opération pour une arthroplastie réussie du genou. Peut être évalué plus avant pour évaluer son efficacité ou autrement chez des patients sélectionnés présentant des contractures sévères en flexion subissant une chirurgie primaire du genou remplacement. Mots-clés: Contracture en flexion, ténotomie des ischio-jambiers, arthroplastie totale primaire du genou.