Comparing Sagittal-Plane Biomechanics of Drop Jump Landing in Athletes With and Without Knee Osteoarthritis 2-Year Post-Anterior Cruciate Ligament Reconstruction.

The study aimed to determine differences in sagittal-plane joint biomechanics between athletes with and without knee osteoarthritis (OA) during drop vertical jump 2 years after anterior cruciate ligament reconstruction (ACLR). Forty-one athletes with ACLR completed motion analysis testing during drop vertical jump from 30 cm. Sagittal-plane peak joint angles and moments and joint contributions to total support moment (TSM) were calculated during first landing. Medial compartment knee OA of the reconstructed knee was evaluated using Kellgren-Lawrence scores (ACLR group: Kellgren-Lawrence <2; ACLR-OA group: Kellgren-Lawrence ≥2). The ACLR-OA group (n = 13) had higher hip and lower knee contributions in the surgical limb than the ACLR group and their nonsurgical limb. Further, the ACLR-OA group had higher peak hip extension moment than the ACLR group (P = .024). The ACLR-OA group had significantly lower peak knee extension and ankle plantar flexion moments and TSM (P ≤ .032) than ACLR group. The ACLR-OA group landed with increased hip extension moment, decreased knee extension and ankle plantar flexion moments and TSM, and decreased knee and increased hip contributions to TSM compared with ACLR group. The ACLR-OA group may have adopted movement patterns to decrease knee load and compensated by shifting the load to the hip. Clinicians may incorporate tailored rehabilitation programs that mitigate the decreased knee load to minimize the risk of knee OA after ACLR.

Reasons for Not Returning to Pre-injury Sport Level After ACL-Reconstruction.

The study aimed to identify athlete-reported reasons for not returning to pre-injury sports level after anterior cruciate ligament reconstruction (ACLR) and to identify the factors associated with these reasons. Ninety-one athletes with 2 years post-ACLR indicated whether or not they had returned to their pre-injury sport level (same frequency, duration, and intensity). Athletes who did not return were asked to provide the reasons. Athletes' characteristics and injury-related factors were used to determine factors associated with the reasons for not returning. Only nine athletes (10%) returned to pre-injury sport level after ACLR. The most common reasons for not returning were lack of confidence or concerns about re-injury (48.8%), followed by continued post-surgical impairments in the reconstructed knee (39%). Having episodes of the knee giving way after ACLR was the only significant predictor of post-surgical impairments (48.8%; OR=8.3, 95%CI=2.48-27.42, p=0.001). Lack of confidence, concerns about re-injury, or post-surgical impairments in the reconstructed knee were the most frequently reported reasons for not returning to pre-injury sports level with 2 years post-ACLR. Reported dynamic knee instability was the only factor associated with ongoing post-surgical knee impairments after ACLR. Rehabilitation programs should address athletes' psychological responses and resolve knee impairments to optimize return to pre-injury sport level after ACLR.

Joint contributions to sagittal plane total support moment in patients with knee osteoarthritis after anterior cruciate ligament reconstruction.

BACKGROUND: Patients with anterior cruciate ligament reconstruction (ACLR) demonstrate lower knee loading. This study aimed to determine whether sagittal plane TSM and joint contributions to total support moment (TSM) in the surgical limb are different between athletes who did and did not show radiological features of knee OA at 2 years after ACLR during triple hops (TH), single hop (TH), single-legged vertical jump (VJ), and walking. METHODS: Forty-one athletes with 2 years of unilateral ACLR surgery participated in this cross-sectional study. Athletes completed motion analysis testing of single-legged TH, SH, VJ, and walking tasks. Sagittal plane TSM and individual joint (ankle, knee, and hip) contributions to TSM were computed at peak knee flexion angle (TSM-PKF). Posterior-anterior radiographs were completed in standing and 30° knee flexion. Kellgren-Lawrence (KL) system was used to identify radiological features of knee OA in the medial compartment of the reconstructed knee (OA-group: KL ≥2; Non-OA group: KL<2). RESULTS: There was a significant group-by-joint-by-task interaction for joint contributions to TSM-PKF (p = 0.012), with the OA-group (n = 13) had lower knee and higher hip contributions compared to the non-OA group during TH, SH, and VJ (p ≤ 0.049). There was a significant joint-by-group interaction for the joint contributions to TSM-PKF (p = 0.004), with the OA-group having lower knee (p = 0.003) and higher hip (p = 0.001) contributions compared to the Non-OA group. SIGNIFICANCE: The OA-group exhibited lower knee and higher hip contributions to the sagittal plane TSM compared to the Non-OA group during the landing phase of single-limb high-demand activities. The OA-group exhibited decreased knee loading and compensated by shifting the mechanical load to the hip joint within the reconstructed knee. Decreased knee loading in the OA-group may have affected the required mechanical loading to maintain knee metabolism and integrity.

Patient-Reported Measures Associated with the Return to Pre-Injury Levels of Sport 2 Years after Anterior Cruciate Ligament Reconstruction.

The International Knee Documentation Committee Subjective Knee Form (IKDC2000) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) are knee-specific measures. However, their association with a return to sports after anterior cruciate ligament reconstruction (ACLR) is unknown. This study aimed to investigate the association between the IKDC2000 and the KOOS subscales and the return to the same pre-injury level of sport two years after ACLR. Forty athletes that were two years post-ACLR participated in this study. Athletes provided demographic information, filled out the IKDC2000 and KOOS subscales, and indicated whether they returned to any sport and whether they returned to the same pre-injury level (same duration, intensity, and frequency). In this study, 29 (72.5%) athletes returned to play any sport and eight (20%) returned to the same pre-injury level. The IKDC2000 (r: 0.306, p = 0.041) and KOOS quality of life (KOOS-QOL) (r: 0.294, p = 0.046) significantly correlated with the return to any sport, but it was age (r: -0.364, p = 0.021), BMI (r: -0.342, p = 0.031), IKDC2000 (r: 0.447, p = 0.002), KOOS-pain (r: 0.317, p = 0.046), KOOS sport and recreation function (KOOS-sport/rec)(r: 0.371, p = 0.018), and KOOS QOL (r: 0.580, p > 0.001) that significantly correlated with a return to the same pre-injury level. High KOOS-QOL and IKDC2000 scores were associated with returning to any sport, and high KOOS-pain, KOOS-sport/rec, KOOS-QOL, and IKDC2000 scores were all associated with returning to the same pre-injury level of sport.

Hip Abductor and External Rotator Strengths Correlate With Hop Symmetry in Men Athletes 2 Years After Anterior Cruciate Ligament Reconstruction.

CONTEXT: Hip muscle strength and hop performance limb symmetries after anterior cruciate ligament reconstruction (ACLR) are not well studied. This study aimed to determine the differences in hip abductors' (ABD) and external rotators' (ER) muscle strength measures between limbs, and the relationship between hip ABD and ER muscle strengths and hop performance limb symmetry indices (LSIs) 2 years after ACLR. DESIGN: Cross-sectional study. METHODS: Forty (level I/II) men athletes 2 years after unilateral ACLR completed 4 single-legged hop tests and involved hip ABD and ER strength testing (maximum voluntary isometric contraction [MVIC]; isokinetic peak torque [PKTQ] at 60°, 180°, and 300°/s; and isotonic peak velocity at 75% of their MVICs). Muscle strength measures were normalized to body mass, and hop performances were reported as LSIs. Paired t test was used to determine strength differences between limbs, and the Pearson correlation coefficient was used to assess the relationship between involved hip muscle strength measures and hop performance LSIs. RESULTS: Hip ER-MVIC (involved: 60.26 [12.01], uninvolved: 63.68 [13.17] N·m/kg) and ER eccentric PKTQ at 60°/s (involved: 32.59 [9.28]; uninvolved: 35.73 [10.50] N·m/kg) were significantly different between limbs (P ≤ .018). Single-hop LSI correlated with hip ER-PKTQ at 180°/s (r = .354) and 300°/s (r = .324, P ≤ .041), while triple-hop LSI correlated with hip ER-MVIC (r = .320), concentric ER-PKTQ at 180°/s (r = .355), eccentric ER-PKTQ at 60°/s (r = .314), and hip ABD-PKTQ at 60°/s (r = .364) and 300°/s (r = .336, P ≤ .049). CONCLUSIONS: Men athletes demonstrated symmetrical hop performance and hip muscle strengths, except for ER hip's MVIC and isokinetic eccentric peak torque at 60°/s 2 years after ACLR. Hop performance LSIs had a few, yet positive moderate relationships with involved hip ABDs and ER strength measures. This may indicate that hip ABD and ER muscle strength measures contribute to athletes' hop performances 2 years after ACLR. Post-ACLR rehabilitation programs might incorporate hip muscle strengthening training to improve athletes' functional performances.

Player Sex and Playing Surface Are Individual Predictors of Injuries in Professional Soccer Players.

Background: The factors contributing to soccer injuries and their influence on the occurrence of injury are controversial and inconclusive. This study aimed to determine the association between player characteristics and playing factors with injuries in professional soccer players. Methods: One hundred and fifty-two professional soccer players completed a self-administered questionnaire that asked about demographic information and injury profile, the type of playing surface on which they sustained their injury, medical treatment, and the time lost due to soccer injury at the end of the soccer season. Results: The injury rate was 44.74% (n = 68; males: 61.50% (n = 56), females: 19.70% (n = 12)). Players' age (OR: 1.15, 95%CI: 1.05−1.25, p < 0.002) and BMI (OR: 1.21, 95%CI: 1.06−1.38, p < 0.003) were significantly associated with soccer injuries. After adjusting for age and BMI, players' sex (OR: 5.39, 95%CI: 2.11−13.75, p < 0.001), previous soccer injury (OR: 3.308, 95%CI: 2.307−29.920, p < 0.001), and playing surfaces (OR: 11.07, 95%CI: 4.53−27.03, p < 0.001) were the significant predictors of soccer injuries. Conclusion: Players' age, BMI, sex, previous soccer injury, and playing surface were associated with injuries among professional soccer players. Old male athletes with high BMI, previous soccer injuries, and playing on natural grass were more likely to sustain soccer injuries than young female players with low BMI who had no previous injuries and played on synthetic surfaces.

The influence of sleep quality and quantity on soccer injuries in professional teams.

BACKGROUND: There is inconsistency in the relationship between sleeping measures and the occurrence of soccer injuries. Further, most studies investigated sleeping quantity and quality during soccer season but not during off-season. The purpose of this study was to determine the influence of sleeping off-season and during soccer season on the occurrence of injuries in professional soccer players. It was hypothesized that lower sleeping hours and players' thought of inadequate sleeping quantity and quality during off-season and soccer season would associate with the occurrence of soccer injuries. METHODS: One-hundred and fifty-two professional soccer players (premier league and division I teams, age: 21.82±4.44, BMI: 22.21±2.74, sex: men [N.=91], women [N.=61]) answered questions related to their sleeping duration and whether that amount of sleep was enough prior to (off-season) and during soccer season. The sleep questions related to sleep quantity were derived from the Arabic Pittsburgh Sleep Quality Index. Players indicated also. Players indicated their injury profile, medical treatment, and time loss due to soccer injury. Sleeping measures were evaluated using univariate and multivariate logistic regression models to determine predictors of soccer injuries. RESULTS: Sixty-eight players (44.73%) were injured. Lower total sleeping time during off-season (OR:0.66, 95% CI:0.51-0.85, P=0.002), answering no on "did you regularly get enough sleep during off-season" (OR: 5.64, 95% CI: 2.58-12.27, P<0.001), and answering no on "do you think that your sleeping hours during off-season were enough" (OR:4.76, 95% CI: 1.98-11.46, P=0.001) associated significantly with soccer injuries (R2:38). CONCLUSIONS: Lower total sleeping time and not getting regularly enough sleeping time during off-season associated with more soccer injuries. This highlights the influence of sleeping quantity and quality off-season on the occurrence of soccer injuries among professional players.

Primary Bone Tumors in North of Jordan.

OBJECTIVE: Primary tumors of bone are relatively uncommon. Little information is available about the etiology, pathophysiology, risk factors and epidemiologic features of bone tumors. In this article, we present the epidemiological data about the primary (benign and malignant) bone tumors in Jordan. METHODS: Retrospectively, we identified and assessed those patients who were diagnosed with primary bone tumor between January 2004 and December 2018 at King Abdullah University Hospital. The following information was obtained: demographics (age, sex), clinical presentation, and location of the tumor. Also, the histopathological results and finding and recurrence of the tumors were retrieved. The included primary bone tumors were those tumors fulfill the World Health Organization classification of soft tissue and bone tumors. RESULTS: During the study period, four-hundred and thirty-seven cases of the primary bone tumor were diagnosed in our institution. More than half of the cases were males (52.5% males and 47.5% females). In most cases, young adults are affected. The mean age for the diagnosis of giant cell tumor of bone (GCTB) is 34.1 years. The appendicular skeleton was involved in 269 (81.5%) patients while the axial skeleton in 60 patients. The most common encountered pathology is the multiple myeloma with 120 patients. After that, osteochondroma was diagnosed in 110 patients. Females were mostly affected by giant cell tumor while the osteochondroma and chondrosarcoma were seen mostly in males. Multiple myeloma tends to develop in elderly while juvenile ossifying fibroma occurred in young pediatrics and Ewing sarcoma in school-age children and adolescents. Giant cell tumor and osteoid osteoma have the tendency to recur. CONCLUSION: The diagnosis of primary bone tumors is of particular important. The reporting of epidemiological studies is essential in order to expand our knowledge regarding this uncommon type of tumors.

The Effectiveness of Autograft Used in Anterior Cruciate Ligament Reconstruction of the Knee: Surgical Records for the New Generations of Orthopedic Surgeons and Synthetic Graft Revisit.

OBJECTIVE: In this article, we aim to revisit the synthetic graft and review the advantages and disadvantages between different types of grafts for patients who underwent anterior cruciate ligament (ACL) reconstruction in a tertiary medical institute for the new generations of surgeons. PATIENTS AND METHODS: Retrospectively, we identified 115 patients who underwent arthroscopic ACL reconstruction between 2006 and 2009. We were able to retrieve 74 patients from them. The 74 patients were divided into 32 patients who underwent primary arthroscopic ACL reconstruction with hamstring and patellar tendon autograft and 42 cases with an active biosynthetic composite (ABC) ligament. The mean the follow-up period for both groups was 7 years. The following information was obtained: standard demographic information (age, sex), clinical presentation, presence of trauma, associated injuries, types of grafts (autograft versus synthetic graft) and postoperative complications. Moreover, functional and clinical outcomes in addition to the satisfaction of patients using the international knee documentation committee (IKDC) score and knee injury and osteoarthritis outcome score (KOOS) were measured. RESULTS: We found that the natural (autograft) was better in terms of clinical and functional outcome than the synthetic one (the scores of KOOS and IKDC were better in natural grafts). Furthermore, the immediate postoperative results for the pivot and Lachman tests were better in natural grafts. On the other hand, the rate of re-rupture was similar for both groups. However, the long-term inflammatory changes and stiffness that is attributed to the immunological reactions were more in the synthetic grafts. CONCLUSION: This study revisited the synthetic graft and provided evidence that the natural grafts are more beneficial with less complications, as they had better immediate and long-term postoperative clinical and functional outcomes. We recommend the utilization of autograft as first choice and the synthetic not to be used given the current criteria.

Racial variations in knee joint laxity: A comparative study of the Jordanian Arab and Malay populations.

BACKGROUND: A high incidence of joint laxity has been reported among Asians compared with Western populations, but clear differences between more specific ethnic populations have not been established. This study aimed to determine the average knee laxity in the Malaysian and Jordanian populations. METHODS: Jordanian and Malaysian medical students from our institution were invited to participate in the study. General demographic data and factors affecting joint laxity were obtained from each participant using a printed questionnaire. Both knees were examined using the anterior drawer test while in 90° of flexion. Knee laxity was measured by three separate independent investigators through a knee laxity tester. RESULTS: One hundred and eighty-six participants (95 females) were enrolled in the study. Among them, 108 Malaysians participated. The Jordanians had significantly higher knee laxity in both knees compared with the Malaysians. The mean average right knee laxity for Jordanians was 2.98 mm vs. 2.72 mm for Malaysians (P = 0.005). Similarly, the mean average left knee laxity for Jordanians was 2.95 mm, while for Malaysians, it was 2.62 mm (P = 0.0001). Furthermore, smokers had significantly more laxity in both knees. After performing a multivariate linear regression analysis for all factors, race was the only independent factor that affected knee laxity in both knees. CONCLUSIONS: Race is directly associated with knee laxity. Jordanians tend to have more laxity in knee joints compared with Malaysians. Larger multi-center and genetic studies are recommended to establish the racial differences between different ethnic groups.

Severe thoracolumbar congenital kyphosis treated with single posterior approach and gradual "in situ" correction.

BACKGROUND: Congenital kyphosis results from the failed formation of the vertebrae during the embryonic period and may be associated with cardiac, urogenital, or spinal cord anomalies. Surgical treatment is the best choice through anterior, posterior, or both approaches. OBJECTIVES: This study aims to evaluate the effect of posterior gradual correction using the "in situ" bender to correct severe thoracolumbar congenital kyphosis with or without osteotomy or excision of the vertebra. METHODS: Twenty-five patients with an age range of 2-23 (mean ± SD = 12.58 ± 6.03) years with severe thoracolumbar kyphosis were treated surgically at our institution between 2004 and 2013. Pedicle screwing, osteotomy, and gradual "in situ" bending through the single posterior approach were the choices of treatment. Cobb's angle, patient's height, and SRS-22r were used to evaluate the patients preoperatively and postoperatively. Follow-up periods were 35-136 months. RESULT: Cobb's angle pre-surgery range was 35-180 (81.48 ± 39.1) degrees improved post-surgery to 0-45 (21.72 ± 13.47) degrees (p-value <0.0001). The range of patients' standing height pre-surgery was 79-170 (142.42 ± 24.85) centimeters increased after surgery to 81-175 (147.76 ± 26.33) centimeters (p-value <0.0001). SRS-22r pre-surgery range was between 2.12 and 3.904 (3.2 ± 0.77) and improved post-surgery to 4.16 and 4.96 (4.59 ± 0.29) (p-value = 0.046). CONCLUSION: Gradual correction with the "in situ" bender with or without osteotomy through the single posterior approach can give satisfying clinical (patients' standing height and SRS-22r scores) and radiological (Cobb's angle) results to treat severe congenital thoracolumbar kyphosis.

Transient Osteoporosis of the Hip: Risk and Therapy.

OBJECTIVE: The aim of this study was to investigate the impact of occupation in patients with transient osteoporosis of the hip (TOH). The study also compares two different types of management for this condition: conservative treatment and surgical drilling. METHODS: This was a retrospective case series study. The medical records for patients diagnosed with TOH at our institution within the period 2012-2017 were retrieved. General demographic data, clinical features, and diagnostic modalities were obtained. In addition, management procedures and their associated prognostic factors were acquired. The effectiveness of these procedures was assessed by the number of days of sick leave, the time needed for full recovery and the number of recurrences of TOH. Also, pain responses at 24 hrs, 48 hrs, and at 1 week were estimated subjectively through a "pain score" out of 10, and objectively through the degree of improvement in daily activity. The patients had a regular follow-up at 4- to 6-week intervals. RESULTS: In total, 15 cases of TOH, 14 men and one woman, were enrolled in the study. The mean age of the patients was 41 years (range 26-59 years). Out of the 15 cases, nine were healthcare professionals (eight physicians and one nurse). Ten patients underwent hip drilling for core decompression and five patients were treated conservatively. The time needed for full recovery was 5.8 weeks for those who underwent drilling, and 48.3 weeks for three patients receiving conservative treatment. The other two patients who were treated conservatively had not achieved full or near-full recovery at the time of reporting this study. CONCLUSION: Physicians may be at increased risk of developing TOH. Further studies should be conducted to examine the role of this occupation as a risk factor. In addition, hip drilling should be considered as an effective treatment modality, especially in those patients who seek a faster recovery.

Epidermal inclusion cyst of the knee.

Epidermoid cysts are asymptomatic, slowly enlarging, firm to fluctuant, dome-shaped lesions. Epidermoid cysts frequently appear on the trunk, neck, face, and scrotum, behind the ears and in the palmoplantar region. We review all the cases of epidermoid cyst of the knee and present a case of non-traumatic-induced epidermal cyst in the popliteal fossa of a 66-year-old male with 10-year history of right knee swelling, which appeared firstly as a small mass 2 × 2 cm in the popliteal aspect of the knee. The mass was increasing gradually in size until 2 years ago when it increased suddenly to gain the dimensions of 4 × 6 cm. MRI of the right knee revealed a well-defined cystic lesion in the subcutaneous tissue measuring about 7 × 5 × 5 cm containing internal debris and septations. He underwent complete surgical excision of the mass. The pathological results revealed an epidermal inclusion cyst. To the best of our knowledge, this is the second description for epidermal inclusion cyst involving the popliteal fossa. We were able to retrieve three cases of epidermal cyst of the knee from the literature since its first description in 2004. Including our case, we had a total of four cases of epidermal cyst of the knee. Three males and one female constituted the patients' sample. The mean age for the patients is 55. The epidermal cyst occurred equally in both knees. The popliteal fossa was the location for two epidermal cysts. Similarly, the prepatellar region was the location for another two cysts.

Anterior versus posterior approach to treat cervical spondylotic myelopathy, clinical and radiological results with long period of follow-up.

BACKGROUND: Cervical spondylotic myelopathy increases with age, but not all cases are symptomatic. It is usually diagnosed clinically and radiologically (X-ray and magnetic resonance imaging). Surgical treatment is indicated in severe symptomatic cases, while treatment controversy exists in the presence of less severe cases. Anterior and posterior approaches are generally used for decompression with no significant differences in the results of both. METHODS: A total of 287 patients of cervical spondylotic myelopathy were treated at our hospital between January 2004 and December 2015. Only 140 patients were eligible for our study. They had at least 5 years of follow-up using full clinical scores and radiological evaluation. They were divided into two groups: group I with 73 patients (aged 23-79 years) underwent posterior decompression, lateral mass instrumentation, and fusion, while group II with 67 patients (aged 33-70 years) underwent anterior decompression, instrumentation, and fusion. Neck Disability Index, local score, and X-ray were used in the evaluation of the patients. RESULTS: Preoperative mean ± standard deviation of Neck Disability Index of both the groups was 32.06 ± 6.33 and 29.88 ± 5.48, which improved in the last visit (>5 years) to 5.81 ± 7.39 and 2.94 ± 5.48 for groups I and II, respectively (p value <0.05). The local score of groups I and II was (P = 1, F = 21, G = 31, E = 19) and (P = 1, F = 12, G = 36, E = 18), which on discharge day improved to (P = 1, F = 4, G = 12, E = 55) and (P = 0, F = 3, G = 6, E = 58) at last follow-up, respectively. Fusion rate was nearly equal for both the groups during all the follow-up intervals and it was 91.1% and 91.7% in the last follow-up. CONCLUSION: There were no significant differences in the clinical and radiological results between the anterior and posterior approaches used in the surgical treatment of spondylotic cervical myelopathy. However, statistically significant results of Neck Disability Index of anterior approach were not clinically important and may be due to changes in the size and shape of the neck in group II.

Patellar Subluxation With Early-Phase Synovial Chondromatosis of the Knee.

Primary synovial chondromatosis is a rare, benign, monoarticular disease process that affects the synovial membrane of the joint, the synovial sheath, or the bursa around the joint. The etiology is unknown, but it has been associated with trauma in some cases. Although it is a benign lesion, if left untreated, it may lead to early secondary osteoarthritis of the joint. The knee joint is affected in 50% to 65% of cases, followed by the elbow and the hip. This article reports a 30-year-old active woman who presented to the author's clinic with a large infrapatellar mass that caused lateral subluxation of the patella, swelling, and episodic pain with crepitations 14 months after direct trauma to the knee. Clinical examination, magnetic resonance imaging, and arthroscopy revealed a large infrapatellar mass causing lateral subluxation of the patella with no loose bodies. Hoffa's disease, para-articular osteochondroma, and early-phase synovial chondromatosis were considered in the differential diagnosis. The histopathologic and clinical features were consistent with early synovial chondromatosis. The patient underwent local excision of the mass through a medial parapatellar arthrotomy. At 5 years of follow-up, she had no recurrence of the lesion or progression of the disease. Early diagnosis of synovial chondromatosis with local excision offers a reliable cure. However, long-term follow-up is advised because of the high recurrence rates as well as the risk of metaplastic transformation.

Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction.

BACKGROUND: spondylolisthesis is a condition in which a vertebra slips out of the proper position onto the bone below it as a result of pars interarticularis defect. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and neural breach. MATERIALS AND METHODS: A randomized and double blinded study consisted of 41 patients aged 36-69 years (18 females and 28 males) treated for symptomatic spondylolisthesis between December,2006 and December, 2009. All patients were randomly distributed into two groups I and II. Twenty patients were in Group I; they underwent reduction of the slipped vertebrae by using Reduction-Screw Technique and posterior lumbar interbody fixation (PLIF). Group II consisted of twenty one patients who underwent only surgical fixation (PLIF) without reduction. All patients in this study had same pre and post operative management. RESULTS: only one case had broken rod in group I that required revision. Superficial wound infection was experienced in two patients and one patient, from group II, developed wound hematoma. The outcome in both groups was variable on the short term but was almost the same on the long term follow up. CONCLUSION: surgical management of symptomatic low grade spondylolisthesis should include neural decompression and surgical fixation. Reduction of slipped vertebral bodies is unnecessary as the ultimate outcome will be likely similar.