ABSTRACT
Iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is an uncommon but important complication of both open and arthroscopic procedures causing neuropathic pain symptoms in the anteromedial aspect of the knee. Whilst the use of ultrasound in the assessment of peripheral neuropathies is well-established, sonographic knowledge in the routine assessment of the IPBSN remains poor. We describe the sonographic assessment of the IPBSN by means of a review article, promulgating radiology's role in providing anatomical information pertaining to the IPBSN and its relationship to adjacent anatomical structures, surgical fixations or fibrous scar tissue.
Subject(s)
Peripheral Nervous System Diseases , Arthroscopy , Humans , Knee , Knee Joint/diagnostic imaging , Peripheral Nervous System Diseases/diagnostic imaging , UltrasonographyABSTRACT
BACKGROUND: Numerous studies have compared patellar tendon (PT) and hamstring tendon (HS) anterior cruciate ligament (ACL) reconstructions in the short to midterm, but fewer long-term results have been published. HYPOTHESIS: There will be no difference in functional outcome between ACL reconstruction performed with PT and HS grafts, but PT grafts will have more donor site morbidity. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Sixty-five patients undergoing ACL reconstruction were randomized to receive either a PT graft or a 4-strand HS graft. Early results were reported at 4, 8, 12, 24, and 36 months. Forty-seven patients (22 of 31 PT and 25 of 34 HS) were reviewed at a mean of 15.3 years. RESULTS: Four graft ruptures (1 PT, 3 HS) and 6 contralateral ACL injuries (4 PT, 2 HS) occurred in the group that was reviewed. There was no statistically significant difference between the groups for any of the variables measured. There was a similar incidence of anterior knee pain and kneeling pain in both groups. The previously observed increased extension deficit in the PT group at 3 years was not present at 15 years, and there was no significant between-group difference in knee laxity. A higher proportion of patients in the PT group were participating in sport on a weekly basis (73% PT, 48% HS; P = .05). There was no difference in the degree of osteoarthritis between the groups. CONCLUSION: This randomized controlled trial showed that HS and PT ACL reconstructions have comparable results at an average 15-year follow-up. Contrary to the study hypothesis, some of the graft differences seen at earlier review were not present at 15 years, and patients with PT grafts were more active in sport participation. Overall, both graft types provided good long-term subjective and objective outcomes.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction/methods , Tendons/transplantation , Adolescent , Adult , Athletic Injuries/physiopathology , Athletic Injuries/surgery , Female , Follow-Up Studies , Humans , Joint Instability/etiology , Joint Instability/physiopathology , Knee Injuries/surgery , Knee Joint/surgery , Male , Osteoarthritis, Knee/etiology , Osteoarthritis, Knee/physiopathology , Pain, Postoperative/etiology , Patellar Ligament/transplantation , Quality of Life , Range of Motion, Articular/physiology , Reoperation/statistics & numerical data , Return to Sport/physiology , Rupture/surgery , Transplantation, Autologous , Young AdultABSTRACT
We present a case in which the radial artery was found running within the carpal tunnel at the time of routine carpal tunnel decompression. It appears to be an anomalous superficial palmar branch of the radial artery that is substituting for the normal radial artery.