Are orthopedic surgeons able to detect 3 mm and 5 mm joint step off on fluoroscopy?

OBJECTIVE: The aim of this study was to examine whether joint step-off created experimentally at 3 mm and 5 mm in the tibial lateral plateau can be accurately evaluated by orthopedic surgeons on fluoroscopic images. PATIENTS AND METHODS: A lateral tibia plateau fracture was created experimentally on above-the-knee amputated material. Using a ruler, step-off at 3 mm and then at 5 mm was made on the joint surface, then joint and lateral fluoroscopy images were obtained. These images were evaluated by 316 orthopedic surgeons. The surgeons were asked whether the joint congruence in the plateau fracture required surgical correction. The same question was asked again after 3 months, and all the responses were recorded. RESULTS: In the first measurements for 3 mm joint step-off, 77 (24.4%) orthopedic surgeons stated that surgical correction was necessary, and for 5 mm, 118 (37.3%) surgeons stated that surgical correction was necessary. In the 3rd month, the need for surgical correction was stated by 144 (45.6%) surgeons for 3 mm, and by 176 (55.7%) surgeons for 5 mm (p=0.001) CONCLUSIONS: Fluoroscopy is not a reliable method to determine articular step-off. Methods such as arthroscopic or open joint surface evaluation should be applied in the operating room.

Comparison of different femoral fixation implants and fit techniques for tunnel widening and clinical outcome in ACL reconstruction using hamstring autograft.

PURPOSE: The purpose of the current study is to investigate in different femoral fixation devices whether tight (undersize drilled) fit technique decreases the tunnel widening and improves the clinical outcome compared to conventional technique in ACL reconstruction using hamstring tendon autograft. METHODS: 93 patients, who underwent Arthroscopic ACL reconstruction whether cortical-cancellous suspension (CP) or cortical suspension (BF) used as fixation device for the hamstring tendon autograft, were included in the study. The cases also grouped as undersize drilled (tight fit) and normal drilled (normal fit) according to their autograft size. There was no difference in demographic data of these four subgroups (CP-TF, CP-NF, BF-TF, and BF-NF) preoperatively. RESULTS: The patients, who had been followed for at least 2 years were included in the study. They were looked for their clinical outcome (Lysholm and IKDC scoring), tunnel widening (on AP and lateral radiographs), and also anterior translation. The BF-TF subgroup showed significantly the best clinical results compared to other three subgroups. There was no difference between BF-TF, CP-TF, and CP-NF in terms of tunnel widening. CONCLUSION: Button fixation of femoral side in ACL reconstruction surgery has good clinical outcome and lower complication rate. Undersize drilling might be preferred in button fixation in order to reduce TW and improve stability and clinical satisfaction. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.