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Introduction: Rectus femoris injuries are common in sports requiring sprinting and kicking, especially in football. In addition to sports injuries, rectus femoris injuries can occur during physically active daily living and physical work. Most muscle injuries heal well by conservative treatment, but more severe ruptures often require surgical treatment, especially in athletes. Some ruptures can cause so severe functional loss of the muscle that it causes problems also in everyday life. Complete rectus femoris mid-substance rupture is a rare injury type, which tends to recover poorly and cause significant functional deficit. Descriptions of this injury type are mainly lacking in the literature and there is no consensus on the management of these injuries. To the best of our knowledge, this is the first report of this kind in the literature including strength measurements pre- and post-operatively. Case Report: We report a case of a 48-year-old Caucasian man who suffered a complete rectus femoris mid-substance rupture at physically active work. The injury mechanism was slipping on an asphalt ramp, leading to rapid eccentric contraction of rectus femoris involving knee flexion and hip extension. The rupture was treated surgically and the muscle strength of quadriceps femoris was measured pre- and postoperatively. Conclusion: This case report showed that muscle strength in knee extension recovers well after an operative treatment of complete rectus femoris mid-substance rupture. Therefore, it can be concluded that operative treatment is beneficial for this specific injury type. This case report brings important and objective evidence on the relevance of surgical treatment in these injuries that are mainly lacking the consensus about the best treatment methods. To the best of our knowledge, this case report is also the first one which indirectly shows the value of isolated rectus femoris muscle in the whole quadriceps muscle group.
RESUMEN
PURPOSE: The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. METHODS: Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. RESULTS: The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. CONCLUSIONS: In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
RESUMEN
Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced. The implants hid the suture knot on the clavicle, and less foreign material was needed between the clavicular and coracoid implants.
RESUMEN
BACKGROUND: Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular. METHODS: Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months. RESULTS: The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle. DISCUSSION: The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.