Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome.

INTRODUCTION: Recent studies showed increasing evidences of anterolateral ligament (ALL) reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction that proves to be more superior to the previous double-bundle (DB) ACLR technique especially in improving knee stability in biomechanic studies. However to date, there have been no studies evaluating the functional outcome of DB-ACLR vs single-bundle (SB) with ALL in ACLR. METHODS: A total of 138 patients with ACL deficient knee were enrolled to the study. Double-bundle ACL reconstruction (DB-ACLR) was performed in 75 patients and single-bundle ACL reconstruction with anterolateral ligament reconstruction (SB + ALL) ACLR was performed in 63 patients. Surgical outcomes were compared with The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Kujala score at the 3rd, 6th and 9th month post-operative. RESULTS: The IKDC score in the 3rd and 6th month was superior in the SB + ALL group compared to the DB group. However, this difference was not statistically significant. In the meantime, there were no statistically significant difference between the Kujala Score at the 3rd, 6th, and 9th months consecutively. There were no statistically significant differences in the functional outcomes of DB-ACLR and SB + ALL groups at the 3rd, 6th, and 9th months post-operative period. CONCLUSION: The functional outcome comparison showed non-superiority of SB + ALL group compared to the DB-ACLR group. The patellar pain was less found in DB-ACLR group at 6- and 9-months post-operative period.

The Banff Patellar Instability Instrument: validity and reliability of an Indonesian version.

BACKGROUND: The Banff Patellar Instability Instrument (BPII) is a valuable scoring tool for assessing patellofemoral instability in patients suffering from patellofemoral pain syndrome (PFPS). The BPII 2.0 is a shortened version of the BPII. However, there is no Indonesian edition of BPII 2.0 that has been validated. This study aimed to determine the validity and reliability of the Indonesian version of the BPII 2.0. MATERIALS AND METHODS: This was a cross-sectional study that used a forward-backward translation protocol to create an Indonesian version of the BPII 2.0. Thirty patients with PFPS were given the questionnaires. The questionnaire's validity was evaluated by analyzing the correlation between score of each subscale and the overall score to the Indonesian version of the Kujala score using Pearson correlation coefficient, while the reliability was evaluated by measuring the internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient). RESULTS: The Indonesian version of BPII 2.0 and the Indonesian version of Kujala score had a strong Pearson correlation coefficient for construct validity. For all subscales, Cronbach α was 0.90-0.98, indicating adequate internal consistency. The test-retest reliability was high, with intraclass correlation coefficient ranging from 0.89 to 0.98 for all subscales. There was no difference in the Indonesian version of BPII 2.0 response between the first and second administration of the questionnaire which was taken 7 days afterward. CONCLUSION: The Indonesian version of BPII 2.0 was determined to be valid and reliable and is therefore an objective instrument to evaluate patellofemoral instability in patients with PFPS in the Indonesian population.

The Role of Lateral Retinacular Release in Preventing Patellofemoral Malalignment in Double-Bundle Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

Background: Loss of internal rotation stability is the major cause of pain after an anterior cruciate ligament reconstruction (ACLR). Many authors described measures to treat this problem to no avail. This is the first study evaluating the role of lateral release with double-bundle ACLR to prevent patellofemoral malalignment after ACLR. Methods: A total of 100 patients were included in this prospective study between January 2018 and December 2019. We compared single-bundle ACLR (group 1, n = 30), double-bundle ACLR (group 2, n = 30), and double-bundle ACLR with lateral release (group 3, n = 40). Clinical outcome was evaluated with the Kujala score while radiological outcome was evaluated using the tibial tubercle-trochlear groove (TTTG) distance in magnetic resonance imaging. The preoperative and postoperative values were compared. Results: At the final follow-up of 6-18 months, group 3 showed the lowest TTTG value (6.7 ± 4.69) compared to group 2 (9.1 ± 4.83) and group 1 (11.74 ± 1.76) (p = 0.03). The Kujala score was significantly improved in all groups: from 68.83 to 89.90 in group 1, from 70.02 to 91.23 in group 2, and from 69.71 to 95.05 in group 3 (p = 0.03). Group 3 showed the most superior improvement in the Kujala score (25.34) compare to group 1 (21.07) and group 3 (21.21) (p = 0.012). Conclusions: Concomitant lateral retinacular release significantly improved the Kujala score. It may serve as a valuable option to overcome patellofemoral pain syndrome in ACLR.

A rare case of oxidized zirconium - All polyethylene tibia unicompartmental arthroplasty failure: A case report.

Oxidized zirconium (Oxinium) implants has been claimed as the best material in terms of wear reduction. However, longevity of an all polyethylene uni knee arthroplasty (UKA) has been a long debate. We reported a rare case of 74 year old female who was performed all polyethylene UKA 6 years prior and fell 3 months prior. After the incident, patient was wheel-chair ridden afterwards. There was no evidence of fracture upon conventional radiography examination. Conversion of UKA to total knee replacement (TKA) was performed and patient was able to walk with aid after the surgery. The failed Oxinium all polyethylene UKA failure in this case is suspected due osteoarthritis progression.

Evaluation of patellar dimension and Bristol Index in Asian population: An MRI study.

BACKGROUND: Restoration of patellar thickness is pivotal during a total knee arthroplasty (TKA). Several studies showed there are differences in the knee measurements between Asian and Western population. PURPOSE: This study aims to evaluate the patellar dimension and Bristol Index of patellar width to thickness (BIPWiT) using magnetic resonance imaging (MRI) in Asian population. STUDY DESIGN: This is a descriptive epidemiology study. METHODS: 101 MRI scans of young adult patients with normal patellofemoral joint (PFJ) age 17-40 were evaluated from January 2019 to December 2020. Exclusion criteria included patella-femoral pathology and degenerative joint disease. Data of gender, body height and weight were obtained from physical examination, while patella height, width and thickness were obtained using MRI measurement. Descriptive analysis was used to get the mean and standard deviation of patella dimension, whereas correlation between patella thickness with patella width and length were analyzed using Pearson correlation and BIPWiT ratio was obtained by dividing the patellar width and patellar thickness. RESULTS: Mean patellar length was 30.06 ± 2.94 (29.48-30.64); patellar width was 44.13 ± 4.44 (43.26-45.01); and patellar thickness was 23.89 ± 2.33 (23.43-24.35). Patellar dimension in male were significantly larger compared to female (P < 0.001). However, there was no difference in cartilage thickness between male and female (P = 0.305). There was strong correlation between patellar width and patellar thickness (r = 0.66; P < 0.001) with BIPWiT ratio of 1.85 ± 0.15. CONCLUSION: BIPWiT of 1.8:1 between patellar width and patellar thickness was recommended as a guide for patellar thickness restoration during TKA. There is no difference of patellar dimension between Asian and Western population in a healthy knee. CLINICAL RELEVANCE: The result of BIPWiT ratio found in this study may aid upon pre-operative planning prior TKA for surgeons in order to achieve optimal patellar thickness and avoid patellofemoral problem. WHAT IS KNOWN ABOUT THE SUBJECT: Currently there are raising concerns about the different sizes of knee measurements between Asian and Western population which will affect techniques during TKA to achieve optimum result. WHAT THIS STUDY ADDS TO THE EXISTING KNOWLEDGE: This study not only prove that there is no difference between patellar dimension of Asian and Caucasian but also found a similar BIPWiT ratio for patellar resection during TKA with previous literature. LEVEL OF EVIDENCE: Level III.

Meniscal bearing dislocation following minimally invasive Oxford medial unicompartmental knee arthroplasty treated with simple open reduction: Case report.

INTRODUCTION: Dislocation of polyethylene insert is one of the most common complications of mobile bearing-medial unicompartmental knee arthroplasty (MUKA). Bearing dislocation was diagnosed by radiograph examination in these cases upon trivial injury. CASE PRESENTATION: We reported one case of meniscal bearing dislocation after an Oxford MUKA treated with a simple open reduction technique. CLINICAL DISCUSSION: Simple open reduction surgery without change of the bearing and the use of knee brace for 6 months was effective in preventing re-dislocation. CONCLUSION: Mobile bearing dislocation is one of the most common complications in mobile-bearing MUKA. Besides the prevention of technical errors, usage of UKA with a frequency of 10-15 per year is recommended to increase the surgeon's learning curve.