Reconstruction of chronic quadriceps tendon rupture using autologous semitendinosus tendon graft: A case report.

INTRODUCTION: Chronic quadriceps tendon rupture is a relatively rare injury that can be challenging to treat. Several techniques have been described for chronic quadriceps tendon repair, including the use of autografts, allografts, and synthetic mesh. We reported a case of 17-year-old male with chronic quadriceps tendon rupture treated using autologous semitendinosus tendon graft. CASE PRESENTATION: A 17-year-old male presented with left knee pain since 8 months ago after he fell into a ditch. Physical examination demonstrated palpable gap on suprapatellar region. Magnetic resonance imaging demonstrated quadriceps discontinuity and hyperintensity surrounding the insertion of the quadriceps tendon. The patient underwent quadriceps tendon reconstruction using ipsilateral autologous semitendinosus graft. After 3 weeks the patient was sent for physiotherapy to regain his left knee's range of motion. At final follow up at six months, the patient was able to walk with bipedal unassisted normal gait. Active knee extension and straight leg raising was possible. Final knee range of motion was 0° to 130°. DISCUSSION: In this case, we demonstrated a successfully treated chronic quadriceps tendon rupture using autologous semitendinosus tendon graft. For cases of chronic quadriceps tendon rupture with tissue loss, it is advisable to utilise an autologous graft for the purpose of repairing and restoring the structure and function of the quadriceps tendon. CONCLUSION: Surgical treatment of chronic quadriceps tendon rupture is challenging and lacks evidence-based guidelines. We propose the use of ipsilateral semitendinosus tendon autograft as choice for chronic quadriceps tendon rupture in this report, as it leads to favorable outcomes postoperatively.

The Use of Combination Paracetamol and Ibuprofen in Postoperative Pain after Total Knee Arthroplasty, a Randomized Controlled Trial.

BACKGROUND: Adequate pain management has an important role in supporting early ambulation after total knee arthroplasty (TKA). Multimodal analgesia is one of the modalities of overcoming postoperative pain. The use of a combination of paracetamol and ibuprofen is expected to reduce the total morphine requirement after TKA. OBJECTIVES: The use of a combination of paracetamol and ibuprofen to reduce morphine requirement after TKA, to provide adequate pain management and early ambulation. STUDY DESIGN: Patients scheduled for total knee arthroplasty who met the requirements for inclusion criteria were consented and randomized using randomizer.org in a 1:1:1 ratio to receive either combination paracetamol iv and ibuprofen iv (Group II), paracetamol iv only (Group II), or ibuprofen iv only (III). SETTING: Thirty-six patients aged 63-68 years who underwent TKA were included in this study. METHODS: All patients were divided into 3 groups. Group I received paracetamol 1 g and ibuprofen 800 mg, group II received 1 g paracetamol iv and 100 mL normal saline, group III received 800 mg ibuprofen iv and 100 mL normal saline, 10 minutes before the end of surgery and every 6 hours up to 24 hours. Total morphine consumption, pain score (resting, walking, knee flexion), and 2 minute-length walking tests were measured in hour 24 postoperative. Data were analyzed with SPSS 16.0. RESULTS: Median of total morphine consumption between 3 groups respectively was 7.5 (3.0-36.0) mg vs 15.0 (4.5-28.5) mg vs 9.0 (0.0-24.0) mg with no difference (P = 0.391). Mean of pain score at walking phase respectively was 4.8 ± 0.5 vs 7.3 ± 1.2 vs 5.6 ± 0.5 (hour 24, P < 0.01). Medians of 2-Minute Walking Test respectively were 6.0 (2-16) meters vs 0.0 (0-4) meters vs 0.0 (0-4) meters (hour 24, P  < 0.01). LIMITATIONS: The total morphine requirement measured in this study illustrates the consumption of morphine in resting phase. CONCLUSION: The combination of paracetamol and ibuprofen is better in reducing the total morphine requirement after TKA when compared with the administration of paracetamol injection alone or ibuprofen injection alone. Combination paracetamol injection and ibuprofen injection also provides adequate pain management in order to help early ambulation.

Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oxford Hip Score.

AIMS: The aim of this study was to perform a cross-cultural adaptation of Oxford Hip Score (OHS) to Indonesian, and to evaluate its psychometric properties. METHODS: We performed a cross-cultural adaptation of Oxford Hip Score into Indonesian language (OHS-ID) and determined its internal consistency, test-retest reliability, measurement error, floor-ceiling effect, responsiveness, and construct validity by hypotheses testing of its correlation with Harris Hip Score (HHS), vsual analogue scale (VAS), and Short Form-36 (SF-36). Adults (> 17 years old) with chronic hip pain (osteoarthritis or osteonecrosis) were included. RESULTS: A total of 125 patients were included, including 50 total hip arthroplasty (THA) patients with six months follow-up. The OHS questionnaire was translated into Indonesian and showed good internal consistency (Cronbach's alpha = 0.89) and good reliability (intraclass correlation = 0.98). The standard error of measurement value of 2.11 resulted in minimal detectable change score of 5.8. Ten out of ten (100%) a priori hypotheses were met, confirming the construct validity. A strong correlation was found with two subscales of SF-36 (pain and physical function), HHS (0.94), and VAS (-0.83). OHS-ID also showed good responsiveness for post-THA series. Floor and ceiling effect was not found. CONCLUSION: The Indonesian version of OHS showed similar reliability and validity with the original OHS. This questionnaire will be suitable to assess chronic hip pain in Indonesian-speaking patients. Cite this article: Bone Jt Open 2021;2(9):765-772.

Patient Height may Predict the Length of the Anterior Cruciate Ligament: A Magnetic Resonance Imaging Study.

PURPOSE: The purpose of this study was to measure the length and width of anterior cruciate ligament (ACL) tibial footprint using magnetic resonance imaging (MRI) and to evaluate correlation between patients' weight and height with the tibial footprint size. METHODS: In total, 207 eligible patients underwent MRI scanning from June 2018 to June 2020. One hundred seventeen knees from patients aged 18 to 40 years old with intact ACL were included in this study. Data of weight, height, body mass index (BMI) from physical examination and tibial footprint length and width from MRI were obtained. Relationship of ACL tibial footprint length <14 mm and association between ACL tibial footprint sizes of MRI with height, weight, and BMI were analyzed. RESULTS: The ACL tibial footprint length and width were, respectively, 11.9 ± 1.8 mm and 10 ± 1.5 mm. Proportion of ACL footprint <14 mm in length was 89.7%. Patient height ≥170 cm was the best predictor of ACL tibial footprint length <14 mm (P = .025). There was a statistically significant relationship between the height of the patients and the length of the ACL tibial footprint. The length of the ACL tibial footprint could be predicted by the formula: length = -7.362 + 11.48 × (height in meters). CONCLUSION: The height of the patients may predict the length of the ACL tibial footprint. Although patient's age, sex, and BMI correlate poorly with ACL tibial footprint width, there was no correlation between patient's weight and ACL tibial footprint size. CLINICAL RELEVANCE: Before ACL reconstruction surgery, an estimation of ACL tibial footprint size might aid in the graft harvesting preparation.