Treatment of Arthrogenic-Muscle-Inhibition in patients after knee-surgery with Motion-Activated-Neuromuscular stimulation - a case-series.

Arthrogenic muscle inhibition (AMI) presents a persistent challenge in postoperative knee rehabilitation and is often resistant to standard care. This case series examines the efficacy of Motion-Activated Neuromuscular Electrical Stimulation (mNMES) in addressing AMI refractory to rehabilitation after ACL (revision) surgery, patellar dislocation, trochleoplasty, or conservative treatment of the patellofemoral pain syndrome. Eight patients who had undergone extensive unsuccessful rehabilitation received six weeks of a novel mNMES treatment regimen. Outcome assessments included patient-reported outcome measures (PROMs) and AMI classification. Results revealed significant improvements in pain reduction, knee function, and AMI reduction. Despite study limitations, mNMES demonstrated promising outcomes and could be used as an adjunct to standard rehabilitation, offering potential for enhancing postoperative outcomes in patients refractory to conventional therapy. Further research is required to validate these findings and optimise treatment protocols.

[Trochleoplasty as a treatment option for recurrent patellofemoral instability]. / Die Trochleaplastik als Behandlungsoption bei chronischer Patellainstabilität.

Chronic patellofemoral instability (PFI) is a multifactorial condition. Trochlear dysplasia is present in 85-96 % of patients with PFI 7. The technique of trochleoplasty introduced in this article represents a causal treatment option and shows promising results. However, as the indication depends on image-morphological, clinical and functional factors, all other risk factors of PFI should always be considered and evaluated.

Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft.

Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability. Recently, various procedures have been described that address reconstruction of the medial patellofemoral complex. We present a technique, where the MPFL is reconstructed anatomically to restore physiological kinematics and stability, using a free gracilis tendon autograft.

Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft.

Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability. Recently, various procedures have been described addressing the reconstruction of the medial patellofemoral complex. We present a technique where the MPFL is reconstructed anatomically to restore physiological kinematics and stability using a free gracilis tendon autograft.

Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis.

BACKGROUND: There is a low level of evidence about clinical results after anterior cruciate ligament (ACL) revision reconstruction using autologous hamstring tendon grafts. HYPOTHESIS: Anterior cruciate ligament revision reconstruction improves knee stability but shows inferior results for functional and subjective outcome and knee stability compared with primary reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between October 1997 and July 2005, 166 single-stage or 2-stage revision ACL reconstructions were done using different graft types. One hundred twenty-four cases underwent a single-stage revision reconstruction with autologous hamstring tendon grafts. At the time of data analysis, 67 cases fulfilled the criteria of minimum 2-year follow-up. Five patients were lost to follow-up (follow-up rate, 91%). Four patients (6%) who experienced graft rupture were counted as failures but not subjected to further detailed analysis. Because of loss to follow-up and exclusion criteria (n = 12), 50 patients were included in the study. For a comparative matched-group analysis, patients with a primary hamstring tendon graft ACL reconstruction were selected out of a database with minimum 2 years' follow-up (N = 284). Patients were followed using the International Knee Documentation Committee (IKDC) and Lysholm scores, KT-1000 arthrometer testing, and additional functional tests. RESULTS: Four of 62 available patients (6.5%) in the revision group experienced graft failure, which was comparable to 16 of 284 (5.6%) in the primary reconstruction group. When the 2 matched groups of 50 patients were further compared, postoperative IKDC results showed no significant differences between groups. The manual maximum KT-1000 arthrometer side-to-side difference was 2.1 +/- 1.6 mm for the revision group and 2.2 +/- 1.1 mm for the primary reconstruction group. The Lysholm score was significantly better in the primary reconstruction group (P = .014). The incidence of postoperative positive pivot-shift test results was not significantly different. The primary reconstruction group showed significantly less extension deficits. Functional testing revealed significantly better results for the primary reconstruction group for stair climbing, squatting, knee bending, and duck walk. CONCLUSIONS: In our patient series, primary ACL reconstruction showed significantly better results in Lysholm score, although the IKDC score and objective knee stability showed no significant difference between the groups. Thus, parameters other than measurable knee stability must be responsible for the inferior results of the revision reconstruction group.

Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.

BACKGROUND: Reconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing. PURPOSE: To determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion. STUDY DESIGN: Descriptive laboratory study. METHODS: Eight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated. RESULTS: Six of 8 insertion points were anterior to a line representing an extension of the posterior cortex, 1 point was touching this line, and 1 point was posterior to it. All points were situated distal to the posterior origin of the medial femoral condyle and proximal to the most posterior point of the Blumensaat line. CONCLUSION: A reproducible anatomical and radiographic point, 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center. CLINICAL RELEVANCE: This radiographic point may be useful both intraoperatively and postoperatively.