RESUMO
BACKGROUND: Previous studies have investigated various factors that contribute to graft failure in hamstring anterior cruciate ligament (ACL) reconstruction. However, there is debate about the potential advantages of increasing graft diameters beyond 8 mm. METHODS: In this retrospective cohort study (level of evidence III), we investigated whether increasing graft sizes beyond 8 mm diameter showed any advantages in reducing the risk of graft failure. We utilized univariate Kaplan-Meier analysis and Cox proportional hazard (PH) regression models to compare the risk of failure in the different patient groups. Mutual adjustment was performed for age, gender, body mass index (BMI), and graft strands. Graft sizes ranging between 8 and 10 mm were assessed for their association with graft failure, alongside examining the impact of graft strands, age, and BMI on graft failure. RESULTS: A total of 487 patients underwent hamstring autograft ACL reconstruction at our hospital between January 2016 and December 2020. Our analysis indicated that among patients undergoing hamstring autograft ACL reconstruction, the risk of graft failure was 1.64 times higher for patients with a graft size between 8.5 and 9 mm (95% CI 0.36-7.43, p=0.483) and 2.19 times higher for patients with a graft size between 9.5 and 10.5 mm (95% CI 0.42-11.31, p=0.384) compared to those with an 8 mm graft. However, there was weak evidence against the null hypothesis. Conclusion: These findings suggest that there is no benefit to increasing graft sizes past 8 mm and that other factors, like surgical technique, should be considered when assessing the risk of graft failure in patients undergoing ACL reconstruction.
RESUMO
Introduction: A calcaneal spur (also known as a heel spur) is a bony outgrowth from the calcaneal tuberosity. Calcaneal spurs are typically detected by X-ray examination. It is a form of exostosis, and it can be fractured as result of trauma as any other bone. An inferior calcaneal spur is located on the inferior aspect of the calcaneus and is typically a response to plantar fasciitis over a period but may also be associated with ankylosing spondylitis (typically in children). A posterior calcaneal spur develops on the back of the heel at the insertion of the Achilles tendon. The only abnormal physical sings are localized tenderness beneath the calcaneum, X-ray sometimes shows a bony spur projecting forward from the under surface of the calcaneal tuberosity. We report a -60-year-old male presented with painful swelling of both heels, after fall from height about 1-2 m, the patient had chronic plantar fasciitis. X-ray done, revealed bilateral calcaneal spur fracture (distal tip), associated with posterior calcaneal spur. The patient treated with well-padded posterior slab for 2-3 weeks, ice pack, analgesia, and non-weight bearing. Case Reports: A 60-year-old man had history of trauma (fall from height about 1-2 m) on his heels, he presented with painful swelling on both heels, with mild limitation of ankle movement. On examination, there were a tender, swelling, mild ecchymosis around the heels, with painful limitation of ankle motion, and pain on weight-bearing. Radiological examination was done for spine, pelvis, hips, all within normal, and ankle X-ray. A/P and lateral revealed bilateral fracture of calcaneal spur. The patient was treated with rest, elevation, ice pack ,and analgesia for 2-3 days, then applications of back slab for 2-3 weeks. By the end of 3rd weeks, the back slab was removed and continue crepe bandage and non-steroidal anti-inflammatory drugs. After 2-3 months of follow-up, the patient no longer had swelling and pain, only mild symptoms of painful heel syndrome. Conclusion: This article presents a rare case of bilateral calcaneal spur fracture in the patient with plantar fasciitis and calcaneal spur, following trauma to both heels, so an awareness of this condition as one of the differential diagnoses of painful heels following trauma.
