Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction?

PURPOSE: The purpose of this study was to evaluate the association between posterior tibial slope (PTS) and anterior cruciate ligament (ACL) graft rupture in patients who have undergone ACL reconstruction by comparing results in patients who experienced graft rupture and a matched control group. METHODS: The study included 64 knees of 64 patients (58 men and 6 women), of mean age 31 years (range, 18-60 years) who underwent revision ACL reconstruction for ACL graft rupture, as well as a control group without ACL graft rupture matched for age, sex, body mass index (BMI), and left or right side. The mean time to failure in study group was 48.5 months, and after revision surgeries, the mean follow-up period was 37.7 months. The graft used for the primary surgery was autograft in 3 patients (4.7%) and allograft in 49 patients (76.6%). The type of graft could not be confirmed in the remaining 12 patients (18.7%). PTS was measured on plain radiographs and compared in the 2 groups. RESULTS: Mean PTS was significantly higher in patients with (13.2° ± 2.5°; range, 8.5°-18.2°) than without (10.9° ± 3.1°; range, 4.9°-13.6°) rerupture (P < .01). When mean PTS was compared in the 37 patients who underwent primary surgery by the same surgeon, it was significantly higher in patients with (13.5° ± 2.5°; range, 8.5°-18.2°) than without (11.1° ± 2.9°; range, 5.1°-13.6°) rerupture (P < .01). PTS in patients with rerupture was not significantly associated with age, gender, BMI, and right or left side. The odds ratio of ACL graft rupture in knees with PTS ≥12° was 4.52 (P < .001). CONCLUSIONS: This study showed that mean PTS was significantly greater in patients with than without noncontact ACL graft rerupture (13.2° vs 10.9°, P < .01). The failure of ACL reconstruction appears to be associated with increased PTS, with PTS ≥12° a risk factor for the failure of ACL reconstruction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Synovial fluid levels of TWEAK and matrix metalloproteinase 1 in patients with osteoarthritis, and associations with disease severity.

PURPOSE: This study assessed the levels of soluble tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and matrix metalloproteinase 1 (MMP-1) in the synovial fluid from osteoarthritic knees to determine their role as well as the relationship between these levels and the severity of osteoarthritis (OA). METHODS: Synovial fluid was obtained from 44 knees of 40 patients. The Kellgren-Lawrence (KL) grade was measured using radiograph. The concentration of TWEAK and MMP-1 in the synovial fluid was assessed by enzyme-linked immunosorbent assay. The underlying inflammatory factors (erythrocyte sedimentation rate and C-reactive protein) were also measured. We analyzed the correlation between the factors measured. In addition, the samples were subdivided into three groups according to OA severity using the KL grade, and the differences in TWEAK and MMP-1 levels between groups were analyzed. RESULTS: The TWEAK and MMP-1 levels in the synovial fluid showed a positive correlation with each other. The TWEAK and MMP-1 levels were compared between the three groups according to the KL grade, and the levels showed a significant difference. A post hoc test demonstrated that the group with advanced OA showed a lower concentration of both factors when compared to groups with early OA. CONCLUSION: The concentration of TWEAK and MMP-1 in the synovial fluid were relatively high in the early stage of OA, and the levels decreased as the OA progressed.

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS: Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. RESULTS: The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). CONCLUSIONS: Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.