Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases

Introduction:

Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables.

Materials and methods:

This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland – Altman plot.

Results:

Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6-8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value <0.05). Female, compared to male, had significantly smaller (p<0.0001) and thinner graft (p<0.0001). There was a strong agreement between the literature and our observed graft diameter, but with an overestimated graft diameter in 18.5% of the cases.

Conclusion:

Among anthropometric parameter, only height and weight had moderate positive correlation with graft diameter. Males had longer and wider ST graft in contrast to age-matched female group.

Tourniquet Use in Arthroscopic ACL Reconstruction: A Blinded Randomized Trial

INTRODUCTION

Despite knowing, that tourniquet induces ischemia and soft tissue damage surgeons still use it. The purpose of this study is to compare post operative pain and quadriceps function in patients undergoing arthroscopy assisted ACL reconstruction with tourniquet and without tourniquet.

METHODS

A blinded randomized prospective trial conducted at Orthopaedic department of a tertiary institute in India from Feb 2019 to June 2019. 45 patients undergoing Arthroscopic ACL reconstruction aged between 18 and 60 years were recruited in the study according to selection criteria. Patients were distributed in 2 groups randomly, namely, tourniquet and non-tourniquet. Preoperatively serum CPK measurement and thigh girth measurement was done. Following standard arthroscopic procedure VAS score monitoring for pain was done for 5 days. Serum CPK levels were performed on postoperative day 1. Thigh girth was measured on postoperative day 21.

RESULT

Pain was significantly high in patients in whom tourniquet was used. VAS scores were significantly high in tourniquet group. Tourniquet group patients required more amount of additional analgesics in postoperative period (p < 0.001). Serum CPK levels were comparable preoperatively while significantly high postoperatively in tourniquet group (p < 0.001). Difference in mean of thigh girth was significant between the groups (p < 0.001) and there is difficulty experienced by patients in performing straight leg raise test after tourniquet use (p = 0.002).

CONCLUSION

Tourniquet use is associated with increased pain, analgesic requirement, damage to muscles and compromises muscle function in early postoperative period. This can not only lead to increased patient discomfort but also difficult initial rehabilitation. Arthroscopic procedures can be uneventfully performed without the use of a tourniquet, and alternative methods should be looked upon and emphasized.

Paratricipital two window approach for complex intraarticular distal humerus fractures: A prospective analysis of 27 patients

BACKGROUND

To investigate the utility and complications of paratricipital 2 window approach for complex intra articular distal humerus fractures (AO/OTA type C).

METHODS

Between December 2012 and September 2016 , 27 patients (male-14, female-13) having mean age of 39 years (range, 22-62 years) with closed intra articular fracture (AO/OTA 13 type C) were surgically managed using paratricipital 2 window approach. Fractures were fixed as per AO principles. All patients were followed up for 21 months (range, 12-28 months) prospectively. Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Student t-test, Pearson co-relation coefficient and Kruskal Wallis test used for statistical evaluation.

RESULT

All cases unite by the end of 3 months. Mean flexion achieved was 120° and extension lag was 10°. Mean arc of motion was 111°. Mean pronation and supination was 70° and 77° respectively. MEPS and motion arc were weak negatively co- related with surgical delay and advancement in age. Post-operative transient ulnar nerve palsy and heterotrophic ossification (HO) was noted in 3.7% cases and infection occurred in 7.4% cases. Hardware prominence noted in 11.1% cases. Mean MEPS was 82. MEPS was excellent in 18.5%, good in 62.9%, fair in 11.1% and poor in 7.4% cases.

CONCLUSION

Paratricipital 2 window approach for these fractures had good functional outcome with fewer complications. We advocate paratricipital 2 window approach when dealing with these complex fractures particularly, in type C1 and type C2.

Outcome following olecranon osteotomy versus paratricipital approach for complex intra-articular (AO 13-C) fracture of distal humerus: a prospective comparative study

BACKGROUND

The paratricipital approach is a relatively new approach in a complex intra-articular fracture of distal humerus (AO13-C). The aim of this study was to ascertain this approach compared with the olecranon osteotomy approach. Also, we aimed to investigate whether advancing age and surgical delay yield a poor outcome.

MATERIALS AND METHODS

Between 2011 and 2015, 51 adult patients with closed AO 13-C-type fractures were included in the study and divided into 2 groups, that is, paratricipital approach (PT) group and olecranon osteotomy (OO) group. Patients were treated by 2 senior trauma surgeons. They were prospectively analyzed for outcome and complications. Mayo elbow performance score (MEPS) was used to evaluate the outcome.

RESULTS

Of the total 51 patients (mean age, 41.6 years), 27 patients were in the PT group and 24 in the OO group. There was no difference in arc of motion (P = .513) and MEPS (P = .127) as well as complication rate (χ² statistic = 0.36, P = .54). However, specifically in the type C3 fracture, the PT group had a poor outcome for arc of motion (P = .002) and MEPS (P = .019) compared with the OO group. Also, age and surgical delay had a weak, negative correlation with arc of motion and MEPS. The association between age and surgical delay against arc of motion was statistically significant (P = .005 and .01, respectively).

CONCLUSIONS

The PT approach and the OO approach can be used alternatively for AO 13-C1 and -C2 fractures with similar outcomes. However, in type C3, the PT approach yields a poor outcome in comparison with the OO approach.

Olecranon Osteotomy Approach for Complex AO-13C Fractures of Distal Humerus: A Prospective Analysis of 24 Cases

Introduction: Olecranon osteotomy is well described approach for complex intra-articular distal humeral fractures. In this study, we investigated the usefulness and complications of olecranon osteotomy approach for such fractures. We hypothesise that outcome is comparable in young adults and middle age group and also functional outcome is independent of fracture subtype following surgical fixation.

Materials and Methods: Between December 2012 and September 2015, twenty-four adult patients (male: 15, female: 9) having mean age of 41.4 years with closed intra-articular fracture (AO-13C) were surgically managed using olecranon osteotomy approach and were followed-up for a mean of 28.5 months (range: 22-35 months). Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Statistical analysis was done using Student t-test and Kruskal Wallis test.

Results: All fractures united by the end of three months. Mean elbow flexion achieved was 123°, mean extension lag was 9° and mean active arc of motion was 114°. Mean MEPS was 87 (excellent: 8, good: 14, fair: 1 and poor: 1). Post-operative transient ulnar nerve palsy was noted in two cases, heterotopic ossification (HO) was in one case, infection in two cases, implant prominence in five and elbow stiffness in three cases. Motion arc was higher in young adults and MEPS was comparable in both age group. Functional outcome was also dependent on fracture subtype. Conclusion: The olecranon osteotomy approach for distal humerus fractures had good functional outcome with fewer complications. Joint congruity and fixation could easily be assessed intraoperatively.