Sonographic Measurement of the Patellar Tendon Should Predict Autograft Bone Patellar Tendon Bone (BPTB) Size: Comparison of Anatomical and Clinical Findings

The use of BPTB autograft is frequently used in ACL reconstruction, however, the risk of potential failure in patients with an anatomically unfavorable patellar tendon may predispose to reconstruction failure. Anatomical study of the extensor apparatus of the knee can provide knowledge about the best option obtain the graft and perform a better preoperative planning. Musculoskeletal ultrasound is a simple, reproducible, affordable technique that could be valid for patellar tendon evaluation. The objective of this study is to evaluate the reproducibility of the patellar tendon measurements by ultrasound and compare them with anatomical measurements, both in cadaver and patients undergoing ACLR. The study consists of two phases; first anatomical study in cadaver. The ultrasound measurement was performed by determining the length, width and thickness of the patellar tendon, both by ultrasound and anatomical dissection. The second phase is a cohort of 42 patients pending surgical ACLR. Previous ultrasound and intraoperative measurements were obtained. Regarding the anatomical study, statistical analysis did not show any differences comparing the measurements in length (p = ns) and thickness (p = ns) of the patellar tendon, although differences were obtained when comparing the results obtained for the width of the tendon after the ultrasound and anatomical measurement (p < 0.001). Same results were obtained in second phase of the study. The reproducibility of ultrasound measurements of the PT is comparable to intraoperatively measurements (without width measurement). These findings can be useful for preoperative planning in the reconstruction of ACL with BPTB Graft and to assess technical modifications prior to surgery.

Assessing long-term return to play after hip arthroscopy in football players evaluating risk factors for good prognosis

PURPOSE

Groin pain is the third most common disease in football players and has often been associated with hip pathology such as femoroacetabular impingement and labral lesions. Hip arthroscopy offers possibilities of function restoration via minimally invasive procedures. The aim of this study is to evaluate professional football player's injuries and their return to play after hip arthroscopy for FAI and labral injuries.

METHODS

Patients that underwent hip arthroscopy between 2009 and 2014 were selected retrospectively. From this population, only professional soccer players competing at national level were included (Tegner 10). Arthroscopic surgery was proposed in patients with persistent pain. All patients were assessed for VAS score preoperatively and at 3, 6, 12 and 24 months post-op. HOS (sport and DLA) and mHHS tests were performed at the same time periods.

RESULTS

All patients were men with a mean age of 26.5 ± 7.1 years old. Preoperative VAS (7.4 ± 1.3), HOS ADL (67.7 ± 5.5), HOS sport (37.6 ± 18.7) and mHHS (72.5 ± 8.8) showed improved scores during long-term follow-up. Time to return to play was 10.8 months (SD ± 4.3), with range between 4 and 20 months. Mean follow-up was 45.4 ± 15.6 months (range from 26 to 72 months). No differences were observed between non-active and active patients at final follow-up with respect to chondral lesions, but significant differences were observed with reference to management of the labrum (p = 0.031), where a higher rate of labrectomies existed among inactive patients and a higher rate of suture among active patients.

CONCLUSIONS

Hip arthroscopy is a safe procedure with very good return to play results, but for optimized return to football one should consider patient age at the time of surgery, the condition of the labrum and low scores on the Harris Hip Score (mHHS) and HOS (sport version) as predictive factors for poor prognosis. Level of evidence IV.

Iliotibial band syndrome following hip arthroscopy: An unreported complication

BACKGROUND

Hip arthroscopy is considered a safe procedure, considering the relatively low rate of complications. Despite several complications have been described following this surgical procedure, the present event has not yet been described. The purpose of the present study is to report an unpublished complication following hip arthroscopy, after reviewing 162 hip arthroscopies and finding iliotibial band syndrome (ITBS) in the knee during followup.

MATERIALS AND METHODS

A retrospective review of 162 hip arthroscopies performed between September 2007 and June 2011 was carried out, evaluating patients who presented ITBS during followup. Indication for hip arthroscopy was failure of conservative treatment in patients with symptomatic femoroacetabular impingement.

RESULTS

During a minimum followup of 2 years, nine patients (5.5%) developed ITBS. All patients were diagnosed with ITBS within the first 45 postoperative days. Conservative treatment was successful in 6 patients while 3 had to undergo surgery. The increased internal rotation, synovitis and increased adduction of the hip can be attributed as predisposing factors to the development of ITBS.

CONCLUSIONS

This is a newly described observation within followup of hip arthroscopy. These findings may help orthopedic surgeons when planning rehabilitation after hip arthroscopy, including stretching exercises to prevent this syndrome.

Comparison of tensiomyographic neuromuscular characteristics between muscles of the dominant and non-dominant lower extremity in male soccer players

PURPOSE

Tensiomyography (TMG) has been used to assess neuromuscular characteristics of muscles of the lower extremity in soccer players. However, the effects of lower extremity dominance on TMG characteristics in this population have not been reported to date. The purpose of this study was to compare the TMG neuromuscular characteristics between the dominant and non-dominant lower extremity in male soccer players.

METHODS

Thirty-eight consecutive healthy male soccer players underwent resting TMG assessment of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), semitendinosus (ST), biceps femoris (BF), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in both lower extremities. The maximal displacement, delay time, contraction time, sustained time, and half-relaxation time were obtained and compared between both sides.

RESULTS

There were no significant differences in the vast majority of the TMG parameters between both lower extremities. The dominant side demonstrated higher VM contraction time (p = 0.008), RF sustained time (p = 0.009), RF half-relaxation time (p = 0.01), and BF sustained time (p = 0.04), but lower VL contraction time (p = 0.03) and VL delay time (p = 0.02) compared to the non-dominant side.

CONCLUSION

In general, TMG-assessed neuromuscular characteristics of the VM, VL, RF, ST, BF, GM, and GL were not affected by lower extremity dominance in male soccer players. Therefore, there is no need to assess both sides when using TMG to monitor the response to training or muscles at risk of injury in soccer players unless there is a specific reason.

LEVEL OF EVIDENCE

Prognostic study, Level II.

Effects of anterior cruciate ligament injury on neuromuscular tensiomyographic characteristics of the lower extremity in competitive male soccer players

PURPOSE

To investigate the effects of anterior cruciate ligament injury on mechanical and contractile characteristics of the skeletal muscles of the lower extremity in competitive soccer players through tensiomyography (TMG).

METHODS

All competitive male soccer players with confirmed acute anterior cruciate ligament tear included underwent resting TMG assessment of muscles of both lower extremities before anterior cruciate ligament reconstruction. The same values were obtained from a sex- and sports level-matched control group. The maximal displacement, delay time, contraction time, sustained time, and half-relaxation time were obtained for the following muscles in all subjects: vastus medialis, vastus laterals, rectus femoris, semitendinosus, biceps femoris, gastrocnemius medialis, and gastrocnemius lateralis.

RESULTS

The majority of TMG parameters were higher in the injured compared to the control group. The contraction time of the vastus medialis, vastus lateralis, and rectus femoris was significantly higher in the injured compared to the control group (p = 0.003, p = 0.001, and p < 0.001, respectively). The biceps femoris was the only hamstring muscle with significant differences between groups, with increased contraction time and maximal displacement in the injured compared to the control group (p = 0.002 and p < 0.001, respectively). The gastrocnemius medialis was clearly more affected than the gastrocnemius lateralis, with contraction time, half-relaxation time, and maximal displacement significantly higher (p = 0.01, p = 0.03, and p < 0.001, respectively), and the sustained time significantly lower (p = 0.01), in the injured compared to the control group. The contraction time of the vastus medialis, vastus lateralis, rectus femoris, semitendinosus, and biceps femoris was significantly higher in the injured compared to non-injured side in the anterior cruciate ligament-injured group (p = 0.007, p = 0.04, p = 0.004, p = 0.02, and p = 0.02, respectively).

CONCLUSIONS

Anterior cruciate ligament injury caused a decrease in contraction velocity (in quadriceps, hamstrings and gastrocnemius medialis), resistance to fatigue (in quadriceps and gastrocnemius medialis), and muscle tone/stiffness (in hamstrings and gastrocnemius medialis). Overall, it was demonstrated that these effects were worst in the quadriceps and gastrocnemius medialis compared to the hamstring and gastrocnemius lateralis. These findings may contribute to a better design of rehabilitation programs in order to optimize the recovery and potentially increase sport performance at return to sport.

LEVEL OF EVIDENCE

Prognostic study, Level II.

Return to play after all-inside meniscal repair in competitive football players: a minimum 5-year follow-up

PURPOSE

The purpose of this study was to report the mid-to-long-term return to sports after all-inside meniscal repair in competitive football players.

METHODS

All football players undergoing all-inside meniscal repair with a minimum Tegner activity score of 9 and minimum follow-up of 5 years were eligible for inclusion. Patients were excluded if: (a) they had ipsilateral or contralateral: meniscectomy, posterior cruciate ligament tear, multi-ligament knee injuries, osteotomies, or meniscal transplant (b) they had meniscal tears in the anterior horn, and (c) they had bucket-handle tears. All patients included were contacted by phone and asked for current sport status or Tegner score. Preoperative Tegner scores were collected from the medical charts.

RESULTS

All patients (n = 29) were men with a median (range) age of 27 (18-37) years and a follow-up of 6 (5-8) years. All meniscal injuries were complete and longitudinal tears. The median preinjury Tegner activity score was 9 (range 9-10). Two patients required revision arthroscopy (6.7 %) with partial meniscectomy before being able to return to competitive football due to suture failure. Twenty-six patients (89.6 %) returned to the same level of competition after recovering from surgery. At the last follow-up, 13 patients (45 %) were able to continue playing football at any level, and 8 (28 %) of them were able to return to the same pre-injury competitive level. The main reasons for the decreased level of activity (from competitive to recreational) or to give up football were job-related or changes in their personal life situation, but were not related to knee or meniscal disorders. Fourteen patients underwent meniscal repair alone, whereas 15 patients had an associated ACL reconstruction procedure. There were no significant differences in the collected variables between both subgroups.

CONCLUSIONS

All-inside meniscal repair allows for excellent results with regard to return-to-play rates in competitive football. However, only half of the patients are still playing football in the mid-to-long-term follow-up, although reasons to give up football are not related to knee or meniscal disorders.

LEVEL OF EVIDENCE

Case series, Level-IV.

Effects of anterior cruciate ligament reconstruction on neuromuscular tensiomyographic characteristics of the lower extremity in competitive male soccer players

PURPOSE

To investigate the effects of anterior cruciate ligament (ACL) reconstruction on mechanical and contractile properties of the skeletal muscles of the lower extremities in soccer players through tensiomyography (TMG).

METHODS

All soccer players with acute ACL tear included underwent resting TMG assessment of muscles of both lower extremities before and 1 year after ACL reconstruction. The muscles assessed were vastus medialis (VM), vastus laterals (VL), rectus femoris (RF), semitendinosus (ST), biceps femoris (BF), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL). The TMG parameters obtained for each muscle were maximal displacement (D m), delay time (T d), contraction time (T c), sustained time (T s), and half-relaxation time (T r).

RESULTS

The injured leg had a significant decrease in VL-T c, ST-T c, GM-T c, GL-T r, and GL-T d, and a significant increase in VM-T r and GM-T s in the postoperative compared to preoperative period. The non-injured leg demonstrated significant preoperative-postoperative changes in the VL, RF, and BF, but not in VM, ST, GM, and GL The magnitude of preoperative-postoperative differences in the injured leg was significantly higher in RF-T c, ST-T c, BF-D m, and GL-T r, but lower in RF-T r and GM-T s, compared to the non-injured leg. Both groups improved their symmetry between the quadriceps and hamstring muscle groups in both sides.

CONCLUSIONS

The quadriceps muscles improved their resistance to fatigue and contraction velocity in both sides, and the hamstring muscles improved their contraction velocity and muscle tone in both sides as well. Improvements in contraction velocity and muscle tone were more evident in the quadriceps and hamstrings of the injured compared to the uninjured side. In addition, the intervention increased the percentage of symmetry between both sides in the TMG of the quadriceps muscles and the balance between ACL-agonist (hamstrings) and ACL-antagonist (quadriceps) muscle groups in both sides. This study shows how ACL reconstruction (and subsequent rehabilitation) can positively impact neuromuscular characteristics of the quadriceps and hamstrings.

LEVEL OF EVIDENCE

Therapeutic, Level II.

Magnetic resonance imaging evaluation of patellar tendon graft remodelling after anterior cruciate ligament reconstruction with or without platelet-rich plasma

PURPOSE

To evaluate the stages of patellar tendon graft remodelling using magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstruction with or without platelet-rich plasma (PRP) injection.

METHODS

98 patients aged 18 to 65 years with complete rupture of the ACL were randomised to undergo reconstruction with the autologous patellar tendon grafts with or without PRP injection. For the PRP group, 8 ml of PRP was obtained in the surgery room and was percutaneously injected into the suprapatellar joint after portal suture. MRI was obtained at months 4, 6, and 12. Remodelling stages of the grafts were classified as hypointense, mildly hyperintense, moderately hyperintense, severely hyperintense, and diffusely hyperintense by a radiologist blinded to treatment allocation.

RESULTS

More patients in the PRP group than controls attained higher stages of remodelling at month 4 (p=0.003), month 6 (p=0.0001), and month 12 (p=0.354).

CONCLUSION

PRP enabled faster remodelling of patellar tendon grafts.

Proximal disinsertion of the common extensor tendon for lateral elbow tendinopathy

PURPOSE

To evaluate surgical outcomes of disinsertion of the common extensor tendon for lateral elbow tendinopathy.

METHODS

Records of 277 men and 128 women who underwent surgery for lateral elbow tendinopathy were reviewed. The indication for surgery was insufficient improvement of pain and inability to return to work after 3 weeks of physiotherapy (stretching, ultrasound) and local corticosteroid injections. According to the Tavernier technique, the origin of the tendons of the extensor carpi radialis brevis and extensor digitorum communis was located, and proximal disinsertion of the common extensor tendon was performed.

RESULTS

Outcome was excellent in 344 (85%) of the patients, good in 46 (11.5%), regular in 9 (2%), and poor in 2 (0.5%). The mean time to return to work was 29 (range, 5-93) days. Immediate complications included infection (n=1), seroma (n=1), cicatricial fibrosis (n=10), radial neuritis (sensory) [n=4], and reactive dermatitis (n=2). Late complications included Frohse's arcade syndrome (n=1) and carpal tunnel syndrome (n=2).

CONCLUSION

Disinsertion of the proximal common tendon is a good option for treating lateral elbow tendinopathy.