ACL Reconstruction With BPTB Graft Using an Oblique Incision Reduces the Incidence of Anterior Knee Pain- Mid Term Follow-up Study

Volume 5 | Issue 2 | September-December 2020 | Page 02-06 | Divya Bandari, David V. Rajan, Santosh Sahanand

Author: Divya Bandari [1], David V. Rajan[1], Santosh Sahanand [1]

[1] Department of Orthopaedics, Gandhi Medical College/Hospital, Musheerabad, Hyderabad, Telangana, India.
[2] Ortho-One Orthopaedic Speciality centre, Hyderabad, Telangana, India.

Address of Correspondence:
Dr. Divya Bandari,
Assistant Proffesor, Gandhi Medical College/Hospital 1-6-129 , Opp. kausalya nivas , near Bharat seva samaj
Musheerabad, Hyderabad, Telangana, India. 500020
E-mail: divi.bandari15@gmail.com

Abstract

Introduction: A BPTB graft is the preferred choice of graft fixation, especially for young athletes who are involved in contact sports. However, there have been limited studies to determine and quantify the degree and characteristics of anterior knee pain and differentiate it from kneeling pain as a separate entity.
Study type: Prospective Study
Materials and methods: In our study we have followed 60 patients 30 each of BPTB and STG graft ACL reconstruction from 2013 to 2016 visiting Ortho one orthopaedic speciality centre with a minimum follow up period of 2 years and assessed the anterior knee pain and kneeling pain in terms of difficulty with the help of IKDC score and also quantified them with the help of VAS scores. We divided Anterior knee pain and Kneeling pain into no pain(VAS 0), mild pain (VAS 1-3), moderate pain(VAS 4-7) and severe pain (VAS 8-10).
Results: On quantifying the pain using the VAS score for anterior knee pain the BPTB and STG group showed no patients with severe pain (8 to 10) at the end of 12 and 24 months. Moderate pain (4 to 7) at 12 months was seen in 12 patients each (40%) and at 24 months in 5 patients (15%) in BPTB group and 4 patients (13.3%) in STG group. There was statistically no diff between both groups at 1 and 2 years follow up. (>0.05)Our study showed less incidence and severity than previously published studies.
Conclusion: The results of the present study showed a trend toward better subjective results with the use of a small oblique incision for the harvest of BPTB graft for ACL reconstruction.
Keywords: Anterior cruciate ligament; Bone patellar tendon bone; semitendinosus; Gracilis; Prospective; Pain; Quantification.

References

1. Noyes FR, Butler DL, Grood ES, et al: Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg 66 A : 344–352, 1984
2. Schatzmann L, Brunner P, Sta¨ubli HU: Effect of cyclic preconditioning on the tensile properties of human quadriceps tendons and patellar ligaments. Knee Surg Sports Traumatol Arthrosc 6 : S56–S61, 1998 .
3. Woo SLY, Hollis JM, Adams DJ, et al: Tensile properties of the human femur-anterior cruciate ligament-tibia complex: The effects of specimen age and orientation. Am JSports Med 1 9 : 217–225, 199
4. Erickson BJ, Harris JD, Fillingham YA, et al. Anterior cruciate ligament reconstruction practice patterns by NFL and NCAA football team physicians. Arthroscopy. 2014;30(6):731e738.
5. Papageorgiou CD, Ma CB, Abramowitch SD, Clineff TD, Woo SL. A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med. 2001;29(5):620e626.
6. Schuette HB, Kraeutler MJ, Houck DA, McCarty EC. Bone-patellar tendon-bone versus hamstring tendon autografts for primary anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Orthopaed J Sports Med. 2017;5(11), 2325967117736484.
7. Kartus, J., Ejerhed, L., Sernert, N., Brandsson, S., & Karlsson, J. (2000). Comparison of Traditional and Subcutaneous Patellar Tendon Harvest: A Prospective Study of Donor Site-Related Problems After Anterior Cruciate Ligament Reconstruction Using Different Graft Harvesting Techniques. The American Journal of Sports Medicine, 28(3), 328–335.
8. Tsuda, E., Okamura, Y., Ishibashi, Y., Otsuka, H., & Toh, S. (2001). Techniques for Reducing Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft. The American Journal of Sports Medicine, 29(4), 450–456.
9. Gaudot F, Leymarie JB, Drain O, Boisrenoult P, Charrois O, Beaufils P. Doubleincision mini-invasive technique for BTB harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Orthopaed Traumatol Surger Res: OTSR. 2009;95(1):28e35.
10. Niki Y, Hakozaki A, Iwamoto W, et al. Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1543e1549.
11. Feller, J. A., & Webster, K. E. (2003). A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine, 31(4), 564–573.
12. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE. Anterior cruciate ligament reconstruction autograft choice: bonetendon-bone versus hamstring. Does it really matter? A systematic review. Am J Sports Med. 2004;32(8):1986-1995
13. Webster, K. E., Feller, J. A., Hartnett, N., Leigh, W. B., & Richmond, A. K. (2016). Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction: A 15-Year Follow-up of a Randomized Controlled Trial. The American Journal of Sports Medicine, 44(1), 83–90

 

How to Cite this article: Bandari D, Rajan DV, Sahanand S | ACL Reconstruction With BPTB Graft Using an
Oblique Incision Reduces the Incidence of Anterior Knee Pain- Mid Term Follow-up Study study| Asian Journal of Arthroscopy | July- December 2020; 5(2): 02-06.

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Arthroscopic Capsular Release of Adhesive Capsulitis- A Systematic Review

Volume 5 | Issue 2 | September-December 2020 | Page 07-12 | Abdul Azeem Badurudeen, Balaji Sambandam

Author: Abdul Azeem Badurudeen [1], Balaji Sambandam [2]

[1] Department of Orthopaedics, Institute of Medical Sciences, Melmaruvathur, Tamilnadu, India.
[2] Department of Orthopaedics, Atlas Hospital, Trichy, Tamilnadu, India.

Address of Correspondence:
Dr. Balaji Sambandam,
Orthopaedic Consultant, Atlas Hospital, Trichy, Tamilnadu, India.
E-mail: balajinimrotz@gmail.com

Abstract

Background: Adhesive capsulitis is one of the commonest disabling problem of the shoulder. Management of this pathology has multiple conservative and surgical options. Among the surgical options arthroscopic capsular release is the most researched technique. The aim of this study is to find the relevance of the procedure in current practice, by systematically reviewing the recent literatures.
Methods: A rigorous online data search was done for scientific English publications between 2000 and 2020. Search engines used were Medline, Google scholar and Cochrane. Keywords used were shoulder stiffness, adhesive capsulitis, frozen shoulder, capsular release and shoulder arthroscopy. Inclusion criteria were original studies, minimum sample size of 10 patients, arthroscopic capsular release as one of the treatment modalities, minimum follow up duration of 6 months, minimum duration of symptoms of 3 months. Studies with secondary adhesive capsulitis, additional procedures such as rotator cuff repairs were excluded from this review. All articles were evaluated by both the authors and data were extracted and analyzed.
Results: Twenty articles met with all inclusion criteria. There were 10 prospective and 10 retrospective studies. Two were level 2 studies, four were level 3 studies and 14 were level 4 studies. Total of 797 patients (810 shoulder) underwent arthroscopic capsular release. The average age was 52. 285 were males. 466 were females. 205 were right shoulders. 204 were left shoulders. Average follow up was 20.25 months. Arthroscopic capsular release resulted in significant improvement in range of motion at all planes and reduced VAS scores. There was a significant improvement in post-operative shoulder functional outcome scores. Complication rate was 3.1%, but none of them were major and recurrence rate was 0.25%.
Conclusion: Arthroscopic capsular release is a very good option for adhesive capsulitis with failed conservative treatment. It results in a significant improvement in range of motion and functional outcome scores. Good result of arthroscopic capsular release was observed very quickly and was maintained in long term. It is a very safe procedure with very minimal complication.
Keywords: Periarthritis; Adhesive capsulitis; Frozen shoulder; Arthroscopic capsular release; Shoulder arthroscopy.

References

  1. Lafosse L, Boyle S, Kordasiewicz B, Aranberri-Gutiérrez M, Fritsch B, Meller R. Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach. Arthroscopy. 2012 Jul;28(7):916-23.
  2. Neviaser JS. Adhesive capsulitis of the shoulder. J Bone Joint Surg Am. 1945;27:211–22.
  3. Tasto JP, Elias DW.Adhesive Capsulitis. Sports Med Arthrosc Rev. 2007;15:216–21.
  4. Le Lievre HMJ, Murrell GAC. Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. J Bone Joint Surg Am. 2012;94:1208-16.
  5. Fernandes MR. Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years. Acta Ortop Bras. 2015;23(2):85-9.
  6. Redler LH, Dennis ER. Treatment of Adhesive Capsulitis of the Shoulder. J Am Acad Orthop Surg. 2019;27: e544-e554.
  7. Berghs BM, Sole-Molins X, Bunker TD. Arthroscopic release of adhesive capsulitis. Journal of shoulder and elbow surgery.2004;13(2):180-5.
  8. Cvetanovich GL, Leroux T, Hamamoto JT, Higgins JD, Romeo AA, Verma NN. Arthroscopic 360◦ Capsular Release for Adhesive Capsulitis in the Lateral Decubitus Position. Arthrosc Tech. 2016;5(5):e1033-e1038.
  9. Barnes CP, Lam PH, Murrell GAC. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. J shoulder and elbow surgery; 2016 Sep;25(9):e256-264.
  10. Mukherjee RN, Pandey RM, Nag HL, Mittal R. Frozen shoulder – A prospective randomized clinical trial. World J Orthop. 2017; 8(5): 394-9.
  11. Gallacher S, Beazley JC, Evans J et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg. 2018 Aug;27(8):1401-6.
  12. Walther M, Blanke F, Wehren LV, Majewski M. Frozen Shoulder – Comparison of different surgical treatment options. Acta Orthop. Belg. 2014;80:172-7.
  13. De Carli A, Vadalà A, Perugia D et al. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections. International Orthopaedics (SICOT). 2012;36:101–6.
  14. Rill BK, Fleckenstein CM, Levy MS, Nagesh V, Hasan SS. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis. Am J Sports Med. 2011 Mar;39(3):567-74.
  15. Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg. 2002;11(6):609-13.
  16. Tsai MJ, Ho WP, Chen CH, Leu TH, Chuang TY. Arthroscopic extended rotator interval release for treating refractory adhesive capsulitis: A viewpoint of “mobilizing subscapularis.” Journal of Orthopaedic Surgery. 2017;25(1);1-7.
  17. Mubark IM, Ragab AH, Nagi AA, Motawea BA. Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release. Ortop Traumatol Rehabil. 2015;17(1):21-8.
  18. Waszczykowski M, Polguj M, Fabiś J. The impact of arthroscopic capsular release in patients with primary frozen shoulder on shoulder muscular strength. Biomed Res Int. 2014;2014:834283.
  19. Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55-60.
  20. Dattani R, Ramasamy V, Parker R, Patel VR. Improvement in quality of life after arthroscopic capsular release for contracture of the shoulder. Bone Joint J. 2013 Jul;95-B(7):942-6.
  21. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):638–44.
  22. Klinger HM, Otte S, Baums MH, Haerer T Early arthroscopic release in refractory shoulder stiffness. Arch Orthop Trauma Surg. 2002;122:200–3.
  23. Ranalletta M, Rossi LA, Zaidenberg EE et al. Midterm Outcomes After Arthroscopic Anteroinferior Capsular Release for the Treatment of Idiopathic Adhesive Capsulitis. The Journal of Arthroscopic and Related Surgery. 2017;33(3):503-8.
  24. Puah KL, Salieh MS, Yeo W, Tan AHC. Outcomes of arthroscopic capsular release for the diabetic frozen shoulder in Asian patients. J Orthop Surg (Hong Kong). 2018;26(1):1-4.
  25. Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint–indication, surgical technique, results. Knee Surg Sports Traumatol Arthrosc. 2001;9(3):178-86.
  26. Uno A, Bain G, Mehta J. Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study.J Shoulder Elbow Surg 1999; 8: 226-30.

 

How to Cite this article: Badurudeen AA, Sambandam B | Arthroscopic Capsular Release of Adhesive Capsulitis- A Systematic Review | Asian Journal of Arthroscopy | September-December 2020; 5(2): 07-12.

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Anterior Tibial Spine Avulsion Fracture With Concomitant Tibial Side Anterior Cruciate Ligament Tear in an Adolescent Male: A Case Report

Volume 5 | Issue 2 | September-December 2020 | Page 13-16 | Ajit Swamy, Ishan Shevate, Girish Nathani, Yogesh Khandalkar

Author: Ajit Swamy [1], Ishan Shevate [1], Girish Nathani [1], Yogesh Khandalkar [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra,
India.

Address of Correspondence:
Dr. Ishan Shevate,
Assistant Professor, Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
E-mail: ishanshevate@gmail.com

Abstract

Introduction: Tibial spine avulsion fractures are common in children and adolescents. Tibial spine avulsion fracture along with an Anterior cruciate ligament(ACL) tear are rarely reported in paediatric age group. We present a case of an adolescent child with avulsion of the anterior tibial spine with a complete tear of antero-medial bundle and near-total tear of a postero-lateral bundle.
Case Report: An adolescent male child presented with twisting injury to right knee while playing football. Local examination revealed positive patellar tap, Lachman test and anterior drawer test were grade 2 positive. Radiographs showed type 3 tibial spine avulsion fracture. Magnetic Resonance Imaging(MRI) and arthroscopy confirmed the diagnosis of avulsion with complete ACL tear. We decided to do transphyseal ACL reconstruction using hamstring autograft and excision of the avulsed fragment. Post operatively physiotherapy and weight bearing were started as per pain tolerance. Patient achieved full range of motion and returned to pre injury activity and sports 1 year post operatively.
Discussion: After reviewing the literature we found that anterior tibial spine fractures along with ACL tear are most uncommon reported in paediatric age group. In nearly 30-60% cases of displaced tibial eminence fracture, concomitant injury either to the meniscus, ligaments or the articular cartilage were diagnosed on MRI. Reported literature shows no difference in percentage of growth abnormalities in transphyseal verses physeal sparing techniques.
Conclusion: A thorough preoperative evaluation with radiographs and MRI is important to detect these injuries and planning the treatment accordingly. Primary ACL reconstruction gives good results in these cases.
Keywords: ACL avulsion fracture with tear; Paediatric sports injury; ACL reconstruction; Concomitant ACl avulsion and tear.

References

1. Lafosse L, Boyle S, Kordasiewicz B, Aranberri-Gutiérrez M, Fritsch B, Meller R. Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach. Arthroscopy. 2012 Jul;28(7):916-23.
2. Neviaser JS. Adhesive capsulitis of the shoulder. J Bone Joint Surg Am. 1945;27:211–22.
3. Tasto JP, Elias DW.Adhesive Capsulitis. Sports Med Arthrosc Rev. 2007;15:216–21.
4. Le Lievre HMJ, Murrell GAC. Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. J Bone Joint Surg Am. 2012;94:1208-16.
5. Fernandes MR. Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years. Acta Ortop Bras. 2015;23(2):85-9.
6. Redler LH, Dennis ER. Treatment of Adhesive Capsulitis of the Shoulder. J Am Acad Orthop Surg. 2019;27: e544-e554.
7. Berghs BM, Sole-Molins X, Bunker TD. Arthroscopic release of adhesive capsulitis. Journal of shoulder and elbow surgery.2004;13(2):180-5.
8. Cvetanovich GL, Leroux T, Hamamoto JT, Higgins JD, Romeo AA, Verma NN. Arthroscopic 360◦ Capsular Release for Adhesive Capsulitis in the Lateral Decubitus Position. Arthrosc Tech. 2016;5(5):e1033-e1038.
9. Barnes CP, Lam PH, Murrell GAC. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. J shoulder and elbow surgery; 2016 Sep;25(9):e256-264.
10. Mukherjee RN, Pandey RM, Nag HL, Mittal R. Frozen shoulder – A prospective randomized clinical trial. World J Orthop. 2017; 8(5): 394-9.
11. Gallacher S, Beazley JC, Evans J et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg. 2018 Aug;27(8):1401-6.
12. Walther M, Blanke F, Wehren LV, Majewski M. Frozen Shoulder – Comparison of different surgical treatment options. Acta Orthop. Belg. 2014;80:172-7.
13. De Carli A, Vadalà A, Perugia D et al. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections. International Orthopaedics (SICOT). 2012;36:101–6.
14. Rill BK, Fleckenstein CM, Levy MS, Nagesh V, Hasan SS. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis. Am J Sports Med. 2011 Mar;39(3):567-74.
15. Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg. 2002;11(6):609-13.
16. Tsai MJ, Ho WP, Chen CH, Leu TH, Chuang TY. Arthroscopic extended rotator interval release for treating refractory adhesive capsulitis: A viewpoint of “mobilizing subscapularis.” Journal of Orthopaedic Surgery. 2017;25(1);1-7.
17. Mubark IM, Ragab AH, Nagi AA, Motawea BA. Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release. Ortop Traumatol Rehabil. 2015;17(1):21-8.
18. Waszczykowski M, Polguj M, Fabiś J. The impact of arthroscopic capsular release in patients with primary frozen shoulder on shoulder muscular strength. Biomed Res Int. 2014;2014:834283.
19. Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55-60.
20. Dattani R, Ramasamy V, Parker R, Patel VR. Improvement in quality of life after arthroscopic capsular release for contracture of the shoulder. Bone Joint J. 2013 Jul;95-B(7):942-6.
21. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):638–44.
22. Klinger HM, Otte S, Baums MH, Haerer T Early arthroscopic release in refractory shoulder stiffness. Arch Orthop Trauma Surg. 2002;122:200–3.
23. Ranalletta M, Rossi LA, Zaidenberg EE et al. Midterm Outcomes After Arthroscopic Anteroinferior Capsular Release for the Treatment of Idiopathic Adhesive Capsulitis. The Journal of Arthroscopic and Related Surgery. 2017;33(3):503-8.
24. Puah KL, Salieh MS, Yeo W, Tan AHC. Outcomes of arthroscopic capsular release for the diabetic frozen shoulder in Asian patients. J Orthop Surg (Hong Kong). 2018;26(1):1-4.
25. Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint–indication, surgical technique, results. Knee Surg Sports Traumatol Arthrosc. 2001;9(3):178-86.
26. Uno A, Bain G, Mehta J. Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study.J Shoulder Elbow Surg 1999; 8: 226-30.

How to Cite this article: Swamy A, Shevate I, Nathani G, Khandalkar Y | Anterior Tibial Spine Avulsion Fracture With Concomitant Tibial Side Anterior Cruciate Ligament Tear in an Adolescent Male: A Case Report | Asian Journal of Arthroscopy | September-December 2020; 5(2): 13-16.

(Abstract)      (Text HTML)      (Download PDF)