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Purpose: The duration for which anterior cruciate ligament reconstruction (ACLR) can be delayed without resulting in a risk of subsequent meniscus injury has remained a debatable topic. The main purpose of this study was to determine the safest delay interval for a delayed ACLR. Methods: This retrospective study included all patients who underwent ACLR between January 2020 and January 2022. The patients were divided into four groups based on the delay interval: <3 months, 3-6 months, 6-12 months and >12 months. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1-year postoperatively. Results: A total of 95 patients were included in this study. ACLR delay of 3-6 months was not associated with the risk of meniscus injury, while a delay of 6-12 months (odds ratio [OR] = 4.35; 95% confidence interval [CI] = 1.13-16.79; p = 0.031) and >12 months (OR = 10.68; 95% CI = 2.55-42.22; p = 0.001) was associated with a likelihood of developing meniscus injury. Meniscus injury risk increased by 12% for each month of ACLR delay (OR = 1.12; 95% CI = 1.04-1.22; p = 0.003). Regarding clinical outcomes at 1-year postoperatively, all groups exhibit the same clinical results. Conclusion: ACLR can be safely delayed up to 6 months after the initial injury. However, a delay for >6 months must be avoided, as it was found to significantly increase the likelihood of developing a meniscus injury. Level of Evidence: Level III, retrospective comparative study.
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INTRODUCTION AND IMPORTANCE: Volar distal radioulnar joint (DRUJ) dislocation with an isolated ulnar styloid fracture is considered as a very rare clinical entity. Due to its subtle clinical presentation, patients often presented late. Optimal management is required to prevent functional impairment and improved quality of life. CASE PRESENTATION: A 51-year-old female presented to our outpatient clinic with neglected volar DRUJ dislocation and isolated ulnar styloid fracture, resulting from a previous injury that was initially misdiagnosed as a wrist sprain approximately four months prior. A plain wrist radiograph and computed tomography scan confirmed the volar DRUJ dislocation and ulnar styloid fracture without any other bony involvement. Surgical intervention was planned, and an open reduction technique was performed, consisting of Kirschner wire stabilization, volar radioulnar ligament plication, and volar capsular repair. DISCUSSION: The involvement of the component of triangular fibrocartilage complex (TFCC) and joint capsule must be evaluated, as both of this structure plays an important role for long-term DRUJ stabilization. Repair or reconstruction must be attempted if an evidence of tears was observed intraoperatively. Temporary stabilization of the distal radioulnar joint while allowing the repaired tissue to heal can be achieved with radioulnar K-wire fixation. CONCLUSION: Our report suggests that this condition can be managed with a radioulnar K-wire stabilization in combination with a soft tissue repair or reconstruction. This approach was found to resulted in satisfactory clinical outcomes.
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INTRODUCTION AND IMPORTANCE: Rupture to the patellar tendon caused by athletic activities is rare, but if not treated promptly, it can lead to unfavorable results such as quadriceps contracture, residual weakness, and reduced knee flexibility. CASE PRESENTATION: A female patient who injured her knee seven months ago while twisting it experienced pain, instability, and tested positive for the anterior drawer and Lachman tests. Radiology results showed a complete tear of the anterior cruciate ligament (ACL) and a partial tear of the patellar tendon on the MRI scan of the right knee. We used a direct end-to-end approximation technique for the patellar tendon, with augmentation through the transosseous site at the patella proximally and tibial tubercle distally, without using a graft. The outcome was good, and this is the first reported case of a successful patellar tendon reconstruction without using implants, synthetic augmentation, or graft. CLINICAL DISCUSSION: This technique could be a promising alternative to repair a chronic patellar tendon rupture without using expensive methods. The use of fiber tape augmentation can be a practical solution for treating a neglected patellar tendon rupture in conjunction with aligamentous injury that requires graft repair. CONCLUSION: The use of fiber tape augmentation might be an alternative method for treating a neglected patellar tendon rupture with concurrent ligament injury needing graft repair. We believe that this technique is easily reproducible and warrants further investigation.
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INTRODUCTION AND IMPORTANCE: The shoulder is one of the most unstable joints of the body. Shoulder dislocation accounts for up to 60% of all major joint dislocations. This study reports two cases of primary traumatic shoulder dislocation and shows that in the elderly, primary traumatic shoulder dislocation is associated with a rotator cuff tear (RCT). CASE PRESENTATION: A case report and narrative review included two female patients, aged 63 and 100 years. Presenting symptoms were instability, pain, and restricted shoulder movement. Both were successfully treated by surgery. Arthroscopy was performed in the first patient and open reduction in the second patient. CLINICAL DISCUSSION: In the first case, we found synovitis around the rotator interval, long head of the biceps tendinitis, and tears of the subscapularis tendon, supraspinatus tendon, and subacromial bursitis. The anterior labrum was normal. In the second case, complete detachment of the infraspinatus tendon was found. In both cases, rotator cuff repair was performed. Primary traumatic shoulder dislocation in the elderly is often associated with rotator cuff injury. Therefore, a detailed evaluation and management of the rotator cuff injury is essential. Rotator cuff injuries cause loss of dynamic stabilization of the shoulder, leading to recurrent shoulder dislocation and chronic shoulder instability. CONCLUSION: The associated pathology of the primary traumatic shoulder dislocation in elderly are rotator cuff tear. The management of the rotator cuff tear in primary traumatic shoulder dislocation can prevent further shoulder instability events.
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BACKGROUND: Fracture of distal-end accounts for 20% of all clavicle fracture. In the situation of impaired bone healing environment such as chronic kidney disease (CKD), nonunion rates after surgery might increase. In the case where bone healing is unexpected, biological healing with tendon graft could be an alternative method to maintain bone reduction. PRESENTATION OF CASE: A 62-year old male with a history of end-stage CKD presented to the hospital with pain, wound, and deformity on the right shoulder. The patient have had surgery in the past 4 months and resulted in a non-union fracture of the distal third right clavicle. The patient underwent implant removal and continued with coracoclavicular ligament reconstruction with autologous tendon grafts of semitendinosus tendon and mini-plate augmentation. DISCUSSION: The Distal clavicle has a high rate of delayed and nonunion even without the presence of comorbidity. A compromised bone quality frequently leads to failed osteosynthesis in patients with end-stage renal failure. In the advanced stages of kidney disease, problems with a renal clearance of phosphate and low 1É-hydroxylase levels resulting in increased serum phosphate levels and low serum calcium levels. Given these circumstances, we considered the idea to maintain fracture reduction by biologic soft tissue healing of the graft to replace the coracoclavicular ligaments as we can not rely on normal bone strength and healing capacity. CONCLUSION: In the situation where bone healing is unexpected, biological healing with tendon graft may be necessary. The use of autologous tendon graft and mini-plate suture augmentation could help to maintain bone reduction in such environment.