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Purpose: To determine potential quadriceps versus hamstring tendon autograft differences in neuromuscular function and return to sport (RTS)-success in participants after an anterior cruciate ligament (ACL) reconstruction. Methods: Case–control study on 25 participants operated on with an arthroscopically assisted, anatomic ipsilateral quadriceps femoris tendon graft and two control groups of 25 participants each, operated on with a semitendinosus tendon or semitendinosus-gracilis (hamstring) tendon graft ACL reconstruction. Participants of the two control groups were propensity score matched to the case group based on sex, age, Tegner activity scale and either the total volume of rehabilitation since reconstruction (n = 25) or the time since reconstruction (n = 25). At the end of the rehabilitation (averagely 8 months post-reconstruction), self-reported knee function (KOOS sum scores), fear of loading the reconstructed knee during a sporting activity (RSI-ACL questionnaire), and fear of movement (Tampa scale of kinesiophobia) were followed by hop and jump tests. Front hops for distance (jumping distance as the outcome) were followed by Drop jumps (normalised knee joint separation distance), and concluded by qualitative ratings of the Balanced front and side hops. Between-group comparisons were undertaken using 95% confidence intervals comparisons, effect sizes were calculated. Results: The quadriceps case group (always compared with the rehabilitation-matched hamstring graft controls first and versus time-matched hamstring graft controls second) had non-significant and only marginal higher self-reported issues during sporting activities: Cohen's d = 0.42, d = 0.44, lower confidence for RTS (d = − 0.30, d = − 0.16), and less kinesiophobia (d = − 0.25, d = 0.32). Small and once more non-significant effect sizes point towards lower values in the quadriceps graft groups in the Front hop for distance limb symmetry values in comparison to the two hamstring control groups (d = − 0.24, d = − 0.35). The normalised knee joint separation distance were non-significantly and small effect sized higher in the quadriceps than in the hamstring groups (d = 0.31, d = 0.28). Conclusion: Only non-significant and marginal between-graft differences in the functional outcomes at the end of the rehabilitation occurred. The selection of either a hamstring or a quadriceps graft type cannot be recommended based on the results. The decision must be undertaken individually. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: To perform a meta-analysis of RCTs evaluating donor site morbidity after bone–patellar tendon–bone (BTB), hamstring tendon (HT) and quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR). Methods: PubMed, OVID/Medline and Cochrane databases were queried in July 2022. All level one articles reporting the frequency of specific donor-site morbidity were included. Frequentist model network meta-analyses with P-scores were conducted to compare the prevalence of donor-site morbidity, complications, all-cause reoperations and revision ACLR among the three treatment groups. Results: Twenty-one RCTs comprising the outcomes of 1726 patients were included. The overall pooled rate of donor-site morbidity (defined as anterior knee pain, difficulty/impossibility kneeling, or combination) was 47.3% (range, 3.8–86.7%). A 69% (95% confidence interval [95% CI]: 0.18–0.56) and 88% (95% CI: 0.04–0.33) lower odds of incurring donor-site morbidity was observed with HT and QT autografts, respectively (p < 0.0001, both), when compared to BTB autograft. QT autograft was associated with a non-statistically significant reduction in donor-site morbidity compared with HT autograft (OR: 0.37, 95% CI: 0.14–1.03, n.s.). Treatment rankings (ordered from best-to-worst autograft choice with respect to donor-site morbidity) were as follows: (1) QT (P-score = 0.99), (2) HT (P-score = 0.51) and (3) BTB (P-score = 0.00). No statistically significant associations were observed between autograft and complications (n.s.), reoperations (n.s.) or revision ACLR (n.s.). Conclusion: ACLR using HT and QT autograft tissue was associated with a significant reduction in donor-site morbidity compared to BTB autograft. Autograft selection was not associated with complications, all-cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor-site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events. Level of evidence: Level I. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the functional and graft survivorship outcomes of the three most common autograft options for primary anterior cruciate ligament reconstruction (ACLR)—hamstring tendon (HT), bone-patella-tendon-bone (BPTB), and quadriceps tendon (QT). Methods: Patients captured by the New Zealand ACL registry who underwent a primary ACLR from 2014 to 2020 were considered for the study. Patients with associated knee injury (including meniscus, chondral, osseous, and additional ligamentous injury) and previous knee surgery were excluded. Comparison was made between HT, BPTB, and QT autografts with respect to Marx and KOOS (Knee Osteoarthritis Outcome Score) scores at minimum 2 years follow-up. In addition, graft survivorship was evaluated by comparing all-cause revision per 100 graft years and revision-free proportion at 2 years post-surgery. Results: 2,582 patients (1,921 HT, 558 BPTB, 107 QT) were included in the study. Differences in adjusted functional outcomes between HT and BPTB were found at 12 months (mean Marx; HT 6.2; BPTB 7.1; P < 0.001) (mean KOOS Sport and Recreation; HT 75.1; BPTB 70.5; n.s.) and 24 months (mean KOOS Sports and Recreation; HT 79.2; BPTB 73.9; P < 0.001). QT was comparable to HT and BPTB in all functional scores at 12 months and 2 years. No statistically significant differences were found in revision rate between all three autograft groups up to 2 years post-surgery (revision rate per 100 graft years; HT 1.05; BPTB 0.80; QT 1.68; n.s. HT vs. BPTB; n.s. HT vs. QT; n.s. QT vs. BPTB). Conclusions: QT was found to be comparable to both HT and BPTB in all functional scores and revision rates up to 2 years post-surgery. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency. [ABSTRACT FROM AUTHOR]

Immobilization using external or internal splints is a standard and effective procedure to treat minor skeletal fractures. In the case of major skeletal defects caused by extreme trauma, infectious diseases or tumors, the surgical implantation of a bone graft from external sources is required for a complete cure. Practical disadvantages, such as the risk of immune rejection and infection at the implant site, are high in xenografts and allografts. Currently, an autograft from the iliac crest of a patient is considered the "gold standard" method for treating large-scale skeletal defects. However, this method is not an ideal solution due to its limited availability and significant reports of morbidity in the harvest site (30%) as well as the implanted site (5–35%). Tissue-engineered bone grafts aim to create a mechanically strong, biologically viable and degradable bone graft by combining a three-dimensional porous scaffold with osteoblast or progenitor cells. The materials used for such tissue-engineered bone grafts can be broadly divided into ceramic materials (calcium phosphates) and biocompatible/bioactive synthetic polymers. This review summarizes the types of materials used to make scaffolds for cryo-preservable tissue-engineered bone grafts as well as the distinct methods adopted to create the scaffolds, including traditional scaffold fabrication methods (solvent-casting, gas-foaming, electrospinning, thermally induced phase separation) and more recent fabrication methods (fused deposition molding, stereolithography, selective laser sintering, Inkjet 3D printing, laser-assisted bioprinting and 3D bioprinting). This is followed by a short summation of the current osteochondrogenic models along with the required scaffold mechanical properties for in vivo applications. We then present a few results of the effects of freezing and thawing on the structural and mechanical integrity of PLLA scaffolds prepared by the thermally induced phase separation method and conclude this review article by summarizing the current regulatory requirements for tissue-engineered products. [ABSTRACT FROM AUTHOR]

Currently there are no guidelines on a safe neutrophil count(ANC) for intravenous antibiotic(IVAB) cessation and hospital discharge in patients recovering after febrile neutropenia(FN). We assessed the safety in selected patients after recent FN of prompt IVAB cessation and hospital discharge. Safety was defined as no fever recurrence after IVAB cessation and readmission in the 10-days post-discharge for infections. A retrospective, single center audit conducted on 92 adult hematology patients admitted with de novo acute myeloid leukemia (AML) for intensive chemotherapy or for an autograft. Most admissions (n = 128/141;91%) were complicated by FN. Half of FN episodes ceased IVAB promptly with a median(range) ANC of 0.6(0.1–4.9x109/L); none of these episodes had recurrent fever requiring IVAB resumption. Prompt discharge occurred in 45% overall. Subsequent unplanned readmission rates were low. In afebrile, stable AML and autograft patients without medico-social barriers to discharge, IVAB can be ceased and hospital discharges safely done ≤24h of ANC ≥ 0.2x109/L. [ABSTRACT FROM AUTHOR]

Purpose: Following posterior cruciate ligament (PCL) rupture, autografts and allografts are routinely used for its reconstruction. This study investigated the efficacy and safety of allografts for primary PCL reconstruction, comparing them to autografts in terms of patient-reported outcome measures (PROMs), functional tests, and complications. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus were accessed in October 2022. All the clinical studies investigating the outcomes of primary PCL reconstruction using allografts, or comparing the outcomes of allografts versus autografts, were accessed. The outcomes of interests were: instrumental laxity, range of motion (ROM), Telos stress radiography, drawer test, International Knee Documentation Committee (IKDC), Tegner Activity Scale, and the Lysholm Knee Scoring Scale. Data on complications were also recorded. Results: A total of 445 patients were included. The mean follow-up was 45.2 ± 23.8 months. The mean age of the patients was 30.6 ± 2.2 years. The time span between the injury and surgical intervention was 12.9 ± 10 months. Overall, 28% (125 of 445 patients) were women. Good baseline comparability was found between the two cohorts. No difference was found in terms of Lysholm Score, ROM, Tegner Scale, IKDC, arthrometer laxity, drawer test, and Telos stress radiography. No difference was found in the rates of anterior knee pain and revision. Conclusion: Allografts can be considered a suitable alternative to autografts for PCL reconstruction. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Background: A pterygium is a triangular fibrovascular subepithelial outgrowth of degenerative bulbar conjunctival tissue that often crosses the limbus and extends on to the corneal surface. Impaired lid movement, pathological conjunctival, corneal, or eyelid changes in pterygium lead to disturbed functioning of tear film. The gold standard treatment is pterygium excision with conjunctival autograft due to its lower (1.9–8%) recurrence rate. This study aimed to see the tear film changes associated with pterygium surgery with conjunctival autograft procedure. Materials and methods: This comparative study was conducted on 66 diagnosed patients of pterygium enrolled after fulfilling the inclusion and exclusion criteria. They were subjected to the Tear breakup time (TBUT) test and Schirmer’s test with a pre-sterilized Whatman 41 filter paper. Pterygium excision with conjunctival autograft was done. TBUT, schirmer’s test was done at each follow up at 1 month, 3 months and 6 months. Results: Mean age of the patients was 57.95±12.41 years. 36 out of total 66 (54.54%) patients were males. The number of patients with deranged TBUT and schirmer’s test decreased drastically after pterygium surgery with conjunctival autograft and the number further reduced at each follow up visit. The patients had significantly higher TBUT values (p=0.0001) 1 month after pterygium surgery with conjunctival autograft as compared to the TBUT values before the surgery. The Schirmer’s test results changed insignificantly over the follow-up period of 1, 3 and 6 months. Conclusion: Abnormal tear film function is associated with development of pterygium. Pterygium excision improves tear film function, TBUT significantly, although the improvement in schirmer’s test is insignificant. [ABSTRACT FROM AUTHOR]

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Background. Variable insertions of Palmaris longus (PL) muscle tendon is described by various authors. Presence of extra PL tendon is also described in literature. As autologus tendon grafting is a blooming arena of clinical research at present time, an additional tendinous slip of PL has promising scope for use as an autograft. Case Report. We report here bilateral bitendinous distal attachment of PL muscle encountered during routine cadaveric dissection. The additional PL tendon in a multitendinous insertion pattern with optimum length and thickness is indeed an additional advantage from the point of view of autograft harvesting. This has also importance in understanding the unusual, altered symptomatology in compressive conditions. Conclusion. Although relatively common, surgeons should be well aware of the various possible aversion of distal attachment of PL which might have significant impact in alteration of symptomatology of neurovascular compressions in the forearm and hand and while choosing an appropriate tendon autograft. [ABSTRACT FROM AUTHOR]

Background: There are no studies on the nonoperative treatment of traumatic partial anterior cruciate ligament (ACL) graft rupture. Purpose/Hypothesis: The purpose of this study was to compare the clinical and radiological outcomes and failure rates between nonoperative treatment and revision ACL reconstruction for traumatic partial ACL graft rupture. We hypothesized that the outcomes and failure rates would be comparable and that nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively evaluated 2114 patients treated for isolated ACL rupture between January 2000 and June 2020. Patients with traumatic partial graft rupture after ACL reconstruction with minimum 2-year follow-up data were included. Patients who met all the following conditions were candidates for nonoperative treatment: (1) Lachman or pivot-shift grade 0 or 1 at 6 months after ACL reconstruction, (2) ACL graft with low to intermediate signal intensity on 1-year postoperative magnetic resonance imaging (MRI), and (3) MRI after reinjury showing definite evidence of trauma, some fibers remaining in continuity of the ACL graft, and no anterior tibial subluxation in the sagittal plane. The patients were divided into 2 groups according to treatment method: nonoperative treatment (group A) and revision ACL reconstruction (group B). Clinical scores, laxity test results, radiological outcomes, and graft failures were compared between the groups. Results: In total, 47 patients had traumatic partial graft rupture (group A, n = 10; group B, n = 37). There were no significant differences between the 2 groups in terms of clinical scores, laxity tests, radiological outcomes, or graft failure. Conclusion: The clinical and radiological outcomes of nonoperative treatment of traumatic partial graft rupture after ACL reconstruction were comparable with those of revision ACL reconstruction. Nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes in selected patients. [ABSTRACT FROM AUTHOR]

Background: Existing systematic reviews have sought to characterize the relative donor-site morbidity of bone–patellar tendon–bone (BTB) and quadriceps tendon (QT) grafts after anterior cruciate ligament reconstruction (ACLR). However, no studies have reported the pooled proportions of patellar fractures and donor tendon ruptures across the body of literature. Purpose: To estimate the proportion of patellar fractures, patellar tendon ruptures, and QT ruptures associated with BTB or QT autograft harvest during ACLR using published data. Study Design: Systematic review; Level of evidence, 4. Methods: A meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using 3 online databases (PubMed, Scopus, and Web of Science). A total of 800 manuscripts were included in the initial research of peer-reviewed articles in English that reported extensor mechanism complications associated with graft harvest in patients after ACLR. Pooled proportions of patellar fractures, patellar tendon ruptures, and QT ruptures were calculated for each graft type (BTB, QT) using a random-effects model for meta-analysis. Results: A total of 28 studies were analyzed. The pooled proportion of patellar fractures was 0.57% (95% CI, 0.34%-0.91%) for the BTB harvest and 2.03% (95% CI, 0.78%-3.89%) for the QT harvest. The proportion of patellar tendon ruptures was 0.22% (95% CI, 0.14%-0.33%) after the BTB harvest, and the proportion of QT ruptures was 0.52% (95% CI, 0.06%-1.91%) after the QT harvest. The majority of included studies (16/28 [57.1%]) had an evidence level of 4. Conclusion: Based on the current literature, the proportion of extensor mechanism complications after ACLR using either a BTB or a QT autograft is low, indicating that the extensor mechanism harvest remains a safe option. A higher proportion of patellar fractures was noted for QT grafts and a higher proportion of donor tendon ruptures was noted for QT grafts compared with BTB grafts. [ABSTRACT FROM AUTHOR]

Introduction: Following total parathyroidectomy (PTx), transcervical thymectomy, and forearm autograft for secondary hyperparathyroidism (SHPT), recurrent SHPT can occur in the autografted forearm. However, few studies have investigated the factors contributing to re-PTx due to autograft-dependent recurrent SHPT before the completion of the initial PTx. Methods: A total of 770 patients who had autografted parathyroid fragments derived from only one of the resected parathyroid glands (PTGs) and who had undergone successful initial total PTx and transcervical thymectomy--defined by serum intact parathyroid hormone level < 60 pg/mL on postoperative day 1--between January 2001 and December 2022 were included in this retrospective cohort study. Factors contributing to re-PTx due to graft-dependent recurrent SHPT before the completion of the initial PTx were investigated using multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimal maximum diameter of PTG for autograft. Results: Univariate analysis showed that dialysis vintage and maximum diameter and weight of the PTG for autograft were significant factors contributing to graft-dependent recurrent SHPT. However, multivariate analysis revealed that dialysis vintage (P=0.010; hazard ratio [HR], 0.995; 95% confidence interval [CI], 0.992-0.999) and the maximum diameter of the PTG for autograft (P=0.046; HR, 1.107; 95% CI, 1.002-1.224) significantly contributed to graft-dependent recurrent SHPT. ROC curve analysis showed that < 14 mm was the optimal maximum diameter of PTG for autograft (area under the curve, 0.628; 95% CI, 0.551-0.705). Conclusions: The dialysis vintage and maximum diameter of PTG for autograft may contribute to re-PTx due to autograft-dependent recurrent SHPT, which can be prevented by using PTGs with a maximum diameter of < 14 mm for autograft. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is necessary to select an effective bone graft material in spinal fusion. Autograft was considered as the “gold standard” of spinal fusion, but there are complications such as donor site morbidity. Allograft can avoid complications associated with harvesting and donor’s volume is sufficient. Different allograft bone materials exhibit its excellent osteogenic ability when using at different sites of spine in spinal fusion. OBJECTIVE: To review the application status quo of allograft material in spinal fusion in recent years. METHODS: Relevant articles in Chinese and English published in PubMed, Web of Science and CNKI Database from 1990 to 2022 were retrieved. Search terms were “fresh frozen bone, autograft, allograft, freeze-dried bone, demineralized bone matrix, allograft spacer, spinal fusion” in English and Chinese, separately. After screening, 95 articles were included and reviewed. RESULTS AND CONCLUSION: Fresh frozen allograft is less used clinically due to its risk of immune rejection and transmission of disease. The fusion effect of freeze-dried bone is similar to autograft bone despite its delayed union in the end. Demineralized bone matrix is a useful graft material when it is used as a graft extender in combination with autograft or to fill the cages to play its biggest fusion ability. The combination with a carrier such as calcium sulfate or hydroxyapatite results in a significant increase in its plasticity and osteogenic activity. The new anatomic allograft spacer has good osteogenic activity, high clinical fusion rate and is effective in maintaining the intervertebral space height and the normal shape of intervertebral foramen. A large number of existing clinical studies have shown that allograft bone material can achieve the same fusion efficiency as autograft bone in spinal fusion, and is as safe and effective as autograft bone. It is a good choice for surgeons and has been widely used in clinical practice. [ABSTRACT FROM AUTHOR]

It has been proposed that delaying the Ross procedure to later in childhood, allowing autograft stabilisation and placement of a larger pulmonary conduit, may improve outcomes. However, the effect of age at the time of Ross procedure on outcomes remains unclear. All patients who underwent the Ross procedure between 1995 and 2018 were included in the study. Patients were divided into four groups: infants, age 1 to 5 years, age 5 to 10 years and age 10 to 18 years. A total of 140 patients underwent the Ross procedure in the study period. Early mortality was 23.3% (7/30) for infants compared to 0% for older children (p <0.001). Survival at 15 years was significantly lower in infants (76.3%±9.9%), compared to children aged 1 to 5 years (90.9%±20.1%), 5 to 10 years (94%±13.3%), and 10 to 18 years (86.7%±10.0%), p =0.01. Freedom from autograft reoperation at 15 years was significantly lower in infants (58.4%±16.2%), compared to children aged 1 to 5 years (77.1%±14.9%), 5 to 10 years (84.2%±6.0%) and 10 to 18 years (87.8%±9.0%), p =0.01. Overall freedom from reoperation at 15 years was 13.0%±6.0% for infants, 24.2%±9.0% for children aged 1 to 5 years, 46.7%±15.8% for children aged 5 to 10 years, and 78.4%±10.4%, p <0.001. The Ross procedure performed after 10 years of age appears to be associated with improved freedom from reoperation, primarily due to a reduction in reoperation on the pulmonary conduit. [ABSTRACT FROM AUTHOR]

In peripheral nerve injuries (PNI) with substance loss, where tensionless end-to-end suture is not achievable, the positioning of a graft is required. Available options include autografts (e.g., sural nerve, medial and lateral antebrachial cutaneous nerves, superficial branch of the radial nerve), allografts (Avance®; human origin), and hollow nerve conduits. There are eleven commercial hollow conduits approved for clinical, and they consist of devices made of a non-biodegradable synthetic polymer (polyvinyl alcohol), biodegradable synthetic polymers (poly(DL-lactide-ε-caprolactone); polyglycolic acid), and biodegradable natural polymers (collagen type I with/without glycosaminoglycan; chitosan; porcine small intestinal submucosa); different resorption times are available for resorbable guides, ranging from three months to four years. Unfortunately, anatomical/functional nerve regeneration requirements are not satisfied by any of the possible alternatives; to date, focusing on wall and/or inner lumen organization/functionalization seems to be the most promising strategy for next-generation device fabrication. Porous or grooved walls as well as multichannel lumens and luminal fillers are the most intriguing options, eventually also including the addition of cells (Schwann cells, bone marrow-derived, and adipose tissue derived stem cells) to support nerve regeneration. This review aims to describe common alternatives for severe PNI recovery with a highlight of future conduits. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes. Methods: Thirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure. Results: Favorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%. Conclusion: Autologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. Methods: Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up. Results: All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups. Conclusion: All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Simple Summary: This study addressed the complexities of nonunion in small animal orthopedics and highlighted the potential of autogenous corticocancellous bone grafts to facilitate bone healing. Autogenous cancellous bone grafting has proven to be the most effective means of stimulating fracture healing in orthopedics; however, filling large bone defects with cancellous bone can be challenging. In these cases, cortical bone grafts may provide mechanical stability to the defective area. This case study investigated the use of the coccygeal bone as an autogenous bone graft to fill a large femoral defect. To prevent fixation failure, rigid fixation was achieved between the coccygeal and femoral bone fragments using orthogonal locking plates and screws, strengthening the mechanical structure. Harvesting was performed immediately before transplantation to increase the viability of the grafted bone. Various methods can be employed to enhance osteoinductivity and osteoconductivity to promote successful engraftment, including the use of platelet-rich plasma and active rehabilitation to improve the blood supply and increase biological activity. Although coccygeal bone grafting has been reported in the radius and tibia, this is the first instance of the coccygeal bone being used as an autogenous bone graft in femoral fracture nonunion. An 11-month-old castrated male Pomeranian presented with nonunion following a femoral fracture that occurred after femoral head and neck osteotomy. Radiography and computed tomography revealed severe atrophy of the proximal bone fragment and retardation of the ipsilateral distal fragment and tibia. An autogenous bone graft using coccygeal bone was performed, in which three and a half coccyges were placed in succession and fixed using an orthogonal locking plate. To promote bone healing and facilitate proper weight bearing and ambulation, bone morphogenetic proteins, biphasic calcium phosphate, platelet-rich plasma, passive-range-of-motion exercises, transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and low-level laser therapy were applied. During the four-year follow-up, it was observed that the previously engrafted bone healed well and maintained stability over a prolonged period, resulting in the patient being able to walk comfortably with good outcomes. However, some degree of lameness was noted in the dog when running owing to limb shortening and joint contracture. [ABSTRACT FROM AUTHOR]

Pulmonary autograft, or Ross procedure, is performed by supplanting a diseased aortic valve with the patient's own pulmonary valve. Reconstruction of the right ventricular outflow tract is then completed using a pulmonary homograft. To our knowledge, infective endocarditis occurring decades after the Ross procedure has not been reported. Diligent echocardiographic examination can be crucial to ensure prompt treatment and avoid the 25% mortality rate associated with infective endocarditis. Clinical suspicion should remain high in those with a pulmonary autograft history. In this article, we report the case of a 39-year-old patient with infective endocarditis presenting 22 years after Ross procedure.

Purpose: To compare the outcomes of pterygium surgery by using an inferior rotational autograft and a conventional superior conjunctival autograft. Methods: This was a prospective interventional comparative study of 85 eyes of patients who were divided into two groups of 45 and 40. Standard techniques of both procedures were performed by a single surgeon. Astigmatism, recurrence rates, time taken, and other complications were compared. Results: All the subjects were in the age group 53 ± 7.56 (40–74) years. Demographic data and type of pterygium were comparable in the two groups. In the rotational group, the preoperative astigmatism was − 2.14 ± 1.36 D, which decreased in 1 week to 1.42 ± 1.11 D, in 1 month to − 1.13 ± 0.99 D, in 3 months to 0.91 ± 0.72 D, and in 6 months to 0.81 ± 0.85 D (P < 0.05 each). Preoperative astigmatism in the conventional group was − 2.63 ± 1.47 D, which decreased to − 1.43 ± 1.04 D in 1 week, −1.18 ± 0.85 D in 1 month, −1.07 ± 0.81 D in 3 months, and − 1.01 ± 0.78 D in 6 months (P < 0.05 each). There was no significant difference between the groups in terms of astigmatism at any follow-up visit (P < 0.05). Complications like dellen, graft edema, and superficial vascularization were seen in both groups. The rotational group had one recurrence (2.86%). No recurrence was noted in the conventional group. None of the complication rates was significantly different between the two groups (P < 0.05). Conclusion: Inferior rotational conjunctival autografting is a good technique for management of pterygium. It has a profile similar to that of conventional conjunctival autograft.

Aim To compare between the outcomes of cauterized conjunctival autograft (CA) with and without mitomycin C (MMC) in primary pterygium surgery. Patients and methods This prospective interventional comparative study included 50 eyes in 50 patients with primary pterygium. Patients were randomly assigned into two equal groups: group 1 underwent pterygium excision with cauterized CA fixation, and group 2 underwent pterygium excision with cauterized CA fixation and intraoperative application of 0.02% MMC for 3 min. All patients underwent a preoperative, first day, first week, first month, third month, and sixth month postoperative ophthalmic examination. Any intraoperative or postoperative complications were recorded. Primary outcomes were reported as incidence of recurrence and any major (sight threatening) complications. Secondary outcomes were reported as any minor complications. Results A total of 50 patients (28 males and 22 females, with male to female ratio 1 : 1.3) were included in this study. Complications encountered in our study included recurrence of pterygium, which occurred in one (4%) eye in group 1 and 0 eyes in group 2. Two (8%) eyes in group 1 versus one (4%) eye in group 2 showed subconjunctival hemorrhage, one (4%) eye in group 2 showed focal scleral thinning, and one (4%) eye in group 2 showed a corneal epithelial defect. There was no statistically significant difference between the two groups regarding the incidence of any complication (P>0.05). Conclusion Cauterized CA without MMC is a safe and effective procedure for the surgical treatment of primary pterygium. There was no added benefit to intraoperative MMC application.

Background. To date, the problem of choosing the optimal graft for anterior cruciate ligament (ACL) reconstruction and the methods for its formation is one of the main trends in the surgical treatment of patients with anterior knee joint instability.The aim. To compare the results of the anterior cruciate ligament reconstruction using the known method and the new proposed method for autograft formation.Materials and methods. The results of treatment of ACL injury in 44 patients were assessed. In the main group (19 patients), an original technique of ACL reconstruction from 1/2 of the width of m. peroneus longus tendon was used. In the control group (25 patients), ACL reconstruction was performed using a graft from the m. semitendinosus tendon prepared by the Lubowitz method.Results. The mean difference in the circumference of the distal third of the hip in the main group was 1.57 ± 1.162 cm and was statistically significantly better than in the control group, where the mean difference in the hip circumference was 4.74 ± 1.7207 cm.The range of motion of the knee joint in the main group 3 months after the surgery was 128.42 ± 9.287°, and in the control group mean flection was 109.6 ± 9.120°.The functional results in the main group were assessed by the Lisholm scale and were statistically significantly better than the results in the control group. The functional results by the AOFAS (American Orthopedic Foot & Ankle Society) scale in the main group were 100 points before the surgery and at all terms after the surgery: this indicates that the use of 1/2 of the width of m. peroneus longus tendon does not cause the its functional impairement.Conclusion. Anterior cruciate ligament plasty with use of 1/2 of the width of m. peroneus longus tendon prepared by the proposed method showed statistically significantly better results compared to the preparation of autograft from semitendinous muscle tendon using known method.

Background Extensive patellar tendon ossification is very uncommon and requires surgical intervention when ossification significantly affects knee function. While various approaches and grafts are available for reconstructing ruptured patellar tendons, there is a paucity of literature regarding the management of joint ankylosis due to severely ossified patellar tendons. Case Presentation This is a case involving an extensively ossified patellar tendon after patellar and tibial tuberosity fracture fixation. Reconstruction of the patellar tendon was performed using ipsilateral semitendinosus and gracilis autografts. At the latest follow‐up of 12 months, the patient achieved knee flexion up to 120° with a slight extension lag and resumed daily activities. Conclusions Autograft hamstring reconstruction of the patellar tendon is suitable for extensive heterotopic ossification of the patellar tendon, resulting in significant improvement in postoperative knee function. Similar patients may be referred for this reconstruction technique.

Abstract Background Hamstring tendons are a popular choice for autografts in anterior cruciate ligament (ACL) reconstruction. However, there is increasing evidence that hamstring tendon autografts carry a high risk of revision and residual instability in young patients. To elucidate the reasons for the inferior outcome of the reconstructed ACL with hamstring tendon autografts in young patients, we investigated the Young’s modulus and the extent of cyclic loading-induced slackening of the semitendinosus tendon used for ACL reconstruction across a broad range of ages. Methods Twenty-six male patients (aged 17–53 years), who were scheduled for ACL reconstruction surgery using the semitendinosus tendon autograft, participated in this study. The distal portion of the harvested semitendinosus tendon, which was not used to construct the autograft, was used for cyclic tensile testing to calculate the Young’s modulus and the extent of slackening (i.e., increase in slack length). Results Spearman correlation analysis revealed that the Young’s modulus of the semitendinosus tendon was positively correlated with the patient’s age (ρ = 0.559, P = 0.003). In contrast, the extent of tendon slackening did not correlate with the patient’s age. Conclusions We demonstrated that the Young’s modulus of the semitendinosus tendon increases with age, indicating that the semitendinosus tendon used for ACL reconstruction is compliant in young patients.

Subscapularis integrity is correlated with function following shoulder arthroplasty. Failure of healing, particularly following anatomic total shoulder arthroplasty, is associated with poor outcomes and the need for revision. Graft augmentation has been used to increase healing following rotator cuff repair but has not been commonly advocated for augmenting the subscapularis following shoulder arthroplasty. The long head biceps tendon is typically tenodesed and discarded during shoulder arthroplasty. Rather than discarding the tendon, the tendon may be compressed and applied to the subscapularis as a biologic scaffold to potentially improve subscapularis healing following shoulder arthroplasty.

Ruptures of the quadriceps tendon (QTRs) are uncommon. If the rupture is not diagnosed, chronic ruptures may develop. Re-ruptures of the quadriceps tendon are rare. Surgery is challenging because of tendon retraction, atrophy and poor quality of the remaining tissue. Multiple surgical techniques have been described. We propose a novel technique in which the quadriceps tendon is reconstructed using the ipsilateral semitendinosus tendon. [ABSTRACT FROM AUTHOR]

Introduction: Due to the inherent activities of the active duty personnel of the Mexican Navy, ligament injuries are constant, particularly the anterior cruciate ligament of the knee (ACL). Currently, we have various techniques and resources for its repair. Objective: identify the clinical results obtained in anterior cruciate ligament reconstruction in active military. Material and methods: retrospective observational study comparing clinical outcomes of anterior cruciate ligament repair in active military with the use of allograft and autograft in 23 patients who met inclusion criteria for the surgical procedure from 2017 to 2019 at the Naval Medical Center. 23 patients (46 in total) were considered for each category of anterior cruciate ligament repair with autologous graft (contralateral patellar) and heterologous graft (cadaveric anterior cruciate ligament). With an average age of autologous (35.6 years), heterologous (35 years). BMI average: autologous (26.5), heterologous (26.5). Male gender in its entirety. The IKDC and Lysholm scales were applied to all patients for the evolution of subjective results of clinical improvement in a 2-year follow-up; where a significant difference (p = 0.0001) could be observed when comparing both anterior cruciate ligament reconstruction techniques. Results: we included 46 patients who underwent anterior cruciate ligament reconstruction for indication of complete injury respectively by the Joint Surgery Service of the Naval Medical Center. A better level of clinical benefit was observed in patients with heterologous graft, both in evaluation by IKDC scale (median 95.52 ± 1.85) as in Lysholm scale (median 94.91 ± 1.62) compared to autologous grafts, IKDC (median 89.92 ± 2.55) and Lysholm (median 86.04 ± 5.58), with value of p = 0.0001 for both cases. Conclusions: The results our study suggests that a superiority of functionality is obtained as reported by patients in whom heterograft was used. [ABSTRACT FROM AUTHOR]

Background: Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the Latarjet procedure and distal clavicle graft in glenohumeral stabilization. Additionally, preoperative planning is typically performed using computed tomography (CT), and few studies have used 3-dimensional (3D) magnetic resonance imaging (MRI) reformations to assess graft dimensions. Purpose: The purpose of this study was 2-fold: (1) to compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bony augmentation techniques and (2) to determine the viability of 3D MRI to assess bone graft dimensions. Study Design: Controlled laboratory study. Methods: A total of 24 patients with recurrent glenohumeral instability and bone loss were included in this study. 3D CT and 3D MRI reformations were utilized to measure pertinent dimensions for 5 orientations of coracoid and distal clavicle autografts: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), (3) distal clavicle attached by its posterior surface (DCP), (4) distal clavicle attached by its inferior surface (DCI), and (5) distal clavicle attached by its resected end (DCR). Glenoid augmentation was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Glenoid bone loss ranged from 0% to 34%. Paired t tests were used to compare graft sizes between patients and compare 3D CT versus 3D MRI measurements. Results: The CLJ had the largest graft surface area (mean, 318.41 ± 74.44 mm2), while the SLJ displayed the most bone-on-bone apposition (mean, 318.41 ± 74.44 mm2). The DCI had the largest graft width (mean, 20.62 ± 3.93 mm). Paired t tests revealed no significant differences between the Latarjet techniques, whereas distal clavicle grafts varied significantly with orientation. All 3D CT and 3D MRI measurements were within 1 mm of each other, and only 2 demonstrated a statistically significant difference (coracoid width: 13.03 vs 13.98 mm, respectively [ P =.010]; distal clavicle thickness: 9.69 vs 10.77 mm, respectively [ P =.002]). 3D CT and 3D MRI measurements demonstrated a strong positive correlation (r > 0.6 and P <.001 for all dimensions). Conclusion: Glenoid augmentation, bony apposition, and graft width varied with coracoid or distal clavicle graft type and orientation. Differences between 3D CT and 3D MRI were small and likely not clinically significant. Clinical Relevance: 3D MRI is a viable method for preoperative planning and graft selection in glenoid bone loss. [ABSTRACT FROM AUTHOR]

Background and objective. Peripheral nerve injury, in all its mechanisms, is a frequent event in the general population. There are diferent methods of repairing it, however there is not enough research on the most effective graft. The objective of this study is to determine the superiority of the combination of polyethylene glycol in polytetrafluoroethylene tubes as a graft versus its isolated use and an autograft. Methods. Experimental study of cases and controls using Wistar rats that were induced, under sedation, nerve injury by extracting a nerve graft from the sciatic nerve and its subsequent repair, divided into 3 groups: autograft, polytetrafluoroethylene graft and polytetrafluoroethylene graft with polyethylene glycol. Results. Eight histopathological variables were analyzed and a total axon count was made, finding a greater number in the autograft samples. Among the clinical variables, limb deformity, macroscopic muscular atrophy and walking disturbance were analyzed, showing the group of the combination of materials an excellent evolution in the 3 categories. Conclusions. The clinical recovery of the operated limb in the group where the combination of the studied materials was used was notably superior, in addition to the observation of much better axonal organization, indicating a superiority of this combination with respect to the other groups evaluated. [ABSTRACT FROM AUTHOR]

Purpose. Peroneus longus tendon graft is not a popular first choice for ACL reconstruction. However, newer literature has shown good outcomes with its use. This study compares functional outcome and donor site morbidity of peroneus longus with hamstring tendon autograft to assess if it can be considered as one of the first choices for ACLR. Methods. This prospective cohort study involves 54 patients who underwent arthroscopic single-bundle ACLR. 27 patients each were operated on with hamstring and peroneus longus autografts. At 2 years follow-up, functional outcome was compared between groups using International Knee Documentation Committee (IKDC), Modified Cincinnati, and Tegner-Lysholm scores. Donor site morbidity in the peroneus longus group was assessed using Foot and Ankle Disability Index (FADI) and The American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results. At 2 years follow-up, there was no statistically significant difference in the mean IKDC (77.26 vs 80.78), Modified Cincinnati (84.41 vs 89.07), and Tegner-Lysholm scores (85.19 vs 88.78) between the hamstring and peroneus groups respectively. Mean FADI and AOFAS scores at 2 years follow up were 96.11 and 91.67 respectively in the peroneus group suggesting no significant donor site morbidity as compared to preoperative scores. Conclusions. Peroneus longus performs similar to hamstring grafts and can be considered as one of the first choices for arthroscopic ACL reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the 5-year clinical and functional outcomes of the soft tissue quadriceps tendon (QT) to those of the hamstring tendon (HT) autograft METHODS: A retrospective review of patients undergoing ACL reconstruction using either soft tissue QT or double tendon HT autograft with at least 5 years of follow up was conducted. Surgical technique included anteromedial portal creation for the femoral tunnel and transtibial technique for the tibia. Graft fixation was achieved with interference composite screws for the QT and combination of interference composite screw and suture button for the HT cohort. The two groups were compared for differences in outcomes including International Knee Documentation Committee (IKDC) score, Lysholm score, return to sport, and complications.Results: A total of 37 patients with QT autograft and 46 HT autografts were included in the study with a mean follow up of 69.9 months and 70.9 months, respectively. The QT group demonstrated a larger graft size on average (9.64mm vs. 7.90mm, p <0.001). The IKDC and Lysholm scores were similar between the two groups at 2-years postoperatively. At 5-years postoperatively, the QT group demonstrated significantly greater IKDC (p 0.018) and Lysholm (p 0.007) scores. The cohorts demonstrated similar rates of achieving minimal clinically important difference (MCID) thresholds at both 2 and 5 years postoperatively. The two groups also demonstrated comparable rates of return to sport, time to return, and postoperative complications.Conclusions: Although the QT autograft demonstrated increased patient reported outcome scores when compared to the HT at 5-years postoperatively, there was no clinically significant difference between the cohorts at 2 or 5 years postoperatively. The QT autograft is an effective alternative to HT autograft with non-inferior results to the hamstring autograft at mid-term follow up.Study Design: Retrospective Comparison Study; Level of Evidence III LEVEL OF EVIDENCE: III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Sportiva Bohemica et Slovaca is the property of Ceska spolecnost telovychovneho lekarstvi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The repair of orthopedic and maxillofacial defects in modern medicine currently relies heavily on the use of autograft, allograft, void fillers, or other structural material composites. This study examines the in vitro osteo regenerative potential of polycaprolactone (PCL) tissue scaffolding, fabricated via a three-dimensional (3D) additive manufacturing technology, i.e., a pneumatic micro extrusion (PME) process. The objectives of this study were: (i) To examine the innate osteoinductive and osteoconductive potential of 3D-printed PCL tissue scaffolding and (ii) To perform a direct in vitro comparison of 3D-printed PCL scaffolding with allograft Allowash® cancellous bone cubes with regards to cell-scaffold interactions and biocompatibility with three primary human bone marrow (hBM) stem cell lines. This study specifically examined cell survival, cell integration, intra-scaffold cell proliferation, and differentiation of progenitor cells to investigate the potential of 3D-printed PCL scaffolds as an alternative to allograft bone material for the repair of orthopedic injuries. We found that mechanically robust PCL bone scaffolds can be fabricated via the PME process and the resulting material did not elicit detectable cytotoxicity. When the widely used osteogenic model SAOS-2 was cultured in PCL extract medium, no detectable effect was observed on cell viability or proliferation with multiple test groups showing viability ranges of 92.2% to 100% relative to a control group with a standard deviation of ±10%. In addition, we found that the honeycomb infill pattern of the 3D-printed PCL scaffold allowed for superior mesenchymal stem-cell integration, proliferation, and biomass increase. When healthy and active primary hBM cell lines, having documented in vitro growth rates with doubling times of 23.9, 24.67, and 30.94 h, were cultured directly into 3D-printed PCL scaffolds, impressive biomass increase values were observed. It was found that the PCL scaffolding material allowed for biomass increase values of 17.17%, 17.14%, and 18.18%, compared to values of 4.29% for allograph material cultured under identical parameters. It was also found that the honeycomb scaffold infill pattern was superior to the cubic and rectangular matrix structures, and provided a superior microenvironment for osteogenic and hematopoietic progenitor cell activity and auto-differentiation of primary hBM stem cells. Histological and immunohistochemical studies performed in this work confirmed the regenerative potential of PCL matrices in the orthopedic setting by displaying the integration, self-organization, and auto-differentiation of hBM progenitor cells within the matrix. Differentiation products including mineralization, self-organizing "proto-osteon" structures, and in vitro erythropoiesis were observed in conjunction with the documented expression of expected bone marrow differentiative markers including CD-99 (>70%), CD-71 (>60%), and CD-61 (>5%). All of the studies were conducted without the addition of any exogenous chemical or hormonal stimulation and exclusively utilized the abiotic and inert material polycaprolactone; setting this work apart from the vast majority of contemporary investigations into synthetic bone scaffold fabrication In summary, this study demonstrates the unique clinical potential of 3D-printed PCL scaffolds for stem cell expansion and incorporation into advanced microstructures created via PME manufacturing to generate a physiologically inert temporary bony defect graft with significant autograft features for enhanced end-stage healing. [ABSTRACT FROM AUTHOR]

Background: Acellular nerve allografts have been used successfully and with increasing frequency to reconstruct nerve injuries. As their use has been expanded to treat longer gap, larger diameter nerve injuries, some failed cases have been reported. We present the histomorphometry of 5 such cases illustrating these limitations and review the current literature of acellular nerve allografts. Methods: Between 2014 and 2019, 5 patients with iatrogenic nerve injuries to the median or ulnar nerve reconstructed with an AxoGen AVANCE nerve allograft at an outside hospital were treated in our center with allograft excision and alternative reconstruction. These patients had no clinical or electrophysiological evidence of recovery, and allograft specimens at the time of surgery were sent for histomorphological examination. Results: Three patients with a median and 2 with ulnar nerve injury were included. Histology demonstrated myelinated axons present in all proximal native nerve specimens. In 2 cases, axons failed to regenerate into the allograft and in 3 cases, axonal regeneration diminished or terminated within the allograft. Conclusions: The reported cases demonstrate the importance of evaluating the length and the function of nerves undergoing acellular nerve allograft repair. In long length, large-diameter nerves, the use of acellular nerve allografts should be carefully considered. [ABSTRACT FROM AUTHOR]

Copyright of Neurologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of the present study was to quantify the morphometric characteristics of three tendon autografts (hamstring tendons (HT), quadriceps tendon (QT), and patellar tendon (PT)) used in anterior cruciate ligament (ACL) reconstruction. For this purpose, knee magnetic resonance imaging (MRI) was obtained in 100 consecutive patients (50 males and 50 females) with an acute, isolated ACL tear without any other knee pathology were used. The level of the physical activity of the participants was determined using the Tegner scale. Measurements of the tendons’ dimensions (PT and QT tendon length, perimeter, cross-sectional area (CSA), and maximum mediolateral and anteroposterior dimensions) were performed perpendicular to their long axes. Higher values were recorded as regards the mean perimeter and CSA of the QT in comparison with the PT and the HT (perimeter QT: 96.52 ± 30.43 mm vs. PT: 63.87 ± 8.45 mm, HT: 28.01 ± 3.73 mm, F = 404.629, p < 0.001; CSA QT: 231.88 ± 92.82 mm² vs. PT: 108.35 ± 28.98 mm2, HT: 26.42 ± 7.15 mm², F = 342.415, p < 0.001). The length of the PT was shorter in comparison with the QT (53.1 ± 7.8 vs. 71.7 ± 8.6 mm, respectively, t = −11.243, p < 0.001). The three tendons showed significant differences in relation to sex, tendon type, and position as regards the perimeter, CSA, and the mediolateral dimensions but not for the maximum anteroposterior dimension. [ABSTRACT FROM AUTHOR]

A 50-year-old man with recurrent pterygium and a 46-year-old woman with primary pterygium underwent surgery using a novel autograft transfer technique that facilitates autograft suturing and ensures correct graft orientation. After removing the pterygium, three edges of the autograft were cut. The autograft was flipped first over the uncut edge and secured to the superior margin of the recipient bed with two sutures. Afterward, the fourth side of the graft was cut and the second flip was done over the sutured edge. Thus, the autograft was in correct surface and side orientation and was sutured to the recipient bed. This simple technique provides both easy transfer and correct orientation of the graft in autograft pterygium surgery.

Context: Recent epidemiology studies indicated a steady increase of anterior cruciate ligament (ACL) injury in young athletes. ACL reconstruction (ACLR) is currently a standard of care, but the effect of ACLR graft including bone patellar tendon bone (BTB), hamstring tendon (HT), or iliotibial band (ITB) on balance and hop performance is understudied. Objective: To compare balance and hop deficits between uninvolved and reconstructed limbs in each autograft type (aim 1) and among the 3 autograft groups (aim 2). Setting: Biomechanical laboratory. Participants: Male ACLR patients who are younger than 22 years (total N = 160; BTB: N = 19, HT: N = 108, ITB: N = 33). Intervention: Approximately 6 to 9 months following ACLR, Y-balance and 4 types of hop tests were measured bilaterally. Main Outcome Measures: Limb symmetry index of balance and hop tests within each graft type and between the 3 graft types. Results: In the BTB group, significant anterior reach, single hop, triple hops, and cross-over hops deficits were observed on the ACLR limb compared with the uninvolved limb. The HT group showed significant deficits in single hop, triple hops, and cross-over hops on the ACLR limb relative to the uninvolved limb. Compared with the uninvolved limb, significantly decreased triple hops and 6-m timed hop deficits in the ACLR limb were recorded in the ITB group. When controlling for confounders and comparing among the 3 autograft types, the only significant difference was anterior reach, in which the BTB group showed significant deficits. Conclusion: Compared with the uninvolved limb, significant hop deficits in ACLR limb were prevalent among adolescent ACLR at ∼6 to 9 months postoperatively. After controlling covariates, significantly reduced anterior reach balance was found in the BTB group compared with the HT and ITB groups. [ABSTRACT FROM AUTHOR]