Introduction The medial collateral ligament (MCL) is the primary static stabilizing structure on the medial aspect of the knee, contributing up to 78% of the restraining force to valgus loads. Sims and Jacobsen reported that 99% of medial injuries requiring operation had an associated injury to the posterior oblique ligament (POL), which was overlooked in many reports. Hypothesis Reconstruction of both superficial MCL and POL might be clinically advantageous in regaining valgus stability compared to superficial MCL reconstruction alone. Both groups were compared regarding the following parameters: clinical evaluation according to the Lysholm and the International Knee Documentation Committee rating scoring systems and stress valgus x-ray. Patients and methods Between January 2015 and April 2017, we conducted a prospective randomized analytical study, including 30 patients suffering from grade III MCL injury. They were divided into two groups (A) and (B). For group A, 15 patients underwent superficial MCL reconstruction only, while for group B, concomitant reconstruction of the superficial MCL and POLs. Results The mean Lysholm score in group A preoperatively was 37.9±8.1 and became 91.0±6.3 postoperatively with P value less than 0.001, while in group B, it was 38.7±11.4 and became 92.9±8.3 with P value less than 0.001. There was no statistical significant difference between both groups postoperatively (P=0.478). Regarding ligament examination of International Knee Documentation Committee score postoperatively, the frequency of cases of A, B, C, and D grades of Lachman in group A was 53.3, 40, 6.7, and 0%, respectively, versus 80, 20, and 0% in group B, and this difference was not statistically significant (P=0.4). According to valgus stress test, the frequency of cases of A, B, C, and D grades in group A was 66.7, 33.3, and 0%, respectively, versus 73.3, 26.7, and 0% in group B, and this difference was not statistically significant (P=0.7). The stress valgus x-ray evaluation of the degree of gapping in extension in group A was 1.7±0.5 versus 1.3±0.7 in group B and this difference was not statistically significant (P=0.1), and the degree of gapping in flexion in group A was 1.8±0.4 versus 1.4±0.7 in group B and this difference was not statistically significant (P=0.1). Conclusion There was no difference in the clinical and the radiological outcome between the reconstruction of the superficial MCL alone versus the concomitant reconstruction of the POL in patients with medial knee instability.
{"title":"Is it sufficient to reconstruct the superficial medial collateral ligament only in medial knee instability? A comparative study","authors":"A. Rashwan","doi":"10.4103/eoj.eoj_86_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_86_21","url":null,"abstract":"Introduction The medial collateral ligament (MCL) is the primary static stabilizing structure on the medial aspect of the knee, contributing up to 78% of the restraining force to valgus loads. Sims and Jacobsen reported that 99% of medial injuries requiring operation had an associated injury to the posterior oblique ligament (POL), which was overlooked in many reports. Hypothesis Reconstruction of both superficial MCL and POL might be clinically advantageous in regaining valgus stability compared to superficial MCL reconstruction alone. Both groups were compared regarding the following parameters: clinical evaluation according to the Lysholm and the International Knee Documentation Committee rating scoring systems and stress valgus x-ray. Patients and methods Between January 2015 and April 2017, we conducted a prospective randomized analytical study, including 30 patients suffering from grade III MCL injury. They were divided into two groups (A) and (B). For group A, 15 patients underwent superficial MCL reconstruction only, while for group B, concomitant reconstruction of the superficial MCL and POLs. Results The mean Lysholm score in group A preoperatively was 37.9±8.1 and became 91.0±6.3 postoperatively with P value less than 0.001, while in group B, it was 38.7±11.4 and became 92.9±8.3 with P value less than 0.001. There was no statistical significant difference between both groups postoperatively (P=0.478). Regarding ligament examination of International Knee Documentation Committee score postoperatively, the frequency of cases of A, B, C, and D grades of Lachman in group A was 53.3, 40, 6.7, and 0%, respectively, versus 80, 20, and 0% in group B, and this difference was not statistically significant (P=0.4). According to valgus stress test, the frequency of cases of A, B, C, and D grades in group A was 66.7, 33.3, and 0%, respectively, versus 73.3, 26.7, and 0% in group B, and this difference was not statistically significant (P=0.7). The stress valgus x-ray evaluation of the degree of gapping in extension in group A was 1.7±0.5 versus 1.3±0.7 in group B and this difference was not statistically significant (P=0.1), and the degree of gapping in flexion in group A was 1.8±0.4 versus 1.4±0.7 in group B and this difference was not statistically significant (P=0.1). Conclusion There was no difference in the clinical and the radiological outcome between the reconstruction of the superficial MCL alone versus the concomitant reconstruction of the POL in patients with medial knee instability.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132747312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Dislocation of the acromioclavicular joint (ACJ) is a common orthopedic injury among athletes and victims of motor vehicle accidents, predominantly motorcycle crashes. There is a common view that early surgical management should be recommended for patients with Rockwood types IV-VI ACJ injuries, as it would prevent long-term sequelae, and also it is required for patients with grades III with heavy manual occupations, athletes, and so on. None of the body joints had been treated with such profuse different techniques in an attempt to properly restore its natural situation. Patients and methods The present study describes and evaluates a new technique of percutaneous application of temporarily dynamic compression design of tension band wiring in type III, IV, and V acute complete ACJ dislocations. Preserving the already injured ACJ capsule, ligaments, surrounding deltotrapezial fascia, and muscles from open surgical trauma is subsequently presumed to contribute in significant stability. All patients underwent surgical management by percutaneous tension band wiring. Patients were followed up from the viewpoint of functional and radiological results at 2, 6, 12, 18 weeks, and 1 year after surgery. Results A total of 30 adult patients were enrolled in the study; one male patient was lost to follow-up at the 12th week appointment (implant extraction); hence, he was excluded from the results. The mean age of the patients was 31.4 years. Overall, 28 were males and two females. Clinical outcomes were regarded as excellent in 25 cases, representing 86.2% (average score=92.65) and good in three cases (average score=85), including a re-wiring case. Two patients (6.8%) experienced partial reduction loss. However, there were no significant differences (P=0.236) between the right and left shoulders regarding coracoclavicular distance. Conclusion Percutaneous tension band wiring technique has shown to provide satisfactory clinical results and shoulder functions. It provides stable fixation, allows early motion exercise by minimizing surgical trauma to preinjured tissues, lowers the complications of rigid internal fixation, and reduces cosmetic problem in scar.
{"title":"Percutaneous tension band wiring in acute complete acromioclavicular joint dislocation","authors":"M. El-shennawy","doi":"10.4103/eoj.eoj_37_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_37_21","url":null,"abstract":"Background Dislocation of the acromioclavicular joint (ACJ) is a common orthopedic injury among athletes and victims of motor vehicle accidents, predominantly motorcycle crashes. There is a common view that early surgical management should be recommended for patients with Rockwood types IV-VI ACJ injuries, as it would prevent long-term sequelae, and also it is required for patients with grades III with heavy manual occupations, athletes, and so on. None of the body joints had been treated with such profuse different techniques in an attempt to properly restore its natural situation. Patients and methods The present study describes and evaluates a new technique of percutaneous application of temporarily dynamic compression design of tension band wiring in type III, IV, and V acute complete ACJ dislocations. Preserving the already injured ACJ capsule, ligaments, surrounding deltotrapezial fascia, and muscles from open surgical trauma is subsequently presumed to contribute in significant stability. All patients underwent surgical management by percutaneous tension band wiring. Patients were followed up from the viewpoint of functional and radiological results at 2, 6, 12, 18 weeks, and 1 year after surgery. Results A total of 30 adult patients were enrolled in the study; one male patient was lost to follow-up at the 12th week appointment (implant extraction); hence, he was excluded from the results. The mean age of the patients was 31.4 years. Overall, 28 were males and two females. Clinical outcomes were regarded as excellent in 25 cases, representing 86.2% (average score=92.65) and good in three cases (average score=85), including a re-wiring case. Two patients (6.8%) experienced partial reduction loss. However, there were no significant differences (P=0.236) between the right and left shoulders regarding coracoclavicular distance. Conclusion Percutaneous tension band wiring technique has shown to provide satisfactory clinical results and shoulder functions. It provides stable fixation, allows early motion exercise by minimizing surgical trauma to preinjured tissues, lowers the complications of rigid internal fixation, and reduces cosmetic problem in scar.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"169 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131858565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background High tibial osteotomies (HTO) and unicompartmental knee arthroplasties are performed for the treatment of isolated unicompartmental osteoarthritis (OA) of the knee. Before the development of knee arthroplasties, HTO was the most common operative treatment option for knee OA. Patients and methods This work was a prospective study on 27 patients with medial compartmental OA who had been admitted to El-Menoufia University Hospital in the period from 2009 to 2013. Results The average age of the patients was 43 years. The average opening height of the osteotomy was 10.8 mm. There were no cases of secondary loss of correction. No patients needed to be treated by a secondary autograft because of delayed bone healing. One patient was reoperated a few days after the first intervention because of overcorrection. Conclusion Open-wedge HTO with the use of optimal surgical techniques (biplanar metaphyseal osteotomy) and the fixation with the internal plate fixator TomoFix has proved to be successful in treatment of unicompartmental gonarthrosis, even without bone grafts or bone substitute material. The complication rate is small, and full weight-bearing is achieved quickly with good medium-term results.
{"title":"High tibial osteotomies − is it still a reasonable option in treatment of osteoarthritis?","authors":"A. El‐Sayed","doi":"10.4103/eoj.eoj_59_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_59_21","url":null,"abstract":"Background High tibial osteotomies (HTO) and unicompartmental knee arthroplasties are performed for the treatment of isolated unicompartmental osteoarthritis (OA) of the knee. Before the development of knee arthroplasties, HTO was the most common operative treatment option for knee OA. Patients and methods This work was a prospective study on 27 patients with medial compartmental OA who had been admitted to El-Menoufia University Hospital in the period from 2009 to 2013. Results The average age of the patients was 43 years. The average opening height of the osteotomy was 10.8 mm. There were no cases of secondary loss of correction. No patients needed to be treated by a secondary autograft because of delayed bone healing. One patient was reoperated a few days after the first intervention because of overcorrection. Conclusion Open-wedge HTO with the use of optimal surgical techniques (biplanar metaphyseal osteotomy) and the fixation with the internal plate fixator TomoFix has proved to be successful in treatment of unicompartmental gonarthrosis, even without bone grafts or bone substitute material. The complication rate is small, and full weight-bearing is achieved quickly with good medium-term results.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133102516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background In complex situations, regular on-shelf orthopedic implants are not suitable or sufficient to ensure the expected biomechanical or biological function, and customized implants could theoretically offer a solution. Preoperative planning, procedure rehearsal, patient teaching, and three-dimensional (3D) bioprinting are other uses of the fast-spreading 3D printing technology. Aim This review deals with the status and future uses of 3D printing and its various applications in orthopedic surgery. In the past decades, enormous technological progress in the field of radiological data acquisition, processing, and 3D printing technologies led to an explosive advancement of this promising industry. Materials and methods A literature review of the recent and relevant publications with a special focus on the various orthopedic applications of 3D printing technology was done. Conclusion 3D printing offers already a valid yet still an expensive solution in certain orthopedic indications. Soon, orthopedic surgeons will be able to use this emerging technology more frequently as more and more companies offer cheaper rapid prototyping manufacturing solutions. Nevertheless, the technology still needs improvement, and many issues such as accuracy, long-term survivorship, and legal liability for the customized implants are still not fully solved.
{"title":"Three-dimensional printing in orthopedics − what an orthopedic surgeon should know","authors":"A. Barakat, M. Alhashash","doi":"10.4103/eoj.eoj_35_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_35_21","url":null,"abstract":"Background In complex situations, regular on-shelf orthopedic implants are not suitable or sufficient to ensure the expected biomechanical or biological function, and customized implants could theoretically offer a solution. Preoperative planning, procedure rehearsal, patient teaching, and three-dimensional (3D) bioprinting are other uses of the fast-spreading 3D printing technology. Aim This review deals with the status and future uses of 3D printing and its various applications in orthopedic surgery. In the past decades, enormous technological progress in the field of radiological data acquisition, processing, and 3D printing technologies led to an explosive advancement of this promising industry. Materials and methods A literature review of the recent and relevant publications with a special focus on the various orthopedic applications of 3D printing technology was done. Conclusion 3D printing offers already a valid yet still an expensive solution in certain orthopedic indications. Soon, orthopedic surgeons will be able to use this emerging technology more frequently as more and more companies offer cheaper rapid prototyping manufacturing solutions. Nevertheless, the technology still needs improvement, and many issues such as accuracy, long-term survivorship, and legal liability for the customized implants are still not fully solved.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":" 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113950717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The aim of this prospective study was to assess the clinical results of arthroscopic ankle arthrodesis for end-stage ankle arthritis in middle-aged active adults, as an alternative to open ankle arthrodesis based on the hypothesis that arthroscopic technique yields similar or better results but with less complications and shorter hospital stay. Patients and methods Between May 2012 and October 2014, this prospective case study was conducted on 19 middle-aged active patients who met the criteria and were followed for at least 2 years. Clinical grading was done at 6 months postoperatively, and final subjective clinical and radiologic assessment was done at least 2 years postoperatively, dividing the results into four groups (excellent, good, fair, and poor). Results After an average of 27.5 months of follow-up, 18/19 (94.7%) patients had their arthrodesis united, and 16 (84.2%) of them were satisfied. Three (15.8%) patients were dissatisfied after arthrodesis. Two (10.5%) of them were dissatisfied because of pain despite fusion occurred. Conclusion The results of arthroscopic ankle arthrodesis for end-stage ankle arthritis in middle-aged active adults in selected patients were clinically and radiologically satisfactory and could be used as an alternative to open technique but with fewer hazards and complications.
{"title":"Arthroscopic ankle arthrodesis for chronic posttraumatic end-stage ankle arthritis in middle-age adults","authors":"M. Montaser","doi":"10.4103/eoj.eoj_55_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_55_21","url":null,"abstract":"Background The aim of this prospective study was to assess the clinical results of arthroscopic ankle arthrodesis for end-stage ankle arthritis in middle-aged active adults, as an alternative to open ankle arthrodesis based on the hypothesis that arthroscopic technique yields similar or better results but with less complications and shorter hospital stay. Patients and methods Between May 2012 and October 2014, this prospective case study was conducted on 19 middle-aged active patients who met the criteria and were followed for at least 2 years. Clinical grading was done at 6 months postoperatively, and final subjective clinical and radiologic assessment was done at least 2 years postoperatively, dividing the results into four groups (excellent, good, fair, and poor). Results After an average of 27.5 months of follow-up, 18/19 (94.7%) patients had their arthrodesis united, and 16 (84.2%) of them were satisfied. Three (15.8%) patients were dissatisfied after arthrodesis. Two (10.5%) of them were dissatisfied because of pain despite fusion occurred. Conclusion The results of arthroscopic ankle arthrodesis for end-stage ankle arthritis in middle-aged active adults in selected patients were clinically and radiologically satisfactory and could be used as an alternative to open technique but with fewer hazards and complications.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129816635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The purpose of this study was to evaluate the effectiveness of treating lumbar fractures by performing instrumented interbody fusion with the adjacent vertebra. Patients and methods In a prospective study, 69 consecutive patients with lumbar fractures were treated by single-level interbody fusion. The fractures involving either the superior or inferior endplate with intact pedicles were included. Results The follow-up period was between 24 and 37 months, with a mean of 28.3 months. The mean preoperative local kyphosis was 10.39° and anterior vertebral height loss was 50.55%. In the final follow-up, they were 2.98° and 16.78%, with a statistically significant difference. On Denis scale for back pain, six patients were P3 with occasional use of medications, and two were P4 with constant use of analgesics at the final follow-up. No case of pesudoarthrosis nor neurologic deterioration was recorded. Conclusion Single-segment interbody fusion is an effective option in fractures of the lumbar region, involving either endplate, provided the body is not severely comminuted.
{"title":"Single-level interbody fusion in treatment of lumbar fractures","authors":"A. Abdelrady, Hany El zahlawy, M. Ibrahim","doi":"10.4103/eoj.eoj_34_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_34_21","url":null,"abstract":"Background The purpose of this study was to evaluate the effectiveness of treating lumbar fractures by performing instrumented interbody fusion with the adjacent vertebra. Patients and methods In a prospective study, 69 consecutive patients with lumbar fractures were treated by single-level interbody fusion. The fractures involving either the superior or inferior endplate with intact pedicles were included. Results The follow-up period was between 24 and 37 months, with a mean of 28.3 months. The mean preoperative local kyphosis was 10.39° and anterior vertebral height loss was 50.55%. In the final follow-up, they were 2.98° and 16.78%, with a statistically significant difference. On Denis scale for back pain, six patients were P3 with occasional use of medications, and two were P4 with constant use of analgesics at the final follow-up. No case of pesudoarthrosis nor neurologic deterioration was recorded. Conclusion Single-segment interbody fusion is an effective option in fractures of the lumbar region, involving either endplate, provided the body is not severely comminuted.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114664493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Plantar fasciitis has been reported to be the commonest cause of inferior heel pain. Most cases of plantar fasciitis respond to conservative nonsurgical measures. In 5–10% of the cases of plantar fasciitis resistant to conservative treatment, surgery may be required. Plantar fascia release performed by sectioning a part of the fascia via an open or endoscopic procedure has been the mainstay of treatment. This study was conducted to compare the outcome of open versus endoscopic plantar fascia release in cases of chronic resistant heel pain. Patients and methods A total of 50 patients with comparable demographics having chronic persistent heel pain that was diagnosed clinically to be due to plantar fasciitis were randomized to either open or endoscopic plantar fascia release. The patients were randomly divided in two groups; each consisted of 25 patients. The open procedures was done through a 3-cm medial incision, whereas the endoscopic procedure was done by the two-portal technique. The patients were assessed preoperatively and postoperatively using the modified American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. In addition, the patient’s overall satisfaction with the procedure, pain level, time taken to return to full activity, and the complication rate were determined. Results The postoperative score was significantly better in group I (the endoscopic group) than group II (the open surgery group). Regarding the pain, restoration of the function without imitation was significantly better in the endoscopic group. Conclusion Endoscopic plantar fasciotomy is a minimally invasive procedure that entails minimal soft tissue dissection, excellent visualization of the plantar fascia, precision in transecting only the medial one-third of the plantar fascia, and thus minimizing postoperative instability. It also results in minimal postoperative pain, with early return to full weight-bearing status and earlier return to normal activities of daily living.
{"title":"Surgical treatment of resistant chronic painful heel using endoscopic versus open approaches: a comparative study","authors":"M. Abouheif, Bahaa A Motawea","doi":"10.4103/eoj.eoj_66_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_66_21","url":null,"abstract":"Background Plantar fasciitis has been reported to be the commonest cause of inferior heel pain. Most cases of plantar fasciitis respond to conservative nonsurgical measures. In 5–10% of the cases of plantar fasciitis resistant to conservative treatment, surgery may be required. Plantar fascia release performed by sectioning a part of the fascia via an open or endoscopic procedure has been the mainstay of treatment. This study was conducted to compare the outcome of open versus endoscopic plantar fascia release in cases of chronic resistant heel pain. Patients and methods A total of 50 patients with comparable demographics having chronic persistent heel pain that was diagnosed clinically to be due to plantar fasciitis were randomized to either open or endoscopic plantar fascia release. The patients were randomly divided in two groups; each consisted of 25 patients. The open procedures was done through a 3-cm medial incision, whereas the endoscopic procedure was done by the two-portal technique. The patients were assessed preoperatively and postoperatively using the modified American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. In addition, the patient’s overall satisfaction with the procedure, pain level, time taken to return to full activity, and the complication rate were determined. Results The postoperative score was significantly better in group I (the endoscopic group) than group II (the open surgery group). Regarding the pain, restoration of the function without imitation was significantly better in the endoscopic group. Conclusion Endoscopic plantar fasciotomy is a minimally invasive procedure that entails minimal soft tissue dissection, excellent visualization of the plantar fascia, precision in transecting only the medial one-third of the plantar fascia, and thus minimizing postoperative instability. It also results in minimal postoperative pain, with early return to full weight-bearing status and earlier return to normal activities of daily living.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121653111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Numerous procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques have focused on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. This report introduces a novel procedure for the reconstruction of complete AC joint dislocation by using double endobutton technique to separately reconstruct the conoid and the trapezoid portions of the coracoclavicular ligament. The aim of this prospective study was to assess the functional and radiological efficacy of minimally invasive double endobutton of coracoclavicular ligament reconstruction in the treatment of acute complete AC joint dislocation. Patients and methods During the period from January 2014 to September 2015, 20 patients with Rockwood types IV and V AC joint dislocation were treated with minimal invasive double endobutton of coracoclavicular ligament reconstruction. The improvement in shoulder functions was assessed using a Constant score and visual analog scale system. Results The authors evaluated the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint. All patients achieved a significant improvement in the pain and function of shoulder. Excellent reduction of the AC joint was maintained. The mean follow-up period was 20.6±5.4 months. The mean Constant scores improved from 25.2±6.6 preoperatively to 92.4±6.5 postoperatively, whereas the mean visual analog scale score decreased from 5.9±1.4 preoperatively to 1.2±0.9 postoperatively; significant differences were observed. The final follow-up revealed that excellent outcomes were achieved in 16 (80%) patients and good outcome in four (20%) patients. Conclusion Preliminary follow-up results for the patients indicated that the method is a safe, practical, and effective surgical approach for treatment of acute complete AC joint dislocation and significantly relieves pain, effectively improves the function of shoulder, and can be used as an alternative to arthroscopic and open methods for acute complete AC joint dislocations.
{"title":"Minimally invasive double endobutton of coracoclavicular ligament reconstruction for the treatment of acute complete acromioclavicular joint dislocation","authors":"W. Ewais","doi":"10.4103/eoj.eoj_64_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_64_21","url":null,"abstract":"Background Numerous procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques have focused on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. This report introduces a novel procedure for the reconstruction of complete AC joint dislocation by using double endobutton technique to separately reconstruct the conoid and the trapezoid portions of the coracoclavicular ligament. The aim of this prospective study was to assess the functional and radiological efficacy of minimally invasive double endobutton of coracoclavicular ligament reconstruction in the treatment of acute complete AC joint dislocation. Patients and methods During the period from January 2014 to September 2015, 20 patients with Rockwood types IV and V AC joint dislocation were treated with minimal invasive double endobutton of coracoclavicular ligament reconstruction. The improvement in shoulder functions was assessed using a Constant score and visual analog scale system. Results The authors evaluated the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint. All patients achieved a significant improvement in the pain and function of shoulder. Excellent reduction of the AC joint was maintained. The mean follow-up period was 20.6±5.4 months. The mean Constant scores improved from 25.2±6.6 preoperatively to 92.4±6.5 postoperatively, whereas the mean visual analog scale score decreased from 5.9±1.4 preoperatively to 1.2±0.9 postoperatively; significant differences were observed. The final follow-up revealed that excellent outcomes were achieved in 16 (80%) patients and good outcome in four (20%) patients. Conclusion Preliminary follow-up results for the patients indicated that the method is a safe, practical, and effective surgical approach for treatment of acute complete AC joint dislocation and significantly relieves pain, effectively improves the function of shoulder, and can be used as an alternative to arthroscopic and open methods for acute complete AC joint dislocations.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125131531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The purpose of this study was to investigate the influence of posterior femoral condylar depth on risk of sustaining anterior cruciate ligament (ACL) injury among the Egyptian population. Patients and methods A total of 400 patients (200 ACL ruptured and 200 ACL intact) were included. Morphometric parameters were measured on knee lateral radiographs, with overlapping of the femoral condyles. Radiographic measurements included the posterior femoral condyle offset (PCO) and ratio. Results The PCO and ratio showed significant differences between both groups. The receiver-operating characteristic curve revealed that the PCO cutoff value of more than 67.8 was associated with increased ACL injury with 76% sensitivity and 74% specificity. Conclusions The data from our study demonstrated that an increase in posterior femoral condyle ratio was associated with an increased prevalence of ACL injuries in Egyptian population. However, further research is needed to determine the distal femur morphology in the Egyptian population and its effect on the risk of primary and secondary ACL injury. Level of evidence Level III, case–control study.
{"title":"Evaluation of posterior femoral condyle depth as an anatomical risk factor for anterior cruciate ligament injury among Egyptian population: a case–control study","authors":"El-Mofty Sherif","doi":"10.4103/eoj.eoj_102_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_102_21","url":null,"abstract":"Background The purpose of this study was to investigate the influence of posterior femoral condylar depth on risk of sustaining anterior cruciate ligament (ACL) injury among the Egyptian population. Patients and methods A total of 400 patients (200 ACL ruptured and 200 ACL intact) were included. Morphometric parameters were measured on knee lateral radiographs, with overlapping of the femoral condyles. Radiographic measurements included the posterior femoral condyle offset (PCO) and ratio. Results The PCO and ratio showed significant differences between both groups. The receiver-operating characteristic curve revealed that the PCO cutoff value of more than 67.8 was associated with increased ACL injury with 76% sensitivity and 74% specificity. Conclusions The data from our study demonstrated that an increase in posterior femoral condyle ratio was associated with an increased prevalence of ACL injuries in Egyptian population. However, further research is needed to determine the distal femur morphology in the Egyptian population and its effect on the risk of primary and secondary ACL injury. Level of evidence Level III, case–control study.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129518410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim The aim of this study was to evaluate the clinical and radiological results of scarf osteotomy in correction of moderate and severe degrees of hallux valgus (HV). Patients and methods Between April 2011 and June 2014, 21 patients with 25 feet of moderate to severe HV deformity were included in this prospective study. The study was conducted to evaluate the clinical and radiological results of correction of moderate to severe HV deformity using scarf osteotomy. While a Z-shaped step-cut osteotomy was used to realign the first metatarsal bone, and another closing-wedge osteotomy of Akin osteotomy may be needed in severe cases to complete the correction of the proximal phalanx of the HV in 15 feet. There were five men and 16 women, with a mean age of 24 years. The mean follow-up time was 24 months. Results Overall, 84% of the patients were very satisfied, 12% were satisfied, and 4% were not satisfied. The mean American Orthopedic Foot and Ankle Society score improved significantly from 36 points preoperatively to 94 at the final follow-up. The intermetatarsal and HV angles improved from the mean preoperative values of 18° and 37° to 8° and 13°, respectively. Satisfactory healing time was expressed as an average return back to work after 6 weeks and back to sports after 12 weeks. Persistence or recurrence of HV was seen in one patient; wound infections occurred in two patients, which settled after the administration of antibiotics; and one patient required further surgery to remove a long distal screw. Conclusion The scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of HV.
{"title":"Scarf osteotomy for the correction of moderate and severe degrees of hallux valgus","authors":"A. Tawfik, S. Sokkar, Ahmed Metwaly","doi":"10.4103/eoj.eoj_54_19","DOIUrl":"https://doi.org/10.4103/eoj.eoj_54_19","url":null,"abstract":"Aim The aim of this study was to evaluate the clinical and radiological results of scarf osteotomy in correction of moderate and severe degrees of hallux valgus (HV). Patients and methods Between April 2011 and June 2014, 21 patients with 25 feet of moderate to severe HV deformity were included in this prospective study. The study was conducted to evaluate the clinical and radiological results of correction of moderate to severe HV deformity using scarf osteotomy. While a Z-shaped step-cut osteotomy was used to realign the first metatarsal bone, and another closing-wedge osteotomy of Akin osteotomy may be needed in severe cases to complete the correction of the proximal phalanx of the HV in 15 feet. There were five men and 16 women, with a mean age of 24 years. The mean follow-up time was 24 months. Results Overall, 84% of the patients were very satisfied, 12% were satisfied, and 4% were not satisfied. The mean American Orthopedic Foot and Ankle Society score improved significantly from 36 points preoperatively to 94 at the final follow-up. The intermetatarsal and HV angles improved from the mean preoperative values of 18° and 37° to 8° and 13°, respectively. Satisfactory healing time was expressed as an average return back to work after 6 weeks and back to sports after 12 weeks. Persistence or recurrence of HV was seen in one patient; wound infections occurred in two patients, which settled after the administration of antibiotics; and one patient required further surgery to remove a long distal screw. Conclusion The scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of HV.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129115259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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