مجله جراحی استخوان و مفاصل ایران
سال هشتم شماره 4 (پیاپی 33، پاییز 1389)

The purpose of this study was to evaluate the functional outcome of arthroscopic treatment of chondral and osteochondral lesions of the knee with arthroscopic osteochondral autograft transfer (Mosaicplasty) and to evaluate the factors affecting the treatment outcome.

In a before and after clinical trial 56 patients with grade 4 full thickness chondral lesion (outer bridge classification) were treated by the arthroscopic mosaicplasty technique over a 4-year period at an hospital in Tehran Iran. The mean time of follow-up was 214 months (16-32 months). The patients were assessed by International Knee Documentation Committee (IKDC) and Lyshom knee scoring scale (LKSS). The impact of age site of chondral lesion (medial or lateral femoral condyle) extent of the lesion (number of plugs) and associated lesions preoperative active levels tourniquet time and surgery complications were studied. In 3 cases second-look arthroscopy was performed.

The result of 78.6% was excellent and 21.4 good based on IKDC. Preoperative Lysholm score was 67.117.6 and postoperative score increased to 93.26.5 (p=.0004). Clinical outcomes were better significantly in patients with associated articular lesions lateral condyles lesions professional athletes and younger patients also in cases with lower plug numbers and sport injuries (p

Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions. Materials: In a cross-sectional study the CT image positions of the tibial and femoral tunnels in 40 patients that had undergone arthroscopic ACL reconstruction using single-bundle hamstring tendon were studied. The parameters that were evaluated were: tibial tunnel position in axial and sagittal cuts femoral tunnel position in axial cut appropriate thickness of the posterior cortex at the intercondylar notch and femoral exit point. The correct position of the tibial and femoral tunnels appropriate thickness of the posterior cortex at the intercondylar notch and the correct position of the "femoral exit point" were respectively recognized in 60% 52.5% 70% and 67.5%. In total the correct position of the femoral and tibial tunnels was seen on 37.5% of patients. These parameters were compared with known standard anatomic positions. Although the incidence of correct tibial and femoral tunnel positioning in ACL reconstruction when viewed separately was acceptable; when looked at as one tunnel was not satisfactory. More precise attention and expertise seem necessary for the operating orthopaedic surgeons.

The anterior cruciate ligament is the primary structure that controls anterior displacement in the unloaded knee. Anterior cruciate ligament reconstruction may return normal functions of the knee. The aim of the present study was to compare three different femoral fixation techniques in anterior cruciate ligament reconstruction. In a clinical trial study 120 patients that were candidates for ACL reconstraution were randomly divided into 3 groups of 40 individuals. The femoral fixations were by the three methods of "Aperfix" "Rigidfix" or "Endobutton". The cases were re-examined 12 months after surgery and evaluated by Lysholm score as well as with KT-1000 machine. The results were compered together for the three above methods. The Lysholm score showed improvement from pre-operative values in all three techniques: From 63.21±18.59 to 90.64±9.47 in "Endobutton" group from 65.72±18.74 to 96.22±5.35 in "Aperfix" and from 69.21±17.45 to 90.64±9.47 in the "Rigifix" group. There were 6 failures in "Endobutton" 4 in "Rigidfix" and one in "Aperfix" group. The anterior displacement tibia was 3.96±1.58 millimeters in "Endobutton" 4.28±1.48 in "Rigidfix" and 4.03±1.79 millimeters in "Aperfix" group. There was no significant difference in the operating time in the 3 groups. Regarding the instant stability of the graft the "Aperfix" method seemed stranger. Further investigations with larger number of cases and longer duration of follow up are recommended.

Treatment of displaced femoral neck fracture in active elderly people is a major undertaking with still unsolved issues. The aim of this study is to determine if primary total hip arthroplasty would have as good an outcome as primary internal fixation of the fracture. In a clinical trial study 80 cases of displaced femoral neck fracture who referred to the university hospitals of Isfahan Iran were enrolled into two treatment groups. Group I of 40 patients received screw fixation and the group II of remaining 40 underwent primary hip arthroplasty surgery. In a 2 year follow-up the surgical outcomes were assessed using VAS pain scale SF36 general health instrument score and Harris hip score (HHS). The pain scale (VAS) SF36 and Harris scores showed significantly better results is arthroplasty group compared with fixation group. The values were as follows: Group 1: pain=4.5 (from 10) SF36=68 HHS=61; group II: pain=3.38 SF36=92 HHS=86. Complications were encountered in 16 cases (40%) in group I and 3 cases (7%) in group II. Displaced femoral neck fractures in 60-70 years old patients treated with primary total hip arthroplasty will have better outcomes in first 2 years with less complication rates.

Surgical wound infection is the most serious complication after surgical treatment and the second most common etiology in nosocomial infection. Nutritional status of the patients is one of the risk factors for surgical site infection (SSI). This study aims at investigating the relationship between the serum albumin level and pre-operative anemia with surgical site infection in patients with open tibial fracture. In a prospective study 56 patients with open tibia fractures were studied in a teaching hospital in Mashhad-Iran. At the time of admission serum albumin level hemoglobin and anthropometric values were measured. Surgical site infection during a one-year follow-up was recorded. The results were analyzed using statistical tests. Nineteen patients (%33.9) were complicated by infection. The odd ration was 1.83 (p=.032) for anemia 2.35 (p=. 018) for hypoalbuminemia and 3.53 (p=.002) for type of open fracture. This study showed that SSI is a problem of great significance in orthopaedic tibia open fracture surgeries. It also showed that hypoalbuminemia and anemia before surgery resulted in a higher SSI occurrence in the patients.

There are different conservative treatments for the osteoarthritis of the medial compartment of the knee and valgus bracing is considered as important one. The purpose of current study was to examine the efficacy of the brace unloading in changing floor reaction force. Ten patients with osteoarthritis in medial compartment of the knee contributed in this quasi-experimental study with and without using knee braces. The magnitude of the mediolateral vector of the ground reaction force and center of pressure displacement in mediolateral direction were measured by using a force plate system (Kistler Swiss). Statistical tests were used to analyze the data. The mean of displacement of center of pressure (COP) was 25 mm and 5 mm with and without brace respectively (p≥.05). The mean of mediolateral vector of the ground reaction force was 28.17 with and 22.45 without brace and there was no significant difference (p≥.05). In contrast there was a significant difference between the magnitudes of the mediolateral vector of the ground reaction force within pre-and post-brace situations (p=.000). Valgus bracing can reduce the magnitude of the mediolateral vector of the ground reaction force and displacement of the COP in the mediolateral direction. It might be concluded that this method can reduce the pain and instability and improve function in patients with osteoarthritis of the medial compartment of the knee.

Xanthogranulomatous osteomyelitis is a rare bone disease. Its primary presentation is similar to bone tumors. According to our research only 3 cases of this disease have been reported in the literature. In this case report a 22 years old patient with right thigh pain fever and significant weight loss associated with radiographic features resembling signs of Ewing's sarcoma is presented. The pathologic diagnosis was xanthogranulomatous osteomyelitis. The patient underwent wide spectrum antibiotic therapy and achieved complete recovery.