مجله جراحی استخوان و مفاصل ایران
سال یازدهم شماره 4 (پیاپی 45، پاییز 1392)

There is a great debate about the proper autograft for arthroscopic anterior cruciate ligament reconstruction (ACLR). In current study، we compared the clinical and functional outcomes of ACLR using either medial hamstring (MH) tendon or patellar tendon (PT). Eighty eight patients with anterior cruciate ligament (ACL) injury contributed to a retrospective study. The study was done in a teaching hospital in Yazd، Iran. Patients were divided into two groups based on the type of autograft used for ACLR: MD (48 patients) and PT (40 patients). In a follow-up of 18. 5±2. 2 months in MH and 19. 3±2. 9 months in PT group، the pain was analized using visual analogue scale (VAS) and the range of knee flexion was measured. The result of the surgery was assessed utilizing Tegner-Lysholm score، KOOS (Knee injury and osteoarthritis outcomes) and return to the previous activity. The two groups were the same in term of range of knee flexion، KOOS and Tegner-Lysholm score. The VAS averaged. 9±. 3 in MH and 1. 15±. 5 in PT groups، with no significant difference. Return to previous activity was seen in 80% of PT group and 85. 4% of MH group. ACLR using either MH or PT autograft، is effective in short-term، and is associated with satisfactory clinical and functional outcomes.

The gold standard in ACL reconstructions has been the bone–patellar tendon–bone autograftfixed with interference screws. This prospective study، aimed to compare two method of fixation for BPTB grafts: press fit fixation vs. interference screw، over a 12 months follow-up interval. In a randomized clinical trial study، 158 patients with an average age of 29. 8 years were treated for torn ACL with BPTB autograft in a teaching hospital in Tehran، Iran. In 82 patients press fit fixation technique، and in 76 cases an interference-screw was used. At the time of final follow-up، 71 patients in press-fit group and 65 patients in interference-screw group were evaluated in terms of return to pre-injury activity level، pain، knee stability، range of motion، IKDC score and complications. In the final follow-up، 59 cases in interference screw and 55 in press-fit screw group had good-to-excellent IKDC score (p≥. 05). The mean laxity assessed improved to 2. 7 mm and 2. 5 mm in press-fit and screw group، respectively. Regarding Lachman and pivot shift tests، there was a statistically significant improvement in the integrity of the ACL in both groups، with no significant difference (p≥. 05). the press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing، no need for removal of hardware، ease for revision and cost effectiveness.

Synthetic hydroxyapatite (HAP)، beta-tricalcium phosphate (ß-TCP) and their composite are promising biomaterials specifically in the orthopaedic and dental fields، as their chemical composition is similar to that of bone. Due to the need for safer bone graft applications، these bone graft substitutes are gradually gaining increased acceptability. The purpose of this study was the evaluation of concurrent use of hydroxyapatite with demineralized calf foetal growth plate (DCFGP) effects on bone healing process. Mid radii bone defect was created in fifteen female New Zealand white rabbits. They were divided into 3 equal groups: In group I the defect filled with DCFGP، in group II was with hydroxyapatite and DCFGP، and in group III with hydroxyapatite alone. Radiographic and histopathologic evaluations were performed blindly and results scored and analyzed statistically. There was a significant difference in bone formation and remodeling at the 56th post-operative day (p=. 03). Group II was superior to group I and III. Histopathologic evaluation revealed significant difference between group II with group I and III. The combination of osteoconductive effect of hydroxyapatiter and osteoinduction of DCFGP will lead to superior bone healing process in comparison with any of those agents when used alone.

The aim of this study was to assess the isokinetic measures of surgically repaired ruptures of the pectoralis major muscle in contrast to non-injured side of the patients and specify the most affected movement of the injured side. Nine pectoralis major muscle tears in nine patients were studied. They were all operated by the same surgeon and after 2. 4 years (1-4 years) of follow up they were clinically examined. They completed a standard questionair and isokinetic dynamometry were carried out bilaterally. There was also a group of six non-injured bodybuilders who were assessed by isokinetic dynamometry to give us normal differences in the values of both limbs. In the patient group، the mean torque of flexion was not different between the injured and uninjured sides (p≥. 05). For the extension movements، the difference was significant (p<. 034) but for the other movements was not. None of the results fell into the excellent or poor categories according to Kakwani classification. Six patients were categorized as good and three patients as fair. The main reason for the three ''fair'' patients was cosmetic complaints in the cases who were operated on three months post injury. The surgical repair of ruptured pectoralis major is beneficial and focusing on strengthening exercises for flexion and extension is essential to achieve the best results.

Preoperative onlay templating is prevalently used to determine the size and placement of acetabular and femoral components before total hip arthroplasty (THA). The purpose of this study was to determine the accuracy and reliability of preoperative onlay templating in uncemented THA. In a cross sectional study، 50 patients who underwent uncemented THA for hip osteoarthritis were selected in one teaching hospital، retrospectively. The study was done in a 4-month period. Using onlay templates، four surgeons determined the size of acetabular and femoral component on plain anteroposterior hip radiographs. Finally، the average percentage of agreement between template and implanted components were considered as the accurate representation. Kappa coefficient was utilized to determine the interobserver reliability. The accuracy of templating for acetabular and femoral component size was 60% and 59. 5%، and the interobserver reliability was 49% and 52%، respectively. Based on our findings، preoperative onlay templating cannot provide us with proper component selection and intraoperative determination of correct size is required for best outcome achievement.