Online ISSN: 2515-8260

Keywords : Anterior cruciate ligament


ACL Injuries In Young Athletes: The Culprit And The Time Lost! A Prospective Correlation Analysis of Anterior Cruciate Ligament Injuries with Meniscal and Chondral Lesions

Dr. SM Adil, Dr. Vyom Sharma, Dr. Shambhu Singh, Dr. Akshay Pushkar, Dr. Kaushik Roy, Dr. Chetan Sood, Dr. KP Jaidev

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 2475-2486

Anterior cruciate ligament (ACL) injuries impair quality of life of an athlete with the possibility of osteoarthritis if left untreated. The aims of the study were to analyse the pattern of chondral and meniscal injuries and the temporal association of severity of these injuries with delay in ACL reconstruction.
Material and Methods: In this prospective study, patients who underwent knee arthroscopy from Jan 2015 to Dec 2018 for clinico-radiologically diagnosed ACL tear were included in the study. Mode of injury, time from injury (TFI) to ACL reconstruction and intraoperative findings of chondral lesions, meniscal tears and other intra-articular injuries was recorded. The association between the index injury and whether there was any significant correlation between TFI, severity of chondral and meniscal lesions and mode of injury were analysed.
Results:429 male and 15 female athletes were included in the study with a mean age of 28.98±7.08 years,53.6% of patients in the 26–35 years age group. Twisting during running events was the most common mode of injury in 139(31.3%) patients. MeanTFI was 55.35±23.84(14-129) weeks. There was a significant correlation between the grade of the chondral lesion and TFI (p < 0.0001) as all grade III and IV chondral lesions were observed with a mean TFI of 69.9±4.23 weeks. The odds of finding a medial meniscus tear associated with a complete ACL tear were statistically significant when TFI was more than 59.3 weeks. There was a significant correlation between the incidence of medial compartment chondral injury and medial meniscus tear at a mean TFI of 55.3 weeks(p=0.007,OR=1.90) without significant correlation between lateral compartment chondral injury and lateral meniscus tear (p=0.91, OR=1.03).There was no significant correlation between a particular mode of injury and ACL tear.
Conclusions: The delay in treatment of ACL injuries greater than 70 weeks leads to higher grade chondral lesions and complex meniscal injuries in young athletes that can be avoided with early management of an ACL deficient knee

Study of correlation between MRI and arthroscopic findings in anterior cruciate ligament and meniscal injuries of the knee joint at a tertiary hospital

Bethi Anirudh Reddy, V Sahethya Mohan Rao, Vikram Goud, Sujitkumar Vakati R, Nayan Raj Puvvada, S. Venkatraman

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 7095-7100

Background: Complete evaluation of knee injury includes a detailed history, thorough clinical examination, radiological evaluation, and arthroscopic examination.  Present study was aimed to study correlation between MRI and arthroscopic findings in anterior cruciate ligament and meniscal injuries of the knee joint at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, comparative, observational study, conducted in ppatients admitted to the hospital with traumatic knee injury, underwent MRI knee followed by arthroscopy.
Results: During study period 60 patients of knee injury underwent MRI knee followed by arthroscopy considered for study. Majority were male (86.67 %), from 20-29 years age group (60 %), had injury dure to motor vehicle accident (43.33 %) & sports related activity (35 %). We compared injuries to ACL, PCL medial meniscus & lateral meniscus mentioned during MRI study with respect to knee arthroscopy using knee arthroscopy as diagnostic gold standard. In cases of ACL tear, MRI had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) & accuracy values as 86.66 %, 73.33 %, 90.69 %, 64.70 % & 83.33 % respectively. In cases of PCL tear, MRI had sensitivity, specificity, PPV, NPV & accuracy values as 86.36 %, 89.47 %, 82.60 %, 91.89 % & 88.33 % respectively. In cases of Medial meniscus tear, MRI had sensitivity, specificity, PPV, NPV & accuracy values as 86.11 %, 87.5 %, 91.17 %, 80.76 % & 86.66 % respectively. In cases of lateral meniscus tear, MRI had sensitivity, specificity, PPV, NPV & accuracy values as 83.33 %, 88.09 % & 75 %, 92.5 % & 86.66 % respectively.
Conclusion: MRI is an excellent, non-invasive, radiation free imaging modality with multiplanar capabilities and excellent soft tissue delineation

Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon – A Prospective Study

Shameer Ismail, Reneesh U P, Sasikumar S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 7875-7881

Background:The standard approach for anterior cruciate ligament (ACL) injuries has historically been arthroscopic ACL reconstruction. It's a minimally invasive treatment that allows the surgeon to understand the derangement of the knee joint. The aim of arthroscopic ACL reconstruction is to restore normal kinematics in the knee joint. The goal of this research was to evaluate the results of Anatomic single bundle ACL reconstruction with hamstring tendon.
Methods: The prospective clinical study was conducted in the Orthopaedic Department, Dr Moopens Medical College formerly DM WIMS Wayanad, Kerala on 36 patients 31(86.11%) males and 5(13.88%) females with chronic ACL tear treated with the hamstring tendon for reconstruction of the anterior cruciate ligament in all patients during the period from June 2019 to December 2021.
Results: There were 31 men (86.11%) and 5 women (13.88%) among the 36 patients. About 25 patients (69.44%) had right-sided ACL injuries, whereas the remaining 11 (30.55%) had left-sided ACL injuries. IKDC SCORE was improved from 42.45 with SD of 9.68 preoperatively to 81.87with SD of 13.40 postoperatively.
Conclusion: Anatomic anterior cruciate ligament reconstruction with hamstring tendon is more effective at replicating the anatomy of the ACL and achieving favourable clinical results.

Ganglion cyst after anterior cruciate ligament (ACL) reconstruction causes and management

Ismail H. Almogbil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 5560-5570

Introduction: A ganglion is a cystic, tumor-like lesion filled with gelatinous fluid that contains hyaluronic acid and other mucopolysaccharides and is encompassed by a dense network of collagen fibers and fibrocytes. The operation is intended to restore knee stability and improve the patient's quality of life. Historically, 75–90% of ACL surgeries result in patients being able to resume their previous level of athletic activity. Significant clinical symptoms are brought on by ACL ganglion cysts. Large ganglia may prevent full extension in these patients, who may also complain of discomfort and stiffness. Decompression of the ganglion at arthroscopy or under the direction of a CT scan is recommended for such patients and offers immediate relief Conclusion: The number of patients undergoing ACL reconstruction is rapidly increasing, and those with a clinical history of discomfort at the extremes of extension and flexion may be suffering from ganglion cysts. Radiologists must be familiar with these treatments and their potential side effects. MRI is the gold standard for radiological diagnosis, and arthroscopic therapy offers rapid symptom alleviation without compromising ligament integrity. MRI can help rule out any other relevant intraarticular abnormalities. This patient's ACL ganglion cyst symptoms were successfully treated using CT scan-guided suction that was also secure.

THE PES ANSERINUS: THE ANATOMY AND PATHOLOGY OF NATURALLY OCCURRING AND EXTRACTED TENDONS

Dr.Mukesh Bansal, Dr Muktyaz Hussain, Dr Alpana Bansal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2312-2320

The goal of this article is to have a comprehensive review of the anatomy of the pes anserinus (PA) and the spectrum of pathologic conditions that can affect this structure. After the insertion site of the PA tendons was fully exposed, careful dissection was performed to determine the exact shape of the PA. Insertions were made into the gracilis and superficial layers of the sartorius and the deep layers of the semitendinosus on the medial side of the tibia. Sixty-six percent of specimens had one semitendinosus tendon at the insertion site, while 31 percent had two, and 3 percent had three. A connection was made between the deep fascia of the leg and the tendons of the gracilis and semitendinosus. The anserine bursa was a somewhat asymmetrical, roughly circular shape. Some of the anserine bursa specimens even extended beyond the proximal line of the tibia. The anserine bursa, as seen from the medial side of the tibia, was situated posteriorly & superiorly from the tibial midline, paralleling the sartorius muscle. Anserine bursa injections should be given at an angle of 20 degrees medially and inferiorly from the vertical line, 15 or 20 millimetres deep, and roughly 20 millimetres medially and 12 millimetres superior from the inferomedial point of the tibial tuberosity.

Presence of antero lateral ligament in knees with and without anterior cruciate ligament tear

Manoj Kumar, Sagar Goel, Nikhil L Gore, Varun Gautam, Mohit Jindal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 615-628

Background: There is a debate around the existence, anatomy, and role of the so called
―anterolateral ligament (ALL). This study was conducted with a primary aim of finding out
and comparing the prevalence of the presence of anterolateral ligament and it’s three portions
(femoral, meniscal and tibial) in knees with and without ACL tear.
Methodology: This is a cross sectional study conducted in which A total of 96 patients
undergoing MRI knee for clinically evident ACL injury or history of chronic knee pain were
included in the study. Out of 96 patients included in the study, 48 patients had ACL tear
(Group A) and 48 patients did not have an ACL tear (Group B). Demographic data and
clinical information were noted for all patients. Descriptive variables were expressed as mean
and standard deviation for quantitative variables and frequency and percentages for
qualitative variables. The data was analyzed using SPSS® version 21.0. Categorical variables
were analyzed using Chi square test and for normally distributed data - t test was used. p
value <0.05 was considered as statistically significant.
Results: ALL was visualized in 65% of the patients included in the study. Its femoral
component was visualized in 56%, tibial component in 63% and meniscal component in 57%
of the patients. The three components were viewed together in 30% of the patients. We found
a significant association between ACL tear and the presence of ALL (p <0.001), with ALL
visualized in around 81%of knees with an ACL tear and only 48% of knees without an ACL
tear. Meniscal tears were significantly associated with the presence of ALL as out of the 62
patients in which ALL was visualized, 24 had an associated medial meniscal tear, 7 had
lateral and 3 had tear in both the menisci.
Conclusion: Our study demonstrated radiological evidence of the existence of the ALL.
Furthermore, we found presence of ALL to be significantly associated with ACL injury and
meniscal tear. Age, gender, or affected side was not found to be associated with the presence
of ALL.

Study of femoral and tibial tunnel position using CT scan, and its effect on functional outcome in arthroscopic ACL reconstruction: A prospective study

Dr. Sunil B, Dr. Arjun A, Dr. Kiran V, Dr. Sathish Babu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 106-113

Background: Accurate placement of tibial and femoral tunnel has significant effect on
functional outcome after anterior cruciate ligament reconstruction (ACLR). Anterior cruciate
ligament tear is one of the common sports injuries, and arthroscopic reconstruction is now a
day’s popular surgery. Its failure is rare but not uncommon. Despite advances, failure rate
after ACL reconstruction (ACLR), ranges from 0.7% to 10%1. Slight anterior placement of
femoral tunnel can lead to restriction of knee flexion and, similarly if tibial tunnel is anterior,
it leads to impingement of graft, surgical failure and also the need for a revision surgery.
Post-operative CT scan provide a reliable and valid way for the assessment of anatomical
tunnel position and obliquity after ACLR.
Materials and Methods: 31 patients with complete ACL tear with or without the meniscal
injury are treated with single bundle arthroscopic reconstruction using hamstring graft tendon.
With common post-operative rehabilitation protocol all patient are followed up clinically and
radiological for next 2 year. Femoral, tibial tunnel positions on sagittal plane. Were measured
interpreted with the clinical parameters. Radiological parameters were summarized as mean
standard deviation and proportions as applicable.
Results: Total no of patients with the age averaged 27.13± 5.89, pre op lysholm score
averaged 64.26±8.93. At 24 months follow up position of the tibial tunnel was found to be at
an average of 31.55%±4.79posterior from the anterior edge of the tibia. The femoral tunnel
was found at an average of 28.54±3.18% anterior to the posterior femoral cortex. 32.2% and
35.5% of patients showed grade 1 anterior drawer and lachman test positive respectively. And
mean lysholm score averaged to be 86.58±5.32.
Conclusion: The location of femoral tunnel in the mid sagittal section from the posterior
cortex 28.54±3.18% of anteroposterior length showed no significant correlation the lysholm
scoring. Locating the tibial tunnel positioning on the tibial plateau from the anterior cortex of
Showed significant p value with functional outcome.

Studying effect of tunnel expansion on functional outcome in anterior cruciate ligament reconstruction using CT scan: A prospective study

Dr. Vanamali B Seetharam, Dr. Arjun A, Dr. Sunil B, Dr. Kiran V, Dr. Sathish Babu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 114-121

Background: Tunnel expansion in anterior cruciate ligament reconstruction (ACL-R) is a
well-accepted phenomenon, still its effect on functional outcome is little known.
Purpose: To study prospectively the effect of change in the tunnel volume as observed with
computed tomography (CT) on functional outcome after ACL-R.
Materials and Methods: This study conducted for a follow up of 24 months of time period
between June 26th 2017 to 31st December of 2019, after approval from ethical committee 31
patients with complete ACL tear with or without the meniscal injury were treated with single
bundle arthroscopic reconstruction using hamstring tendon graft. With common postoperative
rehabilitation protocol, all patients were followed up clinically and radiologically
for two years. Tibial and femoral tunnel volume were measured and correlated with the
clinical parameters. Radiological parameters were summarized as mean, standard deviation
and proportions as applicable.
Results: Total number of 31 patients with the average age 27.13±5.89 and pre-operative
lysholm score average of 64.26±8.93 were included in the study. At the end of 2years follow
up of each patient, 32.2% and 35.5% of patients showed grade 1 anterior drawer and
lachman test positive respectively and mean lysholm score averaged to be 86.58±5.32.
Significant difference of tunnel volume noted at the end of 2 years with a 0.837 cm3 and
0.545 cm3of tibial and femoral tunnel volume respectively.
Conclusion: Noted a significant expansion of both tibial and femoral tunnel volume
postoperatively when compared to the intra-operative tunnel volume. Both the femoral and
tibial tunnel volume showed negative correlation with the functional outcome.

“A COMPARATIVE STUDY OF THE DIAGNOSTIC ACCURACY OF 1.5 TESLA MRI WITH ARTHROSCOPY IN THE EVALUATION OF LIGAMENTOUS INJURIES OF THE KNEE”

Dr. Disha Shah, Dr. Amlendu Nagar, Dr. Sheetal Singh, Dr. Sonal Banzal .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 451-464

Background: Ligamentous injuries to the ligaments and menisci of the knee can lead to significant morbidity and may precipitate osteoarthritis.Arthroscopic diagnosis though invasive is considered as the gold standard. Various imaging modalities like CT scan and MRI have alsobeen used in the diagnosis of these injuries and the quest for the best technique goes on.
Aim: The aim of this study is to assess the diagnostic accuracy of 1.5 T MRI in cases of ligamentous injuries of the knee joint and compare its efficacy with arthroscopy.
Materials & Methods: This is a comparative observational study which included 50 patientswho were clinically suspected to be having ligamentous injuries of the knee. MRI was done for all these patients and all of them laterunderwent arthroscopy in the Department of Orthopaedics-IMCHRC.Statistical analysis was done to derive the sensitivity, specificity, positive predictive value (PPV) and the negative predictive value (NPV) and for this the findings at arthroscopy were taken to be the true diagnosis.
Results: The patients were commonly in the age group of 21-30 years and males with RTA being the commonest mode of injury and duration of injury commonly between 6weeks to 6 months.ACL tear was the commonest injury found in 76% followed by PCL tear in 38% , MM tear in 36%, LM tear in 32%. Regarding the efficacy of 1.5T MRI for ACL tears the sensitivity was 94.6%, specificity 76.9%, PPV 92.1%, NPV 83.3% and accuracy 90%. For PCL it was 94.4%, 93.8%, 89.5%,96.8%,94% respectively. For MM it was 94.7%,100%,100%,96.9%,98% respectively and for LM 83.3%,96.9%.93.9%,91.2%,92% respectively.
Conclusion: MRI is of proven diagnostic value in the evaluation of internal ligamentous injuries of the knee joint. It has a fairly good PPV and its routine use in all clinically suspicious ligamentous injuries of the knee may be recommended. Further since MRI has a high NPV, a normal MRI scan may be used to exclude any pathology and thus avoid an expensive and invasive procedure like arthroscopy.

Anterior cruciate ligament reconstruction using a combination of autograft and allograft tendon

Dr. Sanjeev Kumar Rakesh, Dr. Shailesh Kumar, Dr. Indrajeet Kumar, Dr. Gangdayal Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1746-1752

Aim: The aim of the present study to evaluate the anterior cruciate ligament reconstruction
using a combination of autograft and allograft tendon
Methods: Twenty Total 44 patients were included in this study and divided into two equal
groups 22 patients. Out of 44 patients, 22 were undergoing for auto graftsand 22 patients for
hybrids process. These 22 patients were matched by age (within 1 year) and sex with 22
patients who underwent hamstring autograft ACL reconstruction during the same time period.
Collected data included graft size, patient demographics, intraoperative findings, femoral
tunnel drilling technique, and patient-reported outcome scores (International Knee
Documentation Committee [IKDC],13 Knee injury and Osteoarthritis Outcome Score
[KOOS],14 and Marx activity score 15) prior to surgery.
Results: The final graft size was noted to be larger in the hybrid group (9.5+ 0.6 mm) than
the autograft group (8.4 ±0.9 mm) (P < .001). 5 month postoperatively, no significant
differences in KOOS, IKDC, or Marx activity score were noted between the hybrid and
autograft groups (Table 5 and 6). Both groups demonstrated significant improvements in
KOOS and IKDC compared with preoperative values (P < .001). Revision ACL surgery was
performed in 5 patients in the hybrid group (22.73%) and 2 patients in the autograft group
(9.9%).
Conclusion: Patients who undergo ACL reconstruction with hybrid hamstring grafts and
hamstring autografts report similar patient-reported outcome scores at 15 months
postoperative. Further work is required to investigate potential increased risk of revision ACL
reconstruction

Arthroscopic Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon

Riad Mansour Megahed, Hosam Fathi Mahmoud, Ahmed Hatem Farhan Imam, Abdulmunem Amhimmid Ighleeleeb

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3215-3224

Background: Anatomical single bundle arthroscopic Anterior cruciate ligament
(ACL) reconstruction has been the standard treatment for ACL injured patients. It
is a minimally invasive procedure that allows the surgeon tounderstand the internal
derangements of the knee joint. The purpose of Arthroscopic ACL reconstruction is
to restore the normal kinematics of knee joint. The aim of the current study was
evaluation of the results of anatomic single bundle anterior cruciate ligament
reconstruction using hamstring tendon. Patients and methods: prospective clinical
study was conducted in Orthopedic Department, Faculty of Medicine, Zagazig
University, on 24 patients (18 males and 6 females with mean age 30.16±5.9) with
chronic ACL tear treated with the hamstring tendon for reconstruction of the
anterior cruciate ligament in all patients during the period from April 2020 to April
2021. Results: Grade of Lysholm score improved significantly postoperatively,
where 17 patients were excellent, 5 patients were good, and 2 patients were fair.
IKDC SCORE was improved from 45.83±7.46 preoperatively to 78.12±6.04
postoperatively. There were 19 patients without complication, 4 patients had
superficial infection and 1 patient had deep infection. Conclusion: The anatomic
anterior cruciate ligament reconstitution using hamstring tendon is more effective
for reproducing the anatomy of the ACL and obtaining good clinical results, when
it is done by accessory medial portal because the technique enables for a better view
inside the knee and more obliquity of the reconstructed ACL when compared to the
transtibial technique.

Anterior cruciate ligament reconstruction: single-bundle hamstring versus double-bundle reconstruction with lavsan (polyethylene terephtalate)

Murodjon Ergashevich IRISMETOV; Farrukh Makhamadjonovich USMONOV; Alisher Mukhammadjonovich KHOLIKOV; Kurbon Nurmamatovich RAJABOV; Murodjon Bakhodirovich TADJINAZAROV

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 951-959

Anterior cruciate ligament is one of the main stabilizateur of the knee joint. Many methods were suggested for its reconstruction with different allo- and autografts, as well as synthetic materials. The aim of study is to compare of two methods of ACL reconstruction. Material and metods. The study included 110 patients who underwent ACL reconstruction. I group (54 patients) underwent single-bundle ACL reconstruction with hamstring tendons, II group (56 patients) underwent double-bundle reconstruction with lavsan (polyethylene terephtalate) tape. Patients were evaluated with Lachman, anterior drawer and pivot-shift tests and Lysholm score. Results. Our results showed better results in double-bundle group, especially rotational stability was significant better. Conclusion. Independing of the method of ACL reconstructions these surgeries must be perform taking into account anatomic features and changes of the knee. Double-bundle technique of ACL reconstruction with lavsan provides better stability than single-bundle technique with hamstring tendons.

MRI EVALUATION OF PATTERN OF ANTEROLATERAL LIGAMENT AND POSTEROLATERAL CORNER INJURY ASSOCIATED WITH ANTERIOR CRUCIATE LIGAMENT TEAR WITH IT’S CLINICAL CORRELATION.

Dr. Amruta Dinesh Varma; Rajasbala Dhande

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 1977-1982

Abstract: Background: Understanding the RELATION between anterior cruciate ligament
and postero lateral corner TRAUMA with antero-lateral ligament of knee with it’s clinical
diagnosis would help us better understand the pattern of injury and to take proper
treatment action .Objectives :To find the correlation between pattern of injury of
anterolateralligament , anterior cruciate ligament and posterolateral corner injury on MRI
with it’s clinical correlation and associated findings. Methodology: A cross-sectional study
will be done at Acharya Vinoba Bhave Rural Hospital, Sawangi, involving52 patients who
present with knee trauma for MRI. The sample will be selected and involvement of
Anterior cruciate ligament ,postero lateral corner injury and antero-lateral ligament with
associated findings will be evaluated using T1, T2 and PD MRI sequences. These will be
compared and there association will be calculated which can be used for better planning of
treatment. Results: After appropriate statistical analysis, we expect to find association
between anterolateral ligament and anterior cruciate ligament tear with posterolateral
corner injury and this will be considered for reconstruction. Conclusion: In this
observational study, we expect associations between injured ligaments with aid of clinical
findings . We also expect to find a positive association between anterolateral ligament with
posterolateral corner injury and anterior cruciate ligament tear.