Predrag Rasovic

Fracture of the patella after the anterior cruciate ligament reconstruction.

INTRODUCTION Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. MATERIAL AND METHODS We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. RESULTS The patients were invited for the check-up 5 years (2-8 years) after surgery on average. The mean Lysholm score was 92 (85-100). All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months). In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. DISCUSSION AND CONCLUSION The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.

Bone tunnel enlargement after the reconstruction of anterior cruciate ligament using BTB graft

Background/Aim. Bone-tendon-bone (BTB) graft is one of the strongest biological grafts and it provides a strong initial fixation with the application of interference screws making possible the primary bone healing and bone integration of the graft on the place of fixation during arthroscopic reconstruction of the arterior cruciate ligament of the knee. The aim of our research was to determine if BTB graft from which, throughout the surgical treatment, soft tissue and periosteum are removed, leads to the reduction of the enlargement in the femoral and tibial bone after the arthroscopic reconstruction of the anterior cruciate ligament. Methods. The first phase consisted of bio-mechanical study on 12 pairs of cadaveric BTB grafts. The testing was performed on the mechanical testing machine. The second phase involved clinical testing. The first group consisted of 40 patients treated with the classical BTB autograft. The second group consisted of 56 patients who had two thirds of the bony parts of the bone-tendon-bone autografts of the soft tissue and periosteum removed. We measured the distance between the edge of the sclerotic tunnel on the tibial and femoral bone in three different points: proximal (F1;T1), middle (F2;T2) and the lower part (F3;T3). Results. The experimental part of the study showed no statistically significant difference in graft breakout force expressed in N/mm2 between classically treated BTB graft and graft with a partially removed soft tissue and periosteum. By comparing the expansion of tunnels in all segments in both bone tunnels between study groups, statistically significantly lower enlargement was measured in the group with BTB grafts with partially removed soft tissues and periosteum (p < 0.05). Conclusion. The use of BTB grafts with partially removed soft tissues and periosteum provides less bone tunnel expansion as compared to classically treated grafts of the anterior cruciate tendon.

Bilateral Congenital Posterior Cruciate Ligament Hypoplasia

Congenital aplasia or hypoplasia of the cruciate ligaments is an infrequent condition. The absence of the posterior cruciate ligament (PCL) is extremely rare and is usually associated with other congenital abnormalities of the lower limb such as anterior cruciate ligament (ACL) agenesis, absence of one or both menisci, and absence or dysplasia of the patella1-7. To the best of our knowledge, only one case of a unilateral PCL absence8 and one case of bilateral PCL hypoplasia9 have been reported in the literature. We present the case of a professional athlete with bilateral congenital PCL hypoplasia without other associated congenital anomalies. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A twenty-nine-year-old female professional athlete, who had played handball from the age of twelve years and had competed in the premier league from the age of sixteen years, sustained a twisting injury to the right knee while landing. Seven days later, examination revealed a minimal right knee effusion and a positive Lachman test with a soft end point. The posterior drawer sign had a hard stop, and the posterior sag sign was negative. No lateral or medial instability was observed. Active and passive knee motion was intact. The patient denied any family history of skeletal congenital abnormalities; no abnormalities had been noted during pregnancy, childbirth, or childhood. Five years prior to this event, she had given birth to a healthy girl who had normal physical and mental development. Magnetic resonance imaging (MRI) of the right knee (Figs. 1-A, 1-B, and 1-C) demonstrated a recent ACL tear with a fully disorganized and partially retracted ligament as well as associated intra/periligamentous edema. The PCL did not have a normal appearance; there was only a thin, hypointense bandlike structure, …