Yousef Marwan

Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee With or Without Reconstruction of the Anterolateral Ligament: A Randomized Clinical Trial:

Background: Rotational instability of the knee remains an issue after anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to evaluate the subjective and objective outcomes of combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. The hypothesis was that favorable outcomes can be achieved with this surgical procedure compared with isolated anatomic reconstruction of the ACL. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: One hundred ten patients with a unilateral ACL injury and high-grade pivot shift were randomly assigned to undergo either combined ACL and ALL reconstruction (group A) or isolated ACL reconstruction (group B). Preoperative and postoperative evaluations of the patients were conducted by obtaining history details, recording physical examination findings, measuring knee laxity using the KT-1000 arthrometer, and using validated outcome scores for the knee. P < .05 was considered as the cut-off level of statistical significance. The Fisher exact and Mann-Whitney U tests were used to assess statistical significance. Results: At a mean follow-up of 27 months, 53 and 50 patients in groups A and B, respectively, were available for analysis. No statistically different outcomes were found between the 2 groups except for the KT-1000 arthrometer values. The median KT-1000 arthrometer result for combined ACL and ALL reconstruction was 1.3 mm, while the median result for isolated ACL reconstruction was 1.8 mm (P < .001). None of the patients (n = 0; 0.0%) who underwent combined ACL and ALL reconstruction had anterior translation of greater than 5 mm at maximum pulling strength compared with their normal knees at final follow-up. On the other hand, 3 (6.0%) patients who underwent isolated ACL reconstruction had anterior translation of more than 5 mm. No serious complications were found in both groups. Conclusion: Combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Nevertheless, these findings were not significantly superior to isolated ACL reconstruction except for the instrumented knee laxity testing results. This might indicate that ALL reconstruction should not be performed routinely for patients undergoing ACL reconstruction.

Computed tomography-based morphologic and morphometric features of the coccyx among Arab adults.

Study Design. Cross-sectional, retrospective. Objective. To identify morphological and morphometric features of the coccyx among adult Arabs. Summary of Background Data. Different sacrococcygeal morphologic features were found to be associated with coccydynia. Methods. Review of 202 computed tomographic scans of adult Arab subjects was done (mean age: 47.98 ± 16.46 yr). Sacrococcygeal morphological features including number of coccygeal segments, type of coccyx, joint fusion, joint subluxation, coccygeal spicule, coccygeal sacralization, ventral angulation of the terminal sacral segment (S5), and lateral deviation of coccygeal tip were recorded. Moreover, morphometric measurements including lengths and angles of the sacrococcygeal region were measured. Analysis of data was carried out using P value of less than 0.05 as the cutoff level of significance. Results. Three coccygeal segments were present in 138 (68.3%) of individuals. The majority of the subjects had coccyx type I (96; 47.5%), II (70; 34.7%), or III (31; 15.3%); type I being more common among males (P = 0.004). Bony spicule was present in 109 (54.0%) individuals. Joint fusion, joint subluxation, coccygeal sacralization, ventral angulation of S5, and lateral deviation of coccygeal tip were present in 38.6%, 31.7%, 34.2%, 38.1%, and 38.6% of the subjects, respectively. Joint subluxation and ventral angulation of S5 were more significantly present among females (P = 0.015, P = 0.014, respectively). The mean straight and curved lengths of the coccyx were 3.3 ± 0.7 cm and 3.7 ± 0.8 cm, respectively. The sacrococcygeal structures were longer in males than in females. The mean sacrococcygeal joint angle was 149.2°± 28.1°. Based on the morphometric measurements, the coccyx was more ventrally angulated among females. Conclusion. The coccygeal morphology and morphometry of Arab adults share some similarities and differences with individuals of other ethnic backgrounds. Future studies should investigate the relation between these anatomic features with coccydynia among this population. Level of Evidence: 3

The Feasibility of Two Screws Anterior Fixation for Type II Odontoid Fracture Among Arabs.

Study Design. Retrospective, cross-sectional study. Objective. To evaluate the feasibility of two screws anterior fixation of the odontoid process among Arab adults. Summary of Background Data. Anterior screw fixation is the treatment of choice for type II odontoid fractures. In order to perform the procedure safely, the diameter of the odontoid process should be wide enough to allow for the placement of one or two screws. Methods. A retrospective review of 156 computed tomography scans of the cervical spine was done. The included patients were Arabs, adults (at least 18 years old), and had no evidence of upper cervical spine trauma, deformity, infection, tumor, or surgery. The minimum external transverse diameter (METD), minimum internal transverse diameter (MITD), minimum external anteroposterior diameter (MEAD), and minimum internal anteroposterior diameter (MIAD) of the odontoid process were measured. A P value of ⩽0.05 was considered as the cutoff level of statistical significance. Results. Our study included 94 (60.3%) males and 62 (39.7%) females. The mean age of the subjects was 37.8 ± 16.9 years (range 18–85). The mean values of the METD, MITD, MEAD, and MIAD were 8.7 ± 1.0 mm, 6.0 ± 1.1 mm, 10.3 ± 1.0 mm, and 7.4 ± 1.1 mm, respectively. Men had larger diameters compared to women. This was statistically significant for METD (P = 0.035) and MEAD (P < 0.001). The METD was <9.0 mm in 95 (60.9%) subjects, while the MITD was <8.0 mm in 153 (98.1%) subjects. These findings were not significantly different between males and females. Conclusion. Two screws anterior fixation of type II odontoid fracture is not feasible among the majority of Arabs. Level of Evidence: 3

Locking Screw Migration to the Palm Four Years Following Surgical Implantation of Distal Radius Locking Plate

Hardware-related complications are rare in patients with distal radius fractures who were surgically fixed with volar-locking plates. In this report, we present a case of locking screw loosening and migration to the palm four years following the treatment of type 23-C1 distal radius fracture with a volar locking-plate. This complication occurred without evidence of trauma, infection, non-union or plate breakage. Orthopaedic surgeons should be aware of such rare complication and add it to the list of potential postoperative complications when counseling their patients preoperatively.