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Article
Do All Anterior Cruciate Ligament Tears Need Reconstruction?

Authors: Qasim M.AL Janabi --- Adnan H. Hnoosh --- Ahmed N.M. Altaei
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 166-171
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Anterior cruciate ligament (ACL) injury is common among active individuals, and mostly associated with other complex injuries in the knee. ACL reconstruction is vital for normal knee function. The treatment of ACL injuries of knee depend on many factors including Age of the patients, degree of laxity, level of activities and associated injuries . OBJECTIVE: To assess outcome after conservative management of ACL tear. Moreover, determine the patients who need reconstruction, and the best time to perform surgery. PATIENTS AND METHODS: Prospective study of 72 patients who had unilateral ACL tear, 61 males and 11females (age 18-40Y). 56 patients started management with rehabilitation program without reconstructive surgery, 12of them have underwent surgery after that because of unsatisfied outcome. ACLR performed for 28 patients 7 of them were female, complete ACL tear was observed in 21patients. Hamstring graft by one-incision technique were used: same protocol of rehabilitation was followed postoperatively. This study has been achieved in Al Shaheed Ghazi Al Hariri Hospital. RESULT: Average follow up period of 18 months, 78.5% of patient with rehabilitation (no ACLR) had good functional result. While all patients with ACLR have been satisfied where 85% of them return to their activity at level of I and II sport and 97% of quadriceps girth gaining compared to the sound side also observed at the end of follow up period. CONCLUSION: Not all ACL tear need surgical reconstruction. It is indicated for high-risk life style and repeated attacks of giving way. There is no differences between early and late reconstruction.


Article
Wallplasty Versus Non Wallplasty in Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction

Authors: Firas Abdalhadi ALObidi --- Majed Aswad Alsaad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 1 Pages: 73-78
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopedic procedures. Technical factors especially correct tunnel placement play major role in its success. However its failure rate is still high (10%), and impingement of the graft on the posterior cruciate ligament (PCL) and the medial wall of the lateral femoral condyle is an important cause of failure. Wallplasty is a technique used to prevent graft impingement, but there is no consensus on its routine use.OBJECTIVE:Is to compare between the postoperative knee functional outcome and stability of arthroscopic ACLR performed with wallplasty versus those performed without wallplasty.PATIENTS AND METHODS: A prospective experimental non randomized study was performed on 32 patients (30 males and 2 females) who necessitated arthroscopic ACLR. The patients were divided into 2 groups, in group A (made of 16 patients) the reconstructions were done without wallplasty and in group B (made of 16 patients) were done with wallplasty. Three months postoperatively the two groups were compared in regard to Lasholm score changes (preoperative and postoperative), Lachman test, and Pivot shift test results.RESULTS: There was better improvement in Lasholm score in group B than in group A, and the difference was statistically significant (p value =0.036). Knee stability tests were better in group B than in group A, but the differences were statistically not significant.CONCLUSION: Wallplasty has statistically better functional outcome than non wallplasty in ACLR and it is recommended to be done routinely in all cases of ACLR.


Article
Saving Versus None Saving of Anterior Cruciate Ligament Remnant in Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction(ACLR)

Author: Majed Aswad Jasem Alsaad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 4 Pages: 413-418
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Anterior Cruciate Ligament injury is one of the most common injuries of the knee and reconstruction is a commonly done surgical procedure. Successful outcome depend on factors that affects the stability like anatomic graft placement and secure fixation and other factors that affects the proprioception and revascularization of the graft like preservation of the ACL remnant which is used to reduce repeated graft rupture. OBJECTIVE: To compare the effect of saving of ACL remnant versus none saving on functional outcome and stability of the knee joint postoperatively. PATIENTSANDMETHODS: A prospective comparative non randomized study was used on 30 patients (28 male and 2 female) who underwent arthroscopic ACLR. The patients were divided into 2 groups (A and B), in group A (15 patients), reconstruction was done without saving of ACL remnant and in group B (15 patients), saving of the ACL remnant was performed. In one year follow up the result was compared according to the anterior drawer, Lachman, Pivot shift tests and Lasholm score changes (preoperative and postoperative). RESULTS: Regarding to Lasholm score the result was better in group B than in group A which was statistically significant (p value = 0.025). The knee stability was better in group B than in group A which was statistically insignificant. CONCLUSION: It is recommended to save the ACL remnant if possible with better knee joint functions and less repeated graft rupture.


Article
Evaluation of 80 Cases of Anterior Cruciate Ligament Arthroscopic Reconstruction done in Al‑Wasity Teaching Hospital, Baghdad

Author: Zaid Ali Jasim Shaban, Dhafer Fouad Al-Baher, Hadi Kareem Hadi
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 2 Pages: 160-163
Publisher: Babylon University جامعة بابل

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Abstract

Background: The objectives of anatomic anterior cruciate ligament (ACL) reconstruction is to reproduce the native anatomy of the ACLby restoring native insertion site, the tension pattern of the (ACL), the two functional bundles, and individualizing the surgery for eachpatient. This can be achieved using either the single‑bundle or double‑bundle technique depending on the patient condition. Objective: Thegoal of anatomic reconstruction in short term is to benefit clinical outcome and in long term is to reduce the prevalence of osteoarthritis.To review the results of patients who underwent arthroscopic reconstruction of the (ACL) using the semitendinosus and gracilis tendondouble or triple stranded graft. Materials and Methods: Eighty cases (72 males, 8 females) who met the inclusion criteria of study thatunderwent arthroscopical reconstruction for (ACL) injury and followed up for 6 months in Al‑Wasti Hospital between September 2012and October 2014 were included in this study. Results: Excellent clinical outcome was reported with 92.5% of the patients, 2(2.5%)cases had delay flexion and extension, failure of surgery was reported with only one case and deep venous thrombosis, and infection werereported with two cases only. No significant difference regarding complications was reported according to the method of fixation or sexdifference. Conclusion: Excellent functional outcome was obtained with all methods of fixation which confirm the reliability and safetyof these techniques.


Article
Evaluation of the Clinical Examinations in Diagnosis of Anterior Cruciate Ligament(ACL)Tear in Comparison With A Definite Arthroscopic Diagnosis

Author: Qasim Mohammed Shakir
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 3 Pages: 194-197
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND:The cruciate ligaments consists of a pair of very strong ligaments, connecting tibia to femur crossing like the limbs of letter X and that is why they are called crucial, mostly injured in noncontact sport actions leading to knee instability.AIM OF THE STUDY:To determine the accuracy of the clinical approach in the diagnosis of ACL tear. We used diagnostic arthroscopy as a reference standard for evaluating our results by applying it to all the patients.METHODS:During the period from Dec-2000 to Oct-2002, we led a prospective study of 72 patients with suspected ACL tear, depending on careful history & physical examination, then confirmed by direct arthroscopy.RESULTS:We found that only 52 patients have got ACL tear, 49 of them (94%) were males & 3 (6%) were females. The age range was from 17-49 years, with a mean of 27.5 years, 42% of the patients had associated meniscal injuries. The commonest symptom was a heard pop, & the main sign detected was knee joint effusion due to haemarthrosis.The accuracies of Lachman test, Anterior Drawer Test & Pivot Shift T. were 94%, 82% & 58%respectively, all were improved under G.A., particularly the PST.CONCLUSION:Most of ACL tears can be diagnosed by thorough history& repeated clinical examination only, considering arthroscopy as a last but a definite choice.


Article
Intraoperative Complications of Primary Anterior Cruciate Ligament Reconstruction Using Quadriple Hamstring Tendon Graft (Semitendinosus and Gracilis ): Measures of Avoidance

Author: Majed Aswad Alsaad, Mohammed Abdulzehra, Anas Mohammed Abdulla
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 3 Pages: 297-306
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Anterior cruciate ligament reconstruction is widely done orthopedic procedure, during this procedure there is potential risk for development of complications, which need to be dealt with or better to be prevented by specific measures.OBJECTIVE:To avoid intra operative complications during anterior cruciate ligament reconstruction using hamstring muscles graft in order to reduce incidence of the graft failure due to technical error.PATIENT AND METHOD:prospective cohort study for patient who has undergone primary anterior cruciate ligament reconstruction surgery using hamstring graft by same surgical team during the period from 2016-2017. History, examination and investigations were done for all patients and surgery was done under general anesthesia or spinal anesthesia. Specific rehabilitation program was instructed to all patients. Intra operative complications might be encountered during anterior cruciate ligament reconstruction surgery which includes: cartilage injury, Bleeding, Screw breakage, Screw mal direction and graft harvest complications. Identification of the measures to avoid these complications was crucial in this study.RESULTS:Fifty four patients who underwent primary anterior cruciate ligament reconstruction with mean age 27.7. Fourteen patients (26%) developed complications. Seven patients had cartilage injury (13)% , (2/54) patients had bleeding (3.7)% , (2/54) patients had developed screw breakage (3.7)% , screw mal direction (1.9)% was encountered in (1/54) patient and (2/54) patients had sustained premature graft cutoff short (3.7)%.CONCLUSION: Complications of anterior cruciate ligament reconstruction may occure at any stage of operation, avoidness of these complications is important step in improving the functional outcome and the surgeon need to be aware about it and how to avoid them.


Article
The Effect of Medical Instruments and Therapeutic Exercises on the Rehabilitation of an ACL Injury
أثر الاجهزة الطبية والتمرينات العلاجية في اعادة تأهيل اصابة الرباط الصليبي الامامي بمفصل الركبة

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Abstract

The purpose of this research is identifying the effect of medical instruments and therapeutic exercises on the rehabilitation of an anterior cruciate ligament (ACL) injury. According to the type of research, the researchers used the experimental methodology by taking pretests and posttests. The research population consists of ten patients of Al Rabbat teaching hospital ( state of Khartoum) with an ACL injury. The research sample is divided into two groups: an experimental group and a control group, each consisting of five participants aged between (22-44).The results of this research are:1- There were statistic differences between the circumference of the thigh, knee and calf of the participants of the control group and experimental group, and the latter seemed to show better results.2- There were statistic differences in the active and passiverange-of-motion (ROM) of the knee of the participants of the control group and the experimental group, and the latter seemed to show better results.

هدفت هذه الدراسة الى التعرف على مدى تأثير الاجهزة الطبية والتمرينات العلاجية في اعادة تأهيل التمزق الرباط الصليبي الامامي في مفصل الركبة ، وقد تم استخدام التصميم التجريبي بأسلوب القياس القبلي والبعدي لملاءمته لطبيعة البحث ، وتكون مجتمع الدراسة من المرضى المصابين بالتمزق الرباط الصليبي الامامية بمفصل الركبة خلال العام (2014ــــ2015) في جمهورية السودان ولاية الخرطومو تم اختيار عينة البحث بطريقة العمدية من المصابين بتمزق الرباط الصليبي الامامي لمفصل الركبة ، المترددين على مستشفى الرباط التعليمى في ولاية الخرطوم وكان عددهم (10) وقد قسمت العينة الى مجموعتين ضابطة وتجريبية عدد كل منها خمسة مصاباً تتراوح اعمارهم ما بين (22, 44) سنة .وجاءت نتائج البحث : 1- وجود فروق ذات داله احصائية بين المجموعة الضابطة والمجموعة التجريبية في محيطات الفخذ والركبة والساق والصالح المجموعة التجريبية .2- وجود فروق ذات دالة احصائية بين المجموعة الضابطة والمجموعة التجريبية في المدى الحركي الايجابي للركبة والمدى السلبي للركبة والصالح المجموعة التجريبية .

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