Myositis ossificans as a complication of hamstring autograft harvest for open primary anterior and posterior cruciate ligament and posterolateral corner reconstruction

Myositis ossificans in the pediatric population: a systematic scoping review

Introduction

Circumscribed or pseudomalignant myositis ossificans (MO) is a rare and benign condition characterized by heterotopic bone formation in soft tissues. The clinical presentation of MO, imaging investigations, histological findings, and treatment strategies are unclear, especially in the pediatric population.

Materials and methods

A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French of traumatic and non-traumatic MO. Studies were selected by 2 independent reviewers following the PRISMA recommendation and descriptive data were extracted. We harvest in each case the sex, age at diagnosis, location, presence of initial trauma, pre-emptive diagnosis, modalities of imagery used, realized biopsy, treatment performed, and type of follow-up.

Results

Sixty pediatric cases of MO were identified between 2002 and 2023. Twenty-three patients (38.3%) were diagnosed with idiopathic/pseudomalignant and 37 patients (61.7%) with circumscribed. The mean age at diagnosis was 9.5 years (range 0.2-17 years), with a male-to-female ratio of 1:1. The initial pre-emptive diagnosis was neoplasia in 13 patients (21.7%). The biopsy was percutaneous in 9 patients (15%) and incisional in 7 patients (11.7%). Histological analysis was achieved in 35 cases (57%). Surgical excision was the first line treatment in 46.7% of patients, and non-surgical in the remaining patients. The follow-up strategy was clinical in 16 patients (26.7%) or based on imaging investigation in 23 patients (38.3%).

Discussion

Although MO in children is described as a rare pathology, identifying the benignity of the condition is essential to avoid unnecessary invasive treatment and to avoid delaying the treatment of a potentially life-threatening entity. It seems that there is no consensus established concerning the proper imaging for diagnosis. Clinicians should acknowledge that the absence of a triggering trauma tends to direct the investigation and the management toward a surgical attitude. Conservative management is key, however, surgical excision can be proposed on matured lesions on a case-by-case basis. The absence of recurrence is not excluded. Therefore, a close clinical follow-up is suggested for all cases. The true benefit of a radiological is questioned in a question known to be self-resolving.

Pronounced Heterotopic Ossifications after Traumatic Hamstring Rupture: Is an Ossification Prophylaxis Useful?

Hamstring injuries include a wide range of injuries and affect mainly athletes with high eccentric loads (football, athletics, rugby, climbing). According to the latest literature, unrecognized traumatic ruptures can cause permanent discomfort and may be associated with a poorer postoperative outcome when delayed surgical therapy is performed. Heterotopic ossifications (HO) after hamstring rupture have been described in individual case reports and smaller studies so far. Heterotopic ossifications are mainly known in hip surgery and elbow fractures. In this case report, a 48-year-old patient presented with an increasing swelling with hardening in the area of the right ischial tuberosity. One year before, an impact trauma was the reason for a traumatic hamstring rupture which was diagnosed with a delay. The HO was excised and the tendon refixed with two suture anchors. By limiting the range of motion with a hip-knee orthosis for 9 weeks, a regular postoperative healing process was observed. Heterotopic ossifications after hamstring ruptures have been reported repeatedly but have not been evaluated in any major study so far. It should therefore be considered whether prophylaxis with NSAIDs should be used for conservatively and surgically treated hamstring ruptures, analogous to the ossification prophylaxis for hip endoprostheses or fractures in the elbow region.

Modern synthetic material is a safe and effective alternative for medial patellofemoral ligament reconstruction

PURPOSE

Medial patellofemoral ligament (MPFL) reconstruction is often performed using gracilis autografts, which may be associated with donor site morbidity and complications. The use of a synthetic material can circumvent a harvest operation and has previously been demonstrated to be effective in other types of reconstructive procedures and may be effective in MPFL reconstruction. This study reports the clinical result with the use of a modern ultra-high molecular weight polyethylene with a braided jacket of polyester tape (FT) in MPFL reconstruction compared to using standard autografts.

METHODS

Data were collected prospectively in 50 MPFL reconstructions. The first 27 underwent reconstruction using gracilis tendon (GT) autograft; the following 23 patients were treated with FT. All patients were clinically and radiologically assessed and underwent pre- and post-operative scoring using the Kujala score, Bartlett score, Tegner activity rating scale, SF-12 score and Lysholm score. Statistical significance was tested between groups using ANOVA with repeated measures.

RESULTS

There were no significant differences in the pre-operative scores between the FT and GT groups (n.s.). Both groups showed significant improvements across all scoring modalities between pre- and post-operative periods 12, 24 and 48 months of follow-up (p < 0.05). There were no significant differences in knee function scores between the GT and FT groups.

CONCLUSION

The use of FiberTape in MPFL reconstruction is safe and effective, and it significantly improves patient's quality of life and related post-operative outcome measures. There were no significant differences in all knee scores compared to GT autografts. Using this technique for MPFL reconstruction, tendon harvesting is unnecessary and hence eliminates donor site morbidity-associated complications.

LEVEL OF EVIDENCE

II.

Bioabsorbable interference screw failure in anterior cruciate ligament reconstruction: A case series and review of the literature

BACKGROUND

To report a case series of failures of bioabsorbable interference screws with possible identification of a novel failure mechanism.

METHODS

A retrospective review of ACL reconstructions by the senior author utilizing BioComposite™ Interference Screws (Arthrex, Inc., Naples, FL) was performed. Complications related to screw placement, including fracture, breakage or bending were examined. Our rate and methods of failure were compared to those quoted in the current literature.

RESULTS

Eighty-seven patients of average age 23.8 years met inclusion criteria. There were eight screw failures in six patients, with femoral failure in seven and tibial failure in one. The femoral screw fractured halfway between the tip and head in five, while the head of the screw broke in one and the screw bent in another. In the case of tibial interference screw fracture, failure occurred halfway between the tip and head. The insertion device that was used was replaced after recognition of material deformation and considered a potential contributor to the breakage risk as no further screw failures have occurred since.

CONCLUSIONS

We demonstrate a unique failure mechanism of bio-absorbable interference screws. In each case, the reconstruction was salvaged. Regular inspection of materials and implants can ensure optimal outcomes and decrease complications intra-operatively.

Surgical treatment for muscle injuries

Muscle injury causes functional impairment. The healing process takes time and fibrotic tissue can result. Recurrence and delayed recovery remain as unsolved problems. Surgical intervention can be a feasible alternative to avoid early and late complications associated with complete muscle tear in attempt to improve functional results. This article hopes to provide an update about surgical treatments for muscle tears in different scenarios.