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Punnoose DJ, Varghese J, Theruvil B, Thomas AB. Peroneus Longus Tendon Autografts have Better Graft Diameter, Less Morbidity, and Enhanced Muscle Recuperation than Hamstring Tendon in ACL Reconstruction. Indian J Orthop 2024; 58:979-986. [PMID: 38948366 PMCID: PMC11208339 DOI: 10.1007/s43465-024-01185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/12/2024] [Indexed: 07/02/2024]
Abstract
Background Recently the peroneus longus tendon (PLT) gained popularity in anterior cruciate ligament (ACL) reconstruction and has been utilized with satisfactory outcomes. However, there are concerns regarding donor site morbidity. This study aims to compare the functional outcome of ACL reconstruction using hamstring (HT) and PLT autografts and evaluate the donor site morbidity. Methods Patients who underwent ACL reconstruction were allocated to two groups (HT and PLT). Graft diameter was measured intraoperatively. Knee functional outcome was evaluated with IKDC and Tegner-Lysholm scores preoperatively, and postoperatively after 3 months, 6 months, and 1 year. Donor site morbidities were assessed with thigh circumference measurements, subjective evaluation of sensory disturbances, and ankle scoring with AOFAS and FADI scores. Results At 1-year follow-up, the PLT group showed comparable IKDC (p = 0.925) and Tegner-Lysholm (p = 0.600) scores with those of the HT group. The mean graft diameter in the PLT group (7.93 ± 0.52 mm) was larger compared with the HT group (7.43 ± 0.50 mm) (p < 0.001). The incidence of thigh atrophy (HT-16.7%, PLT-10%) and sensory disturbances (HT-73.3%, PLT-10%) was greater in the HT group. There was no significant ankle donor site morbidity in the PLT group (AOFAS-98.67 ± 3.45, FADI-99.23 ± 1.69). Conclusion ACL reconstruction with PLT had comparable functional outcome with that of HT at 1 year. However, PLT demonstrated larger graft diameter, less donor site morbidity, and enhanced muscle recovery without significantly affecting the ankle function. PLT can be safely used as an acceptable alternative graft choice harvested from outside the knee for ACL reconstruction.
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Affiliation(s)
| | - Jacob Varghese
- Department of Orthopaedics, VPS Lakeshore Hospital, Kochi, 682040 Kerala India
| | - Bipin Theruvil
- Department of Orthopaedics, VPS Lakeshore Hospital, Kochi, 682040 Kerala India
| | - Appu Benny Thomas
- Department of Orthopaedics, VPS Lakeshore Hospital, Kochi, 682040 Kerala India
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Panta S, Joshi A, Basukala B, Sharma R, Singh N, Pradhan I. A comparative study of Infra patellar branch of saphenous nerve injury between vertical and horizontal portal incisions in knee arthroscopy. J Clin Orthop Trauma 2024; 53:102441. [PMID: 38947858 PMCID: PMC11214199 DOI: 10.1016/j.jcot.2024.102441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/29/2024] [Accepted: 06/05/2024] [Indexed: 07/02/2024] Open
Abstract
Background An Infrapatellar Branch of Saphenous Nerve (IPBSN) injury is one of the complications leading to sensory loss in the operated knee. A high incidence of IPBSN injury was reported during hamstring harvest, but there are only a few studies analyzing IPBSN injury during arthroscopy portals. However, there was a lack of randomized comparative studies comparing the incidence of IPBSN injury in horizontal and vertical portals. This study aimed to identify the overall incidence of IPBSN injury and compare the difference between vertical and horizontal portal incisions. We also aimed to observe the recovery pattern of IPBSN injuries in both groups. We hypothesize that since the portal incisions are very small, the incidence of IPBSN injury will be very low, and it will occur more in the vertical incision. Methods After obtaining IRC approval from B&B Hospital IRC, this prospective comparative study was conducted at the AKB center for arthroscopy, sports injury, and regenerative medicine, B&B Hospital. The calculated sample size of 128 consecutive patients was included and divided into groups by the block randomization method. A total of 64 patients were allocated to both groups. Demographic data was recorded. The sensory loss along the IPBSN was examined and documented on the first postoperative day. Their recovery was documented during two weeks and three months of follow-up visits. Parametric and non-parametric tests were applied to analyze the variables. Results IPBSN injury was seen in 12 patients (9.37 %) among 128 study participants. Five patients (7.81 %) had IPBSN injuries in the vertical group compared to seven (10.93 %) in the horizontal group. Recovery was earlier in the horizontal incision group. Conclusion The overall incidence of IPBSN injury during the arthroscopy portal is low. They occur equally in vertical and horizontal portal incisions. The recovery of the IPBSN injury was better and earlier in the horizontal incision group.
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Affiliation(s)
- Sunil Panta
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B & B Hospital, Lalitpur, Nepal
| | - Amit Joshi
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B & B Hospital, Lalitpur, Nepal
| | - Bibek Basukala
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B & B Hospital, Lalitpur, Nepal
| | - Rajiv Sharma
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B & B Hospital, Lalitpur, Nepal
| | - Nagmani Singh
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B & B Hospital, Lalitpur, Nepal
| | - Ishor Pradhan
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B & B Hospital, Lalitpur, Nepal
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Regev GJ, Ben Shabat D, Khashan M, Ofir D, Salame K, Shapira Y, Kedem R, Lidar Z, Rochkind S. Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve. J Orthop Surg Res 2021; 16:464. [PMID: 34289862 PMCID: PMC8293565 DOI: 10.1186/s13018-021-02613-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Injury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery, which can interfere with patient satisfaction and functional outcome. In some cases, injury to the IBSN can lead to formation of a painful neuroma. The purpose of this study was to report the results of surgical treatment in a series of patients with IBSN painful neuroma. METHODS We retrospectively identified 37 patients who underwent resection of IBSN painful neuroma at our institution, after failure of non-operative treatment for a minimum of 6 months. Injury to the IBSN resulted from prior orthopedic surgery, vascular surgery, tumor resection, trauma, or infection. Leg pain and health-related quality of life were measured using the numeric rating scale (NRS) and EuroQol 5 dimensions (EQ-5D) questionnaire, respectively. Clinically meaningful improvement in leg pain was defined as reduction in NRS by at least 3 points. Predictors of favorable and unfavorable surgical outcome were investigated using multivariable logistic regression analysis. RESULTS Patient-reported leg pain, health-related quality of life, and overall satisfaction with the surgical outcome were obtained at 94 ± 52.9 months after neuroma surgery. Postoperative patient-reported outcomes were available for 25 patients (68% of the cohort), of whom 20 patients (80.0%) reported improvement in leg pain, 17 patients (68.0%) reported clinically meaningful improvement in leg pain, and 17 patients (68%) reported improvement in health-related quality of life. The average NRS pain score improved from 9.43 ± 1.34 to 5.12 ± 3.33 (p < 0.01) and the average EQ-5D functional score improved from 10.48 ± 2.33 to 7.84 ± 2.19 (p < 0.01). Overall patient reported satisfaction with the surgical outcome was good to excellent for 18 patients (72.0%). Older age, multiple prior orthopedic knee surgeries, and failed prior attempts to resect an IBSN neuroma were associated with non-favorable surgical outcome. CONCLUSION We conclude that surgical intervention is efficacious for appropriately selected patients suffering from IBSN painful neuroma.
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Affiliation(s)
- G J Regev
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - D Ben Shabat
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - M Khashan
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - D Ofir
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - K Salame
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Shapira
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - R Kedem
- Academic Branch, Medical Corps, IDF, Tel Aviv, Israel
| | - Z Lidar
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Rochkind
- The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Liu Y, Tian L, Raj MS, Cotton M, Ma Y, Ma S, McGrane B, Pendharkar AV, Dahaleh N, Olson L, Luan H, Block O, Suleski B, Zhou Y, Jayaraman C, Koski T, Aranyosi AJ, Wright JA, Jayaraman A, Huang Y, Ghaffari R, Kliot M, Rogers JA. Intraoperative monitoring of neuromuscular function with soft, skin-mounted wireless devices. NPJ Digit Med 2018; 1. [PMID: 30882044 PMCID: PMC6419749 DOI: 10.1038/s41746-018-0023-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peripheral nerves are often vulnerable to damage during surgeries, with risks of significant pain, loss of motor function, and reduced quality of life for the patient. Intraoperative methods for monitoring nerve activity are effective, but conventional systems rely on bench-top data acquisition tools with hard–wired connections to electrode leads that must be placed percutaneously inside target muscle tissue. These approaches are time and skill intensive and therefore costly to an extent that precludes their use in many important scenarios. Here we report a soft, skin-mounted monitoring system that measures, stores, and wirelessly transmits electrical signals and physical movement associated with muscle activity, continuously and in real-time during neurosurgical procedures on the peripheral, spinal, and cranial nerves. Surface electromyography and motion measurements can be performed non-invasively in this manner on nearly any muscle location, thereby offering many important advantages in usability and cost, with signal fidelity that matches that of the current clinical standard of care for decision making. These results could significantly improve accessibility of intraoperative monitoring across a broad range of neurosurgical procedures, with associated enhancements in patient outcomes. A small skin-mounted biosensing device accurately and non-invasively monitors neuromuscular activity in real-time during surgery. With many surgical procedures there is a risk of nerve damage. Although this is often temporary, in some cases it can significantly affect patients’ quality of life. Existing monitoring systems that rely on the accurate placement of needle electrodes into target nerves are cumbersome and expensive. The device developed by a team led by John Rogers, at Northwestern University, and Michel Kliot, at Stanford University, can easily be accommodated to any part of the body to monitor muscle activity in response to nerve impulses and stimulation during surgery. Furthermore, it can wirelessly transmit signals of comparable quality to needle-based systems. These devices could not only increase the use of intraoperative monitoring in hospitals but also contribute to make surgery safer.
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Affiliation(s)
- Yuhao Liu
- Department of Materials Science and Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Limei Tian
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | | | - Matthew Cotton
- Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Yinji Ma
- Department of Engineering Mechanics, AML, Center for Mechanics and Materials, Tsinghua University, 100084 Beijing, China.,Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Siyi Ma
- Department of Materials Science and Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | | | - Arjun V Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nader Dahaleh
- Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | | | - Haiwen Luan
- Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Orin Block
- Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | | | - Yadong Zhou
- Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Engineering Mechanics, Southeast University, 210096 Nanjing, China
| | - Chandrasekaran Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.,Departments of Physical Medicine & Rehabilitation and Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Tyler Koski
- Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | | | | | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.,Departments of Physical Medicine & Rehabilitation and Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Yonggang Huang
- Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Roozbeh Ghaffari
- MC10 Inc., Lexington, MA 02421, USA.,Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Michel Kliot
- Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL 60611, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - John A Rogers
- Department of Materials Science and Engineering, Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
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