Background. Distal humeral fractures are notorious injuries, and they require surgical fixation. The reliability of reconstruction devices has been a subject of debate. Our primary outcome was to detect differences, if any, between two different groups of patients using the patient-reported outcomes measurement information system (PROMIS) Global-10 form and to compare it with the Mayo elbow performance score (MEPS) results. Other secondary outcomes included the difference in union time between patients who received a reconstruction plate vs those who received a pre-contoured anatomical plate. Material and methods. It is a prospective randomised study which included a total of 30 cases equally distributed into two groups. Results. The mean PROMIS and MEPS scores for group A were 31.5 SD 6.6 and 77.7, respectively, compared to 33.7 SD 6.66 and 73, respectively, for the other group. Time to union was 13.4 weeks for group A and 12.6 weeks for the other group. There was no statistically significant difference between the groups regarding union and function. However, reconstruction plates were more cost effective. The correlation between the MEPS and PROMIS G scores in both groups was statistically significant. Conclusion. No superiority of one method of fixation versus the other was demonstrated in terms of patient-related outcomes. Reconstruction plates are a cost-effective alternative in simple fracture patterns.

Background This work was conducted to assess the diagnostic efficiency of isotropic three-dimensional VISTA-fast spin echo versus standard two-dimensional fast spin echo at 1.5 T MRI, in the assessment of internal knee derangement in symptomatic patients, aiming to obtain similar diagnostic accuracy in a shorter time span, with reduction of partial volume artifacts by thin continuous sections. Results This was a non-randomized control study including 39 patients (32 male and 7 females, mean age 37 years old). A correlative study was done utilizing MRI standard 2D FSE (protocol A) versus 3D-VISTA-FSE (protocol B) for medial meniscus (MM) and lateral meniscus (LM), as well as anterior cruciate ligament ACL lesions, comparing the MRI results with the findings of arthroscopy as the gold standard. Both protocols depicted medial meniscus lesions with accuracy, specificity, and sensitivity (97.44%, 96.30%, and 100% respectively), lateral meniscus lesions with accuracy, specificity, and sensitivity (97.44%, 100%, and 50% respectively), and ACL lesions with accuracy, specificity, and sensitivity (100%, 100%, and 100% respectively), while there were no PCL lesions depicted through the study population. Comparing the time factor between both protocols revealed protocol A to consume 13.7 min, while protocol B consumed 6.6 min. Conclusion Three-dimensional isotropic VISTA-FSE sequence, although having similar accuracy in diagnosing cruciate and meniscal lesions as the standard sequences, facilitates thin-section data acquisition and multi-planar image reformation in standard and non-standard planes, without intersection gaps that are crucial for the detection and dissection of compound structures; also, it allows a shorter time span, which is more advantageous for patients, particularly the traumatized and emergency patients.

Background This study was done to evaluate the value of adding the oblique sagittal and oblique coronal MRI to the standard MRI knee protocol for evaluation of suspected ACL graft injuries. Results This was a cross-sectional analytic study where we reviewed 36 MRI knee examinations of 36 patients (30 males, 6 females, age range: 17–60 years, mean age: 26 years) who were subjected to ACL reconstruction and follow-up arthroscopy. Two experienced radiologists, blinded to the results of each other, evaluated the status and the severity of the ACL graft injury using the routine knee MRI (protocol A) and using the routine MRI after adding the oblique sagittal and coronal imaging (protocol B). Weighted kappa statistics were used to evaluate the diagnostic accuracies of the knee MRI before and after the addition of the oblique sagittal and coronal weighted images (protocol A and protocol B, respectively) and to assess the interobserver agreement. The weighted kappa values according to the routine knee MRI were 0.357 (reader 1) and 0.399 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.505 (reader 1) and 0.528 (reader 2). The interobserver agreement weighted kappa value also increased from 0.606 to 0.759 by adding the oblique sagittal and coronal imaging to the routine knee MRI examination. Conclusion The additional use of oblique sagittal and coronal MRI of the knee improves the diagnostic accuracy for diagnosing and grading ACL graft injury with the arthroscopy used as a gold standard.

Background: The ACL functions both as an anterior stabilizer and as a sensory organ. It is not only provides proprioceptive function, but also initiates protective and stabilizing muscular reflexes. Most ACLs are ruptured in the proximal half and most mechanoreceptors have been reported to be located in the sub-synovial layer near the tibial insertion of the ACL. Therefore, it is reasonable to preserve the remnant tissue. Particularly the tibial side, as a source of reinnervation if impingement and Cyclops can prevented. Objective: To compare proprioception after ACL reconstruction with remnant preservation versus non remnant preservation. Methods: This is a prospective single blind controlled randomized study was done from December 2015 to October 2017, it was conducted on forty patients (40 males). Divided into two groups twenty patients in each one to assess proprioception after anterior cruciate ligament reconstruction. Group (A) consisted of 20 patients with mean age 28±5.57 years who underwent to ACLR with tibial remnant preservation. Group (B) consisted of 20 patients with mean age 29.05±5.596 years who underwent to ACLR with non-remnant preservation were selected on the basis of clinical picture and imaging findings.

Background: Rotational laxity has been demonstrated to persist, even in the face of a well-performed Anterior Cruciate Ligament (ACL) reconstruction. The iliotibial band (ITB) has also been shown to have an impact on the control of anterolateral rotational laxity. In particular, recent research would suggest that the capsulo-osseous layer of the ITB, is a major contributor to anterolateral rotational control. Methods: From December 2018 to December 2020, a prospective randomized (simple randomization) analytical clinical study was done to compare the functional outcome of group of patients undergoing ITB for extra articular augmentation of ACL Reconstruction using staple versus group of patients using interference screw. Results: Upon comparing the postoperative, the primary finding is there was significant improvement of pivot shift in both groups with (100 % grade A pivot shift) in group A and (85 % grade A pivot shift) and (15% grade B pivot shift) in group B. So, the primary finding in this study is significant rotational control. The secondary finding is there was statistically significant difference in the postoperative IKDC objective score between the 2 groups (p= 0.004).