Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon ruptures. Methods: This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, presenting twelve cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18 -58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3 -132). The mean time of follow-up was 6.2 years (range 3 -9). Cerclage wire reinforcements were applied in nine of the knees and the left three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

With respect to the comparable complication rate, clinical and radiological outcome of allogenic versus autologous reconstruction of TPF, freeze-dried allograft could be recommended as an appropriate substitute of autograft in this treatment. Nevertheless, the longer follow-up period of the patients could further extend our understanding of the clinical outcome of each component.

Background: Valgus deformity (more than 10°valgus on anatomical measurement) is seen in about 10% of patients undergoing total knee arthroplasty (TKA). Valgus deformity is a challenge for the surgeons both for gap balancing and constraint choice. Objectives: The aim of this study was to describe a surgical technique to perform TKA in valgus knee. Patients and Methods: We retrospectively reviewed 32 primary TKA in 27 patients (25 females and 2 males), with valgus knee deformity performed since 2006 to 2014. All procedures have been done by the senior author. In the balancing stage of each procedure, the iliotibial band has been released completely in the first step, and then step by step pie crusting of other lateral structures has been done as needed. Preoperative and postoperative data were obtained retrospectively through chart review and review of radiographs. All patients were clinically examined by the senior author. Preoperative and postoperative knee society scores (KSSs) and functional knee society score (functional KSS) were obtained accordingly. Results: The patients had an average age of 68 years (range, 52 -83 years) with an average postoperative follow-up period of 47.5 months (range, 12 -100 months). The average KSS improved significantly postoperatively from 42 (range, 20 -69) to 90 (range, 67 -99) (P < 0.0001). The average functional KSS improved significantly (P < 0.0001) from 51.4 (range, 35 -70) to 85.5 (range, 45 -100) during follow-up. An average preoperative range of motion also improved by 15.6 degrees during the last follow-up visit (P < 0.001). We had no complication in our patients. Conclusions:The results of our study show that complete release of the iliotibial band and step by step pie-crusting of other lateral structures correct valgus deformities in a safe and simple manner with high success rate and less constrained prosthesis.

BackgroundTibial plateau fractures can be successfully fixed utilizing 3.5 mm locking plates. However, there are some disadvantages to using these plates.ObjectivesIn the current prospective study, we investigated the outcome of treating different types of tibial plateau fractures with 3.5 mm simple plates which, to our knowledge, has not been evaluated in previous studies.Materials and MethodsBetween 2011 and 2013, 32 patients aged 40 ± 0.2 years underwent open reduction and internal fixation for tibial plateau fractures with 3.5 mm simple plates. The patients were followed for 16.14 ± 2.1 months. At each patient’s final visit, the articular surface depression, medial proximal tibial angle, and slope angle were measured and compared with measurements taken early after the operation. The functional outcomes were measured with the WOMAC and Lysholm knee scores.ResultsThe mean union time was 13 ± 1.2 weeks. The mean knee range of motion was 116.8° ± 3.3°. The mean WOMAC and Lysholm scores were 83.5 ± 1.8 and 76.8 ± 1.6, respectively. On the early postoperative and final X-rays, 87.5% and 84% of patients, respectively, had acceptable reduction. Medial proximal tibial and slope angles did not change significantly by the last visit. No patient was found to have complications related to the type of plate.ConclusionsIn this case series study, the fixation of different types of tibial plateau fractures with 3.5 mm simple non-locking and non-precontoured plates was associated with acceptable clinical, functional, and radiographic outcomes. Based on the advantages and costs of these plates, the authors recommend using 3.5 mm simple plates for different types of tibial plateau fractures.

Background:The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported.Method:This report describes 3 cases of chronic anterior knee dislocation treated by total knee arthroplasty.Results:Three female patients with chronic anterior knee dislocation were treated by hinged prosthesis total knee arthroplasty using the Insall rectus snip approach. At a mean of 17 months (range, 12-24 months) of follow-up, all patients showed a painless stable prosthesis and expressed satisfaction with the results.Conclusions:Total knee arthroplasty for chronic anterior knee dislocation is a challenging procedure. The Insall rectus snip approach with quadriceps release and constrained prosthesis is recommended.