No abstract

Background: Chronic patellar tendon injuries can cause significant functional deficits due to anterior knee pain, extension weakness, and extensor lag. With chronic injuries, the tissue is inadequate and of poor quality. Chronic injuries require autograft or allograft for augmentation or reconstruction. We present reconstruction of a chronic patellar tendon injury with Achilles tendon allograft. Indications: Chronic patellar tendon injuries causing functional deficits, including knee extension weakness, extensor lag, and anterior knee pain. Technique Description: A longitudinal incision is made over the patellar tendon, and the patellar tendon is excised. Two guide pins are drilled in a retrograde fashion through the patella and are overdrilled with a reamer. A trough is made at the tibial tubercle using an oscillating saw. The Achilles allograft calcaneal bone block is contoured to the appropriate size, and then press fit into the trough. Two 4.0-mm fully threaded cannulated screws with washers are used to secure the bone block. The fresh frozen Achilles allograft is doubled over, and a double Krackow running locking suture is placed. A V-Y advancement of the quadriceps tendon is performed to ensure adequate advancement of the patella. The limbs of the Krackow suture are pulled through the patella drill holes and tied with knee in full extension. Results: At 1 year, patients can expect near full range of motion with minimal extensor lag. Reconstruction results in improved pain and function as compared with preoperatively, as well as return to activities. Conclusion: Achilles tendon allograft is a good option for reconstructing chronic patellar tendon injuries. Advantages of the Achilles allograft include the bone-to-bone healing at the tibia, lack of donor site morbidity, and the large amount of tissue available for reconstruction.

Cardiac events are an important cause of postsurgical morbidity and mortality. Statin drugs have been studied as potentially risk-modifying agents in perioperative medicine. They have been shown to confer a protective benefit in cardiac surgery, but the evidence available in noncardiac surgery patient populations remains less conclusive. We hypothesized that perioperative statin treatment would be associated with lower incidence of postsurgical cardiac events (PSCEs) after major noncardiac surgery. A retrospective cohort study included 21,637 major noncardiac surgeries. Statin treatment was the exposure of interest and PSCE was the primary outcome measure. Data collection included patient age, body mass index, smoking status, diabetic status, cardiac event history, statin treatment history, and PSCE diagnoses. Perioperative statin treatment occurred in 4176 cases (19.3%). PSCEs occurred in 50 cases (0.23%), 29 in the untreated control group (0.17%) and 21 in the statin treatment group (0.50%). Relative risk in the untreated group was 0.3303 (95% confidence interval = 0.1886, 0.5786). This implied that statin-treated patients had higher risk than the untreated group. However, a logistic regression model that accounted for observed cardiac disease risk factors showed statin treatment not to be a significant predictor of PSCE in this sample. Analysis repeated in high-risk subsets of the cohort yielded similar results. A propensity score matching method that minimized differences between study groups also failed to demonstrate a significant association between statin treatment and PSCE risk. Our study did not demonstrate a significant association between perioperative statin treatment and PSCEs after major noncardiac surgery.