Background: Anterior cruciate ligament injuries are commonly seen in orthopedic surgery practice. Although anterior cruciate ligament reconstruction (ACLR) has come a long way, the causes of failure have yet to be fully understood. Objective: The aim of this study was to investigate whether or not the intraoperative 4-strand hamstring autograft diameter does in fact influence the failure rates of ACLR. Methods: Retrospective intraoperative data were collected from ACLR patients from the only tertiary center available in Kuwait. Patients who underwent ACLR from 2012 to 2018 for isolated ACL injuries were included in this study, allowing for a 24 month follow-up period The cohorts were categorized into 3 groups: patients with graft size≤8mm, 2, patients with graft sizes≥8mm with 4-strands and patients with graft sizes≥8mm with 4-strands or more. ANOVA analysis was applied to address group differences between mean graft size and strand numbers and subsequently the failure rates for each group. In addition, the Mann–Whitney U test was used to investigate the relationship between revision and initial ACL graft size. Results: Out of the 711 out of 782 patients were included in this study. Only 42.6% of the patients did not need more than 4-strands to achieve an 8mm sized autograft. The patients who had autografts≤8mm in this study accounted for 17.1% of the population. About 7.2% of these patients required revision surgery. Patients with a 4-strand autograft size that was less than 8mm were 7.2 times more at risk for ACLR failure (RR=7.2, 95% CI: 6.02; 8.35, p=0.007). Conclusions: There is a significant correlation between 4-strand autograft diameter size and the need for ACLR revision surgery. Level of evidence: IV case series

Background: The Western Ontario Shoulder Instability Index (WOSI) score is a tool that helps with self-assessment of the shoulder’s functional status in patients experiencing instability problems.The purpose of this study was the cross-cultural adaptation of WOSI into Arabic and assessment of its psychometric properties in comparison to a gold standard-questionnaire, namely the Arabic Disability of the Arm, Shoulder and Hand (DASH) score. Material & Methods: 100 patients participated in this survey, tested initially and retest after two months. The internal consistency tests were performed using Cronbach's alpha. Besides, Pearson's Correlation and Standard response mean (SRM) were calculated to estimate criterion validity and responsiveness of the Arabic WOSI in comparison to the Arabic DASH. Results: The Arabic WOSI had a Cronbach's alpha score of 0.85 at the baseline and 0.91 at the follow-up time period. All subscales had an internal consistency greater than 0.7, except Sport/Work (0.69 at follow-up). A strong correlation with Arabic DASH score was observed (r = 0.79 at baseline & 0.87 at Follow-up) which suggested good validity. Also, moderately correlated changes of baseline to follow-up in DASH and WOSI indicated moderate responsiveness. No ceiling and floor effects were observed among the responses. Conclusion: Overall, the Arabic version of WOSI proved to be a good and reliable diagnostic tool for patients with shoulder instability.

Introduction: Shoulder pain is a major disorder of the musculoskeletal system. To the best of our knowledge, there is no documentation of an Arabic version of the shoulder disability and pain measurements. Constant Murley Score (CMS) is one of the standard questionnaires for clinical practice and research. The aim of this research centred around the evaluation of the Arabic Constant Murley Score and subsequently assessing the reliability and validity in comparison to disabilities of the arm, shoulder, and hand (DASH). Methods: Hundred and twenty five patients took part in this research. We did the internal consistency tests with Cronbach’s alpha. Intra-correlation coefficient, convergent validity, convergent construct validity, responsiveness, and floor and ceiling effects were also calculated. Results: Principal component analysis showed that the variance was 63.31% with a factor range of 0.42–0.85, which fulfils the uni-dimensionality criterion. Also, the Arabic CMS correlated negatively with the DASH score (−0.82, p < 0.001). The Arabic version of CMS was consistent with Cronbach’s alpha of 0.74. With Inter Class Correlation Coefficient (ICC) = 0.83 it also showed a very good test-retest reliability. Conclusion: Ours is the first translation and cross-cultural adaptation of the CMS into Arabic. Important evidences of validity were tested such as uni-dimensionality, convergent validity, and internal consistency. Results demonstrate an acceptable Cronbach’s alpha of 0.74, ICC = 0.830 indicating excellent reliability and a strong correlation of the Arabic CMS with the DASH score (r = −0.820). Overall, the Arabic version of CMS is a good and reliable diagnostic tool for patients experiencing shoulder pain.

Background: The Middle East Lower Limb Score (MELLS) is an adaptation of the WOMAC questionnaire, specifically adjusted according to the cultural issues of the middle eastern patients with Knee or hip disabilities. The primary objective of this study was to verify if the translation and adaptation of the MELLS into Arabic could be used with ease and consistency by Arab-speaking patients suffering lower limb disabilities.Methods: 110 participants were involved in this study. We performed the internal consistency tests with Cronbach’s alpha. We also calculated floor effects, ceiling effects, as well as test-retest reliability (intra-correlation coefficient). To estimate the validity of MELLS, we used two validated questionnaires – WOMAC and OHS. We confirmed the validity of MELLS questionnaire using Spearman’s correlation.Results: MELLS had a Cronbach’s alpha of 0.88 in the first assessment and 0.92 in the second assessment, which was very high and reliable. Both subscales of MELLS had an internal consistency higher than 0.85. No relevant ceiling and floor effect were observed among the responses. Furthermore, strong significant correlation with WOMAC subscales and OHS was observed, which suggested a good construct validity. Responsiveness of MELLS, however, proved to be lower (but not considerably) than other two questionnaires.Conclusion: The Arabic Middle East Lower Limb Score (MELLS) is a useful and reliable diagnostic tool for Middle eastern patients with knee and hip problems.

Background: The Middle East Lower Limb Score (MELLS) is an adaptation of the WOMAC questionnaire, specifically adjusted according to the cultural issues of the middle eastern patients with Knee or hip disabilities. Objectives: The primary objective of this study was to verify if the translation and adaptation of the MELLS into Arabic could be used with ease and consistency by Arab-speaking patients suffering lower limb disabilities. Material & Methods: 110 participants were involved in this study. We performed the internal consistency tests with Cronbach’s alpha. We also calculated floor effects, ceiling effects, as well as test-retest reliability (intra-correlation coefficient). To estimate the validity of MELLS, we used two validated questionnaires – WOMAC and OHS. We confirmed the validity of MELLS questionnaire using Spearman’s correlation. Results: MELLS had a Cronbach’s alpha of 0.88 in the first assessment and 0.92 in the second assessment, which was very high and reliable. Both subscales of MELLS had an internal consistency higher than 0.85. No relevant ceiling and floor effect were observed among the responses. Furthermore, strong significant correlation with WOMAC subscales and OHS was observed, which suggested good construct validity. Responsiveness of MELLS, however, proved to be lower (but not considerably) than other two questionnaires. Conclusion: The Arabic Middle East Lower Limb Score (MELLS) is a useful and reliable diagnostic tool for Middle eastern patients with knee and hip problems.