Anterior cruciate ligament (ACL) reconstruction is becoming increasingly popular in active middle-aged patients with symptomatic instability. The purpose of this study was to retrospectively evaluate the results of ACL reconstruction in patients over the age of 40. Twenty-one patients with a median age of 44 (range 40-56) who had arthroscopically assisted reconstruction using four-stranded hamstring autograft were reviewed. RCI titanium interference screw fixation was used in the tibia, and Endobutton CL fixation in the femur. The clinical results were assessed at a mean follow-up of 2 years. The median value for the Lysholm knee score was 92 (range 74-100), and the median value for the International Knee Documentation Committee score was 83 (range 53-97). For the Tegner activity scale, the median value was 6 (range 4-8) at follow-up. The median side-to-side difference using the KT-1000 arthrometer was 2 mm (range 0-3.5 mm). Hamstring ACL reconstruction in appropriately selected middle-aged patients can yield successful and satisfactory results.

Introduction There are various choices to fix up Atlanto-Axial dislocation (AAD) and Basilar invagination (BI), it may be Posterior only, Anterior only or Combined. Many surgeons refrain from “posterior only” approach of C1-C2 distraction (as described by Atul Goel and Lahiri) because of the fear of Vertebral artery (VA) injury and it's poorly understood course between C1, C2, and Occipital condyles. We describe details of preoperative work and subsequently adopted, customized surgical plans, as per VA configuration to distract & fix the C1-C2 joint to achieve reduction in AAD and BI without harming the Vertebral artery. This case series covers most of the variations of VA around C1-C2 for learning purpose. After seeing this work up, many surgeons may allay their anxieties and take up this single stage corrective measure to achieve correction of deformities in cases of AAD & BI. In the due course author will also explain different variations of Vertebral artery not only in different individuals, but also in same subject on either sides. We describe the adaptive surgical methods taken based on these data to avoid injury to VA, and still achieve a firm distraction and fixation at C1-C2 with this single stage. The technique can thus be extrapolated in various other cases of AAD and BI with hardly any exception. Material and Methods Three serial patients with an established diagnosis of Atlanto-axial dislocation and Basilar invagination are described. All three were evaluated with 3-D MPR CT with vertebral artery angiography (CTA-VA), and MRI at Cervico-medullary junction (MRI-CMJ). The VA in one subject was going through pedicle on one side and in another subject, it was going around the C1-C2 facet joint, while in another case it was entirely intra-spinal. The radiological evaluation was done in both pre and post operative period to describe anomalies of CVJ, different courses of VA and vectors thus used for potential instrumentation. Postoperative scans were used to see adequacy of fixation. Results There was a clear evidence of highly variable course in VA of all three subjects. There were different courses in right and left VAs as well, commanding different choices of instrumentation on both sides in a single individual. All patients achieved reduction of AAD & BI and there was no injury to the vascular structure in question. They all improved in clinical signs and symptoms in the due course. Conclusion Authors conclude that it's mandatory to subject all patients to CT angiography in an order to view the Vertebral artery course wrt C1-C2 facets, which is not only variable in different individuals but also, on both sides in same individual, hence even in a single patient we may need different instrumentation to achieve the same goal. The authors also conclude that instrumentation at C1-C2 without CTA-VA is not only dangerous but can be fatal as well, hence instrumentation done without the above mentioned study should be considered a mandatory practice in the safest interest of patients and to achieve optim...

<p><strong>Background: </strong>The knee joint is the most commonly injured of all joints and the anterior cruciate ligament is the most commonly injured ligament. The bone-patellar tendon-bone (BPTB) autograft is the most commonly used autograft for reconstruction. The bone-patellar tendon-bone autograft has been widely accepted as the gold standard for ACL reconstruction with a high success rate. Objectives of the study were to study the functional outcome of ACL reconstruction using BPTB graft.</p><p><strong>Methods: </strong>The present descriptive observational study was carried out at department of orthopedics, Mediciti institute of medical sciences, Hyderabad involving 30 patients of ACL tear by simple random sampling method. Patients were then evaluated by both subjectively and objectively. They were evaluated by using Lysholm and Gilquist knee scoring scale. Data was analyzed by using SPSS 24.0 version IBM USA.</p><p><strong>Results: </strong>Majority of the patients i.e., 13 (43.3%) were from 26-35 years age group with right sided involvement in 60%. The result was found to be good in 16 i.e., 53.3%, excellent in 10 i.e., 33.3% and fair in 4 i.e., 13.3% patients. Prevalence of complications was reported as 23.3% in our study.</p><p><strong>Conclusions: </strong>Our study of ACL repair using BPTP gives good to excellent results within a span of one year.</p>