Publications by authors named "Sohrab Keyhani"

33 Publications

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach.

J Knee Surg 2020 Nov 25. Epub 2020 Nov 25.

Department of Orthopedic Surgery, Poursina Hospital Orthopaedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

The optimal operative technique for the treatment of the tibial-side avulsion injuries of the posterior cruciate ligament (PCL) is debatable. This study was aimed to evaluate the postoperative outcomes and complications if any after an open direct, posterolateral approach using cannulated cancellous screw fixation of a PCL tibial avulsion. From January 2016 to June 2018, 17 patients (14 males and 3 females) with PCL avulsion fraction treatment-who underwent open reduction and internal fixation using cannulated cancellous screws-were included in this prospective study. A direct posterolateral approach in the prone position was used in all cases. The Lysholm's knee score and International Knee Documentation Committee (IKDC) score were assessed preoperatively and during regular follow-up examinations for at least 1 year (12-20 months) postoperatively. All patients had fracture union and all of their knees were stable upon physical examination. No nerve or blood vessel injuries occurred. The mean Lysholm's scores and mean IKDC scores were improved significantly at the last follow-up. This study provides evidence that open direct posterolateral approach may be reliable for the treatment of tibial-sided bony PCL avulsion fractures. This approach can provide direct visualization of the posterior capsule and PCL avulsion site associated with good reduction and stable fixation, easy application of the screws directly from posterior to anteriorly without extensive soft tissue damage. Nevertheless, long-term follow-up is recommended.
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http://dx.doi.org/10.1055/s-0040-1721093DOI Listing
November 2020

Neuromuscular training improves knee proprioception in athletes with a history of anterior cruciate ligament reconstruction: A randomized controlled trial.

Clin Biomech (Bristol, Avon) 2020 Dec 27;80:105157. Epub 2020 Aug 27.

Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Velenjak St., Tehran 19857-17443, Iran.

Background: Athletes exhibit deficits in knee proprioception following anterior cruciate ligament reconstruction. Neuromuscular training programs improve knee proprioception in uninjured athletes; however, the effects on knee proprioception in athletes who have undergone anterior cruciate ligament reconstruction is not well understood. The purpose of this study was to examine the effects of a neuromuscular training program on knee proprioception in athletes who have returned to sport following anterior cruciate ligament reconstruction.

Methods: Twenty-four male athletes, who had undergone anterior cruciate ligament reconstruction within the previous 6-12 months and returned to sport, participated in this randomized controlled trial. Athletes were randomly allocated to an experimental group (n = 12) that took part in an 8-week neuromuscular training program or a control group (n = 12) that simply continued their typical training routine. Knee position sense was assessed at baseline and after the 8-week period (post-testing). One-way analysis of covariance, with baseline performance included as a covariate, was used to compare knee position sense errors for the reconstructed limbs of the experimental and control groups at the post-testing time point.

Findings: Knee position sense errors decreased by 51.7% for the experimental group and only 4.4% for the control group over the 8-week period. As a result, the experimental group demonstrated lower knee position sense errors, compared to the control group, at the post-testing time point (P < .001).

Interpretation: Athletes with a history of anterior cruciate ligament reconstruction may benefit from participation in a neuromuscular training program, even after completing post-operative rehabilitation.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105157DOI Listing
December 2020

The Prevalence, Zone, and Type of the Meniscus Tear in Patients with Anterior Cruciate Ligament (ACL) Injury; Does Delayed ACL Reconstruction Affects the Meniscal Injury?

Arch Bone Jt Surg 2020 May;8(3):432-438

Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Meniscus tear is a common finding in patients with anterior cruciate ligament (ACL) injury and may affect the natural history of the injury and the outcomes of treatment. In the current study, the characteristics of meniscus tears in patients who underwent arthroscopic ACL reconstruction were investigated.

Methods: The hospital records of 1022 patients were reviewed. The measured variables included the presence of meniscus tear, ramp and root injury, the zone of injury based on the Cooper classification, and the type of tear. The ACL tears with delay more than 3 months for ACLR were recorded as chronic injuries.

Results: The incidence of meniscus tear was 44.4%; among whom, bucket-handle injury was the most common type (30.4%) and the ramp lesion was found in 20.5%. The meniscus was repaired in 56.6%. The incidence of medial meniscus injury was significantly higher in chronic ACL tears and vice versa (). The incidence of ramp lesion (9.1% Vs 20.5%) and root tear (1.3% Vs 2.9%) were significantly higher in the chronic and acute tears, respectively ().

Conclusion: Delay more than 3 months in ACLR was associated with the increased incidence of meniscal injury, specially the medial meniscus, and ramp lesion. It seems that early ACLR may be more helpful for the patients.
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http://dx.doi.org/10.22038/abjs.2019.39084.2076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358246PMC
May 2020

Autogenous Osteochondral Grafting for Treatment of Knee Osteochondritis Dissecans: A Case Series Study.

Arch Bone Jt Surg 2020 May;8(3):426-431

Akhtar Orthopedic Training and Research Hospital, Shahid Beheshti University of medical Sciences, Tehran, Iran.

Background: Although some surgical techniques have been described for the operative treatment of unstable Osteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of the present study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee.

Methods: In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International Cartilage Repair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III (4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At the initial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated.

Results: The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (). Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal, and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1 abnormal knee were documented (). The mean Lysholm score increased from 44.3 per operatively to 86.3 ().Tegner activity score improved from 2.8±1 pre operatively to 5.6±2 ().

Conclusion: Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes. In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriate for autogenous osteochondral grafting with healthy cartilage.
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http://dx.doi.org/10.22038/abjs.2019.39026.2038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358228PMC
May 2020

A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve.

Rev Bras Ortop (Sao Paulo) 2020 Jun 27;55(3):374-379. Epub 2019 Aug 27.

Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Akhtar Hospital, Tehran, Iran.

 The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve.  The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: 44; OG:  48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded.  The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction.  Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.
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http://dx.doi.org/10.1055/s-0039-1692695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316540PMC
June 2020

Contralateral and siblings' knees are at higher risk of ACL tear for patients with a positive history of ACL tear.

Knee Surg Sports Traumatol Arthrosc 2020 Feb 14;28(2):622-628. Epub 2019 Nov 14.

Orthopedic Department, Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences, Parastar Ave., Rasht, Iran.

Purpose: Recent studies have shown that several genetic factors can cause susceptibility to anterior cruciate ligament (ACL) rupture. The aim of the present study was to evaluate certain underlying factors that increase the risk of ACL rupture.

Methods: Eight hundred thirty-six patients with ACL rupture who underwent ACL reconstructive surgery from 2010 to 2013 at an academic center completed a minimum of 5 years post-operation follow-up. The collected variables included sex, age, height, weight, exercise level, time interval between ACL rupture in the first knee and contralateral ACL rupture, dominant leg, side of the involved knee and sibling history of ACL rupture.

Results: The median follow-up duration was 6.5 (range: 5-8) years. Eighty-three patients (9.9%) had a contralateral ACL rupture, and 155 patients (18.5%) had siblings with a history of ACL rupture. The rate of contralateral ACL rupture was three times higher in women than in men and in patients with siblings with a history of ACL rupture than in those without such history. In addition, the risk of contralateral ACL rupture was higher in those younger than 30 years of age, those with a BMI of 20-25 kg/m and those who participated in regular sports activity. However, whether the involved knee was on the dominant or nondominant side had no effect on the incidence of contralateral ACL rupture. The results of the study showed that 69 (83.1%) of the contralateral ACL ruptures occurred within the first 2 years after the primary operation.

Conclusion: In a 5- to 8-year follow-up, one out of every ten patients had a contralateral ACL rupture, and two out of every ten patients had siblings with a history of ACL rupture. The findings suggest that having a sibling with a history of ACL rupture and being female are important risk factors for ACL rupture of the contralateral knee.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-019-05781-zDOI Listing
February 2020

Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? Open subpectoral versus arthroscopic intraarticular tenodesis.

J Orthop Traumatol 2019 Jul 5;20(1):26. Epub 2019 Jul 5.

Orthopedic Department, Guilan University of Medical Sciences, Parastar Ave, Poursina Hospital, P.O. Box: 4193713191, Rasht, Iran.

Background: Lesions associated with the biceps tendon are commonly detected during arthroscopic repair of rotator cuff tears. Acquiring a preferable technique to repair both cuff and long head of biceps tendon (LHBT) lesions was the aim of several recent studies. This study aimed to compare clinical and functional outcomes of open subpectoral versus arthroscopic intraarticular tenodesis in patients with repairable rotator cuff tear associated with LHBT degeneration.

Patients And Methods: In this randomized clinical trial, 60 eligible candidates for arthroscopic rotator cuff repair (mean age 55.7 ± 6.9 years) were allocated to a control group (open subpectoral, SP) or intervention group (intraarticular, IA). In the IA group, an anchor suture was used for both rotator cuff repair and LHBT tenodesis. In the SP group, after arthroscopic repair of the rotator cuff, subpectoral tenodesis of LHBT was performed using an interference screw. Patients were evaluated for 2 years follow-up regarding pain intensity using the visual analogue scale (VAS) and shoulder function using the Constant Score and Simple Shoulder Test.

Results: The two groups were similar with regard to demographic characteristics and preoperative evaluations (all P > 0.05). The functional status of both groups was improved, but not significantly differently so between the two groups (P = 0.1 and P = 0.4, respectively). Pain intensity decreased during the 2-year follow-up period, similarly so in the two groups. Patient satisfaction was also similar in the two groups.

Conclusion: Large and massive rotator cuff tears (tears > 3 cm) associated with LHBT pathologies benefited from intraarticular or subpectoral tenodesis similarly, with no differences in short- or mid-term results between these two techniques.

Level Of Evidence: II.
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http://dx.doi.org/10.1186/s10195-019-0531-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611854PMC
July 2019

Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique.

Musculoskelet Surg 2020 Aug 26;104(2):215-226. Epub 2019 Jun 26.

Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Purpose: The aims of the present study were to evaluate and report the therapeutic outcomes of double-plate fixation in combination with autogenous bridging bone grafting in treatment of nonunion fractures of femur.

Methods: In this retrospective case series study, 41 patients with nonunion fracture of femur who underwent surgery by double-plate fixation and autogenous bridging bone grafting in academic referral center from July 2010 to July 2015 were enrolled. Totally, 32 males and 9 females with mean age of 35 years were evaluated. They were evaluated for related risk factors, previous therapeutic methods, time interval between injury to nonunion surgery and surgery to full clinical and radiological union, duration of follow-up, levels of postoperative limb shortening, and movement limitations.

Results: Ten patients had open fractures and eight patients had infected nonunion in the femoral supracondylar, subtrochanteric, and shaft fractures. Nailing was the most common used method as the primary treatment of femoral shaft fractures. In addition, the mean follow-up time was 37 months. Full union was obtained even in infected cases. Deep vein thrombosis was found in one patient and pulmonary thromboembolism in another patient, and both patients were treated successfully. Moreover, limitations of articular movements were seen in seven patients.

Conclusion: Double-plate fixation in combination with bridging bone grafting is an effective method in the treatment of nonunion of femoral supracondylar, subtrochanteric, and shaft fractures even in the infected cases.
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http://dx.doi.org/10.1007/s12306-019-00615-0DOI Listing
August 2020

Reliability of Knee Flexion-Extension Lyapunov Exponent in People With and Without Anterior Cruciate Ligament Deficiency.

J Sport Rehabil 2020 Feb;29(2):253-256

Objectives: The current study assessed the intrasession and intersession reliability of the knee flexion-extension Lyapunov exponent in patients with anterior cruciate ligament deficiency and healthy individuals.

Study Design: University research laboratory.

Methods: Kinematic data were collected in 14 patients with anterior cruciate ligament deficiency and 14 healthy individuals walked on a treadmill at a self-selected, low, and high speed, with and without cognitive load. The intraclass correlation coefficient, standard error of measurement, minimal metrically detectable change, and percentage of coefficient of variation were calculated to assess the reliability.

Results: The knee flexion-extension Lyapunov exponent had high intrasession reliability, with intraclass correlation coefficients ranging from .83 to .98. In addition, the intersession intraclass correlation coefficient values of these measurements ranged from .35 to .85 regardless of group, gait speed, and dual tasking. In general, relative and absolute reliability were higher in the patients with anterior cruciate ligament deficiency than in the healthy individuals.

Conclusions: Although knee flexion-extension Lyapunov exponent demonstrates good intrasession reliability, its low intersession reliability indicates that changes of these measurements between different days should be interpreted with caution.
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http://dx.doi.org/10.1123/jsr.2018-0468DOI Listing
February 2020

Patient Satisfaction Following Total Knee Arthroplasty: Comparison of Short-Term Results in Rheumatoid Arthritis and Osteoarthritis.

Arch Bone Jt Surg 2019 Jan;7(1):61-66

Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Due to the obvious differences in the natural course of rheumatoid arthritis (RA) and osteoarthritis (OA), different functional outcomes might be expected after Total Knee Arthroplasty (TKA) in these distinct patients. Although several studies have reported the objective outcome of TKA in RA and OA patients, few studies have compared post-operative patient-satisfaction levels.

Methods: In this clinical cohort study 171 patients (RA: n=33, OA: n=138) who underwent TKA with posterior stabilizing knee prosthesis were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) were used to evaluate and compare patients' satisfaction 6 and 12 months after TKA relative to their preoperative state and to make an assessment between two groups.

Results: Both of patient-reported scoring systems showed a statistically significant improvement for OA and RA patients at 6 and 12 months after surgery, relative to their preoperative scores. The results of the OKS and KOOS did not show statistically significant improvement from 6 to 12 months n RA patients. Unlike RA group, OKS and KOOS revealed further improvement between 6 and 12 months for the osteoarthritic patients.

Conclusion: OA patients had continuous improvement in their satisfaction in the first year after TKA with a gentle upward curve. In contrast, in RA patients, recovery was faster and greater in the first six months after surgery and slowed down in the second six months. Patient-reported outcome scores were not significantly different between two groups at the end of the first year.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372268PMC
January 2019

Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel.

J Knee Surg 2020 Apr 6;33(4):410-416. Epub 2019 Feb 6.

Department of Orthopedic Surgery, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24-51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.
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http://dx.doi.org/10.1055/s-0039-1677812DOI Listing
April 2020

Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency.

Knee 2019 Jan 22;26(1):88-96. Epub 2018 Nov 22.

Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion-extension variability in subjects with and without ACL deficiency.

Methods: The knee flexion-extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95 ± 4.69 years) and 22 healthy subjects (24.18 ± 3.32 years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task.

Results: Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion-extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P = 0.01). The interaction of group by cognitive load was not statistically significant (P = 0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition.

Conclusions: The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency.
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http://dx.doi.org/10.1016/j.knee.2018.11.009DOI Listing
January 2019

Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee: Complete Synovectomy and Septum Removal-Midterm Results.

J Knee Surg 2019 May 4;32(5):427-433. Epub 2018 May 4.

Department of Orthopaedics, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

The purpose of this study was to evaluate and describe the clinical results of complete arthroscopic synovectomy through the four arthroscopic portals in the knees affected by diffuse pigmented villonodular synovitis (DPVNS). Between 2009 and 2012, 21 patients (15 men and 6 women) with the diffuse form of PVNS of the knee were enrolled in the study after qualification. The clinical diagnosis was confirmed by magnetic resonance imaging and postsurgical pathologic examination. All patients underwent complete synovectomy through posteromedial, posterolateral, anteromedial, and anterolateral portals. Each patient was evaluated before treatment and followed up for a minimum of 5 years (range: 60-79 months) using the Lysholm score and International Knee Documentation Committee (IKDC) score. Both Lysholm score and IKDC scores were significantly improved in all study participants. No cases of clinical recurrence, infection, joint stiffness, or neurovascular lesions were observed. This study showed that an attentive arthroscopic synovectomy is a safer alternative with better clinical outcomes, with no clinical recurrences.
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http://dx.doi.org/10.1055/s-0038-1646929DOI Listing
May 2019

Intra-sheath versus extra-sheath ultrasound guided corticosteroid injection for trigger finger: a triple blinded randomized clinical trial.

Phys Sportsmed 2018 Feb 10;46(1):93-97. Epub 2017 Nov 10.

e General Practitioner, Guilan Road Trauma Research Center , Guilan University of Medical Sciences , Rasht , Iran.

Objective: The aim of this study is to compare clinical results of ultrasound-guided corticosteroid injection, intra-sheath versus extra-sheath of the finger flexor tendon.

Methods: A total of 166 patients with trigger finger were evaluated in a triple blind randomized clinical trial study. All the patients were injected with 1ml of 40mg/ml methyl prednisolone acetate, under the guidance of ultrasound. Half the patients were injected extra sheath, while the other half were injected intra sheath at the level of first annular pulley.

Results: The two groups were comparable in baseline characteristics (age, gender, dominant hand, involved hand and finger, and the symptoms duration). No significant difference was observed in the two groups with regards to Quinnell grading. In the final visit, 94% of patients from each group were symptom free.

Conclusion: Results of corticosteroid injection intra-sheath or extra-sheath of the finger flexor tendon under ultrasound guidance in patients with trigger finger are comparably alike. Extra-sheath injection at the level of A1 pulley is as effective as an Intra-sheath administration.
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http://dx.doi.org/10.1080/00913847.2018.1400897DOI Listing
February 2018

Reliability of kinematic measures in subjects with anterior cruciate ligament deficiency during dual-task walking.

J Bodyw Mov Ther 2017 Oct 4;21(4):852-859. Epub 2017 Mar 4.

Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Vakil abad Blvd, Bahonar Blvd, Pardis Campus, Mashhad, Iran. Electronic address:

Objective: To define the throughout within- and between-day reliability of gait parameters in single - and dual-task conditions in subjects with and without anterior cruciate ligament deficiency (ACLD).

Methods: Fourteen subjects with ACLD and 14 healthy subjects completed a walking task on a treadmill with three levels of velocity (self-selected, high and low), with or without performing an auditory Stroop task over two sessions each 3-5 days apart. The gait kinematic parameters, including maximum and minimum hip flexion, total hip range of motion, maximum and minimum knee flexion and total knee range of motion were recorded using a motion analysis system. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the coefficient of variation (CV) were used to determine inter- and intrasession reliability of kinematic and cognitive measures.

Results: ICCs for ACLD group in dual-task and single task conditions ranged between 0.50 to 0.93 and 0.53 to 0.93, respectively. ICC values for healthy groups in dual-task and single task conditions ranged between 0.36 to 0.90 and 0.39 to 0.87, respectively. When comparing relative reliability across kinematic variables in different velocities, ICC values were generally identical in all three levels of velocity.

Conclusion: The findings suggest that dual-tasking could also be applied reliably for the assessment of functional activities in subjects with and without ACLD.
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http://dx.doi.org/10.1016/j.jbmt.2017.02.004DOI Listing
October 2017

Anatomical Repair of Stener-like Lesion of Medial Collateral Ligament: A case Series and Technical Note.

Arch Bone Jt Surg 2017 Jul;5(4):255-258

Department of Orthopedic surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Medial collateral ligament tears usually will be treated through non-surgical methods, but, in some cases such as those with tears at the distal insertion where the reduction could be blocked by the pes anserine tendons (Stener-like lesion), surgery will be performed. Here, we present a surgical technique in such cases. In this retrospective case series, we describe six patients diagnosed with Stener-like lesion based on clinical evaluation and imaging results. In the one-year follow-up visit, there was no complaining of pain or joint instability and full range of motion and negative valgus stress test were reported in all cases. The results showed this surgical technique is a useful and safe treatment approach in such cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592368PMC
July 2017

Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view.

Knee Surg Sports Traumatol Arthrosc 2017 Feb 27;25(2):454-458. Epub 2016 Dec 27.

Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The purpose of this study was to evaluate and describe the clinical results and outcomes of a novel method for all-inside suture repair of medial meniscus ramp lesions through posteromedial and posterolateral transseptal portals during anterior cruciate ligament (ACL) reconstruction. Further, this investigation compared the posterolateral view to the notch view for diagnosis and repair.

Methods: Between 2011 and 2014, 166 patients had ramp lesions concomitantly with ACL injury; 128 patients (107 men and 21 women) were enrolled in the study after qualification. All patients underwent repair of the posterior horn ramp lesion of the medial meniscus, using a suture hook device with PDS No. 1 through a posteromedial portal while viewing from the posterolateral transseptal portal during ACL reconstruction, with a minimum of a 2-year follow-up.

Results: Patients were followed up for a minimum of 2 years (range 24-47 months). Their average Lysholm score increased from 61.7 ± 3.2 preoperatively to 87.8 ± 3.9 at last follow-up (p < 0.001). Moreover, their average IKDC scores also improved from 53.6 ± 2.1 (pre-op) to 82.1 ± 3.5 (at last follow-up) (p < 0.001). The peroneal nerve and the popliteal neurovascular bundle were not damaged in any of the patients.

Conclusion: This study provides evidence that the posterolateral transseptal technique protects neurovascular structures. This technique may be used safely and easily for repair of the posterior horn ramp lesion of the medial meniscus during ACL reconstruction.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-016-4410-9DOI Listing
February 2017

Predicting the Hamstring Tendon Diameter Using Anthropometric Parameters.

Arch Bone Jt Surg 2016 Oct;4(4):314-317

Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric parameters such as gender, height and body mass index to predict 4-strand (quadruple) hamstring tendons (gracilis and 2-strand semitendinosus tendons).

Methods: This is a cross-sectional study conducted on all consecutive patients who underwent arthroscopic ACL reconstruction between 2013 and 2015. The anthropometric variables (age, gender, height, and body mass index) were recorded. The quadruple hamstring tendon (gracilis and semitendinosus) autografts were measured using sizing cylinders. The relationship between these parameters was statistically determined using the Pearson Spearman test and linear regression test.

Results: The mean age of the 178 patients eligible for the study was 29.58±9.93 (118 males and 60 females). The mean hamstring tendon diameter was 7.8±0.7 mm, the mean for males was 7.9±0.6 and for females 7.8±9 mm (=0.0001). There were significant correlations between the mean hamstring tendon diameter with BMI (Pearson correlation=0.375, R=0.380, and =0.0001), height (Pearson correlation=0.441, R=0.121, and =0.0001), and weight (Pearson correlation=0.528, R= -0.104 and =0.0001). However, patient's age and genderwerenot found to be a predictor of the size of the hamstring tendon diameter.

Conclusion: Based on findings from this study weight, height, body mass index, and the length of the tendon may be predictors of the hamstring tendon diameter for anterior cruciate ligamentreconstruction. These findings could be used in preoperative planning of patients undergoing ACL reconstruction surgery to estimate the size of the graft and select of the appropriate type of graft.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100445PMC
October 2016

Rotator Cuff Repair: Is there any role for acromioplasty?

Phys Sportsmed 2016 Sep 5;44(3):274-7. Epub 2016 Aug 5.

c Orthopedic Research Center , Guilan University of Medical Sciences , Rasht , Guilan , Iran.

Objectives: Acromioplasty has been one of the most common techniques amongst orthopedic surgeries in the past decade. However, its efficacy in arthroscopic surgeries of rotator cuff repair is still debatable. The purpose of this study is to compare the arthroscopic rotator cuff repair with or without acromioplasty in patients with complete rotator cuff tear.

Methods: In this prospective cohort study, patients with complete rotator cuff tear (acromion type II or III Bigliani) and a history of failure to the conservative treatment for at least 6 months were evaluated for eligibility. Patients, based on the time interval, were placed in one of two groups: arthroscopic rotator cuff repair with (RCR-A group) and without acromioplasty (RCR group). Patients were assessed for two years in term of pain intensity by VAS criteria and shoulder functional status by Quick-DASH, Constant score and simple shoulder test criteria.

Results: In the baseline assessment, RCR-A group (34 patients) and RCR group (33 patients) were similar. Comparing patients in two groups in relation to SST, Quick-DASH and VAS scores preoperatively showed there is no significant difference between the two groups. The SST, Quick-DASH and VAS scores improved significantly in both groups at both the 6-month and 2-year follow-ups (all P < 0.001). The extent of progress in the functional scores was similar in both groups (P > 0.05).

Conclusion: Arthroscopic rotator cuff repair without acromioplasty may be as reliable and useful as conventional rotator cuff repair with acromioplasty. Thus, acromioplasty cannot be recommended as a routine technique in every rotator cuff repair.
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http://dx.doi.org/10.1080/00913847.2016.1216717DOI Listing
September 2016

Hamstring tendon autograft versus fresh-frozen tibialis posterior allograft in primary arthroscopic anterior cruciate ligament reconstruction: a retrospective cohort study with three to six years follow-up.

Int Orthop 2016 Sep 18;40(9):1905-11. Epub 2016 Mar 18.

Orthopaedic Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Selection of various grafts for anterior cruciate ligament (ACL) reconstructions have been employed in order to improve on stability and function of the knee. This study aimed to compare stability and function of the knee after ACL arthroscopic reconstruction by single-loop tibialis posterior (TP) allograft and four-strand hamstring tendon (HT) autograft.

Materials And Methods: The retrospective cohort study included 104 patients in the TP group matched with 118 patients in the HT group in terms of demographic characteristics, associated meniscus injury, subjective and objective knee characteristics. All patients were followed up for at least three years with regards to mentioned criteria and time of return to former activities.

Results: The mean (range) age of TP (88 males and 16 females) and HT (99 males and 19 females) groups was 34.4 (19-48) and 36.9 (20-51) years, respectively. Median (range) follow-up durations were 55 (37-71) and 56 (36-72) months, respectively. No significant differences were observed post-operatively, regarding subjective and objective evaluations. Additionally, time duration for return to former activity was similar in both groups. Post-operative paresthesia and numbness of medial aspect of the calf were observed for two months in eight patients of the HT group which persisted to the final visit in one case. No similar symptom was seen in the TP group.

Conclusion: In arthroscopic ACL reconstruction, fresh frozen doubled TP allograft compared to HT autograft was equally effective in restoring function and stability of knee, permitting return to former activities.

Level Of Evidence: Retrospective comparative, Level III.
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http://dx.doi.org/10.1007/s00264-016-3164-9DOI Listing
September 2016

Which Route of Tranexamic Acid Administration is More Effective to Reduce Blood Loss Following Total Knee Arthroplasty?

Arch Bone Jt Surg 2016 Jan;4(1):65-9

Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty.

Methods: One hundred twenty 120 patients were scheduled to undergo primary total knee arthroplasty. Patients were randomly allocated to three equal groups: IV tranexamic acid (500 mg), topical tranexamic acid (3 g in 100 mL normal saline) and the control. In the topical group, half of the volume was used to irrigate the joint and the other half was injected intra-articularly. The volume of blood loss, hemoglobin (Hb) level at 24 hours postoperative, and rate of transfusion was compared between groups.

Results: The blood loss and Hb level were significantly greater and lower in the control group, respectively (P=0.031). Also, the rate of transfusion was significantly greater in the control group (P=0.013). However, IV and topical groups did not differ significantly in terms of measured variables. No patient experienced a thromboembolic event in our study.

Conclusion: Tranexamic acid is a useful antifibrinolytic drug to reduce postoperative blood loss, Hb drop, and rate of blood transfusion in patients undergoing total knee arthroplasty. The route of tranexamic acid administration did not affect the efficacy and safety.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733239PMC
January 2016

Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial.

Arch Trauma Res 2015 Dec 21;4(4):e30788. Epub 2015 Nov 21.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery.

Objectives: The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients.

Patients And Methods: Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups.

Results: There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups.

Conclusions: Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration, maintained stable hemodynamic parameters, had no complications related to opiates, no nausea and vomiting, and increased patient satisfaction and comfort in comparison to PCA with morphine.
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http://dx.doi.org/10.5812/atr.30788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733531PMC
December 2015

Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature.

Arch Bone Jt Surg 2015 Apr;3(2):137-40

Sohrab Keyhani MD Orthopedic Department, Akhtar Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.

A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468616PMC
April 2015

Arthroscopic Meniscal Repair: "Modified Outside-In Technique".

Arch Bone Jt Surg 2015 Apr;3(2):104-8

Sohrab Keyhani MD Mohammad Reza Abbasian MD Nasim Siatiri MD Ali Sarvi MD Ali Akbar Esmailiejah MD Department of Orthopedic Surgery, Akhtar Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran.

Background: Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named "modified outside-in technique" aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with meniscal injuries by our new technique were evaluated.

Methods: The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients' satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months.

Results: Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients' satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported.

Conclusions: The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464318PMC
April 2015

Achilles tendon repair, a modified technique.

Arch Bone Jt Surg 2013 Dec 15;1(2):86-9. Epub 2013 Dec 15.

Sohrab Keyhani MD, Department of Orthopedic Surgery, Akhtar Hospital Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR) remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia) to avoid complications after open repair.

Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear.

Results: Only, one patient developed deep wound infection (3%). None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7%) were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides.

Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151419PMC
December 2013

Is gabapentin effective on pain management after arthroscopic anterior cruciate ligament reconstruction? A triple blinded randomized controlled trial.

Arch Bone Jt Surg 2013 Sep 15;1(1):18-22. Epub 2013 Sep 15.

Mohsen Mardani-Kivi MD, Department of Orthopedic Surgery Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity . Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament (ACL) reconstruction arthroscopic surgery.

Methods: In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin (G) and placebo (p), with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale (VAS) and the secondary outcome was the amount of opioid consumption and incidence of side effects (including: dizziness, sedation, nausea and vomiting) at 6 and 24 h visits.

Results: The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group (Both P<0.001). Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group (p<0.001, P=0.032). The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups.

Conclusion: In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151400PMC
September 2013

Reliability of dynamic balance simultaneously with cognitive performance in patients with ACL deficiency and after ACL reconstructions and in healthy controls.

Knee Surg Sports Traumatol Arthrosc 2015 Nov 12;23(11):3178-85. Epub 2014 Jun 12.

Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation, KU Leuven, Tervuursevest 101 Bus 1501, 3001, Heverlee, Belgium.

Purpose: To determine the intra- and inter-session reliability of balance and cognitive performance in anterior cruciate ligament-deficient (ACLD) and ACL-reconstructed (ACLR) and matched athletes.

Methods: Using SMART EquiTest, recovery reactions of the groups were assessed during single-leg standing, following medium and large forward perturbations with and without performing a cognitive (Stroop) task. The outcomes included reaction time (RT), latency and amplitude for balance and error ratio (ER) and RT for cognitive performance. The participants of each group repeated the tests 2-7 days after the first session. Intraclass correlation coefficient (ICC) and standard error of measurement were computed in order to assess relative and absolute reliability, respectively.

Results: Single- and dual-task balance measures had moderate to very high reliability in ACLD (ICC = 0.63-0.88), ACLR (ICC = 0.62-0.93) and control (ICC = 0.69-0.98) athletes. The ICCs for RT of Stroop were between 0.87 and 0.90 in ACLD, between 0.70 and 0.74 in ACLR and between 0.66 and 0.70 in controls and for ER of Stroop were between 0.36 and 0.90 in ACLD, between 0.42 and 0.49 in ACLR and between 0.41 and 0.51 in controls.

Conclusions: Balance measures and RT of the cognitive task in single- and dual-task conditions have acceptable reliability and may be incorporated into the evaluation of physical and mental function of athletes following ACL injury and reconstruction. ER of the cognitive task is less reliable which needs to be considered in future research.

Level Of Evidence: Prognostic study, case-control, Level III.
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http://dx.doi.org/10.1007/s00167-014-3116-0DOI Listing
November 2015

Evidence-based status of osteochondral cylinder transfer techniques: a systematic review of level I and II studies.

Arthroscopy 2014 Apr;30(4):497-505

Tehran University of Medical Science and Shariati Hospital, Tehran, Iran.

Purpose: Our purpose was to examine the Level I and II evidence for the use of osteochondral cylinder transfer technique (OCT) for cartilage repair.

Methods: A literature search was carried out for Level I and II evidence studies on cartilage repair using the PubMed database. All the studies that involved OCT were identified. Only Level I and II studies that compared OCT to other modalities of treatment such as microfracture (MF) and autologous chondrocyte implantation (ACI) were selected.

Results: A total of 8 studies matched the selection criteria with 2 Level I and 6 Level II studies. Four studies compared OCT with MF, 3 compared OCT with ACI, and one compared all 3 techniques. Of 3 studies, 4 came from a single center. Mean age of patients ranged from 24 to 33 years, and mean follow-up ranged from 9 to 124 months. The studies from the single center showed superior results from OCT over MF, especially in younger patients, with one study having long-term follow-up of 10 years. They also showed an earlier return to sports. The size of the lesions were small (average < 3 cm(2)). The 4 other independent studies did not show any difference between OCT and ACI, with one study showing inferior outcome in the OCT group. Magnetic resonance imaging (MRI) showed good osseous integration of the osteochondral plugs to the subchondral bone. Histologic examination showed that there was hyaline cartilage in the transplanted osteochondral plugs but no hyaline cartilage between the plugs.

Conclusions: From the studies of a single center, OCT had an advantage over MF in younger patients with small chondral lesions. Comparison of outcomes between OCT and ACI showed no significant difference in 2 studies and contrasting results in another 2 studies. There was insufficient evidence for long-term results for OCT.

Level Of Evidence: Level II, systematic review of Level I and II studies.
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http://dx.doi.org/10.1016/j.arthro.2013.12.023DOI Listing
April 2014

Evidence-based status of second- and third-generation autologous chondrocyte implantation over first generation: a systematic review of level I and II studies.

Arthroscopy 2013 Nov 26;29(11):1872-8. Epub 2013 Sep 26.

Saumya Orthocare: Centre for Advanced Surgeries of the Knee Joint, Ahmedabad, India. Electronic address:

Purpose: The purpose of this study was to examine the Level I and II evidence for newer generations of autologous chondrocyte implantation (ACI) versus first-generation ACI and to establish whether the newer generations have overcome the limitations associated with first-generation ACI.

Methods: A literature search was carried out for Level I and II evidence studies on cartilage repair using the PubMed database. All the studies that dealt with ACI were identified. Only Level I and II studies that compared newer generations against earlier generations were selected, whereas studies that compared ACI against other methods of cartilage repair were excluded.

Results: A total of 7 studies matched the selection criteria. Two studies compared periosteum-based autologous chondrocyte implantation (P-ACI) against collagen membrane-based autologous chondrocyte implantation (C-ACI), whereas one study each compared membrane-associated autologous chondrocyte implantation (MACI) against P-ACI and C-ACI. One study on C-ACI compared results related to age, whereas 2 studies evaluated postoperative rehabilitation after MACI. There was weak evidence showing that C-ACI is better than P-ACI and that MACI is comparable with both P-ACI and C-ACI. The weak evidence is because of studies with short durations of follow-up, small numbers of patients, medium-sized defects, and younger age groups. There is good evidence favoring an accelerated weight-bearing regimen after MACI. There is currently no evidence that supports scaffold-based ACI or arthroscopic implantation over first-generation ACI.

Conclusions: The hypothesis is thus partly proved in favor of C-ACI/MACI against P-ACI with weak evidence, in favor of accelerated weight bearing after MACI with strong evidence, and not in favor of arthroscopic and scaffold-based implantations because of unavailable evidence. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
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http://dx.doi.org/10.1016/j.arthro.2013.07.271DOI Listing
November 2013

Evidence-based status of microfracture technique: a systematic review of level I and II studies.

Arthroscopy 2013 Sep;29(9):1579-88

Saumya Orthocare: Centre for Advanced Surgeries of the Knee Joint, Ahmedabad, India.

Purpose: Although many newer cartilage repair techniques have evolved over the past 2 decades, microfracture is still being advocated as the first line of treatment. Therefore it is timely to conduct a comprehensive review of the literature to assess and report on the current status of Level I and II evidence studies related to microfracture techniques.

Methods: A literature search was carried out for Level I and II evidence studies on cartilage repair using the PubMed database. All the studies that dealt with microfracture techniques were selected.

Results: Fifteen studies that involved microfracture techniques met the inclusion criteria of this review article, with 6 long-term and 9 short-term studies. These studies compared the clinical outcomes of microfracture with those of other treatments such as autologous chondrocyte implantation and osteochondral cylinder transfers. The majority of the studies reported poor clinical outcomes, whereas 2 studies reported the absence of any significant difference in the results. Small-sized lesions and younger patients showed good results in the short-term. However, osteoarthritis and treatment failures were observed at later postoperative periods of 5 to 10 years.

Conclusions: The use of microfracture for the treatment of small lesions in patients with low postoperative demands was observed to result in good clinical outcomes at short-term follow-up. Beyond 5 years postoperatively, treatment failure after microfracture could be expected regardless of lesion size. Younger patients showed better clinical outcomes.

Level Of Evidence: Level II, systematic review of Level I and II studies.
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http://dx.doi.org/10.1016/j.arthro.2013.05.027DOI Listing
September 2013