Background: The Calcaneofibular ligament is cut to increase vision in surgical field in minimally invasive surgery of displaced intraarticular calcaneus fractures with subtalar incision. We aimed to investigate whether this causes talar tilt instability in ankle stress radiographs due to the Calcaneofibular ligament deficiency in postoperative period. Methods: The files of 38 patients who were operated with the diagnosis of displaced calcaneus fracture between 2013 and 2018 were examined retrospectively. All the cases underwent with subtalar approach and the Calcaneofibular ligament was repaired after the operation. The age, sex, injury mechanism, follow-up length, type of fracture by the Sanders classification, preoperative and postoperative Bohler’ s and Gissane’ s angle measurements, talar tilt measurements of intact and fractured side, postoperative calcaneal length, calcaneal height and calcaneal width of the cases were recorded. The obtained data were evaluated statistically. Results: 31 (81. 6%) of the cases were men, seven (18. 4%) were women. The average age was 31. 92± 7. 95 years. The average follow-up time was 15. 82± 3. 33 months. The preoperative Bohler’ s angle was 14. 16± 3. 67 degree, while the postoperative Bohler’ s angle was 31. 53± 4. 60 degree (P<0. 05). The average talar tilt was 0. 96± 0. 87 degrees on the intact side and 1. 19± 1. 12 degrees on the fractured side (P: 0. 001). Although the talar tilt values were statistically higher on the fractured side than the intact side, no radiological instability finding was found in any case. The average postoperative Gissane’ s angles were 126. 45± 6. 69 degrees. The calcaneal length (P: 0. 665), calcaneal width (P: 0. 212) and calcaneal height (P: 0. 341) were statistically similar between the postoperative fractured foot and intact foot. Conclusion: Sectioning of the Calcaneofibular ligament in the surgical treatment with subtalar approach does not cause lateral ankle instability in stress radiographs but may cause laxity. Possible postoperative lateral ankle injuries can be prevented by ankle proprioception exercises.

A 24 year old otherwise healthy male presented with a chief complaint of giving way in the left knee. MRI reported complete anterior cruciate ligament (ACL) tearing. Arthroscopy showed ACL agenesis, ring-shaped lateral meniscus, and an anomalous thick band extending from the anterior horn of the lateral meniscus to the intercondylar notch of the lateral femoral condyle, which is known as the anterolateral meniscofemoral ligament (MFL). The MFL was attached to the anatomic site of anteromedial bundle of ACL. ACL reconstruction surgery was performed using central 1/3 bone tendon bone graft. Practitioners should be aware that ACL reconstruction in lateral meniscofemoral ligament with associated ACL agenesis is a treatment option in which the preservation of MFL, as the stabilizer of anterior horn of lateral meniscus, should be considered during ACL reconstruction.

Background: Multi-ligament knee injury is common after knee dislocation. There are different approaches for treating multi-ligament knee injuries; however, choosing the best approach is a challenging issue. Objectives: This study aimed to investigate the efficacy of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments in multi-ligament knee injury. Methods: In this prospective study, 24 patients who had a grade 3 tear in one collateral ligament in addition to tears in two other knee ligaments were enrolled. At the first stage, collateral ligaments were reconstructed; after the patient gained full range of motion, reconstruction was done for the cruciate ligaments. Patients were followed-up for one year and postoperative evaluations were conducted through clinical tests, International Knee Documentation Committee scores, and Lysholm scales. Results: Twenty-four patients were entered into the final analysis. Synchronous injury of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posterolateral corner, and lateral collateral ligament had the highest frequency (37. 5%). At the one-year follow-up, the average Lysholm and IKDC scores were 86. 4 ± 3. 5 and 83. 8 ± 4, respectively. Range of motion was normal in all patients at the end of the study. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side. Conclusion: The results revealed that a two-stage surgery consisting of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments have good clinical and functional outcomes in multi-ligament knee injuries.

The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment. Isolated grade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occur together with other ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic singlebundle PCL reconstruction (SB-PCLR) typically restores the larger anterolateral bundle (ALB) and represents the most commonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR has led to the development of an anatomic double-bundle (DB) PCLR to restore the native PCL footprint and co-dominant behavior of the anterolateral and posteromedial bundles and re-establish normal knee kinematics. The purpose of this article is to review the pertinent details regarding PCL anatomy, biomechanics, injury diagnosis and treatment options, with a focus on arthroscopically assisted DB-PCLR.

Soft tissues exhibit viscoelastic behavior, which includes time-dependent creep and stress relaxation, and hysteresis in a loading cycle. Changes in the viscoelastic properties of soft tissues such as spinal ligaments under dynamic loading can cause the damages. In this study viscoelastic behavior of spinal ligaments is investigated by considering two different quasi-linear viscoelastic models under dynamic loading for creep and stress relaxation. After developing equations, the results of formulation were compared with the results of experimental data in the literature and finally, the viscoelastic model that had more accurate behavior to the results of experiments, was choose as the appropriate model of spinal ligament. For this purpose, obtained data by Hingoryani in an experimental study (related to creep and relaxation tests on rabbit medial ligament) were plotted in a log-log graph. According to the graphs, it was found that the strain rate decreased with higher levels of stress and relaxation rate decreased with higher levels of strain. According to the results, present formulation and the obtained constants of the equations had acceptable accordance with the experimental results, and therefore these equations can be used for spinal ligaments with acceptable accuracy.

Background: The goal of this study was to evaluate, functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate ligament (ACL) reconstruction.Methods: Fifty patients (male and 18-45 years old) with isolated ACL injury, randomly allocated in two equal groups (in one group, ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft) and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder, in order. Isokinetic flexion strength evaluated in sitting and prone position; the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC) questionnaire. In this study for first time, rotational torque strength of knee was recorded with new design measure, from isometric aspect and not isokinetic.Results: Although significant improvements in IKDC scores, flexion and internal rotation capacity of the knee were observed in both groups, post operatively in respect to pre operatively; there was no significant difference between 2 groups. (P<0.05 or more than 95% confidence Interval of the difference).Conclusion: This study demonstrates that ACL reconstruction surgery, improves knee performance in flexion and internal rotation, regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient), it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex, for more worthfull conclusion, we suggest future study in both sex and with long duration of follow up.

Background: Persistent instability following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48%. Surgery is indicated when conservative management fails to produce a satisfactory functional outcome. Associated intraarticular lesions of talus or extraarticualr lesions like peroneus Brevis tendon injuries can impact the functional outcome of lateral ankle reconstruction. The aim of this study was to report our short-term experience and treatment of concomitant lesions in chronic lateral ankle instability.Methods: 18 patients, aged 21 to 45 years with recurrent ankle sprain and lateral ankle instability who had not responded to at least 3 months conservative treatment and had underwent direct lateral ligament repair were studied. All the patients received ankle arthroscopy and exploration of peroneus Brevis tendon before repair of anterior talofibular and Calcaneofibular ligaments with 14 months (6-22 months) follow-ups. The cases were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score.Results: The mean duration of injury was 19 months. In the diagnostic ankle arthroscopy, 6 patients had some degree of talar chondral lesions, two requiring shaving and drilling. Preoperatively, all patients had poor scores (<50).Postoperatively, 14 (79%) ankles obtained excellent and 4 (21%) good scores.Conclusion: Chronic lateral ankle instability is often associated with concomitant injuries to peroneus Brevis and talar cartilage. Direct repair of anterior talofibular and calcanofibular ligaments is an effective procedure.