Mahmood Karimi Mobarakeh, MD; Hooman Mohammadzadeh Eiedgahi, MD; Habibeh Ahmadipour, MD
Abstract
Background: Anterior cruciate ligament (ACL) is one of the major stabilizing ligaments of the knee. ACL reconstruction usually has high success rate. The choice of graft in ACL reconstruction has been a source of controversy. This study compares the outcome of two commonly used grafts.
Methods: Seventy ...
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Background: Anterior cruciate ligament (ACL) is one of the major stabilizing ligaments of the knee. ACL reconstruction usually has high success rate. The choice of graft in ACL reconstruction has been a source of controversy. This study compares the outcome of two commonly used grafts.
Methods: Seventy patients with ACL tear among the cases referring to training hospitals of Kerman, Iran from 2013 to 2015 were studied. The patients underwent reconstruction, using, randomly, either the "four-fiber semitendinosus autograft" or tibias abterior allograft". The Lysholm, IKDC, KOOS and SF36 scores were evaluated for comparing clinical stability examination, laxity, subjective satisfaction, and return to work before and after surgery.
Results: The two groups were the same in term of age, range of motion, knee flexion, IKDC, KOOS, Lysholm scores as well as SF36. The ligament laxity did not show a significant difference either. The operative time was significantly different between two groups (p < /em><.001).
Conclusions: ACL reconstruction with tibias anterior allograft has similar clinical, functional and stability results as semitendinosous autograft in a short time follow-up; although the operation time was shorter in allograft group.
Amirreza Sadeghifar, MD; Arash Akbari, MD; Mahmood Karimi Mobarakeh, MD
Abstract
Background: Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur, proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute ...
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Background: Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur, proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute to increase risk of osteoarthritis. The objective of this study was to find the correct location of deformity in genuevarum or genuevalgum.Methods: We studied 40 patients with knee deformity at a mean age of 27.4 years (19-38), prospectively. Standing 3-point view radiographs were obtained on each patient, and the limb axis was determined. The data on limb malalignment was analyzed statistically.Results: In 94.5% of cases the location of varus deformity was proximal of tibia and in 5.5% in distal of femur, the best location of osteotomy. Our study also revealed multiple factors contributing to varus deformity, i.e. distal femur in 67.5%of cases, proximal tibia deformity in 92.5% of cases and ligamentous laxity in 77.5%.Conclusions: Varus knee deformity can be from proximal tibia, distal femur or knee laxity. Before any corrective surgery one must clarify location of deformity
Mahmood Karimi Mobarakeh, MD; Mohsen Mardani-Kivi, MD; Ali Akbar Keikha, MD; Keyvan Hashemi-Motlagh, MD; Khashayar Saheb-Ekhtiari, MD
Abstract
Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy ...
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Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL.Methods: In a prospective clinical trial, 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients, 40 knees) or without MCL release (29 patients, 36 knees). The outcome was studied comparing the stability in valgus, pattelar height slope of tibial plateau, and also the knee score (KSS) in a 17.4 months (3-24 months) follow-up.Results: The patients from MCL preserving group, with mean age of 26.7±9 improved their scores of 53.5±15.2 to 81.9±13.4. The cases from MCL-releasing group with mean age of 25.5±8.4 improved the score of 52.4±14.6 to 65.4+17.8. The rates of surgical complication and valgus instability were lower in MCL preserving ones, but tibial slope remained unchanged in either group.Conclusions: Both techniques lead to an improvement in the KSS score however it was more significant in MCL preserving group with lower complication and without valgus instability.
Mohsen Mardani-Kivi; Mahmood Karimi Mobarakeh; Kamran Asadi; Keyvan Hashemi Motlagh; Khashayar Saheb Ekhtiari
Abstract
Background: Cementless total hip replacement is an accepted alternative to total hip replacement with cement in younger patients, but it remains controversial for elderly patients. This study evaluated the functional results and complications of cemented and cementless methods in old patients.
Methods: ...
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Background: Cementless total hip replacement is an accepted alternative to total hip replacement with cement in younger patients, but it remains controversial for elderly patients. This study evaluated the functional results and complications of cemented and cementless methods in old patients.
Methods: In this cross-sectional study, all the patients aged 65 years or older who had been hospitalized for total replacement of hip joint because of femoral neck fracture or osteoarthritis of hip were studied during a 3-year period in three educational hospitals in Iran. "Harris hip score" was used to assess the functional consequences. The early complications -thrombophlebitis of lower limbs, dislocation, hematoma and infection - and late complications - aseptic loosening, dislocation, and reoperation, were documented.
Results: 209 eligible patients, including 96 (45.9%) cemented and 113 (54%) cementless were studied. Patients were followed for a mean period of 5 years and 2 months (51-82 months). The overall rate of early complication was 8 cases (3.8%): five in the cemented and three in cementless group, respectively. Late complications were seen in two cases -one loosening in cemented group and one dislocation in cementless group. The final Harris hip score at the final follow-up was 84.01±4.71 in cemented and 85±5.02 in the cementless groups (p≥.05).
Conclusion: Cementless hip replacement can have a satisfactory functional result like cemented hip replacement procedure in the elderly patients over 65 years of age.
Mahmood Karimi Mobarakeh; Mohsen Mardani Kivi; Sohrab Keyhani; Hadi Safaee
Abstract
Background: High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. ...
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Background: High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. Methods: In this case series study, 60 patients (76 knees, 27 male and 33 female) underwent an open wedge high tibia osteotomy surgery using a T-Buttress plate and a metal wedge in a in a teaching hospital in Kerman-Iran. Patients were assessed clinically and radiographically including Modified Hospital for Special Surgery Knee Scoring System (HSSKS), anatomical and mechanical limb alignment, Insall-Salvati patellar height index and proximal tibia posterior slope angle. Results: The mean tibia-femoral angle changed from -6.8 to +4.33 degrees. 26(43.3%) patients needed iliac cancellous graft. The mean metal wedge size was 11.07 mm (8-15 mm). The mean Modified HSSKS promoted from 75.5 to 98.73. The observed complications were: fracture in five, intraarticular screw penetration in four (one in proximal tibia-fibular joint), infection in two and under-correction in one patient. There was no non-:::union:::, proneal nerve injury, over-correction, plate failure, deep vein thrombosis and bone graft donor site complication. The mean posterior tibia slope changed from 8.05±1.95 to 8.68±1.54 degrees and patellar height index changed from 1.06 to .97. Conclusion: This procedure is a safe and reliable technique and lessened the need for an autograft. Significant improvement in score of Modified HSSKS was seen post operatively.
Mahmood Karimi Mobarakeh, MD; Mohammad Hasan Fadaee, MD; Massoud Mehdinejad Yazdi, MD
Abstract
Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injuries around the knee including ligamentous injuries, delayed :::union:::, and more importantly, vascular ...
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Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injuries around the knee including ligamentous injuries, delayed :::union:::, and more importantly, vascular injuries.Methods: In a cross sectional study of “floating knee” injuries treated in a training hospital of Kerman-Iran over a 1 year period (2003 to 2004) was performed. Seventy eight patients (69 males, 9 females), with a maximum follow-up of 2 weeks entered the study and are reported here. The injury type and, in particular, the vascular status of the limb in terms of prevalence and the fate of limb in first two weeks were the points of concern. Seventy eight “floating knee” patients comprised the study group that was divided into six groups in accordance with the limb vascular status. Each “floating knee” case was further classified according to the level and type of each bone fracture.Results: Out of 78 cases 18 has no pulse and did not regain any hemodynamic stabilization, and 13 had angiography and 5 went directly for arterial exploration. In general 15 cases (19.2%) of “floating knees” had vascular compromise, 8 of whom ended up with amputation. The vascular damage had no direct correlation with age, or anatomic location of fractures.Conclusions: Simultaneous ipsilateral fractures of femur and tibia are associated with around 20 percent chance of vascular injury. Careful and immediate assessment of limb circulation is mandatory for any “floating knee” injuries.
