5 months after ACL reconstruction Rom 15 to 90. why should this happen. What to do now
On Scopy a "cyclops" lesion was seen. this was shaved of and a wide notch plasty was done to prevent further impingement. Full extension was acheieved however flexion was still limited. The suprapatellar pouch and the medial and lateral gutters were leared of the scar. Patellar mobility and full rom was achieved with medial and lateral patellar release which was the next stage of the plan.
The femoral srew looks quite anterior and probably 11 o clock position(but i guess that shouldnt cause rom problem) why the ffd(is it ffd or just lag) is it due to impingement of the graft due to anterior placement of the tunnel. I guess a lateral x ray with some more extension(as much as possible this looks like 45 deg in flexion) would be better.
ReplyDeleteoh yes, it is anterior and may be trans tibial and hence vertical. We do posteriolateral femoral bundle and anteriomedial tibial bundle postion for a single bundle recon today for better rotational control. The ffd may be due to prepatetallar fibrosi. Anterior femoral tunnel causes limitation of flexion and roof impingement.
ReplyDeleteIntent to do a hamstring using a the same tibial tunnel and a different femoral tunnel.
We sarted using a tensioning device at 22mm of traction to standardise the acl tension and not capture the knee.
For sure,the femoral tunnel looks vertical,sir.But i think loss of extension is due to notch impingement which should have been checked intraop and corrected.I would revise only the femoral tunnel and place it at 3 o clock and fix it with a tightrope. But iam still not convinced with the patellofemoral joint.At 30 degrees of flexion in the lateral view,Should there be some joint space?I also see a calcific spot at the inferior pole of patella.
ReplyDeleteDr sreecharan
did u revise it as mentioned?.... sir, when u scoped, what was the culprit in this case... was it the anterior femoral tunnel placement or fibrosis or both?..if the tunnel wasn't causing impingement , would u have just dealt with the fibrosis alone?
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