bluuebunny/crossref_metadata_2025_split huggingface dataset:
ACL Reconstruction In Laxity Patient
Authors: Utoyo Ghuna Arioharjo 
Published: October 2024

Introduction: The anterior cruciate ligament (ACL) is the most commonly injured in the knee and among the most commonly treated sporting injuries. This number has been increasing annually over the last decades. With the increasing incidence of this injury, there also is an inevitable increase in the number of failures and revision surgeries. ACL failure is most commonly caused by a technical error (non anatomic tunnel placement, impingement), biologic failure (graft choice), laxity, infection, and post-traumatic wear/failure. Patients who had generalized joint laxity would have worse outcomes and graft selection was a challenge for this condition Disscusion: Restoring knee joint laxity, to improve knee function, is the primary goal of ACL reconstruction. Nowadays, autografts that usually used for ACLR are BPTB and HT, but each technique has advantages and disadvantages, make a controversy regarding potential of grafts to restore knee laxity. In patients who have excessive joint laxity, the five-year outcomes of ACL reconstruction with bone-patellar tendon-bone grafts are better than those with hamstring grafts in terms of functional outcomes. Double Bundle was better functional outcomes than Single Bundle. HT used more frequently for primary ACLR. BPTB associated with donor-site morbidity problems compared with HT. Conclusion: Generalized joint laxity could be considered one of the risk factors for poor outcomes after ACL reconstruction. Any solution would give a good contribution for dealing with ACL with laxity, even though the simplest one. A careful preoperative evaluation, proper surgical technique and well monitored post operative rehabilitation, affect the final outcome after a ligament reconstruction.
Open Reduction Internal Fixation to Fix Posterior Cruciate Ligament Tibial Avulsion
Authors: Wien Aryana IGN 
Published: October 2024

Tibial avulsion fractures of the Posterior cruciate ligament (PCL) are common; however, methods of surgical treatment are insufficiently described. PCL is the main posterior stabilizer of the knee and limits posterior tibial translation relative to the femur . In addition, the PCL serves as a central axis controlling and imparting rotational stability to the knee. Isolated tear or avulsion of the PCL can be caused by falling onto a flexed knee or by striking the flexed tibia on the dashboard during a motor vehicle accident . Isolated PCL disruption most commonly occurs as avulsion at the point of tibial insertion, as opposed to its femoral origin or as a mid-substance tear. The tibial insertion of the PCL is also more consistent than the femoral insertion. The two PCL fibre bundles insert, without anatomic separation, into the centrally-located fovea or facet on the posterior aspect of the tibia, 1-1.5 cm distal to the joint line, with the posterior horn of the medial meniscus being the anterior-most extension . Chronic disability and early degenerative changes can develop as a result of delayed diagnosis. The posteromedial knee approach is a surgical technique for treating tibial avulsion fractures of the PCL. The technique involves reinsertion and fixation of the PCL bone fragment into its anatomical bed located on the posterior tibial surface. The posteromedial knee approach is reportedly sufficient for re-establishing ligament integrity and function; however, most surgeons are not familiar with this surgical approach because it is poorly-described within the published literature.
Meniscal ramp lesion: Is a routine repair necessary?
Authors: Giarso Peter 
Published: October 2024

Meniscal ramp lesions are injuries of longitudinal vertical and/or oblique peripheral tears of the posterior horn of the medial meniscus at the meniscocapsular junction or the meniscotibial ligament and are frequently associated with concomitant anterior cruciate ligament (ACL) injury. Arthroscopy remains the diagnostic gold standard as magnetic resonance imaging has limited sensitivity. Biomechanically, ramp lesions are known to increase anterior tibial translation and rotational laxity. Clinical investigations regarding optimal management are largely limited to studies of low evidence levels. There is some evidence to suggest that ramp lesion repair at the time of ACL reconstruction restores joint kinematics and that ramp lesion repair is safe and efficacious. Patients with unstable lesions may also benefit from surgical repair compared to a more minimalist approach, primarily in situations where the lesions is found to be unstable during arthroscopic manipulation. While case series have demonstrated that repair is safe and efficacious, comparative studies have failed to suggest that repair of stable lesions results in superior outcomes when compared to conservative treatment approaches. However, repair may be warranted in unstable ramp lesion injuries despite the increased risk for revision surgery. The current body of clinical literature is limited, and further robust, long-term study is warranted to better guide injury diagnosis and management protocol.
High Tibial Osteotomy in Sport-Related Cases
Authors: Valentino Rawung Rangga 
Published: October 2024

High Tibial Osteotomy (HTO) is a surgical procedure increasingly employed in sport-related cases with the aim of preserving knee joint function and delaying or altogether avoiding knee compromise. This technique involves the realignment of the tibial plateau through controlled bone cuts, resulting in an optimized distribution of forces on the knee joint. Sport-related activities often lead to unique knee joint stresses, particularly in cases of chronic anterior cruciate ligament (ACL) deficiency, varus malalignment, or early-stage osteoarthritis. HTO offers an alternative treatment option for athletes and active individuals seeking to maintain their performance levels while simultaneously addressing their knee joint issues. This procedure offers an effective approach to alleviate symptoms, correct alignment, improving stability, preserve meniscal tissue and cartilage, The HTO procedure can be a procedure offered along with ligament reconstruction procedures and other soft tissue repairs in the knee in mal-aligned knee conditions. Studies show that there is a relationship between failure of ACL reconstruction and others soft tissue procedurs and mal alignment of the knee Although HTO offers many advantages, careful patient selection and evaluation is essential to maximize the likelihood of a successful outcome. A comprehensive preoperative assessment, including physical examination, radiographic evaluation, and review of detailed medical history, type of exercise, and patient expectations will help identify eligible patients and reduce the potential for complications.
The Importance of Preoperative Rehabilitation in Knee Ligament Reconstruction Surgery
Authors: Alit Pawana I Putu 
Published: October 2024

The ACL is a central ligament of the knee. The main functional role of the ACL is to provide stability against anterior tibial translation (ATT) and internal rotation. Pre rehabilitation improved patient reported symptoms (Modified Cincinnati Knee Rating System) at 12-weeks post operation. Increased subjective knee scores are associated with increased psychological readiness for return to activity, at 12-weeks post-operation; single leg hop distance/LSI scores were significantly higher in the group who received pre rehabilitation compared to the control group. Goals and benefits of ACL prehabilitation are restore knee range of motion, lower extremity strength, especially quadriceps, knee stability, balance, proprioception, confidence in return to sport and reduce likelihood of reinjured or contra lateral injury. ACL contains mechanoreceptors which affect neuromuscular control of the knee beyond its mechanical function of maintaining knee joint stability The surface EMG can be useful for evaluation of muscle strength and balance for pre operative rehabilitation preparation and also during rehabilitation after ACL injury.
Neuromuscular Training in ACL Injury Prevention: A Narrative Review
Authors: Pangestuputra Agil Wahyu , Changestu Daniel Alexander 
Published: October 2024

Introduction and objective: Anterior cruciate ligament (ACL) injuries remain a significant concern in sports, demanding effective prevention strategies. Neuromuscular training offers promise by enhancing neuromuscular control and biomechanics, potentially reducing ACL injury risks. This narrative review systematically assesses the current literature regarding the effectiveness of neuromuscular training in ACL injury prevention. Encompassing diverse exercises—balance, strength, plyometrics, agility, core stability—and biomechanical analyses, the review highlights multifaceted benefits. Improvements in muscular strength, joint stability, movement mechanics, and neuromuscular coordination are prominent. Moreover, the review emphasizes tailored and progressive protocols, while also addressing potential implementation challenges. Through this synthesis, the narrative review helps us comprehend the crucial part that neuromuscular training plays in preventing ACL injuries, which calls for more research and its incorporation into athletic and rehabilitation programs. The goal is to advance knowledge of the function of neuromuscular training in preventing ACL injuries, in post-ACL Reconstruction therapy, and to offer insightful information to both researchers and practitioners in the field. Methods: This narrative review utilized PubMed to search for studies using Medical Subject Headings (MeSH) terms related to Anterior Cruciate Ligament Injuries, Neuromuscular Training, Motor Learning, Biomechanics Exercise therapy/methods, Knee Injuries/prevention & control, Sports Medicine and Rehabilitation. Searches were confined to titles and abstracts of English-language studies. Inclusion criteria encompassed studies focusing on football athletes (excluding para athletes), across genders, featuring NMT, and targeting primary or secondary injury prevention, including post-ACL Reconstruction Rehabilitation. Result: From an initial pool of 556 studies, 15 were selected for full-text review after title and abstract screening. Following rigorous comparison against eligibility criteria, 6 studies were included in this narrative assessment. Conclusion: This narrative review offers insights from recent research endeavors aimed at optimizing ACL injury prevention and refining post-ACLR rehabilitation strategies. Key findings emphasize the integration of motor learning concepts, utilization of external focus cues within neuromuscular training, and tailored programs designed for specific sports. Studies consistently highlight the potential for improved motor skill acquisition, reduced injury susceptibility, and enhanced biomechanical attributes. Cumulatively, these insights offer valuable guidance for the fine-tuning of ACL injury prevention and rehabilitation protocols.
Surgical Repair of Stener-like Lesion of the Medial Collateral Ligament of the Knee
Authors: Riantho Albert , Parsaoran Butarbutar John Christian , Fidiasrianto Kevin , Ivander Gian 
Published: October 2024

Introduction: Superficial medial collateral ligament (sMCL) tears of the knee will usually be treated non-surgically. But in some cases such as those with tears at the distal insertion, where it may displace over the pes anserinus tendons (Stener-like lesion), surgery will be performed. Here, we describe a patient with acute traumatic Stener-like lesions of sMCL based on clinical evaluation and imaging results, who underwent primary surgical repair. Case Presentation: A 26 years old male patient was admitted to the outpatient clinic with a chief complaint of left knee pain after valgus trauma on the left knee while playing badminton 5 days prior. Clinical examination revealed a moderate swelling and there was tenderness on the medial joint line. The full knee flexion was restricted due to swelling. A valgus stress test showed laxity of the medial joint. The anterior drawer and Lachman test showed anterior laxity. A left knee joint aspiration was done and 45 cc of red cloudy synovial fluid was aspirated. On the MRI examination, a bunched MCL with a displacement of the tibial insertion site over the per anserinus tendons was identified, along with the complete rupture of the ACL. The patient underwent two-stage treatment : an arthroscopic ACL reconstruction and surgical repair of the MCL. After the surgery, the patient wore a knee brace fixed in full extension for 4 weeks. The patient also followed a standard ACL rehabilitation protocol. Follow up were done 6 months after the surgery. Results: At final follow-up, the patient had regained normal stability of the MCL without any laxity in comparison to the contralateral knee. The anterior drawer and Lachman test had returned to normal. Patient was completely pain-free and did not have any complaints of instability. Discussion: Surgical repair is indicated in specific circumstances such as a Stener-like lesion in which the interposition of the pes anserinus between the ligament impeding the healing process of MCL. Prompt surgical intervention can restore the anatomic position of the MCL, promote anatomic healing, and prevent long-term valgus instability. Conclusion: Stener-like lesion of the MCL are rare, and early diagnosis is important in treating this condition. Surgical treatment must be done to provide complete healing of the MCL.
Lateral Discoid Meniscus: A Case Report
Authors: Anggrian  , Utoyo Ghuna Arioharjo 
Published: October 2024

Introduction: Discoid lateral meniscus is a deformity of the meniscus characterized by hypertrophy of the central portion of the meniscus; the incidence rate ranges from 3% to 5% and reaches 15% in Asian ethnicities. Previous researchers have hypothesized that failure to internalize the central portion of the meniscus during embryonic and fetal development due to genetic mutations may be the cause of this disorder. In a number of studies, the detection and selection of appropriate measures have yielded positive results. Case: We reported a 33-year-old male patient complaining that the left leg feels like locking since 4 months ago, previously the patient complained of a left knee sounding "click" after falling while running fast. Patient was diagnosed with a lateral discoid meniscus of the left knee after undergoing a physical examination, an x-ray examination, and an MRI examination. For a torn lateral discoid meniscus, the patient underwent knee arthroscopy and saucerization. Discussion: Discoid meniscus is an anatomical variation of discus-related injuries. The diagnosis is based on the "bow-tie sign" and can be diagnosed by the MRI. The total arthroscopic approach is used to determine the normal position of the discoid, while the saucerization technique is used to maintain normal position. Studies have shown that the saucerization technique can improve the stability of the discoid, reduce neurovascular damage, and reduce the potential of the chondral structure. The combination of saucerization and arthroscopic techniques can help minimize the risk of discoid meniscus injuries. Conclusion: Cases of discoid meniscus are uncommon, and their etiology remains unknown. In asymptomatic cases, conservative is the treatment of choice, whereas in cases with symptoms, surgery can be performed. Saucerization with arthroscopy is currently the most commonly used procedure in its management.
Simultaneous Bilateral Quadriceps Tendon Rupture in A Diabetic Patient: A Rare Case Report and Surgical Technique
Authors: Utoyo Ghuna Arioharjo , Setiadi Christian 
Published: October 2024

Introduction & Objectives: In orthopaedic medicine, a quadriceps tendon rupture (QTR) is an uncommon finding that needs appropriate surgical care to prevent permanent deformity and loss of knee function. Diabetic patients may experience spontaneous quadriceps tendon rupture due to compromised microvascular supply, which puts the quadriceps tendon at risk for fiber degradation and a reduced resistance. Early surgical management is needed to reinsert the tendon at the superior aspect of the patella. Here, we aimed to describe a rare case and the surgical technique of bilateral simultaneous quadriceps tendon rupture in a diabetic patient. Case Presentation: A 78-year-old man with a history of diabetes presented at the hospital due to his inability to straighten his left leg, accompanied by pain. His left knee showed swelling, limited range of motion, and a visible gap in the quadriceps tendon above the patella. The patient had intact pulses in the leg. Radiographic images displayed displacement of the patella, and MRI revealed a disrupted tendon with bleeding and swelling. A preliminary diagnosis of quadriceps tendon rupture was made. The patient underwent surgery to repair the tendon, in this patient we use midline incision, refreshed the ruptured ends. We use tape sutured with Bunnel technique and two suture anchor were running locked krackow stitiches to get more rigid fixation. After operation patient received post-operative rehabilitation with brace is fixed in full extension for 1 weeks and exercise isometrically. Patient can mobilization but uses 2 crutches. After 1 week of immobilization, the range of motion is increased gradually by 10° of flexion per 1-week periods. His final knee range of motion was 0° to 125° in both legs after an entire course of physiotherapy. He was discharged from the clinic after six months and returned to work. Conclusions: Quadriceps tendon rupture is a rare injury that is typically accompanied by a chronic medical condition. Therefore, as the rupture may be the first indication of an underlying problem, patients with bilateral QTR should be assessed for underlying pathologies such as diabetes mellitus or other endocrine disorders, renal, autoimmune, or rheumatologic diseases and we must use rigid fixation because in this chronic medical condition, patient has the risk of reruptured.
Arthroscopic Approach for Fixation of a Neglected ACL Avulsion Fracture: A Case Report
Authors: Febrianto Dani Pratama , Winata Fahroni C. 
Published: October 2024

Introduction: Anterior cruciate ligament (ACL) avulsion fractures constitute a significant proportion of knee joint injuries and can lead to substantial disability if left untreated. These fractures result from forceful hyperextension or a direct impact on the distal end of the femur while the knee is flexed. Presently, Meyers and McKeever's classification system is used to categorise these fractures. The popularity of arthroscopic reduction and fixation techniques due to limited skin incisions and soft-tissue injuries have been growing since there is no gold standard treatment for ACL avulsion fractures. This report aims to describe the potency of arthroscopic techniques in fixing neglected ACL avulsion fractures to improve knee function and calculate it using Patient-Reported Outcome Measures (PROM), the Indonesian version of International Knee Documentation Committee (I-IKDC). Objective: A 19-year-old young woman sustained an ACL injury during a sports activity. Over time, her pain progressively worsened and limiting her ability to perform fully extend her knee and a full squat. X-ray and MRI revealed evidence of avulsion at the ACL insertion site on the tibia, classified as a grade 2 based on Meyers and McKeever's Classification. Despite undergoing conservative therapy, the pain persisted for 8 weeks before the patient was admitted for surgery. Discussion: Her pain really limits her daily activities and her career as a sales promotion representative. For the surgical technique, we did a meticulous cleaning of the fracture site, followed by fixation utilizing a fiber suture. Next, a looping suture was created at the ACL insertion point, threaded through a tibial hole, and fixed at the anterior tibia, aligning with the location of the ACL insertion. Three months after the surgery, we did a follow-up and found that she has no pain when she fully extends her knee, does a squat, and also does light jogging. Her X-ray postoperative shown a united avulsion fracture. We also calculated using I-IKDC and found a satisfactory result of 83% for her knee function. Conclusion: The arthroscopic approach achieved a satisfactory clinical outcome and provided an effective method for the treatment of neglected ACL avulsion fractures..
Arthroscopic Assisted Management Malunion of Tibial Plateu Fracture: A Case Report
Authors: Febrianto Dani Pratama , Winata Fahroni C. 
Published: October 2024

Introduction: A tibial plateau fracture constitutes 1% of all fractures and usually occurs as a result of falls or motor vehicle accidents. Men are more susceptible to experiencing this injury through high-energy mechanisms and often accompanied by soft tissue injuries. Failure in the initial treatment can lead to malunion of the tibial plateau fracture, which frequently results in impaired knee functionality. Severe malunion is necessary for surgery to restore basic knee function. This report aims to outline the benefits of using arthroscopy-assisted open reduction and internal fixation (ORIF) surgery for malunion tibial plateau fractures. Objective: A 20-year-old male experienced a motorcycle accident. He feels pain when he flexes and extends his knee. Radiological assessments, including X-rays and CT scans, revealed a malunion of depressed medial component of the tibial plateau, classified as a tibial plateau fracture type 4 based on Schatzker’s classification. The symptoms persisted for 34 weeks before surgical intervention. Discussion: Arthroscopic-assisted ORIF surgery was performed to realign the irregular bone fragments and stabilize the bone using implants and screws. The arthroscopy was used during surgery to locate the intraarticular malunion site. Two guide wires were inserted with the help of an ACL guide, and then we performed the osteotomy procedure along the guide wires. Next, the fracture site was openly reduced and internally fixed (ORIF) confirmed by using arthroscopy. Simultaneously utilizing arthroscopy and ORIF were chosen for their combined ability to precisely identify fracture borders, using guide wires to accurately pinpoint the osteotomy site. Two months after the surgery, we did a follow-up and found that he has no pain when he flexes and fully extends his knee. The follow-up X-ray also shown good alignment of the tibial plateau. Conclusion: The arthroscopic-assisted ORIF approach yields favorable clinical outcomes, reduces scar tissue-induced pain, improves post-operative knee function, and is effective in treating malunion tibial plateau fractures..