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An Isolated Extra-Articular Procedure can be Indicated for Patients With Minor Instabilities and Intact Graft After Anterior Cruciate Ligament Reconstruction
No full textBackground: Some patients submitted to isolated ACL reconstruction may have symptomatic postoperative rotational instability. The objective of this study was to evaluate a population with mild rotatory instability after ACL reconstruction, which was submitted to an isolated extra-articular procedure.
Methods: Patients submitted to an isolated extra-articular procedure after ACL reconstruction were retrospectively evaluated. Only patients presenting anterior knee instability of less than 5 mm, pivot-shift of a maximum of 1+, and ACL graft intact were included. Demographic data, physical examination and subjective functional scales were evaluated.
Results: Twenty patients were included. The mean age was 27.0 ± 7.3 years. The follow up time after the extra-articular procedure was 27.5 ± 6.2 months. The KT-1000 decreased from 3.0 mm ± 0.7 mm to 2 mm ± 0.4 mm (P = 0.00016). The pivot-shift improved from 100% of grade 1 positivity to 30% (6/20 patients) of grade 1 positivity (P \u3c 0.0001). The IKDC showed no difference (74.4 ± 11.8 vs. 87.6 ± 5.8; P = 0.087), but the percentage of patients who passed the PASS IKDC cut-off value increased from 45% (9/20) to 95% (19/20) (P = 0.0012). The Lysholm increased from 81.1 ± 7.3 to 91.2 ± 5.7 (P = 0.0001).
Conclusions: Patients submitted to an isolated extra-articular procedure due to residual instability after ACL reconstruction showed improvement in physical examination (KT-1000 and pivot-shift) and subjective functional scales. This procedure can be considered for a specific population with minor instabilities and intact ACL graft, avoiding a complete ACL revision
An Uncommon Presentation of Crowned Dens Syndrome Without Systemic Inflammation
Get PDFCrowned Dens Syndrome (CDS) is a rare but important consideration in the differential diagnosis of cervical spine pain in older adults. CDS is characterized by calcium pyrophosphate dihydrate (CPPD) crystal deposition around the odontoid process, often leading to symptoms that overlap with more common conditions such as rheumatoid arthritis (RA), meningitis, or cervical spondylosis. We report the case of a 74-year-old male with chronic neck pain and restricted cervical range of motion. Advanced imaging revealed characteristic calcifications surrounding the odontoid process, pannus formation, and erosive changes at the C1-C2 articulation, consistent with CDS. Clinical evaluation supported a diagnosis of CPPD-related CDS. The patient was successfully managed conservatively with nonsteroidal anti-inflammatory drugs and physical therapy, with notable symptomatic improvement over time. This case reinforces the utility of CT imaging in diagnosing CDS and differentiating it from other inflammatory or degenerative cervical conditions. Awareness of CDS and a high index of suspicion are essential for early diagnosis, appropriate treatment, and avoidance of unnecessary interventions. Conservative management remains effective in most cases; however, further studies are necessary to evaluate alternative therapies for refractory presentations