Ipsilateral fractures of the femur and tibia result in a flail knee joint condition referred to as “ floating knee” . Associated knee ligament injuries are common and have been reported to be frequently missed in initial evaluations. We report the diagnosis and treatment of the concomitant Patellar tendon rupture during fixation of the distal femur and proximal tibia fractures in a patient who presented with floating knee and a history of osteomyelitis. This case further highlights the paramount importance of careful assessment of the knee in patients who present with floating knee injuries. We also recommend that MRI and ultrasonography be used to prevent ignored Patellar tendon ruptures in such patients; particularly when physical exam is challenging or an intra-articular injury is present.

Background: Since anterior cruciate ligament (ACL) reconstruction become more frequently carried out, expectation of less morbidity and earlier return to activities become higher; for this reason graft selection become more important. The purpose of this randomized clinical study is to compare the outcomes of ACL arthroscopic reconstruction when using either Patellar tendon (PT) or tendons of medial hamstring muscle (HS).Materials and Methods: We evaluate the clinical results of 187 patients who underwent these techniques, as assessed by history, instability tests, KT 1000 knee arthrometer, Lysholm and IKDC score, and MRI and compare them. Majority of patients were followed and evaluated 6 months (92%) and 3 years (84%) after arthroscopic reconstruction.Results: There were no differences between the study groups preoperatively. Our comparison has shown significant kneeling pain and anterior knee pain in the PT with respect to HS technique. Although, extension deficits were significantly greater in the PT group, Flexion deficits were not significantly different between the groups. Clinical results according to the Lysholm scale and IKDC score between these techniques were the same, except Lysholm score was worse in PT group than HS group at 3 year follow up. About radiologic evaluation, the tibial tunnel enlargement was significantly higher in HS technique in comparison with PT technique.Conclusion: The use of both grafts had a good and equal outcome and the only difference is their long-term complications. Anterior knee pain, kneeling pain, and more extension deficit could be good reasons for a surgeon to prefer tendons of medial hamstring muscle as graft for performing ACL reconstruction.

Background: Rupture of Achilles tendon is a disabling condition and accounts for approximately 11-18% percent of all tendon ruptures.Objective: The goal of this study was to compare the functional brace with and without Patellar tendon bearing in patients with Achilles tendon rupture.Methods: This was a semi-experimental study initially carried out on 17 patients with Achilles tendon rupture although 3 patients failed to complete the follow-up course and were removed from the study. The remaining 14 patients were randomly divided into 2 groups. The calf circumference and the power of plantar flexion were measured and also the degree of satisfaction in patients evaluated. The data were analyzed using independent t-test, Kolomogrov-Smironov test, and the mean difference by SPSS13.Findings: There was a significant difference between the pre- and post-intervention regarding the calf circumference and also the power of plantar flexion in each group. However, no significant difference between two groups following intervention was found when all 3 variables taken into account (p>0.05).Conclusion: According to the findings of the present study, both kinds of orthoses used were effective on improving the plantar flexion power and reducing the calf circumference but no significant difference between the effects of both groups of orthoses on all variables after intervention was established.

Background and Objective: There has been considerable debate regarding the best treatment of the Achilles tendon rupture. One of the nonoperative treatment method for Achilles tendon rupture is using the functional brace. The aim of this study was to evaluate the effect of the functional brace with/without Patellar tendon bearing on treatment of patients with Achilles tendon rupture.Materials and Methods: In this semi experimental study, 17 patients with Achilles tendon rupture were recruited and randomly allocated into 2 groups: functional brace with Patellar tendon bearing and functional brace without Patellar tendon bearing. Pain, plantar and dorsi flexion strength and the required time for progressively increased dorsi flexion position in orthoses to reach the neutral position were measured. Data analyzed with SPSS-13, independent t-test and Smironov-Kolomogrov.Results: Three patients were excluded during follow up and finally this study was done on 14 patients. The difference of the pain intensity and the plantar and dorsi flexion, in each group, before and after the intervention was significant (P<0.05), but the difference between two groups after intervention in all variables was not significant.Conclusion: This study showed that both brace with/without Patellar tendon bearing are effective on improvement of pain and the plantar flexion and dorsi flexion strength and also are effective in required time to reach the neutral position.

Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired Patellar tendon rupture. Methods: This study included patients with chronic Patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of chronic Patellar tendon rupture. Patients had a mean age of 34. 4 years (range 18-58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3-132). The mean time of follow-up was 6. 2 years (range 3-9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22. 7/84. 5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic Patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Background: Little controversy exists on the indication for reconstruction in anterior cruciate ligament (ACL) tears. The question is what graft is the best and whether specific cultural needs of a population may affect the type of graft selected. Methods: This was a controlled trial study on 79 constructive patients who were randomly treated either with 4-surand hamstring (HTG) or bone Patellar tendon bone graft (BPTB). All the cases were evaluated by Lysholm score, Tegner activity score (TAS) and IKDC grade. Relative anterior tibial displacement was calculated; using knee arthrometer. Results: 43 patients from BPTB group and 36 patients from HTG group with mean age of 28.8 (17-43) fulfilled the criteria of the study. Mean follow-up time was 12.5 months (6-50) and was similar in both groups. The pre-operative findings (age, pre-operative activity level, prevalence of associated meniscal and chondral injuries, pre-operative Lysholm and TAS) were similar. The mean pre-operative Lysholm score was 64.4 (BPTB) and 56.2 (HTG). Pre-op TAS was 2 (BPTB) and 2.7 (HTG). Post-operative mean Lysholm score was 87.5 (BPTB) and 91.7 (HTG). Post-op, more than 50% in each group were either IKDC A or B. There was no significant difference between 2 groups in this regard. No difference between the two groups was observed regarding anterior knee laxity or anterior knee pain. Conclusions: With a 12 month follow-u no significant difference in outcome was found in patients who underwent ACL reconstruction in this patient population using either BPTB or HTG.