Operative results of arthroscopic open ACL reconstruction in 32 patients by BONE-patellar TENDON-BONE graft was evaluated in shariaty hospital from 1997 to 2000. For assessment we used criteria developed by international Knee documentation committee. Signs and symptoms of the patients, their satisfaction and activity level in preoperative and postoperative period were assessed. The IKDC score, signs and symptoms were significantly improved following surgery. One patient showed failure of fixation. Ninety one percent of patients were satisfied with subjective evaluation of normal or near normal. The type of operation (open or arthroscpic), associated meniscal tear, age of the patients and time interval between rupture and reconstruction had no effect on the result but in patients with a quadriceps atrophy in postoperative period, caused result decline.

Background & Aim: Many factors influence the tensile strength of the TENDON in a TENDON-BONE tunnel COMPLEX. The purpose of this study is to determine the influence of TENDON length & time of implantation of the TENDON in the BONE tunnel on the tensile strength of the TENDON in a rabbit model.Material and Methods: In this prospective study fourteen adult (age 6 months) White New Zealand rabbits (weight: 2.5-3 kg) underwent bilateral hindlimb (n=24) surgery in which the Extensor digitorum longus TENDON was implanted into the tibial metaphyseal extra-articular BONE tunnel. Based on the length of BONE tunnel (1 or 2 cm) and duration of implantation (6 or 12 wks), the rabbits were divided into 4 groups. Seven rabbits were sacrificed after 6 weeks (groups 1 and 2) and 7 others were sacrificed after 12 weeks(groups 3 and 4) for TENDON tensile loading test to determine ulitimate pull-out strenght.Results: In group one (1 cm, 6wks) one TENDON was ruptured and four were pulled out, in group two (2 cm, 6 wks) one TENDON ruptured and six pulled-out, in group three (1cm, 12wks) one TENDON was pulled out and five ruptured and in group four (2 cm, 12 wks) five TENDONs ruptured and one was pulled-out. The mean failure force after 6 wks. was 4.98N for group one and 9.37N for group two. After 12 wks. it was 6.36N for group three and 10.81N for group four. Failure force difference was significant between 1 and 2 cm TENDON lengths after 12 wks. TENDON rupture site was significantly different after 6 & 12 wks.Conclusion: This study demonstrated that the TENDON length within a BONE tunnel influences TENDON tensile strength after 12 weeks. In other words, increase in TENDON length within the BONE tunnel, increases its' resistance against tensile strenght with the passage of time. Time of implantation has an additive effect to TENDON length on the TENDON tensile strength of the TENDON-BONE tunnel COMPLEX.

BONE-patellar TENDON auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months). Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm’s score was 63.6(40- 86) preoperatively and 91.88(73-100) at the latest follow up (P < 0.005). No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal BONE graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL reconstruction using BONE-patellar TENDON-BONE graft.

Background and Objective: Anterior cruciate ligament (ACL) tear is one of the most common knee injuries among young adults and sportman. They need reconstruction when they are accompanying with other knee internal derangements to prevent knee osteoarthritis. This study was designed to explore early complication of anterior cruciat ligament reconstruction with BONE-patellar TENDON- BONE graft.Materials and Methods: This prospective and cross-sectional study was done on 13 patients which refered to Qaem hospital in Mashhad-Iran during 2008. The first 3 months complications and problems of anterior cruciate ligament reconstructions, with BONE-patellar TENDON, BONE graft technique, was recorded on regular basis, symptoms and signs were documented.Results: Anterior knee pain and knee stiffness were common as 70% and 38% respectively. We did not observe any infection but in 15% of patients a minor instability (ADT+) was detected. Patients cooperation was low and even 54% of them did not implement, post-operative advices.Conclusion: This study showed that minor instability and subsequent pain are the early problems during the first three month after anterior cruciate ligament constraction. 

Background: Anterior cruciate ligament (ACL) is one of the most important stabilizers of knee joint, which is often injured in major accidents or in sporting activities. Among the many different available techniques for its reconstruction, BONE-patellar-TENDON-BONE graft is a commonly used method. We are reporting our experience with this particular technique. Methods: This was a prospective clinical trial on 39 male patients in a 4-year period who received BONE- patellar- TENDON- BONE graft substitution for their ACL deficient knees. The patients were evaluated in follow-up by American Orthopaedic Society for Sport Medicine (AOSSM) questionnaire, as well as clinical testing 3-48 months after surgery. Results: Anterior knee pain of varying degrees was the most common problem and was observed in 31(82.1%) cases. Giving- way was the main complaint in 33 (84.6%) cases pre-operatively, which decreased to 8 (20.5%) post surgery. Five patients (12.8%) returned to full sporting activities, while 27 (71%) still participated in sports but not to their previous capacity. Twenty seven cases (75.7%) were satisfied with the surgery. Conclusions: Patellar- BONE- patellar- TENDON grafting is a suitable procedure for symptomatic anterior cruciate ligament deficiency and is successful in two third of the cases.

Introduction: Carney COMPLEX is an autosomal dominant syndrome that is defined with different tumors including myxoma in different organs, endocrine tumors and lentiginosis lesions. This is the first case report of this syndrome from Iran.Case: The patient is a 27 year old girl, referred with flank pain. Physical examination revealed hirsutism, truncal obesity, hyperpigmantasion and hypertension; Cushing's syndrome was suggested and confirmed with related classic biochemical tests. She had history of cardiac myxoma during her childhood and had been operated twice.Pituitary microadenoma and right adrenal adenoma were reported on MRI and CT-scan, respectively. Initially laparascopic right adrenalectomy was done; as expected, no remission in signs of Cushing's syndrome was observed after surgery. By laparoscopic adrenalectomy of the other site, Cushing's syndrome resolved. Pathologic report of 1st operation was adrenal adenoma with surrounding pigmented micronodular hyperplasia and of the 2nd one was just pigmented micronodular hyperplasia.Conclusion: We have reported a patient with Carney syndrome along with Cushing's syndrome due to bilateral adrenal hyperplasia and an adenoma in contralateral adrenal and microadenoma of the pituitary as an incidentaloma. This is a new presentation of Carney syndrome.

Background: The gold standard in ACL reconstructions has been the BONE-patellar TENDON-BONE autograftfixed with interference screws. This prospective study, aimed to compare two method of fixation for BPTB grafts: press fit fixation vs. interference screw, over a 12 months follow-up interval.Methods: In a randomized clinical trial study, 158 patients with an average age of 29.8 years were treated for torn ACL with BPTB autograft in a teaching hospital in Tehran, Iran. In 82 patients press fit fixation technique, and in 76 cases an interference-screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference-screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications.Results: In the final follow-up, 59 cases in interference screw and 55 in press-fit screw group had good-to-excellent IKDC score (p³.05). The mean laxity assessed improved to 2.7 mm and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift tests, there was a statistically significant improvement in the integrity of the ACL in both groups, with no significant difference (p³.05).Conclusions: the press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited BONE-to-BONE healing, no need for removal of hardware, ease for revision and cost effectiveness.

Background: Many grafts are used for ACL reconstruction with different methods of fixation. We have presented a new technique for BTB (BONE-TENDON-BONE) graft preparation and compared its biomechanical properties with the classic one to see if the suspensory method of fixation is applicable for BTB grafts. Methods: Eight fresh frozenhumanBTBgraftswereprepared. Graftswererandomlydivided intotwoseparate groups. Each containing 4 grafts. In the first group grafts were prepared with standard BTB graft method and in the second group grafts were prepared with new enfolded method. All the grafts were assembled in a universal testing machine for testing the mechanical properties of the grafts. Maximum tensile strength, failure load and failure mode were derived from machine and the values were compared in each group. Results: Mean failure load for classic group was 1660. 25 and for enfolded group it was 1579. 25 (P = 0. 25). Mean stiffness for classic group was 285. 25 N/meter and for enfolded group it was 268. 75 N/ per meter (P = 0. 1). In classic group, all failures happened at the BONE-ligament junction. In the enfolded group, failures also occurred through the tendino-osseous junction except for one case. Conclusions: Enfolded BTB graft preparation had the same biomechanical indexes of classic method. Therefore this graft preparation method can be used for ACL ligament reconstruction surgery with used of suspensory fixation by Endobutton.