Background: Large defects in chronic Achilles TENDON ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the chronic large gaps in Achilles TENDON ruture using free semitendinosus interposition TENDON GRAFTing.Methods: In a case series study, eleven male patients with mean age of 30±4 years and average defect size of 8.31±1.96 cm in their old Achilles TENDON underwent reconstruction during 6 years in a teaching hospital in Tehran-Iran. Ipsilateral semitendinosus free TENDON GRAFT was used for reconstruction. The cases were evaluated by Ankle-Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS), and the Achilles TENDON Rupture Score (ATRS) to with a mean follow-up of 25.36±3.3 months.Results: The pre-operative AOFAS and ATRS of 70.4±5.3 and 31.7±5.7 preoperatively improved to 91.8±4.8 and 88.7±4.2 values. The ankle dorsiflexion showed a significant decline-postoperative value of 13.5±4.2 degrees compared to preoperative of 17.2±3.9 degrees (p=0.04). All the cases except a professional athlete, returned to their previous activities.Conclusion: This technique offers good clinical and functional results in patients with large defects and is associated with no donnersite morbidity. We recommend this technique for the reconstruction of the chronic at ruptures in patients with over 6 cm defects.

Background: In Flexor Pollicis Longus (FPL) injuries, primary repair with end-to-end suture is the treatment of choice. In cases where primary repair is not possible, TENDON transfer or TENDON GRAFTing is used, each of which has its strengths and weaknesses. We aimed to investigate the effectiveness of each of the above two methods in patients. Methods: Patients with FPL injury who referred to Hazrat Fatemeh Hospital, Tehran, Iran late in 2020 to 2021, if primary TENDON repair was not possible, were randomly repaired with TENDON transfer or TENDON GRAFT. After the appropriate time, the splint was opened and physiotherapy was performed for the patients. Then, at least three months after the repair, the range of motion of the IP and MP joints of the patients thumb was measured and compared in two groups. Results: Ten patients in the TENDON transfer group and 10 patients in the TENDON GRAFT group were studied. In the secondary repair of FPL with TENDON GRAFTing, the range of motion of both IP and MP joints of the thumb was not significantly different compared to repair with TENDON transfer. Conclusion: The findings of this research confirm controversies in this field. In order to obtain more accurate results, it is suggested to carry out a research with a larger number of patients and with strict control over the surgical technique and post-operative care, as well as taking into account the morbidities caused by donor TENDON removal and examining the overall satisfaction of the patients.

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 The anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgeries on the adult knee. Auto GRAFTs are essential for providing knee stability while minimizing donor site morbidity. The peroneus longus TENDON may be an alternative auto GRAFT for ACL reconstruction. This study aimed to evaluate the short-term clinical outcomes and donor site morbidity of ACL reconstruction using the peroneus longus TENDON. Methods This cross-sectional study was conducted on patients with an ACL tear, who underwent arthroscopic reconstruction using the peroneal longus TENDON. The knee functional outcomes were investigated based on the Lysholm and IKDC scores at preoperative and end of at least one year after the procedure. The follow-up period was at least one year, and the GRAFT diameter was measured intra-operatively. In addition, the American Orthopaedic Foot and Ankle Score (AOFAS), the Foot & Ankle Disability Index (FADI), and ankle range of motion were applied to evaluate ankle donor site morbidities. Results A total of 50 patients (47 men and three women) were followed up for at least one year with a mean age of 24. 2 years (17 to 50 years old). The mean follow-up time was 19 months (12-24 months). The mean diameter of the peroneal longus auto GRAFT was 8. 22 ±,0. 5 mm (7-9 mm). The AOFAS, FADI and ankle range of motion indicated no obvious ankle joint dysfunction. Conclusion According to the results, arthroscopic anterior cruciate ligament reconstruction with the peroneal longus TENDON is be a safe and effective auto GRAFT source.

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.

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.

Background: Many of the knees affected by rupture of the posterior cruciate ligament (PCL) lack their desirable function. Researchers are currently seeking surgical procedures for treating PCL rupture, which can offer a reliable degree of objective and subjective knee stability after surgery. This study assesses the results of anatomical reconstruction of PCL using GRAFT from the TENDON of the quadriceps muscle.Methods: This is a descriptive prospective study involving 14 patients with clinical diagnosis of PCL rupture. The patients complained of knee discomfort in spite of conservative treatment and many sessions of physiotherapy. Subjective symptoms of knee instability, i.e. giving way, pain after long walks and pain during climbing, as well as objective knee instability symptoms as assessed by posterior drawer test at 30° and 90° knee flexion, and neutral rotation were recorded and compared prior to and after surgery. The procedure entailed anatomical reconstruction of PCL using GRAFTs taken from the TENDON of quadriceps muscle and part of proximal patella.Results: Two patients were excluded from the study due to their failure to refer for follow-up. The patients included 11 men and 1woman with a mean age of 23 years. The patients displayed statistically significant improvement after surgery as regards subjective symptoms, i.e. giving way, pain after long walks and pain in climbing. Objective knee instability symptoms as evaluated by posterior drawer test at 30° and 90° knee flexion and neutral rotation also showed significant improvement compared to pre-operation findings.Discussion: Reconstruction of PCL is aimed at achieving normal knee kinematics and stability. The procedure used in this study entailed anatomical reconstruction ofPCL. Given the objective and subjective results obtained, the use of this procedure is recommended by authors as the method of choice for reconstructing PCL.

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.