Objectives:To evaluate the associations between magnetic resonance imaging (MRI) findings of the anterolateral ligament (ALL) and clinical variables in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods:This retrospective multicenter study included patients with clinically confirmed ACL tears scheduled for reconstruction between January and August 2024 at three orthopedic centers in Mashhad. MRI examinations were performed using a 1.5-T scanner and interpreted by two to three experienced radiologists. Associations between MRI-detected ALL injuries and clinical variables were analyzed statistically. Results:Eighty-three patients (mean age, 29 years; 90.6% male) were included. MRI identified ALL injuries in 34 patients (41.0%), while 45 patients (54.2%) had no detectable ALL injury; four cases were unclassified. Concomitant ACL and ALL injuries were present in 41.7% of patients. A high-grade pivot shift test was positive in 54.2% of cases. Medial and lateral meniscal injuries were observed in 53.0% and 13.3% of patients, respectively, and joint effusion was present in 60.2%. Significant associations were found between ALL injury and MRI-detected effusion (P = 0.035) as well as a positive pivot shift test (P < 0.001). No significant relationships were observed between ALL injury and age, sex, or anterior drawer test findings. Conclusion:ALL injuries were significantly associated with joint effusion and positive pivot shift test results in patients undergoing ACL reconstruction. Although a possible association with posterior cruciate ligament buckling was observed, larger studies are needed to confirm this finding.
Objectives:The Merle d'Aubigné--Postel (MDP) score is a widely used patient-reported outcome measure (PROM) for assessing hip function for pain, walking ability, and mobility. Despite its widespread international use, no validated Persian version has been available to date. This study aimed to translate and culturally adapt the MDP score into Persian and evaluate its reliability and validity in Persian-speaking patients undergoing total hip arthroplasty (THA). Methods:Following Guillemin et al. guidelines, Persian translation was done using a forward--backward process, followed by expert review and pretesting with 20 patients to ensure clarity and cultural relevance. The adapted instrument was validated in 103 Persian-speaking patients who had undergone THA with at least one year of follow-up. Internal consistency (Cronbach's alpha), test--retest reliability (intraclass correlation coefficient [ICC]), construct validity (correlation with the Harris Hip Score [HHS]), criterion validity (correlation with HHS and the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and content validity (floor and ceiling effects) were evaluated. Inter-rater reliability for mobility was assessed by three orthopedic residents. Results:The Persian MDP score demonstrated high internal consistency (α= 0.74) and excellent test--retest reliability (ICC= 0.95; 95%CI: 0.91--0.98). Inter-rater reliability for mobility was excellent (ICC= 0.89; 95%CI: 0.82--0.94). Construct validity was supported by strong domain-specific correlations (e.g., MDP pain vs. HHS pain: r= 0.73; 95%CI: 0.62--0.81). Criterion validity was confirmed by strong correlations with WOMAC (r= 0.745; 95%CI: 0.65--0.82) and HHS (r= 0.753; 95%CI: 0.66--0.83). Content validity showed no floor effect (0%) and an acceptable ceiling effect (14.5%). Conclusion:The Persian MDP score is a valid and reliable instrument for assessing outcomes after THA in Persian-speaking patients. Its simplicity and strong psychometric properties support its use in clinical and research settings. However, the observed ceiling effect should be considered for excellent postoperative outcomes.
Objectives:Distal humerus fractures require stable fixation to restore elbow function, yet conventional plates often exhibit a geometric mismatch with bone morphology, potentially compromising biomechanical performance. Our finite element analysis (FEA) compared a novel anatomical plate designed to conform to native humeral geometry with a conventional plate for treating type B1 distal humerus fractures. The influence of meshing strategy on the outcomes was also evaluated. Both adaptive and uniform approaches were considered. Methods:A CT-based three-dimensional humerus model with heterogeneous bone properties was reconstructed from scans of a 37-year-old woman. An anatomically contoured plate was compared with a conventional locking plate. Adaptive and uniform meshing were applied separately to each model, and each construct was subsequently tested under 100 N tensile and compressive loads. Results:The anatomical plate showed higher stiffness (up to 13%), a broader contact pressure distribution (23--28 MPa vs. conventional: 12--18 MPa), and a larger area of sticking contact, whereas the conventional plate produced higher shear stresses (p=0.113). Uniform meshing generated significantly greater interfragmentary motion than adaptive meshing (p=0.008) but caused unrealistically high screw stresses (up to 1526 MPa). Adaptive meshing predicted higher bone stresses, whereas uniform meshing concentrated stresses in the screws. Although meshing affected the absolute stress and strain magnitudes, the comparative differences between plate designs remained consistent. Conclusion:The anatomically contoured plate offers greater biomechanical stability than conventional designs for distal humerus fractures, as evidenced by reduced displacement and maintained fragment positioning conducive to healing. An adaptive meshing strategy appears more suitable for FEA of complex fixation components because it yields more reliable stress distributions without altering the primary comparative conclusions. Further experimental validation is warranted before clinical application.
Postoperative infection is a rare but serious complication following anterior cruciate ligament reconstruction (ACLR). This review integrates current epidemiological trends, risk factors, and novel diagnostic and therapeutic approaches reported in the existing literature. The estimated incidence of septic arthritis (SA) after ACLR typically ranges from 0.14% to 2.6%. Male sex, smoking, hamstring autograft use, diabetes mellitus, and elevated body mass index (BMI) were identified as risk factors in earlier studies. Intraoperative presoaking of the graft in vancomycin, known as the 'vancomycin wrap' technique, has reduced infection rates and improved prophylactic practice. Diagnosis relies on patient history, physical assessment, and laboratory findings, including synovial fluid analysis and C-reactive protein (CRP). Management often involves urgent arthroscopic debridement and individualized antibiotic treatment, with the primary aim of preserving the ACL graft. Although graft retention is successful in many cases, persistent infection may require graft removal, which is associated with poorer outcomes.
