Dataset Information

Open Repair of Acute Proximal Adductor Magnus Avulsion.

ABSTRACT: Hip adduction is accomplished through coordinated effort of the adductor magnus, brevis, and longus and the obturator externus and pectineus muscles. Each of these muscles may be injured at its proximal or distal insertion or in its midsubstance. The incidence of injuries to the adductor complex is difficult to determine in sport because of players' underreporting and playing through minor strains. The most commonly injured adductor muscle is the adductor longus muscle. The injury most frequently occurs at the proximal or distal musculotendinous junction, but several case reports of origin and insertional ruptures of the adductor longus exist in the literature. Successful outcomes have been obtained with both operative and nonoperative approaches in these cases. Reports of isolated proximal avulsion of the adductor magnus are less common. This article describes our surgical technique for management of a rare acute proximal adductor magnus avulsion.

SUBMITTER: McNeilan RJ

PROVIDER: S-EPMC6408720 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Open Repair of Acute Proximal Adductor Magnus Avulsion.

McNeilan Ryan J RJ Rose Michael M Mei-Dan Omer O Genuario James J

Arthroscopy techniques 20181224 1

Hip adduction is accomplished through coordinated effort of the adductor magnus, brevis, and longus and the obturator externus and pectineus muscles. Each of these muscles may be injured at its proximal or distal insertion or in its midsubstance. The incidence of injuries to the adductor complex is difficult to determine in sport because of players' underreporting and playing through minor strains. The most commonly injured adductor muscle is the adductor longus muscle. The injury most frequentl ...[more]

PMID: 30899654

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Project description:PurposeTo assess failure rate, outcomes, and patient satisfaction in patients who underwent anterior cruciate ligament (ACL) repair with suture augmentation for clinical instability and proximal avulsion of the ACL.MethodsWe retrospectively reviewed consecutive suture-augmented ACL repairs performed by a single surgeon between January 2014 and June 2016 for proximal ACL avulsion. Patients were included if they were at least 24 months postoperative from repair surgery. Patients were excluded from the study if they underwent primary ACL reconstruction instead of repair or if they had a concomitant multiligamentous knee injury. Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), Veterans RAND-12 (VR-12), Marx Activity, and Single Assessment Numeric Evaluation data were collected.ResultsOf 172 patients who underwent ACL surgery between January 2014 and June 2016, 28 (16%) with Sherman type I or II ACL tears or high-grade partial avulsion with clinical instability underwent ACL repair with suture augmentation. One patient was not available for follow-up. The 27 patients were age 27.4 ± 8.6 years, 18 males (66.7%), and 2.8 ± 0.7 years follow-up (range, 2.0-3.8 years). Of these 27 patients, 4 recurrent ACL injuries (14.8%) required revision to reconstruction. The remaining 23 patients had successful ACL repair with no clinical instability and no subjective complaints at final follow-up. Final scores were KOOS 83.7 ± 12.8, Marx 8.6 ± 4.0, VAS 1.1 ± 1.8, physical VR-12 53.6 ± 5.2, mental VR-12 53.1 ± 8.1, and Single Assessment Numeric Evaluation 83.0 ± 12.9. In the 11 patients with baseline data, significant improvements were observed in composite KOOS (50.4 ± 11.5 to 85.7 ± 8.4; P < .001; VAS: 3.9 ± 2.6 to 0.8 ± 0.8; P = .002; and physical VR-12: 39.9 ± 6.5 to 55.5 ± 3.3; P < .001). All 11 patients (100%) met or exceeded the KOOS composite minimum clinically important difference (mean 34.0 increase).ConclusionsIn patients with proximal ACL avulsion, arthroscopic primary ACL repair with suture augmentation demonstrated high functional outcome and improved patient-reported outcomes at 2-year follow-up. The rate of graft failure was 15%.Level of evidenceLevel IV, therapeutic case series.

Project description:Ischial avulsion fractures classically occur in the pediatric population and are relatively uncommon. These injuries are treated conservatively; however, in cases where there is greater than 2 cm of displacement, surgical intervention is recommended. In some cases, displaced fractures are either misdiagnosed or proper treatment is neglected, and patients who transition into adulthood are left with chronic nonunions that can become a source of pain and disability. Here we present a surgical technique for a chronic ischial avulsion fracture nonunion that is excised, and the hamstring tendons are then primarily repaired to the ischium using suture anchors. Technique Video Video 1 This is a video for the surgical intervention for a patient with a chronic right sided ischial avulsion fracture. The patient is placed in the prone position with all bony prominences padded. After a standard sterile prep and drape of the right lower extremity, an 8 to 10 cm incision is made in the gluteal crease, overlying the right-sided ischium. Electrocautery is used to reveal the underlying gluteal fascia. The gluteal fascia is incised using dissecting scissors. A Schnitt is used to open the interval inferior to the gluteus maximus muscle, and a large retractor is placed. A sciatic neurolysis is performed. The chronic avulsion fracture is revealed using electrocautery. A combination of electrocautery and a cobb elevator is used to free the bony fragment. After removal, the eburnated surface of the ischium is revealed. A combination of curettes and osteotomes are used to create a bleeding bone bed on the native ischium. Next, two 2.8 mm Q-fix (Smith and Nephew, Andover, MA) double-loaded all-suture anchors are placed into the native ischium. From each anchor, 1 suture limb from 1 pair is passed through the hamstring tendon in a locking fashion while the other is left free. From the other suture pair from the same anchor, one limb is passed in a modified Mason-Allen technique, and the other limb is left free. This is repeated for the other anchor. Using the free limbs of the anchors, the tendon is delivered to the ischium. The corresponding suture limbs are tied, and the free ends are cut with a knife. After copious irrigation a multilayer closure is performed. Dermabond is placed on the skin and a dry sterile dressing. After surgery the patient is made flat foot weightbearing in a hip orthosis and is started on chemical anticoagulation. At the first postoperative visit the wound is evaluated, and an X-ray film is obtained. (Soundtrack: Morning Routine by Ghostrifter Official | https://soundcloud.com/ghostrifter-official Music promoted by https://www.chosic.com/free-music/all/Creative Commons CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/)

Dataset Information

Open Repair of Acute Proximal Adductor Magnus Avulsion.

Publications

Open Repair of Acute Proximal Adductor Magnus Avulsion.

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