Papers by Ashraf Abdelkafy
MD conference express, Apr 1, 2015
Research article Natural course of intra-articular shifting bone marrow edema syndrome of the knee
Introduction Treatment approach to fifth metatarsal fractures (FMFs) in athletes has been largely... more Introduction Treatment approach to fifth metatarsal fractures (FMFs) in athletes has been largely influenced by the eagerness to reduce the time away from sport and ensure healing, which provided the drive for primary fixation as the accepted standard of treatment for the athlete. Patients and methods The current study was conducted as a prospective cohort study. A total of 24 patients who had FMF type 1 (avulsion of the tuberosity) were divided into two groups. Group 1 included 12 patients who underwent open reduction and internal fixation using a single screw, whereas group 2 included 12 patients who underwent nonoperative treatment in the form of below-knee cast. Results The average American Orthopaedic Foot and Ankle Society score for group 1 was 98.3, whereas for group 2 was 93.9 (P=0.03). The average visual analog scale for pain in group 1 was 0.5, whereas in group 2 was 1.1 (P=0.13). The average fracture union time in group 1 was 3.8 weeks, whereas in group 2 was 7.5 weeks (P...
The Patellofemoral Joint, 2021
Background: Recent studies of arthroscopic rotator cuff repairs have shown high failure. The diff... more Background: Recent studies of arthroscopic rotator cuff repairs have shown high failure. The different suture configurations were mostly tested in non degenerative animal tendon specimen. We used instead fresh-frozen degenerative human cadaver rotator cuffs. The goal of this study was to determine the biomechanical properties of commonly used arthroscopic stitches in ruptured human cuffs in comparison to intact rotator cuffs. Method: 36 human rotator cuff tendons were harvested, documented according to size, thickness and location of rupture, and divided into a ruptured and non ruptured specimen group. We found 12 ruptured and 24 intact cuffs. Three stitch configurations (simple, horizontal, and massive cuff stitch) with a Fiber Wire 2 (Arthrex) were randomized and biomechanically tested in each set of tendon specimen. The specimen were mounted on a uniaxial load machine (ZM200, Fa Shokoohi) and loaded to failure under displacement control at a rate of 0.6 mm/sec. Ultimate tensile l...
Clinical Anatomy of the Knee
Journal of Shoulder and Elbow Surgery
Frontiers in Physiology
Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength... more Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength and electromechanical delay (EMD) of the knee flexors in healthy young adults of different training status. Methods: Seventy-five male participants (27.7 ± 5.0 years) were enrolled in this study and allocated to three experimental groups according to their training status: athletes (ATH, n = 25), physically active adults (ACT, n = 25), and sedentary participants (SED, n = 25). The fatigue protocol comprised intermittent isometric knee flexions (6-s contraction, 4-s rest) at 60% of the maximum voluntary contraction until failure. Pre-and post-fatigue, maximal eccentric knee flexor strength and EMDs of the biceps femoris, semimembranosus, and semitendinosus muscles were assessed during maximal eccentric knee flexor actions at 60, 180, and 300°/s angular velocity. An analysis of covariance was computed with baseline (unfatigued) data included as a covariate. Results: Significant and large-sized main effects of group (p ≤ 0.017, 0.87 ≤ d ≤ 3.69) and/or angular velocity (p < 0.001, d = 1.81) were observed. Post hoc tests indicated that regardless of angular velocity, maximal eccentric knee flexor strength was lower and EMD was longer in SED compared with ATH and ACT (p ≤ 0.025, 0.76 ≤ d ≤ 1.82) and in ACT compared with ATH (p = ≤0.025, 0.76 ≤ d ≤ 1.82). Additionally, EMD at post-test was significantly longer at 300°/s compared with 60 and 180°/s (p < 0.001, 2.95 ≤ d ≤ 4.64) and at 180°/s compared with 60°/s (p < 0.001, d = 2.56), irrespective of training status. Conclusion: The main outcomes revealed significantly higher maximal eccentric strength and shorter eccentric EMDs of knee flexors in individuals with higher training status (i.e., athletes) following fatiguing exercises. Therefore, higher training status is associated with better neuromuscular functioning (i.e., strength, EMD) of the hamstring muscles in fatigued condition. Future longitudinal studies are needed to substantiate the clinical relevance of these findings.
Orthopaedic Journal of Sports Medicine
SICOT-J, 2016
The purpose of the current study was to investigate the reaction of the femur to the implantation... more The purpose of the current study was to investigate the reaction of the femur to the implantation of the MiniHip(TM) in terms of: (1) bone density change during one year; (2) correlations between stem length, CCD (caput-collum-diaphyseal), femoral offset, T-value, and bone density; (3) other co-variables that influence the change of bone density. MiniHip(TM) implant was performed for 62 patients. The age range of the patients who underwent treatment was 25-78 years. Periprothestic bone density was determined within two weeks postoperatively, after three, six, and twelve months utilizing the DEXA scan. The highest change was observed in the first three months post-implantation, while significant decrease in density was recorded at proximal Gruen zones 1, 2, and 7, and at distal Gruen zone 4. The decrease in density reached a plateau between the third and sixth months after operation. Afterwards, bone density recovered up to the 12th postoperative month. The correlation analysis showe...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Mar 19, 2016
European Journal of Orthopaedic Surgery & Traumatology, 2016
Accurate component alignment in total knee replacement (TKR) is one of the important factors in d... more Accurate component alignment in total knee replacement (TKR) is one of the important factors in determining long-term survivorship. This has been achieved by conventional jigs, computer-assisted technology (CAS) and more recently patient-specific instrumentation (PSI). The purpose of the current study was to investigate the in vivo accuracy of Trumatch™ PSI using validated pin-less computer navigation system. Twenty consecutive selected patients that fulfilled our inclusion/exclusion criteria underwent TKR using PSI. Coronal alignment, posterior slope, resection thickness and femoral sagittal alignment were recorded using pin-less navigation. The position of the actual cutting block was appropriately adjusted prior to proceeding to definitive resections. The coronal alignment using PSI without the assistance of navigation would have resulted in 14 (70 %) within ±3°, 11 (55 %) within ±2° and 6 (30 %) outside acceptable alignment. Thirty-five percentage of proposed femur sagittal alignment and 55 % of posterior tibial slope were achieved within ±3°. Components size was accurately predicted in 95 % of femurs and 90 % of tibia. The purported advantages in restoring alignments using Trumatch™ PSI alone over standard equipment are debatable. However, it predicts sizing well, and femoral coronal alignment is reasonable. Combining Trumatch™ PSI with CAS will allow in vivo verification and necessary corrections. IV.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 13, 2016
The purpose of the study was to compare the rate of secondary resurfacing in a consecutive series... more The purpose of the study was to compare the rate of secondary resurfacing in a consecutive series of five different total knee arthroplasty (TKA) systems. It was our hypothesis that different TKA design features such as sulcus angle or trochlear height influence the rate of secondary resurfacing. A retrospective study was performed on data from patients who underwent TKA without primary patellar resurfacing from 2004 to 2012 in an university-affiliated hospital. The study cohort included 784 TKA patients (m:f = 302:482, mean age at surgery ± SD 71 ± 10). Five different cruciate-retaining TKA systems were used consecutively (Group A, Triathlon, Stryker, Switzerland (n = 296), Group B, PFC Sigma, DepuySynthes, Switzerland (n = 215), Group C, LCS, DepuySynthes, Switzerland (n = 81), Group D, Balansys, Mathys, Switzerland (n = 128), Group E, Duracon, Stryker, Switzerland (n = 64)). Data were retrospectively obtained from hospital archives. Patients demographics, age at surgery, type of ...
SICOT-J, 2016
Background: The transosseous-equivalent cross bridge double row (TESBDR) rotator cuff (RC) repair... more Background: The transosseous-equivalent cross bridge double row (TESBDR) rotator cuff (RC) repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. Methods: Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, the Constant-Murley (CM) Score and Range of motion (ROM). Secondary outcome measures included a Visual Analogue Scale (VAS) for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D) for quality of life assessment. Results: At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. Conclusion: Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up.
International orthopaedics, Jan 7, 2016
Cortical femoral suspensory fixation using screw post in ACLR has the advantage of allowing compl... more Cortical femoral suspensory fixation using screw post in ACLR has the advantage of allowing complete filling of the femoral tunnel with graft tissue. In addition, the low cost of the implants is an advantage in countries where cost is an issue of concern. The purpose of the current study was to evaluate the clinical functional outcome results of cortical femoral suspensory fixation using screw post at mid-term follow-up. Single surgeon single centre prospective case series study. Sixty two patients having complete ACL tears were included in the current study. Average follow-up was 52.6 months (range 38-68). Objective and subjective IKDC scores, Lysholm knee score, SF-36 score, VAS for patients' satisfaction, VAS for pain and Kellgren & Lawrence (K/L) classification of osteoarthritis were used for follow-up evaluation. Objective IKDC score revealed that 59 patients had grade "A" and 3 had grade "B", while no single patient had neither grade "C" nor &...
SICOT-J, 2015
Background: The purpose of the current study was to determine whether a systematic five-step prot... more Background: The purpose of the current study was to determine whether a systematic five-step protocol for debridement and evacuation of bone debris during anterior cruciate ligament reconstruction (ACLR) reduces the presence of such debris on post-operative radiographs. Methods: A five-step protocol for removal of bone debris during arthroscopic assisted ACLR was designed. It was applied to 60 patients undergoing ACLR (Group 1), and high-quality digital radiographs were taken post-operatively in each case to assess for the presence of intra-articular bone debris. A control group of 60 consecutive patients in whom no specific bone debris protocol was applied (Group 2) and their post-operative radiographs were also checked for the presence of intra-articular bone debris. Results: In Group 1, only 15% of post-operative radiographs showed residual bone debris, compared to 69% in Group 2 (p < 0.001). Conclusion: A five-step systematic protocol for bone debris removal during arthroscopic assisted ACLR resulted in a significant decrease in residual bone debris seen on high-quality post-operative radiographs.
Archives of Orthopaedic and Trauma Surgery, 2015
Anatomic positioning of the femoral and tibial tunnels in the native ACL femoral and tibial footp... more Anatomic positioning of the femoral and tibial tunnels in the native ACL femoral and tibial footprints requires an independent drilling either via an accessory medial portal (trans-portal drilling) or using an outside-in drilling technique. Conventional trans-tibial drilling (dependant drilling) was found to lack the ability to accurately position the femoral tunnel in the native ACL footprint. The purpose of the current study was to evaluate the functional outcome results of anatomic single-bundle ACLR using the OI femoral tunnel drilling technique. Single surgeon single center prospective case series study. 64 patients having complete ACL tears were included in the current study. Average follow-up was 15.8 months (range 8-25). Objective and subjective IKDC scores, Lysholm knee score, SF-36 score, VAS for patients&amp;amp;#39; satisfaction, VAS for pain and Kellgren and Lawrence (K/L) classification of osteoarthritis were used for follow-up evaluation. Objective IKDC score revealed that 60 patients had grade &amp;amp;#39;&amp;amp;#39;A&amp;amp;#39;&amp;amp;#39; and 4 had grade &amp;amp;#39;&amp;amp;#39;B&amp;amp;#39;&amp;amp;#39;, while no single patient had neither grade &amp;amp;#39;&amp;amp;#39;C&amp;amp;#39;&amp;amp;#39; nor &amp;amp;#39;&amp;amp;#39;D&amp;amp;#39;&amp;amp;#39;. The average Lysholm Score was 92.4, average subjective IKDC was 91.5. Average SF-36 score was 96.7. The average VAS for operation satisfaction was 9.7. Average VAS for pain was 0.3. Forty-nine patients were classified as normal K/L classification, 7 were grade &amp;amp;#39;&amp;amp;#39;1&amp;amp;#39;&amp;amp;#39;, 8 were grade &amp;amp;#39;&amp;amp;#39;2&amp;amp;#39;&amp;amp;#39;. Comparing pre-operative and follow-up Objective IKDC, Subjective IKDC, Lysholm, SF-36 and VAS for pain scores revealed statistically significant differences (P value &amp;amp;lt;0.05). Arthroscopic-assisted ACL reconstruction using the outside-in femoral tunnel drilling technique shows a good and satisfactory functional outcome results at short- to mid-term follow-up. Level IV.
European Journal of Orthopaedic Surgery & Traumatology, 2014
The purpose was to evaluate the clinical results of arthroscopic meniscal repair of long vertical... more The purpose was to evaluate the clinical results of arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques. Single surgeon retrospective case series study. A total of 38 patients having long vertical longitudinal tears were operated using combined cruciate and horizontal suture techniques. Two patients had to undergo a meniscectomy procedure within the 1st year postoperative and those were considered failure cases; 32 patients were available for follow-up evaluation (average 4.6 years) and six were lost including the two failures. Objective IKDC, modified Lysholm knee score, SF-36 score, VAS for patients&amp;amp;#39; satisfaction and VAS for pain were used for follow-up evaluation. Kellgren and Lawrence (K/L) classification of osteoarthritis was also used. Successful rate was 94.1% (32 patients), while failure was 5.9% (2 patients). Objective IKDC score revealed that 27 patients had grade &amp;amp;quot;A&amp;amp;quot; and 5 had grade &amp;amp;quot;B,&amp;amp;quot; while no single patient had neither grade &amp;amp;quot;C&amp;amp;quot; nor &amp;amp;quot;D.&amp;amp;quot; The average modified Lysholm score was 91.3. Average SF-36 score was 88.4. The average VAS for operation satisfaction was eight. Average VAS for pain was 1.5. Preoperatively, 30 patients were classified as normal K/L classification, while two patients were K/L classification grade &amp;amp;quot;1.&amp;amp;quot; At the time of the follow-up, 24 patients were classified as normal K/L classification, six were grade &amp;amp;quot;1,&amp;amp;quot; two were grade &amp;amp;quot;2,&amp;amp;quot; and thus, six had osteoarthritis progression. Arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques is a safe surgical procedure with good clinical outcome. Level IV.
The Journal of Foot and Ankle Surgery, 2015
The talar neck is deviated medially with reference to the long axis of the body of the talus. In ... more The talar neck is deviated medially with reference to the long axis of the body of the talus. In addition, it deviates plantarward. The talar neck fracture line is sometimes observed to be oriented obliquely (not perpendicular to the long axis of the talar neck). This occurs when the medially deviated talar neck strikes the horizontally oriented anterior lower tibial edge. Internal fixation of a simple displaced talar neck fracture usually requires 2 lag screws. Because the fracture line is obliquely oriented, a better method for positioning the screws perpendicular to the fracture line is to place them in a reversed direction to provide maximum interfragmentary compression at the fracture site, which could increase the likelihood of absolute stability with subsequent improvement in the incidence of fracture union and a reduction of complications, such as avascular necrosis of the body of the talus. Two lag screws are used, with the first inserted from posteriorly to anteriorly (perpendicular to the fracture line) using a medial approach after medial malleolar chevron osteotomy. The second screw is inserted from anteriorly to posteriorly (perpendicular to the fracture line) using an anterolateral approach. Both screw heads should be countersunk. A series of 8 patients underwent this form of internal fixation for talar neck fracture repair, with satisfactory functional outcomes. In conclusion, the use of antegrade-retrograde opposing lag screws is a reasonable method of internal fixation for simple displaced talar neck fractures.
Uploads
Papers by Ashraf Abdelkafy