Objectives: To describe a rare case of significant vascular injury that occurred following the harvest of hamstring tendon graft for anterior cruciate ligament reconstruction, with the need of repair.
Case report: A 30-year-old male soccer player presented with significant swelling and acute pain two hours after anterior cruciate ligament (ACL) reconstruction. Clinical examination and MRI scan showed bleeding, and a large hematoma in the middle of the left thigh. Hemorrhagic contention was only possible after a secondary repair, where a vessel of the sartorius muscle was bleeding profusely 12 hours after the primary surgery.
Discussion: The presence of a large number of vessels on the medial side of the knee associated with blind flexor tendons graft hamstring is cause of vascular injury during removal of the hamstring graft.
Conclusion: Although uncommon, graft hamstring of flexor tendons can have devastating consequences if some hemostasis procedures are not correctly applied.
Leung Ping Chung*
Introduction: Knee pain is one of the commonest disabling diseases of the elderly people. It has been taken for granted that it is a degenerative problem related to curtilage thinning, and the pathology does not involve much inflammatory process. Osteoarthritis is therefore the most popular term used.
Causes of osteoarthritis of the knee: Apart from in-born structural varieties that affects the function of the knee joint, many other causes have been described: "cartilage derived", "ligament derived", "meniscal derived", "bone derived" and "synovial derived" pathologies, all basing on structural changes involved.
There is an important dynamic mechanism that maintains a balanced functional position between the medial and lateral compartments of the knee joint irrespective of existing structural imperfections: the proprioceptive afferent receptor -cerebral autonomous output circuit. Proprioceptive receptors in the muscles, tendons, and joint capsules are detecting all the time the detail positions of the joint components in relation to the standing posture of the individual. They send messages up to the brain so that outputs of muscular adjustments are sent down to initiate chain reactions to maintain the joint in balanced harmony irrespective of structural imperfections.
Evidences of the proprioceptive protection of joints through an autonomous neurological circuit have been proven anatomically, clinically, and also through studies on other joints e.g. the trapezio-metacarpal joint of the thumb.
Discussion: It is therefore appropriate to introduce training activities to boost up the balancing dynamics around the knee joint, particularly for the early clinical presentations of osteoarthritis to prevent deterioration; and also before and after appropriate structural corrections, in order to maintain its functional integrity.