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Figueroa F, Guiloff R, Bolton S, Figueroa D, Tapasvi S, Stocker E. Specific considerations in female patients with patellar instability: current concepts. J ISAKOS 2024:S2059-7754(24)00068-3. [PMID: 38580053 DOI: 10.1016/j.jisako.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Prior literature suggests that patellofemoral instability (PFI) is significantly more prevalent in women than in men. This higher prevalence is commonly attributed to anatomical differences between sexes, particularly with patellofemoral alignment. These differences encompass a higher rate of trochlear dysplasia (TD), patella alta, an increased Q angle, and soft tissue imbalances. In recent years, worse outcomes have been reported in female patients after patellofemoral stabilization surgery using medial patellofemoral ligament reconstruction (MPFLr) alone or in combination with a tibial tubercle osteotomy (TTO), for this reason an "à la carte" plan (addressing the individuals anatomical risk factors) could be more appropriate for female patients.
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Affiliation(s)
- Francisco Figueroa
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile; Hospital Sotero del Rio, 8207257, Chile.
| | - Rodrigo Guiloff
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile; Hospital Sotero del Rio, 8207257, Chile.
| | - Sarah Bolton
- Fortius Clinic, W1H 6EQ, UK; Chelsea & Westminster Hospital, SW10 9NH, UK.
| | - David Figueroa
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile.
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Mabrouk A, An JS, Kley K, Tapasvi K, Tapasvi S, Ollivier M. Combined knee osteotomy and cartilage procedure for varus knees: friend or foe? A narrative review of the literature. EFORT Open Rev 2024; 9:173-180. [PMID: 38457915 PMCID: PMC10958248 DOI: 10.1530/eor-23-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Varus knees with associated cartilage pathologies are not uncommon scenarios that present to orthopaedic surgeons. There is no agreement on the ideal management of varus knees with concomitant cartilage pathology. Through a literature review, the authors tried to answer three main questions: On October 2022, OVID MEDLINE, EMBASE, and COCHRANE databases were searched. Clinical studies reporting on clinical, radiologic, or macroscopic cartilage regeneration following either isolated knee osteotomy or concomitant osteotomy and a cartilage procedure were reviewed. Despite controversies, the literature demonstrated favourable outcomes of combined knee osteotomy and a cartilage procedure in patients with substantial deformity and cartilage defects. Isolated high tibial osteotomy may induce cartilage regeneration in several scenarios and severities of concomitant malalignment and cartilage defects. There are recommendations that knee osteotomy should be added to a cartilage procedure when an extra-articular deformity of > 5° is detected. Some studies report good outcomes for combining a knee osteotomy with cartilage grafting, but they lack a control group of isolated osteotomy. There is still scarce of evidence on the influence of osteotomies on cartilage regeneration and the outcomes of concomitant osteotomy and different cartilage procedures vs isolated osteotomies. With advanced statistical evaluation (artificial intelligence, machine learning) of big datasets, more answers and better results will be delivered.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, United Kingdom
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
| | - Jae-Sung An
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
| | | | | | | | - Matthieu Ollivier
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
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Meena A, Das S, Runer A, Tapasvi K, Hegde P, D'Ambrosi R, Hiemstra L, Tapasvi S. Revision ACL reconstruction in female athletes: current concepts. J ISAKOS 2024:S2059-7754(24)00035-X. [PMID: 38403190 DOI: 10.1016/j.jisako.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
The challenge of revision anterior cruciate ligament (ACL) reconstruction lies in its complexity, varied presentation, and technical intricacies. A successful ACL reconstruction should allow patients to safely return to preinjury activities. However, it is only sometimes simple, and many risk factors and concurrent pathologies come into play. Evaluating and analysing the cause of failure and associated conditions is paramount to addressing them effectively. Despite a plethora of research and improvements in knowledge and technology, e gaps exist in issues such as optimal techniques of revision surgery, graft options, fixation, concurrent procedures, rehabilitation and protocol for return to sports of high-level athletes. Female athletes need additional focus since they are at higher risk of re-injury, suboptimal clinical outcomes, and lower rates of return to sport following revision reconstruction. Our understanding about injury prevention and the protection of ACL grafts in female athletes needs to be improved. This review focuses on the current state of revision ACL surgery in female athletes and provides recommendations and future directions for optimising outcomes in this high-risk group.
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Affiliation(s)
- Amit Meena
- Division of Orthopedics, Shalby Multi-Specialty Hospital, Jaipur, 302021, India; Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria.
| | - Saubhik Das
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria
| | - Armin Runer
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Komal Tapasvi
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Prathik Hegde
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, 20161, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, 20133, Italy
| | - Laurie Hiemstra
- Banff Sport Medicine, University of Calgary, T1W 0L5, Canada
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Farinelli L, Meena A, Sonnery-Cottet B, Vieira TD, Pioger C, Tapasvi S, Abermann E, Hoser C, Fink C. Distal Kaplan fibers and anterolateral ligament injuries are associated with greater intra-articular internal tibial rotation in ACL-deficient knees based on magnetic resonance imaging. J Exp Orthop 2023; 10:113. [PMID: 37943352 PMCID: PMC10635991 DOI: 10.1186/s40634-023-00682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE The purpose of the present study was to assess the internal rotation of the tibia on Magnetic Resonance Imaging (MRI) in a series of consecutive athletes with Anterior cruciate Ligament (ACL) tears. METHODS Retrospective analysis of prospectively collected data was performed to include all consecutive patients who had undergone primary ACL reconstruction between January 2022 and June 2022. The angle between surgical epicondylar axes (SEA) of the knee and posterior tibial condyles (PTC) was measured. A negative value was defined as internal torsion. KFs and ALL injuries were reported. Analysis of covariance (ANCOVA) was performed to examine the independent associations between SEA-PTC angle and injuries of KFs and ALL adjusted for physical variables (age, gender and body mass index [BMI]). Statistical significance was set at a p-value of < 0.05. RESULTS A total of 83 eligible patients were included. The result of multiple linear regression analysis showed that internal tibial rotation was associated with KFs and ALL injuries. The estimated average of SEA-PTC angle in relation to ALL injuries controlling the other variables was -5.49 [95%CI -6.79 - (-4.18)] versus -2.99 [95%CI -4.55 - (-1.44)] without ALL injuries. On the other hand, the estimated average of SEA-PTC angle in relation to KFs lesions controlling the other variables was -5.73 [95%CI -7.04 - (-4.43)] versus -2.75 [95%CI -4.31 - (-1.18)] without KFs injuries. CONCLUSIONS KFs and ALL injuries were associated with an increased intra-articular internal tibial rotation in ACL-deficient knees. The measurement of femorotibial rotation on axial MRI could be useful to detect indirect signs of anterolateral complex (ALC) injuries.
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Affiliation(s)
- Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Amit Meena
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier de Versailles, 177, Rue de Versailles, Le Chesnay, 78157, France
| | | | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria.
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.
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Tapasvi S, Shekhar A. The anterior cruciate ligament: Chronicles of a legend. J ISAKOS 2023; 8:135-136. [PMID: 36924823 DOI: 10.1016/j.jisako.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Sachin Tapasvi
- Chief Consultant, The Orthopaedic Speciality Clinic, Pune, India.
| | - Anshu Shekhar
- Consultant, Sushrut OrthoPlastic Clinic, Raipur, India.
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Meena A, Di Paolo S, Grassi A, Raj A, Farinelli L, Hoser C, Tapasvi S, Zaffagnini S, Fink C. No difference in patient reported outcomes, laxity, and failure rate after revision ACL reconstruction with quadriceps tendon compared to hamstring tendon graft: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07380-5. [PMID: 36961538 DOI: 10.1007/s00167-023-07380-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The purpose of this study was to synthesize and quantitatively assess the outcomes of ACL Revision using a quadriceps tendon (QT) graft and to compare them with those of ACL Revisions performed with hamstring tendons (HT) graft. METHODS A comprehensive search based on the PRISMA protocol was performed across PubMed, Scopus, Embase, and Cochrane Library from inception until February 2022. Clinical studies reporting the outcomes of ACL Revision with QT autograft were included. Subjective and Objective IKDC, Tegner activity level, Lysholm knee score, KOOS score, VAS for pain, knee laxity (KT-1000/2000 arthrometer, Lachman test, and pivot-shift test), and graft failure were assessed. A systematic review and meta-analysis were performed and a quality assessment of the included studies was carried out with the MINORS score. RESULTS Seven studies met the selection criteria and were included in the systematic review for the qualitative synthesis of data. A pooled mean of all the variables was provided for the 7 studies, while 3 studies included a control group of ACL Revision with HT and were included in a meta-analysis. A total of 420 participants with a mean age of 28.9 ± 10.5 years and a mean postoperative follow-up of 39.3 ± 16.4 months were assessed. Of these, 277 patients underwent ACL Revision with QT and 143 patients underwent ACL Revision with HT. In the QT group, average graft failure was 9.8% compared to 17.4% in the HT group. KOOS Sport and pivot-shift test showed better postoperative outcomes in QT than HT, although it was not statistically significant (p = 0.052). CONCLUSION The QT autograft was associated with an improved trend of rotatory laxity, PROMs and failure rate compared to HT autograft after revision ACL reconstruction. The QT autograft for revision ACL reconstruction is supported by the current literature. It is a viable graft that should be considered for both primary and revision ACL reconstruction. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020, Innsbruck, Austria
- Research Unit for Orthopedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada
| | - Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Alberto Grassi
- IIa Clinica Ortopedica E Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Akshya Raj
- Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Luca Farinelli
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Christian Hoser
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020, Innsbruck, Austria
- Research Unit for Orthopedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica E Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020, Innsbruck, Austria.
- Research Unit for Orthopedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria.
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Tuca M, Valderrama I, Eriksson K, Tapasvi S. Current trends in anterior cruciate ligament surgery. A worldwide benchmark study. J ISAKOS 2023; 8:2-10. [PMID: 36154898 DOI: 10.1016/j.jisako.2022.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To benchmark current trends on anterior cruciate ligament reconstruction (ACLR) surgery. METHODS The largest worldwide ACLR survey to date was performed during May 2020, targeted to reach representation of all continents. It was submitted electronically to all International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports surgeons (n = 3,026), asking those who perform ACLR to respond. RESULTS With a final sample size of 2,107, the overall response rate was 69.6%. Median years of practice as orthopaedic surgeon was 15 (range 1-52) and 49.6% of all respondents were defined as high-volume surgeons (>50 ACLR annually). Hamstrings tendon autograft was the preferred graft for primary ACLR (80.3%) and the medial portal femoral drilling was the most frequently used technique (78.5%). Cortical buttons (82.7%) and bioabsorbable screws (62.7%) were the preferred fixation methods for hamstring tendon autograft ACLR in femur and tibia, respectively. Metallic screws (45.2%) were the preferred fixation methods for bone patellar tendon bone autograft in femur and tibia. Most of the respondents routinely used pre-tensioning techniques for their graft preparation (63.8%), but less than half of surgeons preferred antibiotic soaking of the grafts (45.3%). The preferred knee position for graft fixation was 10-30° of knee flexion and neutral rotation (57.0%). The addition of anterolateral augmentation (or extra-articular tenodesis) was infrequent in primary and isolated ACLR (10.0%), but a statistically significant raise was seen for revision surgeries (20.0%). Most used brace in the initial postoperative rehabilitation (54.9%) and the time to allow patients to fully resume sports was at an average of 8.9 ± 2.0 months. Treatment algorithm of paediatric ACL injuries exhibited a low consensus among the respondents. CONCLUSION This worldwide survey benchmarks the current trends in ACL reconstruction, achieving the largest participation of surgeons to date. Among the great variety of options available for ACL reconstructions, surgeons' preferences showed some differences according to their location and expertise. Reporting trends in practice, and not only the evidence, is important to medical education and providing patients the safest care possible. This is a Level V, expert opinion study.
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Affiliation(s)
- María Tuca
- Pontificia Universidad Catolica de Chile, School of Medicine, Chile; Department of Orthopedics, Hospital Clinico Mutual de Seguridad, Santiago de Chile, Chile.
| | - Ignacio Valderrama
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Department of Orthopaedic Surgery, Hospital San José, Santiago, Chile
| | - Karl Eriksson
- Department of Orthopedics, Stockholm Söder Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockolm, Sweden
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Thor J, Han Dave LY, Tapasvi S, Beyzadeoglu T. Short graft anterior cruciate ligament reconstruction: Current concepts. J ISAKOS 2023; 8:29-36. [PMID: 36202296 DOI: 10.1016/j.jisako.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Abstract
Short graft anterior cruciate igament reconstruction is increasing in popularity for performing a primary ACLR. The short graft coupled with the all-inside technique using closed sockets and suspensory fixation at both femoral and tibial ends are its defining features. The outcomes of this technique have been comparable to well established transportal ACLR techniques. It has the benefits of preserved hamstring strength and less pain attributed to transtibial drilling. However, there is a learning curve involved and will require time before mastery of the technique. Furthermore, in combined osteotomy or multiligament surgery, the use of short graft anterior cruciate ligament reconstruction with sockets preserve bone stock and the single tendon harvest spares the other tendons for use in other ligament reconstruction.
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Affiliation(s)
- Jessica Thor
- Department of Orthopaedic Surgery,Changi General Hospital, Singapore.
| | - Lee Yee Han Dave
- Department of Orthopaedic Surgery, National University Hospital, Singapore.
| | | | - Tahsin Beyzadeoglu
- Professor of Orthopedics & Traumatology Halic University & Beyzadeoglu Clinic Istanbul, Turkey.
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Shekhar A, Tapasvi S, Williams A. Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083318. [PMID: 35299712 PMCID: PMC8921756 DOI: 10.1177/23259671221083318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus. Purpose: To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis. Results: Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 (P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair. Conclusion: LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.
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Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, J Deshmukh A, Plancher K, Verma N, McAllister D, Verdonk P, Lustig S, Chandrateya A, Smigleiski R, Solayar G, Chernchujit B, Yung P, Budhiparama N, Hoshino Y, White N, Parker D, Clatworthy M, Brown C, Manzary M, Rajan D, Narvekar A, Tapasvi S, Pardiwala D, Panigrahi R, Arumugam S, Kapoor V, Mody B, Maheshwari J, Dahiya V, Joseph C, Laddha M, Rajgopal A. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc 2022; 30:3634-3643. [PMID: 35435469 PMCID: PMC9013735 DOI: 10.1007/s00167-022-06973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic. METHODS The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus. RESULTS Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis. CONCLUSION It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Raju Easwaran
- Shree Meenakshi Orthopedics and Sports Medicine Clinic, B H 41 East, Shalimar Bagh, New Delhi, 110088, India.
- Department of Arthroscopy and Sports Injuries, Max Super-Speciality Hospital Shalimar Bagh, New Delhi, India.
| | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation and PG College, Pune, India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, India
| | - Mohit Bhandari
- Chair, Department of Surgery, McMaster University, Hamilton, Canada
| | - Anil S Ranawat
- Knee Division of SMI, Hospital for Special Surgery, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery, Columbia, USA
| | - Shital Parikh
- Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Siddharth Joglekar
- Orthopedic Service, VA Central California Health Care System, Fresno, CA, USA
- UCSF Fresno Orthopedic Residency Program, Fresno, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
- Weill Cornell Medical College, New York, USA
- Orthopaedic Foundation, Stamford, CT, USA
- Plancher Orthopaedics and Sports Medicine, New York, USA
| | - Nikhil Verma
- Division of Sports Medicine, Sports Medicine Fellowship, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, USA
| | - David McAllister
- Sports Medicine Service, Vice Chair of Academic Affairs, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
- UCLA Department of Athletics, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Verdonk
- Orthopaedic Center Antwerp, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium
| | - Sebastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, Lyon, France
| | - Amit Chandrateya
- Princess of Wales Hospital Bridgend, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Robert Smigleiski
- Orthopaedics and Sports Medicine, Department at LIFE Institute, LIFE Institute Biological Treatment Centre, Warsaw, Poland
| | - Gandhi Solayar
- Orthopaedic Specialist Centre, Subang Jaya, Selangor, Malaysia
| | - Bancha Chernchujit
- Department of Orthopedics, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong, China
| | - Nicolaas Budhiparama
- School of Vocational Studies and Department of Orthopaedics and Traumatology, School of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo, Jawa Timur, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, School of Medicine, Kobe University, Kobe, Japan
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | | | - Charlie Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Mojieb Manzary
- Orthopedic Services, Johns Hopkins Aramco Health Care Center, Dhahran, Saudi Arabia
- Department of Orthopedics, Johns Hopkins University School of Medicine, Dhahran, Saudi Arabia
| | - David Rajan
- Ortho One-Orthopaedic Speciality Centre, Coimbatore, India
| | - Abhay Narvekar
- P D Hinduja Hospitals Mumbai, Global Hospital Parel, Mumbai, India
| | | | - Dinshaw Pardiwala
- Arthroscopy Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Ranjit Panigrahi
- PG Dept of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
- Kalinga Super Speciality Hospital, Bhubaneswar, Odisha, India
| | - S Arumugam
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Chennai, India
| | - Vikash Kapoor
- Medica Superspeciality Hospital, Medica Hospitals, Kolkata, India
| | - Bharat Mody
- Welcare Hospital, Atladra-Vadsar Ring Road, Atladra, Vadodara, Gujarat, India
| | - Jitender Maheshwari
- Knee and Shoulder Service, Department of Orthopaedics, Sitaram Bharatiya Hospital, New Delhi, India
| | - Vivek Dahiya
- Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram, India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, India
| | | | - Ashok Rajgopal
- Institute of Musculoskeletal Diseases and Orthopaedics, Medanta Medicity, Gurugram, Haryana, India
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Geethan I, Easwaran R, Sahanand S, Sivaraman A, Gupta A, Devgan A, Ashok S, Bhasin VB, Joseph C, Chaudhary D, Pardiwala DN, Gopinathan P, John JT, Maheshwari J, Basumallick MN, Antao N, Shah N, Rajan P, Sancheti P, Dey PC, Ayyadurai P, Gupta PK, Reddy KR, Gupta R, Mittal R, Tapasvi S, Jos ST, Sinha S, Sundararajan SR, Kumar V, Pandey V, Rajan DV. Management Guidelines for Infection After ACL Reconstruction: Expert Opinion Statement Based on the Modified Delphi Survey of Indian Arthroscopy Surgeons. Indian J Orthop 2021; 55:342-351. [PMID: 33927812 PMCID: PMC8046894 DOI: 10.1007/s43465-021-00363-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/16/2021] [Indexed: 02/04/2023]
Abstract
AIM Infection after anterior cruciate ligament (ACL) reconstruction, though rare, is a potentially devastating complication and the evidence-based recommendation on the various topics in its management is limited. The purpose of this study was to develop recommendations for the prevention and management of infections in ACL reconstruction surgery by performing a structured expert consensus survey using Delphi methodology. MATERIALS AND METHODS 22 topics of relevance in the prevention and management of infection following ACL reconstruction were chosen from an extensive literature review. 30 panelists were requested to respond to a three-round survey, with feedback, to develop a consensus statement on the topics. RESULTS Consensus statements could be prepared in eleven out of twenty-two topics including: the graft is retained at the first arthroscopic debridement, the graft is removed when repeated debridement are needed, and revision ACL reconstruction is needed only if the patient develops instability. Concurrence could be obtained in the topics including: longer duration of antibiotics is needed in immunocompromised patients, soaking graft in antibiotic solution reduces infection risk, and knee swelling without warmth does not suggest infection. CONCLUSIONS A proper skin preparation, a longer course of antibiotics in immunocompromised patients, and soaking the graft in antibiotics reduces the risk of infection. In case of infection, a healthy-looking graft must be retained at the first debridement and if the graft must be removed, revision ACL reconstruction is advised only if the patient develops instability. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00363-z.
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Affiliation(s)
- I. Geethan
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur, 621113 India
| | - Raju Easwaran
- Shree Meenakshi Orthopaedics and Sports Medicine Clinic, New Delhi, India
| | | | | | - Arun Gupta
- Department of Orthopaedics, Pushpanjali Hospital and Research Center, Agra, Uttarpradesh India
| | - Ashish Devgan
- Department of Orthopaedics, BDS PGIMS, Rohtak, India
| | | | - V. B. Bhasin
- Department of Orthopaedic Sir Ganga Ram, New Delhi, India
| | | | - Deepak Chaudhary
- Arthroscopy and Sports Medicine Centre, BLK Superspeciality Hospital, New Delhi, India
| | - Dinshaw N. Pardiwala
- Arthroscopy Service, Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospitals, Mumbai, 400053 India
| | - P. Gopinathan
- GMC Foundation Ortho Hospital, Nadakkave Calicut, 11, Kozhikode, India
| | | | - J. Maheshwari
- Knee and Shoulder Clinic, Max Superspeciality Hospital, Saket, New Delhi, India
| | | | - Nicholas Antao
- Department of Orthopaedics, Holy Spirit Hospital Andheri(E), Mumbai, India
| | | | | | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | | | - Prakash Ayyadurai
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Prateek Kr Gupta
- Head Sports Medicine Unit, Department of Orthopaedics Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - K. Raghuveer Reddy
- Sai Institute of Sports Injury and Arthroscopy, Erramanzil Colony, 6-3-252/B/8, Hyderabad, India
| | - Ravi Gupta
- Sports Injury Center, Government Medical College Hospital, Chandigarh, 160047 India
| | - Ravi Mittal
- Department of Orthopaedics, AIIMS, New Delhi, India
| | | | | | | | | | - Vinod Kumar
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, 110002 India
| | - Vivek Pandey
- Department of Orthopaedics, Manipal Academy of Higher Education, KMC, Manipal, India
| | - David V. Rajan
- Ortho One Orthopaedic Speciality Centre, Coimbatore, India
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12
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Tapasvi S, Shekhar A, Chandorkar A, Patil A, Patil S. Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study. Indian J Orthop 2021; 55:416-424. [PMID: 33927820 PMCID: PMC8046888 DOI: 10.1007/s43465-020-00334-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The objectives were: (1) to analyze the MRI healing rates of bucket-handle meniscus repair; (2) to compare the accuracy of assessment of meniscus healing for conventional MRI and Indirect Magnetic Resonance Arthrography (IMRA); and (3) to identify patients who may require second-look arthroscopy after meniscus repair. METHODS This is a prospective observational case series of thirty-seven patients with repaired bucket-handle medial meniscus tear with a minimum one year follow-up. Meniscus healing rates were assessed on direct MRI and IMRA using Henning's criteria. At the same time, patients' symptoms were evaluated according to Barrett's criteria and functional outcomes were recorded using International Knee Documentation Committee (IKDC) score, Knee Osteoarthritis and Outcomes Score (KOOS) and Tegner-Lysholm scores. A further clinical review was performed 18 months after the imaging to assess the evolution of symptoms. RESULTS At a mean of 22.3 ± 7.8 months after the meniscus repair, 56.7% patients showed complete healing and 40.5% patients demonstrated incomplete repair healing on IMRA. 52% patients with complete healing and 40% patients with incomplete healing demonstrated meniscus symptoms. At the second clinical review, 19% patients with complete healing and 20% patients with incomplete healing had meniscus symptoms. There was no co-relation between symptoms, PROMs and healing on MRI. CONCLUSION Indirect MR arthrography offers distinct advantages over direct MRI for assessment of meniscus healing, especially in symptomatic patients. Patient-reported outcome measures and symptomatology are not co-related with the healing status of the meniscus and they resolve in the majority on longer follow-up. A more conservative approach guided by IMRA to assess meniscus healing will avoid early re-operations.
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Affiliation(s)
- Sachin Tapasvi
- The Orthopaedic Speciality Clinic, 16-Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004 India
| | - Anshu Shekhar
- The Orthopaedic Speciality Clinic, 16-Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004 India
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Held M, Schenck RC, Khanduja V, Campos TVDO, Tapasvi S, Williams A, Yau WP, Harner C. Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study. J ISAKOS 2021; 6:193-198. [PMID: 34272294 DOI: 10.1136/jisakos-2020-000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD. METHODS A modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori. RESULTS Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management. CONCLUSION This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Michael Held
- Orthopaedic Surgery, University of Cape Town, Rondebosch, South Africa
| | - Robert C Schenck
- Orthopaedic Surgery, University of New Mexico - Albuquerque, Albuquerque, New Mexico, USA
| | - Vikas Khanduja
- Orthopaedic Department, Addenbrooke's Hospital, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Sachin Tapasvi
- Orthopaedics, The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | | | - Wai Pan Yau
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
| | - Christopher Harner
- University of Texas McGovern Medical School, Pittsburgh, Pennsylvania, USA
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14
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Abstract
The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
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Affiliation(s)
- Sachin Tapasvi
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Anshu Shekhar
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Karl Eriksson
- Orthopedic Surgery, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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Tapasvi S, Shekhar A, Patil S, Pandit H. Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty: an experimental cadaveric study. Bone Joint Res 2020; 9:272-278. [PMID: 32728426 PMCID: PMC7376280 DOI: 10.1302/2046-3758.96.bjr-2019-0258.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position. Methods A total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position. Results Tibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM. Conclusion The sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.
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Affiliation(s)
| | | | - Shantanu Patil
- Translational Medicine & Research, SRM Medical College and Hospitals, SRM University, Kattankulathur, India
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Shekhar A, Singh A, Laturkar A, Tapasvi S. Anterior Cruciate Ligament Rupture with Medial Collateral Ligament Tear with Lateral Meniscus Posterior Root Tear with Posterolateral Tibia Osteochondral Fracture: A New Injury Tetrad of the Knee. J Orthop Case Rep 2020; 10:36-42. [PMID: 33954132 PMCID: PMC8051566 DOI: 10.13107/jocr.2020.v10.i03.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Injuries to the knee ligaments, menisci, and cartilage are possible in high-velocity trauma as in road traffic accidents. Similarly, these structures can be disrupted in proximal tibia fractures. We present a series of three cases which had a previously undescribed injury combination. CASE PRESENTATION The first and second patients presented primarily to us following fall from motorbikes. Both these patients had injuries of the anterior cruciate ligament (ACL), medial collateral ligament (MCL), lateral meniscus body and posterior root tear, and osteochondral fracture of posterolateral tibia. The osteochondral fracture was managed by internal fixation with headless compression screws. The ligaments were either repaired or reconstructed and meniscus root tear was treated by transtibial pull through repair. The third patient also had the same injury but was treated at another center. He presented with early arthritis of the lateral tibiofemoral joint and valgus malalignment. Treatment for him was in the form of lateral distal femur open-wedge osteotomy and MCL reconstruction. All three patients had good outcome at the end of 1year. CONCLUSION We report a new injury tetrad of ACL tear, MCL tear, lateral meniscus posterior root tear, and posterolateral tibia osteochondral fracture. The mechanism of injury is most likely a violent external rotation and anterior translation of the tibia with a valgus directed force during impact. The treatment of this injury can be performed in single or two stages based on the merits of the case. Anatomic reduction and fixation of the fracture takes precedence to avoid later devastating sequel for the knee.
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Affiliation(s)
- Anshu Shekhar
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India,Address of Correspondence: Dr. Anshu Shekhar, The Orthopaedic Speciality Clinic, 16, Status Chambers, Wrangler Paranjpe Lane, Off FC Road, Pune, Maharashtra, India. E-mail:
| | - Ankur Singh
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | - Amit Laturkar
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | - Sachin Tapasvi
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
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Tapasvi S, Mohanty SS, Vedavyasa Acharya KK, Bhattacharya K, Easwaran R, Charugulla SN. Viscosupplementation for Management of Knee Osteoarthritis from an Indian Perspective: An Expert Consensus Report. Pain Ther 2019; 8:217-231. [PMID: 31309467 PMCID: PMC6857206 DOI: 10.1007/s40122-019-0131-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is a progressive degenerative condition and is a significant contributor toward physical disability in the aging population. The current treatment modalities for this condition focus on joint preservation with alleviation of symptoms. Intra-articular hyaluronic acid (IAHA) injections have emerged as the promising mainstay of nonsurgical treatment of OA, especially in patients with mild-to-moderate OA and in certain subgroups of severe OA with comorbidities or with poor response to first-line therapy. The absence of standard guidelines or recommendations for the use of IAHA in India has led to vast variations in the usage of IAHA among practitioners. Hence, this consensus-based document aims to address the issue and establish simplified and easily implemented recommendations on the use of IAHA. METHODS A group of 78 expert orthopedic surgeons discussed in detail the evidence on appropriate criteria for diagnosis, patient selection, and follow-up evaluation for knee OA at two national meetings. In subsequently held regional meetings, key discussion points and clinical experience-based answers were translated into a questionnaire to develop the final expert consensus-based statements for the use of IAHA in patients with knee OA. RESULTS Various consensus statements were obtained on the basis of scientific evidence obtained from PubMed, Cochrane-indexed database, and guidelines related to viscosupplementation and knee OA as well as the experts' clinical experience. This document was drafted, reviewed, validated, and modified by the expert panel until a final agreement was reached. CONCLUSION In this pioneering attempt, the document lays down structured, expert consensus-based statements to guide and align practitioners on the appropriate use of IAHA in the Indian setting. FUNDING Dr. Reddy's Laboratories Ltd.
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Affiliation(s)
| | - Shubhranshu S Mohanty
- Department of Orthopaedics, King Edward Memorial Hospital, Jaslok, Shushrusha and Nanavati Hospitals, Mumbai, India
| | | | | | - Raju Easwaran
- Department of Orthopaedics, Shree Meenakshi Orthopedics and Sports Medicine Clinic, Delhi, India
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Abstract
We describe our experience with the use of a pyramidal configuration external fixator in the management of open fractures of the proximal ulna. A prospective study was conducted. 21 patients with open fractures of the proximal ulna (Gustilo-Anderson Grade II and III A) were treated by the application of a new fixator frame. The soft tissue injury was managed with the help of the plastic surgeons. All the patients were followed up clinically and radiologically for a total duration of 3 years after the injury. They were rated on a combined objective and subjective assessment scale by an independent observer. All the patients were rated as good to excellent at the end of a 3 year follow up. The main advantages were simplified wound care and ease of supplementary plastic procedures. No vascular or neurological complications were encountered. The average time taken for union with the fixator was 9 weeks. All the fractures united well. Mobility and function of the elbow were preserved in all cases.
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Affiliation(s)
- S Tapasvi
- Department of Orthopaedics and Traumatology, B.J. Medical College, Poona, India
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