Reimagined MPFL Reconstruction: Retinacular Fixation of the Doubled Hamstring Graft at the Patella and Suture Anchor-Based Femoral Fixation

Background

Lateral patellar dislocation is frequently observed among teenagers and young adults. There is no consensus on the best type of graft or fixation strategy for the femur and patella, and complications such as iatrogenic patella fracture, tunnel malposition, and grafting failure are common. The objective of our research is to find out the functional outcome of a new method of medial patellofemoral ligament (MPFL) reconstruction, which involves two key components: (1) patellar fixation is accomplished by suturing the two limbs of the looped doubled hamstring graft in a divergent fashion to the retinaculum at the medial border of the upper half of patella and (2) the placement of a suture anchor tied to the graft at the isometric point on the medial femur condyle.

Methods

This study is a retrospective assessment of patients who underwent MPFL reconstruction at our hospital between September 2018 and August 2020. Patients were monitored for at least 2 years after the initial procedure until August 2022.

Results

A total of 29 patients were recruited for the study, with 22 being females and the average age being 30.38 years. During the postoperative period, none of the participants experienced instability, redislocation, patellar/femoral fractures, or abnormal distal femur growth. The Tegner-Lysholm knee score was good to excellent for 17 (58.6%) participants, fair for 10 (34.5%) participants, and poor for 2 (6.9%) participants. The Kujala anterior knee pain score was more than 80 for 19 (65.5%) participants.

Conclusion

This research presents a significant achievement rate of the surgical procedure, accompanied by the mean Tegner-Lysholm knee score of 82.68 and the mean Kujala anterior knee pain score of 82.71. Notably, there were no complications observed in the postoperative period.

A cross sectional survey exploring the awareness and familiarity regarding patient reported outcome measures (PROMs) among joint reconstruction surgeons in India

Background

The aim of this study is to describe the usage of PROM, its use or lack of use, barriers in using it and its future prospect among the arthroplasty surgeons from a developing country like India.

Methods

An online survey was conducted by emailing an anonymous questionnaire to orthopaedic surgeons working in three tertiary care academic institutions and two tertiary care private hospitals. All orthopaedic surgeons or residents who have been performing or assisting in arthroplasty and arthroscopy were included in the study. The study was cross-sectional in design based on a single response from all surgeons.

Results

The mean age of the 87 surgeons participating in this study was 38.6 ± 4.7 years. 62.1% of surgeons had used PROMs for both clinical as well as research purposes at some point. 25.9% of surgeons had an adequate understanding of the function, benefits, and drawbacks of PROMs. Among the barriers against using PROMs, time constraint was agreed upon by most of the surgeons (59.5%). 64.3% of surgeons were willing to incorporate the PROMs into their daily practice if the barriers are overcome.

Conclusion

The limitations of use of PROM should also be borne in mind before embarking on its widespread implementation. Involvement of regulatory and professional societies as well as substantial investment in manpower, money and time is required for making the use of PROMs regular.

712 Gastric Emptying Procedure in Oesophagectomy: Meta-Analysis of Surgical Pyloroplasty vs Nil Intervention

Introduction

Surgical pyloroplasty is often performed to reduce the rate of delayed gastric emptying. However, the clinical significance of this is not clear. The aim of this meta-analysis is to compare the rates of delayed gastric emptying, anastomotic leak, pulmonary complications, need for further pyloric intervention, and mortality in those patients undergoing pyloroplasty following oesophagectomy and those who do not.

Method

Relevant Randomised Control Trials and Cohort Studies were identified. The first group had no drainage procedure following oesophagectomy, whereas the second group underwent a drainage procedure (pyloroplasty). A random effects meta-analysis model was used to compare the outcomes.

Results

12 papers were utilised in the analysis, comprising a total 2567 patients. No significant differences were found between the two groups with regards to delayed gastric emptying (RR 0.87 [95% CI: 0.47 – 1.62], p = 0.66), anastomotic leak (RR 1.20 [95% CI: 0.82 – 1.74], p = 0.34), pulmonary complications (RR 1.04 [95% CI: 0.79 – 1.37], p = 0.79), need for further pyloric intervention (RR 1.44 [95% CI: 0.87 – 2.37], p = 0.16), and mortality (RR 1.18 [95% CI: 0.43 – 3.23], p = 0.75).

Conclusions

Surgical pyloric drainage procedures do not improve outcomes for patients undergoing oesophagectomy, nor does omitting the procedure worsens the outcomes.

SKINTED: A Rare Complication After Total Knee Arthroplasty

Background

Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis is a neuropathic dermatitis specific to total knee arthroplasty (TKA), occurring around the healed surgical scar area. Very few case reports exist in orthopaedic literature regarding this rare skin complication after TKA. We report a series of cases and estimated the incidence of this condition in our institute.

Methods

During the 1-year period from January 2018 to December 2018, patients who have undergone TKA and later presented with skin lesions adjacent to the operated site were identified. Detailed history was taken, and full clinical examination was performed for all the reported cases.

Results

A total of 9 lesions in 8 patients were identified out of a total of 203 consecutive TKAs operated during the study period, with an estimated incidence of 4.4%. The mean age was 64 years (range, 58-78 years). The mean time from surgery to diagnosis was 4 months (range, 3-6 months).

Conclusions

This group of dermatitis caused due to surgical transection of the infrapatellar branch of the saphenous nerve during TKA is a rare cutaneous complication, with an estimated incidence of 4.4% from this study. Lesions typically appear lateral to the operative scar within an area of hypoesthesia. Lesions in all patients improved after topical steroid therapy with no recurrences at further follow-up. Arthroplasty surgeons should have awareness of this benign complication, thereby avoiding unwarranted additional workup and alleviating unnecessary psychological stress to the patient.

Accelerated Ponseti technique: efficacy in the management of CTEV

The current standard practice of treatment for congenital talipes equinus varus (CTEV) is the Ponseti method of manipulation and casting which requires great compliance by caregivers for casting as well as bracing. There is inconclusive evidence regarding optimal cast change interval. This was a prospective non-randomized study conducted at a tertiary care hospital in South India over a 2-year period with a minimum follow-up of 5 years. The patients were divided into 2 groups, one with cast change interval of 7 days and the other group at 3 days. Children with CTEV with age less than 1 year with no previous intervention were included in the study. Functional score devised by Ponseti was determined at final follow-up. The average number of casts in standard and accelerated group was 5.23 ± 0.59 and 4.72 ± 0.61 (p < 0.01). The average number of days required for correction of feet was 54.38 ± 8.01 and 33.88 ± 9.03 (p < 0.01) respectively, for standard and accelerated groups. The Pirani score showed a faster reduction in the accelerated group. This study is the longest prospective study published yet in literature, comparing standard and accelerated Ponseti protocols. Complication rate noted in our study was comparable to study by Morcuende but higher than other studies comparing the techniques. It increases compliance as well as reducing treatment and travel costs for parents, more so in developing countries. At 5-year follow-up, there is no significant difference in the functional outcome.

Short communication: studies on punica granatum-I isolation and identification of some constituents from the seeds of punica granatum

Initial phytochemical screening of the seeds of Punica granatum has revealed the presence of Ursolic acid and beta-Sitosterol alongwith a long straightchain hydrocarbon - nonacosene. Presence of estrogens and glycosides have also been detected.