Femoral Avulsion of the Anterior Cruciate Ligament in a Multiligament Setting: A Unique Case

Anterior cruciate ligament (ACL) femoral avulsions are a rare entity mainly seen in children. We describe a unique case of a bony ACL avulsion with a medial collateral ligament (MCL) and lateral meniscus (LM) tear in a 37-year-old patient who sustained a two-wheeler accident. The ACL femoral avulsion was fixed arthroscopically using a Knee Scorpion and a FiberTape fixed over a suture disc on the lateral cortex. The MCL was repaired with an internal brace using a FiberTape and two SwiveLocks and the torn LM was repaired using all-inside sutures. At 2 years of follow-up, the fragment was united, knee range of motion was 0° to 130°, and Knee Society Score was 98. This is the first case report of a femoral avulsion of the ACL combined with an MCL injury and a meniscus tear where all three were repaired with a unique technique and good results were obtained.

Does the Occupational Activity Level Affect the Quality of Life of Patients Treated with Epidural Steroid Injections for Lumbar Disc Herniations?

STUDY DESIGN: Prospective cohort study. PURPOSE: To determine whether there was any change in the quality of life of patients in sedentary/non sedentary occupations treated with epidural steroid injection for lumbar disc herniations using the 8 components of the SF 36 questionnaire.Overview of Literature: No previously done similar study published. OVERVIEW OF LITERATURE: No previously done similar study published. METHODS: Ninety patients comprising sedentary and non sedentary occupations with lumbar disc herniations on magnetic resonance imaging who were treated with epidural steroid injection at St. John's Hospital Bangalore who met the Spinal Outcomes Research Trial eligibility criteria from April 2009 to May 2010. RESULTS: Of the 90 patients evaluated 44 were of Sedentary and 46 were of non sedentary activity levels, At 6 months primary outcomes physical functioning (p = 0.573, in difference between sedentary and non sedentary, improvement p = 0.001) energy/fatigue (difference between the two p = 0.917, improvement p = 0.001), emotional well being (difference p = 0.912, improvement, p = 0.001), social functioning (difference p = 0.523, improvement p = 0.232), pain (difference p = 0.535, improvement p = 0.001), general health (difference p = 0.738, improvement p < 0.001). CONCLUSIONS: There was a statistically significant improvement in patients of both the sedentary and non sedentary groups p < 0.001 in all components of the SF36 in both sedentary and non sedentary patients except social functioning where the improvement was not statistically significant, and there was no significant difference between non sedentary and sedentary populations over time.