Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

@#Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Anticipating Urinary Retention Following Total Hip and Total Knee Replacements

@#Introduction: Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation. Materials and Methods: One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017. Results: Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17). Conclusion: There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.

Amylase production by endophytic fungi Cylindrocephalum sp. isolated from medicinal plant Alpinia calcarata (Haw.) Roscoe

Amylases are among the most important enzymes used in modern biotechnology particularly in the process involving starch hydrolysis. Fungal amylase has large applications in food and pharmaceutical industries. Considering these facts, endophytic fungi isolated from the plant Alpinia calcarata (Haw.) Roscoe were screened for amylolytic activity on glucose yeast extract peptone agar (GYP) medium. Among thirty isolates of endophytic fungi, isolate number seven identified as Cylindrocephalum sp. (Ac-7) showed highest amylolytic activity and was taken for further study. Influence of various physical and chemical factors such as pH, temperature, carbon and nitrogen sources on amylase production in liquid media were studied. The maximal amylase production was found to be at 30ºC and at pH 7.0 of the growth medium. Among the various carbon and nitrogen sources tested, maltose at 1.5% and Sodium nitrate at 0.3% respectively gave optimum amylase production.