The Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction in Low-Demand, Non-athletic Patients Following a Home-Based Rehabilitation Protocol.

BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure. Most of the literature is on high-demand athletic patients, with little information about the outcomes of low-demand patients. Therefore, we aim to assess the outcomes of non-athletic patients following home-based rehabilitation. METHODS: An observational cross-sectional comparative study was conducted with 30 non-athletic adults with ACL injuries whose pre-injury Tegner activity level was four or less. After six months of reconstruction, patients were assessed for functional outcomes using the Tegner activity level, Lysholm score, International Knee Documentation Committee (IKDC) score, and ACL quality of life (QOL) score. Functional performance was assessed by the carioca test, one-leg hop test, and shuttle test. Functional outcome and performance were compared with an age, sex, and activity level-matched group. Knee stability was assessed by Lachman, anterior drawer, and pivot shift. RESULTS: All patients returned to their pre-injury Tegner activity level. A statistically significant difference was seen in the Lysholm score, IKDC score, ACL QOL score, carioca test, shuttle test, and one leg hop test (p= <0.001 in each); >5mm of translation of the tibia in the Lachman test was seen in three patients, whereas one patient had >5 mm of translation in the anterior drawer test but pivot shift was absent in all. CONCLUSION: We found that all patients returned to their pre-injury Tegner activity level. Most patients had improved knee stability; however, functional outcomes and performance were lower compared to the control group. Therefore, arthroscopic ACL reconstruction is a reasonable treatment option for non-athletic, low-demand patients to get back to their pre-injury functional activity level.

Outcome of Scaphoid Nonunion Using Open Reduction and Internal Fixation With Iliac Crest Bone Graft (Fisk-Fernandez Technique).

Introduction The scaphoid is the most common carpal bone to be fractured and has a high propensity for nonunion. Restoration of scaphoid length mitigates the chances of long-term complications. The aim of this study was to assess the functional outcome of the Fisk-Fernandez technique for the treatment of scaphoid nonunion by using open reduction and internal fixation with trapezoidal iliac crest bone graft.  Materials and methods Fisk-Fernandez technique was used to manage scaphoid nonunion in 31 patients at a tertiary care hospital with follow-up at six weeks, 12 weeks, and 24 weeks. An objective assessment of the outcome was done using a comparison of the pre- and postoperative scaphoid score, QuickDASH, and visual analog score. Discussion The scaphoid is one of the most common carpal bones to get fractured. Anatomical factors, late presentation, and delay in diagnosis render it to usually land in nonunion. A comparison of the preoperative scaphoid, QuickDASH, and VAS scores with six-week, 12-week, and 24-week postoperative scores was made and was found to be statistically significant (p<0.001). Ninety-three percent of patients subjectively reported satisfaction after treatment. Though revascularization was not assessed, the bony union was observed in all the patients. Conclusion The operative technique proposed by Fisk-Fernandez is effective in correcting deformity of the scaphoid as well as providing satisfactory functional outcomes in patients with scaphoid nonunion.