Accelerometer-based portable navigation, a faster guide compared to computer-assisted navigation in bilateral total knee arthroplasty-a randomized controlled study.

PURPOSE: There are limited studies in the literature comparing the alignment accuracy of  the large console, imageless, computer-assisted navigation (CAN) and portable, hand-held, accelerometer-based navigation (ABN) in total knee arthroplasty (TKA).  This study was aimed to compare the operative time, blood loss, radiological, clinical and functional outcomes between CAN- and ABN-guided bilateral TKA. METHODS: From Jan 2016 to Dec 2017, 50 patients who underwent bilateral TKA were randomized to undergo either CAN-guided or ABN-guided TKA. Tourniquet time and blood loss were recorded, and intra-op complications were noted. Post-op radiological outcomes at 2 weeks were compared between the groups. The clinical and functional outcomes using the American Knee Society Scores (KSS) and Oxford Knee Score (OKS) were recorded pre-operatively and post-operatively at 3, 6, 12 months and at the end of the study with a minimum follow-up of 48 months. RESULTS: Both groups were well-matched in terms of patient demographic parameters. The mean surgical time per knee was significantly lower in the ABN group (54.5 ± 5.6 min) compared to the CAN group (61.7 ± 13.7 min; p < 0.01). Mean blood loss per knee in the ABN group was 592.1 ± 245.3 mL compared to 682.8 ± 322.0 in the CAN group (p = 0.11). In the ABN group, the mean post-op mechanical axis was 1.2 ± 3.2° (vs 1.5 ± 2.2° in the CAN group, p 0.6), the frontal femoral angle was 88.8 ± 2.3° (vs 88.8 ± 1.8° in the CAN group, p 1.0) and frontal tibial angle was 90.1 ± 1.6° (vs 89.7 ± 1.1° in the CAN group, p 0.14). At 48 month follow-up, the mean functional KSS in the ABN group was 89.0 ± 5.7 (vs 88.1 ± 4.5 in the CAN group, p 0.37) and the mean OKS was 40.5 ± 2.8 (vs 39.6 ± 3.2 in the CAN group, p 0.12). CONCLUSION: Portable, hand-held ABN offers alignment accuracy and functional outcomes in TKA similar to that with CAN, with a reduced duration of surgery. There was no advantage of either of the techniques in terms of clinical or functional outcomes at 48 month follow-up. LEVEL OF EVIDENCE 1.

Judet's Quadricepsplasty Technique Offers Excellent Functional Outcome Without an Extension Lag for Extension Contracture of the Knee: A Retrospective Cohort of 33 Patients.

Purpose: The Judet's technique of quadricepsplasty for an extension contracture of the knee joint offers the benefit of a sequential and controlled release of the intrinsic and extrinsic soft tissue constituents restricting the knee flexion. The main principle of our study was to analyze the clinical as well as functional outcome and to assess an extension lag following Judet's quadricepsplasty for the knee extension contracture deformity. Materials and Methods: This is a retrospective cohort study comprises of thirty three patients, operated for extension contracture with Judet's quadricepsplasty with the mean follow-up was 30 months. Knee range of motion of the operated knee was recorded preoperatively and at 6, 12 and 24 month follow-up after the surgery. Judet's criteria were used to evaluate the outcomes following the procedure. Results: 92.42° (range, 60°-110°) of knee flexion was achieved after an average follow-up of 24 months compared to preoperative knee flexion was 14.09° (range 5°-25°), reflecting a 74.69° average improvement in knee flexion. Twelve patients had excellent results, nineteen had good results as per Judet's criteria but there were no patients with extension lag. The two patients with fair results had superficial wound infection which healed without any further surgical intervention. Conclusions: Judet's quadricepsplasty offers sequential release without extension lag of the knee joint. Patients with the knee extension contractures deformity can be successfully managed with the Judet's quadricepsplasty to gain useful knee motion and function.

Subintermeniscal Ligament Pullout Suture Technique for Anterior Cruciate Ligament Avulsion Fracture Fixation-AIIMS Technique.

Many methods have been described, including pullout suture technique, for arthroscopic fixation of displaced tibial eminence fracture. We are describing our technique of pullout suture, which is a modification of previously described techniques. We passed two sutures arthroscopically through anterior cruciate ligament (ACL) just above the avulsed fragment and then pulled them out through medial and lateral bone tunnel in anterior aspect of crater in tibial plateau. The third suture passed through ACL was pulled out anteriorly under the transverse intermeniscal ligament through a submeniscal route. All sutures were tied under tension to a screw post placed on the anterior tibia after reducing the avulsed bone fragment. Our technique provides good reduction and even overreduction of the fragment. It also provides good initial fixation strength to work against displacing forces even in small and comminuted bony fragment. This is helpful for achieving adequate stability of knee, complete extension of knee, early rehabilitation, and quicker recovery.

Management of Neglected Peroneal Tendon Dislocation of Iatrogenic Etiology: A Case Report.

Introduction: Neglected peroneal tendon dislocation with iatrogenic etiology has been rarely reported in the literature and its management has not been fully understood to date. Case Report: We present a case of a 25-year-old male who presented with pain over the posterolateral aspect of his left ankle which was diagnosed to be a case of neglected peroneal tendon dislocation of iatrogenic etiology. Peroneal groove deepening with superior retinaculum repair was done in the patient along with loose body removal and osteophyte excision. Subsequent fibrosis augmented with the deepening of the groove maintained peroneal tendon position in the retromalleolar groove. On post-operative follow-up, the patient was completely satisfied with relief of pain and no complications. He also regained full range of motion and could walk without support. Conclusion: Surgical intervention of fibular groove deepening with superior peroneal retinaculum reconstruction results in an excellent outcome for neglected peroneal tendon dislocation.

Expanded Age Indication for Ponseti Method for Correction of Congenital Idiopathic Talipes Equinovarus: A Systematic Review.

The deformity known as congenital idiopathic talipes equinovarus (CTEV) is probably the most common (1 to 2 in 1000 live births) congenital orthopedic condition requiring intensive treatment. With the perception that the treatment of idiopathic CTEV by extensive soft tissue release is often complicated by stiffness, recurrence, and the need for additional procedures, the minimally invasive Ponseti method has been accepted as the first line of treatment, which has achieved excellent results globally. The Ponseti method has achieved excellent results in children with idiopathic CTEV aged ≤2 years. However, the upper age limit for the Ponseti treatment has not yet been defined. We reviewed the published data to determine the efficacy of the Ponseti method in older children with neglected CTEV.