Comparative study of functional outcomes of arthroscopic anterior cruciate ligament reconstruction using anteromedial portal and translateral all-inside technique.

Background: Anterior Cruciate Ligament (ACL) injuries are common in the active population of the Armed Forces. Symptomatic instability prompts individuals to seek a cure or a sheltered appointment. Despite the increasing numbers of ACL reconstructions performed, the outcomes have not been so spectacular with only a meager percentage of our patients returning to preinjury levels of activity. With the premise that an all-inside ACL reconstruction is likely to result in better functional outcomes, the aim of this study was to compare the short-term functional outcomes of a large consecutive series of patients undergoing ACL reconstruction using the translateral all-inside ACL reconstruction technique (AI) and standard anteromedial portal technique (AM) with a minimum follow-up of one year. Methods: A total of 240 patients with isolated ACL tear underwent ACL reconstruction via the AI or AM technique. Their preoperative and postoperative scores were compared to look for any significant differences in functional outcomes. Results: The two groups were matched for age, BMI, mechanism of injury, and interval from injury to surgery. There was no difference in their preoperative scores. Postoperatively, although there were significant improvements across both groups, there was no significant difference between the groups at any point of time. Conclusion: The AI technique has garnered interest in recent literature in addressing ACL injuries. This study found no discernible benefit of the AI technique when compared to the AM technique in terms of functionality following an ACL reconstruction at any point of time up to 1 year following surgery.

Corrigendum to "Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction".

[This corrects the article on p. 312 in vol. 12, PMID: 32903976.].

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction.

BACKGROUD: Anterior cruciate ligament reconstruction (ACLR) remains the gold standard treatment for anterior cruciate ligament (ACL) injury. However, a good functional outcome even after a successful surgery depends on multiple factors. It has been observed that certain patients with a chronic ACL injury demonstrate knee instability voluntarily. The authors observed that these patients might not perform well even after a successful surgery. This study aims to assess the outcome after ACL and other ligament reconstruction in patients with voluntary knee instability. METHODS: From a total of 824 patients who underwent ACLR, 13 patients with a history of voluntary knee instability were selected, and data of these patients (demographic and clinical profile) were obtained. Outcomes of surgery in this group of patients were evaluated by using Lysholm score and Tegner activity level. RESULTS: All patients were young men with a chronic ACL injury and manifested instability. Associated injuries were lateral meniscus tear in 3 patients, medial meniscus tear in 2, and posterolateral corner (PLC) injury in 3. ACLR was done using the semitendinosus-gracilis graft in all patients. Further, anterolateral ligament reconstruction was done in 2 patients and PLC reconstruction, in 3 patients. The mean Lysholm score was 54.76 (range, 48-62) preoperatively and 60.92 (range, 54-78) at a mean follow-up of 14.3 months (range, 11-26 months). The median Tegner activity level was 6 (range, 5-7) before injury and 4 (range, 3-5) at the final follow-up. Twelve of the 13 patients were able to demonstrate instability voluntarily at the time of the final follow-up. CONCLUSIONS: In patients with ACL and other ligament injuries who demonstrated voluntary knee instability, the functional outcome even after successful ligament reconstruction was poor.

Similar functional outcome using single anterior portal and standard two portals technique in recurrent dislocation of shoulder.

PURPOSE: Recurrent dislocation of shoulder (RDS) is a common injury in high demand professionals, like athletes and military personnel. The treatment for the patients with Bankart lesion is the arthroscopic repair. This present study compares the outcomes of two different techniques of arthroscopic Bankart repair i.e. a standard two anterior portals technique and a single anterior portal technique in patients with RDS. METHODS: Patients with traumatic RDS met the inclusion criteria were managed with Bankart repair using either two anterior portals (Group A) or a single anterior portal (Group B) technique. Patients were evaluated before the intervention and at the mean follow-up of approximately two years using Rowe score, Oxford shoulder score and Tegner activity scale. RESULTS: The mean age of the patients in Groups A (n = 34) and B (n = 37) was 29.64 years and 29.05 years respectively (p = 0.66). The dominant shoulder was involved in 27 patients in Group A and 22 patients in Group B (p = 0.069). The operative time in Group A and B was 68.52 min and 46.35 min, respectively (p < 0.001). The complications at follow-up, the mean Rowe score and Oxford score improved significantly in both groups compared with the pre-operative values. However, the final outcome scores were not significantly different between the both groups. The median Tegner's score preoperatively and at follow-up was 7 and 6, respectively in Groups A and B. CONCLUSIONS: Single anterior portal technique is an effective treatment modality, yielding a similar outcome as two anterior portals technique in the management of RDS.

A Study on the Outcome of Antibiotic Eluting Intramedullary Interlocking Nails in the Primary Fixation of Gustilo and Anderson Grades II and IIIA Open Fractures of Tibia.

INTRODUCTION: The incidence and outcome of infection in open tibial fractures is adequately recorded in literature. The aim of this study is to find out the deep infection rate, union rate, and functional outcome of open tibial fractures managed by prophylactic antibiotic eluting interlocking nail. METHODOLOGY: A total of 18 patients with 20 open tibial fractures who met the study criteria were included and followed up for a minimum of 1 year after surgical intervention. Reamed intramedullary interlocking nailing with antibiotic eluting nail was done followed by adequate skin cover. RESULTS: The outcomes were assessed using lower extremity functional scale and radiological union scale in tibial fractures both of which showed maximum improvement in initial 3 months followed by a steady improvement till 1 year with a good degree of correlation between the two scales. The total incidence of deep infection in this study was 5% (n = 1). All cases achieved union and independent ambulation by 1 year. CONCLUSION: Our study shows good radiological and functional outcomes with prophylactic antibiotic-coated nailing of open tibial fractures of Grades II and IIIA. The rate of deep infection is 5% and union rate is 100% in our study. Further comparative studies are required for drawing more conclusions on application of the results in clinical practice.

Is CT scan a predictor of instability in recurrent dislocation shoulder?

PURPOSE: Glenoid bone defect and the defect on the posterior-superior surface of the humerus "Hill-Sachs lesion" are the commonly seen bony lesions in patients with recurrent dislocation shoulder. Computed tomography (CT) scan is considered as the best option in assessing the bony defects in the recurrent dislocation shoulder. The aim of this study was to assess the clinical and radiological co-relation in the patients with recurrent dislocation shoulder. METHODS: Forty-four patients of recurrent dislocation shoulder who were evaluated between January 2015 and December 2017 at a tertiary care center, clinically and radiologically using CT scan and meeting the inclusion criteria, were included. The correlation between the clinical history of the number of dislocations and the bone loss using CT scan was evaluated. Two sided statistical tests were performed at a significance level of α = 0.05. The analysis was conducted using IBM SPSS STATISTICS (version 22.0). RESULTS: All the patients were male with mean age of 25.95 (SD ± 4.2) years were evaluated. Twenty-four patients sustained injury in sporting activities while 20 patients sustained injury in training. There were an average of 4.68 (SD ± 3.1, range 2-15, median 3) episodes of dislocation. Forty-one patients had the glenoid bone loss while 40 had the Hill-Sachs lesions. The mean glenoid width defect was 10.80% (range 0-27%) while the mean Hill-Sachs defect was 14.27 mm (range 0-26.6 mm). The mean area of bone loss of the glenoid surface was 10.81% (range 0-22.4%). The lesions were on track in 34 patients and off track in 10 patients. CONCLUSIONS: CT scan of the shoulder joint is an effective method for assessing the amount of bone loss. The number of dislocations are correlated significantly with off-track lesions and the amount of bone loss on the glenoid and Hill-Sachs lesion. The glenoid width bone loss of more than 9.80% or Hill-Sachs defect of more than 14.80 mm are the critical defects after which the frequency of dislocations increases.

Functional outcome after arthroscopic management of traumatic recurrent dislocation shoulder using Bankart repair and Remplissage techniques.

BACKGROUND: Recurrent dislocation shoulder is one of the common shoulder injuries encountered by the orthopedic surgeon in clinical practice. Bankart repair using the arthroscopic method has become one of the standard techniques in the management of recurrent dislocation shoulder. Remplissage technique can be used as adjunct to Bankart repair in certain conditions. METHOD: In this case series, we have assessed the functional outcome and return to activity at midterm follow-up after arthroscopic management. RESULTS: 51 patients with traumatic shoulder dislocation were operated using the shoulder arthroscopic technique. Rowe score improved significantly at the latest follow-up. No major complication was noticed in our case series. CONCLUSION: The shoulder arthroscopy procedure requires special instrumentation and expertise. We believe that this is a less invasive and safe procedure and provides an additional tool in the management of instabilities including in cases of complex recurrent dislocation of the shoulder.

Hip arthroscopy: Minimally invasive surgery for hip pathologies.

Arthroscopy is considered as one of the revolutionary techniques in the management of musculoskeletal disorders. Hip arthroscopy is a new emerging technique for the management of hip pathologies and it has gained popularity in the past decade. In the present case series, 5 patients with hip pathologies were operated using hip arthroscopy technique and the functional outcome and complications associated with hip arthroscopy were assessed. Harris hip score improved significantly at the latest follow-up. No major complication was noticed in our case series. In conclusion, hip arthroscopy procedure requires good instrumentation and expertise. We believe that it is a safe and less invasive procedure providing an additional tool in the management of hip pathologies.