Functional Outcome of Arthroscopic Suture Pull-Out Fixation in Tibial Spine Avulsion of Anterior Cruciate Ligament.

BACKGROUND: Tibial spine avulsion of the anterior cruciate ligament is a rare intraarticular injury of the knee. In this condition, the tibial attachment site of the anterior cruciate ligament is detached from the knee. The mechanism of the injury is hyperextension of the knee and rotation with valgus force. There are so many treatment options. This study aims to find out the functional outcome of Arthroscopic Suture pull-out fixation in this injury. METHODS: This is a retrospective study done from August 15, 2019, to August 14, 2022. The outcome was analyzed by comparing the preoperative and 12-month postoperative International Knee Documentation Committee Score, Tegner Lysholm Score, Knee Range of motion, and Visual Analog Scale Score. RESULTS: Twenty-two patients were included with a mean age of 18.95 (13-31). Among them 15(68.2%) were male and 7(31.8%) were female. Arthroscopic suture pull-out fixation was done in all the cases. The knee range of motion was improved from preoperatively 35.00±7.86 to 135.68±3.50 at the final follow-up. The Tegner Lysholm score was improved from preoperatively 34.68±1.28 to 94.54±2.97 at the final follow-up. Preoperatively the VAS score was 8.04±1.27 which improved to 0.60±0.50 at the final follow-up. The IKDC score was 23.86±1.42 preoperatively which improved to 92.72±3.28 at the final follow-up with p-value < 0.001 Conclusions: Arthroscopic Suture pull-out fixation of tibial spine avulsion of the Anterior cruciate ligament is a good technique that restores the functions of the knee and has an excellent outcome Keywords: Anterior cruciate ligament; suture pull-out fixation; tibial spine avulsion.

Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament.

BACKGROUND: Mucoid degeneration of the anterior cruciate ligament is a rare pathological condition. This is a condition where the anterior cruciate ligament becomes bulky and seems like a celery stalk appearance. The most common symptom is a pain in the posterior aspect of the knee and consistent clinical finding is a mechanical block to an extension of the knee. This study aims to find out the functional outcome of arthroscopic debridement of this entity. METHODS: This is a prospective observational study from Jan 1st 2021 to Dec 31st 2021 done in 17 patients. The outcome was measured in terms of preoperative and postoperative visual analogue scale, Tegner Lysholm score and International Knee Documentation Committee score. RESULTS: Eleven females and six males were included in this study. The mean age of the patients was 51.41 years. Arthroscopic debridement of mucoid degeneration of the anterior cruciate ligament was done. Preoperative and 6 months postoperative VAS score was 8.12 and 2.00 respectively (p<0.05), preoperative and 6 months postoperative Tegner Lysholm score was 44.00 and 86.29 respectively (p<0.05), and preoperative and 6 months postoperative IKDC score was 29.06 and 79.94 respectively (p<0.05) Conclusions: Arthroscopic debridement serves as an effective way of treatment of mucoid degeneration of the anterior cruciate ligament.

Prevalence of Nerve Injuries in Supracondylar Fracture of Humerus in a Tertiary Care Hospital.

BACKGROUND: Supracondylar fracture is a common childhood injury. These fractures are often associated with neural and vascular injuries. There is discrepancy in literature about the most common nerve injured in such fractures. This study aims to study the nerve injury patterns in supracondylar fractures of humerus in Nepalese children. METHODS: This descriptive cross sectional study was conducted in 152 children (aged 2 to 14 years) with supracondylar fractures of humerus attending in Bharatpur Hospital during the period of one year. All eligible patients were assessed clinically and radiologically. Neurological assessment was done for nerve injury. RESULTS: Out of 152 children, 18(11.8%) had nerve injuries. The mean age was 7.41±2.91 years. Boys were more injured (68.4%) than girls (31.6%). It was more common on non-dominant side (57.9%). Out of 18 nerve injuries, most commonly injured nerve was median nerve 10(55.5%) followed by radial nerve 7(38.9%). Median nerve injury was common in posterolateral displacement and radial nerve injury was common in posteromedial displacement type of fracture.   Conclusions: Displaced supracondylar fractures have relatively higher prevalence of nerve injuries. Most commonly involved nerve is median nerve followed by radial nerve. So, every displaced fracture should be routinely screened for nerve injuries.