ABSTRACT
An acutely locked knee is an incapacitating condition that requires urgent orthopedic intervention. Common causes of the locked knee include a tear of the meniscus, stump of a ruptured anterior cruciate ligament (ACL), loose body, and osteochondral injury. This report describes a rare case of an acutely locked knee due to the concurrent presence of a loose body and a degenerative osteophyte, highlighting the diagnostic challenges and treatment strategies employed for successful management. Notably, to our knowledge, there is no preceding report documenting the same etiology.
ABSTRACT
Purpose: Anterior cruciate ligament injury (ACL) commonly occurs during sporting events. It causes pain, instability and reduction in range of movement of the knee which results in altered balance, reduced strength as well as loading to the involved knee. The challenge to get the patient back to competitive sports level much depends on the rehabilitation process. Post ACLR rehabilitation is challenging due to the long rehabilitation time as well as boring repetitive exercises. The aim of this study is to compare between the effectiveness of using immersive virtual reality (PlayStation VR) in addition to the conventional rehabilitation as an aid in rehabilitation of patients after ACLR in terms of objective functional assessment and pain and subjective knee function scoring. Methods: This randomised controlled trial was undertaken in a tertiary hospital in Malaysia from July 2019 until July 2020. Thirty patients were randomised into a group undergoing purely conventional rehabilitation (Group 1) and a group undergoing both conventional rehabilitation and immersive virtual reality assisted rehabilitation (Group 2). The immersive virtual reality assisted rehabilitation was started at 3 months post operatively for 3 months duration. Limb loading, balance, range of motion, functional hop tests of the knee, pain and subjective scoring of the knee with the International Knee Documentation Committee (IKDC) Scores were measured preoperatively and at 6 months. Results: There were significant differences in terms of improvement of pain scores (p = 0.012) as well as IKDC Scores (p = 0.024) in Group 2 as compared to Group 1. However, there were no significant differences with regards to limb loading, balance, range of motion and functional hop tests of the knee (p > 0.05). No adverse events were observed during the study period. Conclusion: Immersive virtual reality can be used as an adjunct in rehabilitation of patients after ACL reconstruction in terms of improving their pain as well as their subjective knee evaluation. Large randomised control trial is recommended to further investigate the efficacy.
ABSTRACT
The acute locked knee is a common presentation of meniscal tears or other intra-articular injuries. However, a popliteus tendon tear, an uncommon cause of acute locked knee, is often overlooked as a possible diagnosis. Here, we present the case of a 29-year-old male who experienced an acute locked knee following a sports injury. An arthroscopic examination revealed an intrasubstance tear in the popliteus tendon and a complete anterior cruciate ligament tear, while the menisci remained intact. Due to the extension lag caused by the popliteus tendon tear, the anterior cruciate ligament reconstruction was postponed. The patient then underwent a course of physiotherapy before the anterior cruciate ligament reconstruction and eventually achieved full knee extension after six weeks. Further surgical intervention was then performed to address the ligament injury. Our case highlights the importance of considering a popliteus tendon tear as a possible cause of an acute locked knee. Proper diagnosis and management are crucial for achieving optimal outcomes for patients with an acute locked knee and concomitant ligamentous injury.
ABSTRACT
A ganglion cyst is a benign cystic lesion that can occur intraosseously. It is commonly a multiloculated lesion that consists of fibrous tissue with mucoid change and is usually located in the subchondral bone adjacent to the joint. Here, we present a rare case of a 33-year-old woman who presented to our orthopedic clinic with a five-year history of shoulder pain that gradually worsened. The pain was worst after any activity involving the right shoulder, and it also occurred at night and disturbed her sleep. Physical examination showed that the patient had limitations on the extreme range of movement. MRI revealed a subchondral bone cyst at the glenoid fossa. The ganglion cyst was subsequently curetted and packed with a bone graft from the iliac bone. Postoperatively, the pain resolved and the patient's range of movement improved. At the six-month follow-up, new bone formation over the void area caused by the cyst was observed on MRI.
