Comparison of patellar tendon versus hamstrings autografts for anterior cruciate ligament reconstruction in Indian population: A randomised control trial study.

Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The best choice of graft for reconstruction remains undecided. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (QHT) grafts for ACL reconstruction over a 1-year follow-up interval in Indian population. METHODS: 42 consecutive patients with ACL injury were recruited, by pick and draw method and allotted into two groups with 21 patients in each group. Group A patients underwent arthroscopic ACL reconstruction using BPTB graft while QHT autograft was used for patients in Group B. All the patients underwent standard ipsilateral arthroscopic ACL reconstruction procedure using a single incision, antero-medial (AM) portal technique for BPTB or the QHT autograft by a same surgeon. Patients were followed up regularly for a minimum period of 1 year. RESULTS: After one year, the Cincinnati score was 91 ±â€¯4.117 in BPTB group and 89.29 ±â€¯5.371 in QHT group (P = 0.282). There was no significant difference between the two groups in the mean scores with respect to pain, overall activity level and running in the Cincinnati score. None of the patients complained of the knee giving way. Similarly, at 1 year, the Lysholm score was 92.84 ±â€¯2.630 and 90.55 ±â€¯2.395 in the two groups respectively (P = 0.842). There were no episodes of locking or instability and there was no significant difference in the mean Lysholm scores regarding pain and squatting. CONCLUSION: There was no significant functional difference between the two grafts in terms of Lysholm and the Cincinnati score, anterior knee laxity and altered sensation over proximal leg. The patients with QHT groups performed better than BPTB functionally at 6 month so early return to sport is possible even with QHT autograft.

Arthroscopic diagnosis and treatment of shoulder ochronotic arthropathy - A case report.

Alkaptonuria is a rare inherited metabolic disorder, caused by the deficiency of homogentisate 1,2 dioxygenase enzyme. The three major features of alkaptonuria are the presence of homogentisic acid in urine, ochronosis (bluish-black pigmentation in connective tissue) and arthritis of the spine and large joints. We present a 48 years old female presented with pain, restriction of movements of right shoulder. Arthroscopy was suggestive of ochronotic arthropathy. The definitive diagnosis of ochronosis was subsequently confirmed by laboratory and pathologic evaluation.

Bilateral Coracoid Avulsion Fractures with Unilateral Anterior Instability with Glenoid Bone Loss: Use of Avulsed Fragment for Reconstruction of Glenoid.

INTRODUCTION: Coracoid fractures are often missed since the fracture is not visualized in a routine anteroposterior view of the shoulder and special views are not ordered. Shoulder dislocation is common but it is rare to have a dislocation with a coracoid fracture. The purpose of this paper is to present the rare occurrence of bilateral coracoid fractures in a patient with unilateral anterior shoulder instability managed using the same fractured coracoid fragment by the latarjet procedure. CASE REPORT: We report a case of 48 -year -old male who presented to us with a history of recurrent dislocations of the left shoulder. He had frequent episodes of tonic-clonic seizures 5 years back. He was diagnosed to be suffering from neurocysticercosis of the brain for which he was successfully treated. He did not have any episode of seizure later, but he continued to have repeated episodes of dislocation on his left side only. On examination of his left shoulder, he had normal range of motion. He was found to be very apprehensive, even in the midrange. This made us to suspect glenoid bone loss and hence both magnetic resonance imaging and three -dimensional computed tomography (CT) scan of the left shoulder were ordered. The CT scan revealed bilateral coracoid fractures along with glenoid bone loss. An open bony procedure including iliac crest bone graft was planned after a diagnostic arthroscopy keeping in mind that the latarjet procedure may not be possible due to the coracoid fracture. During the operation, we found that the coracoid fragment was large enough to perform a latarjet procedure rather than doing an iliac crest bone graft. This itself provided stability of the shoulder on abduction and external rotation by providing a bony block not requiring any further procedure for the Hill -Sachs lesion. CONCLUSION: Epileptic patients should undergo CT scan evaluation for glenoid bone loss, large Hill -Sachs lesion and to rule out coracoid fractures to plan for bony stabilization procedure and since we have used the same fractured coracoids fragment for latarjet procedure and found to be successful, this add on the knowledge to the orthopedic community.

Low-grade fibromyxoid sarcoma around the knee involving the proximal end of the tibia and patella: A rare case report.

Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. LGFMS is a rare soft tissue tumor that tends to develop in the deep soft tissue of young adults and has the potential for local recurrence or distant metastasis. The current case report presents a 22-year-old male complaining of a slow growing painless mass in the right knee over a period of 10 years. Following complete evaluation by radiological and histopathological examination, a diagnosis of LGFMS was confirmed and a wide excision was performed. Currently, the patient has been under follow-up for the last five years without any evidence of metastasis. The present case report provides further information concerning the diagnosis, imaging and management of LGFMS.