Clinico-Radiological Correlation Between Anterior Cruciate Ligament Deficiency and Hyperextension of the Knee Joint: A Prospective Study.

INTRODUCTION: The anterior cruciate ligament (ACL) primarily restricts anterior sliding of the tibia over the fixed femur, thereby also postulating to prevent hyperextension of the knee joint. The main objective of our study was to identify the role of the ACL in the prevention of knee hyperextension and to quantify the amount of hyperextension caused by an ACL tear, apart from its well-established role in the prevention of anterior tibial translation on the fixed femur. METHODS:  This prospective study was conducted in a tertiary care hospital. Eighty patients with unilateral ACL tears were assessed clinico-radiologically in the preoperative period to quantify the knee hyperextension, which was then compared with the uninjured contralateral knee of the same patient. Posterior tibial slope and notch width index were also assessed to rule out bias in our study. RESULTS: The mean age of patients in our study was 27.3 years. Out of 80 patients, 70 were male and 10 were female. The Pearson coefficient for clinically and radiologically assessed hyperextension was 0.919 (p-value 0.001) and 0.910 (p-value 0.001), respectively. Posterior tibial slope and notch width index assessment showed Pearson coefficients of -0.018 (p-value 0.887) and -0.068 (p-value 0.547), respectively. CONCLUSION: Anterior cruciate ligament complete tear or deficiency produces knee hyperextension, which varies from patient to patient. Though the amount of hyperextension produced is mild (less than five degrees in most patients), it can cause a significant amount of knee instability. Hence, correction of knee hyperextension is crucial while performing ACL reconstruction.

Spontaneous Distal Migration and Protrusion of a Küntscher Intramedullary Nail from the Left Femur: A Rare Complication.

Küntscher intramedullary nail (K-nail) proximal migration in the femoral medullary canal is a common postoperative complication. But spontaneous distal migration of the K-nail across the knee joint and protrusion over the tibia till the tibial tuberosity is a complication that has very rarely been reported in the literature previously. This is the case report of a 41-year-old man who presented with a pus discharging sinus over the tibial tuberosity for the last one year. K-nail insertion was done six years ago. The underlying cause of the migration of the K-nail is subject to controversy and speculation. Infection and delayed union with shortening are some etiological possibilities. Wrong selection of K-nail size, loosely fitted nail, premature weight-bearing, and disuse osteoporosis may also be contributory factors.

Chronic osteomyelitis by Aeromonas hydrophila: A silent cause of concern.

Aeromonas is a Gram-negative bacillus, widely found in aquatic environment. Osteoarticular pathology caused by Aeromonas hydrophila is rarely encountered. To the best of our knowledge, this is the first case of chronic osteomyelitis by A. hydrophila reported from India. We report a case of chronic osteomyelitis of the lower limb due to A. hydrophila, which occurred as a delayed complication following open reduction and internal fixation. Prompt medical and surgical intervention supplemented by a comprehensive microbiological workup aided in pathogen identification and specific antimicrobial administration resulting in the successful outcome of our patient. This case illustrates the utility of multidisciplinary management approach involving microbiologists and orthopedicians in investigating and appropriately managing such cases.

Brodie's abscess of medial distal femoral condyle after a thorn prick: rare clinical presentation.

Thorn prick injuries are generally conceded frivolous and rarely demand medical attention. Howbeit deep seated injuries are well described in the literature. We presented a case of thorn prick injury to the knee that manifested as Brodie's abscess of the medial distal femoral condyle and synovitis. Magnetic resonance imaging (MRI) and ultrasonography could only construe the affliction but not spot the thorn. Arthrotomy was undertaken for exploration and debridement. Empirical therapy with initial systemic Cefotaxime and subsequent Ofloxacin worked well after the surgery. Deep seated injuries by a thorn prick may take a protracted and torpid course. Thorough curettage of the bony lesion and debridement are vital for proper manage- ment.

Seating of TightRope RT Button Under Direct Arthroscopic Visualization in Anterior Cruciate Ligament Reconstruction to Prevent Potential Complications.

The ACL TightRope RT (Arthrex, Naples, FL) is a recently introduced fixation device. The adjustable graft loop allows the surgeon some freedom in terms of the length of the femoral socket, eliminates the need for bothersome intraoperative calculations for selecting loop length, ensures that the socket is completely filled with graft, and provides the possibility of tensioning the graft even after graft fixation. However, the device can be associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. For example, in our experience, sometimes the button of the TightRope RT may not flip, may become jammed inside the femoral canal, or may flip in the substance of the vastus lateralis. To prevent this, we have introduced 2 additional steps in our procedure: (1) direct visualization of the TightRope RT button in the femoral socket with the arthroscope during its passage and (2) a controlled push directly on the button with the help of a guide pin. Thus proper seating of the button is ensured by direct visualization and the crucial push helps in flipping and seating of the button.