Role of imaging in surgical decision making in young knee osteoarthrosis.

Osteoarthrosis is the most common form of knee arthritis, characterized by pain and discomfort from primarily articular cartilage wear. Traditionally in its end stage, it has been treated with total knee arthroplasty, a permanent process with a life span of ten to fifteen years and challenges with revision. With an increasing longevity and epidemic of obesity that the population is facing, naturally, we are seeing more and more patients with osteoarthrosis at a younger age. This makes it imperative to extend the life of the native knee by conservative measures, injections of steroid, hyaluronic acid, or biologicals and finally a slew of surgical alternatives ranging from joint realignment to partial and total joint replacement. Besides the clinical presentation, decisions are made based on joint alignment, extent and degree of cartilage wear and the status of the subchondral bone. Imaging plays an invaluable role in surgical decision making. In this article, we will discuss how imaging is used in our practice during decision making for the management of the young osteoarthritic knee.

A review of role of osteotomy in knee ligament injuries.

Realignment osteotomies around the knee joint are used primarily for management of arthritis. Traditionally, an unstable knee has been considered a contraindication for osteotomy. But with a better understanding of biomechanics of osteotomies and their effect on ligament instabilities, the beneficial role of osteotomies in managing an unstable knee is becoming clearer. This review looks at recent literature on this subject to help in formulating a management plan especially in failed ligament reconstruction patients.

Return to sports after bucket handle medial meniscus tear repair using inside out technique in recreational sports players.

The main purpose of our study is to determine the outcomes of bucket handle medial meniscus tears repaired with the inside out technique in recreational sports players, and the return of these to pre-injury sports levels. 41 athletes with medial meniscus bucket handle tear were included in the study. 28 cases were associated with ACL tear while rest were isolated tears. Medial meniscus repair was done exclusively with arthroscopy assisted inside out technique. Lysholm score, IKDC score and Tegner staging were used to evaluate functional status of patients with minimum 1-year follow-up. Data was analyzed using Wilcoxon Matched pairs test, and Friedman test. All patients were examined clinically at regular intervals. Lysholm score and IKDC score showed significant increase in their values. Tegner staging showed no significant change compared to their preinjury game level. On VAS pain scale, there was significant decrease in their pain at regular follow up intervals. 2 patients had re-tears of the repaired medial meniscus. Repairing bucket handle tears of the medial meniscus in recreational sports players with the inside out technique yields good results in terms of clinical and functional outcomes. It successfully allows them to return to sports at 1 year.

Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction.

PURPOSE: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery. METHODS: Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus. RESULTS: Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout. CONCLUSION: Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the native knee. The clinical relevance is that this study did not support an ACL graft construct more complex than an anatomic single bundle.

Repairing Posteromedial Meniscocapsular Separation: A Technique Using Inside-Out Meniscal Repair Needles.

Posteromedial meniscocapsular separation of the knee has received renewed interest, with many articles describing a high incidence in association with anterior cruciate ligament injury. Various techniques have been described to address these lesions using all-inside meniscal repair sutures or using rotator cuff repair instruments through the posteromedial portal. Most orthopaedic surgeons are accustomed to using the "inside-out" meniscal repair technique with a double-armed suture. This technique is cost-effective and, in our opinion, more efficient in repairing such tears. We present our technique of repairing peripheral meniscocapsular lesions using an inside-out meniscal repair system. We believe that this technique is easily reproducible, is less time-consuming, and ensures a good "bite" of the capsular tissue, producing a robust repair.

Baked beans in the knee? An odd-looking synovial swelling in the knee joint.

Lipoma arborescens (LA) is a rare benign neoplasm affecting large synovial joints, most commonly seen in the knee joint. Unlike other common swellings around the knee joint, LA is intra-articular and can lead to degenerative changes in the knee joint due to mechanical impingement. The importance of correct diagnosis with characteristic MR and macroscopic appearance and appropriate surgical treatment is outlined in this case report.

Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures.

PURPOSE: To compare outcomes of unipolar versus bipolar uncemented hemiarthroplasty and determine factors affecting outcomes. METHODS: 433 and 274 elderly patients with displaced intracapsular femoral neck fractures underwent uncemented unipolar hemiarthroplasty and uncemented bipolar hydroxyapatite-coated hemiarthroplasty, respectively. Surgical options were based on the patient's general condition and preinjury mobility status. In the respective groups, the mortality of 377 and 242 patients and the mobility of 270 and 217 patients were reviewed at the 4-month follow-up. Patient age, sex, American Society of Anesthesiologists [ASA] score, mobility, and mortality of the 2 groups were compared. RESULTS: Patients who underwent unipolar hemiarthroplasty were significantly older, less fit, and less mobile (p<0.001). Patients who underwent bipolar hemiarthroplasty achieved better outcomes for mortality and mobility (p<0.001). Among patients who were able to walk unaided before injury, more of those having bipolar hemiarthroplasty were able to do so at month 4 than those having unipolar hemiarthroplasty (13% vs. 33%, p<0.001). Mortality within 4 months was associated with age, male gender, and ASA score. When patients were stratified according to age groups, mortality within 4 months was lower in patients having bipolar hemiarthroplasty. CONCLUSION: In elderly patients with femoral neck fractures who were fit and physiologically young, uncemented bipolar hemiarthroplasty seemed to achieve better functional outcome.

Unusual mode of mechanical failure of an AO cannulated self drilling screw. A case report.

Cannulated AO screws are commonly used for fracture fixation. Mechanical failure of screws has been well reported but this was mainly breakage of the screw head during removal. We report an unusual mode of failure of an AO self drilling cannulated screw which we have not previously experienced, where the screw threads were found to be unravelled during insertion. We also suggest the way to recognise this complication early and how to prevent or deal with it.