Correlation of tibial parameters like medial, lateral posterior tibial slope and medial plateau depth with ACL injuries: randomized control study.

BACKGROUND: This study aims to compare variables such as medial posterior tibial slope, lateral posterior tibial slope, medial tibial plateau depth calculated by preoperative MRI, and posterior tibial slope calculated by lateral knee X-ray on randomly selected patients with ACL injuries to a control group of patients without the injury. The secondary aim is to determine the critical value of these parameters and ascertain whether they can be used as a screening tool to identify at-risk individuals. METHODS: Study participants included 426 subjects with noncontact knee injuries. Using stratified systematic random sampling, they were randomly divided into two equal groups of sixty, one for patients with ACL tears, and the other for those with ACL that was intact based on clinical and MRI findings. Based on the blinded assessment, MPTS, LPTS, MTPD, and PTS were assessed in MRI and lateral knee X-ray (PTS only), and the results were compared between groups using appropriate statistical models. RESULTS: There were higher MPTS, LPTS, and PTS scores in the ACL tear group when compared to the control group (p < 0.01), while MTPD was lower when compared to the control group (p > 0.05). ROC analysis for predicting ACL tear revealed an area under the curve for MPTS, LPTS, PTS, and MTPD as 0.942, 0.907, 0.967, and 0.878, respectively. The critical angle for MPTS, LTPS, PTS and MTPD was 8.25°,6.75°,8.5° and 2.25 mm, respectively, which has sensitivity of 91.0%, 86.7%, 93.3% and 80%; specificity of 86.7%, 78.3%, 90.0% and 71.7%, respectively. CONCLUSIONS: Medial posterior tibial slope, lateral posterior tibial slope, and posterior tibial slope were significantly higher in individuals in the ACL tear group but there was no significant difference in medial tibial plateau depth. MPTS, LPTS, and PTS are better predictors of identifying at-risk individuals predisposed to ACL injury than MTPD.

Bone Ninja application is reliable alternative to PACS in measuring preoperative and postoperative alignment parameters of total knee arthroplasty.

Background: A picture archiving and communication system (PACS) is a means wherein the images are acquired, displayed, transmitted, and stored digitally. Bone Ninja is an application on iPad (Apple Inc.) on the IOS platform, developed as a teaching tool for deformity corrections around the knee. The principal objective of this study is to determine the reliability and consistency of Bone Ninja application in measuring the preoperative and postoperative alignment in patients undergoing a total knee arthroplasty and compare it with the PACS. Methods: This retrospective cross-sectional study was done using preoperative and postoperative leg-length radiographs of 50 consecutive patients (50 knees) who underwent unilateral total knee arthroplasty. Using Bone Ninja application and PACS, preoperative Lateral Distal Femoral Angle (LDFA), Tibiofemoral Angle (TFA), Medial Proximal Tibial Angle (MPTA) and postoperative Tibial alignment angle (TAA), Tibiofemoral angle (TFA), Femoral alignment angle (FAA) were measured independently by three doctors (two orthopedists and one radiologist). The measurements were repeated after an interval to determine intra and interobserver reliability. Results: Both preoperative (TFA, LDFA, MPTA) and postoperative measurements (TFA, TAA, FAA) showed highly correlated intraobserver and interobserver correlation coefficients. Cohen kappa values for all the measurements were greater than 0.80 but the values were higher for PACS compared to Bone Ninja application. Conclusions: PACS remains the gold standard, but bone ninja application is a reliable alternative for preoperative and postoperative alignment measures in total knee arthroplasty where PACS is not available.

Prospective comparative analysis of efficacy of local debridement with or without vancomycin impregnated calcium sulphate in chronic osteomyelitis.

The primary objective of this study was to compare the efficacy of use of Vancomycin impregnated bioabsorbable calcium sulphate (VCS) pellets along with surgical debridement to control group without the use of calcium sulphate for chronic osteomyelitis. The secondary objective was comparing the results in different subtypes of chronic osteomyelitis. Methods: 50 consecutive patients were enrolled in VCS group and control group based on used whether VCS was used in treatment in addition to surgical debridement or not. Patients were classified using Cerny Mader Classification and were serially followed up to compare efficacy of eradication of infection and complications between the groups. Results: Patients were followed for a minimum of 24 months postoperatively (range, 24-63 months; mean 32.2 ± 4.2months). 88% (44/50) of patients in VCS group achieved eradication of infection when compared to 64% (32/50) in control group at 2-year follow-up period (p < 0.001). Three out of six patient with recurrence in VCS group and 11 out 18 patients in control group achieved eradication after second stage surgery using same protocol using VCS. Among 10 with persistent infection, 5 among these were those with diffuse osteomyelitis and 5 were those with medullary osteomyelitis. In VCS group, 18/50 patients had persistent serous drainage from the wound for up to 4 weeks which was self-limiting. Conclusion: Local debridement combined with antibiotic impregnated calcium sulphate as a single-stage treatment is effective in treating chronic localized osteomyelitis when compared to debridement alone. However, its use alone in diffuse osteomyelitis may be less effective.