Early Failure of Primary Total Knee Arthroplasty Due to Massive Osteolysis Caused by Bio-Absorbable Interference Screws.

We report an unusual case in which an unabsorbed bio-absorbable screw in the tibial tunnel of anterior cruciate ligament reconstruction (ACLR) performed 11 years ago caused massive osteolysis and subsequent failure of total knee arthroplasty (TKA). ACLR was performed using suspensory fixation on the femoral side and a bio-absorbable interference screw on the tibial side. Fragmentation of the bio-absorbable screw at the time of tibial component implantation is thought to have evoked an accelerated inflammatory response, causing osteolysis, which finally resulted in early failure of the TKA.

Spontaneous atraumatic knee haemarthrosis.

Spontaneous knee haemarthrosis is a rare condition, most prevalent in the elderly with osteoarthritis. Recent reports have proposed that the source of bleeding is the peripheral arteries supplying the posterior horn of the lateral meniscus. In this case, a 62-year-old active man presented with acute postero-lateral left knee pain and swelling with limited weight bearing or movement of the knee. No recent history of trauma but history of lateral compartment dominant osteoarthritis and arthroscopic partial lateral meniscectomy of left knee. Aspiration showed a large haemarthrosis and following an MRI scan displaying large areas of full thickness chondral loss, complex tearing of lateral meniscus and loose bodies, the patient had an arthroscopy, washout, debridement of osteochondral tibial defect and diathermy of suspected bleeding point. This report supports the peripheral arteries supplying the posterior horn of the lateral meniscus as the source of bleeding in spontaneous haemarthrosis of the knee.

Ossified proximal patellar tendon rupture.

Extensor mechanism injuries are not uncommon in young active individuals. Patellar tendon is a part of extensor mechanism of the knee which is commonly ruptured due to forced eccentric contraction against flexed knee. There have been reports of pathological changes in the patellar tendon which eventually lead to the rupture. The common pathologies include hypoxic tendinopathy, mucoid degeneration, calcific tendinopathy and tendolipomatosis. We report a rare case of ossified proximal patellar tendon rupture in a fit and active skittle player, who sustained indirect injury to knee while playing soccer. The rupture was confirmed on examination and radiographs. We discovered intraoperatively that the ruptured proximal patellar tendon was ossified which was sequentially repaired with two Krackow sutures, JuggerKnot suture anchor and finally augmented with Leeds Keio tape. Postoperatively, a knee brace was used to immobilise in knee extension with progressive increase in range of motion. This report supports the pool of evidence suggestive of patellar tendon pathology in causing ruptures.

Multilevel lumbar spinal stenosis decompression: midterm outcome using a modified hinge osteotomy technique.

STUDY DESIGN: A prospective cohort study was carried out looking at the functional outcome and post procedure translational segmental instability after multi-level lumbar decompression using a hinge osteotomy technique. OBJECTIVE: The hinge osteotomy technique involves unilateral subperiosteal muscle dissection with osteotomy of the base of the spinous processes, thereby preserving the integrity of the posterior elements. The objective of this study was to show the results of this technique clinically and radiologically. METHODS: Between February 2005 and February 2007, 120 patients (51 male and 69 female) diagnosed with degenerative and/or congenital lumbar stenosis with a mean age of 64 years, underwent central and bilateral canal decompression using the hinge osteotomy technique. A mean of 2 segments (range 2 to 4) was decompressed. All patients were followed for a minimum of 3 years. Five outcome measures were used-visual analog scale for leg pain, Likert scale for functional status, symptom specific well-being score, general well-being score, and oswestry disability index score. The outcomes measures were recorded preoperatively, and at 6 months and 3 years postoperatively. Successful surgical outcome was defined as an improvement in at least 4 of 5 outcome measures. RESULTS: One hundred and eight patients (90%) had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (P<0.001), when measured at the 6-month postoperative mark as compared with preoperatively, with further marginal significant improvement (P<0.05) at 3 years post surgery. There was no evidence of progressive lumbar segmental instability at 3 years postoperatively. CONCLUSIONS: Decompression of multi-level lumbar spine stenosis using the unilateral approach with the hinge osteotomy technique is a safe approach for multi-level stenosis, with good outcome and no evidence of significant segmental translational spinal instability.