Volume index as a new measure of cartilage loss: a retrospective MRI-based study of chondral injury patterns in adult patients with knee pain.

BACKGROUND: Knee pain is one of the commonest symptoms in patients who attend the Orthopaedic outpatient clinics. Chondral defects result in a painful knee. Incidence of chondral defect is reported to be between 5 and 10% over the age of 40. It is well documented that chondral defects can lead to osteoarthritis. Early detection of these lesions and cartilage repair surgery can delay the onset of osteoarthritis. The purpose of this study is to highlight the incidence, associations and correlations between opposing cartilage defects in patients who present to the knee clinic with pain. METHODS: A retrospective analysis was carried out on patients who had Magnetic Resonance Imaging scans for painful knees between June 2017 and May 2019. About 227 consecutive knees were studied for the incidence of chondral defects, number of lesions, grade and size of lesion, geographical location and associated pathology in the knee. RESULTS: All the 227 patients had chondral lesions. Most patients had 2-3 lesions (66.1%) with patellar lesions (76.6%) being the commonest followed by medial femoral condyle (59.9%). Significant correlation was found in grade and size between opposing surface lesions in patella-trochlea, Medial Femoral Condyle-Medial Tibial Plateau and Lateral Femoral Condyle-Lateral Tibial Plateau. Females were more predisposed to patella lesions. Significance between age and lesions were established. CONCLUSION: Incidence of cartilage defects in the knee is very high. Kissing lesions must be considered when treating cartilage lesions. Volume index could be a promising method to quantify lesions.

Patellofemoral joint degeneration: A review of current management.

The patellofemoral component of the knee joint is affected by a wide range of degenerative causes without involving the other parts of the knee. It is often the presenting pathology in early knee osteoarthritis and missed due to a variable presentation. Accurate examination and focused investigation can help with early diagnosis and guide treatment. Various aspects to treatment need to be addressed after thorough evaluation. Guidelines to approach the multifactorial pathology of the patello-femoral joint are provided with focus on the degenerative component of disease.

Nerve entrapment around elbow.

Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles. Electrodiagnostic studies can be a useful adjunct to clinical examination, to help localize the site and quantify the grade of compression. Management should involve a trial of conservative treatment and failing that, surgical treatment should be considered. We hereby provide an overview of nerve entrapments around the elbow including their applied anatomy, etiology, clinical assessment and overview of the current concepts in surgical treatment.

Patellar stabilization-Minimally invasive arthroscopic technique (Shetty & Kim).

Open patellar stabilization surgeries carry a risk of knee stiffness, patello femoral pain, longer time for recovery and poor cosmesis. We describe an arthroscopic assisted minimally invasive technique for patella maltracking which can help eliminate these complications.

Avoid post operative bracing to reduce ACL rerupture rates.

PURPOSE: It has been quoted that the graft is more prone to injury in the early stages of ligamentization between 3 and 6 months when the muscles are weak and compliance with post-op protocol is waning. Purpose of this study was to evaluate the functional outcome of avoiding postoperative bracing following ACL reconstruction and early enhanced recovery protocol on the reinjuries of graft. METHODS: Thirty-two consecutive patients who underwent arthroscopic ACL reconstruction by a single surgeon in the same specialist center between October 2015 and May 2017 were included in the study. All the patients were educated regarding rehabilitation before the index surgery and preoperative quadriceps exercises had been initiated. Rehabilitation was undertaken as per a standard protocol with emphasis on early mobilization. No brace was used. Patients were followed up between 3 months and 1 year. Lysholm knee scores were evaluated at 6 and 12 months postoperatively. RESULTS: No failures were noted (failure defined as instability, stiffness or persistent pain). The average Lysholm knee score at 6 months was 88 and at 12 months period was 91. No statistical significance (P > 0.00001) was noted in the scores between braced and unbraced at 1 year. CONCLUSION: ACL rehabilitation without a knee brace can indirectly prevent rerupture and is a cheaper as well as a safer method with better outcomes.

Chronic anterior cruciate ligament insufficiency results in inferior quality hamstring autografts.

BACKGROUND: Availability of a good quality autograft of adequate length is the first step towards a successful knee ligament reconstruction. Being able to predict the quality and length of hamstring autograft can go a long way in making the surgeon's pre-operative planning a lot easier. The purpose of this study was to find out if any correlation existed between the duration of ACL injury with history of repeated instability episodes and the quality and length of Hamstring graft that was harvested. METHODS: Forty consecutive patients who underwent ACL reconstruction using quadrupled Hamstring tendon graft were evaluated with regard to the duration of injury, number of instability episodes and graft characteristics like difficulty in harvesting the graft, quality and length of the graft. RESULTS: We found a statistically significant difference between the usable length of harvested Hamstring tendon in patients with acute and chronic injury (p = 0.004). There was a significantly high risk of the graft being shorter and of poor quality in patients with chronic injury (odds ratio = 5.7). CONCLUSION: Chronicity of ACL injury with repeated strains can cause fibrosis at the musculotendinous junction and result in harvest of a poor quality and short hamstring autograft. A detailed history with regard to duration of injury and repeated instability episodes will help a surgeon plan better when anticipating a sub-optimal graft.