The Black Knee - A Case Report.

INTRODUCTION: Ochronotic arthropathy in patients with alkaptonuria is a rare hereditary disorder. The altered metabolism causes the homogentesic acid derivatives to deposit in various connective tissues causing characteristic pigmentation. Due to the close clinical resemblance to that of a degenerative disorder, diagnosis of ochronotic arthropathy usually occurs intraoperatively. We report arthroscopic findings of a 50-year-old female with ochronotic arthropathy. CASE REPORT: A 50-year-old woman came with complaints of pain and swelling in the left knee. Clinical examination and MRI findings were correlated to reveal a tear of lateral meniscus. On arthroscopic examination, the blackish pigmentation of the meniscus and the articular cartilage led to the diagnosis of ochronotic arthropathy. CONCLUSION: Arthroscopy plays an important role in diagnosis and treatment of patients with ochronotic arthropathy. The characteristic arthroscopic finding may aid diagnosis even in patients who do not have other systemic manifestations. Timely arthroscopic intervention can help delay the disease progression.

Lesser Tuberosity Avulsion Fracture: A Rare Case Report.

Introduction: Lesser tuberosity avulsion fractures are rare and often missed. Patients often complain only of heaviness around the shoulder and some loss in range of motion. Case Report: This is a rare case of a lesser tuberosity avulsion fracture with displacement. The patient was a 29-year-old male who suffered an injury to the right shoulder due to a fall. Post-fall, the patient developed typical heaviness and restrictions in the range of motion of his right shoulder. Radiographs initially taken were not true anteroposterior (AP) views. The fracture was primarily missed by another surgeon, after which on opting for a true AP radiographs, the fracture was diagnosed. The fracture was managed by an open deltopectoral approach. Fracture fragment was reduced to its footprint and was fixed using 2 × 4.0 mm cancellous screws. Post-surgery, the patient was advised 3 weeks of immobilization after which mobilization was started. By monitored physiotherapy, consistent results can be obtained without loss of reduction. In this case too, full ranges with strength were achieved by 3 months postoperatively. Conclusion: Such fractures often missed may cause loss of external rotation movements in the patient and eventually malunion of the fragment if displaced. Watchfulness and timely management of the fractures can give excellent results. This case report aims at increasing the awareness among the budding shoulder surgeons in identifying such injuries at the earliest, and the means of managing them.

Modified Technique for Patellar Tendon Repair Post-Total Knee Arthroplasty: A Case Report.

INTRODUCTION: Rupture of patellar tendon following total knee arthroplasty (TKA) is a rare but disabling complication. Results of the primary repair of the patellar tendon after the TKA are associated with higher complication rates and a poor outcome. We report a rare case of traumatic patellar rupture, 5 years after the TKA managed using a primary repair with good post-operative outcome. CASE REPORT: A 75-year-old female was operated for sequential bilateral Grade 4 osteoarthritis. Five years after the left-sided TKA, she sustained a fall while coming down the stairs and avulsed her patellar tendon on the left side. The management in our case was done by primary repair using two techniques with augmentation using autologous semitendinosus free graft. CONCLUSION: Management of a patellar tendon rupture/avulsion after TKA is unpredictable and associated with poor functional outcomes. Various methods have been described with inconsistent clinical evidences. The operating surgeon must consider the potential advantages and disadvantages of these techniques.