Vijay Kumar Digge

Objective The purpose of this study was to compare the all-inside (Group A) and conventional (Group B) anterior cruciate ligament reconstruction (ACLR) methods in terms of tunnel or socket morphology and functional outcomes. Design Retrospective cohort study. Methods Tunnel morphology was evaluated using a computed tomography scan and compared with intra-operative tibial and femoral drilling diameter at a mean follow-up of 29 months following ACLR between these groups. Clinical outcomes were studied using the 2000 IKDC subjective knee score, Lysholm score, and Knee Laxity Tester. Results The study compared the tunnel morphology of all-inside (Group A; 20 subjects) and conventional (Group B; 43 subjects) ACLR methods in 63 patients. The results showed no significant differences in functional outcomes between the two groups. However, the femoral tunnel shrunk in Group A by 1.32% and 6.9% at articular (F1) and mid-portion (F2), respectively, compared to Group B at the same locations. The tibial tunnel widened in Group A by 1.91% and 11.07% at articular (T1) and mid-portion (T2) respectively, compared to Group B at the same locations. The statistical analysis showed a significant difference in the tunnel diameter change between the two groups at F2 (P = 0.02), T1 (P = 0.008), and T2 (P = 0.04). Conclusion This study found that patients who underwent all-inside ACLR (Group A) had similar functional outcomes to those who underwent conventional ACLR (Group B). However, “tunnel diameter changes were overall more favourable in the all-inside group, particularly on the femoral side”.

Purpose Evaluation of tunnel widening and functional outcome parameters in conventional ACL reconstruction with and without accessory tibial fixation. Methods 43 patients who underwent hamstring tendon ACL reconstruction were assessed retrospectively with a CT scan for tunnel widening and were compared to intra-operative drilling diameter. The functional assessment comprised of 2000 IKDC subjective knee score, Lysholm score, pivot shift test, and side-to-side difference in knee laxity. Results 22 patients without accessory tibial fixation (Group A) and 21 patients with accessory tibial fixation (Group B) with a minimum follow-up of 29 months were compared. The clinical outcome parameters were comparable between the groups. On the rank-sum test, the percentage change in tunnel diameter did not exhibit any significant difference in the articular(F1) and middle portion(F2) of the femoral socket (P = 0.39 and 0.86 for F1 and F2, respectively) as well as in the articular(T1) and middle portion(T2) of tibial tunnel (P = 0.07 and 0.87 for T1 and T2, respectively). 4 out of 21 Group B patients complained about hardware prominence. Conclusion Accessory tibial fixation has no benefits in terms of tunnel widening and clinical outcomes. Rather it may lead to hardware prominence. Level of evidence III.

Introduction/Background Multiple medical and surgical treatments have been described in the early stages of Avascular Necrosis (AVN) of the femoral head which delay the disease progression. Similarly, multiple studies, trials, reviews, and systematic reviews exist for the various treatments described and their outcomes but with no consensus over which is superior. So in this study, we reviewed the systematic reviews of all the conservative therapies for AVN of the femoral head systematically to identify a single or a combination of non-surgical treatment choices in the initial stages of the disease. Methodology A thorough literature search has been carried out in January 2022 through the use of Pubmed, EMBASE, and Cochrane electronic databases using PRISMA guidelines. The Mesh words and Keywords used were “femoral head AVN”, “Conservative management”, and “Systematic Reviews”. The inclusion criteria used during the screening were, any systematic reviews which included patients with AVN either idiopathic or secondary, who are managed with conservative therapies like bisphosphonates, Hyper Baric Oxygen Therapy (HBOT), Shock wave therapies like Extracorporeal Shock Wave Therapy (ESWT), or electrical therapy like Pulsed Electro Magnetic Field (PEMF). The quality of the included systematic reviews was assessed using AMSTAR-2 criteria. Results The initial search yielded 364 studies which on screening based on our inclusion criteria finally resulted in seven systematic reviews to be included in the present study. There were two systematic reviews for Hyper Baric Oxygen Therapy (HBOT), two for Extracorporeal Shock Wave Therapy (ESWT), one for electrical stimulation modalities like Pulsed Electro Magnetic Field (PEMF), and two for bisphosphonates. The follow-up of the patients in the included systematic reviews varied from 6 weeks to 10 years. The total number of patients varied from 77 to over 1000 across the systematic reviews. Almost all of the studies included a control group that either received the intended treatment with adjuncts or did not receive any treatment at all. Because of the heterogeneous nature of included articles in the systematic reviews, meta-analysis was performed in only three of the included systematic reviews. Conclusion Of all the modalities of treatment described, bisphosphonates are easily available and cost-effective and do not require any hospital resources/machinery for delivering the treatment. So they can be used as an initial line of treatment for patients with early stages of AVN (Ficat and Arlet 1–3) and based on the hospital availability of resources could be supplemented with any of the biophysical modalities (ESWT/PEMF/HBOT) for maximum efficacy to delay the disease progression. Level of Clinical Evidence Systematic review.

Purpose The Judet’s technique of quadricepsplasty for an extension contracture of the knee joint offers the benefit of a sequential and controlled release of the intrinsic and extrinsic soft tissue constituents restricting the knee flexion. The main principle of our study was to analyze the clinical as well as functional outcome and to assess an extension lag following Judet’s quadricepsplasty for the knee extension contracture deformity. Materials and Methods This is a retrospective cohort study comprises of thirty three patients, operated for extension contracture with Judet’s quadricepsplasty with the mean follow-up was 30 months. Knee range of motion of the operated knee was recorded preoperatively and at 6, 12 and 24 month follow-up after the surgery. Judet’s criteria were used to evaluate the outcomes following the procedure. Results 92.42° (range, 60°–110°) of knee flexion was achieved after an average follow-up of 24 months compared to preoperative knee flexion was 14.09° (range 5°–25°), reflecting a 74.69° average improvement in knee flexion. Twelve patients had excellent results, nineteen had good results as per Judet’s criteria but there were no patients with extension lag. The two patients with fair results had superficial wound infection which healed without any further surgical intervention. Conclusions Judet’s quadricepsplasty offers sequential release without extension lag of the knee joint. Patients with the knee extension contractures deformity can be successfully managed with the Judet’s quadricepsplasty to gain useful knee motion and function.

Currently, the management of acute osteochondral fractures (OCFs) of the patella is well established. However, the management of chronic OCFs remains debatable, as it is not clear whether such lesions can be accurately reduced or whether they will reliably heal. With well proven results of open reduction and internal fixation (ORIF) with headless compression screws (HCS) for acute OCFs, the application of this technique in late presenting cases is inconclusive. Thus, we present the clinicoradiological outcome of patients with chronic osteochondral injuries managed with ORIF. Fifteen patients who underwent surgical fixation by ORIF with HCS for chronic OCFs of the patella, between February 2013 and June 2018, were retrospectively analyzed after a mean follow-up of 3.8 years (range: 2–7 years). The mode of injury, size of the osteochondral fragment, and knee range of motion along with Kujala's scoring were examined clinically and radiological assessment was done by X-rays and magnetic resonance imaging (MRI) scans. Fifteen patients (11 males and 4 females), with a mean age of 17 years with chronic OCF of patella were enrolled. Noncontact twisting injuries were the most common mode of injury seen in 86.66% of patients and postcontact injuries in two patients (13.33%). The mean time from trauma to presentation was 7 weeks (range: 6–14 weeks). The mean preoperative Kujala's score improved from 44 to 84.8 at 6 months and 92.6 at 2 years, postoperatively. Intraoperatively, the lesion was found in medial patellar facet in 12 patients and 3 had lesions in the central facet. The mean size of the lesion was 20 mm × 18 mm. Radiological union was observed in all patients, at a mean duration of 16 weeks (range: 12–20 weeks). One patient underwent implant removal 1 year after initial surgery for mechanical symptoms. ORIF of OCFs of the patella using headless cannulated screws is simple, reliable, reproducible, and provides satisfactory outcomes. This technique can be considered for fixation of fragments with adequate subchondral bone.

Purpose: There are limited studies in the literature comparing the alignment accuracy of the large console, imageless, computer‐assisted navigation (CAN) and portable, hand‐held, accelerometer‐based navigation (ABN) in total knee arthroplasty (TKA). This study was aimed to compare the operative time, blood loss, radiological, clinical and functional outcomes between CAN‐ and ABN‐guided bilateral TKA.Methods: From Jan 2016 to Dec 2017, 50 patients who underwent bilateral TKA were randomized to undergo either CAN‐guided or ABN‐guided TKA. Tourniquet time and blood loss were recorded, and intra‐op complications were noted. Post‐op radiological outcomes at 2 weeks were compared between the groups. The clinical and functional outcomes using the American Knee Society Scores (KSS) and Oxford Knee Score (OKS) were recorded pre‐operatively and post‐operatively at 3, 6, 12 months and at the end of the study with a minimum follow‐up of 48 months.Results: Both groups were well‐matched in terms of patient demographic parameters. The mean surgical time per knee was significantly lower in the ABN group (54.5 ± 5.6 min) compared to the CAN group (61.7 ± 13.7 min; p < 0.01). Mean blood loss per knee in the ABN group was 592.1 ± 245.3 mL compared to 682.8 ± 322.0 in the CAN group (p = 0.11). In the ABN group, the mean post‐op mechanical axis was 1.2 ± 3.2° (vs 1.5 ± 2.2° in the CAN group, p 0.6), the frontal femoral angle was 88.8 ± 2.3° (vs 88.8 ± 1.8° in the CAN group, p 1.0) and frontal tibial angle was 90.1 ± 1.6° (vs 89.7 ± 1.1° in the CAN group, p 0.14). At 48 month follow‐up, the mean functional KSS in the ABN group was 89.0 ± 5.7 (vs 88.1 ± 4.5 in the CAN group, p 0.37) and the mean OKS was 40.5 ± 2.8 (vs 39.6 ± 3.2 in the CAN group, p 0.12).Conclusion: Portable, hand‐held ABN offers alignment accuracy and functional outcomes in TKA similar to that with CAN, with a reduced duration of surgery. There was no advantage of either of the techniques in terms of clinical or functional outcomes at 48 month follow‐up.Level of evidence 1.: