Ashish Shukla

Objectives: The patella, a sesamoid bone within the quadriceps tendon, enhances knee extension. Patellar fractures, often from direct or indirect trauma, disrupt the extensor mechanism. Diagnosis involves clinical examination and imaging. Treatment options include non-surgical, minimally invasive percutaneous fixation (MIPF) and open reduction internal fixation (ORIF), each with specific indications and potential complications. This investigation seeks to develop and evaluate a novel percutaneous fixation technique employing FiberWire for the management of transverse patellar fractures. The proposed method aims to mitigate the limitations inherent to both open and minimally invasive surgical approaches. Material and Methods: A retrospective observational study was undertaken at a tertiary care facility between December 2020 and December 2021. Postoperative evaluations were performed at 3, 6, and 18 weeks. A radiographic union assessment was conducted for all participants by the primary investigator. Knee function and stability were quantified using the Knee Society Score (KSS), Lysholm Knee Scoring Scale, and Visual Analogue Scale (VAS). Results: A retrospective pilot study was conducted to evaluate the efficacy of percutaneous fixation for patellar fractures in 15 adult patients. Surgical intervention was performed under spinal anesthesia within five days after the trauma. Postoperative follow-up at 3, 6, and 12 weeks demonstrated significant improvements in knee function, as measured by KSS and Lysholm scores. Radiographic union was achieved in all cases. Patients reported low levels of postoperative pain and high satisfaction rates. Conclusion: Percutaneous fixation of patellar fractures in this small cohort yielded promising early functional and radiological outcomes. Although these preliminary findings are encouraging, larger, long-term studies are necessary to establish the definitive role of this technique.

Aim Habitual dislocation of patella is an uncommon pathological condition. Though numerous techniques have been described in the literature for the treatment of patellar dislocations, none of the single procedure is fully effective in the surgical treatment of habitual dislocation of patella. We described our experience with a two in one procedure for habitual dislocation of patella in ten children. Patients and method Ten children having habitual dislocation were reviewed prospectively for twelve months following surgical procedure. The age ranged between 5 and 9 years. We performed graded lateral soft tissue release and patellar tendon transposition as described by Roux Goldthwait. Clinical results were evaluated using Kujala score, ability to do straight leg raise, knee range of motion and visual analogue scale. Result There has been no recurrence of dislocation. The mean Kujala score before surgery was 48 which improved to 97.8 at 12 months follow-up after the surgical procedure. At 12 months follow-up all patients were able to do straight leg raise and had almost full range of motion. Conclusion We conclude that extensive proximal lateral release along with Goldthwait Roux procedure helps in treating the habitual dislocation in patella in children. Decision for the extent of lateral release must be taken intra-operatively. Our method of treatment is simple, cost effective and reproducible with excellent functional outcome.

Repair of a “U” shaped rotator cuff tear tends to create extreme tensile forces at the central part of the rotator cuff margin, causing tensile overload and may result in subsequent failure. We describe our technique of repairing the “U” shaped tear in which margin convergence is done using Ethibond (Ethicon Inc., New Jersey) and a single triple-loaded suture anchor. It results in the reduction of the strain and also allows the repair of seemingly irreparable tears. We included 10 patients having a “U” shaped degenerative rotator cuff tear. All patients were assessed preoperatively. The University of California at Los Angeles Shoulder score (UCLA shoulder score) recorded preoperatively and at final follow-up was used to assess functional outcome. Out of 10 patients, six were males and four were females. The mean age was 60 years (range 50-70 years). The average follow-up was for 31 months (range 24 - 48 months). The UCLA score increased from an average of 9 preoperatively (range 8 - 12) to an average of 29.6 (range 27 - 31) at the terminal follow-up. The UCLA increased in the postoperative period and was statistically significant (unpaired t-test; p < 0.0001). All patients had good/excellent outcomes (UCLA score > 27). Abduction increased from average 27 degree preoperatively (range 20 degree - 35 degree) to an average 131 degree (range 125 degree - 140 degree) at final follow-up (unpaired t-test; p < 0.0001). Our technique of modified margin convergence achieves low tension repair and anatomical footprint reconstruction with good clinical outcomes using a single triple-loaded anchor.