Jill Monson, Elizabeth Niemuth
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 36-41
Author: Jill Monson [1], Elizabeth Niemuth [2]
[1] Department of Physical Therapy, TRIA Woodbury, 155 Radio Drive, Woodbury, MN 55125, USA,
[2] Department of Physical Therapy, Institute for Athletic Medicine, M Health Clinics and Surgery Center, Minneapolis, MN 55455, USA
Address of Correspondence
Dr. Elizabeth Niemuth,
Institute for Athletic Medicine, M Health Clinics and Surgery Center, 909 Fulton Street SE, Minneapolis, MN 55455, USA.
Email: eniemut1@fairview.org
Abstract
The rehabilitation process after surgical intervention for patellar instability warrants special consideration of the anatomy, biomechanics, and surgical procedure to facilitate the best outcomes for the patient. There is a paucity of evidence-based literature regarding post-operative rehabilitation protocols for the patellofemoral (PF) compartment. Recommendations for early rehabilitation (0–6 weeks) after lateral retinacular lengthening, medial PF ligament reconstruction, tibial tubercle osteotomy, and trochleoplastyare reviewed in this article. For each procedure, the following common post-operative rehabilitation focus points are reviewed: Weight-bearing status and brace use, joint range of motion, and strengthening.
Keywords: Patellofemoral, Rehabilitation, Patellar instability.
References
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| How to Cite this article:. Monson J, Niemuth E. Post-operative Rehabilitation for Select Patellar-stabilizing Procedures. Asian Journal of Arthroscopy Jan – April 2018;3(1):36-41. |
Modern Concept in Posterior Ankle Arthroscopy
Joseph Tracey, Selene G. Parekh
Volume 3 | Issue 2 | May – Aug 2018 | Page 9-12
Author: Joseph Tracey, Selene G. Parekh [2].
[1] Medical University of South Carolina 96 Johnathan Lucas St., Charleston, SC, 29425
[2] Duke University Medical Center, Orthopaedic Surgery North Carolina Orthopaedic Clinic 3609 Southwest Durham Drive Durham, NC, USA 27707
Address of Correspondence
Dr. Selene G. Parekh,
Medical University of South Carolina 96 Johnathan Lucas St., Charleston, SC, 29425 tracey312@live.com
Email: selene.parekh@gmail.com
Abstract
Ankle arthroscopy has evolved rapidly within the last twenty-five years and is now the principal method of treatment of ankle disorders. It would be prudent for an aspiring orthopaedic surgeon to include this technique in his or her armamentarium of surgical techniques. This will provide the surgeon an inclusive option to obtain accurate diagnosis and to discuss management options with the patient. The minimally invasive technique is biologically friendly by preserving the soft tissue envelope. This will also meet patient expectations to achieve an earlier and predictable functional recovery from ankle pathology. This review article will briefly mention historical aspects and outline the basic technique and relevant benefits of ankle arthroscopy. Indications and contra-indications of ankle arthroscopy will be discussed with pertinent review of literature. Complications and outcomes of the procedure will also be highlighted.
Keywords: Ankle arthroscopy, technique, indications
References
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3. Marotta JJ, Micheli LJ. Os trigonum impingement in dancers. The American journal of sports medicine. 1992 Sep;20(5):533-6.
4. Willits K, Sonneveld H, Amendola A, Giffin JR, Griffin S, Fowler PJ. Outcome of posterior ankle arthroscopy for hindfoot impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008 Feb 1;24(2):196-202.
5. Nickisch F, Barg A, Saltzman CL, Beals TC, Bonasia DE, Phisitkul P, Femino JE, Amendola A. Postoperative complications of posterior ankle and hindfoot arthroscopy. JBJS. 2012 Mar 7;94(5):439-46.
6. Lijoi F, Lughi M, Baccarani G. Posterior arthroscopic approach to the ankle. Arthroscopy. 2003 Jan 1;19(1):62-7.
7. Sitler DF, Amendola A, Bailey CS, Thain LM, Spouge A. Posterior ankle arthroscopy: an anatomic study. JBJS. 2002 May 1;84(5):763-9.
8. d’Hooghe PP, van Dijk CN. Hindfoot Endoscopy for Posterior Ankle Impingement. InArthroscopy 2016 (pp. 1067-1077). Springer, Berlin, Heidelberg.
9. Balcı Hİ, Polat G, Dikmen G, Atalar A, Kapıcıoğlu M, Aşık M. Safety of posterior ankle arthroscopy portals in different ankle positions: a cadaveric study. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Jul 1;24(7):2119-23.
10. Urguden M, Cevikol C, Dabak TK, Karaali K, Aydin AT, Apaydin A. Effect of jointmotion on safety of portals in posterior ankle arthroscopy. Arthroscopy 25:1442–1446, 2009.
11. Van Dijk CN, De Leeuw PA, Scholten PE. Hindfoot endoscopy for posterior ankle impingement: surgical technique. JBJS. 2009 Oct 1;91(Supplement_2):287-98.
12. Tonogai I, Hayashi F, Tsuruo Y, Sairyo K. Anatomic Study of Anterior and Posterior Ankle Portal Sites for Ankle Arthroscopy in Plantarflexion and Dorsiflexion: A Cadaveric Study in the Japanese Population. The Journal of Foot and Ankle Surgery. 2018 May 1;57(3):537-42.
13. Spennacchio P, Cucchi D, Randelli PS, et al. Evidence-based indications for hindfoot endoscopy. Knee Surg Sports TraumatolArthrosc2016;24:1386–95.
14. Van Dijk CN, Vuurberg G, Batista J, d’Hooghe P. Posterior ankle arthroscopy: current state of the art. Journal of ISAKOS: Joint Disorders &Orthopaedic Sports Medicine. 2017 Aug 7:jisakos-2016.
15. van Dijk CN, van Bergen CJ. Advancements in ankle arthroscopy. J Am AcadOrthopSurg2008;16:635–46.
16. van Dijk CN. Hindfoot endoscopy. Foot Ankle Clin2006;11:391–414.
17. Ogut T, Ayhan E, Irgit K, et al. Endoscopic treatment of posterior ankle pain. Knee Surg Sports TraumatolArthrosc2011;19:1355–61.
18. van Dijk CN. Hindfoot endoscopy for posterior ankle pain. Instr Course Lect2006;55:545–54.
19. Smyth NA, Murawski CD, Levine DS, Kennedy JG. Hindfoot arthroscopic surgery for posterior ankle impingement: a systematic surgical approach and case series. The American journal of sports medicine. 2013 Aug;41(8):1869-76.
20. Golanò P, Mariani PP, Rodríguez-Niedenfuhr M, Mariani PF, Ruano-Gil D. Arthroscopic anatomy of the posterior ankle ligaments.Arthroscopy. 2002;18:353-8.
21. Beimers L, de Leeuw PAJ, van Dijk CN. A 3-portal approach for arthroscopic subtalar arthrodesis. Knee Surgery, Sports Traumatology, Arthroscopy. 2009;17(7):830-834.
22. Lee KB, Saltzman CL, Suh JS, Wasserman L, Amendola A. A posterior 3-portal arthroscopic approach for isolated subtalar arthrodesis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008 Nov 1;24(11):1306-10.
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Ankle Arthroscopy
Rachala Madhu, Kartik Hariharan
Volume 3 | Issue 2 | May – Aug 2018 | Page 3-8
Author: Rachala Madhu, Kartik Hariharan [1].
[1] Department of Orthopaedic and Foot and Ankle Surgeon Royal Gwent Hospital
Address of Correspondence
Dr. Kartik Hariharan,
Consultant Orthopaedic and Foot and Ankle Surgeon Royal Gwent Hospital Cardiff Rd Newport NP20 2UB United Kingdom
Email: h.kartik@gmail.com
Abstract
Ankle arthroscopy has evolved rapidly within the last twenty-five years and is now the principal method of treatment of ankle disorders. It would be prudent for an aspiring orthopaedic surgeon to include this technique in his or her armamentarium of surgical techniques. This will provide the surgeon an inclusive option to obtain accurate diagnosis and to discuss management options with the patient. The minimally invasive technique is biologically friendly by preserving the soft tissue envelope. This will also meet patient expectations to achieve an earlier and predictable functional recovery from ankle pathology. This review article will briefly mention historical aspects and outline the basic technique and relevant benefits of ankle arthroscopy. Indications and contra-indications of ankle arthroscopy will be discussed with pertinent review of literature. Complications and outcomes of the procedure will also be highlighted.
Keywords: Ankle arthroscopy, technique, indications
References
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4. Kim et al. Reliability and Validity of Magnetic Resonance Imaging for the Evaluation of the Anterior Talofibular Ligament in Patients Undergoing Ankle Arthroscopy. Arthroscopy. 2015 Aug; 31(8):1540-7.
5. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle. Joshy S, Abdulkadir U, Chaganti S, Sullivan B, Hariharan K. Foot Ankle Surg. 2010 Jun;16(2):78-80.
6. Dowdy PA, Watson BV, Amendola A, and Brown JD: Noninvasive ankle distraction: relationship between force, magnitude of distraction, and nerve conduction abnormalities. Arthroscopy 1996; 12: pp. 64-69
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8. Gulihar A, Bryson DJ, Taylor GJ. Effect of different irrigation fluids on human articular cartilage: an in vitro study. Arthroscopy 2013; 29:251–6.
9. Ferkel, Richard D.; Dierckman, Brian D.; Phisitkul, Phinit. Mann’s Surgery of the Foot and Ankle. 9 th ed. Philadelphia, PA: Saunders, an imprint of Elsevier Inc; 2014. p.1723-1827.
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11. Molloy S, Solan MC, Bendall SP. Synovial impingement in the ankle. A new physical sign. J Bone Joint Surg Br. 2003 Apr;85(3):330-3.
12. Brennan SA, Rahim F, Dowling J, Kearns SR. Arthroscopic debridement for soft tissue ankle impingement. Ir J Med Sci 2012; 181(2):253–6.
13. Parma A, Buda R, Vannini F, Ruffilli A, Cavallo M, Ferruzzi A, et al. Arthroscopic treatment of ankle anterior bony impingement: the long-term clinical outcome. Foot Ankle Int 2014; 35(2):148–55.
14. Jones CR, Wong E, Applegate GR, Ferkel RD. Arthroscopic Ankle Arthrodesis: A 2-15 Year Follow-up Study. Arthroscopy. 2018 May; 34(5):1641-1649.
15. Quayle J, Shafafy R, Khan MA, Ghosh K, Sakellariou A, Gougoulias N. Arthroscopic versus open ankle arthrodesis. Foot Ankle Surg. 2018 Apr; 24(2):137-142.
16. Zengerink M, Struijs PA, Tol JL, van Dijk CN. Treatment of osteochondral lesions of the talus: a systematic review [Review]. Knee Surg Sports Traumatol Arthrosc. 2010; 18(2):238-46.
17. Murawski CD, Duke GL, Deyer TW, Kennedy JG. Bone marrow aspirate concentrate (BMAC) as a biological adjunct to the surgical treatment of osteochondral lesions of the talus. Tech Foot Ankle Surg. 2011; 10:18-27.
18. Chen XZ, Chen Y, Liu CG, Yang H, Xu XD, Lin P.Arthroscopy-Assisted Surgery for Acute Ankle Fractures: A Systematic Review. Arthroscopy. 2015 Nov; 31(11):2224-31.
19. O’Loughlin PF, Murawski CD, Egan C, Kennedy JG. Ankle instability in sports [review]. Phys Sportsmed 2009; 37:93-103.
20. Brown AJ, Shimozono Y, Hurley ET, Kennedy JG. Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review. Arthroscopy. 2018 May 2. pii: S0749-8063(18)30185-3.
21. Choi WJ, Choi GW, Lee JW. Arthroscopic synovectomy of the ankle in rheumatoid arthritis. Arthroscopy. 2013 Jan; 29(1):133-40.
22. Kunzler DR, Shazadeh Safavi P, Warren BJ, Janney CF, Panchbhavi V. Arthroscopic Treatment of Synovial Chondromatosis in the Ankle Joint. Cureus. 2017 Dec 23; 9(12):e1983.
23. Saxena A, St Louis M. Synovial Chondromatosis of the Ankle: Report of Two Cases With 23 and 126 Loose Bodies. J Foot Ankle Surg. 2017 Jan – Feb; 56(1):182-186. doi: 10.1053/j.jfas.2016.02.009. Epub 2016 Apr 5. Review.
24. Kanatli U, Ataoğlu MB, Özer M, Yildirim A, Cetinkaya M. Arthroscopic treatment of intra-artricularly localised pigmented villonodular synovitis of the ankle: 4 cases with long-term follow-up. Foot Ankle Surg. 2017 Dec; 23(4):e14-e19.
25. Mankovecky MR, Roukis TS. Arthroscopic synovectomy, irrigation, and debridement for treatment of septic ankle arthrosis: a systematic review and case series. J Foot Ankle Surg. 2014 Sep-Oct; 53(5):615-9.
26. Zengerink M, van Dijk CN. Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2012 Aug; 20(8):1420-31. Epub 2012 Jun 5.
27. Deng DF, Hamilton GA, Lee M, Rush S, Ford LA, Patel S. Complications associated with foot and ankle arthroscopy. J Foot Ankle Surg. 2012 May-Jun; 51 (3):281-4. Epub 2011 Dec 20.
28. Ferkel RD, Heath DD, Guhl JF. Neurological complications of ankle arthroscopy. Arthroscopy. 1996 Apr; 12(2):200-8.
29. Nickisch F, Barg A, Saltzman CL, Beals TC, Bonasia DE, Phisitkul P, Femino JE, Amendola A. Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am. 2012 Mar 7; 94(5):439-46.
30. Vega J, Golan´o P, Peña F. Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016 Apr; 24(4):1304-10. Epub 2014 Aug 24.
31. Koehler RJ, Amsdell S, Arendt EA, Bisson LJ, Braman JP, Butler A, Cosgarea AJ, Harner CD, Garrett WE, Olson T, Warme WJ, Nicandri GT. The Arthroscopic Surgical Skill Evaluation Tool (ASSET). Am J Sports Med. 2013 Jun; 41(6):1229-37. Epub 2013 Apr 2
32. Martin KD, Patterson D, Phisitkul P, Cameron KL, Femino J, Amendola A. Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition, and Proficiency During Diagnostic Examination of Residents in Training. Foot Ankle Int. 2015 Jul; 36(7):827-35.
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Arthroscopy in foot & ankle – Open your mind for your eyes to see
Abhishek Kini, Sachin Tapasvi
Volume 3 | Issue 2 | May – Aug 2018 | Page 2
Author: Abhishek Kini [1], Sachin Tapasvi [2].
[1] Department of Orthopaedics, P.D.Hinduja Hospital& Medical Research Centre, Mumbai, India.
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
Address of Correspondence
Dr. Abhishek Kini,
Dept. of Orthopaedics, PD Hinduja hospital & Medical research centre, Mahim, Mumbai, India. Email: kiniabhishek@gmail.com
One of the best paradoxes in medicine is the need to be stubborn and open-minded. A good doctor must insist on sticking to the vision and stay on course to achieve his treatment goal. But he must be open-minded during the process to newer technologies and advances. One should always look to add a few threads to their existing surgical skills. Foot and ankle arthroscopy is one such thread in modern medicine. It has made significant progress over the last 25 years. Small arthroscopes and instrumentation have been developed to work in tighter spaces, to facilitate small joint surgery. The technique started to gain acceptance in the sports medicine and arthroscopy world more so in the last decade.
These advances have allowed for shorter hospital stays and a shift toward more outpatient procedures, which can lower the rate of complications and decrease the overall cost of care. While the aforementioned trends are exciting for patients and surgeons alike, novel technologies must undergo thorough scientific analysis so that we can offer unbiased options to our patients. With this in mind, we must continue to push the envelope and develop more arthroscopic techniques in the foot and ankle that benefit our patients and return them back to work and sports more quickly and efficiently.
The general orthopaedic surgeon sees a multitude of ankle disorders. Potential surgical interventions can be better recognized with a little more basic knowledge of arthroscopic techniques. It is surprising that ankle arthroscopy is not emphasized in current residency curriculum. The learning curve for ankle arthroscopy is far more rapid than for arthroscopies of the shoulder and the hip. Minimal time investment to develop this skill-set is genuinely worthwhile.
However any new technique or methods should be used in proper indication. “Just because we have a hammer, the world doesn’t become our nail”. Judicious use of the technique and technology is essential for positive growth of any technology. However, once we are sure that new techniques are safe and effective, can we trade in that hammer for an arthroscope?
This issue has contributions from With this issue, we have invited stalwarts in the field of foot and ankle arthroscopy from around the world. It starts with a basic introduction to anterior ankle arthoscopy, followed by modern concepts in posterior ankle arthroscopy. Further, advanced techniques like the arthroscopic management of osteochondral lesions of talus, lateral ankle ligament instabilities, plantar fasciitis and tendon pathologies have been written in a simplified manner. Finally, a review article on foot and ankle arthroscopy, summing up with current updates, indications and techniques completes this issue. This issue. You may add valuable knowledge about foot and ankle arthroscopy to your toolbox, and some of the ideas and results presented will definitely help in decision making for your patients.
As usual your feedback is very important to us and we would love to hear from you about this issue and about the Journal as a whole. As mentioned in the Editorial, the forthcoming issues have some major changes added to the journal format and we take this opportunity to invite you to contribute to Asian Journal of Arthroscopy.
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Third Year of Asian Journal of Arthroscopy
Sachin Tapasvi, Parag Sancheti , Ashok K. Shyam
Volume 3 | Issue 2 | May – Aug 2018 | Page 1
Author: Sachin Tapasvi [1], Parag Sancheti [2] , Ashok K Shyam [2,3]
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India
Address of Correspondence
Dr Sachin Tapasvi
AJA Editorial Office, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [w], Maharashtra, India.
Email: asian.arthroscopy@gmail.com
Patellofemoral Instability Symposium
The editors and the editorial board are proud to announce that Asian Journal of Arthroscopy is in its third year now. Running a clinical Journal is not an easy task, specially when the all involved are active clinicians. With AJA in its third year, the seriousness of running an academic journal is upon us. We understand that the journal is now consolidated and further we just have to keep moving forward.
We are now looking at making some major changes in the Journal format. Till now the Journal was more of a review article Journal where complete issues were dedicated to symposia on single focussed topic. We plan to continue with the symposia’s in future too but a section on Original article, case reports and arthroscopic techniques will be added to the table of contents. We are specially inviting original articles as it will help us in getting better indexing faster.
Arthroscopic techniques section will have articles in a combined video and text part. The text will provide the background of the procedure and details of innovations in the technique and video will describe the entire procedure in details. These video articles will not only be on newer innovation but also from established standard procedures will also be invited to be published by experts. This will help the readers learn many individual nuances that are included in an arthroscopy procedure conducted by experts. This will be started from the upcoming issues.
Case reports are specially invited from the young Arthroscopy Surgeons who see a varied number of cases and presentation and also from the senior surgeons who see really complex cases. Arthroscopy as a science has developed a lot with contributions from single case reports which demonstrated unique challenges and forced surgeons to improvise or develop new techniques and technologies. A special section of Case reports will be kept in every issue of the Journal and if a video can be provided with the case report, it would have much better chance of being accepted
Lastly we are eager to hear from our readers and we invite them to contribute letters to editors to the journal. These letters can be related to articles in the journal or even can be a commentary on a new concept or idea. Questions to editorial board in terms of management of difficult cases are also invited.
As the journal evolves over a period of time, many more new features will be added to it. Feedback from our readers is essential and we request you to write your comments to us
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Patellofemoral Instability Symposium
Sachin Tapasvi, Parag Sancheti, Ashok K. Shyam
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 1-2
Author: Sachin Tapasvi [1], Parag Sancheti [2] , Ashok K Shyam [2,3]
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India
Address of Correspondence
Dr Sachin Tapasvi
AJA Editorial Office, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [w], Maharashtra, India.
Email: asian.arthroscopy@gmail.com
Patellofemoral Instability Symposium
It gives us immense satisfaction and pride in presenting the Asian Journal of Arthroscopy’s Special issue on Patellofemoral Instability to our readers. The symposium unfolds the recent advances on all aspects of this Clinical condition, the management of which has undergone myriads of changes in this century. The problem of recurrent lateral dislocation of the patella has been traditionally treated with a combination of conservative and surgical methods with uneven outcomes for the patient. These extensive surgical procedures involved a bony re-alignment, either distal or proximal to the knee joint along with a soft tissue release or tightening as deemed appropriate by the operating surgeon. These were followed by long recoveries and rehabilitation periods which were not necessarily popular with the subjects. Continuous expansion of our understanding of the biomechanics of the Patello-Femoral articulation and the underlying pathologies leading to its instability has resulted in a paradigm shift in its management which has benefitted from technological advances in minimally invasive and arthroscopic surgery.
In this issue, we aim to demystify the current concept of patellofemoral instability and help the reader in taking more informed decisions in diagnosing and treating this vexing problem. The papers deal with understanding the pathology of primary lateral patellar dislocation, techniques, and review of medial patellofemoral ligament reconstruction, management of patellar chondral defect, technique of tibial tubercle transfer and its indications, and rehabilitation after surgery of patellofemoral instability. Each paper has plenty of figures and tables to vividly describe the details of the topic in question.
We are extremely fortunate that Prof. Elizabeth Arendt, the “Queen” of patellofemoral joint, agreed to be the guest editor for this special issue. All the papers have been designed and written under her able guidance. This in itself certifies the quality of the papers in this issue of Asian Journal of Arthroscopy (AJA).We are deeply indebted to Prof. Arendt and her team of associates and researchers from University of Minnesota, who have taken time off their busy schedules to contribute their scientific work for this issue.
The issue also contains original articles, reviews and case reports which are selected following a rigorous peer review process. We do hope that the wealth of knowledge contained in this issue of AJA will benefit all the readers and help improve patient care in the Indian subcontinent. We also urge the authors from the Asian Subcontinent and specially India to contribute to the journal and help us in providing an international platform to them.
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Functional Outcome after Reconstruction in Patients with Anterior Cruciate Ligament Injuries after Roadside Accident in Non-athlete Population
Pawan Kamal, Shekhar Singhal, Akshdeep Bawa, Rajnish Garg
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 47-51
Author: Pawan Kamal [1], Shekhar Singhal [2], Akshdeep Bawa [3], Rajnish Garg [2]
[1] Navnoor Hospital and trauma centre, Balachaur, Punjab
[2] Dept of Orthoapedics, Dayanand Medical College, Ludhiana, Punjab
[3] King’s College Hospital, London.
Address of Correspondence
Dr Akshdeep Bawa, Fellow Trauma and Orthopaedics,King’s College Hospital,London.
Email: bawa.akshdeep@gmail.com
Abstract
Rupture of the ACL is one of the most common sports injuries in active young people. The exact incidence of anterior cruciate ligament injuries is unknown. Other than sports injuries, road side accidents are the second most common cause of ACL injury. There are no studies where the results after ACL reconstruction done for an acutely injured knee as a result of road side accident have been documented. Our study aimed to determine if the functional outcome was satisfactory if it was done in a patient of road side accident irrespective of any associated meniscal injuries and to evaluate the complications.
Methods: This prospective study was conducted in the Department of Orthopaedics of Dayanand Medical College and Hospital, Ludhiana, Punjab. The patients presenting with knee injury at indoor/ outdoor patient Department of Orthopaedics for period starting from Jan 2007 to Dec 2011 were taken up for study. The diagnosis was confirmed clinically as well as radiographically. Patients with multiligamentous injuries were excluded from the study.Reconstruction was done arthroscopically using ipsilateral Quadrupled hamstring or patellar tendon autograft. Standard operative technique of transtibial ACL reconstruction was followed. The patients were followed at 6 months and one year postoperatively from 2007 to 2011 for assessment of functional results. A total of 107 patient met the inclusion criteria out of which 102 patient could be examined clinically while 5 patients were lost to follow up and one patient died due to some natural cause. After completion of study observations were tabulated & were analyzed qualitatively as well as quantitatively using proper statistical methods.
Results: Post operatively, instability disappeared in 100(98.04%) patients post ACL reconstruction. Only 2(1.96%) patients had occasional episode of instability the operated knee. One patient had instability due to missed postero-medial instability. The mean preoperative subjective IKDC score was 37.9513.88 and post-operative subjective IKDC score changed to 87.9010.07 after ACL reconstruction. After comparing the two scores the P value came out to be <0.001 which was highly significant.
Conclusion: Road traffic accidents and Sports injuries are the commonest cause for anterior cruciate ligament injuries in our country. Arthroscopic ACL reconstruction provides a stable knee with minimal complications. Arthroscopic anterior cruciate ligament reconstruction with BPTB and ST/G grafts is an excellent treatment option for anterior cruciate ligament deficient knees after road side accidents.
Keywords: ACL injury, road side accident, non athletes, functional outcome.
References
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Advances in Kienbock’s Disease: Imaging and Arthroscopy
Simon Bruce Murdoch MacLean, Gregory Ian Bain
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 42-46
Author: Simon Bruce Murdoch MacLean [1], Gregory Ian Bain [1]
[1] Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia.
Address of Correspondence
Dr. Simon MacLean,
Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia.
E-mail: simonmaclean81@gmail.com
Abstract
The treatment of Kienbock’s disease has remained a clinical challenge since its original description over 100 years ago. We present our concepts on pathoanatomy and the role of new imaging modalities. Arthroscopic assessment remains the “gold standard” for the assessment of the lunate and wrist. We present our classification and algorithm as a management aid to the treating surgeon. In addition, we outline the indications and techniques of a number of arthroscopic procedures used to treat the Kienbock’s wrist.
Keywords: Kienbock’s disease; arthroscopy; Imaging.
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Post-operative Rehabilitation for Select Patellar-stabilizing Procedures
Jill Monson, Elizabeth Niemuth
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 36-41
Author: Jill Monson [1], Elizabeth Niemuth [2]
[1] Department of Physical Therapy, TRIA Woodbury, 155 Radio Drive, Woodbury, MN 55125, USA,
[2] Department of Physical Therapy, Institute for Athletic Medicine, M Health Clinics and Surgery Center, Minneapolis, MN 55455, USA
Address of Correspondence
Dr. Elizabeth Niemuth,
Institute for Athletic Medicine, M Health Clinics and Surgery Center, 909 Fulton Street SE, Minneapolis, MN 55455, USA.
Email: eniemut1@fairview.org
Abstract
The rehabilitation process after surgical intervention for patellar instability warrants special consideration of the anatomy, biomechanics, and surgical procedure to facilitate the best outcomes for the patient. There is a paucity of evidence-based literature regarding post-operative rehabilitation protocols for the patellofemoral (PF) compartment. Recommendations for early rehabilitation (0–6 weeks) after lateral retinacular lengthening, medial PF ligament reconstruction, tibial tubercle osteotomy, and trochleoplastyare reviewed in this article. For each procedure, the following common post-operative rehabilitation focus points are reviewed: Weight-bearing status and brace use, joint range of motion, and strengthening.
Keywords: Patellofemoral, Rehabilitation, Patellar instability.
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Management of Patellar Chondral Defects
Kelsey L. Wise, Jeffrey A. Macalena
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 30-35
Author: Kelsey L Wise [1], Jeffrey A Macalena [1]
[1] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.
Address of Correspondence
Dr. Jeffrey A. Macalena,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.
E-mail: maca0049@umn.edu
Abstract
Patellar cartilage has a poor capacity for healing because of the avascular and hypocellular nature of articular cartilage. Surgical options for cartilage defects are varied and include repair, regeneration, and reconstruction. Open reduction internal fixation of chondral defects should be attempted when a large chondral fragment with bone is present. This is frequently seen following patellar dislocation, patellar fracture, or in the setting of osteochondritis dissecans lesions. Cartilage regeneration options include microfracture and a bone marrow-stimulating technique that involves penetration of the subchondral bone. This technique is best for small, isolated defects. Augmentation to microfracture with biologically active adjuncts is becoming more widely available and is thought to enhance stem cell production and tissue regeneration. Cartilage reconstruction options such as autologous chondrocyte implantation area cell-based therapy that develops hyaline-like cartilage, as opposed to the fibrocartilage of microfracture, and has the added advantage of ease in contouring to patellar anatomy. Short-term data suggest improvement of clinical outcomes for most patellar cartilage techniques; however, long-term studies are needed to assess the durability and clinical outcomes of these evolving procedures.
Keywords: Patellar, Chondral, Cartilage.
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28. Biedert RM, Albrecht S. The patellotrochlear index: A new index for assessing patellar height. Knee Surg Sports TraumatolArthrosc 2006;14:707-12.
29. Bernageau J, Goutallier D, Debeyre J, Ferrané J. Nouvelle technique d’exploration de l’articulationfémoro-patellaire: Incidences axiales quadriceps décontractés et quadriceps contractés. [New exploration technique of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps]. Rev ChirOrthopReparatriceAppar Mot 1975;61Suppl 2:286-90.
30. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R, et al. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013;41:374-84.
31. Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. IntOrthop 2010;34:305-9.
32. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003;10:215-20.
33. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report. Arthroscopy 1992;8:335-40.
(Abstract) (Full Text HTML) (Download PDF)
Tibial Tubercle Osteotomy for Patellar Instability: Where are we in 2018?
Marta Engelking, Andrew Schmiesing, Elizabeth A Arendt
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 24-29
Author: Marta Engelking [1], Andrew Schmiesing [1], Elizabeth A Arendt [1]
[1] Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
Address of Correspondence
Dr. Elizabeth A Arendt,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
E-mail: arend001@umn.edu
Abstract
Management of recurrent lateral patellar dislocation (LPD) remains difficult and controversial, despite an expansion of knowledge. With the advancement of medicine, an understanding of known anatomical risk factors of LPD, including patella alta and increased tibial tubercle (TT)–trochlear groove distance, now guide present-day management. However, this is not without drawbacks. Current measurements of anatomical risk factors cannot be considered universal, and it is, therefore,important to consider each case individually. The focus of this article is to highlight the history of patellar instability risk factors associated with TT osteotomy, as well as present-day operative management, which aims to restore normal biomechanics. Our goal is to provide a clinical framework to help clinicians approach surgical management of LPD. Operative versus non-operative management will be discussed in another article. The included case studies will aid in the understanding of patients with patellofemoral instability, presentation, and the clinician’s approach to management, in addition to showcasing the ongoing challenges in treating patellar instability.
Keywords: Patellofemoral joint; patellar instability; lateral patellar dislocation; patella alta; tibial tubercle distalization; tibial
tubercle osteotomy.
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(Abstract) (Full Text HTML) (Download PDF)