Volume 6 | Issue 2 | July-December 2021 | Page 3-7 | Clement Joseph, Yugal Varandani

DOI: 10.13107/aja.2021.v06i02.027

Author: Clement Joseph [1], Yugal Varandani [1]

[1] Department of Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.

Address of Correspondence:
Dr. Clement Joseph,
Senior Consultant & Head, Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.
E-mail: clementorth@yahoo.co.in


There is a resurgence of interest in HTO to treat young to middle aged patients with varus alignment and isolated medial joint osteoarthritis. With improvements in implant design and preoperative planning methods, good outcomes are reported in multiple studies. But the most important factor for a successful outcome is patient selection. The ideal patient would be a middle-aged patient with isolated medial joint arthritis with good range of movements, non-smoker and with reasonable functional status of knee. The indications of HTO are evolving to include patients in higher age groups, with minimal to moderate patellofemoral symptoms and varying amounts of flexion deformities. It is also increasingly being performed as a joint protective surgery following meniscus repairs and cartilage repair procedures and to correct abnormal joint alignment following neglected ligamentous injuries.


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7. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J. 2014;96-B (11):1491-1497. doi:10.1302/0301-620X.96B11.33617 https://doi.org/10.1302/0301-620x.96b11.33617
8. Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):149-152. doi:10.1007/s00167-005-0638-5 https://doi.org/10.1007/s00167-005-0638-5
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10. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br. 2008;90(5):592-596. doi:10.1302/0301-620X.90B5.20386 https://doi.org/10.1302/0301-620x.90b5.20386
11. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91-96. doi:10.1097/01.blo.0000229362.12244.f6 https://doi.org/10.1097/01.blo.0000229362.12244.f6
12. Herbst M, Ahrend MD, Grünwald L, Fischer C, Schröter S, Ihle C. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results [published online ahead of print, 2021 Feb 11]. Knee Surg Sports Traumatol Arthrosc. 2021;10.1007/s00167-021-06457-3. doi:10.1007/s00167-021-06457-3 https://doi.org/10.1007/s00167-021-06457-3
13. Noyes, Frank & Barber-Westin, Sue. (2010). Primary, Double, and Triple Varus Knee Syndromes. In book: Noyes’ Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes (pp.821-895). 10.1016/B978-1-4160-5474-0.00031-X
14. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):170-180. doi:10.1007/s00167-012-2087-2 https://doi.org/10.1007/s00167-012-2087-2
15. Schuster P, Geßlein M, Schlumberger M, et al. Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment. Am J Sports Med. 2018;46(6):1362-1370. doi:10.1177/0363546518758016 https://doi.org/10.1177/0363546518758016
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17. Bin SI, Kim HJ, Ahn HS, Rim DS, Lee DH. Changes in Patellar Height After Opening Wedge and Closing Wedge High Tibial Osteotomy: A Meta-analysis. Arthroscopy. 2016;32(11):2393-2400. doi:10.1016/j.arthro.2016.06.012 https://doi.org/10.1016/j.arthro.2016.06.012
18. Kloos, F., Becher, C., Fleischer, B. et al. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Knee Surg Sports Traumatol Arthrosc 27, 2334–2344 (2019). https://doi.org/10.1007/s00167-018-5194-x
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20. Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R. Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1859-1866. doi:10.1007/s00167-017-4548-0 https://doi.org/10.1007/s00167-017-4548-0
21. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med. 2000;28(3):282-296. doi:10.1177/03635465000280030201 https://doi.org/10.1177/03635465000280030201
22. Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med. 2007;35(11):1844-1850. doi:10.1177/0363546507304717 https://doi.org/10.1177/0363546507304717
23. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131-140. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2958284/
24. Kanamiya T, Naito M, Hara M, Yoshimura I. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy. 2002;18(7):725-729. doi:10.1053/jars.2002.35258 https://doi.org/10.1053/jars.2002.35258
25. Thambiah MD, Tan MKL, Hui JHP. Role of High Tibial Osteotomy in Cartilage Regeneration – Is Correction of Malalignment Mandatory for Success?. Indian J Orthop. 2017;51(5):588-599. doi:10.4103/ortho.IJOrtho_260_17 https://doi.org/10.4103/ortho.ijortho_260_17
26. Nha KW, Lee YS, Hwang DH, et al. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus [published correction appears in Arthroscopy. 2019 Feb;35(2):691] [published correction appears in Arthroscopy. 2020 Mar;36(3):923]. Arthroscopy. 2013;29(2):226-231. doi:10.1016/j.arthro.2012.08.027 https://doi.org/10.1016/j.arthro.2012.08.027
27. Lee DW, Lee SH, Kim JG. Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial?. Arthroscopy. 2020;36(9):2466-2475. doi:10.1016/j.arthro.2020.04.038 https://doi.org/10.1016/j.arthro.2020.04.038

How to Cite this article: Joseph C, Varandani Y | Indications for High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 03-07

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Volume 6 | Issue 2 | July-December 2021 | Page 58-62 | Samir C. Dwidmuthe, Kaustubh Patil, Vikram Sapre, Sushil Mankar

DOI: 10.13107/aja.2021.v06i02.036

Author: Samir C. Dwidmuthe [1], Kaustubh Patil [2], Vikram Sapre [2], Sushil Mankar [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
[2] Department Of Orthopaedics, NKPSIMS & RC, Nagpur, Maharashtra, India.

Address of Correspondence:
Dr. Samir C. Dwidmuthe
Associate professor, Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
E-mail: samirdwidmuthe@aiimsnagpur.edu.in


Background: In anterior cruciate ligament (ACL) reconstruction, cortical suspension devices are used widely. The two most commonly used cortical suspension devices for ACL reconstruction are fixed fixed-length loop devices (FLDs) and adjustable length loop devices ALDs.
Aim: This study is aimed to compare the clinical outcomes between ALDs and FLDs in the femoral fixation component of ACL reconstruction using a hamstring graft. Methods: It was a non-randomized trial which that was conducted at department of orthopaedics tertiary care teaching hospital. The total sample size of the study was calculated as 34, in which 17 patients were placed in FLDs and the rest of 17 patients were placed in ALDs. Functional outcomes were measured by Lysholm score at preoperatively and then postoperatively at one month, two months, and six months. Knee laxity was tested were assessed by the Lachman test and Pivot shift test at preoperatively and postoperatively at 6 months.
Results: The mean Lysholm score increased from at preoperatively was 51.53±6.39 and postoperative score at last, at last, follow up was to 97.94±1.95 in FLD group and from 50.24.±12.36 to 98.29±1.86 in ALD group at 6-month follow-up. No significant difference was found in between the groups for Lysholm score at preoperatively and postoperative follow follow-ups(p>0.05). Lachman and Pivot shift test also showed no significant difference in between the groups (p>0.05).
Conclusion: The clinical effectiveness of FLDs and ALDs were found to be similar in ACL reconstruction.
Keywords: Anterior cruciate ligament reconstruction, Fixed length loop devices, Adjustable length loop devices, Lysholm score, Lachman test, Pivot shift test


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How to Cite this article: Dwidmuthe S C, Patil K, Sapre V, Mankar S | Short Term Clinical Outcomes of Fixed Length Loop Devices and Adjustable Length Loop Devices for Femoral Fixation of Hamstring Graft for Arthroscopic Anterior Cruciate Ligament Reconstruction: A Non-Randomized Comparative Trial | Asian Journal of Arthroscopy | July-December 2021; 6(2): 58-62.

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Volume 6 | Issue 1 | January-June 2021 | Page 11-14 | Ajinkya Achalare, Nilesh Kamat, M.P. Ramraju Mudunuri

Author: Ajinkya Achalare [1], Nilesh Kamat [2], M.P. Ramraju Mudunuri [1]

[1] Kamat Clinic, Pune, Maharashtra, India.
[2] Department of Shoulder Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence:
Dr. Ajinkya Achalare,
Clinical Fellow in Arthroscopy, Kamat Clinic,
Pune, Maharashtra, India.
E-mail: ajinkya1401@gmail.com


Rotator cuff (RC) tears are a common presentation in day-to-day clinical settings. Majority of the symptomatic patients are treated by a surgical repair. Before considering a surgical intervention, it is vital to understand the anatomy of RC footprint and restore it, in order to achieve an optimal tension-free repair, better healing and subsequently good clinical outcomes. Concepts pertaining to the RC footprint over the greater tuberosity (GT) have been constantly changing in the past two decades with meticulous anatomical studies. Traditional concepts of individual insertions of supraspinatus (SSP) and infraspinatus (ISP), SSP alone playing the vital role in shoulder abduction, now stand obsolete. Similarly, being the largest muscle-tendon unit, subscapularis (SSC) has been studied extensively and is now known to have a three dimensional insertion over lesser tuberosity. This article reviews the evolution of concepts pertaining to RC insertion and their clinical application.
Keywords: Rotator cuff; Footprint; Three-dimensional insertion.


1. Clemente CD, editor. Gray’s anatomy of the human body. 30th ed. Philadelphia: Lea & Febiger; 1985. Osteology, and muscles and fasciae of the upper limb. p 233-4.

2. Johnson D, Ellis H, editors. Pectoral girdle, shoulder region, and axilla. In: Standring S, Ellis H, Healy JC, Johnson D, Williams A, Collins P, Wigley C, editors. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh: Elsevier Churchill Livingstone; 2005. p 817-49

3. Clark JM, Harryman DT II. Tendons, ligaments, and capsule of the rotator cuff: Gross and microscopic anatomy. J Bone Joint Surg Am 1992;74:713-725

4. Minagawa H, Itoi E, Konno N, et al. Humeral attachment of the supraspinatus and infraspinatus tendons: An anatomic study. Arthroscopy 1998;14:302-306

5. Ellman H, Gartsman GM, Hengst TC. Arthroscopic shoulder surgery and related procedures. Philadelphia: Lea & Febiger,1993

6. Tierney JJ, Curtis AS, Kowalik DL, Scheller AD. The footprint of the rotator cuff. Arthroscopy 1999;15:556-557

7. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR. The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy. 2006 Jun;22(6):609.e1. doi: 10.1016/j.arthro.2006.04.001. PMID: 16762697

8. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop 1990;254:64-74

9. Ruotolo C, Fow JE, Nottage WM. The supraspinatus footprint: An anatomic study of the supraspinatus insertion. Arthroscopy 2004;20:246-249

10. Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, Muneta T, Akita K. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008 May;90(5):962-9. doi: 10.2106/JBJS.G.00427. PMID: 18451386

11. Hamada J, Nimura A, Yoshizaki K, Akita K. Anatomic study and electromyographic analysis of the teres minor muscle. J Shoulder Elbow Surg. 2017 May;26(5):870-877. doi: 10.1016/j.jse.2016.09.046. Epub 2017 Jan 10. PMID: 28087164.

12. Richards DP, Burkhart SS, Tehrany AM, Wirth MA. The subscapularis footprint: an anatomic description of its insertion site. Arthroscopy. 2007 Mar;23(3):251-4. doi: 10.1016/j.arthro.2006.11.023. PMID: 17349466.

13. Yoo JC, Rhee YG, Shin SJ, Park YB, McGarry MH, Jun BJ, Lee TQ. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy. 2015 Jan;31(1):19-28. doi: 10.1016/j.arthro.2014.08.015. Epub 2014 Oct 18. PMID: 25442662.

14. Ide J, Tokiyoshi A, Hirose J, Mizuta H. An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy. 2008 Jul;24(7):749-53. doi: 10.1016/j.arthro.2008.02.009. Epub 2008 Apr 14. PMID: 18589262.

15. Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg 2002; 11:498-503. doi:10.1067/mse.2002.126208.

How to Cite this article: Achalare A, Kamat N, Mudunuri MPR | Evolving Concepts  in The Rotator Cuff
Footprint | Asian Journal of Arthroscopy | January- June 2021; 6(1): 11-14.

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Volume 6 | Issue 1 | January-June 2021 | Page 1-2| Anshu Shekhar, Nilesh Kamat, Sachin Tapasvi

Author:  Anshu Shekhar [1], Nilesh Kamat [2], Sachin Tapasvi [1]

[1] Orthopaedic Speciality Clinic, Pune Mahatrahtra, India.
[2] Department of Shoulder Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence
Dr Sachin Tapasvi
The Orthopaedic Speciality Clinic, Pune, Mahatrahtra, India.
Email: stapasvi@gmail.com

Rotator Cuff Tears: An Everlasting Enigma

Rotator Cuff (RC) tear is a common cause of disability and pain for which middle aged and elderly individuals seek orthopaedic consultation. A unique feature of RC tear treatment is that it encompasses an entire spectrum, which ranges from humble conservative methods to complicated tendon transfers. There is a now a fair amount of agreement about which treatment modality must be offered to whom, based on tear type, tendon retraction, tissue quality and patient profile. What must be borne in mind however, is that no bridges be burnt when choosing a treatment method. This would keep the door open for a salvage or revision procedure to help the patient. This issue of the Asian Journal of Arthroscopy is a symposium dedicated to management strategies for Rotator cuff tears.


The importance of clinical examination in a patient with shoulder pain and weakness cannot be overemphasized. It is the cornerstone of formulating an individualized treatment plan. Vivek Pandey has discussed the methodology for all the  relevant tests to accurately diagnose a rotator cuff tear, along with their pearls and pitfalls. One of the most important reasons why arthroscopic shoulder surgery in general and rotator cuff surgery is particular has evolved, is the remarkable progress in imaging, especially Magnetic Resonance scans. Anupama Patil has written a detailed descriptive review in this subject. An understanding of the nuances of imaging will help the clinician to clinically co-relate her findings. A sound clinician is one has a grasp of theoretical concepts developed and validated over the years. The ability to a classify rotator cuff tear based on imaging findings and co-relating clinically in the foundation on which every treatment decision is made. Ram Chidambaram has written an exhaustive review detailing all classification systems for rotator cuff tear. Jaap Willems has presented an algorithm for such decision making based primarily on age and tear morphology.


The non-operative treatment of RC tears encompasses pharmacologic therapies, injections, biologics, physical rehabilitation and electrophysiological rehabilitation modalities. These have a definite role in management of RC tears and Denny Lie has performed a systematic review of randomized current trials to present the current evidence for the same. Arthroscopic rotator cuff repair for degenerative tears is now a standard of care in those fail a trial of non-operative treatment. It has demonstrated proven health and economic benefits in the mid-term [1, 2]. A lacuna is current literature is the absence of large randomized controlled trial with long-term results which would settle the debate conclusively. The repair technique has also travelled a full circle with new vigor seen for trans-osseous repairs after having seen the fallacies of anchor-based repairs in the last couple of decades. The issue of subacromial decompression is another elephant in the room on which everybody seems to agree to disagree. SAD does have a definite place in RC repair surgery, considering its potential biological and mechanical benefits. However, what constitutes a ‘decompression’ and how much of an impact does it really have on a multifactorial phenomenon like rotator cuff healing is largely unknown. Amol Tambe has written an exhaustive review on this subject which will help tailor the readers approach to this enigma.


The aim of this issue is to provide the reader with information and knowledge on rotator cuff tears which can then be used to guide patient management. We hope that the wealth of knowledge shared by our authors will enrich the readers and help them in making better decisions when treating patients.

Anshu Shekhar
Nilesh Kamat
Sachin Tapasvi


1. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2018 Mar;27(3):572-576.

2. Mather RC 3rd, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, Tongue J, Williams G Jr. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013 Nov 20;95(22):1993-2000

How to Cite this article: Shekhar A, Kamat N, Tapasvi S | Rotator Cuff  Tears: An Everlasting Enigma | Asian Journal of Arthroscopy | January- June 2021; 6(1): 01-02.

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Volume 6 | Issue 1 | January-June 2021 | Page 08-10 | Sharat Balemane, Kaushik Eswaran, Nishanth Shetty

Author: Sharat Balemane [1], Kaushik Eswaran [1], Nishanth Shetty [1]

[1] Department of Orthopaedics, Yenepoya Medical College,
Mangalore, India.

Address of Correspondence:
Dr. Kaushik Eswaran,
Yenepoya Medical College, Mangalore, India.
E-mail: sbkaushik1993@gmail.com.


Background: The etiopathogenesis of rotator cuff tears remains debatable. Among the many causes, abnormal scapular morphology has been found to accelerate the degenerative process of rotator cuff tears. The morphology and lateral extension of the acromion process were assessed indetail by Nyffeler et al. and the Acromion Index (AI) was introduced, which measures the lateral extension of the acromion. It was theorized that a large lateral extension of the acromion increased the chances of the supraspinatus tendon to degenerate because of impingement between the acromion and the deltoid muscle. The AI was compared between patients with rotator cuff tears and patients with an intact rotator cuff.
Methods: 21 Indian patients presenting to the orthopaedics OPD, Yenepoya Medical College, with rotator cuff tears were taken up for this study between August 2020 and February 2021. Another 21 patients with intact rotator cuff and other shoulder diseases such as frozen shoulder were included in this study. Patients with rotator cuff tears were included in group A, and patients with intact rotator cuff were included in group B. Both groups had the AI measured on radiographs, and their values were compared.
Results: The mean Acromial Index (AI) in the rotator cuff tear group was 0.74 and in the intact rotator cuff group it was 0.59, which was statistically significant. There was no statistical difference in AI between male and female patients. The mean age of the patients in the rotator cuff group was 50.8 years, and in non rotator cuff tear group, it was 50.2 years.
Conclusion: Acromial Index is a useful predictive tool for detecting rotator cuff tears in the Indian population. Further studies are required to assess its usefulness in predicting the progression of a rotator cuff tear.
Keywords: Rotator cuff tear; Acromial Index; Shoulder.


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How to Cite this article: Balemane S, Eswaran K, Shetty N | Acromial Index in Indian Population and its
Significance on Rotator Cuff Tears | Asian Journal of Arthroscopy | January- June
2021; 6(1): 08-10.

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Volume 6 | Issue 1 | January-June 2021 | Page 48-51 | Sachin Kumar, Rajiv Gogna, Daniel Morris, Amol Tambe

Author: Sachin Kumar [1] , Rajiv Gogna [1] , Daniel Morris [1] , Amol Tambe [1]

[1] Derby Shoulder Unit, Royal Derby Hospital, Derby, UK.

Address of Correspondence:
Dr. Amol Tambe,
Consultant, Upper Limb Surgeon, Derby Shoulder Unit, Royal Derby
Hospital, Derby, UK.
E-mail: amol.tambe1@nhs.net


Symptomatic rotator cuff tears cause pain and impaired function. Arthroscopic rotator cuff repair is an established treatment when nonoperative management fails. However, debate exists regarding the requirement of concurrent subacromial decompression. This review aims to answer pertinent questions and outline relevant literature in the role of arthroscopic subacromial decompression in rotator cuff repair.
Keywords: Decompression, Cuff, Arthroscopic, Repair.


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How to Cite this article: Kumar S, Gogna R, Morris D, Tambe A | Should We be Routinely  Performing
Arthroscopic Subacromial Decompression During Rotator Cuff Repair (RCR)?| Asian
Journal of Arthroscopy | January- June 2021; 6(1): 48-51.

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Volume 6 | Issue 1 | January-June 2021 | Page 03-07 | Vijayamohan, Shyam Gopal V, Mohana Chandran, Aleena Antony

Author: Vijayamohan [1], Shyam Gopal V [1], Mohana Chandran [2], Aleena Antony [3]

[1] Department of Orthopaedics, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Physiotherapy, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India
[3] Counsellor, Aster Centre of Excellence in Orthopaedics &Rheumatology, Aster Medcity, Kochi, Kerala, India.

Address of Correspondence:
Dr. Shyam Gopal V,
Specialist, Aster centre of Excellence in Orthopaedics & Rheumatology,
Aster Medcity, Kochi, Kerala, India.
E-mail: shyamg911@gmail.com


Rehabilitation following anterior cruciate ligament surgery continues to evolve, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. In this study we evaluate the functional outcome of Immediate full weight bearing mobilization following arthroscopic ACL (Anterior Cruciate Ligament) reconstruction with quadrupled hamstring graft using endobutton and bioscrew. With the advancement of fixation techniques immediate weight bearing mobilization after arthroscopic ACL reconstruction can give better functional outcome and improved patient satisfaction. Although further large volume multicentric research is needed for establishing a
standardized rehabilitation protocol following arthroscopic ACL reconstruction, immediate weight bearing doesn’t cause any complications and has better outcome as per our study.
Keywords: Arthroscopic reconstruction, ACL, Immediate weight bearing.


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3. Rafael F. Escamilla, PT, PhD, CSCS, FACSM1Toran D. MacLeod, PT, PhD2Kevin E. Wilk, PT, DPT3Lonnie Paulos, MD4James R. Andrews, MD5ACL Strain and Tensile Forces for Weight Bearing and Non—Weight-Bearing Exercises After ACL Reconstruction: A Guide to Exercise SelectionJournal of Orthopaedic & Sports Physical TherapyPublished Online:March 1, 2012Volume42Issue3Pages208-220

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5.Agarwal AR, Dussa KR, Singhal A, et al. A retrospective analysis of arthroscopic ACL reconstruction with hamstring tendon graft. J. Evid. Based Med. Healthc. 2017; 4(64), 3841-3845. DOI: 10.18410/jebmh/2017/767

6. Jorgensen U, Jensen CM, Scanvenius M, et al. Rehabilitation with or without initial weightbearing: a prospective randomized study. Presented at: Sports Medicine 2000; June 6-8, 1995; Stockholm, Sweden.

7. Lysholm J, Gillquist J. (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med; 10-3:150-4

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9. Tajima T, Yamaguchi N, Nagasawa M, Morita Y, Nakamura Y, Chosa E. Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study. BMC Musculoskelet Disord. 2019;20(1):274. Published 2019 Jun 4. doi:10.1186/s12891-019-2653-6

10. Rizer M, Foremny GB, Rush A, III, Singer AD, Baraga M, Kaplan LD, Jose J. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction. Skeletal Radial. 2017;46:161–169. doi: 10.1007/s00256-016-2535-z.

How to Cite this article: Vijayaohan, V Shyam Gopal, Chandran M, Antony A | Functional  Outcome in
Arthroscopic ACL Reconstruction with Immediate Full Weight Bearing Mobilization-Retrospective Study | Asian Journal of Arthroscopy | January- June 2021; 6(1): 03-07.

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Volume 6 | Issue 1 | January-June 2021 | Page 39-47 | Andrew Arjun Sayampanathan, Marcus Wei Ping Tan, Denny Tjiauw Tjoen Lie

Author: Andrew Arjun Sayampanathan [1], Marcus Wei Ping Tan [2], Denny Tjiauw Tjoen Lie [1, 2]

[1] National Preventive Medicine Residency Programme, National University Health System, Singapore.
[2] Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.

Address of Correspondence:
Dr. Denny TT Lie,
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
E-mail: denny.lie.t.t@singhealth.com.sg


Rotator cuff tears are known to result in significant societal burden. This review synthesises the evidence regarding the role and outcomes of conservatively managed rotator cuff tears. 17 prospective randomised controlled trials (RCTs) (Level 1 and 2 studies) were included in this systematic review. Modalities which were studied were classified into physical rehabilitative modalities, electrophysiological rehabilitative modalities, biological therapies, and pharmacologic therapies. Outcomes which were evaluated in the included RCTs comprised of clinical outcomes, functional outcomes, pain scores, quality of life scores, imaging based outcomes, and patient satisfaction scores. As the modalities and outcomes studied were varied, no quantitative analysis could be performed based on the primary data available. Nevertheless, most studies do suggest that conservative treatment remains beneficial for the management of rotator cuff tears. Based on these findings, an algorithm which proposes conservative therapy as the central mode of management for rotator cuff tear patients has been described. More high-quality studies are required in this area of study to allow for a quantitative review (meta-analysis and meta-regression) of the various non-surgical treatment
modalities of rotator cuff tears.
Keywords: Rotator Cuff Tears; Conservative; Non-operative; Management; Randomised controlled trials; Review.


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How to Cite this article: Sayampanathan AA, Tan MWP, Lie DTT | Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trial |
Asian Journal of Arthroscopy | January- June 2021; 6(1): 39-47.

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Volume 6 | Issue 1 | January-June 2021 | Page 36-38 | W. Jaap Willems

Author: W. Jaap Willems [1, 2]

[1] Lairesse Kliniek, Amsterdam, The Netherlands.
[2] International Knee and Joint Centre, Abu Dhabi, UAE.

Address of Correspondence:
Dr. W. Jaap Willems,
Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands.
International Knee and Joint Centre, Abu Dhabi, UAE.
E-mail: w.j.willems@xs4all.nl


Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment.
Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.


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How to Cite this article: Willems WJ | Natural History of Rotator Cuff Tears | Asian Journal of Arthroscopy | January-June 2021; 6(1): 36-38.

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