Indian Journal of Orthopaedics最新文献

{"title":"Reconstructing Quadriceps Tendon Disruptions in Post Total Knee Arthroplasty Patients with an Autogenous Peroneal Tendon Graft: A Viable Alternative","authors":"Rajeev K. Sharma, Udit Vinayak, Jitendra Wadhwani, Sanika Rapole","doi":"10.1007/s43465-024-01247-8","DOIUrl":"https://doi.org/10.1007/s43465-024-01247-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Quadriceps tendon disruption post-total knee arthroplasty (TKA) is rare. Existing reconstruction procedures use allografts or synthetic meshes with varied success. This study evaluates outcomes with autogenous peroneal tendon grafts, a cost-effective alternative, compared to synthetic polypropylene mesh for quadriceps reconstruction.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>16 patients who underwent extensor mechanism reconstruction between 2017 and 2021were retrospectively analysed. Parameters evaluated included type of reconstruction, extensor lag, IKDC (International Knee Documentation Committee) Score and AOFAS-Hindfoot-score (American Orthopaedic Foot and Ankle Society).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>At final follow-up, extensor lag for peroneal autograft group was 6.6° ± 1.5 and for synthetic polypropylene mesh group, 7.2° ± 0.7. Both groups improved in IKDC score (<i>p</i> &lt; 0.01) AOFAS-Hindfoot-score was comparable for peroneal autograft patients with opposite side (<i>p</i> = 0.15).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Autogenous peroneal tendon graft for quadriceps reconstruction could be viable, cost-effective alternative to allografts or synthetic meshes, with good clinical outcomes.</p><h3 data-test=\"abstract-sub-heading\">Graphical Abstract</h3><p> Graphical abstract depicting the harvesting of the peronei grafts and their passage through the quadriceps tendon. Sonographic image showing the preoperative presence of a gap in the quadriceps tendon which is reconstructed post-operatively</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responsible Use of Generative Artificial Intelligence for Research and Writing: Summarizing ICMJE Guideline","authors":"Himel Mondal, Shaikat Mondal, Ayesha Juhi","doi":"10.1007/s43465-024-01258-5","DOIUrl":"https://doi.org/10.1007/s43465-024-01258-5","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Mal-alignment of the CLS Spotorno Femoral Stem Correlate with Functional Outcome of Patients Undergoing Total Hip Arthroplasty? An Evaluation at Mid-term Follow Up","authors":"Jagprit Singh, Mandeep Singh Dhillon, Sandeep Patel, Mahesh Prakash, Sameer Aggarwal, Prasoon Kumar","doi":"10.1007/s43465-024-01236-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01236-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The straight and thin design of the CLS Spotorno stem makes it prone for coronal plane mal-alignment, with potential for cortical impingement; reactive osteogenesis and thigh pain have been documented in this situation with some stems. The literature is scarce about the effect of distal mal-alignment with this particular stem, and its relationship with thigh pain, functional outcomes and stem survival. We assessed functional outcomes with incidence of varus/valgus CLS stem alignment, and correlated stem subsidence of these thin stems with hip scores.</p><h3 data-test=\"abstract-sub-heading\">Methodology</h3><p>Hip arthroplasty cases with CLS Spotorno stems, operated between 2015 and 2022, with a minimum follow up of 18 months were evaluated. Radiology included 100% pelvis x-rays with bilateral hips (anteroposterior with 15° internal rotation plus lateral views); parameters documented were coronal mal-alignment, stem subsidence, any pedestal formation and heterotrophic ossification (HO); special note was made of any thigh pain, and functional outcomes were recorded using mHHS and SF-36 scores.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We evaluated 65 patients with 79 operated hips at an average follow up of 5.26 years. 31.6% (25/79) stems were neutrally aligned, 64.6% (51/79) were in varus alignment and 3.8% (3/79) were in valgus alignment. The mean subsidence was 3.15 mm + 2.26 and 3 cases had Pedestal formation at the stem tip. There was no correlation between varus/valgus stem positions with the mHHS (<i>p</i> = 0.271) and SF-36 score (<i>p</i> = 0.553), which also did not correlate with the stem subsidence. HO formation was seen in 16 hips (20.3%), but no cases in our series needed revision during follow up.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Significant distal malalignment with some subsidence were noted in the hips studied; despite these radiological issues, there were excellent mid-term outcomes and good stems survival, implying that distal malposition may have no bearing on functional outcomes.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Cruciate Ligament and Posterolateral Corner Reconstruction: Clinical Outcomes Following Popliteal Tendon Tenodesis and Popliteal Tendon Reconstruction","authors":"Leonardo Adeo Ramos, Edilson Andrade, Gabriel Taniguti, Renan Moukbel Chaim, Alexandre Pedro Nicolini, Jorge Yamashita, Diego Costa Astur","doi":"10.1007/s43465-024-01243-y","DOIUrl":"https://doi.org/10.1007/s43465-024-01243-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Injuries to the posterolateral compartment (PLC) of the knee require special attention, as incorrect diagnosis and treatment may lead to considerable morbidity. However, no gold standard treatment has been established for PLC injuries.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>38 patients with concomitant (posterior cruciate ligament (PCL) and PLC injuries were divided into two groups according to surgical treatment of the proximal popliteal tendon injury. They were treated with anatomic popliteal tendon, lateral collateral ligament (LCL), and popliteofibular ligament (PFL) reconstruction (group 1; <i>n</i> = 19) and were treated with popliteal tendon tenodesis, LCL, and PFL reconstruction (group 2; <i>n</i> = 19). The Lysholm score, dial test, and lateral compartment opening on varus stress X-ray were used as outcome measurements evaluated before surgery and at 6, 12, and 24 months of follow-up.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Overall, there was a progressive improvement in the Lysholm score and the lateral opening on varus stress radiography during the evaluated periods for both groups (<i>p</i> &lt; 0.001). Patients from group 2 recorded better Lysholm scores than those from group 1 at 12- and 24-month follow-up (<i>p</i> = 0.02). Dial test was negative in all patients after 6, 12, and 24 months.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Patients with popliteal tendon tenodesis were found to have better Lysholm scores than patients with reconstruction after 12 and 24 months of follow-up. There was no difference in the lateral joint opening evaluated by stress radiography between groups. These results show that tenodesis could be a viable treatment option for lateral femoral condyle popliteal disruptions in the context of PLC and PCL combined injuries, and should be considered in the surgical planning process.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Screening of Hip X-rays for Osteoporosis by Singh’s Index Using Machine Learning Algorithms","authors":"Vijaya Kalavakonda, Sameer Mohamed, Lal Abhay, Sathish Muthu","doi":"10.1007/s43465-024-01246-9","DOIUrl":"https://doi.org/10.1007/s43465-024-01246-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Osteoporosis is a significant and growing global public health problem, projected to increase in the next decade. The Singh Index (SI) is a simple, semi-quantitative evaluation tool for diagnosing osteoporosis with plain hip radiographs based on the visibility of the trabecular pattern in the proximal femur. This work aims to develop an automated tool to diagnose osteoporosis using SI of hip radiograph images with the help of machine learning algorithms.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We used 830 hip X-ray images collected from Indian men and women aged between 20 and 70 which were annotated and labeled for appropriate SI. We employed three state-of-the-art machine learning algorithms—Vision Transformer (ViT), MobileNet-V3, and a Stacked Convolutional Neural Network (CNN)—for image pre-processing, feature extraction, and automation. Each algorithm was evaluated and compared for accuracy, precision, recall, and generalization capabilities to diagnose osteoporosis.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The ViT model achieved an overall accuracy of 62.6% with macro-averages of 0.672, 0.597, and 0.622 for precision, recall, and F1 score, respectively. MobileNet-V3 presented a more encouraging accuracy of 69.6% with macro-averages for precision, recall, and F1 score of 0.845, 0.636, and 0.652, respectively. The stacked CNN model demonstrated the strongest performance, achieving an accuracy of 93.6% with well-balanced precision, recall, and F1-score metrics.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The superior accuracy, precision-recall balance, and high F1-scores of the stacked CNN model make it the most reliable tool for screening radiographs and diagnosing osteoporosis using the SI.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Femoral Neck Anteversion is Prevalent in Male Elite Youth Soccer Players with Chronic Ankle Instability","authors":"Osman Coşkun, Serdar Arslan, Gökmen Yapalı, Tuğba Arslan, Engin Dinç, Muhammet Zeki Gültekin","doi":"10.1007/s43465-024-01245-w","DOIUrl":"https://doi.org/10.1007/s43465-024-01245-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The aim of this study was to compare femoral neck anteversion (FNA) and determine the prevalence of increased FNA in male elite youth soccer players with and without chronic ankle instability (CAI). Secondary aims were to evaluate the utility of FNA in predicting CAI and compare ankle and hip muscle strength in the two groups.</p><h3 data-test=\"abstract-sub-heading\">Materials and methods</h3><p>The study included a total of 44 male elite youth soccer players, 22 with CAI (mean age 16.09 ± 1.34) and 22 without CAI (mean age 16.73 ± 1.28). FNA was measured with Craig’s test, range of motion (ROM) was measured with a universal goniometer, and ankle and hip maximum voluntary isometric strength (MVIS) was measured with a handheld dynamometer.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The mean FNA angles of the CAI and control groups were 15.82° ± 1.44° and 12.09° ± 2.37°, respectively (<i>p</i> &gt; 0.05). FNA was greater than 15° in 72% of the CAI group versus 4% of the control group (<i>p</i> &lt; 0.05). A 1° increase in FNA was associated with threefold higher odds of having CAI (odds ratio 3.06, 95% confidence ratio: 1.37–6.81, <i>p</i> &lt; 0.01). Mean ankle eversion and hip abduction MVIS values were 2.67 ± 0.52 Nm/kg and 3.83 ± 0.48 Nm/kg in the CAI group, compared to 3.03 ± 0.58 Nm/kg and 4.46 ± 0.98 Nm/kg in the control group, respectively (<i>p</i> &lt; 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Male elite youth soccer players with CAI had greater FNA and were more likely to have increased FNA than those without CAI. They also exhibited ankle eversion and hip abduction muscle strength deficiencies compared to peers without CAI. FNA may be useful as a predictor of CAI in male elite youth soccer players.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chondrogenic Potential of Umbilical Cord-Derived Mesenchymal Stromal Cells: Insights and Innovations","authors":"Naveen Jeyaraman, Madhan Jeyaraman, Sathish Muthu, Sangeetha Balaji, Swaminathan Ramasubramanian, Bishnu Prasad Patro","doi":"10.1007/s43465-024-01239-8","DOIUrl":"https://doi.org/10.1007/s43465-024-01239-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The advent of tissue engineering and regenerative medicine has introduced innovative approaches to treating degenerative and traumatic injuries, particularly in cartilage, a tissue with limited self-repair capabilities. Among the various stem cell sources, umbilical cord-derived mesenchymal stromal cells (UC-MSCs) have garnered significant interest due to their non-invasive collection, minimal ethical concerns, and robust regenerative potential, particularly in cartilage regeneration.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A comprehensive literature review was conducted using multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar. Search terms focused on \"umbilical cordderived mesenchymal stromal cells,\" \"chondrogenesis,\" \"cartilage regeneration,\" and related topics. Studies published in the past two decades were included, with selection criteria emphasizing methodological rigor and relevance to UC-MSC chondrogenesis. The review synthesizes findings from various sources to provide a thorough analysis of the potential of UC-MSCs in cartilage tissue engineering.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>UC-MSCs exhibit significant chondrogenic potential, supported by their ability to differentiate into chondrocytes under specific conditions. Recent advancements include the development of biomaterial scaffolds and the application of genetic engineering techniques, such as CRISPR/Cas9, to enhance chondrogenic differentiation. Despite these advancements, challenges remain in standardizing cell isolation techniques, scaling up production for clinical use, and ensuring the long-term functionality of regenerated cartilage.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>UC-MSCs offer a promising solution for cartilage regeneration in the field of regenerative medicine. Ongoing research is focused on overcoming current challenges through the use of advanced technologies, including bioreactors and gene editing. Collaborative efforts among researchers, clinicians, and bioengineers are essential to translating the potential of UC-MSCs into effective clinical therapies, which could significantly advance tissue regeneration and therapeutic innovation.</p><h3 data-test=\"abstract-sub-heading\">Graphical Abstract</h3>\u0000","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Stable Do Multiligament Knee Reconstructions Become?: An Objective Stability and PROMs Study","authors":"Vikram Arun Mhaskar, Saif Rahamathulla Sayed, Mahesh Hosmanne, Het Patel, Zoheb Hassan Siddiqui, Garima Varshney","doi":"10.1007/s43465-024-01241-0","DOIUrl":"https://doi.org/10.1007/s43465-024-01241-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of the Study</h3><p>Multiligament injuries (MLKI) of the knee mainly result from high-velocity impacts. This study was done to analyse multilgament knee reconstructions done in a single setting at a minimum 12 month follow-up with objective gait, squat, stability and fluoroscopic examination along with PROMs and compare the individual KD categories. Also, the study analyses the difference between &lt; 30- and &gt; 30-year-olds as well as those who had sporting injuries versus RTAs.</p><h3 data-test=\"abstract-sub-heading\">Methodology</h3><p>All cruciate ligaments were reconstructed arthroscopically. Collateral ligaments were reconstructed using autografts and fixed with interference screws. All were kept non-weight-bearing for 6 weeks on a brace. ROM exercises were begun at the earliest. Gait analysis, stability, balance, squat analysis and fluoroscopic analysis were used to determine the objective outcomes during follow-ups. PROMs were analysed pre- and postoperatively to document the functional activity of the patient. The analysis of the various parameters with objective measurements of the clinical, functional and patient-reported measures was done to assess the outcome in multiligament knee injury patients.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>ACL with MCL was the most common presenting multiligament-involved presentation, with KD3 being the most common pattern of injury. The parameters for contact time, step length, ROM at knee and hip on the normal and operated limbs were near normal and same at a minimum 1-year follow-up with a good stability index. The PROMs improved significantly postop. There was no difference in the results of sporting versus non-sporting injuries, those &lt; 30 and &gt; 30 years and between the individual KD groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The results showed statistically significant improvement in stability and PROMs at follow-up in multiligament reconstructions, but no difference comparing individual KD groups, &lt; 30 and &gt; 30 years age and those injured by RTA s and sporting injuries.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcomes and Return to Sport of Combined ACL Reconstruction and Lateral Extra-Articular Tenodesis in High-Pivot Kabbadi Players: A Prospective Cohort Study of 93 Elite Players","authors":"Manit Arora, Tapish Shukla, Sahil Garg, Chiranjeev Jani","doi":"10.1007/s43465-024-01230-3","DOIUrl":"https://doi.org/10.1007/s43465-024-01230-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Our understanding of antero-lateral rotatory instability (ALRI) has evolved considerably, with a shift towards a combined procedure of ACL reconstruction and lateral extra-articular procedure (LEAP) to reduce ALRI and decrease graft re-rupture rates. Despite mounting evidence for the same in high-pivot and high-contact athletes in the West, there is a paucity of data for regional sports such as kabbadi. To the authors best knowledge, this is the first such study to track the outcomes of the combined procedure (ACLR and LEAP) in kabbadi players.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Ethics approval was obtained from the institutional ethics review committee. A total of 93 consecutive kabbadi players with ALRI were recruited for undergoing the combined procedure of ACLR with lateral extra-articular tenodesis. Demographical variables (age and gender) and functional outcome scores (IKDC, Lysholm, VAS, AOFAS, and FADI) were recorded pre-operatively and followed up at 6 week, 3 month, 6 month and 1 year post-surgery. In addition, complications (pain, stiffness, residual laxity, re-rupture, and infection) and return to sport were recorded.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>All 93 patients completed the prospective cohort study with no drop-outs. The mean age of the study population was 22.4 ± 2.7 years and 84% were males. VAS, IKDC and Lysholm scores showed significant improvement at each time frame during the study period and significant improvement at end of the study period versus baseline. AOFAS and FADI scores showed no significant difference between baseline and end of study period. There was no significant difference with respect to age and gender for knee (IKDC and Lysholm) or ankle (AOFAS and FADI) scores. Return to sport was achieved in 99% of study participants with return to pre-injury level was 86%. Re-rupture rate was low (<i>n</i> = 2 patients) and the majority of complications related to the LET (either a complaint of swelling or shape change phenomenon).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The present study shows that ACLR with LET provides a safe and effective option for treating kabbadi players engaged in an inherently high-pivot and high-contact sport. Knee outcomes (VAS, IKDC and Lysholm scores) showed substantial improvement versus baseline with a high degree of return to sport at pre-injury level and low re-rupture rate.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee Instability Following Fractures Around the Knee Joint: Diagnostic Dilemma and Management Challenges","authors":"Prahalad Kumar Singhi, Ajay Gowtham Amutham Elangovan, Srinivasan B. S. Kambhampati, Sivakumar Raju, M. Chidambaram","doi":"10.1007/s43465-024-01228-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01228-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Aim</h3><p>Knee instability following fractures around the knee joint is not uncommon but is often missed. They present challenges in identifying them during index injury or at follow-up. We share our experience of knee instability following fractures around the knee joint.</p><h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>(1) To identify the pattern of clinically significant knee instability following fractures around the knee joint. (2) To discern the association of fracture morphology with ligamentous disruption. (3) To identify the risk factors for knee ligament injury following fractures around the knee. (4) To recognise the signs of instability in fracture scenarios and their diagnostic pitfalls/management challenges.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>After appropriate Ethical committee clearance and patient consent, a retrospective analysis of 595 fractures around the knee joint was performed at our institute from 2018 to 2021. After employing the exclusion criteria, a total of 92 cases of ligament injuries were included in the analysis. Seventy-six of them were identified and addressed during the index procedure, and 16 of them presented with delayed instability during fracture healing, treated by appropriate arthroscopic ligament reconstruction. Demographic data, mode of injury, fracture morphology, ligament injury pattern and associated injuries were documented and analysed. Functional outcome was assessed using Lysholm scoring and the International Knee Documentation Committee questionnaire at the final follow-up.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The overall incidence of clinically significant knee ligament injury was 15.46%. Among the 76 acute cases, 8 were ACL avulsions, 47 were PCL avulsions, 9 were MCL injuries, 2 were LCL injuries, and 10 had MLKI treated by arthroscopic/open techniques. Out of the 16 cases that presented late, 6 had ACL injuries, 2 had LCL injuries, and 8 of them had a multi-ligamentous knee injury. With respect to the fracture pattern, 56 (60.9%) had tibia fractures, 24 (26.1%) had femur fractures, 3 (3.3%) of them had patella fractures, and 9 (9.8%) had floating knee injuries. The mean Lysholm score was 85.7 ± 9.8. 19.6% (<i>n = </i>18) had excellent outcome, 46.7% (<i>n = </i>43) had good outcome, 23.9% (<i>n = </i>22) had fair outcome and 9.8% (<i>n = </i>9) had poor outcome.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Knee instability following fractures around the knee is not uncommon, one out of six fractures may have significant instability. Identifying and addressing is key for a satisfactory outcome and to avoid its sequalae.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}