Common Peroneal Nerve Palsy Due to Chronic Exertional Compartment Syndrome after Military Training: A Case Report.

Introduction: The common peroneal nerve (CPN) palsy in military personnel due to chronic exertional compartment syndrome (CECS) is uncommon. There are no previous reports of treatment of this condition with simultaneous CPN and superficial peroneal nerve (SPN) neurolysis and compartment release. Case Report: An 18-year-old military recruit presented with complete CPN palsy after sitting cross-legged for 2 h in training. After 3 months of failed non-operative treatment, a clinical diagnosis of CECS with CPN palsy was made and the patient was treated with simultaneous CPN and SPN neurolysis and release of the anterior and lateral leg compartments. The patient had full recovery at 6 months post-operative period and returned to sports at 1 year follow-up. Conclusion: This case report of a young military recruit with CPN palsy after prolonged cross-legged sitting in the setting of CECS demonstrates successful treatment with simultaneous CPN and SPN neurolysis and anterior and lateral compartment release. Future studies should explore the efficacy of this treatment option and prevention strategies of CPN palsy in military personnel.

Image-free handheld robotic-assisted technology improved the accuracy of implant positioning compared to conventional instrumentation in patients undergoing simultaneous bilateral total knee arthroplasty, without additional benefits in improvement of clinical outcomes.

PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent simultaneous bilateral total knee arthroplasty (SB-TKA) using either robotic-assisted TKA (RA-TKA) or conventional TKA (C-TKA). METHODS: Included were the patients who underwent SB-TKA between January 2018 and January 2020 and had a minimum follow-up of 2 years. Of 151 patients included, 117 patients were operated using an image-free handheld robotic sculpting system (RA-TKA group) and 34 patients operated using conventional instrumentation (C-TKA group). The key outcomes noted were multiple patient-reported outcomes (PROs), adverse events, and radiological outcomes. Two investigators independently measured the radiological outcomes on pre- and post-operative radiographs in coronal plane (medial proximal tibial angle [MPTA] and anatomic lateral distal femoral angle [aLDFA]) and sagittal plane (posterior tibial slope [PTS] and posterior condylar offset [PCO]). The chi-square test was used to examine categorical variables. Student's t test was used to analyze the continuous variables. RESULTS: Patients in both groups were similar in baseline characteristics (gender, body mass index, incidence of comorbidities, and length of hospital stay) except that RA-TKA group patients younger (66.7 ± 8.9 vs 70.4 ± 10.5, P = 0.037) than C-TKA group. The operative time was longer in RA-TKA group as compared to C-TKA (189.3 ± 37.1 vs 175.0 ± 28.2, P = 0.040). The final PROs at each were similar between the two groups (P > 0.05). The values of PROs at final follow-up in RA-TKA compared to C-TKA were VAS pain (0.4 ± 0.9 vs 0.4 ± 0.5), KOOS-JR (89.3 ± 5.8 vs 87.1 ± 5.3), and physical (55.9 ± 2.8 vs 55.4 ± 3.2), mental (61.1 ± 4.4 vs 60.2 ± 4.7) component of VR-12 scores, and KSS satisfaction (37.5 ± 1.1 vs 37.1 ± 2.2) (all P > 0.50 or non-significant [n.s.]). While one patient in RA-TKA required revision of femoral component for peri-prosthetic fracture, none of the patient in conventional group were revised (0.85% vs 0%, P = n.s.). The proportion of patients with outliers in RA-TKA group was lower for aLDFA (2.6% vs 22.1%, P < 0.01) and PTS (0% vs 35%, P < 0.01). CONCLUSION: This comparative study in patients undergoing SB-TKA found reduction of outliers in femoral and tibial implant positioning with RA-TKA as compared to C-TKA. There were no differences in both groups for pain, function, and satisfaction at a minimum of 2 years of follow-up. LEVEL OF EVIDENCE: III Therapeutic Study.

Cement Augmentation of Suture Anchor During Arthroscopic Rotator Cuff Repair in Case of Proximal Humeral Bone Deficiency Due to Osteoporosis.

One of the technical challenges during arthroscopic rotator cuff repair is bone deficiency in proximal humerus to get adequate fixation of suture anchors. The typical scenarios that result in bone deficiency at rotator cuff footprint are older individuals, females, osteoporosis, and revision rotator cuff repairs with failed anchors from previous surgery. One of the ways to secure fixation of suture anchors in deficient bone is augmentation with polymethyl methacrylate cement. We present a stepwise technique of cement augmentation of suture anchor during arthroscopic rotator cuff repair to achieve secure fixation of suture anchor and avoid spillage of cement in the subacromial space.

Comparison of Intraarticular Versus Combined Intravenous and Intraarticular Tranexamic Acid Administration in Patients Undergoing Primary Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial in the Middle Eastern Patient Population.

Background: This study aimed to determine whether combined intravenous (IV) and intraarticular (IA) tranexamic acid (TXA) reduces blood loss and the requirement of blood transfusion compared to IA use alone in the middle eastern patients undergoing primary cemented unilateral total knee arthroplasty (TKA). Methods: The present study is a double-blind randomized controlled trial (RTC) comparing the efficacy of IA alone to combined IA and IV routes of TXA administration in patients undergoing primary cemented TKA using a tourniquet performed by two senior surgeons. There were 21 patients in the IA alone and 29 in the combined group. The primary outcome measure was blood transfusion requirement, hemoglobin drop, and the total estimated blood loss on day three of postoperative period. The secondary outcomes were complications including thromboembolic events, wound complications, periprosthetic infection, patient-reported outcomes (PROs) of pain visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and EuroQol 5-dimension (EQ-5D) as well as the range of motion (ROM) at one-year follow-up. Results: None of the patients in either of the comparison group required blood transfusion in the perioperative period. The drop in hemoglobin levels (2.1±1.0 vs. 2.2±1.1, P=0.84) and the total estimated blood loss (884±489 vs. 877±324, P=0.96) on the third postoperative day in the IA alone group showed no statistically significant difference compared to that in the combined group. Moreover, there were no complications noted in patients of either group. At one-year follow-up, there was no significant difference between the two comparison groups regarding the mean PROs of pain VAS, WOMAC, and EQ-5D, as well as ROM. Conclusion: According to the obtained results, this RCT in the middle eastern patient population found no additional benefit of TXA administration through combined IV and IA route over the IA alone in reducing the requirement of blood transfusion and the total blood loss. Further similar studies with larger sample sizes are needed to ascertain the ideal route of TXA administration in patients undergoing primary TKA.

Position of the Patella among Emirati Adult Knees. Is Insall-Salvati Ratio Applicable to Middle-Easterners?

BACKGROUND: Abnormal patellar height is associated with anterior knee pain and several conditions that affect the patellofemoral joint. The aim of this study was to 1) report the incidence of patella alta and patella baja and 2) investigate whether the normal limits of the Insall-Salvati ratio is applicable in adult Middle-Easterners. METHODS: A radiographic review of the lateral radiographs of 736 Middle-Eastern knees were performed. Patellar tendon length (TL) and the patellar length (TP) was digitally measured and the ratios of these measures was used to calculate the Insall-Salvati ratio. RESULTS: The overall mean TL/PL ratio was 1.20±0.17. The Insall-Salvati ratio was higher (p=0.0013) in males (1.22± 0.12) than in females (1.18±0.17). According to our measurement, the recommended levels for defining abnormal patellar position should be 0.86 for patella baja and 1.54 for patella alta. CONCLUSION: The use of TL/PL ratio demonstrated a higher incidence of patella alta and a higher mean TL/PL ratio compared to other techniques. The normal ranges for the TL/PL differs from western populations and may be attributed to lifestyle differences.