Comparative Analysis of Arthroscopic Tight Rope ACL Reconstruction Using four Strand Isolated Semitendinosus Graft and Quadrupled Combined Hamstring Graft.

Background: Arthroscopic ACL reconstruction using hamstring autograft is a quite a popular surgical procedure. But there is a conflict regarding the use of isolated semitendinosus graft or a combined hamstring graft. We did a comparative analysis of the functional outcome after ACL reconstruction performed with four strand semitendinosus graft and a combined hamstring graft over tightrope. Methods: Two groups of 30 patients each with similar demographic profiles, presenting with symptoms of instability after chronic ACL tear were included. A standard single bundle arthroscopic ACL reconstruction was performed by using four-strand semitendinosus graft in Group A and combined hamstring graft in Group B patients. Clinical and functional outcome analysis was done using quantitative anterior tibial translation measurement and Lysholm score. Results: The mean age of subjects in group A was 29 years and in Group B was 28 years. The semitendinosus graft length was insufficient in 13.33% cases in group A. The improvement in Lysholm score and the decrease in the tibial translation were comparable in both the groups at one year of follow-up. No added comorbidities were noted in additional removal of gracilis tendon in group B patients. Conclusion: Isolated semitendinosus four-strand autograft can be used for arthroscopic single bundle ACL reconstruction when adequate graft length is obtained. However, one should not be hesitant in additional removal of gracilis tendon when needed. In terms of functional outcome and patient satisfaction, both the graft configurations stand the same.

Mammoth Giant Cell Tumor of the First Metacarpal: A Case Report and Management Trends.

Giant cell tumor (GCT) is classically described as a locally aggressive, epiphyseo-metaphyseal osteolytic tumor occurring in young adults. They are mostly seen in long bones while some are also found in the iliac bone and spine and a very small proportion occurs in hand bones. Due to the rarity of GCT in metacarpal, there is a paucity of treatment options available. In an extensive literature search on PubMed, Embase, Medline, and Ovid from 2004 till date, very few cases were reported. The various treatment options available are intralesional curettage with or without adjuvant therapy, wide resection, free osteoarticular metatarsal transfer, and, occasionally, ray amputation may also be done. After simple curettage, a reasonably high recurrence rate also imposes comprehensive en-bloc excision, but still, there are many case reports of recurrence. Experience with a case of GCT of the whole first metacarpal extending from the carpometacarpal to the metacarpophalangeal joint is not thoroughly described in the literature. We hereby report a mammoth GCT of the first metacarpal treated by excision and reconstruction by free fibular graft and adjacent joint fusion with an excellent functional outcome at one-year follow-up.

Giant Cell Tumor of the Distal Radius: Wide Resection, Ulna Translocation With Wrist Arthrodesis.

Giant cell tumor (GCT) of the bone is a locally aggressive neoplasm and usually managed with extended curettage and adjuvant therapy, which is associated with reduced risk of recurrence. The juxta-articular distal radius giant cell tumor is challenging due to the destruction of subchondral bone and articular cartilage, making it difficult to salvage the wrist joint anatomy and function. Various methods described include wide resection and reconstruction of allograft or centralization of the ulna with wrist arthrodesis. We present the functional outcome of distal end radius GCT, which was successfully managed with wide local excision, ulna translocation, and wrist arthrodesis. At the two years follow-up, the patient shows excellent functional outcome with supination and pronation movements and no local recurrence.

The Successful Management of a Repetitively Infected Recurrent Proximal Humerus Giant Cell Tumour of 20 Years' Duration With Two-Staged Surgery: A Rare Case Report.

The recurrence of giant cell tumour of bone (GCTB) is quite well known. It is mainly attributed to the presence of microscopic tumour remnants left behind after tumour treatment by intralesional curettage. This condition becomes more serious and alarming when the lesion gets infected postoperatively. Several studies have indicated that the role of adjuvants in preventing the recurrence of GCTs is limited, and complete removal of malignant cells is often mandatory. We present a rare case GCT of the proximal humerus in a female patient who developed repetitive recurrences of the tumour; her salvage procedures were also complicated by the development of infection after every treatment procedure for over 20 years. The patient was finally treated successfully with a two-stage revision and reconstruction procedure.

Arthroscopic Subtalar Arthrodesis as a Treatment Strategy for Subtalar Arthritis: A Systematic Review.

Arthroscopic subtalar arthrodesis is a relatively new technique which is increasingly being used by foot and ankle surgeons as an alternative to open surgery. However, there is still a lack of consensus with respect to the efficacy of the procedure. The purpose of this review was to ascertain (1) whether arthroscopic subtalar arthrodesis improves the functional outcome of treated patients and (2) how do the 2 techniques of subtalar arthroscopy (posterior and lateral) compare with each other. MEDLINE and Cochrane Library databases were accessed by 2 independent reviewers. Inclusion/exclusion criteria were predefined. National Institute of Health risk of bias assessment tool was used to determine the methodological quality of the included studies. A total of ten studies with 234 patients (240 feet) were included. The most common indication for arthroscopic subtalar fusion was posttraumatic subtalar arthritis. Weighted pre- and postoperative American Orthopaedic Foot and Ankle Society scores were 47 and 80.7, respectively. Average time to fusion was 10.2 weeks and weighted mean fusion rate was 95%. Pain secondary to prominent hardware and nonunion were the most common complications. Although improvement in functional scores was higher and complication rate lower with the posterior group, a better fusion rate was seen with the lateral approach. Arthroscopic fusion techniques have shown to be an effective alternative to open surgery. While there was a trend for better functional outcome with the posterior approach, randomized control trials comparing the 2 techniques are needed to better assess their respective outcomes.

Modifiable Risk Factors of Plantar Fasciitis in Non-Athletic Patients and Proposal of a New Objective Assessment System - RKISP / Fatores de risco modificáveis para fasciíte plantar em pacientes não atletas e proposta de um novo sistema de avaliação objetiva - RKISP

Abstract Objective To determine the modifiable risk factors associated with severity of plantar fasciitis and to formulate an objective scoring system for indexing plantar fasciitis in the non-athletic population. Methods This was a prospective observational study. The main outcome measure was the association of a modifiable risk factor, which was measured with the Pearson coefficient (R-value) and the level of significance, which was kept as p < 0.05. Result In a sample size of 50 patients, the body mass index (BMI) and ill-cushioned shoes were found to be significantly associated with pain in plantar fasciitis. All the other risk factors were either non-modifiable or had no significant association. Conclusion Based on available data and further interpretation, an index was be formulated, named as Ranjeet-Kunal Index for Scoring Plantar fasciitis (RKISP), which can be successfully used for not only grading plantar fasciitis but also prognosticating the conservative management of the same, thus deciding the modality of treatment.

Resumo Objetivo Determinar os fatores de risco modificáveis associados à gravidade da fasciíte plantar e formular um sistema objetivo de pontuação para indexação da doença na população não atlética. Métodos Estudo observacional prospectivo. A principal medida de desfecho foi a associação de um fator de risco modificável, mensurada pelo valor de R (coeficiente de Pearson) e pelo nível de significância de p < 0,05. Resultados Em uma amostra de 50 pacientes, o índice de massa corporal (IMC) e calçados com amortecimento inadequado foram associados de maneira significativa à dor na fasciíte plantar. Todos os demais fatores de risco eram não modificáveis ou não apresentaram associação significativa. Conclusão Com base nos dados à disposição e sua interpretação, um índice, denominado Índice de Ranjeet-Kunal de Pontuação da Fasciíte Plantar (RKISP, em inglês) , foi formulado e utilizado com sucesso não apenas na classificação da fasciíte plantar, mas também na determinação do prognóstico de seu tratamento conservativo, auxiliando a escolha da modalidade terapêutica.