Both Hamstring and Quadriceps tendon autografts offer similar functional outcomes after arthroscopic ACL reconstruction in patients over 50 years of age.

PURPOSE: The purpose of this study was to compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports. METHODS: Between 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients with concomitant meniscus, cartilage and MCL injury were also included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or ipsilateral osteoarthritis (Ahlback stage 2 or higher) were excluded. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. Mann-Whitney test was used for unpaired samples, whereas the Friedman test was used for analyzing variables over time. The chi-square statistic test was used to determine differences in categorical data between groups RESULTS: The number of patients in the QT and HT groups was 85 and 143 respectively. The mean age was 54.4 [50-65] and 56.4 [50-65] for the QT and HT groups respectively, 49% and 51% were males in the QT and HT groups respectively. The two groups did not differ significantly in terms of age, gender, time from injury to surgery and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). At the 2-year follow-up, Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores between the two groups (p>0.05). Furthermore, at the 2-year follow-up, Lysholm score, and VAS didn't show significant differences between QT and HT groups. (p=.390; p= .131). Similarly, no differences have been reported in Tegner activity level scores between HT and QT groups at 2 years of follow-up. No significant differences in terms of minimal clinically important difference (MCID) have been detected between the two groups for Lysholm and Tegner activity scores (p = 0.410 and p = 0.420 for Lysholm score and Tegner activity level score respectively). The two groups did not differ in terms of patient's percentage of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease (p=0.01) in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline [116 (81%) vs 98 (69%)]. No case of graft failures and quadriceps tendon rupture was reported in either of the groups. CONCLUSION: Arthroscopic ACL reconstruction by using HT or QT autograft in athletically active older than 50 years patients provide satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity.

Double-Needle Technique for Temporary Stabilization of Unstable Meniscal Tear During All-Inside Meniscal Repair.

Meniscus tears are common in patients with primary or revision anterior cruciate ligament injuries. Given their important mechanical role in the joint, efforts are being made to repair as much of the meniscus tear as possible. However, all-inside repair might be challenging in case of an unstable tear due to the dislocation of the meniscal flap after deploying the first anchor. Therefore, we describe the details of our technique that allows the surgeon to stabilize the meniscal tear before all-inside repair, ensuring the reduction of the tear throughout the entire procedure.

Should I add Orthobiologics to my Knee Osteotomy Practice? A Systematic Review.

IMPORTANCE: Orthobiologics has seen a renaissance over the last decade as an adjunct therapy during osteotomy due to the limited inherent regenerative potential of damaged intraarticular tissues. AIM OR OBJECTIVE: This systematic review aims to present the latest evidence regarding using orthobiologics with simultaneous high tibial osteotomy (HTO) for knee osteoarthritis. The results of this study may guide surgeons to improve their clinical results and clear the air regarding confusion over whether or not to add orthobiologics to HTO in clinical practice backed by scientific evidence. EVIDENCE REVIEW: According to PRISMA guidelines a systematic search for relevant literature was performed in the PubMed (MEDLINE), Scopus, EMBASE, and Cochrane Library databases of all studies published in English from January 1990 to May 2023. The following search terms were entered into the title, abstract, and keyword fields: "knee" or "osteotomy" AND "valgus" or "varus" AND "regenerative medicine" or "PRP" or "mesenchymal stem cells" or "stem cells" or "BMAC" or "bone marrow" or "growth factors" or "umbilical cord blood-derived mesenchymal stem cell" or "stromal vascular fraction". The AMSTAR-2 checklist was used to confirm the quality of the systematic review. Randomised controlled trials (RCTs), prospective and retrospective comparative cohort studies, case-control studies, and case series were included. Studies that reported clinical outcomes in patients treated with knee osteotomy for varus/valgus knee with concomitant adjunction of regenerative treatment [Platelet-rich plasma (PRP), Adipose-derived stem cells (ADSC), Human Umbilical Cord Blood-Derived (HUCBD), Mesenchymal Stem Cells (MSC), bone marrow aspirate concentrate (BMAC), stromal vascular fraction (SVF)] were included. The outcome measures extracted from the studies were the KOOS score, Lysholm score, Subjective IKDC, WOMAC Score, KSS, Tegner, HSS, radiographic tibiofemoral angle, posterior tibial slope and complications. The current systematic review is registered in the PROSPERO Registry (CRD42023439379). FINDINGS: Osteotomy for unicompartmental arthritis with adjunction of orthobiologics such as PRP, ADSC, HUCBD, MSC, BMAC, and SVF presents a consistent statistically significant clinical improvement compared to preoperative scores regardless of the treatment modality used and there were no notable complications associated with the use of these novel agents. CONCLUSIONS AND RELEVANCE: Orthobiologics and knee osteotomies could improve outcomes in patients with knee osteoarthritis desiring Knee preservation surgeries. However, only a few studies are available on the topic to conclude anything with certainty, the patients included in the studies could not be disintegrated based on the grade of osteoarthritis (OA), type, dosage and frequency of administration of orthobiologic and type of additional surgical procedures used. Therefore, better-structured RCTs are required to implement this finding into routine Orthopaedic practice. LEVEL OF EVIDENCE: Level 4.

Partial Subscapularis Tear: State-of-the-Art.

The Subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from traumatic injury or intrinsic degeneration. Partial SSC tears can range in severity and be classified into different categories based on the location of the tear, size of the lesion, and associated pathology. The tear usually begins from the superolateral margin in the first facet and propagates downwards. It is frequently associated with biceps pathology or anterosuperior lesions. These tears are now increasingly recognized as distinct pathology that requires specific diagnostic and management approaches. The current management approaches are shifting towards operative, as partial SSC tears are increasing recognized as distinct pathology. At present, there is no consensus regarding the timing of repair, but the relative tendency of the SSC to retract much faster than other rotator cuff muscles, and difficulty in mobilization, advocates an early repair for SSC irrespective of the lesion size. An associated biceps pathology can be treated with either tenotomy (biceps delamination/erosion) or tenodesis. The techniques of partial SSC repair are constantly improving. There is no reported difference in use of 2-anchor-based conventional single-row (SR), a 3-anchor-based interconnected double-row technique, or a 2-anchor-based interconnected hybrid double-row construct in the repair construct. However, the 2-anchor-based interconnected double-row provides an advantage of better superolateral coverage with the leading-edge protection, as it helps in placing the superolateral anchor superior and lateral to the original footprint. A timely intervention and restoration of the footprint will help restore and rehabilitate the shoulder. Future directions should prioritise injury prevention, early diagnosis with clinic-radiological cues and targeted interventions to mitigate risk.

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature.

Purpose: The aim of the present systematic review was to quantitatively synthesize the best literature evidence regarding osteoarthritis developing after anterior cruciate ligament reconstruction (ACLR), including only studies with a follow-up duration of at least 20 years. Material and Methods: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on four electronic databases (PubMed, Scopus, EMBASE and Cochrane Library). The outcome measures extracted from the studies were failure rate, subsequent knee surgery on the same knee, radiographic development of osteoarthritis measured with Kellgren-Lawrence, International Knee Documentation Committee (IKDC) radiographic score and Ahlbäck classification. The health of both the ACLR knee and the contralateral knee was compared. Results: A total of 1552 patients were included in the study, of which 1290 (83.11%) were operated on using a patellar tendon graft, 190 (12.24%) with hamstrings, 27 (1.73%) with an iliotibial band and 45 (2.89%) with patellar tendon plus a ligament augmentation device (LAD). The mean age at the time of surgery was 25.18 ± 1.91 years, and the mean follow-up time was 23.34 ± 2.56 years. Analysing IDKC Score at final follow-up, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 33.2% (324/976) of the patients showed a moderate to severe degree (Grade C or D) of osteoarthritis, while for Kellgren-Lawrence, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 28.9% (196/678) of the patients showed a moderate to severe degree (Grade III or IV) of osteoarthritis. In total, 1552 patients were registered, 155 reruptures (9.98%) and a total of 300 (19.3%) new surgeries, of which 228 meniscectomy (14.69%), 21 (1.35%) knee arthroplasty and 17 (1.09%) hardware removal were recorded. Conclusions: ACL reconstruction appears to result in mild osteoarthritis in the long term in most of the patients and only less than 33.2% develop a moderate to severe degree of knee OA according to IKDC radiographic score. A slight degree of osteoarthritis appears to be present in ACLR knees compared with contralateral healthy knees. Level of Evidence: Level IV.

Robotic-assisted total knee arthroplasty is not associated with improved accuracy in implant position and alignment compared to conventional instrumentation in the execution of a preoperative digital plan.

Purpose: The primary objective of the present study was to evaluate if robotic-assisted total knee arthroplasty (RO-TKA) results in improved accuracy compared to conventional TKA (CO-TKA) with respect to alignment and component positioning executing a preoperative digital plan. The secondary objective was to compare patient-reported outcome measures (PROMs) between the two groups at 6 months of follow-up (FU). Methods: Patients who underwent primary TKA using the concept of constitutional alignment were identified from the database. Each patient underwent preoperative digital planning as well as postoperative evaluation of the preoperative plan (alignment and component position) using mediCAD® software (Hectec GmbH). Two groups were formed: (i) The RO-TKA group (n = 30) consisted of patients who underwent TKA with a robotic surgical system (ROSA®, Zimmer Biomet) and (ii) the CO-TKA group (n = 67) consisted of patients who underwent TKA with conventional instrumentation. To assess accuracy, all qualitative variables were analysed using the χ 2 test. Tegner activity scale, Oxford Knee Score and visual analogue scale were assessed preop and at 6-month FU. To assess differences between the two groups, a 2 × 2 repeated measures analysis of variance was performed. Results: There was no significant (p > 0.05) difference in the accuracy of alignment as well as tibial and femoral component position between the two groups. At the 6-month FU, there was no significant (p > 0.05) difference in PROMs between the two groups. Conclusion: While robotic TKA may have some potential advantages, no significant difference was found between robotic and conventional TKA with respect to limb alignment, clinical outcomes and component positioning. Level of Evidence: Level III.

The "Golden Age" of quadriceps tendon grafts for the anterior cruciate ligament: a bibliometric analysis.

IMPORTANCE: Bibliometric research is a statistical analysis of publications to measure the scientific output in a specific field in order to highlight medical developments or knowledge gaps and to direct future scientific research. The quantity of orthopedic papers on the internet is astounding and is steadily growing as a result of recent advancements in technology and medicine. This is why choosing the right information is essential. AIM: The purpose of this study was to analyze the current literature for trends in publications regarding quadriceps tendon (QT) grafting of the anterior cruciate ligament (ACL). EVIDENCE REVIEW: PubMed was searched on August 28, 2023. References were collected from PubMed, and trends were analyzed using this information. This search retrieved 405 articles regarding human and animal studies. We analyzed the top 10 authors and journals in terms of publication numbers, citation numbers, and citations per year. The PubMed-by-year feature was used to compare the number of publications regarding ACL reconstruction by quadriceps grafting with all publications in PubMed. FINDINGS: The number of yearly publications averaged 10 or less up to 2018, starting from 1982 when the first paper on the QT was published. However, the number of publications increased from 2018. While the total number of publications on this topic was 405, 260 were published from 2018 alone. The number of citations was 8262 in total overall years. It is expected that the last five years' publications, especially those for the last year, will be low in number, as it takes time for citations to accrue. The journal Arthroscopy published the most articles on this topic, with 57 papers and 1884 citations, followed by the American Journal of Sports Medicine, with 39 articles and 1576 citations. The top three journals on this topic were Arthroscopy, AmericanJournalofSportsMedicine, and KneeSurgery, SportsTraumatology, Arthroscopy. The most published author was Musahl V (with 24 articles), and the most cited author was Xerogeanes JW (with 570 citations). CONCLUSIONS AND RELEVANCE: Global trend analysis suggests that research on anterior cruciate ligament reconstruction with the quadriceps has significantly increased in the last 5 years and that the number of papers on this topic is increasing steadily. We found that the publications and citations are exhibiting a rising trend, Arthroscopy is the most impactful journal, and Musahl V is the most impactful author on the topic. Xerogeanes JW is the author with the most citations on the topic. The promising clinical results of anterior cruciate ligament reconstruction with the QT have attracted the most research interest. LEVEL OF EVIDENCE: Level IV.

Revision ACL reconstruction in female athletes: current concepts.

The challenge of revision anterior cruciate ligament (ACL) reconstruction lies in its complexity, varied presentation, and technical intricacies. A successful ACL reconstruction should allow patients to safely return to preinjury activities. However, it is only sometimes simple, and many risk factors and concurrent pathologies come into play. Evaluating and analysing the cause of failure and associated conditions is paramount to addressing them effectively. Despite a plethora of research and improvements in knowledge and technology, e gaps exist in issues such as optimal techniques of revision surgery, graft options, fixation, concurrent procedures, rehabilitation and protocol for return to sports of high-level athletes. Female athletes need additional focus since they are at higher risk of re-injury, suboptimal clinical outcomes, and lower rates of return to sport following revision reconstruction. Our understanding about injury prevention and the protection of ACL grafts in female athletes needs to be improved. This review focuses on the current state of revision ACL surgery in female athletes and provides recommendations and future directions for optimising outcomes in this high-risk group.

Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study.

Background: The incidence of anterior cruciate ligament (ACL) reconstruction is increasing, and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. Purpose: To evaluate the differences in the patient-reported functional outcomes, concomitant injuries, and graft failure in primary versus revision ACL surgery using QT autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 376 patients with primary ACL reconstruction and 138 patients with revision ACL reconstruction were retrospectively retrieved from a prospectively collected ACL registry. A minimally invasive technique was used for QT autograft harvesting. The surgical procedure and rehabilitation protocol were identical in both groups. To maintain a homogeneous cohort for the study, the groups were matched by age, sex, and preinjury outcome scores (Lysholm knee score, Tegner activity level, and visual analog scale [VAS] for pain). Initial baseline assessments of outcome scores were compared with scores collected at the 2-year postoperative mark. Results: The mean age of the primary group and revision group was 32.9 ± 10.2 years (range, 18-55 years) and 32.3 ± 9.9 years (range, 19-55 years) respectively. Significant preinjury to postoperative improvements were noted in Lysholm (88.2 ± 16.4 vs 83.5 ± 15.0; P = .007) and VAS pain (0.9 ± 1.3 vs 1.5 ± 1.6; P = .001) scores after primary ACL reconstruction compared with revision reconstruction. However, no significant difference was found in Tegner activity level (6.7 ± 1.8 vs 5.9 ± 1.8; P > .430). Primary ACL injury was associated with significantly higher concomitant medial collateral ligament injuries (P = .019), while the revision group was associated with significantly higher concomitant cartilage (P = .001) and meniscal (P = .003) injuries. A significantly higher graft failure rate was noted in the revision group compared with the primary ACL reconstruction group (13.0% vs 5.6%; P = .005). Conclusion: Both primary and revision ACL reconstruction with QT autograft had acceptable functional outcomes. The primary group had better outcomes than the revision group, possibly due to the lower prevalence of meniscal and cartilage injuries in the primary group compared with the revision group. The revision group was associated with higher graft failure than the primary group. QT autograft is a viable graft choice for both primary and revision ACL reconstruction.

Trends in unicompartmental knee arthroplasty among 138 international experienced arthroplasty knee surgeons.

Purpose: Unicompartmental knee arthroplasty (UKA) is an established option for treating isolated unicompartmental knee osteoarthritis (OA), but controversies still exist about patient selection, indications, perioperative management and alignment goals. This survey was designed to understand the current trends of experienced arthroplasty knee surgeons performing UKA. Methods: An online questionnaire was created with SurveyMonkey® to assess global tendencies in the utilization of UKA. A link to the survey was shared with all ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) members. The questionnaire consisted of free and multiple-choice questions and was divided into four sections: demographic information, the surgical activity of the respondents, indications for surgery and postoperative alignment goals. Results: A total of 138 ESSKA members from 34 different countries completed the survey. A total of 81 % of the responders performed fewer than 50 UKAs per year; 53 % of UKAs represented less than 20 % of their knee replacements; 71 % used mainly or only fixed-bearing implants; 81 % performed UKA in a shorter time compared to TKA; and 61 % and 72 % were interested in custom-made UKA and robotics, respectively. Thirty-six percent considered a minimum postoperative alignment of 0° for medial UKA, and 32 % considered 10° as the maximum valgus deformity for lateral UKA. Fifty-five percent had no minimum age cut-off, 47 % had no BMI cut-off, and 57 % believed TKA was better than UKA in knees with concomitant high-grade patellofemoral OA. Approximately 50 % of the surgeons desired a coronal alignment that was the same as the predegeneration alignment. Conclusion: A high level of agreement was reached regarding the following: preference for fixed-bearing UKAs, lower surgical time for UKA compared to TKA, interest in custom-made and robotic UKAs, no age and weight cut-off, TKA preferred in the presence of patellofemoral OA, and a final alignment goal of the predegenerative state both for medial and lateral. There was no agreement regarding length of stay, rehabilitation protocol, preoperative varus and valgus cut-off values, and treatment in cases of absence of anterior cruciate ligament or previous osteotomy.

Increased Intra-Articular Internal Tibial Rotation Is Associated With Unstable Medial Meniscus Ramp Lesions in ACL-Injured Athletes: An MRI Matched-Pair Comparative Study.

Purpose: To analyze internal tibial rotation through magnetic resonance imaging (MRI) of patients with anterior cruciate ligament (ACL) injuries with and without an unstable medial meniscal ramp lesion (MMRL). Methods: Retrospective analysis of prospectively data was performed to include all consecutive patients who underwent primary ACL reconstruction (ACLR) between January 2022 and June 2022. Two groups, ACLR + unstable MMRL and ACLR without MMRL, were constituted. Propensity score matching analysis was used to limit selection bias. The angle between surgical epicondylar axes (SEAs) and the tangent line of the posterior tibial condyles (PTCs) was measured to analyze the rotational alignment between distal femur and proximal tibia. MMRLs were defined unstable if they were ≥1 cm, if the lesions extend beyond the lower pole of the femoral condyle, and/or if there was displacement into the medial compartment by anterior probing. Results: Twenty-eight propensity-matched pairs were included. The ACLR + unstable MMRL presented a significantly greater internal rotation of the tibia compared to ACLR without MMRL (P < .001). An internal tibial rotation was associated with unstable ramp lesions in ACL-injured patients (odds ratio [OR], 0.36; 95% CI, 0.25-0.41; P < .0001). If SEA-PTC was 0°, the sensitivity and specificity of the SEA-PTC angle to detect unstable MMRL were respectively 100% (95% CI, 85%-100%) and 18% (95% CI, 8%-36%). Otherwise, if SEA-PTC angle was -10°, the sensitivity and specificity of the SEA-PTC angle to detect unstable MMRL were respectively 43% (95% CI, 27%-61%) and 96% (95% CI, 81%-100%). Bone edema of the posterior medial tibial plateau was significantly associated with unstable ramp lesions (OR, 1.58; 95% CI, 1.21-2.06; P = .029). Conclusions: Unstable MMRL concomitant to an ACL rupture was associated with an increased tibial internal rotation. Level of Evidence: Level III, retrospective comparative trial.

Comorbidities in Paediatric Psoriasis: Experience from a Tertiary Care Centre.

Background: Psoriasis begins in childhood in around one-third of the cases. There has been conflicting evidence regarding the association of paediatric psoriasis with comorbidities. Aims and Objectives: The objective of this study was to find out various comorbidities (abnormal body mass index, metabolic syndrome, lipid abnormalities, diabetes mellitus, and raised blood glucose) associated with paediatric psoriasis. Materials and Methods: All patients of psoriasis (age <18 years) who visited the Paediatric Psoriasis clinic from January 2017 to September 2021 were recruited in this record-based study. Results: Records of 100 patients were analysed, with female to male ratio of 1:1. The age group ranged from 11 months to 18 years. The average body surface area involved was 5.43%. The average psoriasis area and severity index was 2.47. Joint involvement was seen in 7% of patients in our study. A total of 52 (52%) patients had abnormal body mass index, out of which 21 patients were overweight and 31 were obese. At least one lipid abnormality was found in 66 (66%) patients. The most common lipid abnormality was decreased high-density lipoprotein, followed by raised total cholesterol, raised total triglycerides and raised low-density lipoprotein. 8 (8%) patients were found to have raised blood glucose levels. Out of which, six had impaired fasting glucose and two were diagnosed with diabetes mellitus. 5 (5%) patients were diagnosed with metabolic syndrome. Conclusion: Paediatric psoriasis is a chronic disfiguring disease and may have profound emotional and psychological effects. There is a lack of studies from India on the prevalence of these comorbidities in paediatric psoriasis. More studies are required from different parts of the world for a better understanding of paediatric psoriasis.

Distal Kaplan fibers and anterolateral ligament injuries are associated with greater intra-articular internal tibial rotation in ACL-deficient knees based on magnetic resonance imaging.

PURPOSE: The purpose of the present study was to assess the internal rotation of the tibia on Magnetic Resonance Imaging (MRI) in a series of consecutive athletes with Anterior cruciate Ligament (ACL) tears. METHODS: Retrospective analysis of prospectively collected data was performed to include all consecutive patients who had undergone primary ACL reconstruction between January 2022 and June 2022. The angle between surgical epicondylar axes (SEA) of the knee and posterior tibial condyles (PTC) was measured. A negative value was defined as internal torsion. KFs and ALL injuries were reported. Analysis of covariance (ANCOVA) was performed to examine the independent associations between SEA-PTC angle and injuries of KFs and ALL adjusted for physical variables (age, gender and body mass index [BMI]). Statistical significance was set at a p-value of < 0.05. RESULTS: A total of 83 eligible patients were included. The result of multiple linear regression analysis showed that internal tibial rotation was associated with KFs and ALL injuries. The estimated average of SEA-PTC angle in relation to ALL injuries controlling the other variables was -5.49 [95%CI -6.79 - (-4.18)] versus -2.99 [95%CI -4.55 - (-1.44)] without ALL injuries. On the other hand, the estimated average of SEA-PTC angle in relation to KFs lesions controlling the other variables was -5.73 [95%CI -7.04 - (-4.43)] versus -2.75 [95%CI -4.31 - (-1.18)] without KFs injuries. CONCLUSIONS: KFs and ALL injuries were associated with an increased intra-articular internal tibial rotation in ACL-deficient knees. The measurement of femorotibial rotation on axial MRI could be useful to detect indirect signs of anterolateral complex (ALC) injuries.

Interleukin Levels and Non-Alcoholic Fatty Liver Disease in Chronic Plaque Psoriasis: An Analytical Case Control Study.

Background: Psoriasis is a chronic, immune mediated inflammatory condition of the skin and imbalance in inflammatory mediators could result in insulin resistance, metabolic syndrome and facilitate the occurrence and progression of Non-alcoholic fatty liver disease (NAFLD). Objectives: Primary objectives: To study the frequency of NAFLD in cases of chronic plaque psoriasis and controlsTo study the interleukin levels in cases of chronic plaque psoriasis and controls. Secondary objectives: To study the BMI, lipid profile, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin in cases and controlsTo study the association of age, duration of psoriasis, PASI (psoriasis area severity index), BSA (body surface area) involved, BMI (body mass index), lipid profile, obesity, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin levels with NAFLD in patients of chronic plaque psoriasisTo correlate serum levels of IL1-ß, IL6 and TNF-α with NAFLD in patients of chronic plaque psoriasis. Methods: 50 clinically diagnosed cases of chronic plaque psoriasis with age ≥ 18years, diseases duration ≥ 6 months and 30 age and sex matched controls were recruited. PASI, BSA of cases was calculated and BMI, BP, WC of all subjects was measured. Serum lipid profile, FBS, PPBS, insulin level, IL1- ß , IL6, TNF- α , high frequency B-mode ultrasound, LFT and fibroscan were done in all subjects. Results: 28(56.0%) cases and 2(6.6%) controls had NAFLD with statistically significant difference. Significantly elevated WC, serum insulin, deranged lipid profile, fatty liver, transaminitis, fibroscan score, liver fibrosis, NAFLD and interleukins were found in cases vs controls. There was a significant association of NAFLD in psoriatic patients with increasing duration of psoriasis, BMI ≥23 Kg/m2, high WC, increasing BSA involved, deranged lipid profile, raised total cholesterol levels and increasing number of risk factors. Nonsignificant but positive association of NAFLD in cases was found with high levels of IL1 - ß, IL - 6, TNF-α, FBS and increasing PASI. Conclusion: Significantly increased interleukin levels and their weak positive correlation with the severity of psoriasis (PASI, BSA) in patients of chronic plaque psoriasis explains the possible role of inflammation in the causation of psoriasis. Screening may be considered in psoriatic patients with increasing duration of psoriasis, high WC, high BSA involved, high BMI, obesity, dyslipidemia and insulin resistance. Limitations: Small sample size. Conflict of Intrest: NONE.

Concomitant Injuries Associated With ACL Rupture in Elite Professional Alpine Ski Racers and Soccer Players: A Comparative Study With Propensity Score Matching Analysis.

Background: For elite professional soccer players and alpine skiers, injuries associated with anterior cruciate ligament (ACL) rupture, such as meniscal, cartilage, or collateral ligament lesions, could result in a delayed return to sport compared with isolated ACL injury. Purpose/Hypothesis: The purpose of the study was to provide a detailed description of associated injuries at the time of primary ACL reconstruction in elite soccer players and alpine skiers. It was hypothesized that soccer players and skiers would present different typical injury patterns due to different injury mechanisms. Study Design: Cohort study; Level of evidence, 3. Methods: Surgical reports and arthroscopic images of elite professional soccer players and alpine skiers who underwent primary ACL reconstruction at a single institution between January 2010 and June 2022 were analyzed retrospectively. The presence and location of multiligamentous injury, meniscal tears, and chondral lesions were compared between the athlete groups. A propensity score matching analysis with 1:1 ratio was performed between skiers and soccer players to limit the effect of selection bias. Results: Included were ACL reconstruction data representative of 37 soccer players and 44 alpine skiers. Meniscal pathology was found in 32 (86%) soccer players and 30 (68%) skiers. Chondral injuries were reported in 11 (30%) soccer players and 15 (34%) skiers. Results of the propensity score matching analysis in 15 pairs of soccer players and skiers indicated that soccer players had a significantly higher rate of medial meniscal injuries (73% vs 27%; P = .03) and lateral posterior root tears (33% vs 0%; P = .04) compared with skiers. Conclusion: A higher prevalence of combined chondral and meniscal injuries versus isolated ACL injuries was observed in both groups of athletes. Professional soccer players were characterized by higher prevalence of medial meniscal tears and lateral posterior root lesions compared with professional alpine skiers.

Reconstruction of the anterior cruciate ligament: a historical view.

Management of anterior cruciate ligament (ACL) tears has continuously evolved since its first description in approximately 170 A.D. by Claudius Galenus of Pergamum and Rome. The initial immobilization using casts was replaced by a variety of surgical and conservative approaches over the past centuries. The first successful case of ACL repair was conducted by Mayo Robson in 1885, suturing cruciate at the femoral site. In the nineteenth century, surgical techniques were focused on restoring knee kinematics and published the first ACL repair. The use of grafts for ACL reconstruction was introduced in 1917 but gained popularity in the late 1900s. The introduction of arthroscopy in the 1980s represented the greatest milestones in the development of ACL surgery, along with the refinements of indications, development of modern strategies, and improvement in rehabilitation methods. Despite the rapid development and multitude of new treatment approaches for ACL injuries in the last 20 years, autografting has remained the treatment of choice. Compared to the initial methods, arthroscopic procedures are mainly performed, and more resistant and safer fixation devices are available. This results in significantly less trauma from the surgery and more satisfactory long-term results. The most commonly used procedures are still patellar tendon or hamstring autograft. Additionally, popular, but less common, is the use of quadriceps tendon (QT) grafts and allografts. In parallel with surgical developments, biological reconstruction focusing on the preservation of ACL remnants through the use of cell culture techniques, partial reconstruction, tissue engineering, and gene therapy has gained popularity. In 2013, Claes reported the discovery of a new ligament [anterolateral ligament (ALL)] in the knee that could completely change the treatment of knee injuries. The intent of these modifications is to significantly improve the primary restriction of rotational laxity of the knee after ACL injury. Kinematic studies have demonstrated that anatomic ACL reconstruction and anterolateral reconstruction are synergistic in controlling pivot displacement. Recently, there has been an increased focus on the application of artificial intelligence and machine learning to improve predictive capability within numerous sectors of medicine, including orthopedic surgery.

Clinical and epidemiological profile of lichen striatus in children-Experience from a tertiary care hospital.

We analyzed records of 30 patients with lichen striatus (age < 18 years) in this retrospective study. Seventy percent were females and 30% were males with a mean age of diagnosis of 5.38 ± 4.22 years. The most common age group affected was 0-4 years. The mean duration of lichen striatus was 6.66 ± 4.22 months. Atopy was present in 9 (30%) patients. Although LS is a benign self-limited dermatosis, long-term prospective studies with a greater number of patients will help in better understanding of the disease including its etiopathogenesis and association with atopy.

Posterior Cruciate Ligament Reconstruction Using Flat Soft-Tissue Grafts.

Isolated posterior cruciate ligament (PCL) ruptures are relatively rare, but they more commonly occur in multiligament knee injuries. To date, in isolated or combined injuries with grade III step-off, surgical treatment is recommended to restore joint stability and improve knee function. Several techniques for PCL reconstruction have been described. However, recent evidence has suggested that broad, flat soft-tissue grafts may more closely mimic the native PCL ribbonlike morphology in PCL reconstruction. Furthermore, a femoral rectangular bone tunnel may more accurately re-create the native PCL attachment, allowing grafts to simulate native PCL rotation during knee flexion and potentially improving biomechanics. Therefore, we have developed a PCL reconstruction technique using flat quadriceps or hamstring grafts. This technique can be performed using 2 types of surgical instruments that allow for the creation of a rectangular femoral bone tunnel.