Lateral Epicondylitis Treated with Platelet-Rich Plasma Injection and Corticosteroid Injection.

Introduction: Lateral epicondylitis, or tennis elbow, affects 1%-3% of adults aged 35-50, causing pain and weakness in the dominant elbow due to chronic inflammation of the extensor tendon. While corticosteroid injections (CSI) are commonly used for treatment, they offer only short-term relief. Platelet-rich plasma (PRP) is a promising alternative with potential for long-term benefits. This study compares the efficacy of PRP and CSI in treating lateral epicondylitis. Materials & Methods: A randomized controlled trial was conducted at Chettinad Hospital and Research Institute from February 2020 to March 2021, involving patients with lateral epicondylitis unresponsive to non-invasive treatments. Patients were randomly assigned to receive either PRP or CSI, with pre- and post-treatment pain and function assessed using VAS, PSFS, and PRTEE scores. Results: PRP showed better long-term pain reduction and functional improvement than CSI. At 6 months, PRP-treated patients had significantly lower VAS and PRTEE scores, indicating superior outcomes. Discussion: Although CSI provided quicker initial relief, PRP demonstrated sustained benefits at 3 and 6 months. PRP's effectiveness in promoting tissue healing may explain its long-term success. Conclusion: PRP is more effective than CSI for long-term management of lateral epicondylitis, offering superior pain relief and functional improvement.

Bone Preservation in Femoral Intercondylar Box Cut - A Comparative Study between Older and Newer Generation Implants.

Introduction: This study was conducted to compare the quantity of intercondylar bone removed during femoral box osteotomy for implantation of three contemporary newer generation posterior stabilized (PS) total knee arthroplasty designs Attune PS (DePuy), Anthem (Smith and Nephews), and NexGen Legacy (Zimmer) with the older version from the same manufacturers. Materials and Methods: We compared the maximum volumetric bone resection required for the housing of the PS mechanism of these six designs. Bone removal by each PS box cutting jig was three-dimensionally measured. The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test was used for pairwise comparisons. The level of significance was set at P < 0.05. Results: The newer generation implants save approximately 33% of bone that was resected from the box cut as compared to the older versions. DePuys Attune PS saved 27.1% bone as compared to Sigma PS resecting 6.96 cm3 of bone, and Zimmers Persona saved 40.57% bone as compared to NexGen from the intercondylar box cut resecting 6.18 cm3. Smith and Nephew s Anthem and Genesis have no difference in their box volume with both resecting 7.8 cm3 of bone. Conclusion: Irrespective of implant size, the Attune PS (DePuy) and Nexgen Legacy (Zimmer) cutting jigs always resected significantly less bone than did the jigs of older generations. There was no significant difference in the bone removed during femoral box osteotomy in the newer and older generations of Smith and Nephew.

A Comparative Study on Correlation between Magnetic Resonance Imaging and Arthroscopic Findings in the Knee Joint Injuries.

Introduction: The knee joint primarily allows for flexion and extension and is essentially a hinge joint. The knee joint, like all hinge joints, is strengthened by collateral ligaments - one on each side of the joint. Objective: Our study sought to investigate potential correlations between arthroscopy and magnetic resonance imaging (MRl) examination in the diagnosis of traumatic diseases of the knee. Methods and Materials: A prospective study was conducted on 30 persons who showed signs of having traumatic knee disease. Following a comprehensive evaluation of the patient s medical history and current state of health, we opted to undergo an arthroscopic evaluation and knee MRL. Results: The sensitivity of the MRI was 93.87%, the specificity was 91.54%, the accuracy was 92.50%, and the negative predictive value was 95.58% when compared to arthroscopic inspection as the gold standard. Conclusion: This study demonstrates that MRIs frequently misdiagnose individuals with multiple knee injuries or fail to detect a lesion while doing a diagnostic evaluation. Therefore, if the MRI comes out normal, there is no reason to deny the patient arthroscopy. Due to this MRI flaw, researchers have determined that arthroscopy can be performed following a comprehensive clinical assessment without the need for an MRI.

A Perspective of Growth of Unicompartmental Knee Replacement in India - Registry Data and Global Trends.

Introduction: The purpose of this study is to analyze the trend of unicompartmental knee replacement (UKR) in India, based on the data obtained from the Indian joint registry, in comparison with the global trends. Materials and Methods: This study is a retrospective analysis of data from an Indian joint registry for cases performed between 2016 and 2021. A total of 1086 UKRs were identified and the following information was analyzed: demographic data, diagnosis leading to primary UKR, yearwise surgeon inclination toward UKR, implant preference, regions where UKR was preferred, and the effect of robotics in UKR. UKR registry data were compared with the registry data from the UK (NJR), Sweden (SKAR), Australia (AOJR), and the USA (AJRR). Results: One thousand eighty-six UKRs were included in the study: The vast majority of them (97%) were implanted due to primary osteoarthritis followed by deformity (2%), as in accordance with other registries. Since 2016, though very minimal, there has been a gradual increase in the numbers and the percentage of cases contributed by UKR, of all knee replacements with the maximum of 2.85% reported in 2019. The same has been observed in the global trends as well. Oxford knees (60%) are the most preferred implants followed by journey uni knee (20%) in India. The cities where more unicompartmental knee are performed are in the order of Mumbai (32.78%), Faridabad (9.39%), Pune (7.92%), and Hyderabad (6.35%). Surgeon preference for robotic assisted UKR is increasing, accounting for 34% of UKR in 2020, which is in coherence with AOJR. Conclusion: The percentage of knee replacements contributed by UKR is increasing globally and the same trend can be observed in India. Oxford phase III prosthesis are the most preferred UKR prosthesis. UKRs are mostly performed in selected pockets of India, with Mumbai almost contributing to one-third of all the cases. The use of robotics in UKR is increasing and is expected to give better results in the future.

Single Stance Radiography of the Knee Joint - A Novel Approach to Assess the Degree of Knee Osteoarthritis.

Introduction: Conventional radiography has always been cited as the gold standard for assessing the structural changes associated with osteoarthritis (OA) of the knee. The purpose of the study was to compare the joint space width between both leg-standing and one-leg-standing radiographs in an assessment of the severity of OA of the knee. Materials and Methods: Fifty patients with medial compartment OA were deployed for the study. Patients underwent both leg standing radiographs and one-leg standing radiograph on the affected leg. Kellgren-Lawrence (KL) radiographic classification was used to assess the severity of OA using joint space width. Conclusion: The mean medial joint space width decreased from 3.26 mm in both legs of the standing radiograph to 1.98 mm in the one-leg standing radiograph. Patients on both leg standing radiographs appreciated an increase in grade during the single leg radiograph. Nearly 52% of patients with both leg standing radiographs have changed the KL grading to a more severe grade when undergone a single leg standing radiograph. One-leg standing radiograph was found to be a better representation of joint space width than both-leg standing radiographs.

An Isolated Second Carpometacarpal Joint Dislocation Treated With Open Reduction and Transfixation With K-wire: A Rare Case Report.

Carpometacarpal (CMC) joint dislocation is a rare injury that can be easily missed due to non-specific clinical signs and radiologic findings. We report a patient with an isolated and irreducible dorsal dislocation of the second CMC joint, which required an open reduction and K-wire transfixation. An extensor tendon was found to be interposed between the base and the trapezoid. K-wire removal was done after three weeks and following the removal of the wire, rehabilitation was started.