Utility of SpeedCourt System: A Novel Study of 100 Professional Footballers at FIFA Medical Centre of Excellence Dubai UAE.

Purpose: The SpeedCourt system has been confirmed as an effective and dependable tool for evaluating multi-directional change-of-direction (COD) maneuvers. It has also been employed in the rehabilitation process following Anterior Cruciate Ligament (ACL) injuries and for multi-directional training purposes. This study investigated by means of the SpeedCourt system determines 1) whether there is any difference in COD parameters and countermovement jumps (CMJ) between United Arab Emirates (UAE) and non-UAE professional footballers 2) whether there is any difference between the two lower limbs during change-of-direction manoeuvres. Methodology: This analysis included 100 professional football players from UAE or Non-UAE football clubs who were tested at FIFA Medical Centre of Excellence. With the help of Speedcourt system, 6-s tapping, countermovement jump (CMJ) and chase 15-s tests were performed. Comparison was done between UAE and non-UAE footballers and also between the dominant and non-dominant sides. Results: Out of the 100 players, 83 players were right foot dominant. Apart from the countermovement jump test, there was no significant difference in results between UAE and non-UAE football players. Average time to turn for dominant and non-dominant sides did not show any significant difference, for either group. Conclusion: There is no difference in 6-s tapping, Chase 15-s tests or limb asymmetry amongst UAE and Non-UAE footballers. However, the non-UAE footballers showed significantly better performance in Countermovement Jump Test. The data provide baseline values for forthcoming sports medicine research, which can be taken into account when creating injury prevention or return-to-sport protocols, particularly with regard to change of direction parameters and countermovement jump.

The current trend of proximal tibiofibular ganglion cyst: A summary of 7 case series and 61 case reports.

Purpose: To review the different types of ganglion cysts surrounding the proximal tibio-fibular joint, their management options, outcomes, and recurrence. Design: Descriptive analytical review. Results: 7 case series consisting of a total of 159 patients and 61 case reports consisting of 80 patients (with three patients having bilateral pathology) were included in this review. (Total cysts 159 + 83 = 242). The mean age was 41 years, and 71 % of the patients were males. 96.5 % of the cases were managed operatively, out of which 98 % of patients felt improvement in local symptoms and 71.5 % had improvement in neurological symptoms. Complete excision of the cyst is the primary mode of operative management. Many added procedures with complete excision are to mitigate the risk of recurrence. The recurrence rate of aspiration, simple excision alone, simple excision with recurrent articular branch neurectomy, and simple excision with PTFJ procedures were 77 %, 56 %, 11.5 %, and 0 %, respectively. Outcomes beyond recurrence were poorly reported. Conclusion: There is not enough literature regarding the topic from which any formal systematic review can be done. Our summary suggests that aspiration alone or with steroid injection is associated with the highest recurrence rates among all the procedures. Complete excision with recurrent articular branch neurectomy should be the primary management. Revision cyst excision in isolation is an inadequate treatment option, therefore should be done in conjunction with PTFJ arthrodesis, which reduces the recurrence rates. Better quality studies are needed that report patient-centered outcomes and morbidities following PTFJ procedures.

The flexibility and convenience of using a standard orthopaedic table in peri-articular knee fractures: Allowing ligamentotaxis and improving imaging accessibility.

Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge. Complexity of the fracture often needs multi-planar surgical access. A combined two-staged procedure is frequently suggested both in supine and prone position to address this issue. However, this will significantly increase the operative time and eventually impact the outcome, in addition to the complications associated with prone positioning. In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup, at the same time, giving the flexibility to change the alignment from valgus to varus and vice versa. This facilitates fracture reduction while addressing the anatomical structure of the knee. A further advantage is the unobstructed imaging access throughout the surgical fixation. This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures. We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome. We found that this approach is safe, reproducible and relatively easy to set up in the two centres.

Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature.

PURPOSE: To analyse the incidence of additional soft tissue releases with the lateral parapatellar approach, and the clinical and radiological outcomes of total knee arthroplasties performed using the lateral parapatellar approach for valgus arthritic knees. A review of the existing literature on valgus arthritic knees undergoing knee replacement was performed and our results compared. MATERIALS AND METHODS: This is a prospective cohort study of 50 patients operated by this approach. Operation and clinical records were assessed to determine the number and sequence of soft tissue releases. Functional outcome was measured using the Oxford Knee Score. Radiological assessment included measurement of alignment and implant positioning. RESULTS: 46 patients included. Mean follow-up of 4 years. Additional lateral releases were performed in 11 (24%) cases. Mean valgus alignment corrected from 13.1 degrees pre-operatively to 5.7 degrees post-operatively. Oxford Knee Score improved from a mean pre-operative score of 11.9 to a mean post-operative score of 38.3 at final follow-up. Radiographs revealed lateralisation of the tibial component in 4 patients. No immediate or late post-operative wound complications, late instabilities or revisions were observed. CONCLUSION: Lateral parapatellar approach is highly effective in correcting the valgus deformity with a low incidence of additional soft tissue releases. Medium-term results indicate an excellent functional outcome with no complications.

Operative versus conservative treatment of proximal rectus femoris avulsions: A systematic review with meta-analysis of clinical outcomes, complications and return to sports.

PROSPERO REGISTRATION NUMBER: CRD42020198333. OBJECTIVE: To compare the surgical and conservative treatment of proximal rectus femoris avulsions regarding clinical outcomes, rate of return to sports and incidence of complications. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane, Medline, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting on outcomes of PRFAs or return to sports were included. RESULTS: Nine studies consisting of a total eighty-two patients met the inclusion criteria. The mean age was 22.2 years and 75.9% of patients were male. Mean follow-up was 28.9 months and 65% avulsions were managed surgically. The overall outcomes were similar in surgical and conservative treatment group (p = 0.72) with similar incidence of complications (14%). The rate of return to sports was 95% in surgical and 92.7% in the conservative management groups (p = 0.93). Overall, the quality of the methodology of included studies was low, with a mean CMS of 45.6. CONCLUSION: Both conservative and operative treatment provide excellent outcomes in proximal rectus femoris avulsions, with similar rates of return to sports and incidence of complications. More prospective and good quality studies are needed to compare surgical techniques and time to return to sports. Avulsions with retraction of more than 20 mm and high demand patients may benefit from surgical treatment. Patients should be counselled accordingly.

Recurrent patellar dislocations with patellar cartilage defects: A pain in the knee?

BACKGROUND: Recurrent patellar dislocation in combination with cartilage injures are difficult injuries to treat with confounding pathways of treatment. The aim of this study was to compare the clinical and functional outcomes of patients operated for patellofemoral instability with and without cartilage defects. METHODS: Eighty-two patients (mean age 28.8 years) with recurrent patellar dislocations, who underwent soft-tissue or bony procedures, were divided into two matched groups (age, sex, follow up and type of procedure) of 41 each, based on the presence or absence of cartilage defects in patella. Chondroplasty, microfracture, osteochondral fixation or autologous matrix-induced chondrogenesis (AMIC)-type procedures were performed depending on the nature of cartilage injury. Lysholm, Kujala, Tegner and Subjective Knee scores of both groups were compared and analysed. Complications and return to surgery were noted. RESULTS: With a mean follow up of 8 years, there was a significant improvement observed in all the mean postoperative patient-reported outcome measures of both groups, as compared with the preoperative scores (P < 0.05). Comparing the two groups, postoperative Lysholm, Kujala and Subjective knee scores were significantly higher in patients operated without cartilage defects (P < 0.05). Three patients operated for patellofemoral instability with cartilage defects underwent patellofemoral replacement subsequently. The odds ratio for developing complications was 2.53 for patients operated with cartilage defects. CONCLUSION: Although there is a significant improvement in the long-term outcome scores of patients operated for recurrent patellar dislocation with cartilage defects, the results are significantly inferior compared with those without cartilage defects, along with a higher risk of developing complications and returning to surgery.

Traumatic Cervical Spondyloptosis of the Subaxial Cervical Spine: A Case Series with a Literature Review and a New Classification.

STUDY DESIGN: This is a retrospective study on patients with traumatic subaxial cervical spondyloptosis and includes a review of the available literature regarding the management of this injury. PURPOSE: This study aimed to assess the biomechanics and varied clinical presentations of this rare but devastating injury. OVERVIEW OF LITERATURE: This is a case series of three patients and a review of the available literature on subaxial cervical spondyloptosis. Traumatic cervical spondyloptosis of the subaxial spine is rare, with varied clinical presentations. METHODS: The management of cervical subaxial spondyloptosis represents a challenge to all spine care specialists, and there is a paucity of literature on the best methods for managing this condition. Our experience includes three such patients who visited our tertiary trauma center. This article explains the diverse clinical features of the injury as well as the management of these patients and includes a review of the available literature. RESULTS: Subaxial cervical spondyloptosis is a devastating injury with diverse clinical features. We present a classification of these fractures based on clinical presentation and magnetic resonance imaging results, which can help in decision-making regarding the management of such patients. CONCLUSIONS: This article may help physicians assess this injury in an evidence-based manner and also elucidates the management strategies available for such patients.

Results of Single-Staged Posterior Decompression and Circumferential Fusion Using a Transpedicular Approach to Correct a Kyphotic Deformity due to Thoracolumbar Spinal Tuberculosis.

STUDY DESIGN: This is a prospective study. PURPOSE: The aim of this study was to investigate the results of single-staged posterior decompression and circumferential fusion using a transpedicular approach to correct a kyphotic deformity due to thoracolumbar spinal tuberculosis. OVERVIEW OF LITERATURE: Surgical management is frequently an imperative choice to achieve spinal decompression and deformity correction due to tuberculosis to relieve pain, improve neurology, and reconstruct the spine stability. Since the time anterior radical debridement and noninstrumented fusion was described, it has become apparent that even anterior debridement and bone grafting was often unsatisfactory in correcting or preventing the progression of kyphosis deformity. With the advent of modern segmental spinal instrumentation systems, isolated posterior instrumentation; combined anterior and posterior fusion; and single-staged posterior decompression and circumferential fusion have been described by many authors for correcting angular deformity and stabilizing the spine; however, there is a lack of consensus regarding the most effective means of correcting the deformity due to thoracolumbar spinal tuberculosis. METHODS: This is a prospective study of 20 patients with thoracolumbar spinal tuberculosis who underwent surgery at our institute. RESULTS: Twenty patients who were started on antituberculosis treatment underwent surgery using a single-staged posterior approach involving fixation, decompression, and kyphosis correction. Preoperatively, all patients had varying degrees of neurological deficit and a 27.45° average kyphotic angle, which improved. At the 1-year follow-up, correction was maintained at 6.9°, and 55% of patients showed neurological improvement. None of the patients experienced neurological deterioration. Two patients with lumbar spine tuberculosis underwent revision surgery because of nonunion. CONCLUSIONS: The procedure of posterior decompression, fixation, and circumferential fusion using a transpedicular approach performed for thoracolumbar spinal tuberculosis is effective, safe, and excellent in correcting and maintaining kyphosis.