Extended Medial Coronal Plane Plica Formed by a Rare Fusion of Medial Patellar and Biblike Plicae in the Knee: A Case Report.

The traditional plicae of the knee have been updated recently with reports of new variants in the coronal plane. We report another variant, an extended medial coronal plane plica (EMCPP), previously unreported, in a 70-year-old lady with osteoarthritis of the knee and a loose body. The preoperative symptoms after the excision of the plica and loose body were temporarily relieved for 11 months before she underwent total knee arthroplasty (TKA) for associated osteoarthritis. Excision of the EMCPP could resolve symptoms, but resultant internal scarring or the plica itself could cause difficulty in exposure during TKA.

Management of Anterior Cruciate Ligament Aplasia for the Arthroscopy Surgeons: A Systematic Review.

Background: Anterior Cruciate Ligament Aplasia (ACLA) is a rare condition which can sometimes remain asymptomatic into adult life. Although the quoted incidence is 1.7 per 100,000 live births, it is higher due to these silent cases and can be encountered by the arthroscopy surgeon doing reconstructive procedure for the ACL. The aim of this study is to get information on clinical presentation, imaging, arthroscopy findings and management of the knee in patients with ACL aplasia through a systematic review relevant to the arthroscopy surgeon in making a decision when they encounter such a case. Methods: We performed a systematic review of the literature to get information on this condition that may be relevant to the arthroscopy surgeon from PubMed, Ovid full text, Embase and Ovid Medline databases. After exclusions and inclusions, we found 31 articles relevant to the search which included 101 knees. Results: Most of the publications were case reports due to the rarity of this condition. ACLA is commonly associated with Fibular Hemimelia, Congenital Dislocation of the Knee and Proximal Focal Femoral Deficiency (PFFD). Clinical findings, imaging appearances, other associated findings with ACLA have been listed and management options listed and discussed. Conclusions: Patients with ACLA are often asymptomatic and arthroscopic reconstruction of the ACL appears to be a viable option in selected symptomatic cases only. The arthroscopic surgeon should be aware of the clinical picture and intraarticular findings of ACLA to recognize the condition and make a decision on the optimal management. Further studies are required to report on long-term outcomes of the condition in terms of secondary osteoarthritis development as well as the procedures performed. We recommend forming a global registry to study and further understand the aspects of this condition. Level of Evidence: 4. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00651-2.

Centralizing the Cemented Exeter Femoral Stem Using the Direct Lateral Approach: Surgical Tips and Radiological Evaluation.

Varus malalignment in total hip arthroplasty has been associated with poor long-term outcomes and complications including abnormal load distribution, endosteal osteolysis, frank loosening, and periprosthetic fractures. Postoperative radiographic assessment was performed on 224 patients from our case series who underwent cemented Exeter total hip arthroplasty using the direct lateral approach alone. No patient had a true varus-aligned stem (ie, ≤-5° on the coronal assessment). We describe our surgical technique, with 4 easily reproducible technical tips to achieve positional consistency of the femoral stem: commencing stem insertion from the piriform fossa entry point, using a femoral stem distal centralizer, aiming the tip of the component to the center of the patella, and placing the thumb between the calcar and inferior neck of the femoral component to prevent the stem from tipping into varus.

Clinico-radiological outcomes following anatomical anterior cruciate ligament reconstruction using the TransLateral, all-inside technique.

We present early clinical outcomes of patients following anatomical anterior cruciate ligament reconstruction using a TransLateral, single bundle, all-inside technique with a one-year follow-up and radiological evaluation of socket position. Eligible Patients who underwent a primary ACL reconstruction, using the TransLateral, all-inside technique alone, between Jan 2013 and Feb 2016 were included in this study. Of this group, all patients underwent isolated semitendinosus graft harvest. The Lysholm knee scores were measured preoperatively and at one-year follow-up in 40 patients who underwent ACL reconstruction. Postoperatively, antero-posterior and lateral radiographs were obtained to evaluate the position of the femoral socket (using the Bernard and Hertel Grid) and tibial socket (using the Amis-Jakob line). There were 36 males and 4 females with a mean age of 27.1 years (range 16-49). There was a single non-surgical related mortality prior to the one year follow up. We report no postoperative infections or graft failure at one year. The mean preoperative Lysholm score was 68.7 (Range: 29-95). The mean Lysholm score increased to 92.5% (Range: 59-100, p < 0.05). Evaluation of femoral sockets revealed accurate positioning on the Bernard and Hertel Grid with a mean ACL center of 27% along Blumensaat's line and 34% of the height of the intercondylar notch. The mean tibial socket position was 41.8% (Range: 32%-47%) along the Amis-Jakob Line. Our single surgeon case series utilizing the all-inside, TransLateral ACLR technique highlights good early outcomes with no postoperative complications or graft failure at one year.

Complete bony coalition of the talus and navicular: decades of discomfort.

Tarsal coalition is a congenital disturbance of hindfoot development. Talonavicular coalition is among the rarest forms of aberrant bony union of the tarsus. It frequently occurs bilaterally and in association with a number of skeletal deformities. Some patients are asymptomatic and the anomaly is discovered incidentally on plain radiographs. For others, a troublesome bony prominence will be the principle complaint and in a small proportion of patients marked foot and ankle pain with activity will prove debilitating. The authors describe the case of a 54-year-old male with bilateral foot pain spanning for nearly two decades. Symptom onset was insidious and at the time of presentation, he was limited to 10-15 min of mobilisation on flat ground.

Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.

This study evaluates the criterion validity of the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scales by correlating scores obtained with these rating scales to scores obtained with the Foot Function Index (FFI) in patients with foot and ankle conditions. To date, the AOFAS scoring scales have not been shown to provide valid information despite their popularity. The FFI, on the other hand, has previously been shown to provide valid information in regard to conditions affecting the foot and ankle. A moderately strong inverse criterion validity correlation (Pearson correlation coefficient = -0.68) was shown when preoperative patients were administered both the AOFAS and FFI questionnaires, and the resultant scores were compared. Test-retest reliability measurements showed no significant difference (P = .27) between preoperative AOFAS scale scores measured at least 2 weeks apart. Construct validity was shown (P = .006) when dependent preoperative and postoperative (at least 3 months) AOFAS scale scores were compared, indicative of the clinical rating scales' ability to discriminate and predict quality of life related to foot and ankle conditions. The moderate level of correlation, satisfactory degree of reliability, and responsiveness (ability to distinguish differences between preoperative and postoperative conditions in the same patient) observed in this study suggest that the subjective component of the AOFAS clinical rating scales provides quality-of-life information that conveys acceptable validity regarding conditions affecting the foot and ankle.

Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing.

OBJECTIVE: To investigate the use of the Ilizarov circular fixator and nail retention in treating diaphyseal nonunion following previous intramedullary nailing. DESIGN: Retrospectively reviewed, consecutive series. Mean duration of follow-up after achieving bone union: 19.2 months (range 6 to 33 months). SETTING: A tertiary referral center for nonunion surgery. PATIENTS: Nine patients (two femoral, three tibial, and four humeral nonunions) were included in the study. All patients were referred from other centers after failure to achieve union with intramedullary nailing. Patients who had nonunion with other fixation devices in situ, those with active infection and nonunion following nonoperative treatment, were excluded from the study. The patients had undergone an average of 2.4 operations (range 1 to 5 operations) before application of the Ilizarov fixator. All patients completed the study. INTERVENTION: The circular fixator was used to compress the nonunion site from without, retaining the intramedullary nail in each case. We excluded a patient who had his nonunion site explored followed by bone excision and transport. The mean duration of fixator treatment was 6.2 months (3 to 11 months). MAIN OUTCOME MEASUREMENTS: Clinical and x-ray evidence of bone union, infection, residual deformity, shortening, and assessment of functional outcome. RESULTS: Bone union was achieved in all nine patients using the circular fixator over the nail. The bone results were graded as six excellent, one good, and two fair. All patients reported a reduction in pain and satisfaction with their final outcome. CONCLUSIONS: There is a role for the use of the Ilizarov fixator with nail retention in resistant long bone diaphyseal nonunion in carefully selected patients. This method can achieve high union rates where other treatment methods have failed.