Risk of anterior cruciate ligament injury in population with elevated body mass index.

Aim Anterior cruciate ligament (ACL) injury is among the most common orthopaedic injuries. The elevated body mass index (BMI) can contribute to non-contact ACL injury. This study aims to assess the risk of ACL injury among elevated BMI population people (BMI ≥25 Kg\m2 ). Methods This is a cross sectional study that was conducted in a tertiary care centre in the Kingdom of Saudi Arabia. A total of 302 patients, who had an ACL reconstruction surgery in a ten-year-period (January 2008 to December 2018) were included. Results Sport related injury is significantly higher among the overweight and obese groups (p=0.002). Moreover, the combined ACL tear was higher among the overweight and obese groups (p=0.001). In univariate regression analysis for the selected baseline characteristics, it was found that individuals with higher BMI have chance to develop combined (ACL) injury 2 times higher when compared to those with isolated ACL injury (p=0.003). Also, the ACL type, mode of injury, types of injury and type of sports were statistically significant in univariate regression analysis. However, only the mode of injury was statistically significant after controlling the confounding factors. Other selected variables like type of sport, type of injury and ACL type were not significant. Conclusion Elevated BMI was associated with a higher risk of developing combined ACL tear as well as reinjured individuals.

Prevalence of Plantar Heel Pain Among School Teachers in Medina Region, Saudi Arabia: A Cross-Sectional Study.

Background Plantar heel pain (PHP) can be a common medical complaint among people with both sedentary and active lifestyles due to varied causes. It can affect the quality of life and result in significant disability. Despite many studies on PHP, few have focused on a specific population, such as school teachers. School teachers represent a significant proportion of the population of Medina, and addressing such a complaint and its possible relevant factors, which are most likely to be common among them due to their comparable job duties, will aid us in determining the relationships between personal characteristics, work-related factors, and PHP, as well as in formulating management plans. This study aims to identify the prevalence of PHP and its determinants among school teachers in the Medina region of Saudi Arabia. Methodology This cross-sectional study aims to identify the prevalence of PHP in school teachers. It was conducted in the Medina region of Saudi Arabia. A self-administered, online, validated questionnaire was created and used for data collection. Consent was taken from all participants before answering the questionnaire. Participation was voluntary, and all participants could withdraw from the study at any time. Data were kept confidential and only accessible by the primary investigator, co-investigators, and the statistician; hence, secondary and tertiary blinding was not done. Results Among those who reported PHP, the highest prevalence was among those who did not exercise regularly (94.7%), followed by middle-aged women (64.3%) and those with a high body mass index (44.5%), previous foot problems (43.2%), and chronic medical diseases (41.9%). PHP was less prevalent in male teachers, those with normal body mass index, and those who spent less time standing, had no previous foot problems, and exercised regularly. Most (88.1%) participants with PHP had other musculoskeletal pain, particularly in the lower back (62.6%) and knee (40.1%). Conclusions Teachers can be apprised about the importance of consuming a well-balanced diet and exercising regularly to maintain a healthy weight. We advocate educational programs as they can assist people to understand the need to obtain medical help when they are experiencing pain.

Management of Ankle Charcot Neuroarthropathy: A Systematic Review.

BACKGROUND: Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only. METHODS: A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken. RESULTS: Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy. CONCLUSIONS: Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.

An Unusual Presentation of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection in a Child Treated With Linezolid.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is a major public health concern. MRSA isolates are classified into community-acquired MRSA (CA-MRSA) and healthcare-associated MRSA based on their epidemiology, antibiotic susceptibility patterns, and molecular characteristics. CA-MRSA typically causes skin and soft tissue infections. However, the incidence of invasive infections has increased in recent years. This paper describes the case of a 12-year-old girl with an unusual presentation of CA-MRSA. The patient presented with right thigh pyomyositis complicated by deep vein thrombosis, septic pulmonary embolism, and necrotizing pneumonia. The MRSA isolate was susceptible to vancomycin but resistant to the other anti-MRSA antibiotics. The patient was successfully treated with linezolid after clinical deterioration with vancomycin. A literature review comparing vancomycin and linezolid in invasive MRSA infections among children indicated that linezolid has better lung and tissue penetration than vancomycin, and an early switch is warranted in the case of deterioration after vancomycin administration and the lack of other alternatives.

Role of Particulated Juvenile Cartilage Allograft Transplantation in Osteochondral Lesions of the Talus: A systematic review.

INTRODUCTION/PURPOSE: Osteochondral lesion of the talus (OCLT) is defined as a defect on the articular surface of the talus with/without subchondral bone involvement. Several surgical techniques are described in literature to treat OCLT. Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) is a new emerging technique that has the potential of restoring the native cartilage. However, available data on PJCAT in treating OCLT is confined to a small number of studies with heterogeneous population. The aim of this study is to systematically review the literature on clinical and radiological outcomes of PJCAT in treating OCLT. METHODS: A systematic search of Medline database was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Number of patients and demographic data included age, gender and body mass index (BMI) were extracted. The level of evidence of each included study was identified. When feasible, mechanism of injury, lesion size and average follow up were recorded. The American Orthopedic Foot and Ankle Society Score (AOFAS), and Foot and Ankle Outcome Score (FAOS) were obtained to assess the functional outcomes. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was selected to evaluate the radiological outcomes. RESULTS: A total of 10 studies were eligible for this review involving 132 patients. Postoperative AOFAS scores were available for 44 patients who underwent PJCAT with an average of 86.14 at 25.5 months follow up. FAOS scores have been reported in 3 studies for 81 patients. The average preoperative score was 47.35 which has been improved to 62.88 at follow up of 23.6 months. MOCART was evaluated in 42 feet after the mean follow up of 18.2 months. The repair tissue was characterized by variable features; however, certain peculiarities were observed with higher frequency including infill hypertrophy, incomplete border zone integration, deep surface disruption, structure inhomogeneity, patches of hyperintense signals, damage of subchondral lamina and subchondral bone, adhesions and absence of effusion. CONCLUSION: PJCAT seems to be a promising modality of treatment for OLT in terms of functional outcomes. Fair attempts of defect filling can be confirmed with MRI. Nevertheless, heterogeneous picture of regenerate cartilaginous tissue and lack of repair in subchondral bone and subchondral lamina are not in favor with claims of full restoration of lost normal hyaline articular cartilage.

A Monteggia variant associated with unusual fracture of radial head in a young child: A case report.

INTRODUCTION: Monteggia fracture and its variants are not common among children but may be challenging and lead to serious complications if not treated in acute stage. The different types of associated growth plate fractures of proximal radius are not yet clearly defined in any variant classifications. PRESENTATION OF CASE: A 6-year-old girl was brought to the emergency room after a fall on the left elbow. The plain radiographs showed unstable fracture of proximal ulna with a laterally displaced and comminuted radial head fracture. The patient was treated surgically as a case of a Monteggia variant. The case has been re-evaluated twenty months following the surgery and did not show any radiological signs of growth disturbance nor residual deformity. DISCUSSION: The presented Monteggia variant is rare in terms of associated unique intra-articular fracture of proximal radius. The successful management of the case is based on adhering to the principles of treatment of Monteggia fractures. CONCLUSION: Early recognition of unusual Monteggia variant patterns is crucial to avoid delay in treatment. Adherence to the principles of surgical management in unstable variants is encouraged.

Osteoid osteoma of scapular glenoid: A case report.

INTRODUCTION: Osteoid osteoma is a benign tumor of bone that predominantly affects young age group. It can affect any bone, but lower extremities are more commonly involved more than the upper extremities and it rarely affects the scapular glenoid. PRESENTATION OF CASE: The present case is an 18-year-old female patient who suffered from chronic right forearm and shoulder nocturnal pain for 5 years, which was sometimes relieved by non-steroidal anti-inflammatory drugs intake. Prior to referral to orthopedic clinic, she was diagnosed as a case of a regional pain syndrome, managed by medical treatment without significant improvement. The diagnosis of an inferior glenoid osteoid osteoma was established radiologically. The patient was managed successfully by percutaneous radiofrequency ablation and the pain disappeared gradually after 2 weeks of the procedure. DISCUSSION: The presence of lesions in unusual locations along with an atypical medical history could misinterpret and delay the diagnosis. Osteoid osteoma could be difficult to detect with plain radiographs; thus, advanced imaging is crucial if such lesion is suspected. CONCLUSION: The scapular glenoid osteoid osteoma should be considered as part of the differential diagnosis of chronic shoulder pain especially if there is no response to initial medical treatment. Awareness of atypical presentations of scapular osteoid osteoma is required to avoid delay in diagnosis and treatment.

Debridement and hinged motion distraction is superior to debridement alone in patients with ankle osteoarthritis: a prospective randomized controlled trial.

PURPOSE: To evaluate and compare complication rates and postoperative outcomes in patients with ankle debridement alone vs. debridement and hinged ankle distraction arthroplasty. METHODS: A total of 50 patients with posttraumatic ankle osteoarthritis (OA) with a mean age of 40.0 ± 8.5 years were included into this prospective randomized study: 25 patients in ankle debridement alone group and 25 patients in debridement and hinged ankle distraction group. The mean follow-up was 46 ± 12 months (range 36-78 months). The clinical and radiographic outcomes were evaluated at the 6-month and 3-year follow-up using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, SF-36 quality of life score, and van Dijk OA classification. A Kaplan-Meier survival analysis was performed to calculate the 3-year and 5-year survival rates. RESULTS: Both patient groups experienced significant pain relief, functional improvement, and improvement in quality of life postoperatively. In total, 26 major secondary procedures were performed. The overall survival rates in the debridement and ankle distraction group were 19 of 25 (74%) and 15 of 25 (59%) at 3 years and 5 years, respectively. The overall survival rates in the ankle debridement alone group were 12 of 25 (49%) and 9 of 25 (34%) at 3 years and 5 years, respectively. CONCLUSIONS: The study demonstrated comparable postoperative functional outcome and quality of life. However, rate of postoperative revision surgery was substantially higher in ankle debridement alone group. LEVEL OF EVIDENCE: Randomized controlled study, Level I.

Medial Ankle Instability: The Deltoid Dilemma.

Diagnosis and treatment of medial ankle instability (MAI) are still controversial and poorly discussed in literature. The purpose of this review is to highlight different clinical presentations of MAI and develop a guide for its management. The deltoid ligament complex is injured more commonly than expected, because deltoid ligament injuries may either be isolated or occur in combination with other lesions, such as lateral ankle ligament injury, posterior tibial tendon insufficiency, osteochondral lesion, and others. The presence of a pes planovalgus deformity in a patient without posterior tibial tendon insufficiency may indicate MAI.

How To Diagnose and Treat Infection in Total Ankle Arthroplasty.

Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should include blood tests: C-reactive protein and erythrocyte sedimentation rate. Joint aspiration and synovial fluid analysis can help confirm suspected periprosthetic ankle infection.

Surgical Treatment Options for the Diabetic Charcot Midfoot Deformity.

Management of diabetic Charcot midfoot deformity is one of the most demanding aspects of foot and ankle surgery. Its treatment should aim at reducing the rate of complications, including foot and ankle amputations or limb loss. Attempting reconstruction at Eichenholtz stages I and II carries the risk of infection and loss of fixation. It is advisable to limit surgical reconstruction to Eichenholtz stage III in the absence of any evidence of infection or vascular insufficiency. Achilles lengthening or gastrocnemius-soleus release is an essential initial step in surgery. Addressing the medial foot column first is a key to a successful reconstruction.