Mapping the Research Landscape of Intra-Articular Knee Injections: A Bibliometric Analysis Using the Scopus Database.

Intraarticular injection of osteoarthritis knee is one of the treatment options for pain management and delays the need for knee surgery. Various materials have been promoted for the procedure, ranging from corticosteroid to viscosupplement to the more recent autologous biological materials. Despite the increasing attention and interest in regard to the material selection, efficacy, safety, and effect of this intervention, a comprehensive bibliometric analysis using the Scopus database has yet to be conducted. In this bibliometric analysis, we reviewed the Scopus database from 2003 to 2023 to investigate the literature on intraarticular injection for the treatment of knee osteoarthritis. A total of 1,318 articles that satisfied the selection criteria were included in this review. The trend of intervention shows changes since 2006, with corticosteroid injection and hyaluronic acid as the main topics of publication before 2006. However, starting in 2010, there has been a noticeable shift towards biological agents, such as plasma-rich proteins, and autologous materials, including marrow aspiration and stromal vascular fraction. This shift reflects the increasing interest in regenerative medicine and the potential of these newer therapies to provide improved outcomes. The overwhelming majority of the articles were authored by researchers and clinicians from across European countries, the United States of America (USA), and Australia. Similarly, most of the articles with the highest number of citations were authored by researchers and clinicians from these regions. This comprehensive bibliometric analysis using Scopus in the domain of intraarticular injection has the potential to act as a roadmap for researchers, clinicians, and policymakers, facilitating informed decision-making, promoting collaborative initiatives, and guiding the development of future studies to further advance the options of knee intraarticular injection, specifically in the management of knee osteoarthritis.

Robotic-Assisted Hip and Knee Arthroplasty: A Bibliometric Analysis Using the Scopus Database.

Robotic-assisted hip and knee arthroplasty represents cutting-edge advancements in orthopedic surgery, harnessing robotic technology to enhance precision, improve clinical outcomes, and facilitate intra-operative procedures. In these robotic-assisted surgeries, the robotic systems assist surgeons in planning and executing joint replacement surgeries, thereby facilitating personalized implant positioning and optimizing the fit and alignment of hip and knee implants. Despite the increasing attention garnered by robotic-assisted hip and knee arthroplasty in recent years, a comprehensive bibliometric analysis using the Scopus database has yet to be conducted. This bibliometric analysis reviews the Scopus database from 1961 until 2022 to investigate the literature on the field of robotic-assisted hip and knee arthroplasty. A total of 577 articles that satisfied the selection criteria were included in this review. The majority of the articles focus more on total knee replacement, compared to total hip replacement and unicompartmental knee arthroplasty. The overwhelming majority of the articles were authored by researchers and clinicians from the United States of America (USA) and the United Kingdom (UK). Similarly, most of the articles with the highest number of citations were authored by researchers and clinicians from these regions. This comprehensive bibliometric analysis using Scopus in the domain of robotic-assisted hip and knee replacement has the potential to act as a roadmap for researchers, clinicians, and policymakers, facilitating informed decision-making, promoting collaborative initiatives, and guiding the development of future studies to further advance the field of robotic-assisted hip and knee arthroplasty.

Thermography Research in Diabetic Foot: Insights From a Scopus-Based Bibliometric Study.

Diabetic foot problems are among the most debilitating complications of diabetes mellitus. These problems incur significant economic costs and reduce quality of life. The integration of thermography technology in the screening and management of diabetic foot problems has been proven to be successful in recent years. By detecting changes in temperature, thermography helps identify early infections and assists in patient monitoring. These early successes have inspired more research and publications in this field. To date, a comprehensive bibliometric analysis of thermography-related research on diabetic foot using the Scopus database has not been conducted. This bibliometric analysis aims to fill this gap by reviewing the Scopus database from its inception until 2023 to examine the literature on thermography-related research on diabetic foot. A total of 342 articles met the selection criteria and were included in this analysis. The number of articles in this field remained low until the 2010s, when there was a sudden surge of interest that prompted numerous publications. Authors from the USA contributed the highest number of articles and had the greatest scholarly impact in this field. Despite the major contribution from the USA, there were numerous collaborations between various countries, underscoring the importance of international collaboration in advancing research and exchanging knowledge.

Telescoping Allograft Prosthetic Composite (APC) Reconstruction of the Femur Following Revision Arthroplasty for Neglected Developmental Dysplasia of the Hip (DDH).

Although uncommon, neglected developmental dysplasia of the hip (DDH) poses a technically demanding problem for treating surgeons. Due to the congenital malformation of the native hip joint and distortion of the surrounding soft tissue, addressing limb-length discrepancy is intricate. Despite detailed planning and meticulous soft tissue handling, complications can be difficult to avoid in these patients even under experienced hands. In this case report, we present a 73-year-old lady with neglected DDH who had undergone initial total hip arthroplasty and subsequent revision surgery that failed due to aseptic loosening. Due to limited length in the distal femur, we used a telescoping allograft prosthetic composite (APC) to provide adequate length to the native distal femur during revision with proximal femur fixation. This technique can help avoid the need for total femur replacement (TFR) surgery, which is more invasive and may require tibia replacement.

The Role of Medial Plantar Artery Flap in Heel Pad Reconstruction: A Report of Two Cases.

The heel and sole possess unique anatomical characteristics that serve a weight-bearing and shock-absorbing function. The heel is particularly vital, as any defects in this area can lead to gait instability. Reconstructing a heel defect presents challenges, as the donor flap must be durable enough to withstand high force loads while also providing protective sensation. Recently, the medial plantar artery flap has been successfully employed for the reconstruction of defective heel pads. This flap offers glabrous skin capable of weight transmission and intact protective sensation. In this report, we present two cases of heel pad loss secondary to chronic diabetic complications and trauma, respectively, which were treated with medial plantar artery flap reconstruction. Both cases were successfully treated, and they showed a good functional outcome.

Bibliometric Analysis of Diagnostic Yield of CT Pulmonary Angiogram (CTPA) in the Diagnosis of Pulmonary Embolism (PE).

CT pulmonary angiography (CTPA) is the investigation of choice for diagnosing pulmonary embolism (PE). Due to the speed and ease of performing the CTPA scans, more clinicians are becoming overly reliant on them, even for patients without strong suspicion of PE. We conducted a bibliometric analysis on the PubMed database from 1990 to 2022 to investigate the literature on the diagnostic yield of CTPA in the diagnosis of PE. A total of 166 articles were published in 98 journals. The number of publications has steadily increased since 2010 and peaked in 2020. Authors from 24 countries contributed to these publications, with the overwhelming majority emanating from United States of America, totaling 66 articles. The authors' contributions were relatively well spread out, with the top four authors publishing the highest number of articles at six each. When we investigated the collaboration between the authors, we found limited multinational and multi-institutional collaborations on this topic. Therefore, more multinational and multi-institutional collaborations will be valuable in future studies. In conclusion, this bibliometric analysis summarizes the literature on diagnostic yield of CTPA in the diagnosis of PE and sheds light on the future pathway that researchers and institutions can focus on.

Diagnostic Yield of CT Pulmonary Angiogram in the Diagnosis of Pulmonary Embolism and Its Predictive Factors.

Introduction Computed tomography pulmonary angiography (CTPA) is the reference investigation of choice to diagnose pulmonary embolism (PE). Nevertheless, the use of CTPA should be weighed against its risks, such as radiation and contrast-induced nephropathy. We aim to assess the yield of CTPA in diagnosing PE at a tertiary centre in Malaysia. We also identify predictive factors associated with the yield of CTPA in this cohort. Methods This was a cross-sectional study involving all patients who had had CTPA done at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, from January 1, 2021, to November 30, 2021. All patients' records were retrieved and reviewed. CTPA images were retrieved from the Radiology Information System (RIS) and Picture Archiving and Communication System (PACS). They were double-reviewed by the authors, with the initial reports redacted from reporting radiologists to prevent reporting bias. The predictive factors were determined using simple logistic regression and multiple logistic regression. Results A total of 351 CTPAs were reviewed, of which 93 were found to be positive for PE, giving rise to an overall CTPA yield of 26.5%. Upon simple logistic regression, factors such as gender, discipline, history of trauma, presence of COVID-19 infection, and pneumonia were found to be associated with positive CTPA. Upon multiple logistic regression, male patients were found to have a higher chance of positive CTPA results. On the other hand, patients with COVID-19 infection and pneumonia have a lower chance of positive results in CTPA. Conclusion The yield of CTPA in diagnosing PE at our institution was acceptable at 26.5%. Upon multiple logistic regression, patients with COVID-19 infection and pneumonia were more likely to have a negative CTPA result, highlighting the need for clinicians to be more prudent in requesting CTPAs in these patients.

Evaluation of Feasibility of Medial Plantar Artery Flap With Computed Tomography Angiography in Diabetic Patients: A Pilot Radioanatomic Study.

Background A soft tissue defect resulting from a diabetic heel ulcer can be difficult to address due to limited reconstructive options and unique local area demand. The medial plantar artery flap is ideal for heel defect coverage as it provides a thick glabrous skin with good sensory feedback. The prerequisite of medial plantar artery flap surgery is a patent medial plantar artery, which is a branch of the posterior tibial artery (PTA). Nevertheless, no feasibility study of the medial plantar artery flap in diabetic patients with vascular insufficiency has been reported so far. We conducted a pilot study with the aim of investigating the patency of the medial plantar artery in diabetic patients with suspected peripheral artery disease to determine the vascular feasibility of the medial plantar artery flap in these patients. Material and methods A pilot study was performed at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (IIUM). A total of 15 diabetic patients with suspected vascular insufficiency who had undergone lower limb computed tomography angiography (CTA) from January 2022 to June 2023 were included in this study. All patients were identified via the electronic record system. Lower limb CTA images were retrieved from the Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) and were double-reviewed. Both the posterior tibial artery (PTA) and medial plantar artery (MPA) were assessed for their patency, and the diameter of the lumens was measured if they were patent. Bedside clinical assessments such as palpation of pulses and portable Doppler assessment were evaluated to determine whether they could serve as substitutes for computed tomography angiography (CTA) in assessing the feasibility of medial plantar artery flap using the McNemar test. Results In this study cohort, the medial plantar artery was present in 16 legs and absent in another 14 legs. The largest diameter of the medial plantar artery was 2.5mm (range 0-2.5mm). Palpation of the posterior tibial artery was not optimal for predicting the patency of the medial plantar artery, with a false positive of 21.4% and a false negative of 68.7%. Similarly, a hand-held Doppler assessment of the posterior tibial artery was also ineffective, with a false positive of 64.3% and a false negative of 18.8%. While the medial plantar artery is a continuation of the posterior tibial artery (PTA), PTA patency did not necessarily correlate with medial plantar artery patency. This was demonstrated on CTA assessment, where two legs with absent PTA still have reconstitution, resulting in patency of the medial plantar artery. Additionally, one leg with patent PTA did not have a patent medial plantar artery distally due to calcified vessels. Conclusion This is a first-of-its-kind pilot study attempting to determine the feasibility of medial plantar artery in diabetic patients with vascular insufficiency. The medial plantar artery was present in more than 50% of the investigated lower limbs, paving the way for using the medial plantar artery flap in these patients. Nevertheless, a computed tomography angiogram is essential to determine the patency of the medial plantar artery prior to the flap procedure, as palpation and hand-held Doppler were inadequate to predict the patency of the medial plantar artery in these high-risk patients.

Outcomes of Geriatric Hip Fractures in a Tertiary Referral Center in Malaysia During the COVID-19 Pandemic.

Introduction With the advancing age of the population, there are an increasing number of patients with geriatric hip fractures. Despite the advancement of surgical knowledge and improvement of implant designs to treat geriatric hip fractures, mortality and morbidity remain high among these frail patients. In conjunction with the COVID-19 pandemic, the collateral damage dealt to these patients remains unknown as scarce resources are funneled to deal with the pandemic. This study is geared to investigate the surgical outcomes of patients with geriatric hip fractures who were admitted during the initial phase of the COVID-19 pandemic. Methods This retrospective study was carried out at Hospital Kuala Lumpur, the largest public hospital in the capital of Malaysia, from March 1, 2020, to March 1, 2021. All patients of age 60 years and above were screened for suitability. Only patients who had undergone surgical intervention during the study period were included in this study. Patients' demographic data, mechanism of injury, waiting time for surgery, type of surgery, complications and ambulatory status were obtained from the medical records. Univariate analysis was performed to determine the factors associated with complications as well as the post-operative ambulatory status of the patients. Results A total of 52 patients were included in this study, with a median age of 72 years. The majority of the patients were Chinese (n=21, 40.4%). This was followed by Malay and Indian (n=14, 26.9% each) and other ethnicity (n=3, 5.8%). More than three-quarters of the patients had a trivial injury such as a fall due to a miss-step (n=16, 30.8%) and slip (n=16, 30.8%) and a fall due to dizziness (n=8, 15.4%). Only 12 patients (23.1%) sustained hip fractures due to trauma. The median time to surgery for these patients was 5 days (interquartile range: 4 days). Most of these patients underwent total hip replacement (n=30, 57.7%). This was followed by unipolar hemiarthroplasty (n=11, 21.2%), bipolar hemiarthroplasty (n=10, 19.2%) and internal fixation (n=1, 1.9%). Among these patients, six of them had documented complications. There were periprosthetic joint infection (n=2, 3.8%), dislocation (n=2, 3.8%), hematoma formation (n=1, 1.9%) and seroma (n=1, 1.9%). Six months after the surgery, most of the patients were able to ambulate, albeit some patients required walking aid such as walking stick and walking frame. Univariate analysis showed that all the factors were not associated with the complications and the post-operative ambulatory status of the patients. Conclusion  The incidence of geriatric hip fractures remains high during the COVID-19 pandemic despite the movement control order (MCO) being enforced in Malaysia. With prompt surgical intervention, most of the patients can regain ambulatory status, albeit with a walking aid.

The Creation of Articulating Cement Spacer Using Custom-Fabricated Silicone Mold for the Treatment of Periprosthetic Joint Infection: Two Case Reports.

Joint replacement surgeries have been performed to treat joint arthropathies with excellent outcomes. As the number of joint replacement surgeries surges, the incidence of periprosthetic joint infection (PJI) has also increased. Currently, two-stage revision surgery is the gold standard in the treatment of periprosthetic joint infection. Two-stage revision surgery involves joint washout, the removal of the primary implant, the insertion of a cement spacer, and subsequently the reimplantation of prosthesis after the infection has been eliminated. Custom-made articulating cement spacer has been used with success to improve the patient's ambulatory status and quality of life. Nevertheless, custom-made articulating cement spacer or commercialized cement mold is generally costly. By the modification of previous authors' techniques, we manage to fabricate reusable silicone molds, which can be used to create articulating cement spacers for both hip and knee joints. We share two case reports to illustrate how these fabricated silicone molds can be a cost-effective technique to create articulating cement spacers to manage periprosthetic joint infection in both hip and knee joints. Surgeons in resource-deprived countries can utilize this technique to create articulating cement spacers with minimal cost, but they need to discuss with their patients and check with the local regulatory board on the feasibility of this technique to create cement spacer that will be used in a patient.

COVID-19 Infodemiology: Association Between Google Search and Vaccination in Malaysian Population.

Background In light of the ongoing coronavirus disease 2019 (COVID-19) pandemic, vaccination is one of the most important defensive strategies in combating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccine hesitancy or anti-vaccination attitude has become a barrier to the nationwide vaccination program, potentially sabotaging the effectiveness of vaccination. Thus far, Google Trends (GT) has been used extensively for monitoring information-seeking behavior during the pandemic. We aimed to investigate the association between Google search, the vaccination rate, and the number of vaccinated and infected cases among the Malaysian population. Material and method GT's customizable geographic and temporal filters were applied to include results for predetermined keywords from January 1, 2021, to December 31, 2021. Both Malay and English languages were used to reflect the multi-racial and multi-lingual community in Malaysia. The search volume index (SVI) derived was compared with the numbers of vaccinated and infected cases which were extracted from the open-access database (COVIDNOW in Malaysia) within the same period. Both analyses were performed independently by two authors to ensure accuracy of the data extraction process. A descriptive analysis was used to compare GT analyses and the number of daily vaccinations and positive COVID-19 cases. Results The information-seeking behavior in the public fluctuated from time to time. The interest surged during the initiation of vaccination program and upon the outbreak of COVID-19 in Malaysia. The surge in interest prior to the peak of vaccination rate also indicated that the public tended to get information online prior to getting the vaccines.  Conclusion This observational study illustrates the ability of GT to monitor the interest of vaccination among the Malaysian population during the pandemic. By monitoring the dynamic changes in Google Trends, healthcare authorities can get a glimpse of public perceptions such as attitude towards COVID-19 vaccine, hence potentially identify and stymie any dangerous online anti-vaccination rhetoric swiftly.

Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions.

Background Transpedicular biopsy of spinal lesions is imperative for the generation of a definite diagnosis. Thus far, literature comparing the accuracy and adequacy between fluoroscopy-guided and computed tomography (CT)-guided transpedicular biopsy of spinal lesions is scarce. We aim to compare the accuracy and adequacy of samples collected with the two techniques at the largest tertiary hospital in Malaysia. Materials and methods A total of 60 patients (37 patients with spinal infection and 23 patients with spinal tumour) underwent percutaneous transpedicular biopsy of spinal lesions from January 2013 to December 2017 at a tertiary centre. Demographic data, biopsy method (fluoroscopy-guided and CT-guided), diagnosis, adequacy, and accuracy of samples obtained were assessed. Results Among the 60 samples obtained, only two samples (3.3%) were deemed inadequate. There were 10 biopsy samples (16.7%) that were inaccurate. There was no statistical difference between fluoroscopy-guided and CT-guided transpedicular biopsy in terms of accuracy (p = 0.731) and adequacy (p = 0.492). Conclusions Fluoroscopy-guided and CT-guided transpedicular biopsy of spinal lesions offer similar accuracy and adequacy. Fluoroscopy-guided biopsy of the spinal lesion will be an option for spine surgeons when CT-guided biopsy is not available.

Malaysian Public Interest in Common Medical Problems: A 10-Year Google Trends Analysis.

Background An analysis of internet search has been performed to evaluate the public interest in health problems. Google Trends (GT) serves as a free platform to analyse the search traffic for specific terms in the Google search engine. This observational study aims to investigate the trend of Malaysian population in using the Google search engine on common medical problems and explore the geographical influence on the language used. Material and method Fifteen pairs of keywords, in Malay and English language, were chosen after going through forward and backward translation and vetting by a panel of experts. GT data for the selected keywords from 1st of January 2011 to 31st of December 2020 was extracted. Trend analysis was performed using paired t-test between the first half of the decade and the second half of the decade. The different languages used were analysed based on geographical variation using paired t-test. Results The public interest on those keywords was markedly increased in the second half of the decade with 29 out of 30 keywords showing statistically significant difference. Majority of the states preferred to use Malay keywords, especially those residing at the East Coast of Peninsular Malaysia. Conclusion This observational study illustrates the ability of GT to track healthcare interest among Malaysian population. GT provides a good platform to analyse specific healthcare interest in Malaysian population, but investigators have to bear in mind the geographical influence on the language used.

The Malay Version of the Michigan Hand Outcomes Questionnaire: Cross-Cultural Adaptation, Validation and Reliability Testing.

Background: The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability and validity compared with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in a Malay-speaking population. Methods: The MHQ was cross-culturally adapted into a Malay version based on the guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ and DASH questionnaires. The MHQ was tested twice with an interval of two weeks in between. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method and Cronbach's alpha calculation, respectively. The association between MHQ and DASH questionnaire was assessed with Spearman's correlation calculation. Results: In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed a good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranging from 0.925 to 0.984. Cronbach's alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. Spearman's correlation factor of the MHQ in comparison with DASH showed a fair to moderately strong correlation with the values ranging from 0.513 to 0.757. Conclusions: The Malay version of MHQ was successfully translated and culturally-adapted with excellent reliability (reproducibility and internal consistency) and good construct validity.

Neck of Femur Fracture in Young Patients With End-Stage Renal Disease and Hyperparathyroidism: A Report of Three Cases and Proposed Treatment Algorithm.

Secondary hyperparathyroidism is a complication arising from untreated end-stage renal disease (ESRD). It can invariably lead to osteoporosis and subsequently cause pathological neck of femur (NOF) fracture. Despite being young, osteosynthesis in neck of femur fractures of these patients often leads to nonunion and implant failure due to severely osteoporotic bone. We present our experience in managing three young patients with ESRD and secondary hyperthyroidism who sustained NOF fractures. All three patients were successfully treated and showed no complication at one year post-operation. Based on our experience and literature review, we propose a simple algorithm to guide the management of these patients.

Arthroscopic Subacromial Decompression in the Treatment of Shoulder Impingement Syndrome: A Prospective Study in Malaysia.

Introduction Shoulder impingement syndrome (SIS) is one of the common problems which lead to shoulder disabilities. This condition has been described as impingement to the rotator cuff by the anterior third of the acromion process and has been classified into three stages. Treatment option varies depending on the grade of the disease. Arthroscopic subacromial decompression (ASAD) has become more popular in recent years and has shown to have a good outcome. The purpose of this study is to evaluate the outcomes following ASAD in terms of the functional, clinical, and radiological parameters in treating SIS in the ageing population in Kuantan, Pahang, Malaysia. Materials and methods This was an observational study looking at the outcomes of patients with stage 2 and stage 3 (partial cuff tear) impingement syndrome who underwent ASAD in Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre from May 2018 to June 2019. The functional outcomes were evaluated using American Shoulder and Elbow Surgeons (ASES) score taken at pre-operative, six weeks, three months, and six months post-operation. Clinical outcomes were evaluated using Constant score (CS) taken at six months post-operation. Radiological outcomes were measured by comparing acromiohumeral distance pre- and post-operation on anteroposterior (AP) view radiograph of the affected shoulder. Results A total of 28 patients were selected for the study. On functional outcome, there was a significant effect of time on the ASES scoring system (p-value <0.05) from pre-operative to six months post-operation. On clinical outcome, the CS at six months showed 13 patients have excellent scores, 10 have good, and five have fair scores. There was a statistically significant difference in mean values of all categories (p-value <0.05). In terms of the radiological outcome, this study observed a significant increase in patients' subacromial space on X-ray from the pre-operative and post-operative treatment stages. In this study, we also observed that there was no significant difference in outcomes between partial and intact rotator cuff (RC) tears at six-month post-operation. Conclusion In this study, ASAD was found to be a beneficial intervention in the treatment of patients with shoulder impingement evidenced by the significant outcomes in terms of functional, clinical, and radiological parameters.

Primary B-cell Lymphoma of the Thoracic Spine: A Rare Cause of Spinal Cord Compression.

Primary non-Hodgkin lymphoma arising from the spine is exceedingly rare. Spinal cord compression can be the first presentation of a patient with primary spinal non-Hodgkin lymphoma. Due to its rarity and vague clinical presentation, the diagnosis can be confused with tuberculosis of the spine, a more common disease in this country. We present a case of primary thoracic spine B-cell lymphoma in a 45-year-old lady who presented with spinal cord compression. This case highlights the importance of obtaining histopathological samples for examination and the treating physician should be vigilant on this rare cause of spinal cord compression. Treatment can be initiated promptly once the diagnosis is established as primary spinal non-Hodgkin lymphoma carries a dire prognosis.

A novel technique of isolated gastrocnemius recession: A cadaveric comparison with Strayer procedure.

BACKGROUND: Strayer's gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim to introduce a novel technique of isolated gastrocnemius recession and perform a cadaveric study to evaluate its safety and at the same time compare this novel technique with the existing Strayer procedure biomechanically. METHODS: Eight fresh cadaveric models of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomized equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques. RESULTS: There was no iatrogenic sural nerve or saphenous vein injury in all eight models. There was no significant difference between the two techniques in terms of lengthening (24.25 mm vs 21.00 mm; p = 0.838) and improvement of ankle dorsiflexion (26.5° vs 26°; p = .829). CONCLUSIONS: Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques, and there was no significant difference in efficacy between them. LEVEL OF EVIDENCE: Level II, randomized controlled trial.

MRI Evaluation of Anterolateral Ligament of the Knee: A Cross-Sectional Study in Malaysia.

Introduction After detailed anatomical delineation of the anterolateral ligament (ALL) of the knee, there is a surge in research on this anatomical structure. Owing to the anatomical variation and lack of experience in the identification of this structure, magnetic resonance (MR) evaluation of the ALL produces mixed results. It was aimed to evaluate the ALL using the routinely performed MR imaging of the knee and to determine any associated factors with ALL injuries. Materials and methods Thirty-six MR images of the knee from 31 patients from January 1, 2017, to June 30, 2017, are evaluated. MR sequences performed include T1-weighted, T2-weighted, proton density (PD), and PD fat saturation (FS). All MR images were double-read by two authors and approved by a consultant radiologist with more than 20 years of radiological experience. The ALL was divided into three portions: femoral, meniscal, and tibial, and the ALL was considered fully visualized when all three portions were seen on MR images. Results At least a portion of the ALL was visualized in 27 scans (75%), and it was fully visualized in 20 scans (55.6%). The femoral portion was the most commonly identified (75%), followed by the meniscal portion (69.4%) and the tibial portion (58.3%). ALLs were best visualized on coronal view in PD FS with the lateral inferior genicular artery as a guide to locate the bifurcation of the meniscal and tibial components. Conclusion The ALL can be visualized in routine 1.5-T MR imaging, either full delineation (55.6%) or partially visualized (75%). It is best characterized via a PD-weighted sequence with fat saturation on the coronal plane. The ALL injury was associated with an anterior cruciate ligament (ACL) injury.

Outcomes of Femoral Neck Fractures in Young Patients and the Factors Associated With Complications: A Multicenter Study From Malaysia.

Background and objective Femoral neck fractures are relatively rare in young adults, but they result in prolonged loss of function in these patients, thereby placing a huge burden on a country's healthcare and economy. Femoral neck fractures in young adults are normally treated with head salvage surgery. However, primary head replacement surgeries have been gaining traction recently to expedite the recovery of these patients. In this study, we aimed to investigate the outcomes in young patients with femoral neck fractures and factors associated with their complications. Patients and methods Patients with femoral neck fractures who underwent surgery in three tertiary hospitals [Hospital Tengku Ampuan Afzan (HTAA), Hospital Sultan Haji Ahmad Shah (HOSHAS), and Hospital Kuala Lipis] in Pahang state in Malaysia were reviewed and included in this study. The demographic profile of the patients, injury patterns, intervention details, functional outcomes, and complications were analyzed. The comparison between the sociodemographics, clinical assessment, and complication outcomes was analyzed using statistical software. Results The complications were associated with the mechanism of injury, capsulotomy, and type of fixation. A total of 46 patients were included in the study. Most of the patients were found to have severe displacement based on Garden and Pauwels classification. The majority of the patients underwent femoral head salvage surgeries. Almost half of the patients sustained complications and were unable to achieve weight-bearing status at six months postoperatively. Conclusion Despite a relatively short follow-up period in our study, femoral neck fractures in young adults were found to be associated with a high rate of complications. Primary head replacement surgeries should be considered in high-risk patients with femoral neck fractures.