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To analyze the clinical and functional outcome in patients undergoing an arthroscopically assisted ‘mini open repair’ of rotator cuff tear

Vol 35 | Issue 2 | May-Aug 2020 | page: 42-46 |  Alok Gupta¹, Rajendra Kumar Beniwal², Saumya Agarwal², Shivank Prakash¹


Authors: Alok Gupta¹, Rajendra Kumar Beniwal², Saumya Agarwal², Shivank Prakash¹

¹Department of orthopaedics, Haryana Multispeciality Hospital, Sonipat, Haryana, India.
¹Department of orthopaedics, Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
¹Department of orthopaedics, Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, India.

Address of Correspondence:
Dr. Saumya Agarwal
Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
Email Id- saumyathecalyx.agarwal@gmail.com


Abstract:
Background: A rotator cuff tear is one the most frequent shoulder lesions that require surgical treatment. Methods: 30 patients within the span of 2 years underwent mini open repair for the rotatory cuff tear diagnosed with the help of noninvasive imaging. Pre-operative evaluation of shoulder function was done using the University of California Los Angeles [UCLA] scale. Results: There was sequential improvement in pain, which was significant at 9 to 18 weeks and 18 to 24 weeks interval. There was sequential improvement in the range of motion. The mean score for function was pre-operatively was 5.86. Post-operatively, the mean score was 6.13 at 9 weeks, 7.20 at 18 weeks and 9.60 at 24 weeks. After final UCLA score at 24 weeks sixteen patients (53.33%) were rated as having excellent result, twelve patients (40%) as having good result, and two (6.66%) as having poor result. 28 out of the 30 patients were satisfied with the overall result.
Conclusion: Thus, when comparing mini-open and traditional open methods of rotator cuff repair, it appears that outcomes do not significantly differ. However, the advantages of mini-open repair, which include preservation of the deltoid origin, lower peri-operative morbidity, enhanced cosmesis, shortened rehabilitation, and arthroscopic evaluation of the glenohumeral joint for additional pathology, make it an overall superior method.
Keywords: Rotator cuff tear, Arthroscopy, Shoulder mini open repair


References

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How to Cite this Article: Gupta A, Beniwal R A, Agarwal S, Prakash S | To analyze the clinical and functional outcome in patients undergoing an arthroscopically assisted ‘mini open repair’ of rotator cuff tear. | Journal of Bone and Joint Diseases | May-Aug 2020; 35(2): 42-46 .


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Functional outcome of arthroscopic ACL reconstruction with quadrupled hamstring tendon graft and fixation with metallic screw

Vol 35 | Issue 2 | May-Aug 2020 | page: 36-41 | Sunil Kumar¹, Harsh Singh¹, Prashant Pratap Singh¹, Yogesh Kumar¹, Satyendra Verma¹, Harish Kumar¹


Authors: Sunil Kumar¹, Harsh Singh¹, Prashant Pratap Singh¹, Yogesh Kumar¹, Satyendra Verma¹, Harish Kumar¹

¹Department of orthopaedics , U P University of Medical sciences Saifai, Etawah , India.

Address of Correspondence:
Dr. Harish Kumar,
Department of Orthopaedics, U P University of Medical Sciences Saifai, Etawah, UttarPradesh, India.
E-mail: drharishkumar01@gmail.com


Abstract:

Introduction: Anterior cruciate ligament (ACL) tears mostly managed with arthroscopic reconstruction with auto tendons grafts. Interference screws are often used to secure the graft in bone tunnels in the tibia. Two types of interference screws are used to secure graft bioabsorbable screws and metallic screws mostly of titanium. Although bioabsrbable screws remain popular due to its bioabsorbabilty but in developing countries like india its cost always pose a difference compare to metallic screws. This study shows functional outcomes of arthroscopic ACL reconstruction with quadrupled hamstring graft fixation with metallic screw on tibial side and metallic endobutton on femoral side on short period of time 1 year
Method: This is a prospective outcome study conducted on 35 patients in the Department of Orthopaedics, UPUMS,
saifai between january 2017 to July 2018 .Patients with Chronic and Acute ACL tear of range 18 to 50 years of age were included in the study. Patients having ACL tear with other comobiditis, fractures, multiligaments injuries were excluded from this study. After proper consent all 35 cases were operated with arthroscopic ACL reconstruction with standard surgical procedure using quadruple hamstring grafts.Titanium metallic screws were used to secure graft on tibial side fixation. In post operative period and rehabilitation period standard protocol was followed. All patients were followed in OPD at every month upto 3 month, after 3 months patients followed every three months upto 1 years.
Results: Results of procedure was calculated using lysholm knee score. Lysholm knee score was signicantly improved
from pre op score, mean 72 to mean 82 at 6 months, at 9 months 89 and finally at one year mean score improved to
mean 93 . All these finding were statistically significant from 6 months and continuously improved significantly at 9 and 12 months. Functional results also improved significantly, at 6 months out of 35 patients, 18 patients (50%) showed good results and 16 patients (48%) showed fair results. At 9 months out of 35 patients 32 patients(90%) were presented with good results, in 3 patient(10.3%) presented fair resultS. At final outcome at 12 month out of 35 patients, 8 patients (29%) showed excellent results while 19 patients (68%) showed good results.
Conclusion: Metallic interference screw fixation on tibial side using hamstring tendon graft is viable option as compared to bioabsorbable interference screw fixation .in indian scenerio choice of procedure due to its cost effectiveness
Keywords: Anterior cruciate ligament (ACL), Hamstring tendon graft, Arthroscopy.


References

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cruciate ligament and implications for surgical reconstruction. Strategies in trauma and limb reconstruction, 2(1), 1–12. doi:10.1007/s11751-007-0016-6
2. Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic
Committee current concepts statement. Br J Sports Med. 2008;42(6):394–412. doi:10.1136/bjsm.2008.048934
3. Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train. 2008;43(4):396–408. doi:10.4085/1062-6050-43.4.396
4. Evans S, Shaginaw J, Bartolozzi A. Acl reconstruction – it’s all about timing. Int J Sports Phys Ther. 2014;9(2):268–273.
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2013;32(1):1–12. doi:10.1016/j.csm.2012.08.017
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Published 2017 Mar 18. doi:10.5312/wjo.v8.i3.212
7. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. J Orthop Res. 2016;34(11):1843–1855. doi:10.1002/jor.23414
8. Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. Nonsurgical or Surgical Treatment of ACL
Injuries: Knee Function, Sports Participation, and Knee Reinjury: The Delaware-Oslo ACL Cohort Study. J Bone
J o i n t S u r g A m . 2 0 1 4 ; 9 6 ( 1 5 ) : 1 2 3 3 – 1 2 4 1 . doi:10.2106/JBJS.M.01054
9. Monk APaul, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD011166. DOI: 10.1002/14651858.CD011166.pub2
10) Dhillon M S, Lokesh A V. Bioabsorbable implants in orthopaedics. Indian J Orthop 2006;40:205-9
11) Rocco Papalia, Sebastiano Vasta, Stefano D’Adamio, Antonino Giacalone, Nicola Maffulli, Vincenzo Denaro, Metallic or bioabsorbable interference screw for graft fixation in anterior cruciate ligament (ACL) reconstruction?, British Medical Bulletin, Volume 109, Issue 1, March 2014, Pages 19–29, https://doi.org/10.1093/bmb/ldt038
12) Randy Mascarenhas et al,Bioabsorbable Versus Metallic Interference Screws inAnterior Cruciate Ligament Reconstruction: A SystematicReview of Overlapping Metaanalyse, Arthroscopy: The Journal of Arthroscopic and
Related Surgery, Vol 31, No 3 (March), 2015: pp 561-568
13)http://researchonline.nd.edu.au/cgi/viewcontent.cgi?article =1711&context=med_article
14)http://www.cochrane.org/CD009772/MUSKINJ_bioabs orbable-versus-metal-screw-graft-fixation-surgicaltreatmentanterior- cruciate-ligament-injury


How to Cite this Article: Kumar S, Singh H, Singh PP, Kumar Y, Verma S, Kumar H | Functional outcome of arthroscopic ACL reconstruction with quadrupled hamstring
tendon graft and fixation with metallic screw | Journal of Bone and Joint Diseases | May-Aug 2020;35(2):36-41.
 


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Role of Arthroscopic Synovial Biopsy and Synovectomy in Diagnosis and Management of Chronic Synovitis of the Knee

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 50-52 | Rajat Kapoor, C.P.Pal, Yajuvendra Kumar Sharma, Vikas Mishra.


Authors: Rajat Kapoor [1], C.P.Pal [1], Yajuvendra Kumar Sharma [1], Vikas Mishra [1].

[1] Department of Orthopedics, Sarojini Naidu Medical College Agra, Uar Pradesh, India.

Address of Correspondence
Dr. Chandra P Pal,

Department Of Orthopaedics,

Sarojini Naidu Medical College Agra, Uttar Pradesh, India.

Email: drcportho@gmail.com


Abstact

Background: Synovitis of the knee can be very difficult to treat, especially when the diagnosis remains elusive. Synovitis occurs due to the various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy, and did a review of literature.

Methods: This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2015 and January 2017. Inclusion criteria were patients presenting with persistent swelling of the knee, not responding to conservative measures. We excluded patients who had recurrent synovitis and patients who had septic arthritis. All patients underwent arthroscopic synovial biopsy and partial synovectomy. Pre- and post-operative VAS score was calculated.

Results: In n = 5 patients, the histopathological diagnosis was tuberculosis, which improved with antituberculous drug treatment; in n = 1 patient, the diagnosis was juvenile rheumatoid arthritis; patient improved with synovectomy and NSAIDs. In n = 12 patients, the biopsy report came as chronic non-specic synovitis, 8 of these patients did well with arthroscopic synovectomy, while the other 4 had a recurrence. e average VAS score improved from 8.4 pre-surgery to 4.2 post-surgery.

Conclusions: Arthroscopic synovial biopsy and synovectomy give good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment.

Keywords: Arthroscopy, Biopsy, Chronic synovitis, Synovectomy.


References

1. Tak PP, Breedveld FC. Current perspectives on synovitis. Arthritis Res Ther 1999;1:11-6.
2. Youssef PP, Kraan M, Breedveld F, Bresnihan B, Cassidy N, Cunnane G, et al. Quantitative microscopic analysis of inflammation in rheumatoid arthritis synovial membrane samples selected at arthroscopy compared with samples obtained blindly by needle biopsy. Arthritis Rheum 1998;41:663-9.
3. Singhal O, Kaur V, Kalhan S, Singhal MK, Gupta A, Machave Y, et al. Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision. Int J Appl Basic Med Res 2012;2:102-6.
4. Akmeşe R, Yildiz KI, Işik Ç, Tecimel O, Bilgetekin YG, Firat A, et al. Combined arthroscopic synovectomy and radiosynoviorthesis in the treatment of chronic non-specific synovitis of the knee. Arch Orthop Trauma Surg 2013;133:1567-73.
5. Kuzmanova SI, Zaprianov ZN, Solakov PT. Correlations between arthroscopic findings and synovial membrane histology in patients with rheumatoid synovitis of the knee joint. Folia Med (Plovdiv) 2003;45:60-5.
6. Latosiewicz R, Cylwik B, Dołzyński M. Clinical significance of arthroscopic synovial biopsy in the diagnosis of knee synovitis. Chir Narzadow Ruchu Ortop Pol 1998;63:549-53.
7. Ayral X, Bonvarlet JP, Simonnet J, Amor B, Dougados M. Arthroscopy-assisted synovectomy in the treatment of chronic synovitis of the knee. Rev Rhum Engl Ed 1997;64:215-26.


How to Cite this Article: Kapoor R, Pal C P, Sharma Y K, Mishra V. Role of Arthroscopic Synovial Biopsy and Synovectomy in Diagnosis and Management of Chronic Synovitis of the Knee. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3): 50-52.


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