Current trends in ACL repair: Primary repair, mechanical augmentation and biological supplementation

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:36-40 | Rajeev Raman, Bibhuti Nath Mishra


Author: Rajeev Raman [1], Bibhuti Nath Mishra [2]

[1] Consultant Orthopaedic Surgeon, Joint & Bone Care Hospital, Salt Lake City, Kolkata, India
[2] Consultatnt Orthopaedic Surgeon, Birat Medical College Teaching Hospital, Biratnagar, Nepal.

Address of Correspondence
Dr. Bibhuti Nath Mishra,
Birat Medical College Teaching Hospital, Biratnagar, Nepal
E-mail: drbibhuti5@gmail.com


Abstract

Anterior Cruciate Ligament (ACL) tear is one amongst frequent knee injuries. This injury is troublesome as it causes instability of knee while walking/running and also predisposes to the risk of early osteoarthritis in long run. So, its proper management is important, but has always remained debatable and controversial as well. Advancements in tissue engineering and regenerative medicine has changed the understanding of ACL’s anatomy and it’s healing potential and thus a renewed interest has emerged towards ACL repair again over the established gold standard “ACL reconstruction”. Novel techniques like bridging with fiber tapes, Internal Brace Ligament Augmentation (IBLA), and Dynamic Intraligamentary Stabilization (DIS) have emerged focusing on mechanical strength. Also, supplements like bio-scaffolds, platelets & platelet rich plasma (PRP) are in the offing to aid biological ligamentous healing. We will present review of past practice, current trend and future prospects of ACL repair.
Keywords: Anterior Cruciate Ligament, Repair, Reconstruction, Augmentation, Supplementation


References

1. Zlotnicki JP, Naendrup J-H, Ferrer GA, Debski RE. Basic biomechanic principles of knee instability. Curr Rev Musculoskelet Med. 2016 Jun;9(2):114–22.
2. Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study. J Sci Med Sport. 2009 Nov;12(6):622–7.
3. Lasceski C, Nacca C, Shah SS, Richmond JC. Thoughts on Anterior Cruciate Ligament Surgery over the Past 40 Years: Back to the Future. 2020;5(1):6.
4. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured Patient: A Prospective Outcome Study. Am J Sports Med. 1994 Sep;22(5):632–44.
5. Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone Jt Res. 2014 Feb;3(2):20–31.
6. Engebretsen L, Benum P, Fasting O, Mølster A, Strand T. A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med. 1990 Nov;18(6):585–90.
7. Hewett TE, Di Stasi SL, Myer GD. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2013 Jan;41(1):216–24.
8. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the Preinjury Level of Competitive Sport After Anterior Cruciate Ligament Reconstruction Surgery: Two-thirds of Patients Have Not Returned by 12 Months After Surgery. Am J Sports Med. 2011 Mar;39(3):538–43.
9. Musahl V, Becker R, Fu FH, Karlsson J. New trends in ACL research. Knee Surg Sports Traumatol Arthrosc. 2011 Dec;19(S1):1–3.
10. Shelbourne KD, Gray T, Haro M. Incidence of Subsequent Injury to Either Knee within 5 Years after Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft. Am J Sports Med. 2009 Feb;37(2):246–51.
11. Spindler KP, Huston LJ, Wright RW, et al. The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med 2011;39:348–359.
12. Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair – past, present and future. J Exp Orthop. 2018 Dec;5(1):20.
13. Feagin JA, Abbott HG, Rokous JA. The isolated tear of the anterior cruciate ligament. J Bone Joint Surg Am. 1972;54(6):1340-1341.
14. Davarinos N, O’Neill BJ, Curtin W. A Brief History of Anterior Cruciate Ligament Reconstruction. Adv Orthop Surg. 2014 Apr 17;2014:1–6.
15. Feagin JA, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med. 1976 May;4(3):95–100.
16. Taylor DC, Posner M, Curl WW, Feagin JA. Isolated Tears of the Anterior Cruciate Ligament: Over 30-Year Follow-up of Patients Treated with Arthrotomy and Primary Repair. Am J Sports Med. 2009 Jan;37(1):65–71.
17. Kaplan N, Wickiewicz TL, Warren RF. Primary surgical treatment of anterior cruciate ligament ruptures: A long-term follow-up study. Am J Sports Med. 1990 Jul;18(4):354–8.
18. GRØNTVEDT, TORBJØRN, M.D.†; ENGEBRETSEN, LARS, M.D., PH.D.‡; BENUM, PÅL, M.D., PH.D.†, TRONDHEIM; FASTING, OVE, M.D.§, OSLO; MØLSTER, ANDERS, M.D., PH.D.¶; STRAND, TORBJØRN, M.D.¶, BERGEN, NORWAY A Prospective, Randomized Study of Three Operations for Acute Rupture of the Anterior Cruciate Ligament. Five-Year Follow-up of One Hundred and Thirty-one Patients*, JBJS: February 1996 – Volume 78 – Issue 2 – p 159-69.
19. ANDERSSON, CHRISTER; ODENSTEN, MAGNUS; GILLQUIST, JAN Knee Function After Surgical or Nonsurgical Treatment of Acute Rupture of the Anterior Cruciate Ligament: A Randomized Study With a Long-Term Follow-Up Period, Clinical Orthopaedics and Related Research: March 1991 – Volume 264 – Issue – p 255-263.
20. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term followup of primary anterior cruciate ligament repair: Defining a rationale for augmentation. Am J Sports Med. 1991 May;19(3):243–55.
21. Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H, et al. A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: A preliminary biomechanical study. The Knee. 2014 Mar;21(2):477–80.
22. Daniels SP, van der List JP, Kazam JJ, DiFelice GS. Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know. Skeletal Radiol. 2018 May;47(5):619–29.
23. van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: A paradigm shift. The Surgeon. 2017 Jun;15(3):161–8.
24. van der List JP, Mintz DN, DiFelice GS. The Locations of Anterior Cruciate Ligament Tears in Pediatric and Adolescent Patients: A Magnetic Resonance Study. J Pediatr Orthop. 2019 Oct;39(9):441–8.
25. Palmer I: On the injuries to the ligaments of the knee joint. Acta Chir Scand Suppl 53: 1, 1938.
26. Kennedy JC, Roth JH, Mendenhall HV, Sanford JB. Presidential address: Intraarticular replacement in the anterior cruciate ligament-deficient knee. Am J Sports Med. 1980 Jan;8(1):1–8.
27. McPherson GK, Mendenhall HV, Gibbons DF, Plenk H, Rottmann W, Sanford JB, et al. Experimental mechanical and histologic evaluation of the Kennedy ligament augmentation device. Clin Orthop. 1985 Jun;(196):186–95.
28. Schabus R: Die bedeutung der augmentation fur die rekonstruktion des vorederen kreutxbandes. Acta Chir Austrica Suppl 77: 18-20, 1988.
29. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21–8.
30. Nwachukwu BU, Patel BH, Lu Y, Allen AA, Williams RJ. Anterior Cruciate Ligament Repair Outcomes: An Updated Systematic Review of Recent Literature. Arthrosc J Arthrosc Relat Surg. 2019 Jul;35(7):2233–47.
31. McIntyre V, Hopper GP, Mackay GM. Anterior Cruciate Ligament Repair in a Professional Soccer Player Using Internal Brace Ligament Augmentation: A Case Report Focusing on Rehabilitation. Surg Technol Int. 2019 Nov 10;35:341–8.
32. Iain C Anthony GM. Anterior Cruciate Ligament Repair Revisited. Preliminary Results of Primary Repair with Internal Brace Ligament Augmentation: A Case Series. Orthop Muscular Syst [Internet]. 2015 [cited 2020 Dec 19];04(02). Available from: https://www.omicsonline.org/open-access/anterior-cruciate-ligament-repair-revisited-preliminary-results-of-primary-repair-with-internal-brace-ligament-augmentation-a-case-series-2161-0533-1000188.php?aid=52900
33. Wilson WT, Hopper GP, Byrne PA, MacKay GM. Anterior Cruciate Ligament Repair with Internal Brace Ligament Augmentation. Surg Technol Int. 2016 Oct 26;29:273–8.
34. Heusdens CHW, Hopper GP, Dossche L, Roelant E, Mackay GM. Anterior cruciate ligament repair with Independent Suture Tape Reinforcement: a case series with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):60–7.
35. Smith JO, Yasen SK, Palmer HC, Lord BR, Britton EM, Wilson AJ. Paediatric ACL repair reinforced with temporary internal bracing. Knee Surg Sports Traumatol Arthrosc. 2016 Jun;24(6):1845–51.
36. Häberli J, Henle P, Acklin YP, Zderic I, Gueorguiev B. Knee joint kinematics with dynamic augmentation of primary anterior cruciate ligament repair – a biomechanical study. J Exp Orthop. 2016 Dec;3(1):29.
37. Bieri KS, Scholz SM, Kohl S, Aghayev E, Staub LP. Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work. Injury. 2017 Jun;48(6):1243–8.
38. Henle P, Röder C, Perler G, Heitkemper S, Eggli S. Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord. 2015 Dec;16(1):27.
39. Uchida R, Jacob G, Shimomura K, Horibe S, Nakamura N. Biological Augmentation of ACL Repair and Reconstruction: Current Status and Future Perspective. Sports Med Arthrosc Rev. 2020 Jun;28(2):49–55.
40. Drury JL, Mooney DJ. Hydrogels for tissue engineering: scaffold design variables and applications. Biomaterials. 2003 Nov;24(24):4337–51.
41. Wiig ME, Amiel D, Vandeberg J, Kitabayashi L, Harwood FL, Arfors KE. The early effect of high molecular weight hyaluronan (hyaluronic acid) on anterior cruciate ligament healing: An experimental study in rabbits. J Orthop Res. 1990 May;8(3):425–34.
42. Berry SM, Green MH, Amiel D. Hyaluronan: a potential carrier for growth factors for the healing of ligamentous tissues. Wound Repair Regen. 1997 Jan;5(1):33–8.
43. Robayo LM, Moulin VJ, Tremblay P, Cloutier R, Lamontagne J, Larkin A-M, et al. New ligament healing model based on tissue-engineered collagen scaffolds: New human ligament model. Wound Repair Regen. 2011 Jan;19(1):38–48.
44. Joshi SM, Mastrangelo AN, Magarian EM, Fleming BC, Murray MM. Collagen-Platelet Composite Enhances Biomechanical and Histologic Healing of the Porcine Anterior Cruciate Ligament. Am J Sports Med. 2009 Dec;37(12):2401–10.
45. Patinharayil G. Future trends in ACL rupture management. J Orthop. 2017 Mar;14(1):A1–4.
46. Fleming BC, Proffen BL, Vavken P, Shalvoy MR, Machan JT, Murray MM. Increased platelet concentration does not improve functional graft healing in bio-enhanced ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):1161–70.
47. Cheng M, Wang H, Yoshida R, Murray MM. Platelets and Plasma Proteins Are Both Required to Stimulate Collagen Gene Expression by Anterior Cruciate Ligament Cells in Three-Dimensional Culture. Tissue Eng Part A. 2010 May;16(5):1479–89.
48. Yoshida R, Murray MM. Peripheral blood mononuclear cells enhance the anabolic effects of platelet-rich plasma on anterior cruciate ligament fibroblasts: PBMCs AND PRP STIMULATE FIBROBLASTS. J Orthop Res. 2013 Jan;31(1):29–34.
49. Murray MM, Spindler KP, Devin C, Snyder BS, Muller J, Takahashi M, et al. Use of a collagen-platelet rich plasma scaffold to stimulate healing of a central defect in the canine ACL. J Orthop Res. 2006 Apr;24(4):820–30.
50. Yoshida R, Cheng M, Murray MM. Increasing platelet concentration in platelet-rich plasma inhibits anterior cruciate ligament cell function in three-dimensional culture: INCREASING PLATELET CONCENTRATION INHIBITS FIBROBLASTS. J Orthop Res. 2014 Feb;32(2):291–5.
51. Steinert AF, Kunz M, Prager P, Barthel T, Jakob F, Nöth U, et al. Mesenchymal Stem Cell Characteristics of Human Anterior Cruciate Ligament Outgrowth Cells. Tissue Eng Part A. 2011 May;17(9–10):1375–88.
52. Ge Z, Goh JCH, Lee EH. The Effects of Bone Marrow-Derived Mesenchymal Stem Cells and Fascia Wrap Application to Anterior Cruciate Ligament Tissue Engineering. Cell Transplant. 2005 Nov;14(10):763–73.
53. Zhang J, Pan T, Im H-J, Fu FH, Wang JH. Differential properties of human ACL and MCL stem cells may be responsible for their differential healing capacity. BMC Med. 2011 Dec;9(1):68.
54. Figueroa D, Espinosa M, Calvo R, Scheu M, Vaisman A, Gallegos M, et al. Anterior cruciate ligament regeneration using mesenchymal stem cells and collagen type I scaffold in a rabbit model. Knee Surg Sports Traumatol Arthrosc. 2014 May;22(5):1196–202.
55. Murray MM, Fleming BC. Use of a Bioactive Scaffold to Stimulate Anterior Cruciate Ligament Healing Also Minimizes Posttraumatic Osteoarthritis After Surgery. Am J Sports Med. 2013 Aug;41(8):1762–70..


How to Cite this article: Raman R, Mishra BN. Current trends in ACL repair: Primary repair, mechanical augmentation and biological supplementation. Journal of Clinical Orthopaedics July-Dec 2020;5(2):36-40.

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Orthopaedic and trauma management in covid-19 era: common problems and their probable solution in literature, a narrative review

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:13-19 | Siddharth Dubey, Sidharath Mohindru, Md. Quamar Azam, Bhaskar Sarkar


Author: Siddharth Dubey [1], Sidharath Mohindru [1], Md. Quamar Azam [1], Bhaskar Sarkar [1]

[1] Department of Trauma Surgery AIIMS Rishikesh

Address of Correspondence
Dr. Sidharath Mohindru,
Department of Trauma Surgery AIIMS Rishikesh
E-mail: sidharathmohindru10@gmail.com


Abstract

Purpose: COVID-19 has affected more than 200 countries and has warranted change in the hospital policies and patient management worldwide. It has brought forward many challenges which were and still are being faced by the health care setup in various nations. There still are many unanswered questions and doubts arising in the minds of orthopaedic trauma surgeons all over regarding this pandemic. This article is an attempt to summarise the current knowledge about COVID-19 in relation to orthopaedic trauma.
Methods: This is a review article presenting concise, collected ideas from exhaustive literature taken from PubMed, Google Scholar and Cochrane reviews. Key words such as “COVID-19”, “Management”, “Orthopaedics” and “Trauma” were used and information from various articles has been presented in a concise manner, including the authors’ own personal experience.
Results: There has been a reduction in major trauma cases presenting to the emergency and a dramatic reduction in trauma admissions during the COVID-19 pandemic. Orthopaedic surgeons need to work alongside other frontline health care workers to tackle this calamity. Hospital resources need to be appropriately used in order to provide optimal patient care alongside minimising the risk of spread of infection to other patients and hospital personnel. The decision to operate needs to be a fine balance between suspected orthopaedics and trauma related complications and worsening of respiratory function in patients who are COVID-19 positive.
Conclusion: As orthopaedic surgeons, it is our moral responsibility to try to reduce the impact of the pandemic in which ever manner possible. There is still a lot to discover and guidelines are constantly changing, so it is also important that surgeons stay up to date on the latest protocols.
Key words: COVID-19. Management. Orthopaedic. Trauma.


References

1. Wong KC, Leung KS, Hui M. Severe acute respiratory syndrome (SARS) in a geriatric patient with a hip fracture: a case report. JBJS. 2003 Jul 1;85(7):1339-42.
2. Fang D. SARS: facts and considerations for the orthopaedic community. J Orthop Surg (Hong Kong). 2003; 11(1):3-5.
3. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223):507-13.
4. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-62.
5. Wong J, Goh QY, Tan Z, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020; In Press.
6. Gray AC, White TO, Clutton E, Christie J, Hawes BD, Robinson CM. The stress response to bilateral femoral fractures: a comparison of primary intramedullary nailing and external fixation. J Orthop Trauma. 2020; 23(2):90-7.
7. Lefaivre KA, Starr AJ, Stahel PF, Elliott AC, Smith WR. Prediction of pulmonary morbidity and mortality in patients with femur fracture. J Trauma. 2010; 69(6):1527-35.
8. Steinhausen E, Lefering R, Tjardes T, et al. A risk-adapted approach is beneficial in the management of bilateral femoral shaft fractures in multiple trauma patients: an analysis based on the trauma registry of the German Trauma Society. J Trauma Acute Care Surg. 2014; 76(5):1288-93.
9. Zu ZY, Jiang MD, Xu PP, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020; 21:200490.
10. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; In Press.
11. Sen RK, Tripathy SK, Singh AK. Is routine thromboprophylaxis justified among Indian patients sustaining major orthopedic trauma? A systematic review. Indian J Orthop. 2011; 45(3):197-207.
12. Khak, M., Hakimi, H., Manafi Rasi. A Damage Control Orthopedics in Multitrauma Patients: A Pediatric Case Presentation and Literature Review. Trauma Monthly. 2017; 22(3):e32856.
13. Randelli PS, Compagnoni R. Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Apr 25:1.
14. Mavrogenis AF, Quaile A, Scarlat MM. The virus crisis affects Orthopaedic surgery and scientific activities worldwide. International Orthopaedics. 2020 May 1:1.
15. Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ. 2020; 368:m1086
16. Steroid Injections and NSAIDs COVID 19. British Association of Spine Surgeons (BASS) communication.19.03.2020.
17. Yeh HC, Jones RK, Muggenburg BA, et al. Characterization of aerosols produced during surgical procedures in hospitals. Aerosol Sci Technol. 1995; 22:151–161.
18. Schwartz A, Wilson J, Boden S, et al. Managing resident workforce and education during the COVID-19 pandemic. J Bone Joint Surg Am. 2020; In press.
19. Chavez S, Long B, Koyfman A, et al. Coronavirus disease (COVID-19): A primer for emergency physicians. Am J Emerg Med. 2020; epud ahead of print.
20. Stinner DJ, Lebrun C, Hsu JR, Jahangir AA, Mir HR. The orthopaedic trauma service and COVID-19: practice considerations to optimize outcomes and limit exposure. Journal of orthopaedic trauma. 2020 Apr 13.
21. Sathiyakumar V, Apfeld JC, Obremskey WT, et al. Prospective randomized controlled trial using telemedicine for follow-ups in an orthopaedic trauma population: a pilot study. J Orthop Trauma. 2015; 29:e139–e145.
22. Hollander J, Carr B. Virtually perfect? Telemedicine for COVID-19. N Engl J Med. 2020; epub ahead of print.
23. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020 Mar 11.
24. Khak M, Manafi-Rasi A, Oryadi Zanjani L, Nabian MH. Trauma orthopedic surgeries in COVID-19 pandemic; a trauma management algorithm. The Archives of Bone and Joint Surgery. 2020; 8(Covid-19 Special Issue).
25. Chhabra HS, Bagaraia V, Keny S, et al. COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons. Indian J Orthop. 2020 May 18; 1.
26. Jain VK, Vaishya R. COVID-19 and orthopaedic surgeons: the Indian scenario. Tropical Doctor. 2020; 50(2):108-10.
27. Awad ME, Rumley JC, Vazquez JA, Devine JG. Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020; 28(11):451-63.
28. Massey PA, McClary K, Zhang AS, Savoie FH, Barton RS. Orthopaedic Surgical Selection and Inpatient Paradigms During the Coronavirus (COVID-19) Pandemic. The Journal of the American Academy of Orthopaedic Surgeons. 2020 Apr 15.
29. Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery–challenges and considerations. Journal of Clinical Orthopaedics and Trauma. 2020 May 4.
30. http://covid19.who.int
31. Reid, David. “India confirms its first coronavirus case”. CNBC. Retrieved 28 March 2020
32. Ebrahim SH, Ahmed QA, Gozzer E, Schlagenhauf P, Memish ZA. Covid-19 and community mitigation strategies in a pandemic. 2020.
33. Pfeifer R, Kalbas Y, Coimbra R, et al. Indications and interventions of damage control orthopedic surgeries: an expert opinion survey. European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society. 2020.
34. Sarac NJ, Sarac BA, Schoenbrunner AR, et al. A review of state guidelines for elective orthopaedic procedures during the COVID-19 outbreak. JBJS. American Volume. 2020 Apr 13.
35. Parvizi J, Gehrke T, Krueger CA, Chisari E, Citak M, Van Onsem S, Walter WL. Resuming elective orthopaedic surgery during the COVID-19 pandemic: guidelines developed by the International consensus group (ICM). JBJS. 2020 Jul 15;102(14):1205-12.
36. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta bio-medica: Atenei Parmensis. 2020; 91(1):157-60.
37. Hampton M, Clark M, Baxter I, Stevens R, Flatt E, Murray J, Wembridge K. The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study. Bone & Joint Open. 2020; 1(5):137-43.
38. Fahy S, Moore J, Kelly M, Flannery O, Kenny P. Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland. Bone & Joint Open. 2020; 1(6):261-6.


How to Cite this article: Dubey S, Mohindru S, Azam Md. Q, Sarkar B. Orthopaedic and trauma management in covid-19 era: common problems and their probable solution in literature, a narrative review. Journal of Clinical Orthopaedics July-Dec 2020;5(2):13-19.

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Potential Combination of Hesperetin and Vitamin C based on PLGA (Poly Lactic-co-Glycolic Acid) on Healing Fragility Fracture in Osteoporosis Patients

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 25-29 | Kadek Mercu Narapati Pamungkas, Putu Itta Sandi Lesmana Dewi, Made Agus Maharjana


Author: Kadek Mercu Narapati Pamungkas [1], Putu Itta Sandi Lesmana Dewi [1], Made Agus Maharjana [2]

[1] Bachelor of Medicine and Medical Doctor Profession Study Program of Udayana University, Indonesia
[2] Department of Orthopedics and Traumatology, Faculty of Medicine, Udayana University- Sanglah General Hospital, Indonesia

Address of Correspondence
Dr. Kadek Mercu Narapati Pamungkas,
Bachelor of Medicine and Medical Doctor Profession Study Program of Udayana University, Indonesia
E-mail: narapatipamungkas@student.unud.ac.id


Abstract

Background: Osteoporosis is a degenerative bone disease that occurs around 15.3% in Southeast Asia. Osteoporosis patients are very vulnerable and often experience fragility fractures. Until now, the treatment of fragility fractures, namely pharmacological and operative therapy, has not been optimal in restoring bone density and allowing recurrence.
Purpose: The aim of this research is to find the modality of therapy fragility fracture that can prevent and improve the condition. Methods: This literature was prepared using literature review methods being sourced from valid medical journals such as published in PubMed, Research Gate, and Google Scholar.
Results: Hesperetin in citrus fruit can inhibit RANKL-induced osteoclastogenesis, reduce the amount and size of F-actin, and accelerate fracture healing in vivo. Vitamin C, which is also present in citrus fruit, has an important role in the synthesis of the triple helix collagen and shows better fracture healing at week 4. PLGA has a role in more specific drug delivery, preventing rapid clearance, biodegradable, increasing calcium deposition, and extending drug release time.
Conclusion: Combination of Hesperetin and PLGA-based vitamin C can be promising therapies in the healing and prevention of fragility fractures. Suggestion: The author suggests conducting further research to determine side effects, proper dosage, and drug administration.
Keywords: Fragility Fracture, Hesperetin, PLGA, Vitamin C


References

1. Jilka RL. Biology of the basic multicellular unit and the pathophysiology of osteoporosis. Med Pediatr Oncol. 2003;41(3):182–185. https://doi.org/10.1002/mpo.10334
2. Kementerian Kesehatan RI. Info Datin: Pusat data dan informasi kementerian Kesehatan RI. 2015. ISSN 2442-7659.
3. Noor Z, Sumitro SB, Hidayat M, Rahim A., Sabarudin A, Umemura T. Atomic mineral characteristics of Indonesian osteoporosis by high-resolution Inductively coupled plasma mass spectrometry. ScientificWorldJournal. 2012; 372972. doi: 10.1100/2012/372972.
4. PEROSI. Indonesian Osteoporosis: Fact, Figures, and Hopes. Indonesian Osteoporosis Association. 2009
5. Bolton JM, Targownik, LE, Leung S, Sareen J, Leslie WD. Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women. J Clin Psychopharmacol. 2011;Feb;31(1):56-60.
6. International Osteoporosis Foundation (IOF). What is Osteoporosis?. [cited Jan, 2020]; Available from: https://www.iofbonehealth.org/what-is-osteoporosis.
7. Cheung et al., An updated panggul fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporosis and sarcopenia. 2018;4(1):16-21
8. Levin VA, Jiang X, and Kagan R. Estrogen therapy for osteoporosis in the modern era. Osteoporos Int. 2018:29(5): 1049-1055.
9. Silveira JQ, Cesar TB, Manthey JA, Baldwin EA, Bai J, Raithore S. Pharmacokinetics of flavanone glycosides after ingestion of single doses of fresh-squeezed orange juice versus commercially processed orange juice in healthy humans. J. Agric. Food Chem. 2014;62:12576–12584. doi: 10.1021/jf5 038163
10. Klimczak A, Kozlowska U. Mesenchymal Stromal Cells and Tissue-Specific Progenitor Cells: Their Role in Tissue Homeostasis. Stem Cells Int. 2016:4285215.
11. Zhang Q, Tang X, Liu Z, Song X, Peng D, Zhu W, Ouyang Z, Wang W. Hesperetin Prevents Bone Resorption by Inhibiting RANKL-Induced Osteoclastogenesis and Jnk Mediated Irf-3/c-Jun Activation. Front. Pharmacol. 2018;9:1028. doi: 10.3389/fphar.2018.01028
12. Phillips CL, Yeowell HN. Vitamin C, collagen biosynthesis, and aging. In: Packer L, Fuchs J, eds. Vitamin C in health and disease. New York, USA: Marcel Dekker Inc., 1997;205-30.
13. Alcantara-Martos T, Delgado-Martinez AD, Vega MV, Munuera-Martinez L. Effect of vitamin C on the fracture healing in elderly Osteogenic Disorder Shiogoni rats. J Bone Joint Surg [Br]. 2007;89-B:402-7.
14. Fan D, Rosa E, Murphy M et al. .Mesoporous silicon-PLGA composite microspheres for the double controlled release of biomolecules for orthopedic tissue engineering. Advanced Functional Materials. 2012;22(2): 282–293.
15. Blom AW, Warwick D, Whitehouse MR. Apley and Solomon’s System of Orthopaedic and Trauma Tenth Edition. United Kingdom: CRC Press. 2018
16. Xiao W, Wang Y, Pacios S, Li S, Graves DT. Cellular and molecular aspects of bone remodeling. Front Oral Biol. 2016;18:9–16. https://doi.org/10.1159/000351895
17. Tornquist E, Isaksson H, Turunen MJ. Mineralization of cortical bone during maturation and growth in rabbits. J Bone Miner Metab. 2019. https://doi.org/10.1007/s00774-019-01068-y
18. World Health Organization Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser. 1994;843:1–129.
19. Kanis JA, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24:23–57.
20. World Health Organization. Guidelines for preclinical evaluation and clinical trials in osteoporosis. Geneva: World Health Organization. 1998:59.
21. Choi EJ. Antioxidative effects of hesperetin against 7, 12-dimethylbenz(a)anthracene-induced oxidative stress in mice. Life Sci. 2008. 82:1059–1064
22. Choi EJ, Ahn WS. Neuroprotective effects of chronic hesperetin administration in mice. Arch Pharm Res. 2008;31:1457–1462
23. Hirata A, Murakami Y, Shoji M, Kadoma Y, Fujisawa S. Kinetics of radical-scavenging activity of hesperetin and hesperidin and their inhibitory activity on COX-2 expression. Anticancer Res. 2005;25:3367–3374.
24. Jiang C, et al. Lanthanum chloride attenuates osteoclast formation and function via the downregulation of rankl-induced Nf-Kappab and NFATC1 activities. J. Cell Physiol. 2015;231:142–151. doi: 10.1002/jcp.25065
25. Liu H, et al. Hesperetin suppresses RANKL‐induced osteoclastogenesis and ameliorates lipopolysaccharide‐induced bone loss. J Cell Physiol. 2017;234:11009–11022. https://doi.org/10.1002/jcp.27924
26. Xue D, et al. The role of hesperetin on osteogenesis of human mesenchymal stem cells and its function in bone regeneration. Oncotarget. 2017;8(13):21031–43.
27. U.S Department of Agriculture. Agriculture Research Service. FoodData Central. 2019
28. Aghajanian P, Hall S, Wongworawat MD, Mohan S .The roles and mechanisms of actions of vitamin C in bone: new developments. J Bone Miner Res. 2015;30(11):1945–1955. https://doi.org/10. 1002/jbmr.2709
29. Sun Y, et al. Dietary vitamin C intake and the risk of hip fracture : a dose-response meta-analysis. 2017
30. Zeng L, et al. Can Dietary Intake of Vitamin C-Oriented Foods Reduce the Risk of Osteoporosis, Fracture, and BMD Loss? Systematic Review With Meta-Analyses of Recent Studies. Front. Endocrinol. 2020;10:844. doi: 10.3389/fendo.2019.00844
31. Maruli A, Gunawan B, Jusuf AA. The Role of Vitamin C in Enhancement of Fracture Healing in Fracture with Periosteal Stripping at Sprague-Dawley White Rats Femur. 2013;41(1):9–14.
32. Astete C, Sabliov C. Synthesis and characterization of PLGA nanoparticles. J. Biomater. Sci. Polym. Ed. 2006;17(3):247–289
33. Chaubal M. Polylactides/glycolides – excipients for injectable drug delivery and beyond. Drug Deliv. Tech. 2. 2002;34–36.
34. Biondi M, Ungaro F, Quaglia F, Netti P. Controlled drug delivery in tissue engineering. Adv. Drug Del. Rev. 2008;60(2):229–242.
35. Luan X, Bodmeier R. Influence of the poly(lactide-co glycolide) type on the leuprolide release from in situ forming microparticle systems. J. Cont. Rel. 2006; 110(2):266–272.
36. Lu J, et al. Current advances in research and clinical applications of PLGA based nanotechnology. 2009;4(9):325–341.
37. Wang X. et al. Enhanced bone regeneration using an insulin-loaded nano-hydroxyapatite/collagen/PLGA composite scaffold. International journal of nanomedicine. 2018;13:117-27.


How to Cite this article: Pamungkas KMN, Dewi PISL, Maharjana MA. Potential Combination of Hesperetin and Vitamin C based on PLGA (Poly Lactic-co-Glycolic Acid) on Healing Fragility Fracture in Osteoporosis Patients. Journal of Clinical Orthopaedics July-Dec 2020;5(2):25-29.

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Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 20-24 | Sajeev Shekhar, Vivek Shetty, Yash Wagh


Author: Sajeev Shekhar [1], Vivek Shetty [1], Yash Wagh [1]

[1] Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016

Address of Correspondence
Dr. Vivek Shetty,
Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016
E-mail: vivshetty7777@gmail.com


Abstract

Introduction: Since the major outbreak of COVID-19 in March 2020, all hospitals and surgeons opted to postpone elective scheduled surgeries for personal and patient safety
Aim of this study: In this study of 45 consecutive patients, we changed the surgical protocols during this pandemic, our study highlights difficulties faced and how they were tackled.
Materials and Methods: 45 patients were included in this study operated by a single Senior Surgeon at a tertiary centre and their results were compared to similar surgeries performed in the pre-Covid era, in terms of length of hospital stay, duration of surgery, complications/mortality post operatively and overall risk of infection to the patients and hospital staff.
Results: It was found that the, mortality and morbidity in both times were same in Covid-19 negative patients, overall time taken for the surgery was increased, the hospital stay was increased, usage of resources was increased, difficulties faced were not only by the patients but also the health workers.
Keywords: COVID-19, protocols, donning in, doffing off, operation time, aerosol,.


References

1. Raghavan R, Middleton PR, Mehdi A. Minimising aerosol generation during orthopaedic surgical procedures- Current practice to protect theatre staff during Covid-19 pandemic. J Clin Orthop Trauma. 2020;11(3):506-507. doi:10.1016/j.jcot.2020.04.024
2. Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery –challenges and considerations. J Clin Orthop Trauma. 2020;11:S291-S295. doi:10.1016/j.jcot.2020.04.028
3. Jain AK. Current state of orthopedic education in India. Indian J Orthop. 2016;50(4):341-344. doi:10.4103/0019-5413.185586
4. Jain AK. Teaching-learning: an integral component of sound patient care. Indian J Orthop. 2008;42(3):239-240. doi:10.4103/0019-5413.41846
5. Coronavirus Disease 2019 (COVID-19) | CDC. ” [Online]. Available: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
6. Coronavirus disease (COVID-19). ” [Online]. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
7. Vaishya R, Hospitals IA, Vaish A, Hospitals IA, Jain VK. Resuming elective surgery during the COVID-19 pandemic Resuming elective surgery during the COVID-19 pandemic. 2020;(June):1205-1212.
8. Sobti A, Memon K, Bhaskar RRP, Unnithan A, Khaleel A. Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic. J Clin Orthop Trauma. 2020;(xxxx). doi:10.1016/j.jcot.2020.06.042
9. Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331. doi:10.1016/j.eclinm.2020.100331
10. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-815. doi:10.1016/S0140-6736(20)30360-3
11. Rodrigues-Pinto R, Sousa R, Oliveira A. Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19. J Bone Joint Surg Am. 2020;102(11):946-950. doi:10.2106/JBJS.20.00454
12. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020;67(5):568-576. doi:10.1007/s12630-020-01591-x
13. The Lancet T. COVID-19: protecting health-care workers. Lancet (London, England). 2020;395(10228):922. doi:10.1016/S0140-6736(20)30644-9
14. Placella G, Salvato D, Delmastro E, Bettinelli G, Salini V. CoViD-19 and ortho and trauma surgery: The Italian experience. Injury. 2020;51(6):1403-1405. doi:10.1016/j.injury.2020.04.012.


How to Cite this article: Shekhar S, Shetty V, Wagh Y. Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols. Journal of Clinical Orthopaedics July-Dec 2020;5(2):20-24.

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Meniscus Root Injury: A review

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:41-44 | Rajkumar S Amaravathi


Author: Rajkumar S Amaravathi [1]

[1] Department of Arthroscopy and Sports Injury,St John’s Medical College, Bangalore 560034, Karnataka

Address of Correspondence
Dr. Rajkumar S Amaravathi,
Professor Orthopedics,
Head Division of Arthroscopy and Sports Injury,St John’s Medical College, Bangalore 560034, Karnataka
E-mail: rajamarvathi@gmail.com


Abstract

The meniscus provides shock absorption and stability by generating circumferential stresses as load bearing occurs. This is because of the root attachments of the meniscus to the tibia, preventing meniscus extrusion and a subsequent alteration of the transmitted hoop .Meniscus root tears lead to an increase of peak tibiofemoral contact pressure and tibiofemoral contact area which has been shown to lead to altered biomechanics and an acceleration of degenerative changes of the knee. The treatment method for meniscus injuries now primarily is preservation and anatomic restoration, because non-operative and meniscectomy treatments are associated with poor clinical outcomes and progression to degenerative changes in the joint.
Keywords: Meniscus Root Injury.


References

1. Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA. Risk factors for medial meniscus posterior root tear. Am J Sports Med. 2012 Jul;40(7):1606-10. doi: 10.1177/0363546512447792. Pub 2012 May 11. PMID: 22582224.
2. De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K. MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. AJR Am J Roentgenol. 2009 Feb;192(2):480-6. doi: 10.2214/AJR.08.1300. PMID: 19155414.
3. Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, LaPrade RF. Meniscal Root Tears: Current Concepts Review. Arch Bone Jt Surg. 2018 Jul;6(4):250-259. PMID: 30175171; PMCID: PMC6110430.
4. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008 Sep;90(9):1922-31. doi: 10.2106/JBJS.G.00748. PMID: 18762653.
5. Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ, Slette EL, Mikula JD, LaPrade RF. Lateral Meniscus Posterior Root and Meniscofemoral Ligaments as Stabilizing Structures in the ACL-Deficient Knee: A Biomechanical Study. Orthop J Sports Med. 2017 Jun 15;5(6):2325967117695756. doi: 10.1177/2325967117695756. PMID: 28660229; PMCID: PMC5476330.
6. LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015 Apr;43(4):912-20. doi: 10.1177/0363546514566191. Epub 2015 Jan 26. PMID: 25622987.
7. Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF. Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med. 2014 Dec;42(12):2988-95. doi: 10.1177/0363546514549447. Epub 2014 Sep 19. PMID: 25239930.
8. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pull-out suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011 Dec;27(12):1644-53. doi: 10.1016/j.arthro.2011.06.033. Epub 2011 Oct 7. PMID: 21982389.
9. Antao NA. Patterns of avulsions of posterior horn of medial meniscus. IJO 2000, VOL34(4);284-87.
10. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363-369. doi:10.1177/0363546514559684
11. Forkel P, Foehr P, Meyer JC, Herbst E, Petersen W, Brucker PU, Burgkart R, Imhoff AB. Biomechanical and viscoelastic properties of different posterior meniscal root fixation techniques. Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):403-410. doi: 10.1007/s00167-016-4237-4. Epub 2016 Jul 11. PMID: 27401006.
12. Brody JM, Lin HM, Hulstyn MJ, Tung GA. Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology. 2006 Jun;239(3):805-10. doi: 10.1148/radiol.2393050559. PMID: 16714462.
13. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN. Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2008 Sep;16(9):849-54. doi: 10.1007/s00167-008-0569-z. Epub 2008 Jun 7. PMID: 18536902.
14. Koo JH, Choi SH, Lee SA, Wang JH. Comparison of Medial and Lateral Meniscus Root Tears. PLoS One. 2015 Oct 21;10(10): e0141021. doi: 10.1371/journal.pone.0141021. PMID: 26488288; PMCID: PMC4619510.
15. Lee SS, Ahn JH, Kim JH, Kyung BS, Wang JH. Evaluation of Healing After Medial Meniscal Root Repair Using Second-Look Arthroscopy, Clinical, and Radiological Criteria. Am J Sports Med. 2018 Sep;46(11):2661-2668. doi: 10.1177/0363546518788064. Epub 2018 Aug 17. PMID: 30118319.
16. Steineman BD, LaPrade RF, Santangelo KS, Warner BT, Goodrich LR, Haut Donahue TL. Early Osteoarthritis After Untreated Anterior Meniscal Root Tears: An in Vivo Animal Study. Orthop J Sports Med. 2017 Apr 27;5(4):2325967117702452. doi: 10.1177/2325967117702452. PMID: 28508006; PMCID: PMC5415046.
17. Rajkumar S. Amaravathi, Anoop Pilar, Sandesh G. Manohar, Madan Mohan Muniswamy, Fazal R. Rehman, Naveen J. Mathai . Arthroscopic management of neglected complex knee injury. Int J Res Orthop; Nov 2020(6):1327-1331. DOI: 10.18203/issn.2455-4510.IntJResOrthop20204607
18. Kim YM, Joo YB, Lee WY, Kim YK. Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc. 2020 Jul 25. doi: 10.1007/s00167-020-06151-w. Epub ahead of print. PMID: 32712682.
19. Ke X, Qiu J, Chen S, Sun X, Wu F, Yang G, Zhang L. Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc. 2020 May 10. doi: 10.1007/s00167-020-06055-9. Epub ahead of print. PMID: 32390120.


How to Cite this article: Amaravathi RS. Review of Meniscus Root Injury. Journal of Clinical Orthopaedics July-December 2020;5(2):41-44.

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A rare case report of chronic osteomyelitis of ulna with global involvement in an infant: A management perspective using Modified Masquelet technique with “Atmanirbhar” Gentamycin beads

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:45-48 | Rajesh Lalchandani, Gaurav Garg, Rakesh Parmar, Rajesh kumar Yadav


Author: Rajesh Lalchandani [1], Gaurav Garg [1], Rakesh Parmar [1], Rajesh kumar Yadav [1]

[1] Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016

Address of Correspondence
Dr. Vivek Shetty,
Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016
E-mail: vivshetty7777@gmail.com


Abstract

Chronic osteomyelitis treatment has always been a serious challenge for an orthopaedic surgeon to treat and it needs dedication, perseverance and multiple operations for its complete cure. We hereby report a case of a one year female who presented to us with chronic osteomyelitis ulna with global involvement. The case was successful managed by debridement, excision of sequestered ulna and insertion of locally made gentamycin beads mounted on kirschner wire as a cement spacer in the first stage. After 4 weeks, removal of gentamycin beads was done followed by visualization of membrane formation and fibular grafting mounted on a k wire for stabilization. During follow-up, we observed good uptake of the graft at both the ends and regeneration of the fibula at donor site with no signs of recurrence of osteomyelitis. We are reporting this case because of its unique global involvement of ulna and use of modified Masquelet technique using gentamycin beads(rather than a blob of cement) on a wire as cement spacer and also as a tool for local delivery of antibiotics.
Keywords: Chronic Osteomyelitis, Modified Masquelet technique, gentamycin beads, diaphyseal osteomyelitis


References

1. Chadayammuri, Vivek et al. “Innovative strategies for the management of long bone infection: a review of the Masquelet technique.” Patient safety in surgery vol. 9 32. 14 Oct. 2015, doi:10.1186/s13037-015-0079-0
2. Careri, S. & Vitiello, Raffaele & Oliva, M.S. & Ziranu, A. & Maccauro, G. & Perisano, Carlo. (2019). Masquelet technique and osteomyelitis: innovations and literature review. European review for medical and pharmacological sciences. 23. 210-216. 10.26355/eurrev_201904_17495
3. Dreyfuss U. Acquired radial club hand. A case report. Hand. 1977;9:268-71.
4. D. Bettin, H. Böhm, M. Clatworthy, D. Zurakowski, T.M. LinkRegeneration of the donor side after autogenous fibula transplantation in 53 patients: evaluation by dual x-ray absorptiometry Acta Orthop Scand, 74 (2003), pp. 332-336
5. A.H. Krieg, F. HeftiReconstruction with non-vascularised fibular grafts after resection of bone tumours J Bone Joint Surg Br, 89 (2007), pp. 215-221
6. C.W. Steinlechner, N.C. MkandawireNon-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children J Bone Joint Surg Br, 87 (2005), pp. 1259-1263.


How to Cite this article: Shekhar S, Shetty V, Wagh Y. Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols. Journal of Clinical Orthopaedics July-Dec 2020;5(2):45-48.

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Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 6-12 | Mithun Shetty, Shashi Kumar M.S, Shree Krishnananda Sagar


Author: Mithun Shetty [1], Shashi Kumar M.S [1], Shree Krishnananda Sagar [1]

[1] Department of Orthopaedics AJ Institute of Medical Sciences, Mangalore 575004

Address of Correspondence
Dr. Shashi Kumar,
room no #707, resident hostel aj institute of medical sciences, kuntikana, mangalore 575004
E-mail: shashikumar859@gmail.com


Abstract

Background: Achieving reduction prior to fixation is a key aspect in successfully managing intertrochanteric fractures. In this study of proximal femoral nailing for intertrochanteric fractures, a novel technique of utilizing prefixation compression screw was introduced to achieve and maintain reduction of femoral neck shaft angle.
Materials and Methods: The current prospective study was conducted over a period of six months between July 2018 and January 2019 among patients who underwent surgical fixation by PFN for intertrochanteric fractures of femur. Prefixation compression screw was used in all the cases to achieve and maintain correction of varus. Pre-operative, intra-operative and post- operative neck shaft angles were documented. Data was analysed by using Statistical Package for Social Sciences (SPSS). The results were expressed as percentages and graphs.
Results: There is significant improvement in correction of varus (average increase of neck shaft angle =14.04 degrees) with the use of prefixation screw technique. This procedure did neither increase the blood loss (average blood loss = 34.67 ml) during the procedure nor the duration (average duration = 19.46 mins) of the procedure.
Conclusion: Prefixation compression screw can be used as an effective alternative for varus correction in cases of simple intertrochanteric fractures undergoing PFN fixation with added intra-op and post-op advantages compared to other methods of reduction.
Keywords: Intertrochanteric fractures,Proximal Femoral nailing, Prefixation screw, Varus correction


References

1. Koval KJ, Chen AL, Aharanoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthop Relat Res. 2004; 425:72-81.
2. Voleti PB, Liu SY, Baldwin KD, Mehta S, Donegan DJ. Intertrochanteric Femur Fracture Stability: A Surrogate for General Health in Elderly Patients?. Geriatric orthopaedic surgery & rehabilitation. 2015 Sep;6(3):192-6.
3. Pathania VP, Sharma M, Gupta S, Kaushik SK. Management of intertrochanteric fracture by PFN Vs DHS: a comparative study. Journal of Evolution of Medical and Dental Sciences. 2015 May 14;4(39):6741-51.
4. Rajarajan NS. A comparative study of treatment of unstable intertrochanteric fractures with PFN and cemented hemiarthroplasty. International Journal of Orthopaedics. 2018;4(2):111-5.
5. Marmor M, Liddle K, Buckley J, Matityahu A. Effect of varus and valgus alignment on implant loading after proximal femur fracture fixation. European Journal of Orthopaedic Surgery & Traumatology. 2016 May 1;26(4):379-83.
6. Chang WS, Zuckerman JD, Kummer FJ, Frankel VH. Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures. Clin Orthop Relat Res. 1987;(225):141-6.
7. Desjardins AL, Roy A, Paiement G, et al. Unstable intertrochanteric fracture of the femur: a prospective randomised study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br. 1993;75(3):445-7
8. Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Archives of Bone and Joint Surgery. 2016 Jan;4(1):23.
9. Bakshi DA, Kumar DP, Brar DB. Comparative study between DHS and PFN in intertrochanteric fractures of femur. IJOS. 2018;4(1):259-62
10. Kyavater BS, Gupta S. Comparative study between dynamic hip screw vs Proximal femoral nailing in unstable inter-trochanteric fractures of the Femur in adults. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES-JEMDS. 2015 Jun 22;4(50):8690-3
11. Chun YS, Oh H, Cho YJ, Rhyu KH. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clinics in orthopedic surgery. 2011 Sep 1;3(3):217-24
12. Lourenço PR, Pires RE. Subtrochanteric fractures of the femur: update. Revista Brasileira de Ortopedia. 2016 Jun;51(3):246-53
13. Kulkarni GS, Limaye R, Kulkarni M, Kulkarni S. Intertrochanteric fractures. Indian journal of Orthopaedics. 2006 Jan 1;40(1):16.
14. Siddiqui YS, Khan AQ, Asif N, et al. Modes of failure of proximal femoral nail (PFN) in unstable trochanteric fractures. MOJ Orthop Rheumatol. 2019;11(1):7‒16. DOI: 10.15406/mojor.2019.11.00460
15. K Şemmi, A Taşkın, K Cemil, et al. Mechanical failures after fixation with proximal femoral nail and risk factors. Clin Interv Aging. 2015;10:1959– 1965
16. Tank PJ, Solanki RA, Patet HK, Rathi NV, Misttry J, Bhabhor HB. Results of proximal femoral nail in intertrochanteric fracture femur. Int J Med Sci. 2016;1:17-24.
17. Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femoral nail in unstable trochanteric fractures. SICOT-J. 2017;3.


How to Cite this article: Shetty M, Kumar M.S.S, Sagar SK.Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases. Journal of Clinical Orthopaedics July-Dec 2020;5(2): 6-12.

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Mature Spinal Cord Teratoma In Adults: Report Of Two Unusual Cases And Literature Review

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:49-52 | Sapan Kumar, Sanjeev kumar, Mohit Kumar Patralekh, Ramesh Kumar


Author: Sapan Kumar [1], Sanjeev kumar [1], Mohit Kumar Patralekh [1], Ramesh Kumar [1]

[1] Department of Orthopaedics, VMMC & Safdarjung Hospital, Delhi-110029, India

Address of Correspondence
Dr. Sapan Kumar,
Department of Orthopaedics, VMMC & Safdarjung Hospital, Delhi-110029, India
E-mail:- sapan2576@gmail.com


Abstract

Background: Teratoma is a germ cell tumour that is composed of a variety of parenchymal cell types derived from all three germinal layers (ectoderm, mesoderm, and endoderm). Spinal teratomas are very rare. Only 0.15-0.18% of spinal tumours have been classified as teratomas. We report two cases of spinal cord teratoma managed surgically, with good outcome.
Case reports: A 23 year old female presented with back pain and right lower limb weakness. She was evaluated by blood and radiological investigation. T12 through L2-3 flip laminoplasty with fixation was performed and the tumour was totally removed. The postoperative course was excellent, and histopathologically, numerous fatty cysts consisting of neuroepithelial and epithelial tissues were observed. The final diagnosis was that of a mature cystic teratoma.
Another 22 year old male, was presented with back pain for six months. He was evaluated by blood and radiological investigation. Total resection of the tumour by means of L2 – L3 laminectomy was done. Ectodermal, mesodermal and endodermal
elements were revealed. The final histopathological diagnosis was that of a mature cystic teratoma.
Conclusion: Although intramedullary teratomas are very rare in adults, they need to be considered in differential diagnosis. The present study also compares the literature
concerning adult intradural mature teratoma, summarises the basic clinical characteristics and theory of origin of adult intradural mature teratoma and reviews the available treatment options for this disease.
Key words: Intradural; Intramedullary; Spinal Cord; Teratoma; Adult.


References

1. Virchow R. Die Krankhaften Geschwulste. 1863; vol 1. pp 514
2. Gowers WR, Horsley V. A case of tumour of the spinal cord. Removal; recovery. Medico-chirurgical transactions. 1888;71:377-430.
3. Sharma MC, Jain D, Sarkar C, Suri V, Garg A, Singh M, Mahapatra AK, Sharma BS. Spinal teratomas: a clinico-pathological study of 27 patients. Acta neurochirurgica. 2009 Mar 1;151(3):245-52.
4. Li Y, Yang B, Song L, Yan D. Mature teratoma of the spinal cord in adults: An unusual case. Oncology letters. 2013 Oct 1;6(4):942-6.
5. Elmacı İ, Dağçinar A, Özgen S, Ekinci G, Pamir MN. Diastematomyelia and spinal teratoma in an adult: case report. Neurosurgical focus. 2001 Jan 1;10(1):1-4.
6. Rasmussen TB, Kernohan JW, Adson AW. Pathologic classification, with surgical consideration, of intraspinal tumours. Annals of surgery. 1940 Apr;111(4):513-30.
7. Smoker WR, Biller J, Moore SA, Beck DW, Hart MN. Intradural spinal teratoma: case report and review of the literature. American journal of neuroradiology. 1986 Sep 1;7(5):905-10.
8. Garrison JE, Kasdon DL. Intramedullary spinal teratoma: case report and review of the literature. Neurosurgery. 1980 Nov 1;7(5):509-12.
9. Chandler CL, Uttley D, Wilkins PR, Kavanagh TG. Primary spinal malignant schwannoma. British journal of neurosurgery. 1994 Jan 1;8(3):341-5.
10. Koen JL, McLendon RE, George TM. Intradural spinal teratoma: evidence for a dysembryogenic origin: report of four cases. J Neurosurg. 1998;89:844–51.
11. Vanguardia MK, Honeybul S, Robbins P. Subtotal resection of an intradural mature teratoma in an adult presenting with difficulty initiating micturition. Surg Neurol Int. 2014;5.
12. Koen JL, McLendon RE, George TM. Intradural spinal teratoma: evidence for a dysembryogenic origin. Report of four cases. J Neurosurg 1998;89:844-51.
13. Rewcastle NB, Francoeur J. Teratomatous cysts of the spinal canal; with “sex chromatin” studies. Arch Neurol 1964;11:91-9.
14. Bucy PC, Buchanan DN. Teratoma of the spinal cord. Surg Gynecol Obstet 1935; 60:1137 – 44.
15. Cybulski GR, vonRoenn KA, Bailey OT. Intramedullary cystic teratoid tumour of the cervical spinal cord in association with a teratoma of the ovary. Surg Neurol 1984; 22:267 – 72.
16. Hosoi K. Intradural teratoid tumours of the spinal cord. Arch Pathol 1931; 11: 875-83.
17. Ingaham FD, Bailey OT. Cystic teratomas and teratoid tumours of the central nervous system in infancy and childhood. J Neurosurg 1946; 3: 511 – 32.
18. Matson DD. Neurosurgery of Infancy and Childhood, ed 2. Spring®eld, CC Thomas 1969; pp 647 – 88.
19. Nakayama K. Spinal teratoma (Report of an elderly case). Neurol Med Chir (Tokyo) 1983; 23: 963 – 967.
20. Poeze M, Herpers MJ, Tjandra B, Freling G, Beuls EA. Intramedullary spinal teratoma presenting with urinary retention: case report and review of the literature. Neurosurgery 1999;45:379-85.
21. Rosenbaum TJ. Teratomatous cyst of the spinal canal: Case report. J Neurosurg 1978;49: 292 – 97.
22. Ak H, Ulu MO, Sar M, Albayram S, Aydin S and Uzan M: Adult intramedullary mature teratoma of the spinal cord: review of the literature illustrated with an unusual example. Acta Neurochir (Wien) 2006; 148: 663-9.
23. Allsopp G, Sgouros S, Barber P and Walsh AR: Spinal teratoma: is there a place for adjuvant treatment? Two cases and a review of the literature. Br J Neurosurg. 2000; 14: 482-8.


How to Cite this article: Kumar S, kumar S, Patralekh MK, Kumar R. Mature Spinal Cord Teratoma In Adults: Report Of Two Unusual Cases And Literature Review. Journal of Clinical Orthopaedics July-Dec 2020;5(2):49-52.

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Clinical outcomes of patients undergoing Minimally Invasive Plate Osteosynthesis (MIPO) for distal tibia fractures

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 2-5 | Shikhar D Singh, Sachin Y Kale, Adnan Asif, Jay Parsania, Atul Jain, Prasad Chaudhari


Author: Shikhar D Singh [1], Sachin Y Kale [1], Adnan Asif [2], Jay Parsania [1], Atul Jain [3], Prasad Chaudhari [1]

[1] Department of Orthopedics, DY Patil University School of Medical, Nerul, Navi Mumbai
[2] Department of Orthopedics, Christian Medical College, Vellore
[3] Department of Orthopedics, Deep Chand Bhandu Hospital, New Delhi

Address of Correspondence
Dr. Sachin Y Kale,
Department of Orthopaedics, DY Patil University School of Medical
Sector 7, Nerul, Navi Mumbai – 400706
E-mail: drsinghshikhar@gmail.com


Abstract

Introduction: Distal tibial fracture being subcutaneous poses a surgical challenge and can be complicated with delayed union, non-union, wound infection and wound dehiscence. Minimally Invasive Plate Osteosynthesis (MIPO) of distal fractures is indicted for displaced or unstable fractures due to its technical advantages and satisfactory clinical outcomes.
Methodology: We prospectively studied consecutive adult patients with closed distal tibia fracture treated with locking plates with MIPO technique. We included consecutive patients with Gustillo type 1 closed fracture with or without articular extension. Clinical outcome was assessed using Olerud and Molander Score (OAMS). Radiographic assessment was done to assess for radiological union.
Results: Among the 30 patients, right side was involved in 53% of the patients and the most common type of fracture was 43.A1 type (47%). OAMS done post-operatively found that 67% had excellent outcome, 27% had good outcome, 6% and fair and none of the patients had poor clinical outcome. Radiological union was achieved in 12 weeks in 20%, 12 to 16 weeks in 23%, 16 to 20 weeks in 50% and 20 to 24 weeks and 24 to 28 weeks in one patient each. Superficial wound infections was observed in five patients, ankle stiffness in four patients and delayed union in two patients.
Conclusions: Results of our study show that locking compression plate using MIPO technique does not compromise the periosteal blood supply and does not rely on the compression between the plate and the bone. Thus MIPO is an effective treatment for tibial diaphysis and distal tibia fractures.
Keywords: Distal tibial fractures, locking plate, Minimally invasive percutaneous plate osteosynthesis


References

1. Bucholz RC. Rockwood and Green’s fractures in adults; 2005.
2. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma. 2007;21:628–33.
3. Audig eacute; L, Bhandari M, Hanson B, Kellam J. A concept for the validation of fracture classifications. J Orthop Trauma. 2005;19:401Y406.
4. Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg Arch Für Orthop Unf-Chir. 1984;103(3):190–4.
5. Mario Ronga. Umile Giuseppe Longo with Nicola Maffulli. Minimally Invasive Locked Plating of Distal Tibia Fractures is Safe and Effective. Clin Orthop. 2010;468(4):975–82.
6. Shabbir G, Hussain S, Nasir ZA, Shafi K, Khan JA. Minimally invasive plate osteosynthesis of close fractures of distal tibia. J Ayub Med Coll Abbottabad. 2011; 2:121-124.
7. Patel YC, Jangid AK, Patel CB. Outcome of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fracture. International Journal of Orthopaedics. 2017;3(3):10-4.
8. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Clin Orthop Relat Res. 1993; 292:108-117.
9. Lam SJ. The place of delayed internal fixation in the treatment of fractures of the long bones. J Bone Joint Surg. 1964;46-B(2):393–7
10. Gupta P, Tiwari A, Thora A, Gandhi JK, Jog VP. Minimally invasive plate osteosynthesis (MIPO) for proximal and distal fractures of the tibia: a biological approach. Malaysian orthopaedic journal. 2016 Mar;10(1):29.
11. Kumar A, Sahu SK. A comparative study of management of distal one third tibia fracture by low multidirectional locked nail and minimally invasive plate osteosynthesis (MIPO). International Journal of Orthopaedics. 2020;6(1):34-8.
12. Collinge CA, Sanders RW. Percutaneous plating in the lower extremity. J Am Acad Orthop Surg. 2000;8(4):211–16.


How to Cite this article: Singh SD, Kale SY, Asif A,Parsania J, Jain A, Chaudhari P. Clinical outcomes of patients undergoing Minimally Invasive Plate Osteosynthesis (MIPO) for distal tibia fractures. Journal of Clinical Orthopaedics July-Dec 2020;5(2):2-5.

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Partial Rotator Cuff Tears: a review of the literature

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:30-34 | Stefania Kokkineli, Emmanouil Brilakis, Emmanouil Antonogiannakis


Author: Stefania Kokkineli [1], Emmanouil Brilakis [1], Emmanouil Antonogiannakis [1]

[1] Department of Orthopaedic, HYGEIA Hospital. MD. Erythrou Stavrou 4, Marousi 15123

Address of Correspondence
Dr. Stefania Kokkineli,
Department of Orthopaedic, HYGEIA Hospital. Athens, Greece
Address: Erythrou Stavrou 4, Marousi 15123. Greece
E-mail: stephaniekokkineli@gmail.com


Abstract

Partial- thickness rotator cuff tears are the most common cause of shoulder pain in adults and have been classified into subtypes according to location and depth. The frequency rate and tear size progression increase with age, tobacco use and medical comorbidities. Partial tears are divided into tears of acute, chronic or acute-on-chronic onset. Surgical treatment is indicated in symptomatic patients with persistent pain after failed conservative treatment of at least 3 months, mainly with tears that exceed 50% of the tendon thickness. Arthroscopic repair techniques include in situ and tear completion repair. Authors’ preferred technique for in situ repair is described followed by the postoperative rehabilitation protocol. The surgical techniques described have various advantages and disadvantages with regard to intra- operative complications, clinical outcomes, recovery time and re-tear rates which make it difficult to decide on which technique to use. The option is a matter of surgical indications, philosophy and skills.
Keywords: Partial-thickness rotator cuff tears, transtendon repair, in-situ repair, shoulder, arthroscopy


References

1. Kim, Y., S., Kim, S., E., Bae, S., H., Lee, H., J., Jee, W., H., Park, C. K. Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI. Knee Surg Sports Arthrosc. 2016;25(7), 2073–2080. doi:10.1007/s00167-016-4388-3.
2. Liu, C., T., Ge, H. an, Hu, R., Huang, J., B., Cheng, Y. C., Wang, M., et al. Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear. J Orthop Surg. 2018;26(2):230949901877089. doi:10.1177/2309499018770897.
3. Salem, H., Carter, A., Tjoumakaris, F., Freedman, K., B. Double-Row Repair Technique for Bursal-Sided Partial-Thickness Rotator Cuff Tears. Arthrosc Tech. 2018;7(3):e199–e203. doi:10.1016/j.eats.2017.08.068.
4. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;(254):64–74.
5. Fukuda, H. THE MANAGEMENT OF PARTIAL-THICKNESS TEARS OF THE ROTATOR CUFF. JBJS Br. 2013;85-B(1):3–11. doi:10.1302/0301-620x.85b1.13846.
6. Nathani, A., Smith, K., Wang, T. Partial and Full-Thickness RCT: Modern Repair Techniques. Curr Rev Musculoskelet Med. 2018;11(1):113–121. doi:10.1007/s12178-018-9465-4.
7. Vinanti, G., B., Rossato, A., Scrimieri, D., Petrera, M. Arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion. Knee Surg Sports Trauma Arthrosc. 2016;25(7):2151–2156. doi:10.1007/s00167-015-3953-5.
8. Ardeljan A, Palmer J, Drawbert H, Ardeljan A, Vakharia RM, Roche MW. Partial thickness rotator cuff tears: Patient demographics and surgical trends within a large insurance database. J Orthop. 2019;17:158‐161. doi:10.1016/j.jor.2019.08.027.
9. Lee CS, Davis SM, Doremus B, Kouk S, Stetson WB. Interobserver Agreement in the Classification of Partial-Thickness Rotator Cuff Tears Using the Snyder Classification System. Orthop J Sports Med. 2016;4(9):2325967116667058. doi:10.1177/2325967116667058.
10. Kanatli, U., Ayanoğlu, T., Aktaş, E., Ataoğlu, M. B., Özer, M., Çetinkaya, M. Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear. JSES. 2016;25(11), 1824–1828. doi:10.1016/j.jse.2016.02.026.
11. Jordan, R., W., Bentick, K., Saithna, A. Transtendinous Repair of Partial Articular Sided Supraspinatus Tears is associated with Higher Rates of Stiffness and Significantly Inferior Early Functional Scores than Tear Completion and Repair: A Systematic Review. Orthop Traumatol Surg. 2018;104(6):829-837. doi:10.1016/j.otsr.2018.06.007.
12. Liem, D., Gosheger, G., Vogler, T. PASTA-Läsionen – Debridement versus Naht. Der Orthopäde. 2016;45(2):125–129. doi:10.1007/s00132-015-3201-1.
13. Kim HJ, Kim JY, Kee YM, Rhee YG. Bursal-Sided Rotator Cuff Tears: Simple Versus Everted Type. Am J Sports Med. 2017;46(2):441–448. doi:10.1177/0363546517739577.
14. Habermeyer, P., Krieter, C., Tang, K., Lichtenberg, S., Magosch, P. A new arthroscopic classification of articular-sided supraspinatus footprint lesions: A prospective comparison with Snyder’s and Ellman’s classification. JSES. 2008;17(6):909–913. doi:10.1016/j.jse.2008.06.007.
15. Rahu, M., Kartus, J., T., Põldoja, E., Pedak, K., Kolts, I., Kask, K. Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization? Orthop J Sports Med. 2018;6(6):232596711878131. doi:10.1177/2325967118781311.
16. Dow, D. F., Mehta, K., Xu, Y., England, E. The Relationship Between Body Mass Index and Fatty Infiltration in the Shoulder Musculature. J Comput Assist Tomogr. 2018;42(2):323-329. doi:10.1097/rct.0000000000000672.
17. Yamamoto, N., Mineta, M., Kawakami, J., Sano, H., Itoi, E. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders. Am J Sports Med. 2017;45(11):2524–2531. doi:10.1177/0363546517709780.
18. Ranebo, M., C., Björnsson Hallgren, H., C., Adolfsson, L., E. Patients with a long-standing cuff tear in one shoulder have high rates of contralateral cuff tears: a study of patients with arthroscopically verified cuff tears 22 years ago. JSES. 2018;27(3):e68–e74. doi:10.1016/j.jse.2017.10.007.
19. Camurcu, Y., Ucpunar, H., Ari, H., Duman, S., Cobden, A., Sofu, H. Predictors of allocation to surgery in patients older than 50 years with partial-thickness rotator cuff tear. JSES. 2019;28(5):828-832. doi:10.1016/j.jse.2018.12.014.
20. Gereli, A., Kocaoglu, B., Ulku, T. K., Silay, S., Kilinc, E., Uslu, S., Nalbantoglu, U. Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2498–2504. doi:10.1007/s00167-018-4870-1.
21. Hahn, S., Lee, Y., H., Chun, Y., M., Park, E., H., Suh, J., S. Magnetic resonance arthrography results that indicate surgical treatment for partial articular-sided supraspinatus tendon avulsion: a retrospective study in a tertiary center. Acta Radiologica. 2017;58(9), 1115–1124. doi:10.1177/0284185116684673.
22. Hohmann, E., Shea, K., Scheiderer, B., Millett, P., Imhoff, A. Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline. Arthroscopy. 2019;36(3):913-922. doi:10.1016/j.arthro.2019.06.012
23. Kim, Y., S., Lee, H., J., Bae, S., H., Jin, H., Song, H. S. Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears. Arthroscopy. 2015;31(11):2191–2198. doi:10.1016/j.arthro.2015.05.016.
24. Lacheta, L., Millett, P., J. Editorial Commentary: Is Arthroscopic In Situ Repair Effective for Long-Term Functional Recovery and Pain Relief in Symptomatic Partial Rotator Cuff Tears? Arthroscopy. 2019;35(3):703–705. doi:10.1016/j.arthro.2018.12.010.
25. Ono Y, Woodmass JM, Bois AJ, Boorman RS, Thornton GM, Lo IK. Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear—A Meta-Analysis. Adv Orthop. 2016;2016: 7468054. doi:10.1155/2016/7468054.
26. Ranalletta, M., Rossi, L., A., Bertona, A., B., Atala, N., A., Tanoira, I., Maignon, G., Bongiovanni, S., L. Arthroscopic Transtendon Repair of Partial-Thickness Articular-Side Rotator Cuff Tears. Arthroscopy. 2016;32(8):1523–1528. doi:10.1016/j.arthro.2016.01.027.
27. Rossi, L., A., Atala, N., A., Bertona, A., Bongiovanni, S., Tanoira, I., Maignon, G., Ranalletta, M. Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears. Arthroscopy. 2019; 35(3):698-702. doi:10.1016/j.arthro.2018.09.026.
28. Shin SJ, Jeong JH, Jeon YS, Kim RG. Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique. Arch Orthop Trauma Surg. 2016;136(12):1701–1708. doi:10.1007/s00402-016-2546-1.
29. Zafra M, Uceda P, Muñoz-Luna F, Muñoz-López RC, Font P. Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study. Arch Orthop Trauma Surg. 2020;10.1007/s00402-020-03387-6.
30. Fukuta, S., Amari, R., Tsutsui, T. Double Arthroscopic Transtendon Repair of Partial-Thickness Articular Surface Tears of the Rotator Cuff: A Surgical Technique. J Orthop Surg. 2015;23(3):395–397. doi:10.1177/230949901502300329.
31. Osti, L., Buda, M., Andreotti, M., Osti, R., Massari, L., Maffulli, N. Transtendon repair in partial articular supraspinatus tendon tear. Br Med Bull. 2017;123(1):19–34. doi:10.1093/bmb/ldx023.
32. Heuberer, P., R., Smolen, D., Pauzenberger, L., Plachel, F., Salem, S., Laky, B., et al. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity. The Am J Sports Med.2017;45(6):1283–1288. doi:10.1177/0363546517689873..


How to Cite this article: Kokkineli S, Brilakis E, Antonogiannakis E. Partial Rotator Cuff Tears: a review of the literature. Journal of Clinical Orthopaedics July-Dec 2020;5(2):30-34.

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