Guidelines on Infection after ACL Reconstruction

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 53-59 | I. Geethan, Raju Easwaran

Author: I. Geethan [1], Raju Easwaran [2]

[1] Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur

[2] Director, Shree Meenakshi Orthopaedics & Sports Medicine Clinic

 

Address of Correspondence
Dr. I. Geethan,
Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur
E-mail: igeethan@gmail.com

Abstract

Infection after ACL reconstruction (ACLR) is a rare but disastrous event that increases the cost of treatment and affects the short and long term outcome. Clinicians must be aware of the best preventive practices and be knowledgeable regarding the early diagnosis and prompt management to minimise the complications following ACLR. Recent literature has identified the risk factors for infection after ACLR and has proposed recommendations for its management. This article reviews the recent literature and proposes a plan for prevention of infection and its treatment. Specifically, the use of Bone Patellar Tendon Bone graft in patients at a higher risk of infection and Vancomycin wrapping of graft are the two interventions that can reduce the risk of infection. A surgeon must have a low threshold for suspecting infection and early graft preserving arthroscopic lavage must be performed on suspicion of infection. Culture directed antibiotics must be given for 6 weeks following infection. Graft and hardware must be removed in patients requiring repeat debridement. Revision ACLR is offered only for those patients who report instability.
Keywords: Infection, ACL reconstruction, Prevention, Management

References

  1. Dubousset J, Charpak G, Dorion I, Skalli W, Lavaste F, Deguise J, et al. Anew 2D and 3D imaging approach to musculo-skeletal
    physiology and pathology with low-dose radiation and the standing position: The EOS system. Bull Acad Natl Med 2005;189:287-300.
  2. Wybier M, Bossard P. Musculoskeletal imaging in progress: The EOS imaging system. J Bone Spine 2013;80:238-43.
  3. Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS (®) biplanar X-ray imaging: Concept, developments, benefits, and limitations.
    J Child Orthop 2016;10:1-14.
  4. Garg B, Mehta N, Bansal T, Malhotra R. EOS® imaging: Concept and current applications in spinal disorders. J Clin Orthop Trauma 2020;11:786-93.
  5. Mishra P, Lal A, Mohindra M, Mehta N, Joshi D, Chaudhary D. Incidence, management and outcome assessment of post operative infection following single bundle and double bundle acl reconstruction. J Clin Orthop Trauma [Internet]. 2018 Apr 1 [cited 2021 Jan 17];9(2):167–71. Available from: https://pubmed.ncbi.nlm.nih.gov/29896022/.
  6. Brophy RH, Wright RW, Huston LJ, Nwosu SK, Spindler KP, Kaeding CC, et al. Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Jt Surg – Am Vol. 2015 Mar 18;97(6):450–4.
  7. Barbara K, Alan I, Goran V, Saša J. Knee infection following anterior cruciate ligament reconstruction: a cohort study of one thousand, eight hundred and ninety one patients from the single-centre database. Int Orthop [Internet]. 2020 May 1 [cited 2 0 2 1 J a n 1 7 ] ; 4 4 ( 5 ) : 8 6 9 – 7 5 . A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/32114657/
  8. Wang C, Lee YH a. D, Siebold R. Recommendations for the management of septic arthritis after ACL reconstruction. Vol. 22, Knee surgery, sports traumatology, arthroscopy  : official journal of the ESSKA. 2014. p. 2136–44.
  9. Otchwemah R, Naendrup JH, Mattner F, Tjardes T, Bäthis H, Shafizadeh S. Effective graft preservation by following a standard protocol for the treatment of knee joint infection after anterior cruciate ligament reconstruction. J Knee Surg. 2019;32(11):1111–20.
  10. Torres-Claramunt R, Gelber P, Pelfort X, Hinarejos P, Leal[1]Blanquet J, Pérez-Prieto D, et al. Managing septic arthritis after knee ligament reconstruction. Vol. 40, International Orthopaedics. Springer Verlag; 2016. p. 607–14.
  11. Nag HL, Neogi DS, A.R. N, V. AK, Yadav CS, Singh U. Tubercular Infection After Arthroscopic Anterior Cruciate Ligament Reconstruction. Arthrosc – J Arthrosc Relat Surg. 2009 Feb;25(2):131–6.
  12. Muscolo DL, Carbo L, Aponte-Tinao LA, Ayerza MA, Makino A. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction. Clin Orthop Relat Res. 2009;467(9):2420–5.
  13. Sun L, Zhang L, Wang K, Wang W, Tian M. Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: Acase report with review of the literature. Knee [Internet]. 2012 Oct [cited 2021 Jan 17];19(5):728–31. Available from: https://pubmed.ncbi.nlm.nih.gov/22209694/.
  14. Vallianatos PG, Tilentzoglou AC, Koutsoukou AD. Septic Arthritis Caused by Erysipelothrix rhusiopathiae Infection after Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction. Arthroscopy [Internet]. 2003 [cited 2021 Jan 1 7 ] ; 1 9 ( 3 ) . A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/12627143/.
  15. Schollin-Borg M, Michaëlsson K, Rahme H. Presentation, Outcome, and Cause of Septic Arthritis after Anterior Cruciate Ligament Reconstruction: A Case Control Study. Arthrosc – J Arthrosc Relat Surg [Internet]. 2003 [cited 2020 Oct 2 9 ] ; 1 9 ( 9 ) : 9 4 1 – 7 . A v a i l a b l e f r o m: Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study – PubMed (nih.gov)
  16. Cancienne JM, Gwathmey FW, Miller MD, Werner BC. Tobacco Use Is Associated with Increased Complications after Anterior Cruciate Ligament Reconstruction. Am J Sports Med [Internet]. 2016 Jan 1 [cited 2021 Feb 5];44(1):99–104. Available from: http://journals.sagepub.com/doi/10.1177/0363546515610505
  17. Geethan I, Easwaran R, Sahanand S, Sivaraman A, Gupta A, Devgan A, et al. Management Guidelines for Infection After ACL Reconstruction: Expert Opinion Statement Based on the Modified Delphi Survey of Indian Arthroscopy Surgeons. Indian J Orthop [Internet]. 2021 Feb 1 [cited 2021 Feb 3];1–10. Available from: http://link.springer.com/10.1007/s43465-021- 00363-z
  18. Bibbo C, Patel D V., Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: A prospective randomized study. Clin Orthop Relat Res [Internet]. 2005 [cited 2021 Feb 3];438(438):204–8. Available from: https://pubmed.ncbi.nlm.nih.gov/16131892/
  19. Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic Review and Cost Analysis Comparing Use of chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection. Infect Control Hosp Epidemiol [Internet]. 2010 Dec [cited 2021 Feb 3 ] ; 3 1 ( 1 2 ) : 1 2 1 9 – 2 9 . A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/20969449/
  20. WHO Surgical Site infection Prevention Guidelines Web Appendix 7 Summary of a systematic review on the effectiveness and optimal method of hair removal [Internet]. [cited 2020 Oct 27]. Available from: http://gradepro.org/
  21. Pérez-Prieto D, Portillo ME, Torres-Claramunt R, Pelfort X, Hinarejos P, Monllau JC. Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2018 Feb 1 [cited 2021 Jan 17];26(2):558–62. Available from: https://pubmed.ncbi.nlm.nih.gov/28988312/
  22. Parada SA, Grassbaugh JA, DeVine JG, Arrington ED. Instrumentation-specific infection after anterior cruciate ligament reconstruction. Vol. 1, Sports Health. 2009. p. 481–5.
  23. Tuman J, Diduch DR, Baumfeld JA, Rubino LJ, Hart JM. Joint Infection Unique to Hamstring Tendon Harvester Used During Anterior Cruciate Ligament Reconstruction Surgery. Arthrosc – J Arthrosc Relat Surg. 2008 May;24(5):618–20.
  24. Werner CML, Necas T, Schneeberger AG. Defects of camera covers after arthroscopic surgery. J Shoulder Elb Surg [Internet]. 2006 Mar [cited 2021 Feb 4];15(2):199–202. Available from: https://pubmed.ncbi.nlm.nih.gov/16517365/
  25. Bansal A, Lamplot JD, VandenBerg J, Brophy RH. Meta[1]analysis of the Risk of Infections After Anterior Cruciate Ligament Reconstruction by Graft Type. Am J Sports Med [Internet]. 2018 May 1 [cited 2021 Feb 5];46(6):1500–8. A v a i l a b l e f r o m : http://journals.sagepub.com/doi/10.1177/0363546517714450
  26. Hurvitz AP, Prentice HA, Funahashi TT, Maletis GB. Screw and Sheath Tibial Fixation Associated With a Higher Likelihood of Deep Infection After Hamstring Graft Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2020 Mar 1;48(4):806–11.
  27. Pérez-Prieto D, Portillo ME, Torres-Claramunt R, Pelfort X, Hinarejos P, Monllau JC. Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2018 Feb 1 [cited 2020 Nov 17];26(2):558–62. Available from: https://pubmed.ncbi.nlm.nih.gov/28988312/
  28. Badran MA, Moemen DM. Hamstring graft bacterial contamination during anterior cruciate ligament reconstruction: clinical and microbiological study. Int Orthop [Internet]. 2016 Sep 1 [cited 2021 Jan 17];40(9):1899–903. Available from: https://link.springer.com/article/10.1007/s00264-016-3168-5.
  29. Grayson JE, Grant GD, Dukie S, Vertullo CJ. The in vitro elution characteristics of vancomycin from tendons. Clin Orthop Relat Res [Internet]. 2011 [cited 2020 Nov 17];469(10):2948–52. Available from: https://pubmed.ncbi.nlm.nih.gov/21246314/
  30. Vertullo CJ, Quick M, Jones A, Grayson JE. A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthrosc – J Arthrosc Relat Surg. 2012 Mar;28(3):337–42.
  31. Schuster P, Schlumberger M, Mayer P, Raoulis VA, Oremek D, Eichinger M, et al. Lower incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction with quadriceps tendon compared to hamstring tendons. Knee Surgery, Sport Traumatol Arthrosc. 2020.
  32. Pérez-Prieto D, Torres-Claramunt R, Gelber PE, Shehata TMA, Pelfort X, Monllau JC. Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction. Knee Surgery, Sport Traumatol Arthrosc. 2016 Sep 1;24(9):2724–8.
  33. Offerhaus C, Balke M, Hente J, Gehling M, Blendl S, Höher J. Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction. Knee Surgery, Sport Traumatol Arthrosc. 2019 Sep 1;27(9):3014–21
  34. Wan KH-M, Tang SP-K, Lee RH-L, Wong KK, Wong K-K. The use of vancomycin-soaked wrapping of hamstring grafts to reduce the risk of infection after anterior cruciate ligament reconstruction: An early experience in a district general hospital. Asia-Pacific J Sport Med Arthrosc Rehabil Technol [Internet]. 2020 Oct 1 [cited 2020 Oct 25];22:10–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32642443
  35. Figueroa D, Figueroa F, Calvo R, Lopez M, Goñi I. Presoaking of Hamstring Autografts in Vancomycin Decreases the Occurrence of Infection Following Primary Anterior Cruciate Ligament Reconstruction. Orthop J Sport Med. 2019;7(9).
  36. Xiao M, Sherman SL, Safran MR, Abrams GD. Surgeon practice patterns for pre-soaking ACL tendon grafts in vancomycin: a survey of the ACL study group. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2020 [cited 2021 Jan 17]; Available from: https://pubmed.ncbi.nlm.nih.gov/32902684/
  37. Phegan M, Grayson JE, Vertullo CJ. No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2016 Sep 1 [cited 2021 Jan 1 7 ] ; 2 4 ( 9 ) : 2 7 2 9 – 3 5 . A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/25771788/
  38. Naendrup JH, Marche B, de Sa D, Koenen P, Otchwemah R, Wafaisade A, et al. Vancomycin-soaking of the graft reduces the incidence of septic arthritis following ACL reconstruction: results of a systematic review and meta-analysis. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2020 Apr 1 [cited 2 0 2 1 J a n 1 7 ] ; 2 8 ( 4 ) : 1 0 0 5 – 1 3 . Av a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/30656372/
  39. Jacquet C, Jaubert M, Pioger C, Sbihi A, Pithioux M, Le Baron M, et al. Presoaking of Semitendinosus Graft With Vancomycin Does Not Alter Its Biomechanical Properties: A Biomechanical In Vitro–Controlled Study Using Graft From Living Donors. Arthrosc – J Arthrosc Relat Surg [Internet]. 2020 Aug 1 [cited 2 0 2 1 J a n 1 7 ] ; 3 6 ( 8 ) : 2 2 3 1 – 6 . A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/32304710/
  40. Lamplot JD, Liu JN, Hutchinson ID, Chen T, Wang H, Wach A, et al. Effect of Vancomycin Soaking on Anterior Cruciate Ligament Graft Biomechanics. Arthrosc – J Arthrosc Relat Surg [Internet]. 2 0 2 0 [ c i t e d 2 0 2 1 J a n 1 7 ] ; A v a i l a b l e f r o m : Effect of Vancomycin Soaking on Anterior Cruciate Ligament Graft Biomechanics – PubMed (nih.gov)
  41. Pérez-Prieto D, Perelli S, Corcoll F, Rojas G, Montiel V, Monllau JC. The vancomycin soaking technique: no differences in autograft re-rupture rate. A comparative study. Int Orthop [Internet]. 2020 [cited 2021 Jan 17]; Available from: https://pubmed.ncbi.nlm.nih.gov/32944802/
  42. Bohu Y, Klouche S, Sezer HB, Herman S, Grimaud O, Gerometta A, et al. Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2020 Aug 1 [cited 2021 Jan 1 7 ] ; 2 8 ( 8 ) : 2 5 7 8 – 8 5 . A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/32025764/
  43. Carney J, Heckmann N, Mayer EN, Alluri RK, Vangsness CT, Hatch GF, et al. Should antibiotics be administered before arthroscopic knee surgery? Asystematic review of the literature [Internet]. Vol. 9, World Journal of Orthopaedics. Baishideng Publishing Group Co; 2018 [cited 2021 Jan 15]. p. 262–70. Available from: https://pubmed.ncbi.nlm.nih.gov/30479973/
  44. Jefferies JG, Aithie JMS, Spencer SJ. Vancomycin-soaked wrapping of harvested hamstring tendons during anterior cruciate ligament reconstruction. A review of the ‘vancomycin wrap.’Vol. 26, Knee. Elsevier B.V.; 2019. p. 524–9.
  45. Yazdi H, Gomrokchi AY, Nazarian A, Lechtig A, Hanna P, Ghorbanhoseini M. The effect of gentamycin in the irrigating solution to prevent joint infection after anterior cruciate ligament (ACL) reconstruction. Arch Bone Jt Surg. 2019 Jan 1;7(1):67–74.
  46. Barbier O, Danis J, Versier G, Ollat D. When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy. Knee. 2015 Oct 1;22(5):380–3.
  47. Plante MJ, Li X, Scully G, Brown MA, Busconi BD, DeAngelis NA. Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2013 May 15 [cited 2021 Jan 17];21(3):696–701. A v a i l a b l e f r o m : https://link.springer.com/article/10.1007/s00167-012-2049-8.
  48. Oh HL, Chen DB, Seeto BG, MacDessi SJ. Mycobacterium fortuitum infection after anterior cruciate ligament reconstruction using a polylactic acid bioabsorbable screw: Case report. Knee. 2010 Mar;17(2):176–8.
  49. Vallianatos PG, Tilentzoglou AC, Koutsoukou AD. Septic Arthritis Caused by Erysipelothrix rhusiopathiae Infection after Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction. Arthroscopy. 2003;19(3).
  50. Metcalf K, Ko JWK, Quilici S, Barnes P, Crawford DC. Differentiating Occult Propionibacterium acnes Infection From Aseptic “Biologic” Interference Screw Hydrolysis After Anterior Cruciate Ligament Reconstruction: Introducing a Novel Culture Protocol for Detecting Low-Virulence Organisms. Orthop J Sport Med. 2015 Oct 23;3(10).
  51. Rhee SM, Kim MS, Kim JD, Ro K, Ko YW, Rhee YG. Hematologic Expression After Shoulder Surgery: Normalization Curve of Serum Inflammatory Markers. Arthrosc – J Arthrosc Relat Surg. 2021 Jan 1;37(1):71–82.
  52. Nam JH, Cho MR, Lee SH, Song SK, Choi WK. C-reactive protein course after classical complication free total knee arthroplasty using navigation. Knee Surg Relat Res [Internet]. 2020 Dec 1 [cited 2021 Feb 6];32(1):56. Available from: https://kneesurgrelatres.biomedcentral.com/articles/10.1186/ s43019-020-00074-z
  53. Costa GG, Grassi A, Lo Presti M, Cialdella S, Zamparini E, Viale P, et al. White Blood Cell Count is the most Reliable Test for the Diagnosis of Septic Arthritis after Anterior Cruciate Ligament Reconstruction. An observational study on 38 patients. Arthrosc J Arthrosc Relat Surg [Internet]. 2020 Dec [ c i t e d 2 0 2 1 J a n 1 7 ] ; A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/33278527/
  54. Ligament Reconstruction. An observational study on 38 patients. Arthrosc J Arthrosc Relat Surg [Internet]. 2020 Dec [ c i t e d 2 0 2 1 J a n 1 7 ] ; A v a i l a b l e f r o m : https://pubmed.ncbi.nlm.nih.gov/33278527/
  55. Pérez-Prieto D, Trampuz A, Torres-Claramunt R, Eugenia Portillo M, Puig-Verdié L, Monllau JC. Infections after Anterior Cruciate Ligament Reconstruction: Which Antibiotic after Arthroscopic Debridement? J Knee Surg [Internet]. 2017 May 1 [cited 2021 Jan 17];30(4):309–13. Available from: https://pubmed.ncbi.nlm.nih.gov/27367205/
  56. Pogorzelski J, Themessl A, Achtnich A, Fritz EM, Wörtler K, Imhoff AB, et al. Septic Arthritis After Anterior Cruciate Ligament Reconstruction: How Important Is Graft Salvage? Am J Sports Med. 2018 Aug 1;46(10):2376–83.
  57. Waterman BR, Arroyo W, Cotter EJ, Zacchilli MA, Garcia ESJ, Owens BD. Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal. Orthop J Sport Med. 2018 Feb26;6(3).
  58. Kusnezov N, Eisenstein ED, Dunn JC, Wey AJ, Peterson DR, Waterman BR. Anterior Cruciate Ligament Graft Removal Versus Retention in the Setting of Septic Arthritis After Reconstruction: A Systematic Review and Expected Value Decision Analysis. Vol. 34, Arthroscopy – Journal of Arthroscopic and Related Surgery. W.B. Saunders; 2018. p. 967–75.
  59. Cote MP. Editorial Commentary: Graft Removal Versus Retention for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Accounting for Patient Preference Flips the Script on Current Practice [Internet]. Vol. 34, Arthroscopy – Journal of Arthroscopic and Related Surgery. W.B. Saunders; 2018 [cited 2021 Jan 15]. p. 976–8. Available from: https://pubmed.ncbi.nlm.nih.gov/29502709/
  60. Makhni EC, Steinhaus ME, Mehran N, Schulz BS, Ahmad CS. Functional Outcome and Graft Retention in Patients with Septic Arthritis after Anterior Cruciate Ligament Reconstruction: A Systematic Review. Vol. 31, Arthroscopy – Journal of Arthroscopic and Related Surgery. W.B. Saunders; 2015. p. 1392–401.
How to Cite this article: Geethan I, Easwaran R. Guidelines on Infection after ACL Reconstruction. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1): 53-59.

 (Abstract    Full Text HTML)   (Download PDF)

Role of anterolateral reconstruction in ACL surgery. Why, When and How?

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 45-52 | Philippe Landreau

Author: Philippe Landreau [1]

[1] DxBone, Bone and Joint Excellence Center Dubai, United Arab Emirates

Address of Correspondence
Dr. Philippe Landreau,
DxBone, Bone and Joint Excellence Center Dubai, United Arab Emirates
E-mail: landreau@mac.com

Abstract

Ruptures of the anterior cruciate ligament (ACL) cause both abnormal anterior translation and anterolateral rotation of the tibia under the femur. Isolated intra-articular ACL reconstruction has evolved significantly over the past years, but in many cases it is insufficient to correct rotational laxity. There are several justifications for anterolateral plasty in the context of ACL surgery: The persistence of anterolateral laxity after some isolated ACL intra-articular reconstructions, the evidence of traumatic lesions of these anterolateral structures after ACL tear and the recent anatomical and biomechanical research on the anterolateral complex of the knee. One more justification is that some recent studies comparing the outcomes after isolated ACL reconstruction and those after ACL reconstruction combined with anterolateral reconstruction are in favor of the simultaneous procedures. The addition of an extra-articular procedure to the intra-articular reconstruction of the ACL can improve the outcomes particularly in these situations: Young age (<25 ans), sports with pivot contact particularly if high level, pivot-shift Grades 2–3, recurvatum of the knee and generalized hyperlaxity, posterior tibial slope superior to 12°, meniscus deficiency, and ACL revision. Different surgical techniques have been proposed and described. They can be classified in two groups: The techniques using an ilio-tibial band graft to perform a lateral tenodesis and the procedures aiming to reconstruct the anterolateral ligament. Both techniques intend to control the anterolateral displacement of the tibial plateau.
Keywords: Anterolateral ligament, anterior cruciate ligament, anterolateral reconstruction, lateral tenodesis, condylar strap

References

  1. Lemaire M. Rupture ancienne du ligament croisé antérieur du genou: fréquence, clinique, traitement (46 cas). J Chir 1967;83:311:311.
  2. Macintosh D, Darby T. Lateral substitution reconstruction. In: Proceedings of the Canadian Orthopaedic Association. J Bone Joint Surg Br 1976;58(1):142.
  3. Losee RE, Johnson TR, Southwick WO. Anterior subluxation of the lateral tibial plateau. Adiagnostic test and operative repair. J Bone Joint Surg Am. 1978 Dec;60(8):1015-30.
  4. Ellison AE. Distal iliotibial-band transfer for anterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1979 Apr;61(3):330-7.
  5. Andrews JR, Sanders R. A “mini-reconstruction” technique in treating anterolateral rotatory instability (ALRI). Clin Orthop Relat Res. 1983;(172):93-6.
  6. Marshall JL, Warren RF, Wickiewicz TL. Primary surgical treatment of anterior cruciate ligament lesions. Am J Sports Med. 1982;10(2):103-7.
  7. Sonnery-Cottet B, Thaunat M, Freychet B, et al. Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med 2015;43:1598–43:1.
  8. Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–45:5.
  9. Ardern CL, Webster KE, Taylor NF, et al. 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;39:538–39.
  10. Wright RW, Magnussen RA, Dunn WR, et al. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction. Asystematic review. J Bone Joint Surg Am. 2011 Jun 15;93(12):1159-65.
  11. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med. 2016 Jan 15.
  12. Segond P. Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Prog Med. 1879;7: 297–9 3:297–9, 319–21, 340–1.
  13. Monaco E, Helito CP, Redler A, Argento G, De Carli A, Saithna A, Helito PVP, Ferretti A. Correlation Between Magnetic Resonance Imaging and Surgical Exploration of the Anterolateral Structures of the Acute Anterior Cruciate Ligament-Injured Knee. Am J Sports Med. 2019 Apr;47(5):1186- 1193.
  14. Vesalius A. De Humani Corporis Fabrica. Lib II, Cap 53. Padua: University of Padua; 1543.
  15. Kaplan EB. The iliotibial tract; clinical and morphological significance. J Bone Joint Surg Am. 1958 Jul;40-A(4):817-32.
  16. Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med. 1986 Jan[1]Feb;14(1):39-45.
  17. Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy. 2007 Mar;23(3):269-74.
  18. Vincent JP, Magnussen RA, Gezmez F, et al. The anterolateral liga- ment of the human knee: an anatomical and histologic study. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):147- 152.
  19. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013;223:321–22.
  20. Claes S, Luyckx T, Vereecke E, Bellemans J. The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy. 2014 Nov;30(11):1475-82.
  21. Geeslin AG, Chahla J, Moatshe G, Muckenhirn KJ, Kruckeberg BM, Brady AW, Coggins A, Dornan GJ, Getgood AM, Godin JA, LaPrade RF. Anterolateral Knee Extra-articular Stabilizers: A Robotic Sectioning Study of the Anterolateral Ligament and Distal Iliotibial Band Kaplan Fibers. Am J Sports Med. 2018 May;46(6):1352-1361.
  22. Landreau P, Catteeuw A, Hamie F, Saithna A, Sonnery-Cottet B, Smigielski R. Anatomic Study and Reanalysis of the Nomenclature of the Anterolateral Complex of the Knee Focusing on the Distal Iliotibial Band: Identification and Description of the Condylar Strap. Orthop J Sports Med. 2019 Jan 17;7(1):2325967118818064.
  23. Engebretsen L, Lew WD, Lewis JL, Hunter RE. The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med. 1990 Mar-Apr;18(2):169-76.
  24. Monaco E, Maestri B, Conteduca F, Mazza D, Iorio C, Ferretti A. Extra-articular ACL reconstruction and pivot shift: in vivo dynamic evaluation with navigation. Am J Sports Med 2014;42:1669–42
  25. Marom N, Ouanezar H, Jahandar H, Zayyad ZA, Fraychineaud T, Hurwit D, Imhauser CW, Wickiewicz TL, Pearle AD, Nawabi DH. Lateral Extra-articular Tenodesis Reduces Anterior Cruciate Ligament Graft Force and Anterior Tibial Translation in Response to Applied Pivoting and Anterior Drawer Loads. Am J Sports Med. 2020 Nov;48(13):3183-3193.
  26. Noyes FR, Barber SD. The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. J Bone Joint Surg Am. 1991;73(6):882-892.
  27. O’Brien SJ, Warren RF, Wickiewicz TL, et al. The iliotibial band lateral sling procedure and its effect on the results of anterior cruciate ligament reconstruction. Am J Sports Med. 1991;19(1):21-24.
  28. Devitt BM, Bouguennec N, Barfod KW, Porter T, Webster KE, Feller JA. Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of oste- oarthritis: a systematic review and best evidence synthesis. Knee Surg Sports Traumatol Arthrosc. 2017;25(4):1149-1160.
  29. Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P. Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med. 2010;38(6):1094-1102.
  30. Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, et al. Over[1]the-top ACL reconstruction plus extra-articular lateral tenodesis with ham- string tendon grafts: prospective evaluation with 20- year minimum follow-up. Am J Sports Med. 2017;45(14):3233- 3242.
  31. Getgood AMJ et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020 Feb;48(2):285-297.
  32. Trojani C, Beaufils P, Burdin G, Bussière C, Chassaing V, Djian P, Dubrana F, Ehkirch FP, Franceschi JP, Hulet C, Jouve F, Potel JF, Sbihi A, Neyret P, Colombet P. Revision ACL reconstruction: influence of a lateral tenodesis. Knee Surg Sports Traumatol Arthrosc. 2012 Aug;20(8):1565-70.
  33. Bertoia JT, Urovitz EP, Richards RR, Gross AE. Anterior cruciate reconstruction using the MacIntosh lateral-substitution over[1]the-top repair. J Bone Joint Surg Am. 1985 Oct;67(8):1183-8.
  34. Duthon VB, Magnussen RA, Servien E, Neyret P. ACL reconstruction and extra-articular tenodesis. Clin Sports Med. 2013 Jan;32(1):141-53.
  35. Lerat JL, Dupré La Tour L, Herzberg G, Moyen B. Revue de 100 patients opérés pour laxité chronique antérieure du genou par un procédé dérivé des méthodes de K. Jones et de D. MacIntosh. Intérêt de la radiographie dynamique pour l’analyse objective des résultats [Review of 100 patients operated on for chronic anterior laxity of the knee by a procedure derived from the Jones and MacIntosh methods. Value of dynamic radiography for the objective analysis of the results]. Rev Chir Orthop Reparatrice Appar Mot. 1987;73 Suppl 2:201-4.
  36. Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, et al. Over[1]the-top ACL reconstruction plus extra-articular lateral tenodesis with ham- string tendon grafts: prospective evaluation with 20- year minimum follow-up. Am J Sports Med. 2017;45(14):3233-3242.
  37. Smith JO, Yasen SK, Lord B, Wilson AJ. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee. Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3151-6.
  38. Helito CP, Bonadio MB, Gobbi RG, da Mota E Albuquerque RF, Pécora JR, Camanho GL, Demange MK. Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament. Arthrosc Tech. 2015 Jun 1;4(3).
How to Cite this article: SLandreau P. Role of anterolateral reconstruction in ACL surgery, why, when and how?. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):45-52.

 (Abstract    Full Text HTML)   (Download PDF)

Tibial Condyle Fractures: Current Concepts of Internal Fixation

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 32-44 | Vivek Shetty, Sajeev Shekhar, Yash Wagh

Author: Vivek Shetty [1], Sajeev Shekhar [2], Yash Wagh [2]

[1] Consultant Orthopaedic Surgeon, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
[2] Department of Orthopaedics, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Vivek Shetty,
Consultant Orthopaedic Surgeon, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
Sector 7, Nerul, Navi Mumbai – 400706
E-mail: vivshetty7777@gmail.com

Abstract

Intraarticular Proximal Tibial fractures pose a great challenge, due to its wide variety of complex injury patterns and hence have a varied management protocol. There are various classifications and treatment options described in literature which do not give any guidelines on surgical approach and management. This review article is an attempt to provide a surgical protocol of treatment of these complex challenging fractures keeping in mind the mechanism of injury, understanding of the fracture pattern, surgical approach and column specific reconstruction.
Keywords: Tibial, Condyle

References

  1. Barei, S. E. Nork, W. J. Mills, M. B. Henley, and S. K. Benirschke, “Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two[1]incision technique,” J. Orthop. Trauma, vol. 18, no. 10, pp. 649–657, 2004,
  2. Wang et al., “Updated Three-Column Concept in surgical treatment for tibial plateau fractures – A prospective cohort study of 287 patients,” Injury, vol. 47, no. 7, pp. 1488–1496, 2016.
  3. Jeelani and M. H. Arastu, “Tibial plateau fractures – review of current concepts in management,” Orthop. Trauma, vol. 31, no. 2, pp. 102–115, 2017.
  4. E. Honkonen, “Degenerative arthritis after tibial plateau fractures,” J. Orthop. Trauma, vol. 9, no. 4, pp. 273–277, 1995.
  5. Wennergren, C. Bergdahl, J. Ekelund, H. Juto, M. Sundfeldt, and M. Möller, “Epidemiology and incidence of tibia fractures in the Swedish Fracture Register,” Injury, vol. 49, no. 11, pp. 2068–2074, Nov. 2018.
  6. Elsoe, P. Larsen, N. P. H. Nielsen, J. Swenne, S. Rasmussen, and S. E. Ostgaard, “Population-based epidemiology of tibial plateau fractures,” Orthopedics, vol. 38, no. 9. Slack Incorporated, pp. e780–e786, Sep. 01, 2015.
  7. P. Stannard, R. Lopez, and D. Volgas, “Soft tissue injury of the knee after tibial plateau fractures.,” J. Knee Surg., vol. 23, no. 4, pp. 187–192, 2010, doi: 10.1055/s-0030-1268694.
  8. Kfuri and J. Schatzker, “Revisiting the Schatzker classification of tibial plateau fractures,” Injury, vol. 49, no. 12, pp. 2252–2263, 2018, doi: 10.1016/j.injury.2018.11.010.
  9. J. Raschke, C. Kitt, and C. Domnick, “Partial proximal tibia fractures,” EFORT Open Rev., vol. 2, no. 5, pp. 241–249, May 2017, doi: 10.1302/2058-5241.2.160067.
  10. jie Shen et al., “Surgical Treatment of Lateral Tibial Plateau Fractures Involving the Posterolateral Column,” Orthop. Surg., vol. 11, no. 6, pp. 1029–1038, Dec. 2019, doi: 10.1111/os.12544.
  11. Schatzker, R. Mcbroom, and D. Bruce, “The tibial plateau fracture: the Toronto experience 1968–1975,” Clin. Orthop. Relat. Res., vol. 1, no. 138, pp. 94–104, 1979.
  12. F. Luo, H. Sun, B. Zhang, and B. F. Zeng, “Three-column fixation for complex tibial plateau fractures,” J. Orthop. Trauma, vol. 24, no. 11, pp. 683–692, 2010.
  13. Xie, Y. Zhan, Y. Wang, J. F. Lucas, Y. Zhang, and C. Luo, “Comparative Analysis of Mechanism-Associated 3- Dimensional Tibial Plateau Fracture Patterns,” J. Bone Jt. Surg. – Am. Vol., vol. 102, no. 5, pp. 410–418, Mar. 2020.
  14. Wahlquist, N. Iaguilli, N. Ebraheim, and J. Levine, “Medial Tibial Plateau Fractures: A New Classification System,” J. Trauma, vol. 63, no. 6, pp. 1418–1421, 2007.
  15. Krause et al., “Intra-articular tibial plateau fracture characteristics according to the ‘Ten segment classification,’” Injury, vol. 47, no. 11, pp. 2551–2557, Nov. 2016.
  16. Yao et al., “3D mapping and classification of tibial plateau fractures.,” Bone Joint Res., vol. 9, no. 6, pp. 258–267, Jun. 2020, doi: 10.1302/2046-3758.96.BJR-2019-0382.R2.
  17. Yang, Q. Zhai, Y. Zhu, H. Sun, S. Putnis, and C. Luo, “The incidence of posterior tibial plateau fracture: An investigation of 525 fractures by using a CT-based classification system,” Arch. Orthop. Trauma Surg., vol. 133, no. 7, pp. 929–934, Jul. 2013.
  18. Krause and K. H. Frosch, “Response to the letter-to-the[1]editor by Dhillon et al. “Simple four column classification can dictate treatment for intra articular tibial plateau fractures much better than ten segment classification“, Injury 2017,” Injury, vol. 48, no. 10. Elsevier Ltd, pp. 2369–2370, Oct. 01, 2017.
  19. J. Warner et al., “The Effect of Soft Tissue Injuries on Clinical Outcomes after Tibial Plateau Fracture Fixation,” J. Orthop. Trauma, vol. 32, no. 3, pp. 141–147, Mar. 2018.
  20. J. Gardner et al., “The incidence of soft tissue injury in operative tibial plateau fractures. A magnetic resonance imaging analysis of 103 patients,” J. Orthop. Trauma, vol. 19, no. 2, pp. 79–84, Feb. 2005.
  21. Holzach, P. Matter, and J. Minter, “Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: Use of a cannulated reduction system,” J. Orthop. Trauma, vol. 8, no. 4, pp. 273–281, 1994, doi: 10.1097/00005131-199408000- 00001.
  22. Stannard, C. Finkemeier, J. Lee, and P. Kregor, “Utilization of the less-invasive stabilization system internal fixator for open fractures of the proximal tibia: Amulti-center evaluation,” Indian J. Orthop., vol. 42, no. 4, pp. 426–430, Oct. 2008, doi: 10.4103/0019-5413.43390.
  23. F. Luo, H. Sun, B. Zhang, and B. F. Zeng, “Three-column fixation for complex tibial plateau fractures,” J. Orthop. Trauma, v o l . 2 4 , n o . 11 , p p . 6 8 3 – 6 9 2 , N o v. 2 0 1 0 , d o i : 10.1097/BOT.0b013e3181d436f3
  24. W. Cho et al., “Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach,” Int. Orthop., vol. 41, no. 9, pp. 1887–1897, 2017, doi: 10.1007/s00264-017-3563-6.
  25. Ducic, A. L. Dellon, and K. S. Graw, “The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid-third of the lateral leg,” Ann. Plast. Surg., vol. 56, no. 6, pp. 635–638, Jun. 2006.
  26. Lobenhoffer, T. Gerich, T. Bertram, C. Lattermann, T. Pohlemann, and H. Tscherne, “Spezielle posteromediale und p o s t e r o l a t e r a l e z u g a n g e z u r v e r s o r g u n g v o n tibiakopffrakturen,” Unfallchirurg, vol. 100, no. 12, pp. 957–967, Dec. 1997.
  27. H. Frosch, P. Balcarek, T. Walde, and K. M. Stürmer, “A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures,” J. Orthop. Trauma, vol. 24, no. 8, pp. 515–520, 2010.
  28. Luo C. F. Frosch K.H., “(237) Trauma Academy | 360° Tibial Head fracture treatment | Part 1 | Prof. K-H Frosch & Prof. C-F L u o Y o u T u b e . ” https://www.youtube.com/watch?v=O10gAwXZhic.
  29. W. Chen and C. F. Luo, “Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis,” Int. J. Clin. Exp. Med., vol. 8, no. 8, pp. 13708–13715, 2015.
  30. Galla and P. Lobenhoffer, “Der direkte dorsale zugangsweg zur versorgung posteromedialer luxationsfrakturen des tibiakopfes,” Unfallchirurg, vol. 106, no. 3, pp. 241–247, Mar. 2003, doi: 10.1007/s00113-002-0554-9.
  31. He et al., “A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures,” Arch. Orthop. Trauma Surg., vol. 133, no. 1, pp. 23–28, Jan. 2013.
  32. Orapiriyakul, T. Apivatthakakul, and C. Phornphutkul, “Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study,” Arch. Orthop. Trauma Surg., vol. 138, no. 4, pp. 505–513, Apr. 2018.
  33. M. J. Hutton, “The role of arthroscopy in the management of tibial plateau fractures,” Arthroscopy, vol. 1, no. 2, pp. 76–82, 1985, doi: 10.1016/S0749-8063(85)80035-9.
  34. Krause, A. Preiss, N. M. Meenen, J. Madert, and K. H. Frosch, “‘Fracturoscopy’ is superior to fluoroscopy in the articular reconstruction of complex tibial plateau fractures – An arthroscopy assisted fracture reduction technique,” J. Orthop. Trauma, vol. 30, no. 8, pp. 437–444, Aug. 2016.
  35. Wang, F. Cao, M. Liu, J. Wang, and S. Jia, “Incidence of Soft[1]Tissue Injuries in Patients with Posterolateral Tibial Plateau Fractures: ARetrospective Review from 2009 to 2014,” Journal of Knee Surgery, vol. 29, no. 6. Georg Thieme Verlag, pp. 451–457, Aug. 01, 2016, doi: 10.1055/s-0036-1581132.
  36. Khatri, V. Sharma, D. Goyal, and K. Farooque, “Complications in the management of closed high-energy proximal tibial plateau fractures,” Chinese J. Traumatol. – English Ed., vol. 19, no. 6, pp. 342–347, Dec. 2016.
  37. Delamarter R.B., Hohl H., and Hopp Jr E., “Ligament injuries associated with tibial plateau fractures – PubMed,” Clinical O r t h o p e d i c r e l a t e d r e s e a r c h , 1 9 9 0 . https://pubmed.ncbi.nlm.nih.gov/2293934/ (accessed Dec. 01, 2020).
  38. Wilppula and G. Bakalim, “Ligamentous tear concomitant with tibial condylar fracture,” Acta Orthop., vol. 43, no. 4, pp. 292–300, 1972, doi: 10.3109/17453677208991267.
  39. Phisitkul, T. O. Mckinley, J. V. Nepola, and J. L. Marsh, “Complications of locking plate fixation in complex proximal tibia injuries,” J. Orthop. Trauma, vol. 21, no. 2, pp. 83–91, Feb. 2007, doi: 10.1097/BOT.0b013e318030df96.
  40. Q. Xu, Y. L. Zhu, X. Y. Fan, T. Jin, Y. Li, and X. Q. He, “Implant[1]related infection in the tibia: Surgical revision strategy with vancomycin cement,” Sci. World J., vol. 2014, Sep. 2014, doi: 10.1155/2014/124864.
  41. Lichte et al., “Are bilateral tibial shaft fractures associated with an increased risk for adverse outcome?,” Injury, vol. 45, no. 12, pp. 1985–1989, 2014, doi: 10.1016/j.injury.2014.10.005.
  42. A. Softness, R. S. Murray, and B. G. Evans, “Total knee arthroplasty and fractures of the tibial plateau,” World Journal of Orthopaedics, vol. 8, no. 2. Baishideng Publishing Group Co, pp. 107–114, 2017, doi: 10.5312/wjo.v8.i2.107.
  43. “AO Foundation Surgery Reference. ” https://surgeryreference.aofoundation.org/.
How to Cite this article: Shetty V, Shekhar S, Wagh Y. Tibial Condyle Fractures: Current Concepts Of Internal Fixation. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):32-44.

 (Abstract    Full Text HTML)   (Download PDF)

Ten Lessons Learnt From Covid Pandemic

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 4-5 | Dr. Parag Sancheti, Dr. Ashok Shyam

Author: Dr. Parag Sancheti [1], Dr. Ashok Shyam [1]

[1] Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India

[1] Hospital: Sancheti Institute for orthopaedics and rehabilitation, Pune, India

Address of Correspondence
Dr. Ashok Shyam
Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India.
Hospital: Sancheti Institute for orthopaedics and rehabilitation, Pune, India.
E-mail: drashokshyam@gmail.com

 

Ten Lessons Learnt From Covid Pandemic

We are living through unprecedented times of Covid19 Pandemic. The sudden onset and heavy impact of the Pandemic caught most of us unaware and took us on a long roller coaster ride of uncertainty. We are in still the clutches of an unseen enemy that is dismantling us at our very genetic code level. However, we believe ‘Adversities Bring out the Worst & Best in Everything’ At the onset, we would like to pay homage to everyone who has lost near and dear ones during this Pandemic. We were among the more fortunate ones to not face such eventuality, but we all have met our own dark places and have indeed learnt something valuable from this experience. We will be sharing ten lessons and insights that we have learnt at various levels, including professional, community, administrative family, personal and global perspectives.

1. Use of the Internet: Our use of online resources has exponentially increased during the Pandemic. The use of webinars, Zoom meetings, work from home, telemedicine all played a significant role during the last few months of our lives. And we predict these will continue to be part of our lives in future too. However, social media and online resources are also double-edged swords, and we have to learn to Utilize Social Media wisely and optimally

2. Work Expands to The Time Available: We have always cribbed about not having enough time but the pandemic made us realise that having more time was not the solution. With more available time, we realize that we were performing lesser. However, we now understand the importance of time more acutely than ever before, and should learn good time management

3. Administrative Responsibilities: As head of the hospital or organizations, we were in unique positions. We were faced with anxieties and fear of our staff and co-workers. We quickly realized Reassurance & Positive Communication played a vital role. We also recognized the Urgent Need for the Reorganization of our work systems. Challenging times help us differentiate between people who are with you or otherwise. This realization helps us a lot in the long run specially for growth of an organisation

4. Humility, Gratitude: If we have to take one single lesson to take away from this Pandemic, then it will be humility and gratitude. Migrant helpless labourer’s and many others faced very tough times, and this made us realize and learn to understand & live life in a different view. We must stop complaining about minor things, be thankful that we are in a better position. We must show gratitude to the higher power or have faith in whatever we individually perceive as divine. It is one of our greatest sources of strength and courage.

5. Strengthen Family Relationships: In our busy schedules, most of us had lost touch with our families, even with our close ones. Pandemic gave us time to strengthen these ties and reinvent them. We realized the importance of the safety of our family and understand that one of the greatest gifts that we have is that the closest people that we care for, are healthy and happy

6. Opportunity for Great Personal Development: Pandemic also gave us enough time to introspect about ourselves and realign priorities in our lives. We needed to Introspect & Rediscover ourselves and our Value Systems. Many of us realized our long lost passions and started working on them, and hopefully, we would continue working on them

7. Adequate reserves for bad times: Money is essential, and those who had reserves and resources used them to tide over difficult times. We have to educate ourselves in terms of financial knowledge and be wiser about our economic outlooks

8. Everything was on a standstill but still life went on. Things like restaurants, mall, movie theatres, entertainment centres, air travels etc all were closed but we were still very much here. We realized that many things that we thought were important in our lives were quite dispensable and this realization will help us in future too

9. E- education is one of the greatest discovery of this Pandemic. The gain and sharing of knowledge were simplified, and it diversified into massive knowledge sharing platforms. Starting from schools to colleges to universities and national and international societies all focussed on e-education. This increased the outreach of quality education to each and every corner of the world.

10. Pandemics Shape History: Plague – 14th Century had 200 million deaths, Smallpox – 15th Century – 50 million deaths, Cholera – 1817 – 1 million deaths, Spanish flu – 1918 – 50 million deaths and now in Covid-19 Ongoing – more than a million deaths so far and still counting. However, we realize that we are all in this together, and Together, we WILL Survive & Thrive We have to realize that We are Descendent of Cavemen, Who have braved and survived with much fewer resources, and we will survive this too. Although we are practising social distancing, in a way, we are more socially connected than ever

Many of these lessons or insights we already knew; however, Pandemic has forced us to perceive these things intimately. We would underline again that humility, gratitude and understanding that safety of our family and dear ones is most valuable things in our lives have been major learning points for us. We believe many of us have also learned many more and many different lessons from this Pandemic. We hope we all come out of it as a better person, both individually and professionally.

How to Cite this article: Sancheti P, Shyam A. Ten Lessons Learnt From Covid Pandemic. Journal of Clinical Orthopaedics. January-June 2021;6(1):4-5.

(Abstract    Full Text HTML)   (Download PDF)

Current Concepts in High Tibial Osteotomy

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page:24-31 | Vikram Arun Mhaskar, Yogesh Jain, Jitendra Maheshwari

Author: Vikram Arun Mhaskar [1], Yogesh Jain [1], Jitendra Maheshwari [1]

[1] Knee & Shoulder Clinic, New Delhi, Max Superspecilaity Hospital Saket, New Delhi, India

Address of Correspondence
Dr. Vikram Arun Mhaskar,
Knee & Shoulder Clinic, New Delhi, Max Superspecilaity Hospital Saket, New Delhi, India
E-mail: drvikrammhaskar@gmail.com

Abstract

Background: High tibial osteotomy is an effective procedure for the management of medial compartment osteoarthritis. This paper intends to analyze the current indications, contra indications, technique, complications, survival, and recent advances of this procedure.

Method: Literature review was done by searching journals with “High tibial osteotomy,” “Indications of HTO,” “Alignment in HTO,” “Survival and clinical outcomes of HTO,” and “Recent advances in HTO.” A total of 12 articles were found suitable for this study and reviewed.

Outcomes: Indications have largely remained the same except for thrust, which was earlier, a contra indication, Biplanar osteotomy, patient specific instrumentation; 3D printing and computer navigation are the recent technical modifications. The rate of complications is variable in different studies and the 5-year survival is still over 90% in most studies. Rate of serious complications is low but minor complications are high.

Conclusion: HTO is a successful procedure in treating medial compartment OA in isolation or with ligament deficiencies with a good 5 and 10-year survival. Recent advances have focused on improving planning, rehabilitation, and accuracy of alignment.

Keywords: High Tibial Osteotomy, osteotomy, deformity, gene varum, osteoarthritis, knee preservation, deformity correction

References

  1. Takeuchi R, Umemoto Y, Aratake M, Bito H, Saito I, Kumagai K, Sasaki Y, Akamatsu Y, Ishikawa H, Koshino T, Saito T. A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee. Journal of Orthopaedic Surgery and Research. 2010 Dec;5(1):65.
  2. Petersen W, Metzlaff S. Open wedge high tibial osteotomy (HTO) versus mobile bearing unicondylar medial joint replacement: five years results. Archives of orthopaedic and trauma surgery. 2016 Jul 1;136(7):983-9.
  3. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High tibial osteotomy. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2005 Jul 1;13(4):279-89.
  4. Brouwer RW, Bierma-Zeinstra SM, Van Koeveringe AJ, Verhaar JA. Patellar height and the inclination of the tibial plateau after high tibial osteotomy: the open versus the closed-wedge technique. The Journal of bone and joint surgery. British volume. 2005 Sep;87(9):1227-32.
  5. . Figueroa F, Mhaskar V, Scholes C, Pearlman A, Coolican M, Parker D, Fritsch B. Symptomatic relief in medial opening wedge high tibial osteotomies for the treatment of knee osteoarthritis is influenced by concurrent procedures and preoperative pain level. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2018 Jan 1;3(1):8-16.
  6. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High tibial osteotomy: a systematic review and current concept. Archives of Bone and Joint Surgery. 2016 Jun;4(3):204.
  7. Pape D, Kohn D, Van Giffen N, Hoffmann A, Seil R, Lorbach O. Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee surgery, sports traumatology, arthroscopy. 2013 Jan 1;21(1):82-9.
  8. Kim JH, Kim HJ, Lee DH. Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis. Scientific Reports. 2017 Aug 4;7(1):1-7.
  9. Mhaskar VA, Maheshwari J, Ugrasen H. Bilateral HTO in same sitting: Perioperative challenge or feasible option?. Journal of Arthroscopy and Joint Surgery. 2020 Apr 1;7(2):69-73. 16.
  10. Rand JA, Neyret P. ISAKOS meeting on the management of osteoarthritis of the knee prior to total knee arthroplasty. In ISAKOS congress 2005
  11. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A12-28-year followup study of closing wedge high tibial osteotomy. Clinical Orthopaedics and Related Research®. 2006 Nov 1;452:91-6.
  12. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A10-to[1]22-year followup study. Clinical orthopaedics and related research. 1999 Oct(367):18-27.
  13. Michaela G, Florian P, Michael L, Christian B. Long-term outcome after high tibial osteotomy. Archives of orthopaedic and trauma surgery. 2008 Jan 1;128(1):111-5.
  14. Aglietti P, Rinonapoli EM, Stringa GA, Taviani AN. Tibial osteotomy for the varus osteoarthritic knee. Clinical orthopaedics and related research. 1983 Jun(176):239-51.
  15. Ivarsson IN, Myrnerts RU, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A5 to 7 and 11 year follow-up. The Journal of bone and joint surgery. British volume. 1990 Mar;72(2):238-44.
  16. RUDAN JF, SIMURDAMA. High tibial osteotomy: a prospective clinical and roentgenographic review. Clinical Orthopaedics and Related Research®. 1990 Jun 1;255:251-6.
  17. Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. The Journal of bone and joint surgery. American volume. 1984 Sep;66(7):1040-8.
  18. Stuchin SA, Johanson NA, Lachiewicz PF, Mont MA. Surgical management of inflammatory arthritis of the adult hip and knee. Instructional course lectures. 1999;48:93-109
  19. Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC. The role of joint load in knee stability. JBJS. 1981 Apr 1;63(4):570-85.
  20. Lee DC, Byun SJ. High tibial osteotomy. Knee surgery & related research. 2012 Jun;24(2):61.
  21. Murphy SB. Tibial osteotomy for genu varum. Indications, preoperative planning, and technique. The Orthopedic Clinics of North America. 1994 Jul 1;25(3):477-82.
  22. Solayar GN, Chinappa J, Harris IA, Chen DB, Macdessi SJ. A comparison of plain radiography with computer tomography in determining coronal and sagittal alignments following total knee arthroplasty. Malaysian Orthopaedic Journal. 2017 Jul;11(2):45.
  23. Müller M, Strecker W. Arthroscopy prior to osteotomy around the knee?. Archives of orthopaedic and trauma surgery. 2008 Nov 1;128(11):1217-21.
  24. Friemert B, Oberländer Y, Danz B, Häberle HJ, Bähren W, Gerngross H, Schwarz W. MRI vs. arthroscopy in the diagnosis of cartilage lesions in the knee. Can MRI take place of arthroscopy?. Zentralblatt fur Chirurgie. 2002 Oct 1;127(10):822-7.
  25. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten-to 20- year follow-up. The Journal of Bone and Joint Surgery. British volume. 2008 May;90(5):592-6
  26. Berman AT, Bosacco SJ, Kirshner ST, Avolio Jr A. Factors influencing long-term results in high tibial osteotomy. Clinical orthopaedics and related research. 1991 Nov 1(272):192-8. 28. Bonnin M, Chambat P. Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis. Der Orthopade. 2004 Feb;33(2):135-42.
  27. Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010 Dec 1;26(12):1607-16.
  28. Bonnin M, Chambat P. Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis. Der Orthopade. 2004 Feb;33(2):135-42.
  29. Jenny JY, Tavan A, Jenny G, Kehr P. Long-term survival rate of tibial osteotomies for valgus gonarthrosis. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur. 1998 Jul;84(4):350-7.
  30. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, Van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. The Journal of bone and joint surgery. British volume. 2008 Dec;90(12):1548-57.
  31. Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis: indications, operative technique, and results. JBJS. 1973 Jan 1;55(1):23-48.
  32. Odenbring S, Tjörnstrand B, Egund N, Hagstedt B, Hovelius L, Lindstrand A, Luxhöj T, Svanström A. Function after tibial osteotomy for medial gonarthrosis below aged 50 years. Acta orthopaedica Scandinavica. 1989 Jan 1;60(5):527-31.
  33. Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat Award: is neutral mechanical alignment normal for all patients?: the concept of constitutional varus. Clinical Orthopaedics and Related Research®. 2012 Jan 1;470(1):45-53.
  34. Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. Journal of orthopaedic research. 1991 Jan;9(1):113-9.
  35. Halder A, Kutzner I, Graichen F, Heinlein B, Beier A, Bergmann G. Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients. JBJS. 2012 Jun 6;94(11):1023-9.
  36. Dugdale TW, Noyes FR, Styer DA. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clinical orthopaedics and related research. 1992 Jan(274):248-64.
  37. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH, Jeong JH. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014 Jan 1;30(1):72-9.
  38. Kanamiya T, Naito M, Hara M, Yoshimura I. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2002 Sep 1;18(7):725-9.
  39. Madry H, Kon E, Condello V, Peretti GM, Steinwachs M, Seil R, Berruto M, Engebretsen L, Filardo G, Angele P. Early osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Jun 1;24(6):1753-62.
  40. Tischer T, Paul J, Pape D, Hirschmann MT, Imhoff AB, Hinterwimmer S, Feucht MJ. The impact of osseous malalignment and realignment procedures in knee ligament surgery: a systematic review of the clinical evidence. Orthopaedic journal of sports medicine. 2017 Mar 24;5(3):2325967117697287.
  41. Kim KI, Seo MC, Song SJ, Bae DK, Kim DH, Lee SH. Change of chondral lesions and predictive factors after medial open[1]wedge high tibial osteotomy with a locked plate system. The American Journal of Sports Medicine. 2017 Jun;45(7):1615-21.
  42. Krych AJ, Hevesi M, Desai VS, Camp CL, Stuart MJ, Saris DB. Learning from failure in cartilage repair surgery: An analysis of the mode of failure of primary procedures in consecutive cases at a tertiary referral center. Orthopaedic journal of sports medicine. 2018 May 9;6(5):2325967118773041.
  43. Giffin JR, Shannon FJ. The role of the high tibial osteotomy in the unstable knee. Sports medicine and arthroscopy review. 2007 Mar 1;15(1):23-31.
  44. Badhe NP, Forster IW. High tibial osteotomy in knee instability: the rationale of treatment and early results. Knee Surgery, Sports Traumatology, Arthroscopy. 2002 Jan 1;10(1):38-43.
  45. Voos JE, Suero EM, Citak M, Petrigliano FP, Bosscher MR, Citak M, Wickiewicz TL, Pearle AD. Effect of tibial slope on the stability of the anterior cruciate ligament–deficient knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2012 Aug 1;20(8):1626-31.
  46. Lee SH, Lee OS, Teo SH, Lee YS. Change in gait after high tibial osteotomy: Asystematic review and meta-analysis. Gait & posture. 2017 Sep 1;57:57-68.
  47. Marriott KA, Birmingham TB, Giffin RJ, Jones IC. Gait biomechanics pre and post combined high tibial osteotomy and acl reconstruction. Osteoarthritis and Cartilage. 2014 Apr 1;22:S112-3.
  48. Leitch KM, Birmingham TB, Dunning CE, Giffin JR. Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent. Gait & posture. 2015 Jul 1;42(2):165-71.
  49. Liu X, Chen Z, Gao Y, Jin Z. High tibial osteotomy: review of techniques and biomechanics. Journal of healthcare engineering. 2019 May 2;2019.
  50. Ekhtiari S, Haldane CE, Simunovic N, Musahl V, Ayeni OR. Return to work and sport following high tibial osteotomy: a systematic review. JBJS. 2016 Sep 21;98(18):1568-77.
  51. Park CH, Bae DK, Kim KI, Lee JW, Song SJ. Serial changes in the joint space width and joint line convergence angle after closed-wedge high tibial osteotomy. American J Sports Med 2017 Dec;45(14):3254-61.
  52. DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC. Midterm follow-up of opening-wedge high tibial osteotomy. The American journal of sports medicine. 2010 Oct;38(10):2077- 84.
  53. Amzallag J, Pujol N, Maqdes A, Beaufils P, Judet T, Catonne Y. Patellar height modification after high tibial osteotomy by either medial opening-wedge or lateral closing-wedge osteotomies. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 Jan 1;21(1):255-9.
  54. Bae DK, Song SJ, Kim HJ, Seo JW. Change in limb length after high tibial osteotomy using computer-assisted surgery: a comparative study of closed-and open-wedge osteotomies. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 Jan 1;21(1):120-6.
  55. Hankemeier S, Mommsen P, Krettek C, Jagodzinski M, Brand J, Meyer C, Meller R. Accuracy of high tibial osteotomy: comparison between open-and closed-wedge technique. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 Oct 1;18(10):1328-33.
  56. Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X, Zayni R, Bonnin M, Jalil R, Amzallag J, Rosset P. Posterior tibial slope changes after opening-and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthopaedics & Traumatology: Surgery & Research. 2012 Feb 1;98(1):68-74.
  57. Georgoulis AD, Makris CA, Papageorgiou CD, Moebius UG, Xenakis T, Soucacos PN. Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study. Knee Surgery, Sports Traumatology, Arthroscopy. 1999 Sep 1;7(1):15-9.
  58. Lee DC, Byun SJ. High tibial osteotomy. Knee surgery & related research. 2012 Jun;24(2):61.
  59. Robin JG, Neyret P. High tibial osteotomy in knee laxities: concepts review and results. EFORT open reviews. 2016 Jan;1(1):3-11.
  60. Song EK, Seon JK, Park SJ. How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics. 2007 Oct 1;30(10):S127.
  61. Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM. Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 Feb 1;18(2):204-11.
  62. Krettek C, Miclau T, Gru O, Schandelmaier P, Tscherne H. Intraoperative control of axes, rotation and length in femoral and tibial fractures technical note. Injury. 1998 Dec 1;29:29-39.
  63. Saleh M, Harriman P, Edwards DJ. A radiological method for producing precise limb alignment. The Journal of bone and joint surgery. British volume. 1991 May;73(3):515-6.
  64. FuJISAwA YO, Masuhara KE, Shiomi SH. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. The Orthopedic clinics of North America. 1979 Jul;10(3):585.
  65. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clinical orthopaedics and related research. 1989 Sep(246):250-9.
  66. Noyes FR, Barber SD, Simon R. High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees: a two-to seven-year follow-up study. The American journal of sports medicine. 1993 Jan;21(1):2-12.
  67. Jakob RP, Murphy SB. Tibial osteotomy for varus gonarthrosis: indication, planning, and operative technique. Instructional course lectures. 1992;41:87.
  68. Spahn G, Kl inger HM, Harth P, Hofmann GO. Knorpelregeneration nach valgisierender Tibiakopfosteotomie. Ergebnisse einer arthroskopischen Studie. Zeitschrift für Orthopädie und Unfallchirurgie. 2012 Jun;150(03):272-9.
  69. Antonescu DN. Is knee osteotomy still indicated in knee osteoarthritis?. Acta Orthopaedica Belgica. 2000 Dec;66(5):421-32.
  70. Maas S, Diffo Kaze A, Dueck K, Pape D. Static and dynamic differences in fixation stability between a spacer plate and a small stature plate fixator used for high tibial osteotomies: a biomechanical bone composite study. International Scholarly Research Notices. 2013;2013.
  71. Kaze AD, Maas S, Waldmann D, Zilian A, Dueck K, Pape D. Biomechanical properties of five different currently used implants for open-wedge high tibial osteotomy. Journal of experimental orthopaedics. 2015 Dec 1;2(1):14.
  72. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012 Jan 1;28(1):85-94.
  73. Perren SM. Optimizing the degree of fixation stability based on the strain theory. Der Orthopade. 2010 Feb;39(2):132-8.
  74. Staubli AE, Jacob HA. Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. International orthopaedics. 2010 Feb 1;34(2):167-72.
  75. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, Magnitskaya N, Mukhanov V, Neyret P, Solomin LN, Sorokin E. Advances in modern osteotomies around the knee. Journal of experimental orthopaedics. 2019 Dec 1;6(1):9.
  76. Solomin LN, Shchepkina EA, Korchagin KL, Sabirov FK, Takata M, Tsuchiya H. The new method of long bone multilevel deformities correction using the orthopedic hexapod (preliminary report). Traumatology and Orthopedics of Russia. 2017 Oct 4;23(3):103-9.
  77. Mattei L, Lea S, Nicolaci G, Ferrero G, Marmotti A, Castoldi F. Closing wedge tibial osteotomy: is it an actual procedure nowadays?. planning. 2017;3:6.
  78. Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Südkamp N, Niemeyer P. Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. International orthopaedics. 2015 Apr 1;39(4):689-96.
  79. Bode G, Schmal H, Pestka JM, Ogon P, Südkamp NP, Niemeyer P. A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5. Archives of orthopaedic and trauma surgery. 2013 Jan 1;133(1):43-9.
  80. Sterett WI, Steadman JR. Chondral resurfacing and high tibial osteotomy in the varus knee. The American journal of sports medicine. 2004 Jul;32(5):1243-9.
  81. Trinh TQ, Harris JD, Siston RA, Flanigan DC. Improved outcomes with combined autologous chondrocyte implantation and patellofemoral osteotomy versus isolated autologous chondrocyte implantation. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013 Mar 1;29(3):566-74.
  82. Waller C, Hayes D, Block JE, London NJ. Unload it: the key to the treatment of knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Nov 1;19(11):1823-9.
  83. Parker DA, Beatty KT, Giuffre B, Scholes CJ, Coolican MR. Articular cartilage changes in patients with osteoarthritis after osteotomy. The American journal of sports medicine. 2011 May;39(5):1039-45.
  84. Verdonk PC, Verstraete KL, Almqvist KF, De Cuyper K, Veys EM, Verbruggen G, Verdonk R. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surgery, Sports Traumatology, Arthroscopy. 2006 Aug 1;14(8):694-706.
  85. Hernigou PH, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. The Journal of bone and joint surgery. American volume. 1987 Mar;69(3):332.
  86. Jenny JY, Tavan A, Jenny G, Kehr P. Long-term survival rate of tibial osteotomies for valgus gonarthrosis. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur. 1998 Jul;84(4):350-7.
  87. Wang G, Zheng G, Gruetzner PA, Mueller-Alsbach U, von Recum J, Staubli A, Nolte LP. A fluoroscopy-based surgical navigation system for high tibial osteotomy. Technology and Health Care. 2005 Jan 1;13(6):469-83.
  88. Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T. Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surgery, Sports Traumatology, Arthroscopy. 2012 Mar 1;20(3):586-93.
  89. Picardo NE, Khan W, Johnstone D. Suppl 2: Computer[1]Assisted Navigation in High Tibial Osteotomy: A Systematic Review of the Literature. The Open Orthopaedics Journal. 2012;6:305.
  90. Victor J, Premanathan A. Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. The bone & joint journal. 2013 Nov;95(11_Supple_A):153-8.
  91. Jones GG, Jaere M, Clarke S, Cobb J. 3D printing and high tibial osteotomy. EFORT open reviews. 2018 May;3(5):254-9.
  92. Henckel J, Richards R, Lozhkin K, Harris S, Baena FR, Barrett AR, Cobb JP. Very low-dose computed tomography for planning and outcome measurement in knee replacement: the imperial knee protocol. The Journal of bone and joint surgery. British volume. 2006 Nov;88(11):1513-8.
  93. Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, Toms A. Complications associated with opening wedge high tibial osteotomy—A review of the literature and of 15 years of experience. The Knee. 2016 Mar 1;23(2):276-82.
  94. Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GR. Complications after tomofix medial opening wedge high tibial osteotomy. Journal of Knee Surgery. 2009 Jul 1;22(3):218.
  95. Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. International Orthopaedics 2010;34(2):155-60.
  96. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. The American journal of sports medicine. 2011 Jan;39(1):64-70.
  97. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. The bone & joint journal. 2014 Nov;96(11):1491-7.
  98. Niinimäki TT, Eskelinen A, Mann BS, Junnila M, Ohtonen P, Leppilahti J. Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee: Finnish registry-based study of 3195 knees. The Journal of bone and joint surgery. British volume. 2012 Nov;94(11):1517-21.
  99. Darden CN, Katsman A, Alaia MJ, Strauss EJ, Jazrawi LM. Short-Term Clinical Outcomes of High Tibial Osteotomy with the iBalance HTO System. Bulletin of the NYU Hospital for Joint Diseases. 2019 Oct 1;77(4):256-62.
How to Cite this article: Mhaskar VA, Jain Y, Maheshwari J. Current Concepts in High Tibial Osteotomy. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):24-31.

 (Abstract    Full Text HTML)   (Download PDF)

From the Desk of the President…

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 2-3 | Dr. Shubhranshu S. Mohanty

Author: Dr. Shubhranshu S. Mohanty [1]

Bombay Orthopaedic Society, KEM Hospital and Nanavati Hospital – 400050, India.

Address of Correspondence
Prof (Dr). Shubhranshu S. Mohanty
Hon. President, Bombay Orthopaedic Society.
Hospital: KEM Hospital and Nanavati Hospital, India.
E-mail: drssmohanty@hotmail.com

 

From the Desk of the President…

All over the world, people were worried about the pandemic that took a toll on the entire mankind. However, an old adage goes: “Instead of worrying about what you cannot control, shift your energy to what you can create”. But creation is always difficult, time-consuming, and involves utilising your body and mind towards an appropriate direction and cause. Moreover, when the creation is nearing completion, one tries to achieve excellence, thereby making the process longer. But when the creation is complete, the satisfaction you get is unparalleled! It’s like a mother having a baby. Despite all the ordeals, after looking at the baby’s face, a mother forgets them instantly because when the baby is born, he/she creates a Mother as well!

Academic writing’ has been the most difficult task for an Orthopod. Dealing with a difficult patient, diagnose a difficult problem, perform a difficult surgery is one thing — but to pen these experiences has traditionally not been a cup of tea for most of our esteemed members. The Bombay Orthopaedic Society (BOS) stands for academics, and academic writing is the strength of any Association. It is relatively easy to present a case, but becomes difficult to present a series of cases, and it is even more difficult to follow it up and write a manuscript. But when the manuscript is ready and accepted for publication by a peer-reviewed journal, the amount of satisfaction is overwhelming. It leaves a permanent impression about your excellence around the world and you stand alone among the peers. That is why BOS began recognising the publications of its members since 2006, when I was the Secretary of this August society.

In a time of destruction, create something… at least start with a case report. The case which you have handled differently and unconventionally gives a better outcome to not only the patient, but the entire Orthopaedic community. After your case reports are published, you can get a little confidence in going for a case series, then retrospective analysis, followed by prospective studies. Of course, all these creations are possible with good record keeping. You need to maintain a record of each and every patient you handle, from conservative or operative. Electronic gadgets are a useful tool now-a-days. Besides your creation, the record keeping will help you in handling any medicolegal issues as well. Hence it is of dual benefit to every orthopod.

While I am coming close to the end of my tenure, I shall be devoting more time to the editorial board of our journal in a different role. We are striving hard to make our “Journal of Clinical Orthopaedics” to make it indexed in PubMed. This needs more and more original articles or case reports. Hence, contributions from the grass-root level will help to build up our journal to national and international repute and get recognition with our 2,740-strong members contributing to reach a mammoth academic platform!

Let’s do it together!!

Long live BOS !

Prof. (Dr) Shubhranshu S. Mohanty

President BOS

How to Cite this article: Mohanty S. From the Desk of the President. Journal of Clinical Orthopaedics. January-June 2021;6(1):2-3.

(Abstract    Full Text HTML)   (Download PDF)

Treatment of unstable intertrochanteric femoral fractures in elderly population – A retrospective comparison between those treated by PFNA versus Primary Hemiarthroplasty of the hip

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 19-23 | Ranade Uday Arun, Anne Sai Laxman

Author: Ranade Uday Arun [1], Anne Sai Laxman [1]

[1] Department of Orthopaedics, KIMS Hospitals, Kondapur, Hyderabad, Telangana – 500084, India

Address of Correspondence
Dr. Ranade Uday Arun,
Department of Orthopaedics, KIMS Hospitals, # 1-112/86, Survey No 55/ EE, Kondapur Village, Serilingampally Mandal, Hyderabad – 500084, India
E-mail: dr.udayranade@gmail.com

Abstract

Introduction: Unstable intertrochanteric femur fractures (IFF) have traditionally been reduced and internally fixed with either a hip screw and a side plate or more recently with the proximal femur nails. To counteract the complications of prolonged recumbency, some surgeons advocated using a primary hemiarthroplasty of the hip to treat such patients.
Aim:  Present study is being done to present the data at our institute in order to further our understanding of treatment of unstable IFFs in the elderly.

Methods and Material: A retrospective comparison study where data of 32 patients with unstable IFF (AO type 31 A2 and A3), who satisfied the inclusion and exclusion criteria and who underwent either a PFNA fixation or a primary hemiarthroplasty of the hip from the period of June 2018 to Jan 2019 was collected. Follow up was for a minimum of 12 months. Baseline data, perioperative data and post-operative data was collected. Statistical analysis was done by a statistician using SPSS software Ver 21.0.
Results: PFNA group showed significantly better Harris hip scores at the end of 12 months than the PHH group. Even the surgical time, intra-operative bleeding, amount of blood transfusions and length of stay was significantly less in PFNA group than PHH group.
Conclusions: Proximal femur fixation with PFNA device with its smaller incision, lower blood loss, faster operating time and shorter hospital stay has definitive advantages over a primary hemiarthroplasty hip.
Keywords: Unstable Intertrochanteric Femur Fractures, PFNA, Primary hemiarthroplasty Hip, Bipolar modular prosthesis, Proximal femur fixation

References

1. . Zhou S, Liu J, Zhen P, Shen W, Chang Y, Zhang H, et al. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: Aretrospective study. BMC Musculoskelet Disord 2019;20:500.
2. Koval KJ. Intramedullary nailing of proximal femur fractures. Am J Orthop (Belle Mead NJ) 2007;36 Suppl 4:4-7.
3. Park MS, Cho HM, Kim JH, Shin WJ. Cementless bipolar hemiarthroplasty using a rectangular cross-section stem for unstable intertrochanteric fractures. Hip Int 2013;23:316-22.
4. Luo X, He S, Zeng D, Lin L, Li Q. Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: Case report. Int J Surg Case Rep 2017;38:37-42.
5. Bansal K, Dahuja A, Kaur R, Singh J, Shyam R. Proximal femur nail vs cemented bipolar prosthesis in unstable intertrochanteric femur fractures in elderly: A prospective study. Int J Orthop Sci 2019;5:642-5.
6. Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma 1987;1:298-305.
7. Kumar GN, Meena S, Kumar NV, Manjunath S, Raj MK. Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: A prospective study. J Clin Diagn Res 2013;7:1669-71.
8. Lee YK, Ha YC, Chang BK, Kim KC, Kim TY, Koo KH. Cementless bipolar hemiarthroplasty using a hydroxyapatite-coated long stem for osteoporotic unstable intertrochanteric fractures. J Arthroplasty 2011;26:626-32.
9. Enocson A, Mattisson L, Ottosson C, Lapidus LJ. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop 2012;83:493-8.
10. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: A study for the treatment of intertrochanteric fractures. Injury 2012;43:876-81.
11. Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: A systematic literature review and meta-analysis. Int Orthop 2020;44:623-33.

How to Cite this article: Arun RU, Laxman AS. Treatment of unstable intertrochanteric femoral fractures in elderly population – A retrospective comparison between those treated by PFNA versus Primary Hemiarthroplasty of the hip. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):19-23.

 (Abstract    Full Text HTML)   (Download PDF)

Interview with Dr. Nandkishore Laud conducted by Dr Ashok Shyam and Dr Nicholas Antao

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 92-94 | Nandkishore Laud, Ashok Shyam, Nicholas Antao

Author: Nandkishore Laud [1], Ashok Shyam [1], Nicholas Antao 

[1] Department of Orthopaedics, KIMS Hospitals, Kondapur, Hyderabad, Telangana – 500084, India

Address of Correspondence
Dr. Ranade Uday Arun,
Department of Orthopaedics, KIMS Hospitals, # 1-112/86, Survey No 55/ EE, Kondapur Village, Serilingampally Mandal, Hyderabad – 500084, India
E-mail: dr.udayranade@gmail.com

Abstract

Introduction: Unstable intertrochanteric femur fractures (IFF) have traditionally been reduced and internally fixed with either a hip screw and a side plate or more recently with the proximal femur nails. To counteract the complications of prolonged recumbency, some surgeons advocated using a primary hemiarthroplasty of the hip to treat such patients.
Aim:  Present study is being done to present the data at our institute in order to further our understanding of treatment of unstable IFFs in the elderly.

Methods and Material: A retrospective comparison study where data of 32 patients with unstable IFF (AO type 31 A2 and A3), who satisfied the inclusion and exclusion criteria and who underwent either a PFNA fixation or a primary hemiarthroplasty of the hip from the period of June 2018 to Jan 2019 was collected. Follow up was for a minimum of 12 months. Baseline data, perioperative data and post-operative data was collected. Statistical analysis was done by a statistician using SPSS software Ver 21.0.
Results: PFNA group showed significantly better Harris hip scores at the end of 12 months than the PHH group. Even the surgical time, intra-operative bleeding, amount of blood transfusions and length of stay was significantly less in PFNA group than PHH group.
Conclusions: Proximal femur fixation with PFNA device with its smaller incision, lower blood loss, faster operating time and shorter hospital stay has definitive advantages over a primary hemiarthroplasty hip.
Keywords: Unstable Intertrochanteric Femur Fractures, PFNA, Primary hemiarthroplasty Hip, Bipolar modular prosthesis, Proximal femur fixation

How to Cite this article: Laud N, Shyam AK, Antao N. Orthowalkathon: Interview with Dr. Nandkishore Laud
conducted by Dr Ashok Shyam and Dr. Nicholas Antao. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):92-94.

 (Abstract    Full Text HTML)   (Download PDF)

ALPSA Lesion or Bankart does it Really Matter in Shoulder Instability? A Review of Literature with Surgical Technique for ALPSA Repair

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  January-June 2021 | page: 14-18 | Timothy Weiwen Teo, Andy Teck Huat Wee

Author: Timothy Weiwen Teo [1], Andy Teck Huat Wee [1]

[1] Consultant Orthopaedic Surgeon Khoo Teck Puat Hospital

[2] Consultant Orthopaedic Surgeon Pinnacle Orthopaedic Group

Address of Correspondence
Dr. Timothy Weiwen Teo,
Consultant Orthopaedic Surgeon Khoo Teck Puat Hospital
E-mail: timothyteo.ww@gmail.com

Abstract

The anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion has been described as a distinct pathology from the classic Bankart lesion in anterior glenohumeral instability. ALPSA lesions are associated with younger patients, patients with more chronic symptoms, more episodes of pre-operative instability and associated with increased humeral and glenoid bone loss as compared to Bankart lesions. After surgery, ALPSA lesions also have a higher risk of redislocations and greater loss of range of motion. In this article, we outline some surgical pearls in dealing with ALPSA lesions.

Keywords: Anterior labroligamentous periosteal sleeve avulsion, bankart, traumatic anterior shoulder instability, labrum

References

1. KHovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res 1982;166:127-31.
2. Bankart AS. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 1939;26:23-9.
3. Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 2007;23:985-90.
4. Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: Acause of anterior instability of the shoulder. Arthroscopy 1993;9:17-21.

5. Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJ. Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Arthroscopy 2008;24:1277-83.
6. Lee BG, Cho NS, Rhee YG. Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2011;19:1563-9.
7. Bernhardson AS, Bailey JR, Solomon DJ, Stanley M, Provencher MT. Glenoid bone loss in the setting of an anterior labroligamentous periosteal sleeve avulsion tear. Am J Sports Med 2014;42:2136-40.
8. Ahmad CS, Galano GJ, Vorys GC, Covey AS, Gardner TR, Levine WN. Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single-and double-row capsulolabral repairs. J Shoulder Elbow Surg 2009;18:948-54.
9. Burkhart SS, de Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging HillSachs lesion. Arthroscopy 2000;16:677-94.
10. Farber JM, Buckwalter KA. Sports related injuries of the shoulder: Instability. Radiol Clin North Am 2002;40:235-49.
11. Elentuck D, Palmer WE. Direct magnetic resonance arthrography. Eur Radiol 2004;14:1956-67.
12. Shankman S, Bencardino J, Beltran J. Glenohumeral instability: Evaluation using MR arthrography of the shoulder. Skeletal Radiol 1999;28:365-82.
13. Magee T. 3-T MRI of the shoulder: Is MR arthrography necessary? AJR Am J Roentgenol 2009;192:86-92.
14. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res 1993;291:20-8.
15. Owens BD, Nelson BJ, Duffey ML, Mountcastle SB, Taylor DC, Cameron KL, et al. Pathoanatomy of first-time, traumatic, anterior glenohumeral subluxation events. J Bone Joint Surg Am 2010;92:1605-11.
16. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Arthroscopy 2003;19:722-31.
17. Magee T, Williams D, Mani N. Shoulder MR arthrography: Which patient group benefits most? AJR Am J Roentgenol 2004;183:969-74
18. Gaunt BW, Shaffer MA, Sauers EL, Michener LA, McCluskey GM, Thigpen C. The American society of shoulder and elbow therapists’ consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther 2010;40:155-68.
19. Nolte PC, Arner JW, Cooper JD, Elrick BP, Millett PJ. Arthroscopic fixation of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) of the shoulder. Arthrosc Tech 2020;9:e553-8.

20. Spatschil A, Landsiedl F, Anderl W, Imhoff A, Seiler H, Vassilev I, et al. Posttraumatic anteriorinferior instability of the shoulder: Arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 2006;126:217-22.
21. Zhu W, Lu W, Zhang L, Han Y, Ou Y, Peng L, et al. Arthroscopic findings in the recurrent anterior instability of the shoulder. Eur J Orthop Surg Traumatol 2014;24:699-705.

How to Cite this article: Teo TW,  Wee ATH. ALPSA Lesion or Bankart does it Really Matter in Shoulder Instability? A Review of Literature with Surgical Technique for ALPSA Repair. Journal of Clinical Orthopaedics Jan-Jun 2020;6(1): 14-18.

 (Abstract    Full Text HTML)   (Download PDF)

Whats new in Paediatric Orthopaedics in 2020?

/in /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 89-91 | Arkesh M, Sandeep Patwardhan, Ashok Shyam

Author: Arkesh M [1], Sandeep Patwardhan [1], Ashok Shyam [1]

[1] Sancheti Institute for Orthopaedics and Rehabilitation, Shivajinagar, Pune, Maharashtra India.

Address of Correspondence
Dr. Arkesh M,
Paediatric Orthopaedic Fellow, Sancheti Institute for Orthopaedics and Rehabilitation, Shivajinagar, Pune, Maharashtra India
E-mail: dr.arkesh@gmail.com

References

1. Li J, Yue C, Wang HQ, Guo X, Chen K, Ma J, Wang J, Tang X. External fixation and Kirschner wires in the treatment of paediatric displaced supracondylar femur fractures. J Child Orthop. 2020 Aug 1;14(4):293-298.
2. Teo TL, Schaeffer EK, Habib E, El-Hawary R, Larouche P, Shore B, Aarvold A, Carsen S, Reilly C, Mulpuri K. Is the modified Gartland classification system important in deciding the need for operative management of supracondylar humerus fractures? J Child Orthop 2020;14: 502-507.
3. Kuzma AL, Talwalkar VR, Muchow RD, Iwinski HJ, Milbrandt TA, Jacobs CA, Walker JL. Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus. J Pediatr Orthop. 2020 Jan;40(1):e25-e29.
4. Lin JS, Samora JB. Pediatric acute compartment syndrome: a systematic review and meta-analysis. J Pediatr Orthop B. 2020 Jan;29(1):90-96.
5. Mellor X, Buczek MJ, Adams AJ, Lawrence JTR, Ganley TJ, Shah AS. Collection of Common Knee Patient-reported Outcome Instruments by Automated Mobile Phone Text Messaging in Pediatric Sports Medicine. J Pediatr Orthop. 2020 Feb;40(2):e91-e95.
6. Miller DJ, Flynn JJM, Pasha S, Yaszay B, Parent S, Asghar J, Abel MF, Pahys JM, Samdani A, Hwang SW, Narayanan UG, Sponseller PD, Cahill PJ; Harms Study Group. Improving Health-related Quality of Life for Patients With Nonambulatory Cerebral Palsy: Who Stands to Gain From Scoliosis Surgery? J Pediatr Orthop. 2020 Mar;40(3):e186- e192.
7. Dinçer R, Köse A, Topal M, Öztürk İA, Engin MÇ. Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed? J Pediatr Orthop B. 2020 Mar;29(2):158-163.
8. Ernat JJ, Wimberly RL, Ho CA, Riccio AI. Vascular examination predicts functional outcomes in supracondylar humerus fractures: a prospective study. J Child Orthop 2020;14: 495-501.
9. Wang C, Su Y. An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. J Pediatr Orthop. 2020 Mar;40(3):e216-e221.
10. Adams AJ, Mahmoud MAH, Wells L, Flynn JM, Arkader A. Physeal fractures of the distal femur: does a lower threshold for surgery lead to better outcomes? J Pediatr Orthop B. 2020 Jan;29(1):40-46.

How to Cite this article: Arkesh M, Patwardhan S, Shyam A. Whats new in Paediatric Orthopaedics in 2020. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):89-91.

 (Abstract    Full Text HTML)   (Download PDF)