Publications by authors named "Sachin Tapasvi"

19 Publications

  • Page 1 of 1

Anterior Cruciate Ligament Rupture with Medial Collateral Ligament Tear with Lateral Meniscus Posterior Root Tear with Posterolateral Tibia Osteochondral Fracture: A New Injury Tetrad of the Knee.

J Orthop Case Rep 2020 May-Jun;10(3):36-42

The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Introduction: Injuries to the knee ligaments, menisci, and cartilage are possible in high-velocity trauma as in road traffic accidents. Similarly, these structures can be disrupted in proximal tibia fractures. We present a series of three cases which had a previously undescribed injury combination.

Case Presentation: The first and second patients presented primarily to us following fall from motorbikes. Both these patients had injuries of the anterior cruciate ligament (ACL), medial collateral ligament (MCL), lateral meniscus body and posterior root tear, and osteochondral fracture of posterolateral tibia. The osteochondral fracture was managed by internal fixation with headless compression screws. The ligaments were either repaired or reconstructed and meniscus root tear was treated by transtibial pull through repair. The third patient also had the same injury but was treated at another center. He presented with early arthritis of the lateral tibiofemoral joint and valgus malalignment. Treatment for him was in the form of lateral distal femur open-wedge osteotomy and MCL reconstruction. All three patients had good outcome at the end of 1year.

Conclusion: We report a new injury tetrad of ACL tear, MCL tear, lateral meniscus posterior root tear, and posterolateral tibia osteochondral fracture. The mechanism of injury is most likely a violent external rotation and anterior translation of the tibia with a valgus directed force during impact. The treatment of this injury can be performed in single or two stages based on the merits of the case. Anatomic reduction and fixation of the fracture takes precedence to avoid later devastating sequel for the knee.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.13107/jocr.2020.v10.i03.1738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051566PMC
May 2021

Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study.

Indian J Orthop 2021 Apr 12;55(2):416-424. Epub 2021 Mar 12.

SRM University, Kattankulathur, Tamilnadu India.

Objectives: The objectives were: (1) to analyze the MRI healing rates of bucket-handle meniscus repair; (2) to compare the accuracy of assessment of meniscus healing for conventional MRI and Indirect Magnetic Resonance Arthrography (IMRA); and (3) to identify patients who may require second-look arthroscopy after meniscus repair.

Methods: This is a prospective observational case series of thirty-seven patients with repaired bucket-handle medial meniscus tear with a minimum one year follow-up. Meniscus healing rates were assessed on direct MRI and IMRA using Henning's criteria. At the same time, patients' symptoms were evaluated according to Barrett's criteria and functional outcomes were recorded using International Knee Documentation Committee (IKDC) score, Knee Osteoarthritis and Outcomes Score (KOOS) and Tegner-Lysholm scores. A further clinical review was performed 18 months after the imaging to assess the evolution of symptoms.

Results: At a mean of 22.3 ± 7.8 months after the meniscus repair, 56.7% patients showed complete healing and 40.5% patients demonstrated incomplete repair healing on IMRA. 52% patients with complete healing and 40% patients with incomplete healing demonstrated meniscus symptoms. At the second clinical review, 19% patients with complete healing and 20% patients with incomplete healing had meniscus symptoms. There was no co-relation between symptoms, PROMs and healing on MRI.

Conclusion: Indirect MR arthrography offers distinct advantages over direct MRI for assessment of meniscus healing, especially in symptomatic patients. Patient-reported outcome measures and symptomatology are not co-related with the healing status of the meniscus and they resolve in the majority on longer follow-up. A more conservative approach guided by IMRA to assess meniscus healing will avoid early re-operations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43465-020-00334-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046888PMC
April 2021

Management Guidelines for Infection After ACL Reconstruction: Expert Opinion Statement Based on the Modified Delphi Survey of Indian Arthroscopy Surgeons.

Indian J Orthop 2021 Apr 1;55(2):342-351. Epub 2021 Feb 1.

Department of Orthopaedics, Maulana Azad Medical College, New Delhi, 110002 India.

Aim: Infection after anterior cruciate ligament (ACL) reconstruction, though rare, is a potentially devastating complication and the evidence-based recommendation on the various topics in its management is limited. The purpose of this study was to develop recommendations for the prevention and management of infections in ACL reconstruction surgery by performing a structured expert consensus survey using Delphi methodology.

Materials And Methods: 22 topics of relevance in the prevention and management of infection following ACL reconstruction were chosen from an extensive literature review. 30 panelists were requested to respond to a three-round survey, with feedback, to develop a consensus statement on the topics.

Results: Consensus statements could be prepared in eleven out of twenty-two topics including: the graft is retained at the first arthroscopic debridement, the graft is removed when repeated debridement are needed, and revision ACL reconstruction is needed only if the patient develops instability. Concurrence could be obtained in the topics including: longer duration of antibiotics is needed in immunocompromised patients, soaking graft in antibiotic solution reduces infection risk, and knee swelling without warmth does not suggest infection.

Conclusions: A proper skin preparation, a longer course of antibiotics in immunocompromised patients, and soaking the graft in antibiotics reduces the risk of infection. In case of infection, a healthy-looking graft must be retained at the first debridement and if the graft must be removed, revision ACL reconstruction is advised only if the patient develops instability.

Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00363-z.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43465-021-00363-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046894PMC
April 2021

Revision ACL Reconstruction: Principles and Practice.

Indian J Orthop 2021 Apr 19;55(2):263-275. Epub 2021 Jan 19.

The Orthopaedic Speciality Clinic, 16 Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004 India.

Introduction: The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and so is the number of revision surgeries for a failed ACLR. The spectrum of ACL failure includes symptoms of recurrent instability, pain, and/or stiffness.

Discussion: Factors contributing to ACL failure may be classified as patient-related, surgeon-related, and biological factors. Of these, tunnel malposition and recurrent trauma are the most common causes. Detailed patient assessment, imaging, and studying details of the index surgery are critical prior to planning revision surgery. Infection has to be ruled out prior to planning any reconstructive surgical procedure. Osseous malalignment in the coronal or sagittal planes would also need correction along with or prior to revision ACL surgery. Revision ACL reconstruction maybe performed as a one-stage or two-stage procedure. Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two-stage approach. Autografts are preferred for revision ACL due their lesser re-tear rates and better outcomes. Associated meniscus tears and cartilage injuries are more common in revision than in primary surgery and need to be managed appropriately. Extra-articular reconstruction for controlling anterolateral instability is frequently required as well.

Conclusion: Revision ACL reconstruction is a complex undertaking due to limited graft options, compromised anatomy and high frequency of associated injuries. Patient expectations must be tempered because functional outcomes and return to pre-injury sports are inferior to a primary surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43465-020-00328-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046893PMC
April 2021

Discoid lateral meniscus: current concepts.

J ISAKOS 2021 01 16;6(1):14-21. Epub 2020 Sep 16.

Orthopedic Surgery, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden.

The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jisakos-2017-000162DOI Listing
January 2021

Anatomic medial knee reconstruction restores stability and function at minimum 2 years follow-up.

Knee Surg Sports Traumatol Arthrosc 2021 Feb 22. Epub 2021 Feb 22.

Consultant Orthopaedic Surgeon, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.

Purpose: Chronic grade 3 tears of the medial collateral ligament and posterior oblique ligament may result in valgus laxity and anteromedial rotational instability after an isolated or multiligament injury. The purpose of this study was to prospectively analyze the restoration of physiologic medial laxity as assessed on stress radiography and patient reported subjective functional outcomes in patients who undergo an anatomic medial knee reconstruction.

Methods: This was a prospective study which included patients with chronic (> 6 weeks old) posteromedial corner injury with or without other ligament and meniscus lesions. Pre- and post-operative valgus stress radiographs were performed in 20° knee flexion and functional outcome was recorded as per the International Knee Documentation Committee (IKDC) and Lysholm scores. All patients underwent anatomic medial reconstruction with two femoral and two tibial sockets using ipsilateral hamstring tendon autograft. Simultaneous ligament and meniscus surgery was performed as per the associated injury pattern. All patients were followed up for a minimum of 24 months post-surgery.

Results: Thirty-four patients (23 males, 11 females) were enrolled in the study and all were available till final follow-up of mean 49.7 ± 14.9 months. The mean age was 30.6 ± 7.9 (18-52 years). Two patients had isolated medial sided lesions and 23 had associated ligament injuries. The mean follow up was 49.7 (24-72) months. The mean IKDC score improved from 58 ± 8.3 to 78.2 ± 9.5 (p < 0.001). Post-operatively there were 15 excellent, 11 good and 8 fair outcomes on Lysholm score. The mean pre-operative valgus side-to-side opening improved from 7.5 ± 2.5 mm to 1.2 ± 0.7 mm on stress radiography (p < 0.001).

Conclusion: Anatomic reconstruction of the superficial medial collateral and posterior oblique ligaments restore stability in a consistent manner cases of chronic grade 3 instability. The objective functional results, subjective outcomes and measures of static medial stability are satisfactory in the short term.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-021-06502-1DOI Listing
February 2021

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty: an experimental cadaveric study.

Bone Joint Res 2020 Jun 23;9(6):272-278. Epub 2020 Jul 23.

University of Leeds, Leeds, UK.

Aims: The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position.

Methods: A total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position.

Results: Tibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM.

Conclusion: The sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/2046-3758.96.BJR-2019-0258.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376280PMC
June 2020

Does increased femoral component size options reduce anterior femoral notching in total knee replacement?

J Clin Orthop Trauma 2020 Mar 16;11(Suppl 2):S223-S227. Epub 2019 Mar 16.

The Orthopaedic Speciality Clinic, 16 Status Chambers, 1221/A Wrangler Paranjpe Road, Off F.C. Road, Pune, 411004, India.

Objective: Total knee arthroplasty (TKA) is currently the best option for management of advanced knee arthritis for patients who have exhausted conservative management. There have been significant implant design improvements and this is a continuing process to help the surgeon replicate patient anatomy and kinematics. Amongst the many variables in implantation to achieve a well-functioning TKA, getting optimal femoral component sizing is one. Every implant system has certain discreet implant sizes and the surgeon has to strive to obtain the best fit possible for the patient and attain a well aligned and stable TKA. The aim of this study was to assess the frequency of various femoral component sizes being implanted with a system which has 2.5 mm antero-posterior increment between sizes, and to assess the incidence of anterior femoral notching when using a posterior referencing system.

Materials And Methods: A retrospective analysis of 739 TKAs implanted in 532 patients between January 2013 and January 2016 at a single center using a single posterior stabilized implant system was done. Patient demographics and femur component size used was obtained from hospital patient records. Immediate post-operative radiographs were analyzed to look for anterior femoral notching and presence of this was classified according to Tayside classification. A telephonic follow up at minimum 2 tears post-surgery was done to interview for occurrence of supracondylar femur fracture or revision for any other causes.

Results: There were 207 bilateral and 325 unilateral TKAs performed in 532 patients during the study period. There were 245 males and 287 females with an average age of 61.3 years (43-81 years, SD = 7.2). The most commonly used femoral component was 60 mm and an intermediate size prosthesis was used in 43.11% patients. The incidence of femoral notching ranged from 0 to 6.3%. No patient had sustained a supracondylar condylar fracture at minimum 2 years follow up.

Conclusion: The availability of a larger number of femoral components in a TKA system allows the surgeon the modularity to choose and obtain the best fit possible. Restoration of posterior condylar offset, preventing anterior notching, medio-lateral overhang and patellofemoral joint stuffing are greatly dependent on correct femoral component sizing. The findings from our study underscore the need to use an implant system with as many femoral size options as possible with lesser increments in between sizes to minimize anterior femoral notching when using a posterior referencing technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcot.2019.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068002PMC
March 2020

Anatomic Posterolateral Corner Reconstruction With Autogenous Peroneus Longus Y Graft Construct.

Arthrosc Tech 2019 Dec 11;8(12):e1501-e1509. Epub 2019 Nov 11.

SRM Medical College, SRM Institute of Science and Technology, Kattankulathur, India.

The posterolateral corner of the knee is composed of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, which provide varus and rotational stability to the knee. An anatomic technique reconstructs these structures through 2 femoral sockets and 1 tibial and 1 fibular tunnel. This reconstruction can be performed using a peroneus longus autograft that is prepared as a Y construct. The peroneus longus autograft is preferred because it provides adequate length and diameter for the entire reconstruction. Initially, the doubled loop of the Y is passed into the tibial tunnel and fixed with an adjustable cortical button. The shorter limb of the Y is used for reconstruction of the popliteus tendon. The longer limb of the Y is passed from posterior to anterior through the fibular tunnel and is fixed in the tunnel with an interference screw to re-create the popliteofibular ligament. The remaining graft is then shuttled deep to the iliotibial band and superficial to the popliteus tendon, into the femoral socket, to re-create the fibular collateral ligament.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2019.07.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928377PMC
December 2019

Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee.

J Arthroplasty 2020 03 10;35(3):732-740. Epub 2019 Oct 10.

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA.

Background: Total knee arthroplasty requires careful surgical technique to attain the goal of a well-aligned and symmetrically balanced knee. Soft tissue balance and correct femoral component rotation are paramount in achieving these goals. The two competing techniques to select femoral component rotation and soft tissue balance are the gap balance technique and the measured resection technique.

Methods: We performed a randomized, prospective study to compare the two techniques in patients undergoing simultaneous bilateral total knee arthroplasty, whereby one technique was performed in each knee. Fifty (50) subjects were enrolled into the study. The inclusion criteria were osteoarthritic varus knee deformities with similar deformities in both knees. Subjects were followed up for a minimum of two years.

Results: The knees balanced via the gap balance technique had significantly more posterior medial bone removed from the femur than those knees balanced via the measured resection technique (P < .001). Knees in the gap balance group tended to require more medial knee releases in extension and tended to have smaller sized femoral components as a result of cutting more bone from the femur in flexion. The modular tibial polyethylene bearing tended to be thicker in the gap balance group. Despite these differences, average knee flexion and functional revised Oxford Knee Scores at 2-year follow-up were not statistically different.

Conclusion: At 2-year follow-up, there were no differences between the function and scores using the two techniques. Long-term follow-up will be necessary to evaluate any differences in long-term durability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2019.10.002DOI Listing
March 2020

Viscosupplementation for Management of Knee Osteoarthritis from an Indian Perspective: An Expert Consensus Report.

Pain Ther 2019 Dec 15;8(2):217-231. Epub 2019 Jul 15.

Medical Affairs GG India, Dr. Reddy's Laboratories Ltd, Hyderabad, India.

Introduction: Knee osteoarthritis (OA) is a progressive degenerative condition and is a significant contributor toward physical disability in the aging population. The current treatment modalities for this condition focus on joint preservation with alleviation of symptoms. Intra-articular hyaluronic acid (IAHA) injections have emerged as the promising mainstay of nonsurgical treatment of OA, especially in patients with mild-to-moderate OA and in certain subgroups of severe OA with comorbidities or with poor response to first-line therapy. The absence of standard guidelines or recommendations for the use of IAHA in India has led to vast variations in the usage of IAHA among practitioners. Hence, this consensus-based document aims to address the issue and establish simplified and easily implemented recommendations on the use of IAHA.

Methods: A group of 78 expert orthopedic surgeons discussed in detail the evidence on appropriate criteria for diagnosis, patient selection, and follow-up evaluation for knee OA at two national meetings. In subsequently held regional meetings, key discussion points and clinical experience-based answers were translated into a questionnaire to develop the final expert consensus-based statements for the use of IAHA in patients with knee OA.

Results: Various consensus statements were obtained on the basis of scientific evidence obtained from PubMed, Cochrane-indexed database, and guidelines related to viscosupplementation and knee OA as well as the experts' clinical experience. This document was drafted, reviewed, validated, and modified by the expert panel until a final agreement was reached.

Conclusion: In this pioneering attempt, the document lays down structured, expert consensus-based statements to guide and align practitioners on the appropriate use of IAHA in the Indian setting.

Funding: Dr. Reddy's Laboratories Ltd.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40122-019-0131-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857206PMC
December 2019

Osteochondral Lesion in Diffuse Pigmented Villonodular Synovitis of the Knee.

Knee Surg Relat Res 2019 Mar;31(1):67-71

Department of Orthopaedic Surgery, The Orthopaedic Speciality Clinic, Pune.

Pigmented villonodular synovitis (PVNS) is a rare benign condition that is locally aggressive and may destructively invade the surrounding soft tissues and bone causing functional loss of the joint and the limb. The knee is the most affected joint (range, 28% to 70%) but involvement of the bone is not a common feature seen at this site. We present a rare case of diffuse PVNS of the knee associated with subchondral cyst of the lateral femoral condyle. This posed a diagnostic dilemma because of bone invasion. The radiological image of synovitis was pathognomonic of PVNS but etiology of the osteolytic lesion was confirmed only on histopathology. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5792/ksrr.18.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425890PMC
March 2019

Knotless Medial Meniscus Posterior Root Repair.

Arthrosc Tech 2018 May 2;7(5):e429-e435. Epub 2018 Apr 2.

Orthopaedic Specialty Clinic, Pune, India.

Medial meniscus posterior root tears are common injuries, especially in the Asian world. This injury must be repaired where indicated to restore knee biomechanics and prevent arthritis. Suturing the meniscus using suture tapes provides good hold of the tissue. The use of a 70° arthroscope and creation of a transseptal portal improve visualization of the posterior compartment. Creation of a high posteromedial portal achieves the correct trajectory for the suture anchor insertion. A knotless suture anchor can be used to fix the posterior root at its anatomic attachment site. This obliterates the need for transtibial drilling for a suture pull-out repair or for knot tying and suture shuttling as for a conventional suture anchor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2017.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984279PMC
May 2018

Primary Anterior Cruciate Ligament Repair With Augmentation.

Arthrosc Tech 2018 Feb 22;7(2):e139-e145. Epub 2018 Jan 22.

SRM Medical College, SRM University, Kattankulathur, Tamil Nadu, India.

Anterior cruciate ligament (ACL) tears are usually managed by reconstruction with autograft or allograft, but primary repair in carefully selected patients is a reasonable option. Proximal avulsions presenting early with excellent tissue quality are amenable to repair and healing. Restoration of native ACL preserves its proprioceptive and kinematic functions. A repair is less invasive and avoids graft-related problems, and faster rehabilitation is possible. Protection for the repair in the early stages will allow better healing. We present our technique of ACL repair using knotless suture anchors with high-strength sutures and protection using high-strength sutures tapes inserted through the same anchors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2017.08.063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851946PMC
February 2018

Meniscal Preservation is Important for the Knee Joint.

Indian J Orthop 2017 Sep-Oct;51(5):576-587

The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Native joint preservation has gained importance in recent years. This is mostly to find solutions for limitations of arthroplasty. In the knee joint, the menisci perform critical functions, adding stability during range of motion and efficiently transferring load across the tibiofemoral articulation while protecting the cartilage. The menisci are the most common injury seen by orthopedicians, especially in the younger active patients. Advances in technology and our knowledge on functioning of the knee joint have made meniscus repair an important mode of treatment. This review summarizes the various techniques of meniscus tear repair and also describes biological enhancements of healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ortho.IJOrtho_247_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609379PMC
October 2017

Localized pigmented villonodular synovitis of posterior compartment of the knee.

J Orthop Surg (Hong Kong) 2017 Sep-Dec;25(3):2309499017727923

1 The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Pigmented villonodular synovitis (PVNS) is an uncommon entity involving articular or extra-articular tissues and maybe localized or diffuse in extent. The knee is by far the commonest joint to get involved. Localized PVNS of the knee can occur in any location but its confinement to the posterior compartment is infrequent. We present our experience of managing localized posterior compartment PVNS of the knee. There were 10 patients (7 males and 3 females) with average age of 33 years. These patients had symptoms of pain, locking, or swelling for a mean of 13.9 years before diagnosis. All the patients underwent arthroscopic synovectomy without adjuvant therapy, and PVNS was proven on histopathology. At an average follow-up of 23 months, no patient had recurrence of symptoms. The average International Knee Documentation Committee (IKDC) score at last follow-up was 85.21. Magnetic resonance imaging evaluation at final follow-up did not reveal any residual disease or recurrence in any patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2309499017727923DOI Listing
July 2018

Primary Repair of Tibial-Sided Avulsion of the Anterior Cruciate Ligament.

Arthrosc Tech 2016 Aug 15;5(4):e901-e906. Epub 2016 Aug 15.

The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Lesions of the anterior cruciate ligament (ACL) are common; the current gold standard of treatment for such lesions is ACL reconstruction. Tibial-sided soft-tissue avulsion is a rare subtype of ACL injuries. Unlike femoral-sided ACL repair, surgery for acute tibial-sided ACL ruptures has been neither reported nor described. This technical note presents a method for primary anatomic ACL reinsertion for an acute distal soft-tissue avulsion-type ACL injury, using a transosseous pull-out repair technique. Our technique, as an alternative to reconstruction, has the potential to enhance healing due to marrow stimulation (tibial tunneling). It also preserves the native insertion site and proprioceptive function, which may, in turn, reduce the risk of post-traumatic osteoarthritis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2016.04.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040597PMC
August 2016

Thromboprophylaxis with dabigatran after total hip arthroplasty in Indian patients: A subanalysis of a double-blind, double-dummy, randomized RE-NOVATE II study.

Asian J Surg 2017 Apr 30;40(2):145-151. Epub 2016 Apr 30.

Fortis Hospital, Mohali, India.

Objective: In the Re-NOVATE II study, oral dabigatran provided thromboprophylaxis after total hip arthroplasty and improved compliance postdischarge in a global population. This article aims to identify trends (if any) in the Indian population.

Methods: In this prospective, double-blind, double-dummy study, patients scheduled for primary, unilateral, elective total hip arthroplasty were randomized to 220 mg oral dabigatran once daily, starting with a 110 mg half-dose, 1-4 hours after surgery, or subcutaneous enoxaparin 40 mg once daily, starting the evening before surgery. Each group received a placebo of the other study drug. The primary efficacy outcome was the composite of total venous thromboembolism (VTE) and all-cause mortality. Secondary outcome measures were composite of major VTE and VTE-related mortality during the treatment period. The major safety outcome was incidence of bleeding events.

Results: Of the 179 Indian patients randomized, 91 received oral dabigatran and 88 received subcutaneous enoxaparin for 28-35 days. Total VTE and all-cause mortality occurred in 18.7% of patients in the dabigatran group and 13.7% in the enoxaparin group [odds ratio = 1.4 (95% confidence interval 0.6, 3.5)]. Major VTE and VTE-related mortality was numerically lower in the dabigatran group (7.9%) compared with the enoxaparin group (9.9%). Safety outcomes were comparable between both groups.

Conclusion: Dabigatran is an effective oral alternative to enoxaparin for thromboprophylaxis as demonstrated by the RE-NOVATE II study global results. Data analyzed in Indian patients indicate comparable effects of dabigatran etexilate for major efficacy and safety outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asjsur.2015.10.007DOI Listing
April 2017

Osteochondral autografts.

Curr Rev Musculoskelet Med 2015 Dec;8(4):423-8

The Orthopaedic Speciality Clinic, 16 Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004, India.

The healing potential for articular cartilage lesions is limited due to many physiological, local and mechanical factors. Spontaneous healing of partial- and full-thickness lesions is slow, and subsequent tissue response is usually not durable. In symptomatic, and high-demand, patients, a definitive treatment modality must be offered which allows for a sustained recovery with minimal debilitation. Injuries, which damage the subchondral bone, heal with the formation of fibrocartilage. This tissue fails long-term survival because of its inability to withstand the variable cyclic loads and compression forces that it is subjected to. While regeneration of the damaged cartilage by an entirely new articular surface is a goal beyond current available techniques, repair of the osteochondral defects with normal hyaline cartilage is possible by various options. Osteochondral defects that are larger then 2 cm are best treated by osteochondral autograft technique. The short-term outcomes of the present series show excellent results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12178-015-9299-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630221PMC
December 2015