Indian Journal of Orthopaedics最新文献

Introduction

Injuries to the posterolateral compartment (PLC) of the knee require special attention, as incorrect diagnosis and treatment may lead to considerable morbidity. However, no gold standard treatment has been established for PLC injuries.

Methods

38 patients with concomitant (posterior cruciate ligament (PCL) and PLC injuries were divided into two groups according to surgical treatment of the proximal popliteal tendon injury. They were treated with anatomic popliteal tendon, lateral collateral ligament (LCL), and popliteofibular ligament (PFL) reconstruction (group 1; n = 19) and were treated with popliteal tendon tenodesis, LCL, and PFL reconstruction (group 2; n = 19). The Lysholm score, dial test, and lateral compartment opening on varus stress X-ray were used as outcome measurements evaluated before surgery and at 6, 12, and 24 months of follow-up.

Results

Overall, there was a progressive improvement in the Lysholm score and the lateral opening on varus stress radiography during the evaluated periods for both groups (p < 0.001). Patients from group 2 recorded better Lysholm scores than those from group 1 at 12- and 24-month follow-up (p = 0.02). Dial test was negative in all patients after 6, 12, and 24 months.

Conclusion

Patients with popliteal tendon tenodesis were found to have better Lysholm scores than patients with reconstruction after 12 and 24 months of follow-up. There was no difference in the lateral joint opening evaluated by stress radiography between groups. These results show that tenodesis could be a viable treatment option for lateral femoral condyle popliteal disruptions in the context of PLC and PCL combined injuries, and should be considered in the surgical planning process.

Introduction

Osteoporosis is a significant and growing global public health problem, projected to increase in the next decade. The Singh Index (SI) is a simple, semi-quantitative evaluation tool for diagnosing osteoporosis with plain hip radiographs based on the visibility of the trabecular pattern in the proximal femur. This work aims to develop an automated tool to diagnose osteoporosis using SI of hip radiograph images with the help of machine learning algorithms.

Methods

We used 830 hip X-ray images collected from Indian men and women aged between 20 and 70 which were annotated and labeled for appropriate SI. We employed three state-of-the-art machine learning algorithms—Vision Transformer (ViT), MobileNet-V3, and a Stacked Convolutional Neural Network (CNN)—for image pre-processing, feature extraction, and automation. Each algorithm was evaluated and compared for accuracy, precision, recall, and generalization capabilities to diagnose osteoporosis.

Results

The ViT model achieved an overall accuracy of 62.6% with macro-averages of 0.672, 0.597, and 0.622 for precision, recall, and F1 score, respectively. MobileNet-V3 presented a more encouraging accuracy of 69.6% with macro-averages for precision, recall, and F1 score of 0.845, 0.636, and 0.652, respectively. The stacked CNN model demonstrated the strongest performance, achieving an accuracy of 93.6% with well-balanced precision, recall, and F1-score metrics.

Conclusion

The superior accuracy, precision-recall balance, and high F1-scores of the stacked CNN model make it the most reliable tool for screening radiographs and diagnosing osteoporosis using the SI.

Purpose

The aim of this study was to compare femoral neck anteversion (FNA) and determine the prevalence of increased FNA in male elite youth soccer players with and without chronic ankle instability (CAI). Secondary aims were to evaluate the utility of FNA in predicting CAI and compare ankle and hip muscle strength in the two groups.

Materials and methods

The study included a total of 44 male elite youth soccer players, 22 with CAI (mean age 16.09 ± 1.34) and 22 without CAI (mean age 16.73 ± 1.28). FNA was measured with Craig’s test, range of motion (ROM) was measured with a universal goniometer, and ankle and hip maximum voluntary isometric strength (MVIS) was measured with a handheld dynamometer.

Results

The mean FNA angles of the CAI and control groups were 15.82° ± 1.44° and 12.09° ± 2.37°, respectively (p > 0.05). FNA was greater than 15° in 72% of the CAI group versus 4% of the control group (p < 0.05). A 1° increase in FNA was associated with threefold higher odds of having CAI (odds ratio 3.06, 95% confidence ratio: 1.37–6.81, p < 0.01). Mean ankle eversion and hip abduction MVIS values were 2.67 ± 0.52 Nm/kg and 3.83 ± 0.48 Nm/kg in the CAI group, compared to 3.03 ± 0.58 Nm/kg and 4.46 ± 0.98 Nm/kg in the control group, respectively (p < 0.05).

Conclusion

Male elite youth soccer players with CAI had greater FNA and were more likely to have increased FNA than those without CAI. They also exhibited ankle eversion and hip abduction muscle strength deficiencies compared to peers without CAI. FNA may be useful as a predictor of CAI in male elite youth soccer players.

Background

The advent of tissue engineering and regenerative medicine has introduced innovative approaches to treating degenerative and traumatic injuries, particularly in cartilage, a tissue with limited self-repair capabilities. Among the various stem cell sources, umbilical cord-derived mesenchymal stromal cells (UC-MSCs) have garnered significant interest due to their non-invasive collection, minimal ethical concerns, and robust regenerative potential, particularly in cartilage regeneration.

Methods

A comprehensive literature review was conducted using multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar. Search terms focused on "umbilical cordderived mesenchymal stromal cells," "chondrogenesis," "cartilage regeneration," and related topics. Studies published in the past two decades were included, with selection criteria emphasizing methodological rigor and relevance to UC-MSC chondrogenesis. The review synthesizes findings from various sources to provide a thorough analysis of the potential of UC-MSCs in cartilage tissue engineering.

Results

UC-MSCs exhibit significant chondrogenic potential, supported by their ability to differentiate into chondrocytes under specific conditions. Recent advancements include the development of biomaterial scaffolds and the application of genetic engineering techniques, such as CRISPR/Cas9, to enhance chondrogenic differentiation. Despite these advancements, challenges remain in standardizing cell isolation techniques, scaling up production for clinical use, and ensuring the long-term functionality of regenerated cartilage.

Conclusion

UC-MSCs offer a promising solution for cartilage regeneration in the field of regenerative medicine. Ongoing research is focused on overcoming current challenges through the use of advanced technologies, including bioreactors and gene editing. Collaborative efforts among researchers, clinicians, and bioengineers are essential to translating the potential of UC-MSCs into effective clinical therapies, which could significantly advance tissue regeneration and therapeutic innovation.

Graphical Abstract

Purpose of the Study

Multiligament injuries (MLKI) of the knee mainly result from high-velocity impacts. This study was done to analyse multilgament knee reconstructions done in a single setting at a minimum 12 month follow-up with objective gait, squat, stability and fluoroscopic examination along with PROMs and compare the individual KD categories. Also, the study analyses the difference between < 30- and > 30-year-olds as well as those who had sporting injuries versus RTAs.

Methodology

All cruciate ligaments were reconstructed arthroscopically. Collateral ligaments were reconstructed using autografts and fixed with interference screws. All were kept non-weight-bearing for 6 weeks on a brace. ROM exercises were begun at the earliest. Gait analysis, stability, balance, squat analysis and fluoroscopic analysis were used to determine the objective outcomes during follow-ups. PROMs were analysed pre- and postoperatively to document the functional activity of the patient. The analysis of the various parameters with objective measurements of the clinical, functional and patient-reported measures was done to assess the outcome in multiligament knee injury patients.

Results

ACL with MCL was the most common presenting multiligament-involved presentation, with KD3 being the most common pattern of injury. The parameters for contact time, step length, ROM at knee and hip on the normal and operated limbs were near normal and same at a minimum 1-year follow-up with a good stability index. The PROMs improved significantly postop. There was no difference in the results of sporting versus non-sporting injuries, those < 30 and > 30 years and between the individual KD groups.

Conclusion

The results showed statistically significant improvement in stability and PROMs at follow-up in multiligament reconstructions, but no difference comparing individual KD groups, < 30 and > 30 years age and those injured by RTA s and sporting injuries.

Introduction

Our understanding of antero-lateral rotatory instability (ALRI) has evolved considerably, with a shift towards a combined procedure of ACL reconstruction and lateral extra-articular procedure (LEAP) to reduce ALRI and decrease graft re-rupture rates. Despite mounting evidence for the same in high-pivot and high-contact athletes in the West, there is a paucity of data for regional sports such as kabbadi. To the authors best knowledge, this is the first such study to track the outcomes of the combined procedure (ACLR and LEAP) in kabbadi players.

Methods

Ethics approval was obtained from the institutional ethics review committee. A total of 93 consecutive kabbadi players with ALRI were recruited for undergoing the combined procedure of ACLR with lateral extra-articular tenodesis. Demographical variables (age and gender) and functional outcome scores (IKDC, Lysholm, VAS, AOFAS, and FADI) were recorded pre-operatively and followed up at 6 week, 3 month, 6 month and 1 year post-surgery. In addition, complications (pain, stiffness, residual laxity, re-rupture, and infection) and return to sport were recorded.

Results

All 93 patients completed the prospective cohort study with no drop-outs. The mean age of the study population was 22.4 ± 2.7 years and 84% were males. VAS, IKDC and Lysholm scores showed significant improvement at each time frame during the study period and significant improvement at end of the study period versus baseline. AOFAS and FADI scores showed no significant difference between baseline and end of study period. There was no significant difference with respect to age and gender for knee (IKDC and Lysholm) or ankle (AOFAS and FADI) scores. Return to sport was achieved in 99% of study participants with return to pre-injury level was 86%. Re-rupture rate was low (n = 2 patients) and the majority of complications related to the LET (either a complaint of swelling or shape change phenomenon).

Conclusion

The present study shows that ACLR with LET provides a safe and effective option for treating kabbadi players engaged in an inherently high-pivot and high-contact sport. Knee outcomes (VAS, IKDC and Lysholm scores) showed substantial improvement versus baseline with a high degree of return to sport at pre-injury level and low re-rupture rate.

Aim

Knee instability following fractures around the knee joint is not uncommon but is often missed. They present challenges in identifying them during index injury or at follow-up. We share our experience of knee instability following fractures around the knee joint.

Purpose

(1) To identify the pattern of clinically significant knee instability following fractures around the knee joint. (2) To discern the association of fracture morphology with ligamentous disruption. (3) To identify the risk factors for knee ligament injury following fractures around the knee. (4) To recognise the signs of instability in fracture scenarios and their diagnostic pitfalls/management challenges.

Methods

After appropriate Ethical committee clearance and patient consent, a retrospective analysis of 595 fractures around the knee joint was performed at our institute from 2018 to 2021. After employing the exclusion criteria, a total of 92 cases of ligament injuries were included in the analysis. Seventy-six of them were identified and addressed during the index procedure, and 16 of them presented with delayed instability during fracture healing, treated by appropriate arthroscopic ligament reconstruction. Demographic data, mode of injury, fracture morphology, ligament injury pattern and associated injuries were documented and analysed. Functional outcome was assessed using Lysholm scoring and the International Knee Documentation Committee questionnaire at the final follow-up.

Results

The overall incidence of clinically significant knee ligament injury was 15.46%. Among the 76 acute cases, 8 were ACL avulsions, 47 were PCL avulsions, 9 were MCL injuries, 2 were LCL injuries, and 10 had MLKI treated by arthroscopic/open techniques. Out of the 16 cases that presented late, 6 had ACL injuries, 2 had LCL injuries, and 8 of them had a multi-ligamentous knee injury. With respect to the fracture pattern, 56 (60.9%) had tibia fractures, 24 (26.1%) had femur fractures, 3 (3.3%) of them had patella fractures, and 9 (9.8%) had floating knee injuries. The mean Lysholm score was 85.7 ± 9.8. 19.6% (n = 18) had excellent outcome, 46.7% (n = 43) had good outcome, 23.9% (n = 22) had fair outcome and 9.8% (n = 9) had poor outcome.

Conclusion

Knee instability following fractures around the knee is not uncommon, one out of six fractures may have significant instability. Identifying and addressing is key for a satisfactory outcome and to avoid its sequalae.

Background

The use of rehabilitative knee braces after anterior cruciate ligament reconstruction (ACLR) has been controversial. This study aimed to evaluate the early functional outcome associated with post-ACLR brace use.

Methods

This prospective observational case–control study was conducted at AKB Center for Arthroscopy, Sports Injury, and Regenerative Medicine, B&B Hospital, Lalitpur, Nepal. A total of 132 patients undergoing arthroscopic ACLR with or without a meniscal procedure were enrolled in this study, with the final analysis consisting of 66 patients in the control group (brace group) and 66 patients in the case group (no brace group). Braces were applied to the affected lower limb in the control group in the operating room immediately after surgery and were continued for 4 weeks post-operatively. The rehabilitation protocol was the same for both groups. The patients were evaluated on the 3rd post-operative day, 2 weeks, 6 weeks, and 12 weeks post-operatively in terms of Lysholm knee scores, clinical tests (Lachman and pivot shift test), range of motion (flexion and extension), VAS scores for pain, thigh girth differences, and the 12-item short-form health survey (SF-12) scores.

Results

There were no significant differences between the two groups regarding outcome measures, except the mental component summary of SF-12 which was significantly better in the non-braced group (P = 0.006).

Conclusion

There was no significant difference in early functional outcome between the braced and non-braced groups following ACLR with or without a meniscal procedure. Better SF-12 mental component summary scores were seen in the nonbraced group, which indicated possible mental discomfort in patients with brace use.

Purpose

The objective of this study was to conduct a comprehensive assessment of MLKI outcome studies in order to ascertain the overall rates of return to sport following MLKI.

Methods

A systematic review was conducted based on the PRISMA guidelines. Quality assessment of the systematic review was performed using the MINORS Score. The following search terms were browsed in the title, abstract, and keyword fields: “multiligament knee” or “MLKI" AND “return to sport” or “sports activity” or "athletes" or "sports" or "sportsman". The resulting measures extracted from the studies were the rate of RTS, level of RTS, complications, revision surgery, Tegner, International Knee Documentation Committee (IKDC) Lysholm and anterior cruciate ligament-return to sport after injury (ACL-RSI).

Results

A total of 439 patients were included in the study, of whom 383 (87.2%) were male and 56 (22.8%) were female. The mean age at surgery was 28.06 ± 8.93 years. The mean time from injury to surgery was 97.68 ± 127.81 weeks, while the mean follow-up was 42.83 ± 39.22 months. Of 312 patients who completed the follow-up and reported to be sportsmen before surgery, 184 (58.97%) returned to the same or higher pre-injury level, 58 (18.58%) returned to a lower level, while 69 (22.11%) did not return to sports activity. The author analysed the Tegner score in three studies and noted a decrease compared to the pre-injury level (from 7.12 ± 0.8 pre-injury to 4.59 ± 0.57 at the final follow-up; p < 0.001). At the final follow-up, 4 studies analysed IKDC with a mean value of 75.14 ± 9.6, 3 reported a mean Lysholm of 51.81 ± 27.6, and two reported a mean ACL-RSI of 64.82 ± 0.149. Among the 439 patients, a total of 90 (20.5%) complications/re-operations were reported, while a total of 29 (6.6%) failures were recorded.

Conclusions

Return to sport after MLKI occurs in approximately 75% of surgically treated patients, though return to high-level sport is about 60% of the patients. Furthermore, one in five patients report complications, while the failure rate is relatively low (< 7%).

Level of Evidence

Systematic review of level 4.

Background

Scaphoid nonunion often requires surgical management involving the combination of a bone graft and internal fixation to restore the carpal alignment and length. While traditionally, the scaphoid waist nonunions have been treated with open bone grafts, with the advent of arthroscopy, bone graft reconstruction can now be carried out as an arthroscopic assisted minimally invasive procedure. We aimed to compare outcomes between open and arthroscopic bone grafting in the treatment of scaphoid nonunion.

Methods

A review protocol was established according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed/Medline, Cochrane, Embase, and Google Scholar were searched for articles on open and arthroscopic bone grafting for scaphoid nonunion with a minimum 12 month follow-up. The primary outcome was union rates in the two techniques. Secondary outcomes were changes in pain scores, complications, functional outcomes using different scoring systems, grip strength, range of motion at the wrist, and radiological parameters for restoring normal carpal alignment.

Results

Forty studies reporting on 1534 wrists were included (1152 open, 382 arthroscopic). The union rate was 93.4% and 93.2% with open and arthroscopic techniques, respectively. The functional scores were comparable between the two techniques. All patients had a reduction in their pain scores. The radiological outcome parameters were not reported by any of the studies in the arthroscopic group.

Conclusion

While bone grafting with both open and arthroscopic techniques for scaphoid nonunion showed comparable union rates and functional scores, further research is needed to assess the radiological outcomes of the arthroscopic technique.