Introduction Ideal surgical positioning and placement of implants during arthroplasty are crucial for long-term survival and optimal functional outcomes. Inadequate bone stock or defects, and anatomical variations can influence the outcomes. Threedimensional printing (3DP) is an evolving technology that could provide patient-specific instrumentation and implants for arthroplasty, taking into account anatomical variations and defects. However, its application in this field is still not adequately studied and described. The present review was conceptualised to assess the practicality, the pros and cons and the current status of usage of 3DP in the field of hip and knee arthroplasties and joint reconstruction surgeries. Methods A PubMed database search was conducted and a total number of 135 hits were obtained, out of which only 30 articles were relevant. These 30 studies were assessed to obtain the qualitative evidence of the applicability and the current status of 3D printing in arthroplasty. Results Currently, 3DP is used for preoperative planning with 3D models, to assess bone defects and anatomy, to determine the appropriate cuts and to develop patient-specific instrumentation and implants (cages, liners, tibial base plates, femoral stem). Its models can be used for teaching and training young surgeons, as well as patient education regarding the surgical complexities. The outcomes of using customised instrumentations and implants have been promising and 3D printing can evolve into routine practice in the years to come. Conclusion 3D printing in arthroplasty is an evolving field with promising results; however, current evidence is insufficient to determine significant advantages that can be termed cost effective and readily available.
Coronoid fractures are less frequent injuries seen in around one-tenth of patients with elbow dislocation. Any injury to the coronoid process can be associated with elbow instability, in which injury to collateral ligaments co-exists, resulting in a loss of congruency of the elbow joint. However, there is a scarcity of evidence regarding patients' management with elbow dislocation and associated coronoid fractures. So, our aim is to assess the functional outcome of the elbow after operative fixation in patients with any type of coronoid fracture with associated elbow dislocation. A total of six patients with closed coronoid fracture of the elbow, with associated elbow dislocation, without any other associated trauma or previous surgery to the same limb, were included in our study. After closed reduction, patients with an incongruent reduction of the elbow joint were operated. The injured structures were repaired in an inside-out sequence: the coronoid fragment was first reduced by using a lasso-type suture. The larger fragments of the coronoid were fixed with either a screw or a plate when deemed necessary. Then, the lateral collateral ligament was repaired either using a suture anchor or transosseous (No. 2 Arthrex; Naples, Florida) sutures. After repair, the elbow was examined for stability radiologically using the hanging arm test; a concentric reduction of the elbow in lateral view during this test indicates a stable elbow. All patients showed a good to excellent outcome on the Mayo elbow performance score (MEPS) at the final follow-up (three patients had an excellent score while three had a good score). At the final follow-up, mean elbow flexion was 124º, loss of extension was 10º in only one patient, mean supination was 80º, and mean pronation was 72º. Isolated fractures of the coronoid associated with elbow dislocation require appropriate evaluation and management. Closed reduction and immobilization alone in young and active patients may not be sufficient, especially in patients with incongruent ulnohumeral joint. Surgical fixation of the coronoid fragment and repair of the collateral ligament, whenever indicated, can provide good functional outcomes.
Introduction:To evaluate the incidence of anterolateral ligament (ALL) tear in acute knee injury and its association with anterior cruciate ligament tear (ACL). Methods: Forty patients with isolated early ACL tears were prospectively reviewed under 3T-MRI evaluation to identify ALL tears. This was correlated with trauma mechanisms and degree of knee instability. Patients less than 18, or more than 50 years of age, and those with posterolateral corner injury or LCL instability were excluded, which left 31 patients (30 males: 1 female; mean age: 28.6 years) for the final evaluation. Results: The ALL was visualized completely on the MRI in all 31 patients. ALL had mid substance tear in 19 knees (61.3%), proximal femoral attachment in eight knees (25.8%), at the tibial end in 6 knees (19.3%) and was seen torn at both proximal and distal ends in five knees (16.1%). Clinical correlation revealed higher number of giving way episodes, more functional loss of activities and higher grades of pivot shift test in cases with ALL tear along with ACL tear as compared with patients who had ACL deficiency without concomitant ALL tear (p value <0.05). Conclusion: The ALL can be identified in all cases with 3T-MRI. Tears are clearly seen and may be classified according to location. We found no correlation of ALL tears with injury mechanism; however ACL deficient knees with concomitant ALL tear on MRI had more functional impairment and instability. Level of evidence: II b.KEY WORDS: anterolateral ligament (ALL), knee injury, ACL deficient knee, 3T MRI, knee instability.
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