Background Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. Methods A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. Results 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. Conclusion Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research.
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A 24-year-old male presented to Department of Orthopaedics St. Martha's hospital with a history of sustained injury to both his knees. While unloading heavy stone bars from a vehicle, the object fell on legs from behind forcing the both knee joints into flexion and external rotation, followed by hitting of his both knees to the wall in front of him. In emergency room, clinical examination revealed a marked effusion in knees, crepitus and tenderness over inferior pole patella on both sides. Lachman test was positive (grade 2) on right side and it was negative on left side, varus and valgus stress test was negative on both sides. Active extension of both legs was present. X-ray imaging of both knees showed a bilateral inferior pole of patella fracture with minimal displacement, bilateral small bony avulsion on the AP view which is elliptical in outline near the lateral tibial condylar articular margin suggested Segond fracture and tibial spine avulsion on right knee b]. MR imaging and CT scan [Table/ Fig-4] confirmed the ACL on right knee with avulsion fracture of patella with contusion of lateral tibial condyle. Further imaging of right knee was not undertaken as there was no clinical instability. Examination under anaesthesia revealed bilateral pivot shift test positive co-relating our radiological findings of bilateral ALL avulsion. Patient was treated by arthroscopic right ACL avulsion fixation with pull through technique over suture disc. Bilateral patella inferior pole fracture was treated conservatively with knee brace since the extensor mechanism was intact. Segonds fracture was treated conservatively with brace. surgical technique: Diagnostic arthroscopy was carried out to assess additional injuries like meniscal injury, chondral injury and other ligament tears. Fracture crater was adequately cleaned. Two drill holes were made with 2.7 mm guide wire with the help of ACL jig, medial and lateral to ACL and exiting out on medial tibial cortex. With the Arthroscope in lateral portal, 90 degree suture lasso was passed through medial portal and through the posterior half of ACL substance close to fragment and the suture loop retrieved through lateral portal. A ETHIBOND (no. 2) was passed through the loop and taken out through medial portal. This step was repeated in a similar manner through anterior half of substance of ACL [ Patella fractures, tibial spine avulsion and Segond fractures are mainly due to trauma to the knee which may be direct or indirect injuries. While each entity is well documented when occurring in isolation, but bilateral inferior pole patella fracture, tibial spine avulsion in the right knee and bilateral segond fracture in a same patient is a rare occurrence. We report a case of 24-year-old male with such an injury. The diagnosis was confirmed by X-ray, CT scan and MRI imaging of right knee. Then the patient was treated with arthroscopic anterior cruciate ligament (ACL) avulsion fixation with pull through technique and suture disc; bilateral inferior pole patella was treated conservative...
Introduction: Distal radius fractures are commonly treated by fixation using a volar locking plate. In some fracture patterns, this mode of fixation is not adequate. This case report aims to describe one such case. Case report: We report a case of a 28-year-old gentleman who presented with volar subluxation of the radiocarpal joint early in the postoperative period following fixation of the distal end radius volar locking plate. Conclusion: Volar locked plates have become the most common fixation strategy for distal radius fractures. In certain fracture patterns where a volar locking plate would be inappropriate, an alternative fixation strategy should be considered such as rim plate. Keywords: Volar locking plate, Volar rim plate, Radiocarpal dislocation
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