Purpose Surgical treatment in advanced-stage infantile Blount’s disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation. Methods A prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount’s disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score. Results The mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients. Conclusion Single-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount’s disease and precluded the use of external immobilization, with no evidence of deformity recurrence. Level of evidence IV

Purpose Treatment of moderate to severe stable slipped capital femoral epiphysis (SCFE) remains a challenging problem. Open reduction by modified Dunn procedure carries a considerable risk of osteonecrosis (ON). Imhauser osteotomy is capable of realigning the deformity without the risk of ON, but the remaining metaphyseal bump is implicated with significant chondro-labral lesions and accelerated osteoarthritis. We conducted this study to evaluate the efficacy and safety of Imhauser osteotomy combined with osteochondroplasty (OCP) through the surgical hip dislocation (SHD) approach. Methods A prospective series of 23 patients with moderate-severe stable SCFE underwent Imhauser osteotomy and OCP through SHD. The mean age was 14.4 years (13 to 20) and the mean follow-up period was 45 months (24 to 66). The outcome measures included clinical and radiological parameters and Harris hip score (HHS) was used as a functional score. Results The mean HHS improved significantly from 65.39 to 93.3. The limb length discrepancy improved by a mean of 1.72 cm. The mean flexion and abduction arcs showed a significant improvement (mean increase of 37.5° and 18.5°, respectively). The mean internal rotation demonstrated the most significant improvement (mean increase of 38.5°). All the radiographic parameters improved significantly; including anterior and lateral slip angles (mean improvement 37.52° and 44.37°, respectively). The mean alpha angle decreased by 39.19°. The articulo-trochanteric distance significantly increased to a mean of 23.26 mm. No cases of ON or chondrolysis were identified. Conclusion Combined Imhauser osteotomy and OCP through the surgical dislocation approach provide a comprehensive and safe management of moderate to severe stable SCFE. Level of evidence IV

We systematically reviewed the literature to compare the clinical and radiologic outcomes and retear rates of superior capsular reconstruction (SCR) using fascia lata autograft (FLA) versus human dermal allograft (HDA) in cases of massive irreparable rotator cuff tears. Methods: Searches of Pub Med and Cochrane Library identified clinical studies addressing SCR using FLA and HDA. Two reviewers independently screened the titles, abstracts and full texts to extract data from eligible studies. Reported outcome measures were descriptively analyzed. Results: A total of 6 studies with 2 study groups satisfied the inclusion criteria. The number of shoulders in the HDA group was 155, and in the FLA group, the number was 140 shoulders. The mean age at time of surgery for the HDA group and the FLA group was 60.49 years and 65.8 years, respectively, and the mean follow-up was 15.2 months and 44.6 months, respectively. Active elevation improved from of 121-130 to 158-160 in the HDA group and from 74.8-133 to 130.4-146 in the FLA group. Active external rotation improved from 36-45 in the HDA group and from 13-28 to 30-43 in the FLA group. The Visual Analog Scale for pain improved from 4-6.25 to 0.38-1.7 points in the HDA group, whereas in the FLA group, it improved from 6-2.5 points. In the HDA group, American Shoulder and Elbow Surgeons scores improved from 42-52 to 77.5-86.5, whereas in the FLA group scores improved from 35-54.4 to 73.7-94.3. The acromiohumeral distance improved in both groups. The retear rate was 3.4%-55% in the HDA group and 4.5%-29% % in the FLA group. Conclusions: Arthroscopic SCR for massive, irreparable rotator cuff tears using both fascia lata allograft and human dermal allograft leads to improvement in clinical outcomes and radiologic outcomes. There is a lower retear rate in fascia lata allografts. The current literature is heterogeneous and has low levels of evidence. Level of Evidence: Level IV, systematic review of level IV studies.

Background: The annual rate of primary THA has been increasing with new designs promoting THA in the younger population, therefore increasing rates and complexity of hip revision surgeries. Different types of acetabular defects in hip revisions, usually make the use of primary cementless cups quite difficult. In complex defects, using cages with cemented cups or combining cementless cups with metal augments, are possible reconstruction solutions. The Delta TT acetabular revision system provides a solution to complex defects combining the advantages of both cage construct and primary implants, with modularity that helps restore anatomical hip centre and biomechanics. The aim of this study is to evaluate the short-term results of the use of the Delta TT revision system in acetabular revision surgeries. Type of the study: A retrospective case series. Methods: 24 patients underwent acetabular revision using (Delta TT) revision system, from 2018 to 2021. The mean follow-up was 20.75 months. Clinical and functional outcomes were assessed using Harris Hip Score. Results: The use of the Delta TT revision system in acetabular revision surgery provided adequate pain relief, and early patient mobilization. The preoperative HHS mean of 29.88 improved to a mean of 85.21, at the last, follow-up. None of the patients developed periprosthetic infection or loosening or nerve palsy during the follow-up period. Conclusion: Short-term clinical outcomes for the use of the Delta TT revision cup system in acetabular revision are encouraging with good functional outcomes and patient satisfaction.

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Background Shoulder pain is a common and disabling complaint. It is responsible for approximately 16 % of all musculoskeletal disorders1 Shoulder pain is defined as chronic when it has been present for longer than six months, regardless of whether the patient has previously sought treatment2. The most common causes of chronic shoulder pain are reported to be rotator cuff disorders, acromioclavicular joint (ACJ) disease and glenohumeral joint (GHJ) disorders3 Aim of the Work The aim of this study is to evaluate the role of both ultrasonography and conventional MRI imaging in diagnosing various causes of chronic shoulder pain not caused by trauma. Patients and Methods 101 patients were evaluated for chronic shoulder pain ranging in age from 20 to 70-years-old. They were referred to the radiology department (Ultrasound unit and MRI unit) at Ain Shams University hospitals during the period between September 2016 and June 2018, from orthopaedic, rheumatology and physical medicine departments. Once a patient satisfied the inclusion and exclusion criteria for this study, an elaborate history was taken from all the patients which was followed by a thorough clinical evaluation, in which duration of symptoms, affected side, dominant hand, range of movement was checked. Patients were subjected to sonographic evaluation of the shoulder joint followed by MRI of the affected shoulder with mean interval between sonography and MRI about 10 days (range, 5-15 days). Results Total of 101 patients with chronic shoulder joint pain were enrolled in our study. 58 % of the patients were in the age group of 41-55 years with mean age of 48 years. Majority (42 %) of patients had chronic shoulder pain over 6-9 months. Complaints mainly resided in the form of tenderness (65 %) and night pain (25 %). Females constituted most of the patients around 68% of the cases. Majority (72%) patients in our study had right hand dominance. 57 % of the sampled patients gave positive history of heavy use of the affected shoulder. 78 % of patients demonstrated acromion morphological changes that had a direct impact on the rotator cuff findings. Amongst the rotator cuff tendons, Supraspinatus tendon was the most common tendon to be involved in our study in both USG and MRI. USG detected 92 patients and MRI detected 96 patients with supraspinatus tendon pathologies which included tendinosis, tears and calcifications and other non-rotator-cuff related findings. Total of 53 were diagnosed as rotator cuff-tear, followed by subacromial-subdeltoid bursitis (n = 32), supraspinatus impingement (n = 14), calcific tendinitis (n = 7) respectively. Supraspinatus tendinopathy was the most common diagnoses (n = 51) followed by Partial thickness tear of supraspinatus (n = 19) then full thickness of supraspinatus (n = 17). USG showed a sensitivity of 52.6% and specificity of 87.8 %, NPV of 88.9 % and PPV of 50 % with 78.8 % MRI agreement for partial thickness tears. USG showed 88 % sensitive, 97% specific, had 97 % PPV, 100% NPV, and was 96 % accurate in diagnosing complete tendon tear. MRI had a higher efficacy for both full thickness as well as partial thickness tears, whereas USG had a higher efficacy for full thickness tears only. Our study shows MRI to be a highly sensitive as well as specific technique for differentiation among different shoulder pathologies.

Background: The presence of cavitary acetabular defects can present a major challenge during revision hip arthroplasty. The purpose of this study was to retrospectively review the early clinical and radiographic outcomes of a dual-mobility, cementless acetabular shell system when combined with autologous or synthetic bone graft substitute composite in revision hip arthroplasty for cavitary acetabular defects. Methods: Fourteen revision hip arthroplasties for acetabular protrusion and cavitary acetabular defects were performed at our institutions between May, 2015 to June, 2016. A direct lateral approach was used for all patients. All patients were assessed with the Oxford Hip Score. Serial postoperative radiographs were assessed for signs of osseointegration and acetabular component migration. Failures were defined as gross acetabular component migration and deterioration of patient self-reported outcome score postoperatively. Results: After a mean follow-up of 28.9 mo, the Oxford Hip Score and hip pain scores were significantly improved (P≤0.01). Radiographically sufficient bone graft osseointegration was obtained in all patients with no detected acetabular component migration. Conclusions: This study showed good overall short-term functional and radiographic outcomes of the dual-mobility, uncemented acetabular shell system in combination with autologous or synthetic bone graft composite in revision hip arthroplasty for cavitary acetabular defects. Level of Evidence: Level IV.

Introduction Rupture of the patellar tendon after total knee arthroplasty is an infrequent but serious complication. Several methods for treating this catastrophic complication have been described. The purpose of this article was to evaluate the results of semitendinosus graft augmentation with direct repair in the treatment of patellar tendon rupture after total knee arthroplasty. Material and methods From 2012 to 2014, six patients who underwent cemented total knee arthroplasty without patellar resurfacing presented with patellar tendon rupture after operation. Patellar tendon repair and augmentation with autogenous ipsilateral semitendinosus graft was scheduled with preparation of stocks of primary and revision prosthesis. Results All knees required revision either all components or one of the components. Postoperative radiograph confirmed that normal patellar height was with good alignment of all prosthesis components. Patients were followed up for average 1.5 years. No intra-or postoperative complications were recorded. Functionally, scores at final follow-up were excellent in two patients and good in four patients according to Knee Society clinical rating scores. The average active range of motion is from 10 to 135°. All patients could return to their daily activities without pain. Conclusion The right alignment and rotation of the knee prosthesis, together with good surgical technique in a primary operation, are the most important factors to avoid the catastrophic complication of patellar tendon rupture during or after the total knee arthroplasty. However, if patellar tendon rupture does occur, the use of our operative technique and rehabilitation program can bring good functional results.