Purpose Posterior component separation with transversus abdominis release is a new procedure and is quickly gaining popularity. It has shown promising results in terms of low recurrence rates for large and complex hernias. However, there are very little Indian data available on this to date. The purpose of this study was to assess the outcomes of the technique at three centers in India. Methods This was a retrospective analysis of the prospectively collected data. Patients with a minimum follow‐up of 3 months who underwent open or minimal access posterior component separation were included. Results A total of 72 patients (open = 44, minimal access = 25, and hybrid = 3) were included in the analysis. At a follow‐up ranging from 3 months to 35 months, there were two recurrences (2.78%). Surgical site occurrences were seen in 23/72 (31.9%), and surgical site infection was seen in 7/72 (9.7%). Surgical site occurrence requiring procedural intervention was 3/72 (4.2%). There were two (2.78%) mortalities in the open group due to myocardial infarction. Conclusion Posterior component separation with transversus abdominis release may have advantages in terms of low recurrence in large hernias in the Indian population and can be used in carefully selected patients.

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Injuries to the knee ligaments specially the anterior cruciate ligament (ACL) have high prevalence, especially in sports and sports-related activities. When these ligaments rupture, the balance between knee mobility and stability is disrupted, resulting in aberrant knee kinematics and injury to other tissues in and around the knee joint, resulting in morbidity and discomfort 1 . While a large proportion of injured patients have surgical ACL reconstruction (ACLR) to restore mechanical stability in the knee joint, there is little evidence to suggest how to best combine surgery and rehabilitation to improve knee function. Given the fact that ACLR outcomes aren't perfect, there's a pressing need to keep looking for strategies to improve patient outcomes 2 .Prior to ACLR, patients were advised to undergo preoperative rehabilitation, commonly known as prerehabilitation (Prehab), to assist them prepare physically and mentally for surgery and postoperative therapy 3,4 . Prehabilitation is intended to improve pre-and postoperative physical function by exercise training intervention, in addition to bridging a long preoperative period till surgery and so preventing further deterioration of symptoms 5 . According to Wilk et al the pre-operative phase of rehabilitation following an acute ACL injury is important to the overall effectiveness of the ACL reconstruction process 6 . According to current literature, the pre-operative rehabilitation should aim for the following: 1) education and mental preparation; 2) full knee extension; 3) a 20% pre-operative quadriceps strength deficiency; 4) a normal gait pattern; 5) minimal edema and 6) reducing the chances of a second ACL injury 5,6 .

Introduction: This article reports a case of surgical repair of traumatic rupture of tibialis posterior (TP) tendon in a young healthy male after alleged history of grinder (heavy machine) injury over the foot, with the help of a suture anchor and running whip stitch followed by immobilization in a below knee slab postoperatively. The acute rupture of the TP tendon (TPT), compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. Case Report: A 32-year-old healthy male presented to the outpatient clinic with a history of pain and swelling in the right foot for 10 months after alleged history of sustaining a grinder (heavy machine) injury to the medial aspect of the right foot 10 months ago. Anteroposterior and oblique radiographs of the right foot suggestive of no skeletal pathology and patient was managed conservatively with analgesic, anti-inflammatory, and compression bandaging. A magnetic resource imaging of the right foot was advised after no relief of symptoms and was suggestive of high-grade tear of the distal tibialis posterior tendon from the level of medial malleolus to its insertion. Surgical repair of the TPT was planned with a suture anchor placed in the navicular bone. The procedure was carried out under spinal anesthesia and there were no complications in the intraoperative or post-operative period. Patient was given a below knee slab with the foot in inversion postoperatively which was revised into a below knee cast with foot in inversion. Six-week post-operative follow-up, cast was removed and physiotherapy was started for the patient that included Active Ankle ROM and Gait Training, patient had a Modified Olerud and Molander Score of 45/100. Six-month post-operative follow-up, patient was relieved of chronic pain and was able walk and stand on his toes without pain and showed significant improvement in gait with Modified Olerud and Molander Score 90/100. Conclusion: The TPT is the main dynamic stabilizer of the medial longitudinal arch of the foot. With appropriate surgical technique, adequate post-operative immobilization followed by physiotherapy surgical repair of the TPT helped alleviate the chronic pain experienced by the patient during weight bearing activities.