Magnetic resonance imaging (MRI) without contrast is sufficient to diagnose an intra-articular ganglion cyst of the knee. MRI with intravenous contrast may be considered for cysts in the infrapatellar fat pad, which are not a typical presentation.The current literature supports treating symptomatic cases or those discovered accidently during knee arthroscopy with arthroscopic excision.Although aspiration of these cysts results in a higher recurrence rate than excision, it is associated with quicker recovery. Thus, aspiration might be chosen as an initial treatment for anyone who would like to avoid surgery or requires a rapid recovery, including professional athletes.Open excision may be considered for infrapatellar fat pad cysts that are >4.5 cm in size.
Purpose Using iliac crest autograft has been considered as gold standard for gap illing in medial opening wedge high tibial osteotomy (MOW-HTO) but is associated with donor site morbidity and pain. The purpose of this study was to compare the results of the use of iliac crest autograft versus allograft from the same anatomic site in terms of union and recurrence. Methods Forty-six patients with genovarum with or without medial compartment osteoarthritis were enrolled based on speciic inclusion and exclusion criteria and were randomly assigned into two groups. MOW-HTO was done using iliac crest allograft (23 patients) or autograft (23 patients) as void iller. Follow-up visits were done monthly for the irst 3 months and then every 3 months until 1 year and then at 5th and 8th postoperative year. The clinical assessment of union, anatomical indices of proximal tibia, complications and WOMAC score were assessed for both groups.
ResultsThe amount of correction (degrees), recurrence, complication rates, time to get symptom-free, radiologic union and knee scores was similar in both groups. The symptom-free time was 6.1 (SD = 0.9) weeks in autograft group versus 6.2 (SD = 0.8) weeks in allograft group (p = 0.73, 95% CI -0.4 to 0.6). The time to radiologic union had a between-group diference of 0.3 weeks (p = 0.58, 95% CI -1.6 to 0.9). There was one case of surgical site infection in graft harvest site. No nonunion or delayed union was encountered in either group. Fifty-two percent of the autograft patients reported more intense postoperative pain in iliac graft harvest site than tibial osteotomy site. Conclusions According to our results, iliac crest allograft can be safely used in MOW-HTO with comparable eicacy and safety to iliac crest autograft. Clinical trial registry The clinical trial was approved by clinicaltrial.gov with identiier NCT00595712.
Introduction
Total hip arthroplasty (THA) has become the treatment of choice for patients with severe haemophilic arthropathy of the hip. However, the intraoperative and postoperative complications, including blood loss and infection, are significant concerns. Direct Anterior Approach (DAA) might be beneficial in THA of patients with haemophilia.
Aim
The present study was conducted to assess outcomes of THA using DAA in patients with haemophilia.
Methods
We retrospectively reviewed our joint replacement database. From January 2010 to December 2015, we had 12 patients with haemophilia who underwent 14 THAs by DAA and followed for an average of 69 months.
Results
All patients were male with a mean age of 36 ± 7 years at the time of THA. The mean Harris Hip Score improved from 46 preoperatively to 89 at the final follow‐up visit. One dislocation and one infection occurred. Only one patient with simultaneous bilateral THA needed a transfusion. All components were radiologically well fixed at the final follow‐up visit except one acetabular loosening that needed revision. All patients were satisfied with the outcome of the surgery at the final follow‐up visit.
Conclusion
In this study, it was observed that complications of cementless THA using DAA in haemophilia patients with hip arthropathy are comparable to other surgical approaches. However, the complication of bleeding in this approach might be less.
Multiligament knee injuries (MLKIs) are among the most detrimental injuries, which can cause significant compromise of joint stability and function. Our aim was to investigate the functional outcomes of nonsport-induced MLKIs who presented late after injury and underwent delayed arthroscopic reconstruction. In a retrospective cohort of 18 MLKI patients (19 knees, January 2012–2018) who had undergone arthroscopic reconstruction, we assessed the knee range of motion, return to work/sport, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Arthritis Index, Lysholm, and Tegner scores. The preoperative scores were retrieved from the patients' registry database. We reviewed their surgical notes and extracted the operation data, including the damaged ligaments, stages of the surgery, and associated meniscal injury. There were 14 males and 4 females with a mean age of 30.57 ± 10.31 years. The mean time from injury to surgery was 17.31 ± 11.98 months. The most common injury was anterior cruciate ligament/posterior cruciate ligament (31.6%). The mechanisms of injury were motor vehicle accidents (72.2%), falls (22.2%), and sports (5.6%). The reconstruction was either single (61.2%) or multiple stage (38.8%). The pre- and postoperative scores were 45.31 ± 7.30 versus 79.16 ± 11.86 IKDC, 3.84 ± 1.26 versus 8.37 ± 1.16 Tegner, and 60.42 ± 7.68 versus 89.42 ± 8.81 Lysholm, respectively. All the scores showed significant improvement at mean follow-up of 24.05 ± 9.55 months (p < 0.001). In conclusion, delayed arthroscopic reconstruction of MLKIs significantly improved the functional outcomes and return to work in patients presenting late to the orthopaedic clinic. There was no relationship between the demographic variables, mechanism of injury, number of injured ligaments, and the stages of surgery and the functional outcomes in this group of patients.
Background: The aim of this study was to compare the efficacy of 3 methods of intraoperative analgesic cocktail injection during total knee arthroplasty (TKA)-intra-articular (IA), periarticular (PA), and combined intra-articular and periarticular (IA1PA)-on controlling early postoperative pain.Methods: This was a prospective double-blinded parallel randomized clinical trial. A total of 153 patients scheduled for TKA were allocated to IA, PA, or IA1PA (51 patients each) by block randomization. The primary outcome was morphine consumption. Secondary outcomes were visual analogue scale (VAS) pain, knee flexion, straight leg raising, Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The morphine consumption was lowest in the PA group (median = 0, interquartile range [IQR] = 5) and highest in the Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A421).
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