Backgroud: Frozen shoulder also called as adhesive capsulitis is a condition characterised by global limitation of humeroscapular motion resulting from contracture and loss of compliance of the glenohumeral joint capsule. Frozen shoulder is a common problem and results in frustrating debilitation for its sufferers. There can be many reasons for pain and stiffness of shoulder joint, so it is very important to differentiate between adhesive capsulitis and the other causes. Objective: The main objective of the study was to evaluate the various modes of treatment for frozen shoulder and to identify various causes and associations of frozen shoulder in Indian population. To the best of our knowledge no prospective study has been done which have compared different treatment options in patients of adhesive capsulitis in Indian population. Methods: The study was done on 75 patients which were divided into three groups, based on the mode of management i.e. conservatively with medication and physiotherapy, physiotherapy and intraarticular injection and arthroscopic capsular release. The range of movement and functional outcome was compared using Constant & Murley score. Conclusion: We found that patients undergoing conservative management showed benefits of various treatment options if the condition is diagnosed at an early stage but the results convincingly prove the advantages of arthroscopic capsular release in patients with chronic painful stiff shoulder or in failed conservative treatment.
Introduction: Chronic lateral patellar instability is one of the commonly seen clinical conditions encountered by knee surgeons. Medial patellofemoral ligament (MPFL) reconstruction has become mainstay treatment over the last three decades. Upto 26% complication rates have been reported in literature with MPFL reconstruction. The purpose of this study is to analyse failure rates, complications of surgery for PF instability and to identify the predictive factors for failure. Methods: A retrospective analysis of prospectively collected data was performed of all 215 (234 knees) patients who had undergone MPFL reconstruction between October 2007 and August 2018. All the cases with any postoperative complications or failures were included. A failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability or anterior knee pain not resolving with conservative methods. Other complications such as stiffness, infection, neurological deficit and deep vein thrombosis were also included. Lysholm, Kujala, Tegner and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle-trochlear groove distance were analysed pre and post operatively. Results: Ten patients (4.27%) had a revision of MPFL reconstruction, seven patients (3%) had removal of their metal work. Post-operative stiffness was in only three patients (1.28%) and required manipulation under anesthesia. Six patients (2.56%) had patellofemoral replacement over time while three patients had arthroscopic debridement for cartilage related pathology. There was also one case each of femoral nerve palsy(related to the nerve block), post-operative deep infection, deep vein thrombosis?. Conclusion: To our knowledge, this is the only study recording the failures and complications of MPFL reconstruction on a large patient database. Age above 30, obesity, cartilage lesions, hyperlaxity and female gender are predictors of a poor subjective outcome. Identifying the potential risk factors preoperatively can prevent future complications.
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