Purpose: Various modes of therapy have been directed at breaking the vicious cycle at early stage of synovitis in haemophilia patients. This study was planned to assess the short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 (P-32) radiosynoviorthesis. Methods: P-32 samarium radiocolloid was injected into the knee and patients were followed up at 1 and 3 months, respectively. Clinical outcomes was assessed using Tegner Lysholm scores (TLSs), Modified Knee Society Clinical Rating System (MKSS) score and circumference of the knee joint. The radiological outcomes were assessed using X-ray, ultrasonography and bone scan. Results: Among the fifteen haemophilia A patients studied, there was statistically significant difference in TLS (w 2 (2) ¼ 27.887 and p value < 0.001), MKSS scores (w 2 (2) ¼ 27.745 and p < 0.001) and circumference of the knee joint (w 2 (2) ¼ 21.333 and p < 0.001) at preoperatively, 1-and 3-month follow-up. There were no changes noted in follow-up X-rays compared with the preoperative X-ray. Ultrasonography showed that clinical improvement was more in suprapatellar and medial parapatellar regions in the last 2 months compared to the first month of follow-up. Post P-32 bone scan showed marked decrease in uptake in the affected knee joint suggestive of radio ablation of synovial tissue. Conclusion: P-32 radiosynoviorthesis done for chronic synovitis among haemophilia A patients showed significant improvement in both clinical and radiological parameters. Ultrasonography can be utilized as non-invasive radiological modality for follow-up of P32 response for knee joint.
To investigate the incidence and location of meniscal tears in relation to complete vs partial anterior cruciate ligament (ACL) injury. Subjects and Methods: We collected MRI of 114 patients (114 knees) diagnosed with combined ACL and meniscal injury at a follow up 3 months to 2 years of knee injury at our center in last 3 years. The subjects comprised 68 males and 46 females ranging in age from 20 to 55 years. The patients were divided into two groups: Meniscal tears with Partial ACL injury and Complete ACL injury and the results were compared between this two groups. Results: The incidence of complete ACL injury diagnosed with MRI was 52.63% (60 of 114 knees) and partial ACL injury was 47.36% (54 of 114 knees). Regarding the locations of meniscal tears, in complete ACL injury (60 knees), medial meniscal tear was found in 60% (36 of 60 knees), lateral meniscal tear in 31.66 % (19 of 60 knees), and bilateral meniscal tears in 8.33 % (5 of 60 knees). In Partial ACL injury (54 knees), medial meniscal tear was found in 46.29 % (25 of 54 knees) and lateral meniscal tear in 42.59 % (23 of 54 knees) and bilateral (including medial and lateral) meniscal tears in 11.11 % (6 of 54 knees). Bucket handle tear was observed in 11 knees (medial: 8 knees, lateral: 3 knees) in complete ACL injury, and 4 knees (medial: 3 knees, lateral: 1 knee) in partial ACL injury. Conclusion: Incidence of medial meniscus tear was more than 50% in complete ACL injury. Lateral meniscus tear was more associated with partial ACL injury compared to complete ACL injury.
Aim: There are various medical and surgical modalities available at breaking the vicious cycle of synovitis-hemarthrosis-synovitis at an early stage of synovitis in patients of haemophilia. Our study was planned to assess the short term clinical outcome in chronic knee synovitis among haemophilia A patients treated with phosphorus-32 (P-32) radiosynovectomy. Methods: Fifteen haemophilia A patients with chronic knee synovitis were injected with P-32 Samarium radiocolloid into the knees. These patients were clinically assessed at time of injection, at one and at three months post procedure. The parameters evaluated are the Tegner Lysholm Score (TLS), Modified Knee Society Clinical Rating System score (MKSS) and by measuring the circumference of the knee joint pre and post injection. Results: Among the fifteen haemophilia A patients studied, there was statistically significant difference in all three parameters recorded with TLS having χ2 (2) = 27.887 and p value <0.001, MKSS scores having χ2 (2) = 27.745 and p <0.001, and circumference of the knee joint showing χ2 (2) = 21.333 and p <0.001 at the end of one and three months follow up. Conclusion: P-32 radiosynovectomy done for chronic knee synovitis among haemophilia A patients showed significant improvement in clinical parameters. Hence we suggest that this simple procedure may be added to the armamentarium of current options available for these patients.
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