Delayed rather than early reconstruction of the anterior cruciate ligament is the current recommended treatment for injury to this ligament since it is thought to give a better functional outcome. We randomised 105 consecutive patients with injury associated with chondral lesions no more severe than grades 1 and 2 and/or meniscal tears which only required trimming, to early (< two weeks) or delayed (> four to six weeks) reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft. All operations were performed by a single surgeon and a standard rehabilitation regime was followed in both groups. The outcomes were assessed using the Lysholm score, the Tegner score and measurement of the range of movement. Stability was assessed by clinical tests and measurements taken with the KT-1000 arthrometer, with all testing performed by a blinded uninvolved experienced observer. A total of six patients were lost to follow-up, with 48 patients assigned to the delayed group and 51 to the early group. None was a competitive athlete. The mean interval between injury and the surgery was seven days (2 to 14) in the early group and 32 days (29 to 42) in the delayed group. The mean follow-up was 32 months (26 to 36). The results did not show a statistically significant difference for the Lysholm score (p = 0.86), Tegner activity score (p = 0.913) or the range of movement (p = 1). Similarly, no distinction could be made for stability testing by clinical examination (p = 0.56) and measurements with the KT-1000 arthrometer (p = 0.93). Reconstruction of the anterior cruciate ligament gave a similar clinical and functional outcome whether performed early (< two weeks) or late at four to six weeks after injury.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.

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Introduction Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure about obtaining informed consent for total knee arthroplasty (TKA). We developed a solution for this need for a pre-designed, evidence-based informed consent form for patients undergoing TKA. Materials and methods We extensively reviewed the literature on the medico-legal aspects of TKA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in TKA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had undergone TKA in the previous year. Based on all of the above, we developed an evidence-based informed consent form. The form was then reviewed by a legal expert, and the final version was used for 1 year in actual TKA patients operated at our institution. Results Legally sound, evidence-based Informed Consent Form for Total Knee Arthroplasty. Conclusion The use of legally sound, evidence-based informed consent for total knee arthroplasty would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.

Introduction: Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. Methods: We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Preoperative and post-operative functional assessment was done using Tegner Lysholm score. Results: Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. Conclusions: Lipoma arborescens is a rare condition which should be a differential in patients with mono-articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence.