Background: Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partial-thickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. Purpose: To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. Results: Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 ± 13.8 N and 108.1 ± 16.6 N, respectively ( P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) ( P = .009). Conclusion: Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. Clinical Relevance: Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.
Objective: To evaluate the effectiveness of Platelets-Rich-Plasma therapy against Steroid therapy in the treatment of Planter fasciitis. Study Design: Quasi Experimental study. Setting: Department of Orthopedic, Hayatabad Medical Complex, Peshawar. Period: January to June 2021. Material & Methods: In which participants were divided into two groups (steroid vs PRP). A total of 61 individuals with PF who have failed to respond to conservative therapy were intervened. 31 of them received steroid injection while 30 participants received PRP. The AOFAS and the VAS scoring system were recorded pre- and post-injection phases at 4 weeks, 3 months and 6 months period to evaluate the outcomes. Statistical analyses were performed to compare between the two means. Results: In both groups, the VAS, the AOFAS, and PF thickness improved significantly after injection. However, based on the available data, there was no discernible difference in improvement between the two groups for the above-mentioned factors. Conclusion: In our study, we found that both steroid and PRP injections had no statistically significant differences in VAS and AFAS scores (post treatment), we found that both were equally beneficial in treating Planter Fasciitis.
Objective: To evaluate articular Cartilage after Knee injuries in young population as predictor of early Osteoarthritis, to pave the much more effective OA preventive measures in young population. Study Design: Descriptive Case Series. Setting: Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Period: 2020 to 2021. Material & Methods: One hundred forty five patients was conducted in Early Osteoarthritis was defined as a diffuse and ill-defined involvement, but originated in the cartilage surrounding a focal lesion, considered to include a maximal involvement of 50% of the cartilage thickness (ICRS Grade II) based on the macroscopic ICRS classification. Articular cartilage evaluation (Chondral lesions and OA) were recorded on set proforma according to ICRS grading system. Results: Mean age was 32 years. Significant risk for early osteoarthritis was 17.9%; female had higher risk for early osteoarthritis as compared to male with p value of 0.03. Correlation between patient’s age and grade of chondral lesion with risk for early Osteoarthritis were significant with p value of 0.00 and .002 respectively. Significant risk for early osteoarthritis was 10.25%, 23.08% and 15.38% respectively for anterior cruciate ligament tear, medial meniscus, and lateral meniscus injury. 42.65% anterior cruciate ligament injuries were associated with concomitant injuries, whereas significant risk for early OA was 17.24% as compared to isolated ACL injuries of 57.35% with significant risk for early OA of 10.25%. Concomitant meniscal and ACL injuries had significant risk for early OA was 23.53%. Conclusion: Arthroscopic evaluation of articular Cartilage damage after Knee injuries is good predictor of early Osteoarthritis in young population.
OBJECTIVES The study aimed to compare the clinical outcome of transverse versus longitudinal incision for surgical release of the first dorsal compartment of the wrist to treat de Quervain’s disease. METHODOLOGY In this quasi-experimental study, all the patients with resistant de Quervain’s tenosynovitis who had the surgical release of the first dorsal compartment between January 2008 and December 2020 were included. The surgeries were performed under local anaesthesia. The first dorsal compartment of the wrist was approached through either a longitudinal or transverse incision, and the tendons of the abductor pollicis longus and extensor pollicis brevis were released. Patients were followed for a minimum of three months, and the primary outcome measure was the Visual analogue score (VAS) for relief of pain and secondary outcome measures were any immediate or delayed complications. RESULTS98 patients were included in the study with a female-to-male ratio of 7:1. The cohort’s mean age was 44 years (Range 25-75). Most patients were housewives exposed to manual work with the involvement of the dominant hand. There were no major complications besides wound issues and transient paresthesia in few patients. The longitudinal incision was associated with less transient nerve palsies, less duration of surgery and easier identification of structure and anomalies. The only advantage of transverse incision was less scar formation. The clinical outcome was similar in both groups: 94% of patients had complete pain relief (VAS 0). CONCLUSION There was no difference in the outcome of de Quervain tenosynovitis when released with a transverse or longitudinal incision. The longitudinal incision had fewer complications as compared to the transverse incision.
Objectives: To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction andpercutaneous pinning. Material and Methods: This prospective study of 50 patients who presented with displaced supracondylar fracture ofhumerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar overperiod from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperativereduction was assessed by Baumann angle. All patients were followed for one year. Results: Mean age of the patients was 7.02 years± 2.25 SD. Loss of Baumann angle in injured side was range from 2O to 8O. Loss of carrying angle in injured side was range from 3O to 9O. WhenBaumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 ± 2.22 SDand 4.320 ± 1.52 SD respectively. Using Flynn’s criteria 36 (72%) patients out of 50 patients with carrying-angle loss considered to be excellentresults and 14(28%) good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Conclusions: Baumannangle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylarhumeral fractures in children.
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