Medial Meniscus Repair Using "AJStitch": A Cost-Effective All-Inside All-Suture Meniscal Repair System.

All-inside techniques are based on devices that use PEEK (polyether ether ketone) or biocomposite anchors placed at extracapsular locations such as anchorage points over which the sutures are tied. However, because of complications like irritability and intra-articular migration of these hard anchors, suture-based all-inside meniscal repair systems are now gaining popularity. Although these devices have advantages over conventional all-inside devices, they are costly, thus limiting their widespread use.

Early Functional Outcome After Anterior Cruciate Ligament Reconstruction in Patients Using Post-Operative Brace or No Brace: A Prospective Observational Case-Control Study.

Background: The use of rehabilitative knee braces after anterior cruciate ligament reconstruction (ACLR) has been controversial. This study aimed to evaluate the early functional outcome associated with post-ACLR brace use.

Methods: This prospective observational case-control study was conducted at AKB Center for Arthroscopy, Sports Injury, and Regenerative Medicine, B&B Hospital, Lalitpur, Nepal.

Combined cuff repair and superior capsular reconstruction reinforcement in patients with massive rotator cuff (re)tears: a minimum 2-year clinical and radiological follow-up.

Background: Due to the ageing population, the number of symptomatic degenerative rotator cuff tears has increased substantially, and some are challenging to repair due to poor tendon quality with significant retraction. In order to optimize repair integrity and function, rotator cuff repair reinforcement with a superior capsule reconstruction has been proposed. This study presents the results of a technique combining cuff repair and capsular reconstruction (CRACR) using acellular dermal allograft in patients with massive rotator cuff tears and retears.

A comparative study of Infra patellar branch of saphenous nerve injury between vertical and horizontal portal incisions in knee arthroscopy.

Background: An Infrapatellar Branch of Saphenous Nerve (IPBSN) injury is one of the complications leading to sensory loss in the operated knee. A high incidence of IPBSN injury was reported during hamstring harvest, but there are only a few studies analyzing IPBSN injury during arthroscopy portals. However, there was a lack of randomized comparative studies comparing the incidence of IPBSN injury in horizontal and vertical portals.

Is Venous Thromboembolism Prophylaxis Needed in Patients Undergoing Knee Arthroscopy? A Prospective Observational Study.

Background: Although rare, deep vein thrombosis is a potentially life-threatening complication of knee arthroscopy. There are scanty literature analysing deep vein thrombosis after arthroscopy in Nepal. This study aimed to identify the prevalence of deep vein thrombosis in patients undergoing knee arthroscopy without chemoprophylaxis postoperatively at 2 weeks and 6 weeks, respectively.

Implantless Supplementary Fixation of Anterior Cruciate Ligament in Tibia with "Make and Use" Anchor.

Supplementary fixation after anterior cruciate ligament reconstruction may be necessary in some situations. There are several methods described for supplementary fixation with their advantages and disadvantages. Anchor fixation is preferred by many because it does not require a second surgery for removal.

Semitendinosus Autograft Transplant for Medial Meniscus.

Treatment of meniscal tears has evolved over the last few decades, and preservation has now become the gold standard of treatment. Advancements in repair technique have extended the indication of repair. However, meniscectomy has to be performed in some situations.

Ramp Tear among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction in a Tertiary Care Centre.

Introduction: Ramp tear is a specific injury that affects the posterior horn of the medial meniscus and its meniscosynovial or meniscocapsular attachments. The actual prevalence of ramp lesion is unknown due to the high probability of misdiagnosis or underdiagnosis caused by the low sensitivity of imaging modalities and poor visualization during arthroscopy. This study aimed to find out the prevalence of ramp tear among patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre.

"Make and Use" All Suture Anchor-A Cost-Effective Method of Making an All-Suture Anchor.

All-suture anchors (ASA) are newer anchors that anchor soft tissues to the bone. It has several biomechanical and clinical advantages; however, the high cost of this anchor limits its use in low socioeconomic countries. The cost of the anchor dramatically increases the cost of surgery; hence, acceptance of surgery is also affected if patients have to pay their expenditure from their pocket.

Positive Pivot Shift Test among Patients with Displaced Anterior Tibial Spine Fractures Undergoing Arthroscopic Fixation in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Understanding of displaced anterior tibial spine fractures has evolved over the years and is now considered to be anterior cruciate ligament avulsion injuries rather than intra-articular fractures. However, there are very few studies available evaluating the presence or absence of a pivot shift test, which is specific in diagnosing anterior cruciate ligament insufficiency, in patients with anterior tibial spine fractures. This study aimed to find out the prevalence of the positive pivot shift test among patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation in a tertiary care centre.

Variations in common operations in athletes and non-Athletes.

Background: Achieving pre-injury activity level after an injury is the fundamental goal of any orthopedic treatment for an athlete. Unfortunately, pre-injury activity levels differ significantly in different patient categories, especially in athletes and non-athlete. Hence, an outcome suitable to a non-athlete may not be adequate for an athlete.

Epidemiological profile of anterior cruciate ligament injuries in a tertiary referral trauma center of Nepal.

Background: Sports related injuries are the leading cause of Anterior Cruciate Ligament (ACL) tear in the Western world. Although professional and recreational sporting activities are increasing in Nepal, they are not as common and prevalent in comparison to western world. In contrast, Road Traffic Accident (RTA) is a very common cause of knee injuries in Nepal.

Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction.

Even after anterior cruciate ligament (ACL) tear, its remnant retains the vascularized synovial sheets, fibroblasts, myofibroblasts, and various mechanoreceptors within it. The aim of preserving the remnant is to retain these components during ACL reconstruction. In the recent past, there has been an increasing trend towards preserving remnants during ACL reconstruction.

Arthroscopy-Assisted All-Suture Coracoclavicular and Acromioclavicular Joint Stabilization in Acute Acromioclavicular Joint Injuries.

The existing literature agrees on surgical management for Rockwood grade IV and V injuries, but there is no consensus which type of surgery is the most appropriate one. More than 150 surgeries have been described for this condition in the literature. In an injury of less than 3 weeks, most surgeons prefer suture-button devices for coracoclavicular stabilization.

Predictive Accuracy of Blumensaat Line Angle and Its Apex along with Anterior Cruciate Ligament Inclination Angle for Diagnosis of Anterior Cruciate Ligament Tear with Abundant Remnant.

Background: Anterior Cruciate Ligament Blumensaat line angle and Anterior Cruciate Ligament Inclination angle can be measured when Anterior Cruciate Ligament is visualized on Magnetic Resonance Imaging. Both these angles can be helpful to determine the intactness of Anterior Cruciate Ligament. The aim of this study was to evaluate the diagnostic accuracy of Anterior Cruciate Ligament - Blumensaat line angle, apex of Anterior Cruciate Ligament - Blumensaat line angle and Anterior Cruciate Ligament - Inclination angle to determine the status of Anterior Cruciate Ligament in terms of tear or no tear.

Implant-Free, Transtibial, Bone Bridge Fixation for Knee Surgery Including Tibial Spine and Meniscal Root Fixation.

Fixation over bone bridge is commonly performed during transosseous pullout knee surgeries. This technique requires the drilling of 2 bony tunnels separately. Herein, we describe our technique in which bone bridge fixation is performed with a single bony tunnel.

Outside-In Repair of Longitudinal Tear of Medial Meniscus: Suture Shuttle Technique.

Meniscal tears are commonly encountered conditions of the knee. In the past, torn menisci were treated by excision of the loose flap. A better understanding of the meniscus anatomy and its biomechanical characteristics has led to the concept of meniscus preservation in eligible cases.

Weave Technique for Reconstruction of Medial Collateral Ligament and Posterior Oblique Ligament: An Anatomic Approach Using Semitendinosus Tendon.

Medial collateral ligament (MCL) is the most commonly injured ligament in knee. The majority of MCL tears can be managed conservatively, and reconstruction or augmentation is required in few selected cases. Anatomic MCL and posterior oblique ligament reconstruction have good functional outcome, but it requires 2 tunnels each in the tibia and femur, which may be a limitation in cases in which multiligament reconstruction is required.

Pseudoaneurysm of the Popliteal Artery Leading to Foot Drop After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Rare Complication: A Case Report.

Case: A 32-year-old man underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft. He complained of persistent posterior knee pain in the postoperative period and at 4 weeks postsurgery developed foot drop and intense posterior knee pain. On clinicoradiological evaluation, a popliteal pseudoaneurysm (PSA) was diagnosed.

A Definition of Significant Instability and a Scoring System for Predicting Meniscal Tears in ACL-Deficient Knees.

Background: Patients with anterior cruciate ligament (ACL)-deficient knees risk recurrent instability of the affected knee, which may predispose to meniscal injuries. Various studies have correlated the incidence of meniscal tear with elapsed time from ACL tear and number of instability events. However, it is not clear how significant an instability event needs to be to contribute to a meniscal tear.

The effectiveness of a modified Metaizeau technique in fixation of adult radial neck fractures: a prospective study with a modification of the Broberg-Morrey classification.

Background: The incidence of adult radial neck fractures is lower compared with its pediatric counterpart. The literature on adult radial neck fracture management is limited; also, there is a lack of a detailed fracture classification system. In our study, we are evaluating the modified Metaizeau technique for the treatment of adult radial neck fractures.

Topical vs Intravenous Tranexamic Acid in Reducing Blood Loss After Bilateral Total Knee Arthroplasty: A Prospective Study.

Background: Total knee arthroplasty (TKA) results in substantial postoperative blood loss with increased morbidity. Despite various studies proving the efficacy of tranexamic acid (TXA), no consensus exists on the routes of administration.

Methods: Seventy consecutive patients with knee arthritis undergoing simultaneous bilateral TKA, who were eligible and fulfilled the criteria, were taken up for this study.

External Iliac Artery-Appendicular Fistula due to Antegrade Unusual Migration of K-Wire from Hip to Pelvis: An Unreported Complication.

Background. K-wires are thought to be extremely safe implants and complications as a result of direct insertion or migration are very rare. Complications may be life-threatening in some instances where migration results in injury to vital organs.

Clear cell chondrosarcoma calcaneum - a case report and review of literature.

Chondrosarcoma is the second most common primary bone malignancy accounting for 20-25% of all bone sarcomas. However chondrosarcoma of the foot is rare with just a handful of cases being described. Among the subtypes clear cell variant is the rarest and has never been documented in the foot.