Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

Background: Arthroscopically aided anterior cruciate ligament reconstruction using hamstring graft can be fixed to femoral condyle by suspensory and aperture fixation methods. The following study was undertaken to investigate whether there is any difference in functional outcomes with these fixation methods as measured by the Lysholm knee score and to determine tunnel widening post operatively with these two methods and does it affect the functional outcome.Methods: 50 patients of clinically and radiologic ally diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft with  suspensory (n=25) and aperture (n=25) fixation methods on femoral side. They were compared post operatively with Lysholm score, clinical laxity tests and percentage of tunnel enlargement using computed tomograms at 01 year.Results: At the end of 6 months there was no much difference in Lysholm score between both the groups (P =0.663) and at the end of 01 year aperture group had slightly better outcome. However, the difference was not statistically significant (p =0.173). There was more tunnel widening in the suspensory group especially of the femoral tunnel in the coronal plane. However, the amount of tunnel widening in both the groups was not significant statistically (P =0.071 and P =0.963). Tunnel widening is not associated with inferior clinical outcomes or functional knee score.Conclusions: Aperture and Suspensory fixation methods of hamstring graft at femoral condyle in ACL reconstruction are comparable clinically and there is no advantage of one particular method over other. Although comparatively more tunnel widening is seen in suspensory fixation methods; it does not affect the final clinical outcomes or functional knee scores.

Evaluation of Ponseti method in correction of congenital talipes equinovarus

Background: Congenital idiopathic clubfoot is a complex foot deformity often requires many months of treatment and frequently resulted in incomplete or defective correction by older methods. Deformity can be corrected with serial manipulation and casting with minimal or no surgery as reported by Ponseti. This study is an attempt to evaluate the effectiveness of Ponseti technique in treatment of idiopathic congenital talipes equino varus.Methods: 30 patients between age group of 01 to 24 weeks with 48 feet having congenital idiopathic clubfoot were treated using Ponseti technique. The guidelines for treatment were followed as per the Ponseti method of serial manipulation and casting at weekly intervals.Results: 43 (89.58%) cases were treated successfully by using Ponseti technique without need of extensive surgery. 42 feet required tenotomy. 38 (79.16%) feet had an excellent outcome, 5 (10.42%) feet had a fair outcome and 05 feet (10.42%) had poor outcome as measured by the Pirani scoring system. 7 (14.58%) patients had cast related complications.Conclusions: The Ponseti method is a safe, effective and reproducible method for correction of idiopathic congenital talipes equinovarus which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot

Comparative study between bone patellar tendon bone and quadrupled hamstring autografts in arthroscopic anterior cruciate ligament reconstruction with aperture fixation

Background: Bone patellar tendon bone (BPTB) and hamstring (HT) auto grafts have been used routinely in reconstruction of ACL over past two decades. Controversy still remains as to which graft is superior over other. Many studies have compared these graft options using different implants and different methods of fixation. Continuation of efforts in the same direction; purpose of the study is to compare these two graft options utilizing identical implants and similar method of fixation.Methods: 40 patients of clinically and radiologically diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft (n=20) and bone patellar tendon bone auto graft (n=20) utilizing bioscrew by aperture fixation method in both the groups. They were compared post operatively for symptomatic improvement, clinical and rolimeter laxity tests and Lysholm functional knee scoring at 02 year.Results: At the end of 02 years laxity measurement by rolimeter showed slightly better results in BPTB group; however it was not statistically significant (p value= 0.362). Knee pain at the end of 02 year was slightly more in HT groups (45%) as compared to BPTB group (35%) but not significant (p value =0.748). Instability symptoms are comparable in both the groups (sense of giving away on exertion). Manual laxity testing by Lachman and Pivot shift tests were comparable in both the groups with p value of 0.695 and 0.999 respectively. Lysholm functional knee score also showed no statistical significance (p value =0.957).Conclusions: There is no significant difference between HT and BPTB auto grafts in terms of clinical and functional outcome at the end of 02 years.

Comparative study of complications and final outcome between bone patellar tendon bone and hamstring auotgraft in ACL reconstruction

Background: The most common current graft choices in ACL reconstruction are the bone-patellar tendon–bone (BPTB) graft and the quadrupled Hamstring graft. Though BPTB is considered to be the gold standard; hamstring tendon (HT) grafts have increased in popularity over last decade. Our aim in this study is to assess the complications, comorbidities, difficulties and final outcome between BPTB and Hamstring grafts in ACL reconstruction.Methods: 71 male patients with isolated tear of ACL between age group of 18-45 years were included in the study. 35 patients in group A underwent ACL reconstruction using bone patellar tendon bone autograft and 35 patients in group B were managed by reconstructing ACL using quadrupled Hamstring autograft. All the patients in both the groups were followed up at 08 weeks,06 months and 01 year post surgery and evaluated by Lysholm knee scoring system.Results: The Lysholm scoring scale scores in anterior cruciate ligament reconstruction showed that BPTB group and Hamstring group have similar outcome. One case (2.8%) each of patellar fracture and graft contamination occurred in BPTB group. There were 09 cases of superficial infection of which 03 were from BPTB group and 06 were from Hamstring group. Conclusions: There is statistically no significant difference in the overall clinical outcome between bone-patellar tendon- bone and Hamstring autografts. With precise surgical techniques, meticulous attention to sterility and proper wound closure most of the complications in both the techniques can be minimized or avoided

Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures

Background: In the management of peri-trochanteric fractures, intramedullary (IM) devices have proven advantage over extramedullary devices. IM devices allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between IM devices like proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA), the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The following study was undertaken in an attempt to compare these two types of Intra-medullary devices.Methods: Between January 2012 and June 2013, 50 patients with unstable intertrochanteric fractures fulfilling inclusion and exclusion criteria, were randomized into 2 groups to undergo CRIF with either standard PFN (n=25) or PFNA (n=25). They were compared in terms of demography, per-operative variables and postoperative parameters including functional evaluation till 1year postoperatively.Results: Background demographic variables, fracture type and pre-injury ambulatory status were comparable between the groups. Operative duration of surgery, amount of blood loss and number of fluoroscopic images were significantly lower in PFNA group as compared to PFN group. Post op complications like infection, non-union, cut out/z-effect, loss of reduction, re-operation and mortality rates didn’t differ significantly between the groups. Post op functional recovery as evaluated by pain, use of walking aids and Harris hip scores were similar in both groups. Conclusions: PFNA significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFNA offers no significant benefits over PFN in terms of post-operative functional recovery or complications

Evaluation of Ponseti method in correction of congenital talipes equinovarus

Background: Congenital idiopathic clubfoot is a complex foot deformity often requires many months of treatment and frequently resulted in incomplete or defective correction by older methods. Deformity can be corrected with serial manipulation and casting with minimal or no surgery as reported by Ponseti. This study is an attempt to evaluate the effectiveness of Ponseti technique in treatment of idiopathic congenital talipes equino varus.Methods: 30 patients between age group of 01 to 24 weeks with 48 feet having congenital idiopathic clubfoot were treated using Ponseti technique. The guidelines for treatment were followed as per the Ponseti method of serial manipulation and casting at weekly intervals.Results: 43 (89.58%) cases were treated successfully by using Ponseti technique without need of extensive surgery. 42 feet required tenotomy. 38 (79.16%) feet had an excellent outcome, 5 (10.42%) feet had a fair outcome and 05 feet (10.42%) had poor outcome as measured by the Pirani scoring system. 7 (14.58%) patients had cast related complications.Conclusions: The Ponseti method is a safe, effective and reproducible method for correction of idiopathic congenital talipes equinovarus which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot

Comparative study of complications and final outcome between bone patellar tendon bone and hamstring auotgraft in ACL reconstruction

Background: The most common current graft choices in ACL reconstruction are the bone-patellar tendon–bone (BPTB) graft and the quadrupled Hamstring graft. Though BPTB is considered to be the gold standard; hamstring tendon (HT) grafts have increased in popularity over last decade. Our aim in this study is to assess the complications, comorbidities, difficulties and final outcome between BPTB and Hamstring grafts in ACL reconstruction.Methods: 71 male patients with isolated tear of ACL between age group of 18-45 years were included in the study. 35 patients in group A underwent ACL reconstruction using bone patellar tendon bone autograft and 35 patients in group B were managed by reconstructing ACL using quadrupled Hamstring autograft. All the patients in both the groups were followed up at 08 weeks,06 months and 01 year post surgery and evaluated by Lysholm knee scoring system.Results: The Lysholm scoring scale scores in anterior cruciate ligament reconstruction showed that BPTB group and Hamstring group have similar outcome. One case (2.8%) each of patellar fracture and graft contamination occurred in BPTB group. There were 09 cases of superficial infection of which 03 were from BPTB group and 06 were from Hamstring group. Conclusions: There is statistically no significant difference in the overall clinical outcome between bone-patellar tendon- bone and Hamstring autografts. With precise surgical techniques, meticulous attention to sterility and proper wound closure most of the complications in both the techniques can be minimized or avoided

Proceedings of National Conference on Relevance of Engineering and Science for Environment and Society

This conference proceedings contains articles on the various research ideas of the academic community and practitioners presented at the National Conference on Relevance of Engineering and Science for Environment and Society (R{ES}2 2021). R{ES}2 2021 was organized by Shri Pandurang Pratishthan’s, Karmayogi Engineering College, Shelve, Pandharpur, India on July 25th, 2021. Conference Title: National Conference on Relevance of Engineering and Science for Environment and SocietyConference Acronym: R{ES}2 2021Conference Date: 25 July 2021Conference Location: Online (Virtual Mode)Conference Organizers: Shri Pandurang Pratishthan’s, Karmayogi Engineering College, Shelve, Pandharpur, India