Shoulder chondromatosis with multiple loose bodies and glenoid erosion- managed by arthroscopic loose body removal and BMAC

Chondromatosis is a rare, benign condition of the joints with metaplasia of synovium into cartilage leading to the formation of loose bodies. Involvement of the shoulder joint is uncommon. Symptomatic individuals require removal of the loose bodies. Here we describe a case report of a patient with synovial chondromatosis of the shoulder with multiple loose bodies causing glenoid cartilage erosions and loss. This required not only loose body removal but cartilage regenerative procedure- bone marrow aspirate concentrate (BMAC) application. Post-surgery, he had a rapid resolution of symptoms

A short term analysis of external rotation deficit following a combined arthroscopic bankart with remplissage and rotator interval closure for anteroinferior instability with subcritical bone loss

Background: Our study aims at assessing the clinical outcomes of our patients who have undergone arthroscopic bankart and remplissage along with rotator interval closure in the treatment of anteroinferior instability with subcritical bone loss, with focus on external rotation deficit. Methods: This is a single-center retrospective study including 48 consecutive patients who underwent surgery Arthroscopic Bankarts with remplissage procedure for anterior shoulder instability with Hill-Sachs lesion. In our study, the minimum follow-up was 6 months and the average follow-up of was 21months. At the last follow-up, active range of motion, western ontario shoulder instability index (WOSI) and University of California at Los Angeles (UCLA) scores were assessed. Results: 48 patients who underwent surgery in the time period of 2019-2023 who completed minimum 6months follow up were included in the study. The average age of the patients was 31.7 years (range, 16-52 years), with 93.8% male patients and 6.2% female patients. The range of motion at follow-up was comparable with the normal side, with loss of terminal external rotation in 2 patients (4%). Average University of California at Los Angeles score was 30.7 and Western Ontario shoulder instability index was 3.8%. One patient had only one episode of subluxation and there was one case of infection. Conclusions: The results of our study validate the combination of Remplissage and rotator interval closure with Bankart repair in the treatment of anterior instability with glenoid bone loss <15% irrespective of tracking of Hill Sachs lesion for excellent functional outcomes, least rate of recurrence and without significant loss of external rotation

Tubercular infection after arthroscopic rotator cuff repair.

Tubercular septic arthritis after shoulder arthroscopy has not been reported in the English literature to our knowledge. A case of Tubercular septic arthritis of the shoulder following arthroscopic rotator cuff repair is presented. The sinus and the wound healed well, and laboratory parameters returned to normal, which suggests that the infection was well controlled with the treatment follow-up of 1 year. But the functional score was poor due to repeated surgeries; long-standing infection and the arthritic changes developed. Tubercular infection can occur after arthroscopic shoulder surgery especially in healthcare workers in zones endemic for Tuberculosis. Level of evidence V

Arthroscopic Superior Capsular Reconstruction Using Hybrid Autologous Fascia Lata and the Long Head of Biceps Tendon Graft: the Central Beam Concept

Superior capsular reconstruction is a joint salvage treatment option for retracted irreparable rotator cuff tears in relatively young patients. Various graft options have been described in the literature, including autologous fascia lata graft, synthetic graft, and dermal patches. Superior capsular reconstruction using long head of biceps tendon autograft alone has also been described by few authors. In this technical note, we describe a modified technique of performing arthroscopic superior capsular reconstruction using both fascia lata graft and the intra articular portion of the long head of biceps tendon. Our technique resembles central beam concept over which the fascia lata graft is anchored, providing good structural support to the graft and enabling graft healing and improved clinical outcomes

All Arthroscopic Salvage Technique for Intraoperative Vertical Split Coracoid Graft Fracture in Latarjet Procedure—Technical Note

Intraoperative vertical coracoid graft fractures during the Latarjet procedure are well-described complications, which typically have a poor prognosis or may necessitate further iliac crest bone grafting for stabilization. The vertical split coracoid fractures are reasoned to be caused by excessive tightening of the screws, poor bone quality, especially in females and the smaller dimension of the coracoid graft. In this technical note, we propose an arthroscopic salvage technique for salvaging the fractured coracoid graft and to avoid the need for additional bone graft, thereby reducing morbidity to the patient. We use two double-loaded, all-suture anchors (Stryker, India) on either side of the split coracoid graft, and double-pulley configuration of suture tightening is done, providing compression and stability to the fractured graft

Changes in structural attributes of plant communities along disturbance gradients in a dry deciduous forest of Western Ghats, India

Changes in tree and understory plant diversity and community composition in two sites at different disturbance levels were studied on the Anaikatty hills, Western Ghats. Systematic sampling using small scale permanent quadrates (50 x 20 m for trees, 5 x 5 m for shrubs/saplings, 1 x 1 m for herbs/seedlings) enumerated 3,376 individuals of trees (106 species), 8,599 of individuals shrubs (122 species) and 16,659 individuals of herbs (145 species). Among the two sites, species richness and diversity were highest for low disturbed stand (98 and 3.9, respectively) compared to high disturbed site (45 and 2.71, respectively). Result of cluster analysis showed that two distinct clusters were formed on the basis of disturbance of the area in concordance with our field observation. A total of 37 species were common to both sites, sixty one species exclusively found in low disturbed site and eight species were pertained to highly disturbed site. Mann-Whitney test based on Monte Carlo approximation at 95% confidence levels indicated that both populations were not entirely different. The clear difference was only observed for average basal area of trees, density of seedlings, number of species, density and diversity for shrubs and number of species and diversity for herb. The species composition were different in two stand i.e., Nothopegia racemosa-Albizia amara-Maba neilghrrensis in low disturbed stand and Albizia amara-Pleiospermium alatum-Bauhinia racemosa in high disturbed stand. The major disturbance factors identification using spearman rank correlation indicated that the disturbance in low disturbed habitats were mostly from past logging followed by cutting and illicit felling and grazing, while in high disturbed habitats, it was human presence, past logging and lopping and fuel wood collection

Diagnosis and management of pulmonary nodules

There are an increased number of pulmonary nodules discovered on CT scan images in part due to those performed for lung cancer screening. Risk stratification and patient involvement is critical in determining management ranging from interval imaging to invasive biopsy or surgery. A definitive diagnosis requires tissue biopsy. The choice of a particular biopsy technique depends on the risks/benefits of the procedure, the diagnostic yield and local expertise. This review will focus on the evaluation and management of pulmonary nodules based on the Fleischner Society and American College of Chest Physician guidelines. There have been recent changes to both societies' recommendations for incidental detection of solid and subsolid nodules, risk stratification, imaging, minimally invasive diagnostic techniques and definitive surgical options