Ultrasound guided platelet rich plasma or corticosteroid for supraspinatus tendonosis or partial tear: an observational study of clinical outcome

Background: The clinical application of platelet rich plasma (PRP) in rotator cuff tears has increased recently. Many studies have found no difference between placebo controls and PRP and corticosteroids (CS) and some have found more rapid benefits with PRP injections. The present study was undertaken with the objectives to observe and assess efficacies of the two different treatment modalities in terms of symptomatic relief and recovery of ROM and to ascertain the duration of symptom free period and functional improvement on follow up. Methods: Observational clinical outcome study, conducted at a tertiary care hospital between September 2020 and March 2022 after institute ethical committee clearance. A total of 100 patients, with a positive clinical test for supraspinatus and magnetic resonance imaging (MRI) suggestive of supraspinatus tendinitis were divided to 2 groups and based on whether they received either intra-articular CS or PRP injection under ultrasonography (USG) guidance All patients were followed up at for assessing the outcomes at 6 weeks, 3 months and 6 months from intervention Results: The clinical outcome of the group receiving the PRP was better than group receiving CS intervention. Conclusions: PRP should therefore be considered as a viable option to treat supraspinatus tendinopathy/partial tear as it is cheap, readily available modality using patients own blood which is more acceptable to patient and also safe to individual where complications related to corticosteroids anticipated. Ultrasound guided procedure were found to enhance the accuracy of injection

Outerbridge classification as a predictor for the need of patellar resurfacement in total knee arthroplasty: a prospective study

Background: Residual anterior knee pain after total knee arthroplasty is one of the common causes of early revision surgery in form of patellar resurfacing and even resurfacing the patella in these circumstances may not relieve the symptoms. So, the decision to perform patellar resurfacing during total knee arthroplasty to prevent anterior knee pain remains controversial. The purpose of this study is to determine if the outerbridge classification can predict the need for Patellar resurfacing as part of total knee arthroplasty.Methods: 100 patients with advanced osteoarthritis of knee fulfilling the inclusion and exclusion criteria were randomized into two groups of 50 patients each. In group A-patellar resurfacing done and in group B-patella was not resurfaced while carrying out TKR. Each patient was assessed intraoperatively and his/her patella classified as per Outerbridge classification. Patients were followed-up at 03, 06 and 12 months postoperatively and assessed by modified hospital for special surgery (HSS) knee scores.Results: In case of Outerbridge class III group there is a statistically significant difference (p value -0.002) in HSS score at 03 months, which becomes highly significant at 06 months (p value -0.001) and 01 year (p value <0.001). Similarly, there is statistically significant difference in HSS score (p value- 0.001) in Outerbridge class IV group at 03 months, 06 months and 01 year.Conclusions: Patellar resurfacing in patients undergoing total knee arthroplasty with patella in Outerbridge class III and IV can be safely carried out to further improve the functional outcome. There is no distinct advantage of resurfacing patella in Outerbridge class I and II in terms of functional gain. Thus, Outerbridge classification for patella can effectively guide us whether to resurface patella or not in patients undergoing total knee arthroplasty.

Osteological morphometric analysis of instrumentation safe zones of C1 and C2 vertebra in North Indian population: a multicentric study

Background: The complex anatomy and critical functional role of the C1 and C2 vertebrae necessitate precise understanding of safe zones for instrumentation to mitigate risks during surgical interventions. This study aimed to conduct a comprehensive morphometric analysis to identify and characterize safe zones for instrumentation within C1 and C2 vertebrae. Though there are multiple radiological based studies, actual osteological measurements are not available for North Indian population. Methods: 200 atlas and axis vertebrae were measured within an accuracy of 0.01 mm to ascertain various dimensions, distances and angles to guide safe exposure and instrumentation. To the best of our knowledge this observational morphometric study is first to provide actual osteological measurements in large number of C1 and C2 vertebrae in North Indian population. Results: The morphometric analysis revealed precise measurements of pedicle dimensions, transverse foramen parameters, and distances from key anatomical landmarks within C1 and C2 vertebrae. Safe zones for instrumentation were identified based on these measurements, considering the optimal implant size and trajectory to minimize the risk of neural or vascular damage. Differences between the morphology of North Indian, South Indian and Turkish C1 and C2 morphology was also identified. Conclusions: This study provides critical insights into the morphometric parameters which can be used to identify safe zones for instrumentation within the C1 and C2 vertebrae. The identified safe zones and associated measurements are essential for optimizing surgical strategies, enhancing instrumentation accuracy, and ultimately improving patient outcomes during craniovertebral surgical procedures. Spine Surgeons can utilize this data to tailor surgical approaches and implant placements, promoting safer and more effective interventions in the challenging anatomical region of the craniovertebral junction

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

Prevalence of Generalized Ligament Laxity in Adult Indian Population: A Cross Sectional Study and Review of Literature

Background and objective Generalized ligament laxity (GLL) is defined as increased range of motion across multiple joints in an individual. Its prevalence has been reported to be between 5% & 15%. Though there has been implication of increased prevalence in Indian population, there are relatively few studies related to the prevalence of GLL in adult Indian population . There is also a dearth of literature on, which specialty outpatient department (OPD), these patients commonly present to, with their complaints. The objective of this study was to assess the prevalence of generalized ligament laxity in adult Indian population. Methods 5400 patients were selected from various outpatient departments of a tertiary care hospital after informed consent. After stratification for age and sex, Beighton’s score assessment was done.  Results Using the Beighton’s score of four or more, to assess the prevalence of generalized ligament laxity; a total of 735 (13.61%) participants had GLL in the entire study population of 5400. Significantly higher number of patients were found to have GLL from the sample recruited from Orthopaedic OPD (p=0.013) as compared to other OPDs. The highest Beighton’s score was 8/9, recorded in a 29-year female in the Orthopaedic OPD. It was observed that in all OPDs the mean Beighton’s scores were higher in female than in male participants in each subgroup; also there was a decline in mean scores with increase in age in all OPDs which can be inferred as a decrease in GLL with age. Conclusion This study is the largest Indian study to investigate the prevalence of GLL in the adult population in India. The study found that there was a significant prevalence of GLL in the adult population especially in females compared to males in all ages, though prevalence of GLL reduced with age. This study has implications of prevention of injuries in people with GLL. Though orthopaedic surgeons generally primarily manage the people with GLL, they do not have a high index of suspicion towards the same. Identifying these individuals and making a diagnosis regarding the same is problematic but doing so will help these individuals live a pain-free life

Changing pattern of utilization of human donor cornea in India

Purpose: To review the changing pattern of donor, corneal utilization in an eye bank at a Tertiary Care Center in Northern India by analyzing the trend in the years 2003, 2008, and 2011. Methods: A retrospective review of eye bank records for 3 years (2003, 2008, and 2011) was performed at the National Eye Bank. Details including a clinical grade of donor cornea, indication of corneal transplantation (therapeutic or optical), type of procedure (penetrating or lamellar keratoplasty [LK]), and clinical diagnosis of the graft recipients were recorded. Primary outcome measure was to observe any preference toward LK, judicious usage of donor corneal tissue, and impact of lamellar corneal transplant in the usage of donor corneas. Secondary outcomes included overall utilization rate and change in trend of indication for keratoplasty. Results: A total of 673, 745, and 864 corneas were retrieved in the years 2003, 2008, and 2011, respectively. The percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011 (P = 0.014); however, this change was reflected only in the usage of nonoptical grade corneas and not for the optical grade corneas. There was an overall increase in lamellar corneal procedures for any clinical grade of cornea (P = 0.0019); number of Descemet's stripping automated endothelial keratoplasty (DSAEK) procedures increased significantly (P < 0.001), particularly for pseudophakic corneal edema (PCE) (P = 0.0085) and failed graft (P = 0.002). Significant increase in the utilization of nonoptical grade corneas was observed over the years (P = 0.005), though the utilization did not increase significantly for optical purposes viz., LK (P = 0.08). Conclusions: Utilization rate of donor corneas increased over the years, primarily due to increase in usage of nonoptical grade corneas for therapeutic purposes. There was a procedural shift toward DSAEK for PCE and failed graft. However, an increase in usage of nonoptical grade corneas for LK, a single donor corneal tissue for two recipients, and retrieval or utilization of optical grade cornea was not observed

Changes in stereoacuity following implantable Collamer lens implantation in patients with myopia

The study evaluated the impact of implantable Collamer lens (ICL) implantation on stereoacuity in myopes in a retrospective case series. Ninety-five eyes of 48 patients were recruited. Distance and near stereoacuity were measured using distance Randot stereotest and TNO test, respectively, before surgery and at 4 weeks postoperatively. Mean age of the patients was 23.67 ± 3.7 years. Mean uncorrected distance visual acuity (UDVA) was 1.28 ± 0.37 logarithm of the minimum angle of resolution (logMAR) (median: 1.3; range: 0.3-1.8), and median best-corrected distance visual acuity (BDVA) was 0.18 logMAR (range: 0-0.6). There was a significant improvement in both UDVA and BDVA postsurgery (P < 0.001; Wilcoxon signed rank test). The overall improvement in stereopsis was observed in 15/48 (31.25%) and 13/48 (27.10%) subjects for near and distance, respectively, with no significant difference between the two (P = 0.82; Fisher′s exact test). Among stereoblind individuals, the odd′s ratio for near stereoacuity to improve in comparison to distance stereoacuity was 8.85 (95% confidence interval: 1.68-46.70; P = 0.01). ICL implantation for refractive correction aided stereoacuity improvement in myopes more so for near

Scleral tunnel phacoemulsification: Approach for eyes with severe microcornea

Cataract surgery in eyes with microcornea is associated with frequent complications such as corneal edema, posterior capsular rent, and risk of unplanned aphakia. We describe an improved surgical technique for the creation of surgical incisions during phacoemulsification in eyes with cataract associated with microcornea. A retrospective analysis of eight patients (8 eyes) operated at our center was undertaken. The mean age of the patients was 29.5 ± 10.9 years. All eyes were operated using the scleral pocket incision for phacoemulsification. This scleral pocket incision was tangential to the limbus and created approximately 2.5 mm behind limbus through which phacoemulsification probe was inserted. Because of the posterior placement of incision, the anterior chamber crowding was minimized. There was no incidence of port-site peripheral corneal edema. Fifty percent eyes developed transient central corneal edema, the intraocular lens in bag was implanted in 5/8 eyes, and none developed Descemet′s membrane detachment. Mean best-corrected visual acuity improved from 1.85 ± 0.38 logarithm of minimum angle of resolution (LogMAR) to 1.26 ± 0.70 LogMAR postoperatively (P = 0.01; paired t-test). Posterior incision placement during phacoemulsification in microcornea helps achieve favorable postoperative outcomes in contrast to outcomes using clear corneal approach described in literature