Lipoma Arborescens: A Case of Massive Knee Swelling

Vol. 10 | Issue 1 | January-February 2022 | Page: 29-31 | Rinju Krishnan, Aditi A. Pinto, Tarun Desai, Rajkumar S. Amaravathi

DOI:10.13107/jkoa.2022.v10i01.049


Authors:  Rinju Krishnan [1], Aditi A. Pinto [1], Tarun Desai [1], Rajkumar S. Amaravathi
[1]

[1] Department Of Orthopaedics, St. Johns Medical College, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Rajkumar S. Amaravathi,
Department Of Orthopaedics, St. Johns Medical College, Bangalore, Karnataka, India.
E-mail: rajamarvathi@gmail.com


Abstract


Lipoma arborescens is not so common condition of unknown etiology. The usual presentation is that of a long standing mono articular soft tissue swelling involving the knee joint. This diagnosis is not often made clinically but usually made with the help of Magnetic Resonance imaging and Biopsy. We are reporting a case of chronic massive knee joint swelling so as to raise awareness about the condition and its imaging features, so that misdiagnosis can be avoided and early appropriate treatment can be given.
Keywords: Lipoma arborescens, Synovium, Magnetic Resonance Imaging


References


1. Arzimanoglu A. Bilateral arborescent lipoma of the knee. J Bone Joint Surg Am. 1957 Jul;39-A (4):976–9.
2. Davies AP, Blewitt N. Lipoma arborescens of the knee. Knee. 2005 Oct;12(5):394–6.
3. Al-Ismail K, Torreggiani WC, Al-Sheikh F, Keogh C, Munk PL. Bilateral lipoma arborescens associated with early osteoarthritis. Eur Radiol. 2002 Nov;12(11):2799–802.
4. Adelani MA, Wupperman RM, Holt GE. Benign synovial disorders. J Am Acad Orthop Surg. 2008 May;16(5):268–75.
5. Kloen P, Keel SB, Chandler HP, Geiger RH, Zarins B, Rosenberg AE. Lipoma arborescens of the knee. J Bone Joint Surg Br. 1998 Mar;80(2):298–301.
6. Huang G-S, Lee H-S, Hsu Y-C, Kao H-W, Lee H-H, Chen C-Y. Tenosynovial lipoma arborescens of the ankle in a child. Skeletal Radiol. 2006 Apr;35(4):244–7.
7. Siva C, Brasington R, Totty W, Sotelo A, Atkinson J. Synovial lipomatosis (lipoma arborescens) affecting multiple joints in a patient with congenital short bowel syndrome. J Rheumatol. 2002 May;29(5):1088–92.
8. Sharma SD, Bagri DR, Gupta RK, Sarna A. Lipoma arborescens. Indian J Pediatr. 2011 Aug;78(8):1016–8.
9. In Y, Chun K-A, Chang E-D, Lee S-M. Lipoma arborescens of the glenohumeral joint: a possible cause of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2008 Aug;16(8):794–6.
10. Noel ER, Tebib JG, Dumontet C, Colson F, Carret JP, Vauzelle JL, et al. Synovial lipoma arborescens of the hip. Clin Rheumatol. 1987 Mar;6(1):92–6.
11. Doyle AJ, Miller MV, French JG. Lipoma arborescens in the bicipital bursa of the elbow: MRI findings in two cases. Skeletal Radiol. 2002 Nov;31(11):656–60.
12. Napolitano A. [Lipoma arborescens of the synovial fluid; clinical contribution to a case located at the synovia of the wrist]. Prog Med (Napoli). 1957 Feb 28;13(4):109–18.
13. Moukaddam H, Smitaman E, Haims AH. Lipoma arborescens of the peroneal tendon sheath. J Magn Reson Imaging. 2011 Jan;33(1):221–4.
14. Soler T, Rodríguez E, Bargiela A, Da Riba M. Lipoma arborescens of the knee: MR characteristics in 13 joints. J Comput Assist Tomogr. 1998 Aug;22(4):605–9.
15. Natera L, Gelber PE, Erquicia JI, Monllau JC. Primary lipoma arborescens of the knee may involve the development of early osteoarthritis if prompt synovectomy is not performed. J Orthop Traumatol. 2015 Mar;16(1):47–53.
16. Weston WJ. The intra-synovial fatty masses in chronic rheumatoid arthritis. Br J Radiol. 1973 Mar;46(543):213–6.
17. Erduran M, Meriç G, Ulusal AE, Akseki D. The complete type of suprapatellar plica and lipoma arborescens: a case report. Acta Orthop Traumatol Turc. 2014;48(6):703–6.
18. Hayashi S, Adachi N, Ikuta Y, Shimizu R, Nakasa T, Ishikawa M, et al. Lipoma arborescens in bilateral knee joints accompany gouty tophi: A case-based review of the literature. J Orthop Sci. 2019 Jan;24(1):184–8.
19. Franco M, Puch JM, Carayon MJ, Bortolotti D, Albano L, Lallemand A. Lipoma arborescens of the knee: report of a case managed by arthroscopic synovectomy. Joint Bone Spine. 2004 Jan;71(1):73–5.


How to Cite this article:  Krishnan R, Pinto AA, Desai T, Amaravathi RS | Lipoma Arborescens: A Case of Massive Knee Swelling | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 29-31.


 


                                          (Abstract Text HTML)      (Download PDF)


Calcaneal Intraosseous Lipoma: A Case Report

Vol. 10 | Issue 1 | January-February 2022 | Page: 26-28 | Bharath Raju G, Ravish V N, Naveen Kumar, B M Bharath Gowda

DOI:10.13107/jkoa.2022.v10i01.048


Authors:  Bharath Raju G [1], Ravish V N [1], Naveen Kumar [1], B M Bharath Gowda [1]

[1] Department of Orthopaedics, KIMSH & RC, V.V Puram, Bangalore, Karnataka, India.

Address of Correspondence

Dr. B M Bharath Gowda,
Department of Orthopaedics, KIMSH & RC, V.V Puram, Bangalore, Karnataka, India.
E-mail: bharathg931@gmail.com


Abstract


Background: This case report is presented to increase awareness among clinicians about the existence of this rare cause of calcaneal pain. Intraosseous lipoma is a rare, benign primary tumour occurring in the bone We report a 40-year-old lady who presented with the history of one week old trauma with pain in the lateral aspect of right ankle which was clinically diagnosed to be right lateral collateral ligament sprain. The radiographs of the right ankle and heel incidentally revealed a lytic lesion. The patient had no symptoms persisting to foot and heel. MRI of right foot was suggestive of calcaneal stage 2 intra osseous lipoma. In view of the subchondral location of the lesion, prophylactically the lesion was treated with curettage and bone grafting to prevent the pathological fracture. The post-operative radiographs demonstrated continued remodelling and healing of the graft site. The patient was followed up on an OPD basis and made a full recovery with good patient compliance. Even though this tumour is rare, there is a need for physicians to recognize its radiological findings and offer the appropriate treatment options. It is also important for primary care physicians to be aware that there are other causes of heel pain than the common suspects.
Keywords: Intraosseous lipoma, Heel pain, Lytic lesion, Benign primary tumour


References


1. Schajowicz F. Other connective tissue tumors. Lipoma. In: Schajowicz F, editor. Tumors and tumorlike lesions of bone. Pathology, radiology and treatment. New York: Springer Verlag; 1994; p. 406-11
2. Child PL. Lipoma of the os calcis; report of a case. Am J Clin Pathol. 1955; 25(9):1050-2.
3. Hatori M, Hosaka M, Ehara S, Kokubun S. Imaging features of intraosseous lipomas of the calcaneus. Arch Orthop Trauma Surg. 2001;8:429-32
4. 4. Muramatsu K, Tominaga Y, Hashimoto T and Taguchi T: Symptomatic intraosseous lipoma in the calcaneus. Anticancer Res 34: 963-966, 2014.
5. Ozdemir H, Bozgeyik Z, Kocakoc E, Kalender O. MRI findings of intraosseous lipoma: Case report. Mag Reson Imaging. 2004;22:281-4
6. Richardson AA, Erdmann BB, Beier-Hanratty S, Lautz D, Jacobs PM, Julsrud ME and Ringstrom JB: Magnetic resonance imagery of a calcaneal lipoma. J Am Podiatr Med Assoc 85: 493-496, 1995.
7. Genchi V, Scialpi M, Scarciolla G, Dimauro F and Trigona A: Intraosseous lipoma of the calcaneus. Characterization with computerized tomography and magnetic resonance in a case. Radiol Med 99: 86-88, 2000 (In Italian)
8. Pogoda P, Priemel M, Linhart W, Stork A, Adam G, Windolf J, Rueger JM and Amling M: Clinical relevance of calcaneal bone cysts: A study of 50 cysts in 47 patients. Clin Orthop Relat Res 424: 202-210, 2004
9. Weinfeld GD, Yu GV and Good JJ. Intraosseous lipoma of the calcaneus: A review and report of four cases. J Foot Ankle Surg. 2002;416: 398-411.
10. Yildiz HY, Altinok D, Saglik Y. Bilateral calcaneal intraosseous lipoma: A case report. Foot Ankle Int. 2002;23:60-63.
11. Hirata M, Kusuzaki K, Hirasawa Y: Eleven cases of intraosseous lipoma of the calcaneus. Anticancer Res. 2001;21:4099- 4103
12. Cao Y. Internal fixation combined with bone grafting for large intraosseous calcaneal lipoma: A case report. Mol Clin Oncol. 2017 Nov;7(5):877-879. doi: 10.3892/mco.2017.1421. Epub 2017 Sep 19. PMID: 29181183; PMCID: PMC5700290.
13. Toepfer A, Lenze U, Gerdesmeyer L, Pohlig F, Harrasser N. Endoscopic resection and allografting for benign osteolytic lesions of the calcaneus. Springerplus. 2016 Apr 11;5:427. doi: 10.1186/s40064-016-2059-y. PMID: 27104115; PMCID: PMC4828351.


How to Cite this article:  Raju G B, Ravish VN, Kumar N, Gowda BMB | Calcaneal Intraosseous Lipoma: A Case Report | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 26-28.

 


                                          (Abstract Text HTML)      (Download PDF)


Total Knee Arthroplasty in Bilateral Severe Fixed Flexion Deformity: A Case Report

Vol. 10 | Issue 1 | January-February 2022 | Page: 22-25 | Rajesh S, Supreeth D R, Hemant K. Kalyan

DOI:10.13107/jkoa.2022.v10i01.047


Authors: Rajesh S [1], Supreeth D R [1], Hemant K. Kalyan [1]

[1] Department of Orthopaedic Surgery, Manipal Hospital, Bengaluru, Karnataka, India

Address of Correspondence

Dr. Supreeth D R,
Department of Orthopaedic Surgery, Manipal Hospital, Bengaluru, Karnataka, India.
E-mail: 18supreethdr@gmail.com


Abstract


Background: Severe bilateral Fixed flexion deformity of the knees resulting from irreversible joint damage is a disabling complication of long-standing rheumatoid arthritis, associated with loss of ambulatory ability. While Total knee Arthroplasty is an effective treatment for such patients, it poses significant intra-operative technical demands and challenges with post-operative rehabilitation.
Method: We report a case of Severe Fixed flexion deformity of both knees in a 46-year-old male with long-standing rheumatoid arthritis, non-ambulatory since 5 years, treated by sequential total knee arthroplasty.
Results: Treating Severe bilateral Fixed flexion deformities in a non-ambulatory patient by sequential total knee Arthroplasty using standard implants yielded complete deformity correction and pain-free restoration of active range of motion in both knees with stable independent ambulation and complete restoration of lower limb function within 3 months of surgery.
Conclusion: Our case is particularly remarkable for complete restoration of stable, pain-free restoration of ambulation within 3months in a patient with severe bilateral knee fixed flexion deformities who had been non-ambulatory for 5 years preceding his bilateral sequential total knee arthroplasty.
Keywords: Fixed flexion deformity, Total knee arthroplasty, Common peroneal nerve, Rheumatoid arthritis.


References


1. Lu H, Mehdi G, Zhou D, Lin J: Simultaneous bilateral total knee arthroplasty for rheumatoid arthritis. Chin Med J (Engl). 1996, 109 (12): 937- 940.
2. Giles R. Scuderi,Robert B. Bourne,Philip C. Noble,James B. Benjamin,Jess H. Lonner, W. N. Scott:The New knee society Scoring system Clin Orthop Relat Res. 2012 Jan; 470(1): 3–19.
3. Scuderi GR, Kochhar T: Management of flexion contracture in total knee arthroplasty. J Arthroplasty. 2007, 22 (4 Suppl 1): 20-24.
4. Ito J, Koshino T, Okamoto R, Saito T: 15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty. 2003, 18 (8): 984-992. DOI,10.1016/S0883-5403(03)00262-6.
5. Abe S, Kohyama K, Yokoyama H, Shigeru M, Yasuhiro T, Natsuko N, Yasuhiro S, Hiroyuki F: Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases. Mod Rheumatol. 2008, 18 (5): 499-506. DOI. 10.1007/s10165-008-0079-3. 9.
6. Massin P, Petit A, Odri G, Ducellier F, Sabatier C, Lautridou C, Cappelli M, Hulet C, Canciani JP, Letenneur J, Burdin P, Sociétéd’orthopédie de l’oues: Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Orthop Traumatol Surg Res. 2009, 95 (4 Suppl 1): S7-S12.
7. Sarokhan AJ, Scott RD, Thomas WH, Sledge CB, Ewald FC, Cloos DW: Total knee arthroplasty in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 1983, 65 (8): 1071-1080.
8. Knutson K, Leden I, Sturfelt G, Rosen I, Lidgren L: Nerve palsy after knee arthroplasty in patients with rheumatoid arthritis. Scand J Rheumatol. 1983, 12 (3): 201-205. DOI.10.3109/03009748309098533.
9. Omeroglu H, Ozcelik A, Turgut A: Bilateral peroneal nerve palsy after simultaneous bilateral total knee arthroplasty. Report of a case with rheumatoid arthritis. Knee Surg Sports TraumatolArthrosc. 2001, 9 (4): 225-227. DOI, 10.1007/s001670100211.
10. Figgie HE, Brody GA, Inglis AE, Sculco TP, Goldberg VM, Figgie MP: Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis. ClinOrthopRelat Res. 1987, 224: 237-243. 33
11. Smilowicz M: Problems involved in total knee arthroplasty for rheumatoid arthritis patients. OrtopTraumatolRehabil. 2000, 2 (4): 27-31.


How to Cite this article:  Rajesh S, Supreeth DR, Kalyan HK | Total Knee Arthroplasty in Bilateral Severe Fixed Flexion Deformity: A Case Report | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 22-25.

 


 


                                          (Abstract Text HTML)      (Download PDF)


A Comparative Study Between the Functional and Radiological Outcomes of ACDF Using Locking Stand Alone Cage And Anterior Cervical Plate With Titanium Disc Cage in Degenerative Cervical Spine Disease

Vol. 10 | Issue 1 | January-February 2022 | Page: 15-21 | HS Chandrashekar, Mohan N S, Ashwin S, Syed Farhan Bukhari, Nithin S M

DOI:10.13107/jkoa.2022.v10i01.046


Authors: HS Chandrashekar [1], Mohan N S [1], Ashwin S [1], Syed Farhan Bukhari [1], Nithin S M
[1]

[1] Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Ashwin S,
Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bangalore, Karnataka, India.
E-mail: ashwinsuresh47@gmail.com


Abstract


Background: Cervical spondylotic radiculopathy and myelopathy are common problems for which anterior cervical discectomy and fusion is a gold standard procedure. There are various implant options available, two of which are commonly used in practice. Anterior cervical cage with plate and locking standalone cage. Our study aims to compare these two methods to know the functional and radiological outcomes after Anterior cervical discectomy and fusion procedure.
Materials and Methods: We performed a prospective comparative study of 60 patients with single or two level degenerative cervical spine disease with failed conservative management. They were divided randomly into 2 groups of 30 patients each one group treated using locking standalone cage and the other with anterior cervical plate with cage using Smith Robinson approach. The clinical outcome was measured using visual analogue scores, Robinson’s criteria and Neck disability index and the radiological outcome was assessed using cobb’s angle, segmental height and segment angle with a follow up period of 2 years.
Results: At 2 years follow up, good functional outcomes were obtained in both implant groups in terms of Robinson criteria, neck disability index and visual analogue scale. And good radiological outcomes were obtained in both implant groups with 93.3% fusion rates in both groups. Significant dysphagia was seen in the cage with plate group(26.6%) and significant cage subsidence was noted in the standalone cage group(20%).
Conclusion: The functional and radiological outcomes are superior at 2 years follow up in both implant groups. Hence standalone cage and cage with plate technique both are equally safe and effective treatment options in 1 or 2 level degenerative cervical spine disease.
Keywords: Anterior cervical discectomy and fusion, Neck Disability Index, Visual Analogue scale, Locking standalone cage, Anterior cervical plate, cage subsidence, Robinson criteria.


References


1. John C Quinn,MD Paul D, Kiely, MCh, FRCh, Darren R, Lebl, MD, Alexander P, Hughes MD- Anterior surgical treatment of cervical spondylotic myelopathy HSS Journal(2015) 11:15-25, DOI 10.1007/s11420-9408-6
2. Ehab Shiban, Karina Gapon, Maria Wostrack, Bernhard Meyer, Jens Lehmberg-Clinical and radiological outcome after anterior cervical discectomy and fusion with standalone empty polyetheretherketone (PEEK) cages-Acta Neurochir(2016) 158:349-355, DOI 10.1007/s00701-015-2630-2
3. Paolo Perrini, Federico Cagnazzo, Nicola Benedetto, Riccardo Morganti, Carlo Gambacciani- Cage with anterior plating is advantageousover the standalone cage for segmental lordosis in the treatment of two level cervical degenerative spondylopathy: a retrospective study- Clinical Neurology and Neurosurgery 163(2017) 27-32.
4. Mithun Nambiar, Kevin Phan, John Edward Cunningham, Yi Yang, Peter Lawrence Turner, Ralph Mobbs- Locking standalone cages versus anterior plate constructs in single level fusion for degenerative cervical disease: a systematic review and meta analysis- Eur Spine J(2017) 26:2258-2266 DOI 10.1007/s00586-017-5015-9
5. Zhongai Li, Yantao Zhao, Jiaguang Tang, Dongfeng Ren, Jidong Guo, Huadong Wang, Li Li, Shuxun Hou- A comparison of a new zero profile, standalone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2 year follow up- Eur Spine J(2017) 26:1129-1139 DOI 10.1007/s00586-016-4739-2
6. Christopher Brenke, Martin Dostal, Johann Scharf, Christel Weib, Kirsten Schmieder, Martin Barth- Influence of cervical bone mineral density on cage subsidence in patients following stand alone anterior cervical discectomy and fusion- Eur Spine J(2015) 24:2832-2840 DOI 10.1007/s00586-014-3725-9
7. Zoe B. Cheung, MD, MS1 , Sunder Gidumal, BA1 , Samuel White, BA1 , John Shin, MD1 , Kevin Phan, MD, MSc, MPhil1 , Nebiyu Osman, BA1 , Rachel Bronheim, BA1 , Luilly Vargas, BSN1 , Jun S. Kim, MD1 , and Samuel K. Cho, MD1-Comparison of Anterior Cervical Discectomy and Fusion With a Stand-Alone Interbody Cage Versus a Conventional Cage-Plate Technique: A Systematic Review and Meta-Analysis- Global Spine Journal 2019 Vol 9(4) 446-455 DOI 10.1177/2192568218774576
8. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complication. Spine (Phila Pa 1976). 2007;32(21):2310-2317.
9. Fogel GR, McDonnell MF. Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J. 2005;5(2):140-144.
10. Ahn SS, Paik HK, Chin DK, Kim SH, Kim DW, Ku MG. The fate of adjacent segments after anterior cervical discectomy and fusion: the influence of an anterior plate system. World Neurosurg. 2016;89:42-50
11. Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005;87(3):558-563
12. Liu Y, Wang H, Li X, et al. Comparison of a zero-profile anchored spacer (ROI-C) and the polyetheretherketone (PEEK) cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy. Eur Spine J. 2016;25:1881-1890
13. Karikari IO, Jain D, Owens TR, et al. Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: a systematic review. J Spinal Disord Tech. 2014;27(1):1-10.
14. Hwang SL, Hwang YF, Lieu AS et al: Outcome analyses of interbody titanium cage fusion used in the anterior discectomy for cervical degenerative disc disease. J Spinal Disord Tech, 2005; 18: 326–31
15. Dufour T, Huppert J, Louis C et al: Radiological analysis of 37 segments in cervical spine implanted with a peek stand-alone device, with at least one-year follow-up. Br J Neurosurg, 2010; 24: 633–40
16. Kwon WK, Kim PS, Ahn SY, et al. Analysis of associating factors with C2-7 sagittal vertical axis after two-level anterior cervical fusion: comparison between plate augmentation and stand-alone cages. Spine (Phila Pa 1976). 2017;42:318-325.
17. Li Z, Zhao Y, Tang J, et al. A comparison of a new zero-profile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study. Eur Spine J. 2017;26(4):1129-1139.
18. Kawakami M, Tamaki T, Yoshida M, Hayashi N, Ando M, Yamada H. Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord. 1999;12(1):50-56.
19. Lee CH, Hyun SJ, Kim MJ et al: Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech, 2013; 26: 112–18
20. Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B et al. Long term follow up after interbody fusion of the cervical spine. J Spinal Discord Tech, 2004;17:79-85.


How to Cite this article:  Chandrashekar HS, Mohan NS, Ashwin S, Bukhari SF, Nithin SM | A Comparative Study Between the Functional and Radiological Outcomes of ACDF Using Locking Stand Alone Cage And Anterior Cervical Plate With Titanium Disc Cage in Degenerative Cervical Spine Disease | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 15-21.

 


 


                                          (Abstract Text HTML)      (Download PDF)


Functional Outcome Following Concurrent Medial Meniscus Posterior Horn Root Repair during High Tibial Osteotomy in Early Medial Compartment Osteoarthritis

Vol. 10 | Issue 1 | January-February 2022 | Page: 09-14 | Kumar Amerendra Singh, Hitesh Shah

DOI:10.13107/jkoa.2022.v10i01.045


Authors: Anoop Pilar [1], Madan Mohan M [1], Sunil L K [1], Surendra Babu S [1], Padmanabhan Sekaran [2], Rajkumar S. Amaravathi [1]

[1] Department of Orthopaedics, St Johns Medical College and Hospital, Bangalore, Karnataka, India.
[2] Department of Physiotherapy and Rehabilitation, Sparsh Hospital, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Rajkumar S. Amaravathi,
Department of Orthopaedics, St Johns Medical College and Hospital, Bangalore, Karnataka, India.
E-mail: rajkumar_as@yahoo.co.in


Abstract


Background: Meniscal root tears cause biomechanical changes comparable to a total meniscectomy. The resultant compromise in hoop stress, leads to decreased tibiofemoral contact area and increased contact pressure. This will lead to early arthritis. The meniscus root tear causes more detrimental changes in people with varus alignment of the lower limb. This increases the chances of progression to arthritis, causing joint pain and functional limitation, eventually necessitating early replacement surgery. Surgical management with repair of the meniscus, with corrective osteotomy restoring the normal anatomy, has been reported to improve clinical and functional outcomes and delay the replacement surgery. This study aimed to evaluate the functional outcome following concurrent Medial meniscus posterior horn root (MMPHRTs) repair during open medial wedge high tibial osteotomy (HTO) with medial osteoarthritis.
Methods: We performed posterior horn root repair with open medial wedge HTO in 9 patients, between 2016 and 2021. The mean follow-up of patients was 2 years. The mean Lysholm and IKDC scores showed significant improvement (7 had excellent and 2 had satisfactory scores). Patients returned to their expected activity of daily living.
Conclusion: Concurrent MMPHRT repair along with medial open wedge HTO for medial compartmental osteoarthritis with varus alignment gives good results and has shown good clinical and radiological outcome on short term follow-up.
Keywords: Meniscal root tear, Medial open wedge HTO, Preoperative planning, Outcome.


References


1. Fithian, D.C.; Kelly, M.A.; Mow, V.C. Material properties and structure-function relationships in the menisci. Clin. Orthop. Relat.Res. 1990, 252, 19–31.
2. Koenig, J.H.; Ranawat, A.S.; Umans, H.R.; Difelice, G.S. Meniscal root tears: Diagnosis and treatment. Arthrosc. J. Arthrosc. Relat.Surg. 2009, 25, 1025–1032.
3. Kan, A.; Oshida, M.; Oshida, S.; Imada, M.; Nakagawa, T.; Okinaga, S. Anatomical significance of a posterior horn of medial meniscus: The relationship between its radial tear and cartilage degradation of joint surface. Sports Med. Arthrosc. Rehabil.Ther. Technol. 2010, 2, 1.
4. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922–31.
5. Marzo JM, Gurske-DePerio J. Efects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med. 2009;37(1):124–9.
6. Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med. 2014;42(3):699–707.
7. Jiang EX, Abouljoud MM, Everhart JS, DiBartola AC, Kaeding CC, Magnus sen RA, et al. Clinical factors associated with successful meniscal root repairs: a systematic review. Knee. 2019;26(2):285–91.
8. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011;27(12):1644–53.
9. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic fndings with medial meniscectomy. Arthroscopy. 2011;27(3):346–54.
10. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138–43.
11. Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH. Early surgical repair of medial meniscus posterior root tear minimizes the progres sion of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. Am J Sports Med. 2020;48(11):2692–702.
12. Chung KS, Ha JK, Ra HJ, Kim JG. Preoperative varus alignment and post-operative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc. 2021.
13. Chung KS, Ha JK, Ra HJ. Kim JG (2016) Prognostic factors in the midterm results of pullout fxation for posterior root tears of the medial meniscus. Arthroscopy. 2016;32(7):1319–27.
14. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42(3):69–78.
15. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhofer P. Out come after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):170–80.
16. Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S. Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years’ follow-up. Knee. 2014;21(2):445–50.
17. Birmingham TB, Moyer R, Leitch K, Chesworth B, Bryant D, Willits K, et al. Changes in biomechanical risk factors for knee osteoarthritis and their association with 5-year clinically important improvement after limb realignment surgery. Osteoarthritis Cartilage. 2017;25(12):1999–2006.
18. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy 2004;20(04):373–378
19. Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD. Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg Br 2009;91(02): 190–195
20. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH, et al. Second-look arthroscopic assessment of cartilage regeneration after medial openingwedge high tibial osteotomy. Arthroscopy. 2014;30(1):72–9.
21. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med. 2010;38(7):1420–4.
22. Kim KI, Seo MC, Song SJ, Bae DK, Kim DH, Lee SH. Change of chondral lesions and predictive factors after medial open-wedge high tibial oste otomy with a locked plate system. Am J Sports Med. 2017;45(7):1615–21.
23. Jung WH, Takeuchi R, Chun CW, Lee JS, Jeong JH. Comparison of results of medial opening-wedge high tibial osteotomy with and without sub chondral drilling. Arthroscopy. 2015;31(4):673–9.
24. Wakabayashi S, Akizuki S, Takizawa T, Yasukawa Y. A comparison of the healing potential of fbrillated cartilage versus eburnated bone in osteo arthritic knees after high tibial osteotomy: an arthroscopic study with 1-year follow-up. Arthroscopy. 2002;18(3):272–8.
25. LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc 2015;23(01):152–157
26. Lee DW, Kim MK, Jang HS, Ha JK, Kim JG. Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason-Allen stitch and simple stitches. Arthroscopy 2014;30(11):1439–1446
27. Krych AJ, Reardon PJ, Johnson NR, et al. Non-operative manage ment of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2017;25(02): 383–389
28. Chung KS, Ha JK, Yeom CH, et al. Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 2015;31(10):1941–1950
29. Han SB, Shetty GM, Lee DH, et al. Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthro scopy 2010;26(10):1326–133
30. Okazaki Y, Furumatsu T, Masuda S, Miyazawa S, Kodama Y, Kamatsuki Y, et al. Pullout repair of the medial meniscus posterior root tear reduces proton density-weighted imaging signal intensity of the medial menis cus. Acta Med Okayama. 2018;72(5):493–8.
31. LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015;3(4):912–20.
32. Kim YM, Joo BY, Lee WY, Kim YK. Remodifed Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc. 2020.
33. Lee DW, Lee SH, Kim JG. Outcomes of medial meniscal posterior root repair during proximal tibial osteotomy. Is root repair benefcial? Arthroscopy. 2020.
34 Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T. Pullout repair of a medial meniscus posterior root tear using a FasT-Fix all-inside suture technique. Orthop Traumatol Surg Res 2016;102(07):951–954
35 Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 2017;45(01):42–49


How to Cite this article:  Pilar A, Madan MM, Sunil LK, Babu SS, Sekaran P, Amaravathi RS | Functional Outcome Following Concurrent Medial Meniscus Posterior Horn Root Repair during High Tibial Osteotomy in Early Medial Compartment Osteoarthritis | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 09-14.

 


 


                                          (Abstract Text HTML)      (Download PDF)


Management of Late Presented Perthes Disease

Vol. 10 | Issue 1 | January-February 2022 | Page: 05-08 | Kumar Amerendra Singh, Hitesh Shah

DOI:10.13107/jkoa.2022.v10i01.044


Authors: Kumar Amerendra Singh [1], Hitesh Shah [1]

[1] Department of Pediatric Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Address of Correspondence

Dr. Hitesh Shah,
Professor, Department of Pediatric Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
E-mail: hiteshshah12@gmail.com

 


Abstract


A child with Perthes disease presents at or after an advanced stage of advanced fragmentation is considered a late
presentation. The maximum femoral head deformation happens at the stage of advanced fragmentation. Preventive strategies are needed if the child presents before the advanced stage of fragmentation. The corrective strategies are deliberated if the child presents as a late presenter. The natural history of late presented Perthes is poorer than early presentation. Clinical features, investigation, various prognostic factors, management options and decision making of late presented Perthes disease have been revealed.
Keywords: Late presented Perthes disease, Hinge abduction, Severe collapse, Extrusion, Poor prognosis


References


1. Shah H. Perthes disease: evaluation and management. Orthop Clin North Am. 2014 Jan;45(1):87-97. doi: 10.1016/j.ocl.2013.08.005. Epub 2013 Sep 26. PMID: 24267210.
2. Kim SS, Lee CW, Kim HJ, Kim HH, Wang L. Treatment of Late-Onset Legg-Calve-Perthes Disease by Arthrodiastasis. Clin Orthop Surg. 2016 Dec;8(4):452-457. doi: 10.4055/cios.2016.8.4.452. Epub 2016 Nov 4. PMID: 27904729; PMCID: PMC5114259.
3. Grzegorzewski A, Szymczak W, Synder M, Drobniewski M. Czynniki prognostyczne w chorobie Perthesa [The prognostic factors in perthes disease]. Chir Narzadow Ruchu Ortop Pol. 2006;71(3):177-82. Polish. PMID: 17131722.
4. Joseph B. Management of Perthes’ disease. Indian J Orthop. 2015 Jan-Feb;49(1):10-6. doi: 10.4103/0019-5413.143906. PMID: 25593353; PMCID: PMC4292319.
5. Shah, H. (2014). Perthes Disease. Orthopedic Clinics of North America, 45(1), 87–97. doi:10.1016/j.ocl.2013.08.005
6. Farsetti P, Benedetti-Valentini M, Potenza V, Ippolito E. Valgus extension femoral osteotomy to treat “hinge abduction” in Perthes’ disease. J Child Orthop. 2012 Dec;6(6):463-9. doi: 10.1007/s11832-012-0453-8. Epub 2012 Nov 16. PMID: 24294308; PMCID: PMC3511687.
7. Nakamura J, Kamegaya M, Saisu T, Kenmoku T, Takahashi K, Harada Y. Hip arthrography under general anesthesia to refine the definition of hinge abduction in Legg-Calvé-Perthes disease. J Pediatr Orthop. 2008 Sep;28(6):614-8. doi: 10.1097/BPO.0b013e3181842013. Erratum in: J Pediatr Orthop. 2013 Oct-Nov;33(7):774. PMID: 18724196.
8. Joseph B, Price CT. Principles of containment treatment aimed at preventing femoral head deformation in Perthes disease. Orthop Clin North Am. 2011 Jul;42(3):317-27, vi. doi: 10.1016/j.ocl.2011.04.001. Epub 2011 May 6. PMID: 21742143.
9. Iwamoto M, Nakashima Y, Nakamura T, Kohno Y, Yamaguchi R, Takamura K. Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg-Calvé-Perthes disease. J Orthop Sci. 2018 Jan;23(1):156-160. doi: 10.1016/j.jos.2017.09.012. Epub 2017 Oct 2. PMID: 28982606.
10. Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does a femoral varus osteotomy alter the natural evolution of Perthes’ disease? J Pediatr Orthop B. 2005 Jan;14(1):10-5. doi: 10.1097/01202412-200501000-00002. PMID: 15577301.
11. Freeman RT, Wainwright AM, Theologis TN, Benson MK. The outcome of patients with hinge abduction in severe Perthes disease treated by shelf acetabuloplasty. J Pediatr Orthop. 2008 Sep;28(6):619-25. doi: 10.1097/BPO.0b013e3181804be0. PMID: 18724197.
12. Wright DM, Perry DC, Bruce CE. Shelf acetabuloplasty for Perthes disease in patients older than eight years of age: an observational cohort study. J Pediatr Orthop B. 2013 Mar;22(2):96-100. doi: 10.1097/BPB.0b013e32835b5726. PMID: 23164833.
13. Dammerer D, Braito M, Ferlic P, Kaufmann G, Kosiol J, Biedermann R. Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up. Hip Int. 2021 Feb 10:1120700020988150. doi: 10.1177/1120700020988150. Epub ahead of print. PMID: 33566697.
14. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: Classification of radiographs with the use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004 Oct;86(10):2103-20. PMID: 15466719.


How to Cite this article:  Singh KA, Shah H |  Managementof Late Presented Perthes Disease | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 05-08.

 


 


                                          (Abstract Text HTML)      (Download PDF)


Editorial

Vol. 10 | Issue 1 | January-February 2022 | Page: 04 | Anil K. Bhat

DOI:10.13107/jkoa.2022.v10i01.043


Authors: Anil K. Bhat [1]

[1] Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Address of Correspondence:
Dr. Anil K. Bhat,
Associate Dean, Professor and Head Department of Hand Surgery,
Kasturba Medical College Manipal, Manipal Academy of Higher Education,
Manipal, Karnataka, India.
E-mail: jkoa.editor@gmail.com

 


Editorial


Science is a way of equipping yourself with the tools to interpret what happens in front of you.”
— Neil de Grasse Tyson
Scientific research has always been an arduous task, involving patient and meticulous search on the library shelves and internet sources for past literature, doing thought-provoking experiments, documenting their productive results, writing and publishing reports. All this demands efficient use of time with a well-planned program, which includes close monitoring and supervision of projects, writing proposals, and scientific reports, while avoiding errors, quoting the correct citations, connecting networks, and searching for relevant journals for publication. How do we all plan for this challenging task?
Mercifully there are numerous online tools for the novice to help them organize their documents, search and cite literature, communicate and connect with professional contemporaries, and even more. An array of options are available, although the right tools yielding the best results may often be difficult to find. Here are a few options which I feel may be useful for our members.
• Project management tools like Trello and GanttPRO help manage project progress utilizing hierarchical listing that includes scheduling activities, formulating action plans, setting deadlines, resource allocation, establishing completion deadlines, and viewing progress.
• Innovative grammar check tools are now a ‘must have’ aid, detecting spelling, sentence and punctuation errors and correcting grammatical flaws. Grammarly and Trinka AI are two popular grammar checker tools available for researchers, which enhance the quality of language in the manuscript.
• EndNote and Mendeley have used reference management tools for correct citation and linking references in scientific articles.
• The bane of plagiarism can now be managed with numerous plagiarism checker tools such as Turnitin and Duplichecker. There are currently many journal finder tools, like Elsevier journal finder, which help send our article to the right and appropriate journal and save our precious time.
• Progress in research is vitally dependent on sharing individual scientific work for which exchange of ideas and connection between researchers. A great help encouraging collaborative effort is to connect through scientific, social networks sites like ResearchGate. These forums promote and publicize the research done in the scientific community and establish links between teams across continents. Many of these sites have a free trial version, which researchers, in the beginning, can use.

We congratulate our contributors to this edition and hope for more contributions from all our members as we finally move away from this pandemic. Have a great academic feast at KOACON 2022.

Sincerely
Dr Anil K. Bhat
Editor in Chief, JKOA
Associate Dean, Professor and Head
Department of Hand surgery
Kasturba Medical College, Manipal, MAHE


How to Cite this article:  Bhat AK | Editorial | Journal of Karnataka Orthopaedic Association | January-February 2022; 10(1): 04.

 


                                          (Full Text HTML)      (Download PDF)