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Background: Meniscal injuries frequently require surgical intervention to restore knee joint function and stability. Intraoperative platelet-rich plasma (PRP) injection has emerged as a potential adjunctive therapy to enhance tissue healing post-meniscal repair. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in terms of pain relief, functional recovery, and overall success rates in patients undergoing meniscal repair procedures. Methods: A comprehensive search strategy was employed to identify relevant studies across Scopus, PubMed, Embase, and the Cochrane Library databases. The inclusion criteria encompassed human studies, including randomized controlled trials (RCTs), cohorts, and case-control studies, focusing on intraoperative platelet-rich plasma (PRP) use post-meniscal repair and reporting outcomes related to pain, functionality, and cure rates. Exclusion criteria comprised animal studies, non-English publications, studies lacking relevant outcome measures, and those with insufficient data. Two reviewers independently screened titles and abstracts, resolving disagreements through consensus or consultation with a third reviewer, followed by a full-text assessment for potentially eligible studies. Data extraction was conducted independently by two reviewers using a standardized form. The reliability of observational studies was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses and pooled effect estimates for main outcomes were computed using RevMan 5.3, a meta-analysis tool. Results: The demographic analysis revealed that the PRP group had an average age of 41.39 years, while the control group had an average age of 42.1 years. In terms of gender distribution, the PRP group consisted of 61 men and 29 women, while the control group had 62 men and 34 women. Pain ratings showed a preference for PRP with a mean difference of 4.83 (p = 0.13). However, there was no significant difference in Lysholm scores (mean difference: - 0.44, p = 0.91) or IKDC scores (mean difference: 2.80, p = 0.14) between the PRP and control groups. Similarly, ROM measures did not show a statistically significant difference, with a mean difference of 2.80 (p = 0.18). Additionally, there was no significant distinction in failure rates between the PRP and control groups, as indicated by a weighted mean difference of 0.71 (p = 0.52). These findings suggest that while PRP may offer some benefits in pain relief, its impact on functional recovery, range of motion, and failure rates following meniscal repair procedures is inconclusive. Conclusion: The current evidence regarding the effect of intraoperative platelet-rich plasma (PRP) injection on patients undergoing meniscal repair remains inconclusive. While some studies suggest potential benefits in terms of pain relief and functional recovery, others show no significant differences compared to control groups. The impact of PRP therapy on overall success rates, including rates of re-tear and revision surgery, is also uncertain. Further well-designed randomized controlled trials with larger sample sizes are needed to provide more robust evidence and guide clinical practice in orthopedic surgery.
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Tuberculosis (TB) is a widespread global disease that significantly impacts daily life. Skeletal TB comprises about 10-35% of all TB cases. Significant research on the spine and hip exists, but due to the rarity of cases, the management of TB is less explored. Furthermore, exercising the option of total knee arthroplasty (TKA) in TB knees is still in its initial stages. This systematic review aims to identify and comprehend the difficulties associated with diagnosing TB-affected knees, their treatment outcomes, and complications related to TKA. A systematic review of existing English literature retrieved from PubMed, Google Scholar, and Web of Science databases was performed using the PRISMA guidelines. A case series of arthroplasty performed on TB knees included a description of the diagnostic approach, clinical outcome, and complication rates. Moreover, studies involving case series with follow-up functional outcomes were included. The Coleman Methodology was used to assess the quality of the studies. A total of six studies (75 knees) were systematically reviewed in this study. The diagnosis of TB knee is multimodal, with MRI being a reliable tool. Administering anti-TB chemotherapy is essential during the perioperative period. Regarding recurrence, a two-stage TKA has a lower risk of recurrence. It is plausible to state that anti-TB chemotherapy needs to be initiated in the perioperative period to prevent the chances of recurrences. Two-stage TKA is reserved for patients who require soft tissue debridement despite adequate chemotherapy.
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The present study is aimed at investigating the effect of hybridisation on Kevlar/E-Glass based epoxy composite laminate structures. Composites with 3 mm thickness and 16 layers of fibre (14 layers of E-glass centred and 2 outer layers of Kevlar) were fabricated using compression moulding technique. The fibre orientation of the Kevlar layers had 3 variations (0, 45 and 60°), whereas the E-glass fibre layers were maintained at 0° orientation. Tensile, flexural, impact (Charpy and Izod), interlaminar shear strength and ballistic impact tests were conducted. The ballistic test was performed using a gas gun with spherical hard body projectiles at the projectile velocity of 170 m/s. The pre- and post-impact velocities of the projectiles were measured using a high-speed camera. The energy absorbed by the composite laminates was further reported during the ballistic test, and a computerised tomographic scan was used to analyse the impact damage. The composites with 45° fibre orientation of Kevlar fibres showed better tensile strength, flexural strength, Charpy impact strength, and energy absorption. The energy absorbed by the composites with 45° fibre orientation was 58.68 J, which was 14% and 22% higher than the 0° and 60° oriented composites.
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In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards, we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery for appropriate selected patients. Nonetheless, there are differences between approaches. Mini-medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini-subvastus and mini-midvastus are trickier and require more caution related to risk of haematoma and vastus medialis oblique (VMO) nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient-specific instrumentation or robotic, may breach a surgeon's duty of care towards patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR.
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Artroplastia de Reemplazo de Rodilla/métodos , Artropatías/cirugía , Articulación de la Rodilla/cirugía , Humanos , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
INTRODUCTION: Subtrochanteric fractures have a bimodal age distribution. They are mostly due to high violence trauma in the younger age group. They almost always require open reduction and internal fixation. Due to the increase in the emergence of native bone setters, these fractures are increasingly been managed by these spurious bone setters using native splints. As a result, non-union rate is high among such patients. These patients definitely need open reduction with internal fixation +/- bone grafting. The choice of implants used can be either a dynamic condylar screw plate (DCS) orproximal femoral nail (PFN). CASE SERIES: Here we have used a surgical grade 316 L stainless steel proximal femoral anatomical locked compression plate (PF-LCP). We analyzed 13 patients with established non unions of subtrochanteric fractures treated in our centre by the use of the PF-LCP. There were 10 males and 3 females. The average age was 48.23 years. All our patients were followed up by serial radiographs at 6, 12, 18, 24 weeks and thereafter at 6 months interval. Union was achieved in 11 out of 13 patients at 12 weeks whereas two patients had delayed union which eventually healed at 18 weeks and 24 weeks. The average Harris hip score at 1 year follow-up was excellent in eight, good in four and fair in one patient respectively. CONCLUSION: We conclude that in complicated non-unions, the use of PF-LCP has a definite positive role in the management of such cases.
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INTRODUCTION: Hip dislocation in a child less than 3 years is a very rare event. Only a few case reports have been documented in Western literature. It is rarely reported from Indian population. Hip dislocations are mostly due to low velocity injury in children younger than 3 years. We report such a case of hip dislocation in a 2 year old child. CASE REPORT: A 25 month old child presented to our casualty following a fall from a slide 3 hours prior to presentation. His right lower limb was adducted and internally rotated. There was severe pain on attempting movements. An X-ray of the pelvis was taken which showed a posterior hip dislocation on the right side. The child had an emergency closed reduction under general anaesthesia followed by a broom stick plaster cast with hips in 30° abduction. Congruency of reduction was checked with image intensifier before plaster application. The plaster was removed at 6 weeks and gradual weight bearing started. The child was reviewed at 6 and 18 months with MRI scans at 6 and 18 months. There were no signs of avascular necrosis or chondrolysis. CONCLUSION: Paediatric hip dislocation (less than 3 years of age) is a very rare entity whose incidence is on the rise due to the increase in road traffic accidents. The key stone in proper management is clinical suspicion, early recognition and promptreduction (within 6 hours). Also gentle manipulation during reduction has a definite role in preventing iatrogenic chondrolysis and osteonecrosis of femoral head.
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INTRODUCTION: Established non-unions pose a real nightmare for even the most accomplished surgeon. The variations in anatomy due to extensive fibrous tissue growth, soft tissue contractures around the fracture site and bony alterations like smoothening and sclerosis of the fracture ends must each be addressed as a whole if good outcome is to be expected. CASE SERIES: Here we present a series of 11 patients who had bimalleolar fracture of the ankle following which they had native splinting. These patients presented to us with established non-union. There were 7 males and 4 females in the study. The average age was 44.63 years. Ten out of the 11 patients went on to union (90.1%) following internal fixation with or without immobilization in a plaster cast at an average of 13.8 weeks (range 12-17 weeks). The remaining patient did not progress to union and was advised revision fixation but she refused. She was put on an ankle foot orthoses and mobilized with satisfactory results. There was no infection in any of the patients. Two patients had delayed wound healing with delayed suture removal at 18 days. Weight bearing was started at the end of 16 weeks in all the patients. All patients were assessed using the Karlsson and Peterson functional score for the ankle. Six patients had excellent outcome, 3 had good outcome, 2 had fair with one patient having poor functional result. CONCLUSION: We conclude that open reduction internal fixation +/- bone grafting provides excellent union rates and good functional results in even the most established non unions of bimalleolar fractures of the ankle.
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PURPOSE: We analysed 11 patients with malignant musculoskeletal tumours of the humerus who underwent limb salvage surgery with total humeral custom endoprosthesis from 1990 to 2009. METHODS: There were six male and five female patients, with a mean age of 17 years. The most common diagnosis was osteosarcoma. The average follow-up period was 66 months, with the maximum being 180 months. Functional and oncological outcomes were analysed. RESULTS: The one and five year cumulative survival (Kaplan-Meier method) rates were 90.9% and 77.9 %. The average Musculoskeletal Tumour Society Score (MSTS) was 80%. Two patients died due to metastasis. One patient had a forequarter amputation for local recurrence. The procedure provides fast recovery and relatively good restoration of elbow function, whereas active shoulder movements remain limited CONCLUSION: Total humeral custom endoprosthetic replacement represents a viable treatment option in indicated patients, providing reliable and reasonable function of the upper limb, with a low complication rate.
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Neoplasias Óseas/cirugía , Húmero/cirugía , Recuperación del Miembro , Neoplasias de los Músculos/cirugía , Procedimientos de Cirugía Plástica , Diseño de Prótesis , Adolescente , Adulto , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/mortalidad , Neoplasias Óseas/rehabilitación , Niño , Femenino , Humanos , India/epidemiología , Estimación de Kaplan-Meier , Masculino , Neoplasias de los Músculos/diagnóstico , Neoplasias de los Músculos/mortalidad , Neoplasias de los Músculos/rehabilitación , Osteosarcoma/diagnóstico , Osteosarcoma/mortalidad , Osteosarcoma/rehabilitación , Osteosarcoma/cirugía , Prótesis e Implantes , Tasa de Supervivencia , Adulto JovenRESUMEN
We analysed 17 patients with primary malignant bone tumour of the femur who underwent limb salvage surgery with the total femoral custom mega prosthesis during the period 1994-2008. The patients were in the age group of 12-73 years, with a mean age of 30.94 years. There were 14 males. The most common diagnosis was osteosarcoma. The average follow-up period was 54.05 months with the longest being 168 months. The average Musculoskeletal Tumour Society (MSTS) functional score was 66.6%. The two- to 14-year overall survival was 82.4%. Three patients died of disease and one patient required amputation. Complications encountered were deep infection and dislocation of the prosthesis.
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Neoplasias Óseas/terapia , Fémur/cirugía , Prótesis de Cadera , Recuperación del Miembro/métodos , Osteosarcoma/cirugía , Diseño de Prótesis , Adolescente , Adulto , Anciano , Neoplasias Óseas/mortalidad , Neoplasias Óseas/patología , Niño , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Fémur/fisiopatología , Humanos , India/epidemiología , Recuperación del Miembro/instrumentación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Osteosarcoma/mortalidad , Osteosarcoma/secundario , Complicaciones Posoperatorias , Cuidados Preoperatorios , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
We analysed the results of 24 cases of aggressive benign and malignant tumours of the distal radius treated by resection and prosthetic replacement between 1995 and 2006. Patient ages ranged from 18 to 74 years, averaging 33 years; 18 were males. Recurrent giant cell tumour was the most common tumour. The prosthesis used was a bipolar hinge custom mega prosthesis manufactured locally. Average follow-up was 78 months. The average Musculoskeletal Tumor Society (MSTS) functional score achieved was 75%. The ten-year prosthesis survival was rate 87.5%. Infection was the most common complication.