Prupose: Hemophilic knee arthritis is one of the most common presenting symptoms of hemophilia and its management continues to be challenging to practitioners. Platelet-rich plasma (PRP) has been shown to have a short-term efficacy in the treatment of hemophilic knee arthritis, but evidence for this treatment is limited. To determine the effect of pure PRP injections on symptoms and function in patients with HKA through a 24 months period of follow-up.
Methods: A prospective, parallel-group, double-blinded, single-center, sham-controlled randomized clinical trial that included participants from a tertiary care center starting January 1, 2019, with follow-up completed on August 31, 2021. (ClinicalTrials.gov: ChiCTR1800018120) Participants were older than 18 years with hemophilic knee arthritis confirmed by magnetic resonance imaging and randomly allocated to interventions in a 1:1 ratio. Three sessions (1 every week) of standard intra-articular injection of PRP (n = 92) or sham saline (n = 89) delivered by physicians. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0-96; higher scores indicate more pain and worse function; minimal clinically important difference, 6.4 points) over 24 months.
Results: Among 190 patients assigned to a platelet-rich plasma or sham injections (mean age, 30.61 years; 190 [100%] men), 189 (96.9%) completed the trial. At 24-month follow-up, mean WOMAC score values in the plasma-rich plasma group vs the sham injection group were 40.2 vs 42.3 (adjusted mean difference, −2.2 [95% CI, −5.7 to 1.4]). The most common adverse events compared between patients in the platelet-rich plasma group vs the sham group were injection site discomfort (8 vs 4 patients).
Conclusion: Among patients with hemophilic knee arthritis, three intra-articular platelet-rich plasma injections, compared with placebo injections, did not significantly improve hemophilic knee symptoms and function over 24 months. The results of this study do not support the use of PRP injections for hemophilic knee arthritis.

Background: Cell based therapies currently in use utilises chondrocytes removed from a healthy region of the cartilage, but these cells are unable to maintain their phenotype in expanded culture. The repaired tissue is fibrocartilaginous in place of hyaline. Cartilage derived stem/progenitor i.e. CSPCs cells are of interest for cartilage repair due to their inherent replicative potential. These cells isolated from the edge of the injury site and they have shown abundant clonability for expansion without losing their potential for chondrogenic differentiation. Here, we investigate the isolation and characterisation of CSPCs population that is resident within articular cartilage.
Methods: Cartilage tissue was removed from two different sites i.e. From Injury site and Healthy non-weight-bearing areas and their qualitative and quantitative parameters were analysed.
Results: The primary culture establishment was successfully achieved for 20 cell lines. Both kind of cells exhibited fibroblast-like morphology, high proliferation rate, less population doubling time, colony forming ability, alkaline phosphatase activity, no senescence activity, normal karyotyping, expression of the cell surface and intracellular marker proteins, and demonstrated multilineage potential.
Conclusions: We have identified and characterised a novel cartilage progenitor population resident in articular cartilage from edge of injury site which will greatly benefit future cell-based cartilage repair therapies due to its ability to maintain chondrogenicity upon extensive expansion unlike full-depth chondrocytes that lose this ability after few population doublings.

Purpose
Fracture union after osteosynthesis of FNF take place by compression of the fracture ends and possible neck shortening. Compromised functional outcome may be seen due to femoral neck shortening. The implant of choice for femoral neck fracture fixation is one of the most challenging management controversies in present times. The study compares femoral neck shortening after internal fixation of femoral neck fracture with FNS (Femoral Neck System) or MCS (Multiple Cannulated Cancellous Screws).
Methods
This was a prospective parallel interventional non-inferiority double-blinded single-center randomized controlled trial. All patients between 18 and 60 years of age undergoing internal fixation for sub-capital or trans-cervical fracture neck femur were randomized and allocated into one of the two groups - the Test group (Group FNS) and the Control group (Group MCS). Primary outcome was determined by measuring one-year femoral neck shortening difference on radiographs between FNS and MCS. Secondary outcome aimed to correlate neck shortening with PROMs in the form of modified Harris hip score (HHS) at the end of one-year follow-up.
Results
From December 1, 2021, to April 30, 2022, 60 patients were prospectively enrolled. The primary outcome at the final follow-up, femoral neck shortening, was 3.77 ± 1.87 mm in group FNS which was significantly lower than in the control group MCS, 6.53 ± 1.59 mm.
Conclusion
FNS had significantly lower femur neck shortening than the MCS group. There was no statistically significant difference in PROMs at one-year follow-up compared to MCS. Overall, this study suggests that FNS can be a rational alternative implant for internal fixation in young adults (<60 years) with trans-cervical and sub-capital femur neck fractures.

Introduction:
Dupuytren's contracture presents a significant challenge in hand surgery, requiring effective treatment strategies to improve patient outcomes. The aim of this study is to report the long-term results of PNF and open fasciectomy in terms of functional recovery, pain relief, contracture reduction, complications, and recurrence rates.
Methods:
We conducted a randomized controlled trial, assigning patients with stage IV Dupuytren's disease to either the PNF group or the open fasciectomy group. PNF is a relatively new, minimally invasive procedure that allows for a quicker healing process and reduced morbidity. Both groups received postoperative care, including stretching exercises and extension splinting, to maximize the benefits of the respective procedures. The patients were thoroughly evaluated preoperatively and at various intervals postoperatively to assess the efficacy of each treatment.
Results:
In the PNF group, local puncture pain was variable and resolved within two days, with complete healing evident after three days. No cases of flexor tendon lesions, hematomas, recurrence, or infections were reported. Conversely, the open fasciectomy group experienced local pain resolution after four days, and complete healing was evident after 14 days. However, six cases reported skin rupture, two cases experienced hematomas, and one case had an infection. Three patients in the open fasciectomy group experienced recurrence after eight years.
Discussion:
Our findings indicate that PNF is a favorable method for treating stage IV Dupuytren's contracture due to its minimally invasive nature and excellent outcomes. All 66 patients in the PNF group achieved full hand function, demonstrating its effectiveness in preserving hand function with minimal side effects. Furthermore, the avoidance of skin incisions in PNF resulted in less tissue damage, reduced pain, swelling, and quicker recovery, making it a cost-effective and time-efficient alternative for cases with advanced Dupuytren's disease

Introduction:Malrotation of the tibial component in a total knee replacement leads to anterior knee pain, patella dislocations, extensor mechanism disruptions, knee stiffness and prosthesis loosening. Techniques like free-floating technique, medial 1/3 rd of the tibial tubercle, medial border of the tibial tuberosity, Akagi’s line, transcondylar line of tibia, posterior condylar line of tibia, midsulcus of tibial spines, curve on curve technique have been advocated. None of these have been shown to be accurate and reproducible. We developed a novel ‘Sharma’s Venn Diagram’ method to assess the tibial component rotation.Methods: Fifty-two consecutive knee replacements were included in a prospective observational study. The average age of the study group was 53.6 years (48–76 years) Thirty-one were females and 3 were males. The patients were followed a minimum of one years (max 2 years, average 1.8 years). ‘Sharma’s Venn diagram Method (C)’ was compared to free-floating method (F) and post-op CT scans using Berger protocol (B).Results:Tibial rotation calculated using Sharma’s Venn diagram method (C) coincided with the final component placement in 50/52 knees. The free floating method (F) coincided with method (C) in 30/52 knees with an average 4.8° external rotation in 5 knees and an average of 5.2° internal rotation in 17 knees. Bland Altman method was used to compare method (C) with Method (F), The difference was statistically significant p < 0.0001. Venn diagram method is reliable, accurate and easily reproducible by any surgeon performing tkr and correlates with postoperative 2D CT-based assessment of tibial component rotation.