Introduction: Surgical technique of anterior cruciate ligament
reconstruction have evolved over the past 3 decades along with debate regarding timing of reconstruction. Delayed rather than early reconstruction of ACL is the current recommended treatment for injury to this ligament since it
is thought to give better functional outcome. However, there is no consensus in the literature regarding the optimal time of surgical intervention. Aims and Objectives : The primary objective of this study is to compare the functional outcomes of early and delayed reconstruction of the anterior
cruciate ligament tear with respect to optimum time of intervention. Methodology: All patients who underwent ACL reconstruction in our hospital was enrolled in this study. Patients was categorised into 2 groups based on presentation from time of injury-early presentation (less than 3 weeks from
injury) and delayed presentation (more than 3 weeks from injury). Hamstring or peroneus longus grafts were used and standard surgery protocol and physiotherapy was followed. Outcome was assessed using the Lysholm score, IKDC score, knee Range of motion and clinical tests to assess stability.
Results and conclusion : 30 patients underwent ACL reconstruction, 15 each in group 1 (early presentation) and group 2 (delayed presentation). The functional outcome of delayed reconstruction is better than early reconstruction of the anterior cruciate ligament in the initial follow-up but both resulted in the same at the end of 1 year. The range of motion was better in the delayed group than in the early group.

Abstract:
Background: Patellar tracking refers to the dynamic relationship between the patella and trochlea during knee motion. Patellar maltracking occurs as a result of imbalance of this relationship often secondary to anatomic morphologic abnormality.
Aim: to assess the clinical efficacy and experience of total arthroscopic lateral retinacular release combined with medial retinacular plication for the treatment of lateral patellar maltracking.
Patients and method: A total of 15 knees in 12 patient (10 female) with lateral patellar maltracking underwent arthroscopic Lateral retinaculer release and arthroscopic medial retinaculer plication. The visual analogue scale (VAS), Lysholm scores, patella medial pushing distance, patellar tilt angle (PTA), and lateral patellofemoral angle (LPFA) were measured and evaluated before and after surgery. Post op. above knee cast for 5 to 6 weeks then physiotherapy for 6 weeks.
Conclusions
Full arthroscopic lateral retinacular release combined with medial retinacular plication is an effective minimally invasive technique, which can effectively correct anomalies of force line and skeleton of patella, relieve pain, and restore knee joint motor function with less complications.

Aim: The current study investigated short-term functional outcomes and postoperative recurrence of instability following concurrent re-do arthroscopic Bankart repair and Extra-articular Soft Arthroscopic Latarjet Technique (ex-SALT).
Patients & Methods: This prospective case-series study included 9 patients diagnosed with postoperative recurrence of gleno-humeral instability following stand-alone arthroscopic Bankart repair. Patients with significant (>20%) glenoid bone loss were excluded from the study. Included patients were managed with re-do arthroscopic Bankart repair in concurrence with Extra-articular Soft Arthroscopic Latarjet Technique (ex-SALT). Remplissage capsulo-tenodesis was superadded in patients with engaging Hill-Sachs lesion. Outcome measurements included 1-year postoperative pain, range of motion, and the American Shoulder and Elbow Surgeon (ASES) and Rowe Instability scoring systems. Failure was defined as frank or subtle post-revision recurrence of instability episodes.
Results: Age of included 8 male and 1 female patients ranged from 18 to 34 years. Statistical analysis revealed significant postoperative improvement in outcome measurements of pain, range of active forward flexion and external rotation, and ASES and Row instability scores (P<0.05). By the indexed follow up, no failure could be reported.
Conclusion: For revision management of recurrent anterior gleno-humeral instability in patients with insignificant glenoid bone loss; re-do arthroscopic Bankart repair in concurrence with ex-SALT (and when indicated, Remplissage capsulo-tenodesis) can yield short-term satisfactory outcomes as regards pain, range of motion, function instability recurrence. However, these favorable outcomes should be validated via further biomechanical and longer-term clinical cohort studies.

Background: Tennis elbow is a very common elbow pathology caused by repetitive trauma over the tendon of Extensor Carpi Radialis Brevis (ECRB) at the common extensor origin. Most cases respond to conservative treatment while resistant cases may need arthroscopic or open surgical release. This study aimed to compare the clinical and functional outcomes of arthroscopic and open release for resistant tennis elbow in selected patients. Patients and Methods: This was a prospective study that was conducted over three years (between 2015 and 2018) and included 30 patients with resistant tennis elbow. The patients were randomized into two equal groups with fifteen patients in each group. The first group (A) had undergone an arthroscopic release while the second group (B) had undergone an open release. All patients were evaluated preoperatively, 3 weeks postoperatively, and 1 year postoperatively using MEPS, DASH Score, and VAS. Results: One year postoperatively, the mean MPES, DASH score, and VAS were improved significantly in both groups. There was no significant difference in the outcome scores between both groups. The average time for return to work was 5.8 ± 2.07 (4-12) weeks for group-A and 8.8 ± 1.97 (7-14) weeks for group-B. There were no significant complications in both groups. Conclusion: Both arthroscopic and open release are similar and effective in the treatment of resistant tennis elbow as noticed by improvement in MEPS, DASH score, and VAS at the end of follow up. The arthroscopic release permits earlier recovery and return to work.

Aim: The study investigated short-term functional outcomes of concurrent arthroscopic suture anchor capsulo-labral repair and Intra-articular Soft Arthroscopic Latarjet Technique/in-SALT (i.e., arthroscopic soft-tissue biceps tenodesis to upper subscapularis using simple stitches) for management of post-traumatic anterior gleno-humeral micro-instability.
Patients & Methods: In this prospective cohort study, 21 patients were allocated into group-(A); criteria of enrollment included (1) history of persistent post-traumatic shoulder pain with failure of 3-month conservative management, (2) clinical diagnosis of anterior gleno-humeral micro-instability, and (3) arthroscopic diagnosis of lax attenuated capsule, hypermobile medially-reflected antero-inferior labrum, and type-II SLAP lesion. Patients included in group-(A) were managed with arthroscopic in-SALT and arthroscopic suture-anchor capsulo-labral plication. Outcome measurements included 2-year postoperative pain, range of motion and the ASES and Rowe Instability scores. Outcome measurements of group-(A) were then compared to those of a concurrent group-(B) of 34 patients (with type-V SLAP lesion as a result of recurrent anterior gleno-humeral dislocation) managed with in-SALT and arthroscopic Bankart repair.
Results: Study groups were matched as regards demographics and baseline VAS and functional scores. In group-(A), statistical analysis showed significant 2-year postoperative improvement in outcome measurements (P-value<0.05). In addition, group-(A) showed insignificant differences in 2-year postoperative outcome measurements compared with group-(B) (P-value>0.05).
Conclusion: Based on comparable postoperative outcomes, post-traumatic anterior gleno-humeral micro-instability can be arthroscopically-managed in a way similar to that of recurrent anterior gleno-humeral dislocation with type-V SLAP lesion (i.e., with concurrent arthroscopic suture anchor capsulo-labral repair and in-SALT. However, these recommendations should be validated via further studies.

Introduction: Multi-ligament knee injuries (MLKI), defined as those that are accompanied by rupture of at least two of the four major ligaments in the knee, are rare but a significant cause of morbidity and functional instability. Case presentation: We report a case of a 61-year-old who suffered a fall from his own height due to non-contact twisting injury. The clinical examination revealed gross knee instability and suspected knee dislocation, and a prompt reduction was done. Post reduction neurovascular status was once again evaluated without neurological dysfunction and strong palpable distal pulses. Anterior-posterior and lateral radiographs were taken and management consisted in immobilization after reduction and admission to our service. MRI results showed a midsubstance ACL rupture, PCL rupture on his femoral insertion, MCL and POL rupture in addition to MPFL femoral avulsion and a partial tear of the LCL, which can be classified as a KD type III-M, according to the Schenck classification.
The patient subsequently underwent PCL reinsertion using pull out technique, POL, MCL and MPFL reinsertion with anchors in addition to MCL internal bracing reinforcement. Total weight-bearing was initiated 2 months postoperatively and at 6 months follow-up the patient was satisfied with the outcome, with no complaint of instability. Discussion: Ultimately, only a few cases of native KD were reported for patients older than 60 years old. Due to early repairing of major ligaments and consequent significant improvement, with no symptoms of instability and overall satisfaction, we were able to avoid a total knee arthroplasty with great results.

Background: Advancements in arthroscopic surgeries, evolving technology, and increased awareness have tremendously increased the incidence of ACL reconstruction surgeries worldwide. However, the understanding of the ACL and the reconstructed ACL is still evolving and ACL re-tear rates are still as high as 20-25%, meaning that every four to five athletes are suffering a second ACL tear. Methodology:
We retrospectively reviewed outcomes of revision AL reconstruction with Quadriceps and bone-patella tendon-bone revision ACI reconstruction over the past 4 years at our Institute. 32 patients who were professional football players, underwent revision ACL reconstruction with BPTB or Quadriceps tendon graft with or without suture tape augmentation. Clinical outcomes were assessed using Knee injury and Osteoarthritis Outcome Score (KOOS) and assessment of ligament laxity. All patients were followed up for a minimum of 24 months. Results: Revision surgery was performed from 12 months to 50 months after the index surgery. 21 patients returned to sports (65.6%) at the last follow up. Three patients had failure of surgery; two subsequently underwent re-revision ACL reconstruction. One patient underwent high tibial osteotomy and repair of avulsedreconstructed ACL. Conclusion: Preoperative planning is an essential component of a successful reconstruction surgery. Alignment pathologies are the most common reason for failure followed by ligament laxity. Structured rehabilitation protocol is essential for optimal postoperative outcomes.