Introduction: Achilles tendinopathy [AT] is a functional problem characterized by swelling and pain above the Achilles tendon insertion region. In individuals with AT, PRP or platelet-rich plasma can be used as an alternative modality of treatment with an aim to lessen the discomfort and enhance functional recovery. We assessed the available data supporting the effectiveness of PRP in treating chronic AT.
Materials and Methods: We did a literature search for randomized controlled trials [RCTs] that contrasted the effectiveness of PRP with that of eccentric exercise and placebo injections as treatment for AT in databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The Visual analogue scale [VAS] score, Victorian Institute of Sports Assessment-Achilles [VISA-A] score, and Achilles tendon thickness were used to measure the results. We used the RevMan 5.3.5 software for statistical analysis.
Results: We included five RCTs in this meta-analysis. There was no significant difference in the VISA-A between the PRP and placebo groups at 12 weeks, 24 weeks and 1 year after treatment. However, at 6 weeks after treatment PRP exhibited better efficacy than the placebo treatment. Two studies in our meta-analysis included VAS scores and tendon thickness. There was no significant difference in VAS scores at 6 weeks and 24 weeks after treatment. However, VAS scores at 12 weeks and tendon thickness were significantly different.
Conclusion: PRP injection is an effective treatment for chronic AT. It has a unique potential for increasing function and reducing discomfort in AT patients.

Aim: The study investigated short-term functional outcomes and postoperative recurrence of instability following concurrent arthroscopic Bankart repair and Intra-articular Soft Arthroscopic Latarjet Technique/in-SALT (i.e., soft-tissue biceps tenodesis to subscapularis using simple stitches) versus concurrent arthroscopic repair of Bankart and type-II SLAP lesions for management of type-V SLAP lesion.
Patients & Methods: This prospective consecutive cohort study included 53 patients with arthroscopic diagnosis of type-V SLAP lesion. Patients were allocated into 2 groups; group-(A) of 19 patients managed with concurrent arthroscopic repair of Bankart and type-II SLAP lesions; and group-(B) of 34 patients managed with concurrent arthroscopic Bankart repair and in-SALT. Patients with significant (>20%) glenoid bone loss were excluded from the study. Outcome measurements included 2-year postoperative pain, range of motion and ASES and Rowe Instability scores. Failure was defined as frank or subtle postoperative recurrence of instability episodes; or objective diagnosis of Pop-eye deformity.
Results: Age of included patients ranged from 18 to 43 years. The study groups showed comparable significant postoperative improvement in outcome measurements (P-value<0.05) with relatively less 3-month postoperative pain in group-(B). By the indexed follow up, 2 cases in group-(A) had post-traumatic instability recurrence. No Pop-eye deformity could be reported.
Conclusion: For management of type-V SLAP lesion; concurrent arthroscopic Bankart repair and in-SALT can yield short-term satisfactory outcomes comparable to those of concurrent arthroscopic repair of Bankart and type-II SLAP lesions; however, the former option might offer advantages of less postoperative pain, instability recurrence, and cost. Nevertheless, these outcomes should be validated via further studies.

Anterior cruciate ligament (ACL) reconstruction with hamstring graft has an increased infection rate when compared to Bone Patellar Tendon Bone graft as reported. Antibiotic presoaking of graft prior to ACL reconstruction has shown to decrease infection rates. Most studies in literature describe and have recommended presoaking the hamstring graft with Vancomycin to reduce infection rates in ACL reconstruction. Few studies have reported on the usage of Gentamicin for presoaking of hamstring graft. Gentamicin is a broad-spectrum aminoglycoside antibiotic and is a much cheaper alternative to Vancomycin. Through this study we wanted to study whether Gentamicin presoaking of hamstring graft is useful in the prevention of infection in primary ACLR. In this study we followed up 236 patients who underwent arthroscopic primary ACL reconstruction treated with hamstring graft soaked in gentamicin prior to fixation. All patients were operated by the same surgeon. All patients were given 3 doses of Intravenous Cefuroxime as prophylaxis perioperatively. 2 infections (0.84%) were reported in 236 patients both were deep infections. There were no superficial infections reported in our series of patients. This result is similar to studies in literature where Vancomycin is used for presoaking the hamstring graft. Gentamicin is a cost effective and a comparable alternative to Vancomycin for presoaking the hamstring grafts to prevent infections during arthroscopic ACL reconstruction.

Background – OCD (Osteochondral defect) is not very uncommon cause of knee pain in young population. Reported incidence of OCD is around 27 per 100000. Trauma history may vary from trivial trauma to the significant sports injury. Majority of patients come with history of locking, frequent knee pain and swelling. X- ray raises the suspension if bony part of the lesion is large, it tend to miss in pure chondral lesion. MRI is confirmatory with evaluation of other structure like ligament, meniscus. Method- We treated 22 case of neglected OCD from march 2016 to November 2019. All patients has average delayed presentation 7 month duration, MRI confirmed the diagnosis with measure the lesion. We treated all patients with removal of loose body and OATS (Osteochondral auto graft transplantation) with open/ arthroscopy depending upon size and location. Result- all patients treated with OATS shows significant reduction in pain, improvement in weight bearing. All patients showed well incorporation of osteochondral graft. Conclusion- OATS is cost effective single stage surgical procedure for large osteochondral defect. It can be performed with associated lesions like ACL reconstruction, meniscal repair. It requires a learning curve from open to total arthroscopic procedure. Key words- OCD (osteochondral defect), OATS (Osteochondral auto graft transplantation), loose body, arthroscopic

Purpose:The study aimed to assess the clinical and radiological (computed tomography and magnetic resonance imaging) outcomes after ACL reconstruction by the Trilink all inside technique using autogenous semitendinosus Y graft. Methods:38 symptomatic ACL deficient knees were operated using the Trilink technique. Clinical evaluation based Tegner activity score, International Knee Documentation score (IKDC), modified Lysholm Knee Scoring Scale and KT 1000 arthrometer was done pre operatively and at 6 weeks, 3 months and 6 months postoperatively. CT-Scan evaluation was done on day 3 and at 6 months to assess the size, position, and enlargement of tunnels. MRI was done at 6 months to study graft ligamentization. Results:The mean of IKDC scoring was 49.37%+3.78% in pre-operative period which increased to 81.89%+3.76% at 6 months. The mean of Lysholm scoring increased from 58.79±4.42 to 94.79±2.12 at 6 months. 94.7% of the subjects showed excellent results. On CT evaluation, the AM femoral tunnel widened by 3.78±8.13% at aperture, by 11.54±23.86% at midtunnel while PL femoral tunnel widened by 7.56±10.24% at aperture,by 6.29±17.11% at midtunnel at 6 months. The Tibial tunnel was widened by 3.27±8.52% at aperture site, by 1.80±6.78% at mid-point at 6 months.MRI at 6 months showed that 10.6% of the subjects had 5 Figueroa score whereas 89.4% had 4. All cases had no synovial fluid at graft tunnel interface and showed good ligamentization. Conclusion: Clinicoradiological outcomes of arthroscopic all inside ACLR using semitendinosus Y graft (Trilink technique) offers excellent results in terms of post-operative knee stability and functional outcome.

Purpose: To compare the clinicoradiological outcomes of modified Trilink technique of all-inside double bundle anterior cruciate ligament reconstruction versus anatomic single bundle ACL reconstruction using autologous semitendinosus graft. Methods -40 symptomatic ACL deficient knees were operated with half undergoing single bundle ACLR while the rest underwent the novel modified trilink technique. Clinical evaluation based on Tegner activity score, International Knee Documentation score (IKDC), Lysholm Knee Scoring and KT-1000 arthrometer was done pre operatively and at 6 weeks, 3 months and 6 months postoperatively. CT-Scan evaluation was done on day 3 and at 6 months to assess the size, position, and enlargement of tunnels. MRI was done at 6 months to study graft ligamentization. Results: At 6 months post ACL reconstruction, the mean Tegner scores, Lysholm scores, IKDC scores, and the mean laxity were comparable in both the groups with marginally more favourable outcomes in Double bundle group. CT evaluation showed a significant widening of the femoral and tibial tunnels at 6 months in cases of single bundle ACLR as compared to the DB-ACLR .MRI at 6 months showed good to excellent Feguiora scores for all cases. Conclusion: Clinical studies show improved kinematic restoration using modified trilink technique as compared to single bundle ACLR but the differences are not statistically significant. However, when assessed by CT scans, single bundle ACLRs show significantly more tunnel dilation than the modified trilink technique even though both techniques show good ligamentization on MRI scans.

Purpose:- To evaluate the clinicoradiological outcomes of Arthroscopic PCL reconstruction using autogenous peroneus longus graft using all inside technique and to evaluate graft site morbidity. Methods:- A total of 12 PCL deficient knees underwent All inside Arthroscopic PCL reconstruction using ipsilateral Peroneus graft. Clinical tests of knee stability viz. Posterior Drawer, Posterior Lachman's, Posterior Sag, and Dial tests were done at 6 months post-surgery. IKDC and Cincinnati Knee rating systems were calculated at 2 ,6, 12 and 24 weeks. The CT-Scan evaluation was done at 6 months post-op to assess the position of tibial and femoral tunnels. MRI was done at 6 months post-op to assess the condition of PL graft in vivo. The graft site morbidity was accessed using AOFAS and FADI scores at 2 weeks, 6 weeks, 3months, and 6 months post-op. Results:- All patients reported good clinical outcomes on clinical evaluation and IKDC score (46.67 at pre op vs 78.17 at 6 months). Graft site morbidity scores were also excellent (AOFAS 35.33 at 2 weeks vs 93.67 and FADI 13.67 vs 95.67 at 6 months. CT evaluation showed that tibial tunnel was more anteromedial than the intraoperative goal. All patients showed good ligamentization on MRIs at 6 months Conclusion:- Single bundle PCL reconstruction- all inside technique using peroneus longus tendon grafts offers excellent results in terms of post-operative knee stability and functional outcome. CT evaluation showed scope of improvement in tunnel position. All our patients showed adequate characterization of the grafts as assessed by MRI.

It is known that high medial and lateral tibial slopes are associated with non-contact anterior cruciate ligament (ACL) tears. We aimed to evaluate the lateral and medial bony and cartilage tibial slopes of patients with ACL rupture and patients who underwent MRI for other reasons. Between January 2021 and April 2023, 63 patients’ knee MRI images were evaluated using MERGE (Multiple Echo Recombined Gradient Echo) sequence. Thirty patients had ACL rupture, and 33 patients were in control group with other minor knee problems. Patients with significant chondral lesions were excluded. The slopes were measured by taking the tangents of the anterior and posterior most superior regions of the bone and cartilage structures of the medial and lateral tibial plateaus. The difference between cartilage and bone slopes was calculated. Mean posterior slopes were 6,514° ± 3,205 for medial compartment bone, 5,995°±3,272 for lateral compartment bone, 7,420° ±3,223 for medial compartment cartilage and 6,792°±3,638 for lateral compartment cartilage. Patients with ACL rupture had a statistically significant higher mean lateral cartilage slope (8,360° vs 5,366°, p=0,001) and mean lateral bony slope (7,213° vs 4,887°, p=0,004) than other patients. As a result of our study, we observed that patients with ACL rupture had a higher lateral compartment bone and cartilage slope than other patients. We know the relationship between tibial slope measurements on X-ray and ACL tears. This study states that cartilage slope measurement in MRI images can be used in this respect in ACL tears, even without X-ray.

PURPOSE: To evaluate the clinical and radiological outcomes of All inside-arthroscopic reconstruction of Anterior Cruciate ligament using autogenous semitendinosus graft with small length bony sockets (10 – 15mm). METHODS: Total 25 Patients underwent single bundle ACL reconstruction via the all-inside technique with small bony sockets. Functional outcome measures including the Lysholm score, International Knee Documentation Committee score and Tegner Activity Scale were calculated before surgery and at 6 weeks, 3 months and 6 months. At final follow-up, anteroposterior knee stability was assessed with KT-2000 measurements. Radiological assessment of tunnel widening was done on CT on day 3 and 6 months postoperatively. MRI was used to assess graft ligamentization at 6 months postoperatively. RESULTS: The IKDC score (42.90%v 83.64%, P < .0001), Lysholm score (54.64v 91.52, P <0.001), and Tegner activity score (1 v 4.64, P < .001) showed a significant improvement between baseline and final clinical follow-up. The mean side-to-side KT-2000 difference preoperatively was 6.36mm while at final follow-up, it was 1.04mm, p <0.01.on CT assessment it was found that the femoral tunnel was widened by 18.32% at aperture site, by 17.62% at mid distance at final post-op whereas the tibial tunnel was widened by 16.2% at aperture, by 13.9% at mid at final post- op. All the patients showed good ligamentization on MRI at final follow up. CONCLUSION: Single bundle anterior cruciate ligament reconstruction using all inside technique involving small bony sockets using multi-stranded hamstring tendon grafts offers excellent results in terms of post-operative knee stability and functional outcomes

Recurrent patella instability (RPI) is a common and debilitating condition which affects mainly affects adolescents and young adults. Medial patello-femoral ligament (MPFL) reconstruction is the most popular surgical treatment for RPI. The commonest graft choice in the literature is ipsilateral hamstring tendon (gracilis or semitendinosis) but the complication rate remains high (16-26%). Conversely, there are very few papers regarding the use of modern, synthetic graft. 85 patients with simple RPI who underwent MPFL reconstruction using a modern, synthetic graft (Neoligament, UK) from 2014 – 2022 were reviewed. Exclusion criteria were: patella alta, malalignment, trochlea dysplasia and significant pain between episodes of instability. The author has developed an operative technique which is anatomic, minimally invasive and reproducible. Pre and post-operative Kujala and Oxford knee scores were collected pre and post op and were analysed. The male to female ratio was 20:60. Average age 28 years. The follow up range was 12-98 months (mean follow up 57.6 months). We found a statistically significant increase in mean Kujala (p<0.001) and Oxford knee scores (p<0.001) post-operatively. No major complications such as knee stiffness, soft tissue reaction, re-dislocation, patella fracture were identified in the series. We had 9 minor complications (10.5%): 5 cases of continued pain, 2 cases of residual instability and 2 superficial infection. This study demonstrates that MPFL reconstruction using modern, synthetic graft using the technique described, achieves excellent clinical outcomes with low complication rates (10.5%) when compared to the published literature in the medium term.

Introduction: Recurrent anterior shoulder instability is a common issue in physically active people and the Latarjet procedure is one of the surgical techniques to restore shoulder function and stability. However, off-track lesions of the shoulder can pose a challenge, and the standard Latarjet procedure may not always be effective in these cases. To address this, a modified technique called the congruent arc Latarjet procedure has been developed. Methods: This retrospective study assessed the functional outcomes of the congruent arc Latarjet procedure in 25 patients with off-track lesions and recurrent anterior shoulder instability. Patients were evaluated before surgery and at 1, 6, 12, and 24 months postoperatively using the visual analogue score (VAS), Rowe score, and range of motion. Results: Results showed significant improvements in VAS and Rowe score from preoperatively 7.4 ± 0.91 and 20.80 ± 2.46 to 1.48 ± 0.58 and 95.76 ± 1.83 respectively, at 24 months postoperatively (p < 0.05). 92% of patients had an excellent outcome, and range of motion improved, with forward flexion improving to 159.12 ± 6.19 from 72.84 ± 3.98 and external rotation improving to 45.16 ± 2.89 from 9.60 ± 2.34, at 24 months postoperatively. Conclusion: The congruent arc Latarjet procedure is an effective technique for treating off-track lesions in patients with recurrent anterior shoulder instability and quite reliable in restoring shoulder function and stability.

Background: Meniscal injuries are commonly associated with ACL tears. Surgical reconstruction of the ACL is a standard treatment option, and concurrent meniscal repairs can be performed in select cases of associated meniscal tears. However, the outcomes, like return to sports, of ACL reconstruction with bilateral meniscal repairs have not been well studied. Methods: In this study, we retrospectively reviewed the medical records of 21 patients who underwent ACL reconstruction with bilateral meniscal repairs between 2019 and 2021 using hamstring autograft. The mean age of the patients was 28.6 years (range 18-42), and the mean follow-up period was 18.5 months (range 12-26). ACL and meniscal tears were diagnosed via MRI or during the arthroscopy. Results: At the final follow-up, all patients had achieved full range of motion of the knee joint and returned to sports. Mean return to sports was 8.6 months. IKDC improved from a mean of 49.87 to a mean of 87.90. The Lysholm score improved from a mean of 58 preoperatively to a mean of 92 at the final follow-up, indicating good clinical outcomes. 2 patients (9%) had a retear at 6 and 11 months respectively. Conclusion: ACL reconstruction with bilateral meniscal repairs using hamstring autograft and a combination of all-inside, inside-out or combination of both suturing result in good clinical outcomes with low rates of complications. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.