Introduction : This study aimed to compare the clinical outcomes and the survivorship of UKA on SPONK versus osteoarthritis at a minimum follow-up of 10 years.
Methods : This case-control study included all medial UKA for SPONK operated on between 1996 and 2010 with a minimum 10-year follow-up (n=47). Each case was matched with a medial UKA on osteoarthritis based on BMI, gender, and age. A similar all-poly fixed bearing UKA was used in every case. Clinical (Knee Society Score (KSS) and complications) and radiological (loosening) data were collected at the last follow-up. Kaplan Meier survivorship analysis was performed using revision with implant removal as the endpoint.
Results : Mean follow-up was 13.2 years [10;21]. Mean age and BMI were 72.9 ±8.4 years and 25.5 ±3.6 Kg/m2 in SPONK group. At the last follow-up, knee and function KSS were respectively 89.5 ±12 and 79 ±18 in SPONK group vs 90 ±15 (p=0.85) and 81.7 ±17 (p=0.47) in control group. Complications and radiological results in each group showed no significant differences. The survival rate free from any revision was 85.1% at the last follow-up in SPONK group and 93.6% in control group. The leading cause for revision was aseptic tibial loosening (57.1%) in SPONK group. The 15-year Kaplan Meier survival estimate was 83% in SPONK group and 93.6% in control group (p=0.28).
Conclusion : The long-term survivorship and clinical outcomes were similar between UKA for SPONK versus osteoarthritis, without a higher risk of femoral loosening.

Background: In adolescent athletes the treatment of Anterior Cruciate ligament (ACL) tear is still a topic of debate. The aim of the present study was to evaluate the functional outcomes and complication of transphyseal ACL reconstruction in adolescent athletes. Methods: This was a retrospective study. Thirty- four athletes who underwent transphyseal ACL reconstruction using a hamstring tendon graft were included in the study. All patients were evaluated for functional outcomes (Lysholm and Tegner activity score) and
complications (angular or limb length discrepancy) at the final follow-up. Results: Mean age at the time of the surgery was 13.8±0.79 years. At a mean follow-up of 64.88±23.91 months, Lysholm and Tegner activity score was 96.47±5.04 and 8.1 respectively. 27/34 (79%) of patients returned to the same level of sports. The mean time to return to sports was 7.20±6.79 months. 3/34(1%) patients had re-injury of graft and none of the patients had any angular deformity or limb length discrepancy. Conclusion: Transphyseal ACL reconstruction shows satisfactory results without any growth disturbances in skeletally immature athletes.

Background: Anterior Cruciate Ligament (ACL) injuries are common in sportspersons; however there is still no consensus on the factors affecting Return to Sports (RTS) after ACL reconstruction (ACLR) with hamstring graft. Methods: This was a prospective cohort study. 123 sportspersons were assessed for the factors affecting RTS. Patients with RTS were labelled as group I and patients who didn’t return to sports (non-RTS) were labelled as group II. Results: There were a total of 81 (65.85%) patients in group 1 and 42 (34.14%) patients in group II.The mean time to RTS in group I was 7.98±2.76 months. Younger age (p<0.0001), lower socioeconomic status (p<0.0001), international and national level sportspersons (p=0.02 and 0.0001 respectively), mean delay in surgery <6 months (p=0.03), low mean preoperative KT-1000 score (p<0.0001), high mean pre-operative Lysholm score (p=0.02), post-operative thigh wasting of <1 cm (p<0.0001) and low mean Tampa score for Kinesiophobia (TSK) (p<0.0001) had statistically significant positive co-relation with RTS. However, gender, Body Mass Index (BMI), type of sports, mode of injury, meniscal and chondral damage, size of graft, pre-operative thigh wasting and post-operative Lysholm score and KT-1000 score were found to be comparable between both the groups (p>0.05). Conclusion: Younger age, lower socio-economic status, elite level athletes, <6 months delay in surgery, high pre-operative Tegner Activity Scale score (TAS) and Lysholm score, less pre-operative KT-1000 score, <1cm post-operative thigh wasting and less post-operative TSK were found to have high RTS rates.

Introduction
This meta-analysis aims to determine the time to RTS following TKA.

Methods
Using the PRISMA guidelines, an electronic search of PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trails was performed on TKA and RTS in English, published since the database's inception to 31st October 2020. Pooled analysis using the random effect model on overall proportions at the different time intervals and the end of the follow-up was carried out for all studies.

Results
In total, 1,611 studies were retrieved from literature search. Of these, nine studies met the inclusion criteria with 1,307 patients. Two studies with 148 patients demonstrated an overall pooled proportion of 18.7% (95% CI: 8.2% - 32.3%) of patients RTS at 3 months post-TKA; Three studies reported RTS rate at 6 months 70.% (95% CI: 48-88.4). Two studies with 123 patients demonstrated an overall pooled proportion of 84.0% (95% CI: 77.1% – 89.9%) patients RTS at 12 months. 986 patients returned to sport from 1,307, with an overall adjusted proportion return to the sport of 87.9 (95% CI: 80.5-93.8% ) at the end of follow-up; mean of 14 months (range 3 – 36 months).

Conclusion
Patients undergoing TKA were found to successfully RTS; pooled proportion analysis showed an increasing rate of RTS with time, at a mean of 14 months following TKA, where 87.9% of patients had returned to sports. These findings will enable more informed discussions and rehabilitation planning between patients and clinicians on RTS following TKA.

Introduction –Supracondyler femur periprosthetic fractures are rare and are managed by various modalities.they are often difficult to treat because of various factors likeosteoporosis,communition,female gender,poor bone stock.fixation of supracondyler femur fracture with locking plate provides excellent results in terms of radiological and clinical outcome.Case report-We report a case of 70 yr old female with pain and swelling in right knee since 1 day.She had history fall 1 day back and was operated with total knee replacement 6 years back. We operated her with open reduction and internal fixation with distal femur locking plate and it provided excellent clinical outcome.discussion-Periprosthetic fracture are rare entity in total knee replacement.Various factors are involved in causing peri prosthetic fracture like Female gender,osteoporosis,limited bone stock,recent corticosteroid treatment.Challenges in the surgical management of fractures by ORIF are associated comminution at the fracture.Consequently, this fixation may need to be protected in a cast brace till radiological evidence of bone healing. Plate fixation has been regarded as an acceptable procedure in elderly patient with periprosthetic femoral fractures, even with slightly loosened prostheses.The aim of treatment in fractures of the distal femur proximal to the TKA prosthesis is to achieve a painless stable knee without significant residual malalignment or malfunction. Early mobilization and function are essential in obtaining a good result.Conclusion-Periprosthetic fracture is a rare entity.In an elderly patient,open reduction and internal fixation with a locking plate osteosynthesis in an provides excellent clinical and radiological outcome.
Keywords-distal femur,periprosthetic fracture,total knee replacement, open reduction and internal fixation

Background: Malrotation of the tibial component in a tkr leads to anterior knee pain, patella dislocations, extensor mechanism disruptions and knee stiffness and prosthesis loosening. Techniques like free floating technique, medial 1/3 rd of tibial tubercle, medial border of 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 knee replacements were included in a prospective observational study. The average age of the study group was 53.6 years(48-76 yrs) Thirty one were females and 3 were males. The patents were followed minimum for one year (max 2 yrs, average 1.8 yrs). ‘Sharma’s Venn diagram Method (C)’ which was compared to free floating method (F) and post op CT scans using Berger protocol(B).
Results:Tibial rotation calculated using the 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 degree external rotation in 5 knees and an average of 5.17 degree 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.
Conclusion: Our method is reliable, accurate and easily reproducible by any surgeon on table and correlates with postoperative 2D CT based assessment.

Introduction
The primary objective was to carry out a systematic review and meta-analysis of published literature on UKA and the time to RTS following surgery.

Methods
The PRISMA guidelines were followed to undertake this meta-analysis. A search was performed on MEDLINE, EMBASE and the Cochrane Library with the keywords “arthroplasty” and “return to sports” from inception to August 2020. The quality of the articles was graded according to the Methodological Index for Nonrandomised Studies checklist. The primary outcome assessed was the time taken for RTS.

Results
A total of 10 studies were reviewed with a patient population of 730. The time taken to RTS was between 1 month and 24 months, 53.28% RTS within 3 months, and 76.68% RTS within 6 months. Walking had the quickest return to sports with 7.87 weeks (SD: 8.4), whilst tennis had an average RTS of 10.1 weeks (SD: 2.5). Robotic UKA had a significantly quicker RTS of 4.2 months compared to the conventional jig based approach of 10.5 months (p<0.001)

Conclusion
Using the random effect model, the overall pooled data highlighted that 91.70% of the total number of patients RTS between 1 and 24 months after surgery, 76.68% of patients returned within 6 months of surgery. Low-intensity sports such as walking had the highest number of patients returning to sports, whilst robotic surgery had the best outcomes for patients. This systematic review and meta-analysis serve as helpful guidance for clinicians and patients to predict the time patients are likely to RTS after UKA.

Introduction: The aim of this study was the comparison of the effects of low-level laser therapy (LLLT), light and routine treatments on clinical outcomes in patient’s post-primary total knee arthroplasty (TKA). Objectives: To evaluate the effects of LLLT and light therapy post knee replacement in order to enhance the quality of life. Material and methods: In this RCT study, 45 cases after total knee arthroplasty were divided into 3 groups (LLLT, light and control group). We evaluated and compared swelling, pain level, range of motion, the Knee Society Score (KSS) and knee functional Score before surgery and 3 months after interventions. Results: There were 16 (35.6%) males and 29 (64.4%) females in this study. The mean age of patients was 64/31±7/11 years (48 to 81). Knee range of motion in the LLLT group increased 104.5 degrees, in the light group increased 94.7 and in control group 82.26 degree (p value <0.0001). Knee swelling decreased 2.4 centimeters in the LLLT group, 2.2 cm in the light group and 1.7 in the control group at 3 months after intervention(p value<0.0001). The study revealed significantly higher improvement in KSS (54 Score) and KSS functional (40.2 Score) in the LLLT group compared with other groups(P value <0.0001). Conclusion: Our study showed that using LLLT early in the rehabilitation protocol of patients undergoing TKA could be a useful tool to control of pain and swelling. LLLT is also associated with better outcome in these patients considering knee ROM and function at 3 months after surgery.

Introduction: Combined intravenous(IV)/intraarticular(IA) administration of Tranexamic acid(TXA) is associated with significantly lower blood loss during or just after total knee arthroplasty(TKA) than IV alone or IA alone administration of the same dose of TXA in multiple studies. However,to the best of our knowledge, no TKA study has compared the mentioned three methods when tourniquet without drainage catheter is used. we aim to determine the most effective route for TXA administration(among IA,IV,combined IA/IV) for TKA surgeries using tourniquet without drainage catheters. Methods: We performed a double blinded clinical trial on a total of 147 TKA candidates. The amount of blood loss and hemoglobin drop were evaluated in three matched case groups administered TXA during the TKA either via IV, IA or IV plus IA route. Drainage catheter was used for none of the cases. Results: The combined group showed an average blood loss of 630±252ml which was significantly lower than the IV group(878±268ml,P-value<0.01) and the IA group(774±288ml,P-value=0.03). Besides, the mean hemoglobin and hematocrit drop was significantly lower in the combined group compared to the other two groups, 48 and 72 hours postoperatively(P-value<0.05). Conclusions: The TXA administration via IV plus IA route had 28% and 19% reduction of blood loss in comparison with using the TXA via IV alone and IA alone methods respectively. Therefore, given the surgery is performed with tourniquet application, TXA usage via IV plus IA route may be a more effective way for reducing the perioperative blood loss in TKA cases in patients undergoing TKA without drain placement.

Introduction:
Anterior cruciate ligament tears are commonly seen in young active sports persons. The injury leads to functional instability, altered knee joint biomechanics and usually requires surgical treatment. Presently ACL reconstruction is the gold standard treatment in the young athletic population. In our study variables studied were age, gender, players of various sports, level of sports, injured side, socio-economic status, thigh wasting, fear of re-injury, duration of injury before surgery, and concomitant meniscal and chondral injury with severity and functional outcome as hindrance for return to sports.
Material and methods:
It was a retrospective study. All patients who underwent ACL reconstruction surgery at GMCH-32 in the last 5 years were identified from hospital records and all the above-mentioned variables were studied.
Results:
The present study was performed on 225 patients who underwent ACL reconstruction surgery. Elder age group, thigh wasting >1.5cm, duration of injury > 6months, lower-middle and upper-lower socioeconomic class of Modified Kuppuswamy scale, presence of meniscal injury with concomitant articular cartilage injury specifically severe grades and >12 months of injury, fear of re-injury as scaled by TSK with score ≥37, Lysholm-Tegner activity score <95, KL Grade 1,2 are the hindrance after ACL reconstruction surgery which were statically significant.
Conclusion:
All the above-mentioned variables except gender, players of various sports, level of sports, the injured side were statically significant.

To examine how gender differences affected willingness to undergo Total and unicondylar knee arthroplasty and whether age group affects willingness based on gender.
This is a retrospective analysis of patients underwent knee arthroplasty between 2003 and 2019 in HHUMC,a referral general hospital in South Lebanon. Revision surgeries due to loosening or infection were excluded.
The number of females to males in both groups was compared to identify whether gender variance has an effect on willingness to do knee arthroplasty and if age has an impact on willingness.
Our survey included 475 patients who underwent total knee arthroplasty from 2009 till 2019 and 87patients who underwent Unicondylar knee arthroplasty from 2003 till 2019. Out of the TKA patients, 367(77.3%) were females with mean age group of 69.4 years and 108(22. 7%) were males with mean age 71.7 years. The number of females who underwent Unicondylar knee arthroplasty was 75(86.2%) with a mean age of 62.4 years and the number of males was 12 (13.8%) with a mean age 62.8 years. The number of females in both groups was greater than the number of males with ratio of 3.4:1 and 6.25:1 respectively with no significant difference in the mean age between genders.In our study the number of females to males who did knee
arthroplasty does not reflect the true number of females to males that have symptomatic knee
osteoarthritis. Thus, the numbers present in both groups are probably explained by the fact that females
have more willingness to undergo arthroplasties than males.