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Musculoskeletal disorders are one of the major health burdens and a leading source of disability worldwide, affecting both juvenile and elderly populations either as a consequence of ageing or extrinsic factors such as physical injuries. This condition often involves a group of locomotor structures such as the bones, joints and muscles and may therefore cause significant economic and emotional impact. Some pharmacological and non-pharmacological treatments have been considered as potential solutions, however, these alternatives have provided quite limited efficacy due to the short-term effect on pain management and inability to restore damaged tissue. The emergence of novel therapeutic alternatives such as the application of orthobiologics, particularly bone marrow aspirate (BMA) clot, have bestowed medical experts with considerable optimism as evidenced by the significant results found in numerous studies addressed in this manuscript. Although other products have been proposed for the treatment of musculoskeletal injuries, the peculiar interest in BMA, fibrin clot and associated fibrinolytic mechanisms continues to expand. BMA is a rich source of various cellular and molecular components which have demonstrated positive effects on tissue regeneration in many in vitro and in vivo models of musculoskeletal injuries. In addition to being able to undergo self-renewal and differentiation, the hematopoietic and mesenchymal stem cells present in this orthobiologic elicit key immunomodulatory and paracrine roles in inflammatory responses in tissue injury and drive the coagulation cascade towards tissue repair via different mechanisms. Although promising, these complex regenerative mechanisms have not yet been fully elucidated.

There is little literature available about the type of sports and concomitant knee injury.

To help in better prediction of concomitant knee injuries in football and kabaddi players.

Five hundred and seventeen male athletes [Football (n=226) and Kabaddi players (n=291)] aged between 16 and 35 years were enrolled in the study. These were categorized into five groups depending upon the time interval between injury and surgery (0-3 months, 3-6 months, 6-9 months, 9-12 months, 12-18 months and 18-24 months). Meniscal and chondral damage present at the time of ACL reconstruction was documented.

The overall incidence of meniscal tear was more in kabaddi players (220/291) as compared to football players (144/226; p=0.003). The incidence of both menisci tear was more in kabaddi as compared to football (p=0.02). Incidence of lateral meniscus tear (147/291) in kabaddi was more as compared to football (84/226; p=0.002). The incidence of condylar damage was comparable in both groups. Medial femoral condyle was more commonly injured in both the sports irrespective of time frame.

The chances of meniscus injuries were more in kabaddi players compared to football players in ACL deficient knee. The time interval between injury and surgery had a direct correlation with meniscus and chondral injuries.

Level III, retrospective study.

Level III, retrospective study.

To find clinical outcome of in-vivo standard 80N tensioning of quadrupled hamstring graft during arthroscopic single bundle ACL reconstruction in comparison to traditional graft tensioning.

Sixty cases of isolated ACL tears were included in this study. All cases underwent Arthroscopic ACL reconstruction with Tibial attachment sparing quadrupled hamstring graft. Cases were divided into group I and group II (30 cases each). Graft Tensioning in group 1 was conventional one-handed unmeasured pull and in group II it was measured tension of 80N with tensionometer during graft fixation. Pre-operative and post-operative (12 months) Anterior tibial translation (ATT) was measured with KT-1000 arthrometer. Clinical outcome was measured using Lysholm knee scoring system at 6weeks, 3months, 6months, 12 months and compared statistically among both groups.

The mean pre-op ATT of 10.6±2.04mm (group I) & 10.83±2mm (group II) improved to 3.63±1.16mm (group I) & 3.63±0.92 (group II) respectively at one year without significant difference (p value 1). The mean pre-op Lysholm score was 46.73±6.77 (group I) and 45.97±8.68 (group II). The mean Lysholm score at 6 weeks was 91.5±2.78 (group I) and 93.43±3.02 (group II) with significant difference (p value 0.014). At 3 months it was 95.4±2.99 (group I) and 97.07±2.07 (group II) with significant difference (p value 0.025). At 6 months it was 95.53±2.46 (group I) and 97.5±1.2 (group II) with significant difference (p value 0.0002). At 1 year it was 95.73±2.22 (group I) and 97.8±0.979 (group II) with significance (p value 0.0001).

The clinical score of ACL reconstruction is better when in-vivo 80N tension is applied using tensionometer during graft fixation in comparison to conventional manual tensioning but there is no difference in ATT.

The clinical score of ACL reconstruction is better when in-vivo 80 N tension is applied using tensionometer during graft fixation in comparison to conventional manual tensioning but there is no difference in ATT.

The number of periprosthetic joint infections (PJI) is continuously increasing because of the increasing number of arthroprostheses performed every year. Two-stage revision, using antibiotic-loaded spacers, remains the gold standard for their treatment. The aim of our study is to compare the use of preformed vs hand-made spacers in hip arthroplasty infections evaluating infection eradication, bone loss and clinical/functional outcomes.

From January 2010 to December 2017 we performed a prospective nonrandomized study. We pooled 50 patients affected by infected hip joint replacements, and divided them in 2 groups, one receiving commercially preformed spacers and the other receiving hand-made spacers. The study endpoint was set at 12 months. Intra-operative and peri-operative complications, Harris Hip Score (HHS), Short Form 12 Health Survey, intra-operative and radiological evaluation of bone loss were collected. Data were analyzed using descriptive statistics, T-test and Fisher Exact test.

We found a statistically significant differences (p<0.05) between the two groups in favour of the VancogenX group for the following variables surgical time, first and second stage intraoperative complication rates, infection eradication. Moreover, the preformed-spacers group had better results in the preservation of bone stock, even though the difference was not statistically significant (p>0.05).

Our results support the use of preformed antibiotic spacers, even though more studies are needed.

Our results support the use of preformed antibiotic spacers, even though more studies are needed.

To verify if transverse acetabular ligament (TAL) can be used as an anatomical landmark to reliably orient the cup in primary total hip arthroplasty and compare it to acetabular cups placed with the help of mechanical angle guide (MAG) device.

Thirty Five patients with primary total hip arthroplasty, all performed by the same surgeon were included in the study. All patients had undergone surgery by anterolateral approach and all were cementless total hip arthroplasty. TAL was used as a reference guide for positioning of the cup in one group while MAG device was used in the other. Post operatively CT was done to confirm the version and inclination of the acetabular cup and the femoral stem version. SPSS was used for statistical analysis.

18 males and 17 females were included. The most common etiological cause for THR was secondary osteoarthritis due to AVN (40%). At 18 months follow up, there was just 1 case of dislocation in group in which angle guide device was used. The mean anteversion of the acetabular cup on CT findings was 23.82° by using TAL while 18.35° with help of MAG device (P<0.05). All were within Leweniks safe zone.

The TAL and MAG device both can be effectively used to align the acetabulum component. TAL is patient specific intraoperative landmark which is not affected by patient positioning while angle guide device can give false positive assessment of cup version.

The TAL and MAG device both can be effectively used to align the acetabulum component. TAL is patient specific intraoperative landmark which is not affected by patient positioning while angle guide device can give false positive assessment of cup version.Instability after total hip arthroplasty (THA) can be a problematic complication and remains one of the leading causes of revision surgery in the early post-operative period. read more Dual mobility (DM) implants decrease dislocation risk after THA but they come with their own set of complications. Selective use of DM implants for THA in high risk groups can confer the advantages of this construct while mitigating the risks. In this paper, we review the current literature to examine the evidence for or against use of DM implants in various clinical scenarios and provide an algorithm for when to consider using DM design construct in THA.

Multiple hereditary exostosis (MHE) is the formation of benign, cartilage-capped bony outgrowths predominantly extending from the metaphysis of long bones that presents with reduction in growth, deformity, restricted motion, short stature and premature osteoarthritis.

To review the clinical and radiological results of a stemless reverse shoulder arthroplasty in a case of MHE.

81-year-old, right hand dominant short-statured retired male engineer with long standing shoulder pain and restricted movements on the background of an old proximal humeral fracture managed conservatively.The radiographs revealed osteoarthritis and a mal-united proximal humerus fracture on the background of MHE with 3 plane bone deformity and a lack of medullary canal.

The patient underwent a stemless reverse shoulder arthroplasty. At 6 months post operatively the patient had recovered well with a range of movement including forward flexion 110°, external rotation 20° and abduction of 80°. Internal rotation remained limited to buttocks. Improved ADLIER, Subjective shoulder value and Constant Murley score compared to pre-operative figures.

The stemless humeral component relies on metaphyseal impaction for stability. When the humeral canal is malformed or in presence of malunited distal fractures, it circumvents the need of navigating a deformed diaphysis with encouraging postoperative results.

The stemless humeral component relies on metaphyseal impaction for stability. When the humeral canal is malformed or in presence of malunited distal fractures, it circumvents the need of navigating a deformed diaphysis with encouraging postoperative results.

The incidence of septic arthritis is 2-10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection.

Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation.

With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same.