Shalby Hospitals is Indian organisation which was established in Ahmedabad as a joint replacement centre in 1994 by Dr. Vikram Shah. Shalby today runs a chain of 10 multi-specialty hospitals in Ahmedabad, Surat, Indore, Vapi, Jabalpur, Jaipur and Mohali. Vikram Shah.
Local Anesthetic Systemic Toxicity (LAST) is a rare but potentially life-threatening complication affecting the central nervous and cardiovascular systems. Despite the widespread use of local anesthetics in dental practice, severe adverse events may occur. A 50-year-old female presented with altered sensorium and severe respiratory distress six hours after a dental procedure. On arrival, she was tachycardic with gasping respirations and a Glasgow Coma Scale score of 7/15. Arterial blood gas analysis showed respiratory acidosis. Neuroimaging and cardiac evaluation were unremarkable. Laryngoscopy revealed airway edema, requiring urgent intubation and ventilatory support. The patient improved with supportive intensive care and was discharged without neurological deficits. A probable diagnosis of LAST was made based on temporal association and exclusion of other causes. This case highlights an atypical presentation of LAST with delayed onset, absence of seizures, and predominant respiratory failure. Early recognition and prompt management are crucial to improve outcomes.
Neglected multi-ligament knee injury (MLKI) or tibial-femoral knee dislocation is a rare injury with significant consequences. This review aims to summarise injury patterns, treatment recommendations, and outcomes. MEDLINE, PubMed, and EMBASE were searched on 28 January 2025. Neglected MLKI was defined as untreated or inadequately treated MLKI or knee dislocations where definitive surgical management was unintentionally delayed for ≥3 weeks without appropriate interim management. PRISMA, R-AMSTAR and Cochrane guidelines were followed. Eighteen case reports (19 patients; 20 knees) were included. Mean age was 41.5 years (range: 17–65 years) with 11.1
Abstract:Anterior cruciate ligament (ACL) injuries are frequent among professional American football players and often require surgical reconstruction followed by prolonged rehabilitation. Return to play (RTP) is a key outcome, yet substantial variability persists in reported RTP rates, timelines, level of return, and re-injury risk. This systematic review and meta-analysis aimed to compare RTP rates, time to RTP, return to preinjury performance, and ACL re-rupture rates in professional American football players across three time periods. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed, Embase, and the Cochrane Library identified studies reporting RTP outcomes following ACL reconstruction (ACLR) in professional American football players, including selected high-level collegiate cohorts. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies. Four outcomes-overall RTP rate, time to RTP, return to preinjury level, and ACL re-rupture rate-were extracted and meta-analyzed across three publication periods (before 2016, 2016-2020, and after 2021) to explore temporal trends. Twelve studies met the inclusion criteria, including 1,166 professional American football players. The pooled RTP rate was 73.1% (95% confidence interval [CI], 62.5-80.5). No significant differences were found across periods (p > 0.05), although RTP rates numerically decreased from 78.9 to 69.8%. Among players returning to sport, 93.6% (95% CI, 77.7-100) regained their preinjury performance level, with no significant temporal differences (p > 0.05). The pooled ACL re-rupture rate was 4.4% (95% CI, 2.0-7.3), with comparable rates across periods. Mean time to RTP was 340.1 days (95% CI, 313.1-367.1), with no temporal differences. More than 70% of professional American football players RTP after ACLR, and most returning athletes regain their preinjury performance level, with low re-rupture rates. Although more recent studies reported numerically lower return-to-play rates, these differences were not statistically significant. This systematic review and meta-analysis included levels III and IV evidence studies and was registered with PROSPERO (registration no. CRD420251022080).
To analyze whether magnetic resonance imaging (MRI) can predict return to sport after anterior cruciate ligament (ACL) reconstruction and whether a correlation exists between return to sports, level of activity and MRI signals. The search terms selected for inclusion in the title, abstract, and keyword fields were as follows: ‘anterior cruciate ligament’ OR ‘ACL’ AND ‘graft maturation’ OR ‘MRI’ AND ‘return to sport’ OR ‘sports activity.’ For each study, patient data and the MRI protocol used to assess graft maturation were extracted. An analysis of the correlations between MRI and ACL reconstruction was performed. A total of 394 patients were included from 7 studies. The mean radiological follow-up was 19.06 ± 11.02 months. Three studies reported no correlations between graft bending angle, signal/noise ratio, signal intensity or Howell score and return to sport. One study revealed that T2* was correlated with return to sport. A further investigation demonstrated that those who were able to regain their preinjury athletic performance exhibited considerably lower ACL/PCL ratio and ACL/muscle ratio of the ACL mid-substance compared to those who were unable to attain the same level of athletic performance. Only one study reported correlations between 12-month SNRs and 60-month Cincinnati, Lysholm and Tegner activity scales, whereas Biercevicz revealed that the combination of volume and the SI predicted the KOOS score at the 5-year follow-up. There are no reliable radiological parameters available that correlate with return to sport after anterior cruciate ligament reconstruction, but MRI can potentially play a key role in closing this gap. Systematic review of level IV. PROSPERO—CRD42024574365.
Anterior cruciate ligament (ACL) rupture is one of the most severe injuries in professional soccer players, often leading to long absences from competition and career-threatening consequences. Understanding how return to play (RTP) outcomes have evolved over time is essential for optimizing recovery and minimizing re-injury risk. The aim of this systematic review and meta-analysis was to compare RTP rate, level of RTP, time to RTP, and ACL graft re-rupture rate in professional soccer players across three distinct time periods after ACL reconstruction (ACLR). Following PRISMA guidelines, MEDLINE (PubMed), Embase (Elsevier), and the Cochrane Library were systematically searched on March 8, 2025, and updated on March 22, 2025. Studies reporting RTP outcomes after ACLR in professional soccer players were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Four primary outcomes—RTP rate, level of RTP, time to RTP, and ACL graft re-rupture rate—were extracted and meta-analyzed across three publication periods (2011–2016, 2017–2021, 2022–2025). Twenty studies met the inclusion criteria, comprising 1,988 professional soccer players (5 published before 2017, 5 between 2017 and 2021, and 10 after 2021). The mean player age at surgery did not differ across time periods (p > 0.05). Overall, 92.3
