BACKGROUND:Anterior cruciate ligament (ACL) reconstruction using hamstring autograft is a standard procedure for restoring knee stability. Graft diameter is a key determinant of surgical success, with smaller grafts associated with higher failure rates. Preoperative prediction of hamstring graft size using simple anthropometric parameters may assist in surgical planning and improve outcomes. OBJECTIVES:To evaluate the relationship between anthropometric measurements and quadrupled hamstring graft diameter in patients undergoing ACL reconstruction. METHODS:This prospective study was conducted at a tertiary care center over 18 months (August 2023-February 2025) and included 48 patients aged 18-55 years undergoing primary ACL reconstruction with hamstring autograft. Preoperative parameters recorded included age, gender, height, weight, body mass index (BMI), and thigh circumference. Graft diameter was measured intraoperatively using a graft sizing block. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York), with p < 0.05 considered significant. RESULTS:The mean age was 40.5 ± 8.3 years, with male predominance (70.8%). Mean height, weight, and BMI were 165.7 ± 6.6 cm, 78.8 ± 7.9 kg, and 24.9 ± 3.9 kg/m², respectively. The mean thigh circumference and graft diameter were 53.0 ± 5.0 cm and 7.91 ± 0.82 mm. Height showed a strong positive correlation with graft diameter (r = 0.666, p < 0.001), while thigh circumference showed a moderate positive correlation (r = 0.367, p = 0.010). BMI demonstrated a significant negative correlation (r = -0.330, p = 0.022). Males had significantly larger graft diameters than females (8.30 ± 0.60 mm vs 6.96 ± 0.41 mm, p < 0.001). CONCLUSION:Anthropometric parameters, particularly height, are reliable predictors of hamstring graft diameter in ACL reconstruction. Preoperative assessment can help identify patients at risk of inadequate graft size and guide surgical planning, including consideration of alternative graft options to optimize outcomes.

This prospective randomized comparative study evaluated the clinical efficacy of glenohumeral (GH) versus subacromial (SA) corticosteroid injections in managing primary frozen shoulder. The study was conducted at a tertiary care center in North India between 2023 and 2025. Sixty patients aged 20-70 years with stage 1 primary frozen shoulder, unresponsive to at least six weeks of conservative treatment, were included. Participants were randomly allocated to receive either a GH or SA injection containing triamcinolone, lidocaine, and saline. Each followed a standardized home-based exercise program. Outcomes were assessed at baseline and at 4, 8, and 12 weeks post-injection using the visual analogue scale (VAS), Constant-Murley score, and shoulder range of motion (ROM) parameters. These included forward (FWD) flexion, abduction, and internal and external rotation. Both GH and SA injections resulted in statistically significant improvements across all parameters over time (p < 0.0001). Comparative analysis revealed no significant difference between groups in pain relief, activities of daily living (ADLs), or internal rotation. However, GH injections showed significantly superior improvement in FWD flexion, abduction, and external rotation compared with SA injections. The findings suggest that both injection sites are effective for pain relief and functional improvement in primary frozen shoulder. Intra-articular GH injections may offer greater benefits for restoring specific shoulder movements, particularly those most affected by capsular fibrosis.

Abstract Hemophilic arthropathy is a common complication of hemophilia A and can lead to chronic synovitis, joint damage, and eventually ankylosis. We present a case report of a 39-year-old male patient with a history of recurrent hemorrhages into the joints. He had a history of traumatic injury to both upper limbs and lower limbs. The patient was on bed rest for 6 months. Subsequently, he developed ankylosis of both elbows in 30° of flexion and ankylosis of the right (Right) knee in 40° of flexion with tricompartmental arthritis of the left knee joint. Radiologically, the left knee joint showed reduced joint space with tricompartmental arthritis. The patient was managed by the tumor prosthesis for the Rt knee. He was advised for management of the elbow joints for which he was not willing. Postoperatively, he was allowed knee range of motion exercises and walking with a walker for 4 weeks followed by a stick for 1 month. At 6-month follow-up, he was able to walk effortlessly without support. The Knee Society Score improved from 47 preoperatively to 75 at 6-month follow-up.

Background: The quadriceps angle, commonly known as the Q-angle, is the angle formed between the vectors of the pull of the quadriceps muscle and the patellar tendon. The literature varies in terms of the values of Q angles measured by various researchers. It is well appreciated that the normal Q-angle should fall between 12° and 20°, with males being at the lower end of this range and females having higher measurements. An increase in Q-angle beyond the normal range has been associated with knee extensor dysfunction leading to patellar instability. Keeping in mind the clinical and biomechanical importance of the Q-angle, the aim of this study was to compare and establish the range of the Q-angle in healthy individuals and evaluate its variations with respect to age, weight, height, gender, dominant side, and femoral bicondylar distance. These observations will be helpful for sports therapists in understanding the evaluation of Q-angle in athletes as a prognostic value for probable knee pathologies that may appear in the future. Methods: The current study was conducted at a tertiary care center, and a total of 100 healthy adults between the ages of 18 and 35 were enrolled in the study (50 males and 50 females), following which their Q-angles, bicondylar distances, and femur lengths were measured. Individuals with any lower limb injury that resulted in a ligamentous, muscular, or bony defect; any spinal or neurological injury; any diagnosed knee disorder, such as a fracture, acute or chronic knee pain, patellar dislocation, or prior orthopaedic surgery in the lower extremities, were excluded from the study. Data were analyzed using paired t-tests, independent sample t-tests, ANOVA, and Pearson correlation coefficients. Result and conclusion: The mean Q-angle in males was found to be 11.14° ± 1.9° on the right side and 10.84° ± 1.86° on the left side. In females, it was found to be 13.68° ± 1.87° on the right side and 13.61° ± 2.04° on the left side. Among males, right and left Q-angles showed significant positive correlations with height, weight, BMI, right femur length, left femur length, right bicondylar distance, and left bicondylar distance (p<0.05). The highest correlation was found between weight and BMI. Among females, the right Q-angle showed significant positive correlations with weight and BMI (p<0.05). The highest correlation was found with weight.

BACKGROUND:The measurement of the posterior tibial slope (PTS) angle is crucial for various knee surgeries such as total knee replacement, high tibial osteotomy, and anterior cruciate ligament reconstruction. This hospital-based study aimed to determine the average PTS angle in the knee joints of the North Indian population and provided valuable data to aid knee surgeries in this region. METHODS:An analysis of 200 plain X-ray films, specifically the true lateral view of both knees in 20-degree flexion, was conducted on participants who exhibited skeletal maturity with no arthritis, tumours, or previous knee surgeries. The PTS measurements were performed manually. The data were analyzed statistically by matching them with variables such as gender, age, laterality, and body mass index (BMI). RESULTS:The study revealed the following findings for the posterior tibial slope in a section of the North Indian population: there was no significant laterality difference (right knee: 12.76±2.35°, left knee: 12.55±2.46°); no notable sexual dimorphism (males: right knee - 12.79±2.65°, left knee - 12.25±2.65°, females: right knee - 12.73±2.11°, left knee - 12.77±2.30°). However, as age advanced, there were significant differences observed (PTS: 14.27±1.28° and 13.84±1.80° in the 18-40 years age group, 11.36±1.76° and 11.31±1.97° in the 41-60 years age group, 10.32±2.82° and 10.56±3.04° in the >60 years age group for the right and left knee, respectively). No significant correlation was found with BMI (PTS: 13.12±3.13° and 12.59±3.14° for BMI <25, 12.88±2.15° and 12.80±2.34° for BMI 25-30, 12.00±2.09° and 11.66±2.99° for BMI >30 in the right and left knee, respectively). CONCLUSIONS:The study demonstrated significant variations in the posterior tibial slope based on age, emphasizing the need for individualized treatment in knee surgeries. The research provided valuable insights into normal PTS values specific to the North Indian population, offering regional data to inform knee surgery procedures.

Background: Lockdown had hindered persons’ ability to engage in regular physical activity. Our study analysed bone trauma patients who visited the orthopedic department based on the mode of injury, kind of extremity involved, and the bone implicated. Methods: This was a retrospective cross-sectional study of patients visiting the orthopedic surgery department of a North Indian tertiary health care centre. Patient data was recorded from the case sheets. Results: A total of 792 patients’ data was collected, out of which 250 patients were those of during lockdown, and 542 patients were of non-lockdown phase. During the lockdown phase, the patients who have undergone RTA were 37 (14.8%), those admitted for domestic trauma were 128 (51.2%), and those for miscellaneous causes were 85 (34%). During the non-lockdown phase, RTA were 145 (26.739%), domestic were 318 (58.608%) and miscellaneous were 79 (14.652%). During lockdown, the site of injury was upper limb in 59 patients, lower limb in 154 patients, vertebrae in 37 patients. In the non-lockdown phase, the upper limb was injured in 95 patients, lower limb in 377 patients, vertebrae in 52 patients and hip bone in 17 patients. Femur was the most affected bone. Conclusions: There was a decrease in the number of instances during the lockdown. During both the periods, the majority of geriatric patients were from rural areas. Domestic trauma cases were most prevalent in the older age range, and the most common extremity implicated appeared to be the lower limb, with the femur being the most involved bone in both stages.

Background: Bone tumors remain a formidable challenge for orthopedic surgeons. In developing countries, the challenge is exacerbated by limited diagnostic, therapeutic, and management facilities and ignorance. Patients with upper and lower-extremity muscle and skeletal tumors are candidates for amputation or surgical rescue of the limbs. Traditionally, limb rescue surgery by neo-adjuvant chemotherapy is the preferred surgery method for localized carcinoma. Amputations are usually reserved for patients with increased tumor size. The purpose of this study is to investigate health-related quality of life (HRQOL) and physical disability, focusing on surgical care, gender, and age, in adolescent and young adult survivors of malignant bone tumors treated surgically. Methods: This cross-sectional study consists of 38 long-term survivors who underwent amputation or limb-salvage surgery at King George's Medical University, Lucknow, from 2019 to 2022. After obtaining ethical clearance and informed consent, 38 patients which included 26 patients treated with limb salvage in Group A and 12 patients treated with amputation in Group B were included in the study. The SF-36 and HUI3 scores were used to assess the functional outcome and health-related QoL of these patients. Results: After minimal six months of interventions, we have found a significant improvement in all the following factors: physical functioning (P=0.000), role limitations due to physical health (P=0.000) and emotional problems (P=0.001), energy/fatigue (P=0.000), emotional well-being (P=0.000), social functioning (P=0.000), pain (P=0.000), and general health (P=0.000). Group A showed a higher degree of significance than Group B through SF-36 (Short Form-36, patient-reported outcome), whereas HUI-3 did not show any significant outcomes (P=0.347). Conclusion: The overall quality of life of patients with salvaged limbs appears to be higher than that of the quality of life of amputee patients in tumor survivor patients. Further analyses must be carried out to verify the results and focus on areas that have a major impact on the overall quality of life using other assessment tools. The impact of therapy on the quality of life depends on maintaining the necessary structures for functional functions, adjusting patient expectations to cancer treatments, and designing long-term rehabilitation programs to support functional functions.

Introduction The use of a drain after various types of arthroscopic surgeries has long been debated. Whether a drain offers an advantage in terms of pain, swelling, and functional outcome after arthroscopy-assisted reconstruction of the anterior cruciate ligament (ACL) needs to be investigated. This study was designed to assess the validity of the use of an intra-articular drain after routine arthroscopic ACL reconstruction and to assess the various complications associated with its use. Material and methods Forty-four patients (group I included patients for whom an intra-articular drain was used and group II included patients for whom an intra-articular drain was not used) diagnosed with ACL injury were included in the study. The patients in group I had a drain placed inside the joint, while those in group II had a drain placed outside the joint cavity but the drain placement was such that there remained no patient or observer bias. Results Outcome assessment was performed on days one, two, and three followed by weeks one, four, and eight, and six months after surgery by determining a visual analog pain (VAS) score. The assessment was also done for the range of motion (ROM) in terms of loss of flexion and extension with a hand-held goniometer, knee hemarthrosis, and thigh circumference. Although there was a difference in both the groups in terms of the above-mentioned parameters in the early post-operative period, the difference becomes insignificant at the final follow-up at six months. Conclusion From this study, we conclude that putting an intra-articular drain after ACL reconstruction offers no advantage in terms of functional outcome in the long term.

Aneurysmal bone cysts (ABC) are blood-filled, locally destructive, expansile lesions of the bone. ABC of the proximal femur is usually unilateral in presentation. As far as the English literature is concerned, there is no case report of bilateral involvement of the proximal femur by primary ABC. We hereby present a rare case of bilateral primary ABC of the proximal femur with pathological fracture of the right femoral neck. The patient underwent right hip hemiarthroplasty and open biopsy and curettage of the left proximal femur. ABC is usually unilateral in location. Whenever there is a bilateral lesion in the proximal femur usually ABC is not suspected as a differential diagnosis, but ABC may have a bilateral presentation.

Background: This study was conducted to compare the accuracy of MRI findings and clinical examination of ligamentous and meniscal injuries of the knee, taking arthroscopy as a standard diagnostic tool in knee injuries. Methods: All patients with knee injuries attending the outpatient department or emergency of our hospital underwent clinical examination. Out of them, 60 patients with knee injuries were subjected to clinical examination, MRI, and then arthroscopy. The findings of these diagnostic tools in respect to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and meniscus injuries were validated, compared, and analyzed using various statistical tools. The accuracy, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and specificity were calculated and an agreement between various tests was established using kappa statistics. Results: The accuracy of clinical examination in our study was 88% for ACL tears, 85% for meniscal tears, and 100% for PCL tears. The kappa measure of agreement between arthroscopy and clinical finding and MRI for ACL was 0.610 and 0.698, respectively, which was statistically significant. MRI (98.1) was found to be a more sensitive test for detecting ACL injury than clinical examination (90.4%) resulting in higher diagnostic accuracy (98.3%), while diagnostic accuracy of clinical examination and MRI was found to be 100% for PCL injuries. Hence, MRI is an excellent screening tool for ligamentous and meniscal injuries of the knee joint. We can avoid diagnostic arthroscopy in patients with knee injuries having equivocal clinical and MRI examinations and can proceed for therapeutic arthroscopy to deal with such injuries. Conclusions: For the assessment of ligamentous and meniscal injuries, MRI is an accurate and noninvasive modality. It can be used as a first-line investigation but arthroscopy remains the gold standard.

Background: Inter-hospital transfer is a common in trauma victims due to paucity of super-specialty care, lack of specialty beds, and lack of funding. The government of Uttar Pradesh introduced Emergency Medical Response system (EMRS). There is a need to audit and evaluate the transfer process since the introduction of the service. The objectives of this study were to identify critical gaps in the transfer of trauma patients and secondary over triage to the trauma centre of KGMU.Methods: This prospective observational study was conducted on trauma victims referred to the trauma centre. Patients were evaluated for clinical status, Injury Severity Score, protective patient devices present, type of intravenous fluid infusion, mode of transport, and level of referring hospital. Transfer records, transport vehicles and accompanying personal were evaluated.Results: Of the 342 patients enrolled in the study, 91 had a GCS score <8 and 112(32.74%) had a diastolic BP <60 mm Hg at arrival. Twenty patients (5.8%) were referred from tertiary care centers, 74(21.6%) were referred from district hospitals, 136(39.76%) were referred from primary care centers and 112(32.74%) were referred from private hospitals. Date and time of injury was not recorded in any of the patients. Referral time was recorded in 48(14.03%) patients. One hundred seventy-six patients (51.14%) were transferred in EMRS ambulances, 102(29.82%) patients met the criteria for secondary over triage.Conclusions: There is a need to adopt and strictly implement guidelines for transfer of trauma victims to plug the critical gaps in the transfer process.

Background: Study is carried out to measure the additional effect of using Fiber-tape on functional outcome of anterior cruciate ligament tear managed by augmenting ACL reconstruction with Fiber tape. Methods: The standardised, Anterior Drawer test Lachman test, Pivot shift test, Lysholm knee score quantified in terms of the side-to-side difference in laxity both preoperatively and postoperatively.Result: The present study was conducted on patients with anterior cruciate ligament tear admitted in department of orthopaedics, King George’s Medical University, Lucknow. The present study had total of 50 subjects among which 25 were assigned in to two groups randomly, viz Group 1 of the treatment procedure – Quadruple hamstring graft alone and Group 2 of patients with augmented hamstring graft with fibertape. On comparing the improvement in grades at 12 weeks and 6 months follow-up, fiber group showed significantly more improvement compared with the non-fiber group. None of the cases in both the groups showed positive pivot shift test at 6 months follow up.Conclusion: In our study it was found that the improvement in grades of anterior drawer test and Lachman test in fibertape augmented group was significantly more than the non-augmented group at 12 weeks and 6 months. Follow up period of 6 months was a limiting factor in our study. This technique needs further clinical evaluation to assess the long term results and the effect of protection of the graft and also to study the clinical behavior of the resultant collagen fibertape.

Background: Osteoarthritis is a very common chronic degenerative disease most commonly affecting the knee joints. In present study we compared the efficacy of autogenous platelet rich plasma (PRP) versus visco supplementation in treatment of early osteoarthritis of knees. Methods: 30 patients (56 knees) were registered and divided into two groups. Out of which PRP in 28 knees and visco supplementation in 28 knees injected during. Visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were measured. These scores were measured at first visit, 6 weeks, 12 weeks and at 24 weeks. Results: All registered patients were randomized in two groups. Group I (total 16 patients and 28 knees) for intraarticular PRP injection and group II (total 14 patients and 28 knees) for intraarticular viscosupplement injection. Out of 28 knees of group I; 12 (42.85%) knees belonged to grade II and 16 (57.15%) of grade III. Out of 28 knees of group II; 15 (53.57%) knees of grade II and 13 (46.45%) of grade III. None of the knees belonged to grade I and grade 0. There was significant difference in outcome of two treatment groups (p<0.05) at 24 weeks. Conclusions: Treatment with PRP showed a significantly better clinical outcome compared with viscosupplemention at 24 weeks follow up. Although patients achieved lower WOMAC and VAS scores in PRP group at 6 and 12 weeks follow up that was statistically insignificant. We conclude that long term results of PRP are better than viscosupplementation.

Anterior cruciate ligament (ACL) damage or injury is the most frequent type of sports injury to the knee and could result in recurrent knee instability, meniscal tears, and articular cartilage degeneration. This study aim was to compare results of single bundle and double bundle double tunnel surgical procedures for anterior cruciate ligament reconstruction. Patients were enrolled from May 2018 to November 2018 and followed up for six months duration. Before surgery, we compared the mean Tegner Lysholm score between the SB and DB group which was 52.50 and 56.0 respectively and differences among them were not statistically significant (p=0.076). After 6 months of surgery TL score between SB and DB reconstruction were compared and differences among them were found to be statistically significant (p

Background: Distal femoral fractures are among challenging orthopaedic injuries. Precontoured locked plating and retrograde nailing are two trending methods of fracture fixation in such patients. Purpose of present study was to compare precontoured distal femur locked plating and retrograde intramedullary nailing for treatment of extra articular type A distal femur fractures.Materials and Methods: A prospective randomized study including 32 patients of extra articular distal femur fracures, was conducted in the department of orthopedic surgery, KGMU Lucknow. Patients were divided in two groups by random allocation. Patients of group I (18 patients) were treated by distal femoral locked plating and group II (14 patients) by retrograde distal femoral nailing using standard technique.Results: The mean age of group I and group II was 48.00±15.65 & 40.43±14.39 years respectively. The female – male ratio for both groups was matched (p=.075). The time of full weight bearing was significantly (p=0.004) less in nailing group. Bone union was seen earlier in group II (DFN) and it came to be statistically significant (p value-0.0006). Knee pain was present in 42.86% of patients in group II and it came out to be statistically significant (p

Tubercular dactylitis is defined as tubercular infection of the metacarpals, metatarsals and phalanges. It is a rare form of extra pulmonary tuberculosis. Bones of the hand are more commonly affected than the bones of the feet. Tubercular dactylitis is common in children and children below 6 year of age accounts for 85% of cases. The diagnosis is usually by a combination of clinical suspicion coupled with radiological investigation and confirmation by biopsy. We hereby present a case report of tubercular dactylitis in a 65 year old female which was treated by antitubercular therapy.

Introduction: Dislocations of elbow constitute about 3–6% of all injuries occurring around elbow in children. Posterior dislocations are the most common type, whereas other types of dislocations, especially lateral dislocation in a child are extremely rare. Case Report: A 9-year-old boy with a history of trauma presented with complaints of pain, swelling, and difficulty to move his left elbow. Radiographs revealed lateral dislocation of elbow associated with avulsion of medial condyle. Closed reduction was done successfully under short general anesthesia. Conclusion: Pure lateral dislocation of the elbow is rare in pediatric age group. Lateral elbow dislocation is mostly managed surgically, but a chance of conservative management should be given before surgery.

The tubercular involvement of the long bones of the extremities is very rare so, tuberculosis as a differential diagnosis is usually missed when a patient present with pain and swelling over long bones. The radiology is usually suggestive of the malignancy. We hereby present a case with pain and swelling over the ulna with a suspicion of malignanacy, but biopsy and per-operative findings were suggestive of tuberculosis.

Aims: To quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult patients.Settings and Design: A prospective cohort study at an institutional trauma center.Materials and Methods: A total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6th week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients.Statistical Analysis Used: Student t-test, Mann-Whitney U-test and Pearson correlation coefficient.Results: As per the last clinico-radiological follow-up at the 24th week, patients were grouped into two groups: Group I (normal union n = 38) and Group II (impaired healing n = 12). The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6th week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6th week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant.Conclusion: Serum albumin is moderately associated with the baseline and 6th-week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures.

The number of total hip arthroplasties is ever increasing. Literature about glove perforation rates in arthroplasties in India is very scarce. The purpose of our study was to determine the incidence of glove perforation and increasing the awareness of possible glove perforations to decrease the risk of infection. We performed a prospective study in which we tested gloves worn by all scrubbed personnel. A total of 1408 gloves were collected from 42 primary total hip and 13 revision total hip arthroplasties. Incidence of glove perforation was found to be more in revision total hip arthroplasty. We found a greater outer glove perforation rate of about 38.33% as compared to 25 % inner glove perforation rate. Outer glove perforation was recognized 100% of time intraoperatively but inner glove perforation was noted only 17% of time. First assistant recorded highest rate of glove perforation.