فهرست مطالب

  • Volume:8 Issue: 3, 2020
  • تاریخ انتشار: 1399/02/12
  • تعداد عناوین: 23
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  • Javad Mortazavi, MohammadHossein Nabian * Pages 323-324

    An enormous technological improvement in Ultrasonography devices has occurred during last decade, providing excellent soft-tissue contrast and high spatial resolution images. Nowadays, musculoskeletal ultrasonography is going to be a stethoscope in the hand of orthopedic surgeons for the diagnosis of many musculoskeletal pathologies, as well as an accurate guide for therapeutic interventions. Therefore, it is wise for practicing orthopedic surgeons to learn musculoskeletal ultrasonography in collaboration with radiology colleagues as this would improve the patients' care .

    Keywords: Ultrasonography, Musculoskeletal Diseases, Diagnosis, Orthopedic procedures
  • E. Carlos RODRIGUEZ MERCHAN * Pages 325-331

    Patellofemoral (PF) osteoarthritis (OA) is a somewhat predominant illness, affecting up to 24% of women and 11% ofmen over the age of 55 years who suffer from symptomatic knee OA. The purposes of this narrative overview are tosummarize the present situation of patellofemoral arthroplasty (PFA) in the treatment of solitary PF-OA, and to givean account of the clinical results of PFA for the management of solitary PF degenerative OA of the knee. A CochraneLibrary and PubMed (MEDLINE) examination related to the position of PFA in PF-OA was carried out. A number ofpublications have encountered that PFA is an efficacious treatment for solitary PF-OA. Additionally, a systematic reviewdescribed fairly good results of PFA survivorship and functional outcomes at short- and mid-run follow-up in the settingof solitary PF-OA. Success of PFA depends on accurate patient selection rather than prosthetic failure or wear. In manyreports, the main cause of PFA failure is advancement of tibiofemoral OA. In contemporary times, encouraging resultshave been accomplished by the association of PFA and unicompartmental knee arthroplasty (UKA). In conclusion,patients with solitary PF-OA with severe anterior knee pain may be candidates for PFA. The success of the surgicalprocedure and the long-run survivorship of PFA are related to a good surgical technique and observation to meticulousindications and contraindications in patient selection. Newer prostheses have also played a part to amelioratedoutcomes. PFA is an alternative for younger patients with solitary PF-OA.Level of evidence: III

    Keywords: Isolated patellofemoral osteoarthritis, management, patellofemoral arthroplasty, Results
  • Dinesh Kumar. V *_Yogesh Ashok Sontakke_Shishir Suranigi Murugharaj Pages 332-342

    Ever since its description, anterolateral ligament (ALL) of the knee joint remains as the hotspot of controversies.Though it has been described under various descriptions, the structure gained its limelight when it was christenedas anterolateral ligament by Claes in 2013. The main reason for the controversies around it is the lack of concreteevidences regarding its attachments, morphology, biomechanical aspects and radiological appearance. Similarly therole of ALL in pivot shift phenomenon also remains as a point of debate. The advocates of ALL suggest that becauseof its ability to modulate internal rotation and attachment to the lateral meniscus, ALL contributes to the pivot shiftphenomenon. Similarly, the orientation of ALL stands as the reason for varied documentation with respect to imagingtechniques. With the growing body of evidence, it is imperative to fix our stand regarding the structure because, iffound to be morphologically persistent, it can be used for concomitant anterolateral stabilization along with anteriorcruciate ligament reinforcement surgeries. The present review tries to systematically review the anatomy, variations inclassifications, descriptions, histology, radiology and biomechanical features of ALL. At the end of the review, we wouldlike to find the answer for the question: Is ALL a distinct ligamentous structure located at the anterolateral aspect of theknee? What is the contribution of it to the tibial internal rotation stability?Level of evidence: II

    Keywords: Anterolateral ligament, Anatomy, Arthroscopy, Biomechanics, Knee joint, lateral capsule
  • Javad Javadi Hedayatabad, Amir R. Kachooei, Negar Taher Chaharjouy, Niloufar Vaziri, Hasan Mehrad Majd, Maryam Emadzadeh *, Mansour Abolghasemian, Mohammad H. Ebrahimzadeh Pages 343-354
    Background

    Of the pharmacological modalities for knee osteoarthritis (OA), intra-articular injections including ozone(O3) and hyaluronic acid (HA) are commonly used for reducing pain and improving function. In this systematic reviewand meta-analysis, we aimed to compare the effect of O3 versus HA in reducing pain and increasing function in patientswith knee OA.

    Methods

    After searching databases, we included 6 randomized controlled trials on patients with knee OA thatcompared the effects of intra-articular injection of ozone versus HA. The primary outcome was visual analogue scale(VAS) of pain. The secondary outcome was Western Ontario and McMaster Universities Arthritis Index (WOMAC)score.

    Results

    There was a total of 237 patients in the HA group and 230 patients in the Ozone group. Of 6 studies, 4 werein English, 1 was in Persian, and 1 was in German language. The overall Standardized Mean Difference (SMD) for VASpain did not show a significant difference between the groups although it favored HA injection (1.27 [95%CI: (-0.12)-2.66]). Total WOMAC score showed a significant difference over the time favoring HA injection (4.5 [95%CI: 1.1-8]).However, no single time point showed any significant difference between groups.

    Conclusion

    This meta-analysis showed no significant difference between HA and ozone in reducing pain andimproving function in patients with knee OA, although the overall results favored HA over ozone. Since previous studieshave shown comparable results between HA and placebo, ozone seems to fall in the same category with more placeboeffect rather than a real disease-modifier.Level of evidence: I

    Keywords: Hyaluronic acid, Knee Osteoarthritis, Ozone, Pain, WOMAC score
  • Javad Mortazavi *, Babak Sattartabar, Alireza Moharrami, Seyed Hadi Kalantar Pages 355-362
    Background

    Total knee arthroplasty (TKA) can cause excessive blood loss requiring allogenic transfusions.Tranexamic acid (TXA) has been increasingly used for lowering blood loss. The present study aimed to comparethe efficacy of intravenous (IV) and intra-articular (IA) administrations of TXA in TKA patients who receive aspirin aschemoprophylaxis and uses no drain post-operative.

    Methods

    In this prospective randomized clinical trial, 49 TKA patients were intravenously given 15 mg/kg dose ofTXA, and 49 patients intraarticularly received 15 mg/kg of TXA. Demographic information, pre-operative and postoperativehemoglobin values of the patients were used for assessing total perioperative blood loss by GOOD &NADLER formulae.

    Results

    There was not any significant difference between the IV TXA and IA TXA groups concerning blood loss(P=0.102). However, the decrease in hemoglobin level at 48 hours post-operation compared to the preoperativelevel in the IV TXA group was significantly higher than that in the IA TXA group (-2.3 ±0.8 vs. -1.9 ±1.0 g/dL;P=0.038). No blood transfusion was needed, and the deep venous thrombosis and pulmonary embolization werenot observed in either of the groups (P>0.05).

    Conclusion

    Our study showed that during TKA, the IA TXA is equally safe and effective as its IV infusion concerningdecreased blood loss and adverse effects. The use of TXA during TKA is safe for patients who receive less potentchemoprophylaxis agents such as aspirin.Level of evidence: I

    Keywords: Blood loss, Intra-articular, Intravenous, TKA, Tranexamic acid
  • Ali Torkaman, Amir Rostami, MohammadReza Sarshar, Hamidreza Yazdi *, Hossein Akbari Aghdam, Paniz Motaghi Pages 363-367
    Background

    Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challengingconcerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXAcan be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route ofadministration but few works on a comparison between them. The current study aimed to compare the effectivenessof intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total kneearthroplasty.

    Methods

    Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups:one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other groupreceived 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring thewhole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic bloodtransfusion and also thromboembolic events.

    Results

    Patients who received topical TXA had a higher total drain output (P<0.0001) compared to intravenousinjection. The hemoglobin drop also was more in the topical group although it was marginally significant (P=0.05).

    Conclusion

    Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKAcompared to topical administration.Level of evidence: I

    Keywords: Blood loss, Intravenous, Topical, Total knee arthroplasty, Tranexamic acid
  • Pichitchai Atthakomol *, Sezai Ozkan, Kyle R. Eberlin, Neal Chen, Jonathan Winograd, Sang Gil Lee Pages 368-372

    plexus injury. Few studies report the rate of revision surgeries following free functional muscle transfers. We examinedthe reoperation rate and indication for reoperation after primary reconstruction of upper extremity function with a freegracilis transfer after brachial plexus injury.

    Methods

    From 2003-2016, we identified 25 patients who underwent a free functional gracilis muscle transfer forrestoration of upper extremity function. We reviewed their medical charts to record patient, injury, and treatmentcharacteristics. Indication for reoperation and reoperative procedure were also identified.

    Results

    Fourteen out of 25 patients (56%) had a reoperation after FFGT. Four flaps were re-explored for vascularcompromise, but there were no flap failures. The majority of reoperations involved adjustment of tendon excursion(8/14) which demonstrated that tenolysis was the main procedure.

    Conclusion

    Despite promising results of free functional gracilis transfers, reoperation is relatively common and shouldbe discussed with the patient as a preoperative strategy. Early exploration of vascular compromise may decrease theflap failure. Poor tendon excursion is a common unpredicted consequence after FFMT and is the main indication forreoperation.Level of evidence: IV

    Keywords: brachial plexus injury, free functional muscle transfers, indication, Reoperation rate
  • Caleb M. Yeung, Laura Moore, Jonathan Lans, Santiago A. Lozano Calderón * Pages 373-377
    Background

    Angioleiomyomas are rare tumors arising from vascular tissue that can occasionally present in the hand.Reports of angioleiomyomas in this location are highly limited. Here, we describe the presentation and outcomes of aseries of cases of angioleiomyomas.

    Methods

    A retrospective case review of five patients with angioleiomyomas arising in the hand was performed. Patientswere identified via International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosiscodes and were reviewed through the electronic medical record for demographic information, tumor characteristics,management, and outcomes. A literature review was also conducted of angioleiomyomas.

    Results

    Five patients were diagnosed with angioleiomyoma at our institution between 1992 and 2015. Patientspresented with a painful, slow-growing hand mass in all cases. The majority of patients were male and of middle-age.All of the patients were successfully treated with marginal excision and had full return to functional status withoutrecurrence.

    Conclusion

    Angioleiomyomas are rare tumors that can arise in the hand and should be included in the differentialdiagnosis of a patient presenting with a painful hand mass. They can be successfully treated with marginal excision.Level of evidence: IV

    Keywords: Angioleiomyoma, Hand tumors, vascular tumor
  • Mehrdad Sadighi, Javad Mortazavi, Adel Ebrahimpour *, Alireza Manafi Rasi, Mohammad H. Ebrahimzadeh, Meisam Jafari Kafiabadi, Seyyed Saeed Khabiri, Saber Barazandeh Rad, Monireh Yaghoubi, Mohammadreza Chehrassan Pages 378-382
    Background

    Surgery in the time of COVID-19 pandemic is a challenging issue while treatment of affected fracturepatients is inevitable. The present study summarizes the challenges that an orthopedic surgeon is confronting duringthe surgical treatment of fracture patients with concomitant COVID-19 infection.

    Methods

    Demographic and fracture related data of 13 fracture patients with concomitant COVID-19 infection whowere treated with surgery was collected from three trauma centers in Tehran and Kermanshah cities from 21, February2020 to April 3, 2020.

    Results

    All patients were male with mean age of 38.6±19.5 years. Eight patients had high energy fracture and sevenpatients had multiple fractures and trauma. Wrist and hand were the common sites of fracture following hip and pelvis. Themean interval time period between the diagnosis of COVID-19 infection and surgery was 2.3±1.5 days. Before surgery, allpatients except one had been admitted to the corona dedicated wards, while two patients were admitted to the intensivecare unit (ICU). One of the ICU admitted patients died. All the 12 alive patients remained in home isolation after discharge.

    Conclusion

    Fracture surgery in COVID-19 patients has many challenges such as lack of medical resources, delayof surgery, medial staff fear, and patient isolation. However, a multidisciplinary approach using all potential hospitalresources would lead to successful operation and acceptable outcome.Level of evidence: III

    Keywords: Coronavirus, COVID-19, Fracture, Orthopedic, Trauma
  • Suresh K. Nayar *, Rebecca Glasser, Eugene Deune, John Ingari, Dawn Laporte Pages 383-390
    Background
    Patient-Reported Outcomes Measurement Information System (PROMIS) scores can quantify symptomsand limitations after upper extremity surgery. Our objective was to determine how these scores compare amongstpatients with trapeziometacarpal osteoarthritis treated either nonoperatively or operatively.
    Methods
    In this retrospective comparative study, we compared PROMIS scores (upper extremity function [UEF],pain interference, and depression) between 43 patients who underwent nonoperative treatment (nonsteroidal antiinflammatorydrugs/splinting/injections) and 33 patients who underwent trapeziectomy with ligament reconstructionand tendon interposition for trapeziometacarpal osteoarthritis (minimum 6-month recovery period) by 4 surgeons from2014–2018. PROMIS scores were compared across all patients by Eaton-Littler staging. We used linear regression toassess correlations between time-since-surgery and each PROMIS domain. Multivariable linear regression was usedto identify patient and disease factors independently associated with PROMIS scores.
    Results
    Surgery was not associated with better UEF (37 vs. 40, P=0.23), less pain interference (58 vs. 56, P=0.42),or fewer symptoms of depression (47 vs. 46, P=0.59). Similarly, no differences were observed across all patient byEaton-Littler stage for UEF (P=0.49), pain (P=0.48), or depression (P=0.90). For the operative group, greater timesince-surgery, or patient recovery period, correlated moderately with worse UEF (R=0.41) and increased pain (R=0.37).
    Conclusion
    In small retrospective comparative cohorts, surgery was not associated with better UEF, pain, ordepression scores compared with nonoperative treatment for trapeziometacarpal osteoarthritis.Level of evidence: III
    Keywords: ligament reconstruction tendon interposition, outcomes, Patient-Reported Outcomes Measurement Information System, Thumb carpometacarpal joint osteoarthritis, Trapeziometacarpal osteoarthritis
  • Adel Ebrahimpour, Mohammadreza Chehrassan *, Mehrdad Sadighi, Mehdi Azizmohammad Looha, Amin Karimi, Atieh Akbari, Alireza Raeisi, MohammadEsmaeil Akbari Pages 391-399
    Background

    The effect of race and ethnicity on some kind of malignant bone tumors including Ewing sarcomahas been proven in different studies. In order to evaluate the latter, national cancer registries may help to increaseunderstanding about potential cancer causes, prevention and control strategies, and apply these findings to controlhealth problems among populations with similar characteristics.

    Methods

    A national population-based cancer registry study based on all patients affected by Ewing Sarcoma wasregistered in the Iran National Cancer Registry (INCR) between 2008 and 2015 was designed. Demographic data ofmicroscopically confirmed cases of bone Ewing sarcoma were registered. Patients with Ewing sarcoma were dividedin groups to describe the primary site of the tumor (including axial or appendicular bones) and analyzed. In order toanalyze the survival rate, randomized selection of the patient through the INCR data-base was performed.

    Results

    A total of 678 cases of malignant Ewing sarcoma of the bone were identified through the INCR. The meanage of Ewing sarcoma in Iran was 21.53 years. Nearly half of patients were observed at the age group of 15-24. Thetotal crude incidence rate of Ewing sarcoma was 1.29 in 1 million. The mean 5 year survival rate was 47%. The Meansurvival rate for study population was 5.53.

    Conclusion

    The crude incidence rate of Ewing sarcoma in Iran is relatively lower with respect to other registries. Themajority of patients are in 15-25 years group and shows affection by Ewing sarcoma in an older age. Socioeconomicfactors had direct influence on survival rate.Level of evidence: IV

    Keywords: Ewing sarcoma, Malignant bone tumors, Sarcoma
  • Ali Birjandinejad, Reza Zandi, Elham Karimi * Pages 400-406
    Background
    Acquiring knowledge about anatomic and geometric quantities of bones is among the most vitalparameters in orthopedic surgery that has a significant effect on the treatment of various disorders and subsequentoutcomes. The aim of this study was to obtain anthropometric information for distal femur in order to compare withsimilar dimensions of prosthesis used in total knee arthroplasty (TKA) surgery and to design more suitable and optimalcomponents.
    Methods
    Morphological data of distal femur were measured in 132 knees (81 males and 51 females) using magneticresonance imaging (MRI). The data included anterior-posterior (AP) length, medial-lateral (ML) width, medial AP (MAP),lateral AP (LAP), MAP to LAP distance in the anterior distal femur namely anterior medial lateral (AML) width, medialand lateral condyle width, and intercondylar notch. The aspect ratio (ML/AP) was also calculated and the results werecompared with similar dimensions of currently used knee implants.
    Results
    Our data showed that men are significantly larger in all dimensions than women. In the distal femur withsimilar AP lengths in both sexes, women had a smaller ML width than men (P<0.001). Comparison between the distalfemur and studied prostheses showed no high correlation and similarity between the femoral component and femoralcondyle prostheses in the resected surface of the bone.
    Conclusion
    The results of this study can provide the data needed to design prostheses suitable for the Iranianpopulation.Level of evidence: III
    Keywords: Anthropometric, Distal femur, knee, magnetic resonance imaging, Prosthesis
  • Farshad Nikouei, Naveed Nabizadeh, Elham Mirzamohammadi, Maryam Ameri, Saeed Sabbaghan, Behrooz Givehchian *, Farshad Safdari Pages 407-412
    Background
    An oscillating bone saw is rarely used to perform laminectomy. The purpose of this study was to describea relatively quick and harmless technique for multilevel laminectomy in patients with lumbar spinal stenosis (LSS) usingan oscillating bone saw to find out how this instrument affects the time of surgery and rate of complications.
    Methods
    This prospective study was conducted on 45 patients with LSS who required multilevel laminectomy. Thebones were cut using an oscillating sagittal saw equipped with a fine 1-cm blade. Posterolateral fusion was performed ifany evidence of spinal instability occurred, or the correction of deformity was addressed. The time spent for laminectomyfrom initial cutting to the whole bone removal (T1) and the duration of laminectomy (i.e., from initiation to the end ofdecompression; T2) were recorded for the corresponding level. The volume of harvested autograft was also measured,and any dural injuries were reported.
    Results
    Posterolateral fusion was performed on 32 (71.1%) patients. The mean T1 and T2 per level were estimated at70.5±5.4 and 157.5±12.1 sec, respectively. In addition, the mean volume of harvested autograft per level was obtainedas 3.5±1.2 cc. No durotomy was observed during laminectomy using an oscillating bone saw. However, a dural tearoccurred in one patient when a Kerisson punch was utilized for ligamentum flavum removal and foraminotomy.
    Conclusion
    Based on the findings, it can be concluded that laminectomy by means of the oscillating bone saw is asafe procedure that provides a sufficient volume of harvested autograft for fusion. This technique could also induce aremarkable reduction in the time of surgery.Level of evidence: IV
    Keywords: decompression, laminectomy, lumbar spine, oscillating saw, Stenosis
  • Hosseinali Hadi, Mahmood Jabal Amoli, Abolfazl Bagherifard, Ahmadreza Behrouzi, Fatemeh Safi, Amir Azimi, Mahtab Ghanbari, Gholamreza Azarnia Samarin * Pages 413-419
    Background
    The maintenance of deformity in the ankle and hindfoot after correction of knee deformity following kneearthroplasty may cause abnormal tension in the knee and patient dissatisfaction. The aim of this study was to determinethe effect of knee arthroplasty on the hindfoot alignment in patients with severe genu varum and valgum.
    Methods
    A total of 84 patients with primary osteoarthritis, were enrolled in the study. The knee deformity was measuredusing a long leg film before surgery. The long axial radiographic view of hindfoot was taken in the standing position forall patients, before and six months after surgery. Comparisons were made on changes in the hindfoot angles measuredbefore and after surgery.
    Results
    A total of 84 patients with mean age of 62.28 ± 7.77 years, 77 (92%) and seven patients (eight percent)had knee varus and valgus deformity, respectively. In the knee varus group, the mean preoperative hindfoot anglewas + 5.32 ± 6.12 ° (valgus) which was changed to - 0.25 ± 4.91 ° (varus) in the postoperative phase. In the kneevalgus group, the mean pre and postoperative hindfoot angles were - 7.71 ± 7.06° (varus) and - 2.14 ± 5.92 ° (varus),respectively. The mean preoperative hindfoot angle in severe and very severe varus knee groups were + 5.45 ± 3.30and + 5.28 ± 6.86 °, respectively. These angles were changed to + 0.21± 5.17 and -1.60 ± 3.89° six months aftersurgery, respectively. The mean preoperative hindfoot angle in severe and very severe valgus knee deformity groupswere - 7.00 ± 4.69 and -8.66 ± 10.69 °, respectively. These angles were changed to - 2.00 ± 5.71 and - 2.33 ± 7.50°after surgery, respectively. There was no significant difference between patients with severe and very severe deformityin terms of pre and post-operative hindfoot angle.
    Conclusion
    The hindfoot alignment is significantly corrected after knee arthroplasty. The severity of knee deformitydoes not correlate with the severity of the hindfoot deformity before and after surgery.Level of evidence: I
    Keywords: Genu valgum, genu varum, Hindfoot alignment, Knee arthroplasty
  • Mohammad Dehghani, Behrooz Fadaei *, Shirvan Rastegar, Abolghasem Zarezadeh, Keyvan Ghadimi, Roham Nikkhah, Sepehr Eslami Pages 420-425
    Background

    Carpal tunnel syndrome (CTS) is characterized by complications such as pain, paresthesia, andnumbness in the fingers. There are some surgical therapies for the management of severe carpal tunnel, but differencesexist between the treatments available for creating the opposition. The current study was conducted to compare theeffect of modified Camitz and BRAND techniques on thumb opposition in patients with severe CTS.

    Methods

    A total of 40 patients with severe CTS who were candidates for opponensplasty were enrolled in this clinicaltrial study at Alzahra and Kashani hospitals, Isfahan, Iran, from 2014 to 2018. The patients were divided into two groupsof modified Camitz and BRAND. Quick DASH-9 and Kapandji scores as well as pulp and side pinch and pronationangle were assessed before and after the surgeries.

    Results

    Quick DASH-9 score, Kapandji score, pulp and side pinch and pronation angle significantly improved postoperatively(P=0.0XXX, P=0.0XXX, P=0.0XXX, P=0.0XXX, and P=0.0XXX, respectively). But, no significant differenceswere seen in the mentioned variables between both groups pre and post-operative (P>0.05, for all the studied variables).No postsurgical complications were seen in any of the groups.

    Conclusion

    The findings of the present study demonstrated that, both Modified Camitz and BRAND techniquesare effective and safe techniques, yielding high improvements, but no serious complications. Both techniques can beconsidered for treatment of patients with severe CTS.Level of evidence: II

    Keywords: BRAND, Carpal tunnel syndrome, Modified Camitz, Opposition
  • Sohrab Keyhani, Mehran Soleymanha, Rene Verdonk, Mohammadreza Abbasian * Pages 426-431
    Background

    Although some surgical techniques have been described for the operative treatment of unstableOsteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of thepresent study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee.

    Methods

    In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International CartilageRepair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III(4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At theinitial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated.

    Results

    The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (P<0.001).Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal,and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1abnormal knee were documented (P<0.001). The mean Lysholm score increased from 44.3 per operatively to 86.3(P<0.001).Tegner activity score improved from 2.8±1 pre operatively to 5.6 ±2 (P<0.001).

    Conclusion

    Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes.In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriatefor autogenous osteochondral grafting with healthy cartilage.Level of evidence: IV

    Keywords: Autogenous Osteochondral Grafting, healing enhancement, OCD, Osteochondritis dissecans
  • Sohrab Keyhani, AliAkbar Esmailiejah, MohamadSajad Mirhoseini *, Seyyed Mohsen Hosseininejad, Naser Ghanbari Pages 432-438
    Background

    Meniscus tear is a common finding in patients with anterior cruciate ligament (ACL) injury and may affectthe natural history of the injury and the outcomes of treatment. In the current study, the characteristics of meniscus tearsin patients who underwent arthroscopic ACL reconstruction were investigated.

    Methods

    The hospital records of 1022 patients were reviewed. The measured variables included the presence ofmeniscus tear, ramp and root injury, the zone of injury based on the Cooper classification, and the type of tear. The ACLtears with delay more than 3 months for ACLR were recorded as chronic injuries.

    Results

    The incidence of meniscus tear was 44.4%; among whom, bucket-handle injury was the most common type(30.4%) and the ramp lesion was found in 20.5%. The meniscus was repaired in 56.6%. The incidence of medialmeniscus injury was significantly higher in chronic ACL tears and vice versa (P<0.001). The incidence of ramp lesion(9.1% Vs 20.5%) and root tear (1.3% Vs 2.9%) were significantly higher in the chronic and acute tears, respectively(P<0.001).

    Conclusion

    Delay more than 3 months in ACLR was associated with the increased incidence of meniscal injury,specially the medial meniscus, and ramp lesion. It seems that early ACLR may be more helpful for the patients.Level of evidence: IV

    Keywords: anterior cruciate ligament, Arthroscopy, chronic injury, Meniscus, ramp lesion
  • Khodamorad Jamshidi, Milad Haji Agha Bozorgi, Hassan Assad Kassir, Alireza Mirzaei * Pages 439-444
    Background
    Conservative management is generally the primary treatment for intramuscular hemangimas. However,many patients will require surgery later in their life, after suffering a long period of pain. We aimed to evaluate theoncologic and functional outcomes of surgery as the initial treatment of single-muscle hemangiomas.
    Methods
    Medical profiles of 17 patients with hemangiomas of vastus medialis for whom surgery was selected asthe initial treatment were reviewed. The indication for surgery was a bothersome pain. Postoperative muscle strengthwas assessed with manual muscle testing (range 0-5). The postoperative pain was measured by a visual analog scale(VAS) for pain (range 0-10). Lyshölm-Tegner knee scoring scale was used for the evaluation of knee function.
    Results
    The mean age of the patients was 25.9±8.6 years. Surgery was performed as wide resection in 13 cases andas marginal resection in 4 cases. At a mean follow-up of 55.76±30 months, two local recurrences (11.8%) were observed.At the last evaluation session, muscle strength grade was 5/5 in 13 patients and 4/5 in four patients. Postoperativepain was noticed in four patients (VAS=1). Knee function was excellent in 13 patients and good in four patients. Bothof the local recurrences occurred in marginally resected lesions. Three out of four cases with reduced muscle strength,postoperative pain, and reduced function were also treated with marginal resection.
    Conclusion
    If a wide surgical margin is achievable without compromising the limb function, surgical resection couldbe considered as the primary choice of treatment for single-muscle hemangiomas.Level of evidence: IV
    Keywords: conservative treatment, Intramuscular hemangiomas, Surgery
  • Reza Khanzadeh, Reza Mahdavinejad *, Ali Borhani Pages 445-453
    Background
    The purpose of this study was to identify the effects of eight weeks of conventional and suspension corestability exercises by use of the designed device on characteristic of intervertebral discs in low back pain.
    Methods
    A total of 27 men with chronic low back (CLB) pain due to lumbar disc herniation in L4-L5 and L5-S1 regionswere enrolled in this quasi-experimental study. After assessing the pain intensity using a visual analog scale (VAS) anddetermining the disc herniation index using MRI, each group of patients were asked to perform either conventionalor suspension exercises for eight weeks, each week consisting of three training sessions. The pain intensity wasassessed at the end of the first, second, third, fourth and eighth weeks and the disc hernia index was determined againat the end of the eight weeks of exercises.
    Results
    The results indicated significant changes in the intensity of pain in both groups through the period of eightweeks of exercise with a remarkable pain relief. In relation to the structural characteristics of the intervertebral disc, dataanalysis did not reveal any significant change between the pre- and post-test.
    Conclusion
    Considering the beneficial effects of the stability exercises and specially suspension stability exerciseswith respect to pain alleviation and reduced use of sedatives and anti-inflammatory drugs, this method can be helpfulat early stages of treatment for chronic pains.Level of evidence: I
    Keywords: core stability exercises, Disc herniation, Pain, suspension core stability exercises
  • Seyed Hosein Fattahi Masoum_AmirHossein Jafarian_Alireza Sharifian Attar_Fatemeh Sadat Abtahi Mehrjardi *_Mehrdad Fakhlaei_Leila. S Arani_Sharifeh Kamalimotlagh_Asieh Sadat Fattahi Pages 454-456

    Primary synovial sarcoma of mediastinum is very rare among soft tissue sarcomas. Only a few cases have been reportedin the literatures. The best treatment is still unclear, but, surgical resection is the main therapy. In this article we reporta case of a 20*20 cm (2000gr) primary giant mediastinal synovial sarcoma in a 42 year-old man. We performed radicalexcision of the tumor and the metastasis.Level of evidence: V

    Keywords: chemotherapy, Mediastinal Mass, Soft tissue sarcoma, Synovial sarcoma
  • Matthew D. Riedel *, Ian T. Watkins, Johnathon R. Mccormick, Hans P. Van Lancker Pages 457-460

    Article Highlights: 1) This article provides a full anticoagulant reference for the practicing orthopaedic surgeon which can be used in any clinical scenario, whether urgent or elective surgical intervention is required 2) A comprehensive list of anticoagulant reversal agents and drugs with short half-lives (for bridging) are described with the intention to provide the data needed to safely manage a patient peri-operatively during urgent orthopaedic surgical care (i.e. fracture or infection) 3) Half-life and method of excretion for all drugs are included with the intention to accurately guide decisions regarding the appropriate timing of scheduling elective orthopaedic surgical care with regards to anticoagulant metabolism and effect 4) The practicing orthopaedic surgeon using this guide should always consider medical co-management of these complex patients as their medical co-morbidities may not be amenable to anticoagulant reversal or peri-operative cessation of therapy, even for a short period 5) The data contained in this article stands to serve as a foundation upon which institution-specific guidelines regarding the peri-operative management of orthopedic patients on long-term anticoagulation can be developed

    Keywords: anticoagulation, surgical outcomes, surgical timing, perioperative safety, orthopaedic surgery
  • Samundeeswari Saseendar, Saseendar Shanmugasundaram Saseendar *, Srinivas BS Kambhampati Pages 461-462

    Proximal fibular osteotomy is a surgical procedure that has evoked significant interest and controversy in the recent past. Vaishya et al have made a significant effort in compiling the available evidence on the topic. However, we would like to make some significant suggestions and additions to the findings in their manuscript.

    Keywords: Medial osteoarthritis, PFO, knee pain
  • Hamidreza Yazdi, MohammadTaher Ghaderi * Pages 463-464

    The causes of malalignment in total knee arthroplasty can be categorized into three different groups; 1) Errors in bone cuts 2) Errors in implant fixations, and 3) The method of setting down the cutting guides (1). We would like to announce that more several distal femoral valgus cut errors may occur during total knee replacement.

    Keywords: valgus dut, distal femoral cut, cut error, Total knee replacement