Faster Rehabilitation Research Articles

Transition from straight lateral to direct anterior approach in total hip arthroplasty: a retrospective single-centre study.

The muscle-sparing direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity for reduced postoperative pain and faster rehabilitation. The aim of this study was to evaluate the potential benefits of transitioning from straight lateral approach (SLA) THA to DAA THA, and investigate whether these benefits outweigh potential disadvantages of the DAA learning curve. Patients undergoing surgery between 2015 and 2020 (n = 2275) were categorised into three periods: pre-transition period (2015-2016) utilizing SLA exclusively, transition period (2017-2018) incorporating both SLA and DAA, and post-transition period (2019-2020) employing only DAA. The Hip disability and Osteoarthritis Outcome Score - Physical function Short-form (HOOS-PS) was recorded pre-surgery and one-year post-surgery. Furthermore, complications, blood loss, duration of surgery and length of stay were compared between groups. A larger improvement in HOOS-PS score was found for DAA in comparison with SLA (37.13 ± 18.62 vs. 32.55 ± 22.83; p < 0.001). Significant improvements were found for the DAA group regarding duration of surgery (70:02 ± 15:54 min vs. 79:47 ± 15:03 min; p < 0,001) and length of stay (1.68 ± 1.80 days vs. 3.39 ± 1.85 days; p < 0,001) compared to the SLA group. Total number of complications was higher for SLA (n = 87 (9.2%)) compared to DAA (n = 77 (6.5%); p = 0.018), with more femoral fractures for SLA (n = 35 (3.7%) vs. n = 6 (0.5%); p < 0.001) whereas more dislocations were found for DAA (n = 24 (2.0)% vs. n = 7 (0.7%); p = 0.017). More specifically, a higher number of dislocations occurred during the DAA transition period when compared to the SLA pre-transition period (n = 12 (2.7%) vs. n = 4 (0.6%); p = 0.008). Transitioning from SLA to DAA for THA improves patient-reported outcomes but does not seem to result in a higher overall complication rate. Suggesting the advantages of the DAA outweigh the potential disadvantages of the learning curve.

Fast rehabilitation does not worsen clinical, radiological, and arthroscopic outcomes after medial meniscus posterior root repair: A retrospective comparative study

Background/ObjectiveThe main surgical treatment for medial meniscus posterior root tear (MMPRT) has shifted from meniscectomy to meniscus repair; however, there is no clear consensus regarding the optimal postoperative management strategy after MMPRT repair. This study aimed to perform a comparative analysis of patients who received conventional rehabilitation or fast rehabilitation following MMPRT repair. MethodsThe current retrospective cohort study compared clinical, radiological, and arthroscopic outcomes after conventional rehabilitation (group A, January 2020 to April 2020, 24 patients) with those after fast rehabilitation (group B, May 2020 to August 2020, 24 patients) in patients who underwent pullout repair for MMPRT. Partial weight-bearing and range of motion exercises were allowed 2 weeks postoperatively in group A and 1 week postoperatively in group B. In patients with an average weight of approximately 60 kg, full weight bearing was allowed 4 weeks postoperatively in group A and 3 weeks postoperatively in group B. ResultsAt 12 months postoperatively, the clinical scores, including International Knee Documentation Committee and Japanese Knee Injury and Osteoarthritis Outcome Score, significantly improved in both groups (p < 0.01). Although meniscus healing was achieved in both groups, medial meniscus extrusion significantly progressed by 0.9 mm in group A and 0.8 mm in group B (p < 0.01, compared with preoperative extrusion). There were no significant differences in clinical scores, arthroscopic meniscal healing status, or medial meniscus extrusion progression on magnetic resonance images between the groups. ConclusionA fast rehabilitation protocol can be safely implemented without compromising patient outcomes after pullout repair for MMPRT.

Three-dimensional individual joint reconstruction through the Mako robotic arm-assisted surgical technique : Possibilities and limitations of the surgical technique

Although knee arthroplasty represents avery successful treatment for osteoarthritis or joint destruction, arelevant number of patients is still not completely satisfied with the outcome. Higher satisfaction and faster rehabilitation seem to be achievable through patient-individualized alignment of the prosthesis and especially through reproducible robotic-assisted implantation. The topic of robotics in orthopedics and especially in knee endoprosthesis is not new and began in the 1990s with the Robodoc system. The resurgence of robotics with new systems can be referred to as an innovation in the orthopedic operating room. Interest in this has risen significantly, not only among surgeons, but especially among patients, primarily because it seems to offer better joint function and patient satisfaction, as well as faster rehabilitation.

Prospective Research Comparing Different Trochanteric Fracture Fixation Techniques.

Aim Evaluation and comparison of various methods of trochanteric fracture fixation. Methods This study was conducted prospectively at the Orthopaedics Department of Dr. D Y Patil Medical College and Research Centre. The study spanned 18 months and involved 100 patientstreated in the outpatient and the emergency department. Patients who fulfilled that specific criteria were selected for this study and the appropriate surgical intervention for each group was determined through radiological examination. Results Of the 100 patients, 55 (55%) were male and 45 (45%) females. Patients in our collection ranged from 20 to 90 years old. Proximal Femoral Nail (PFN), Dynamic Hip Screw (DHS ), and Proximal Femoral Locking Compression Plate (PFLCP ) groups averaged 56, 58, and 64 years old, respectively. The most common cause of intertrochanteric fracture was domestic falls (60%), followed by road traffic accidents (35%). The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification rated 40 individuals (40%) as stable and 60 as unstable. Most patients in our study had unstable A3 fractures. PFN patients had 16 A3 fractures. In DHS, 32 patients suffered A3 fractures. Twelve PFLCP patients suffered A3 fractures. The smallest group had A1 fractures. Six PFN patients suffered A1 fractures. Two DHS patients had A1 fractures. Two PFLCP patients suffered A1 fractures. PFN group mean scores improved significantly after one and three months in this study. At six months, the PFN group had a significant mean score improvement. Conclusion PFN results ranged from satisfactory to excellent, offering numerous advantages over other methods such as DHS and PFLCP. The benefits of PFN include a shorter lever arm, fracture site compression, and enhanced rotational stability, which contribute to a lower chance of mechanical failure. Additionally, patients treated with PFN typically experience shorter hospital stays, earlier mobilization, less blood loss, shorter surgery times, faster rehabilitation, and quicker bone healing, making PFN a highly effective treatment option for certain fractures.

Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review.

In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger patients with higher physical demands are more likely to suffer from this pathological condition, reduced invasiveness, faster recovery time, and improved knee kinematics are preferred to allow for satisfying clinical and functional outcomes. Thus, a new surgical strategy combining medial unicompartmental knee replacement (UKR) and ACL reconstruction has been proposed to allow bone stock preservation, to reduce surgical morbidity and recovery time, and ultimately to improve joint kinematics and clinical outcomes. Based on the data present in the literature, in the setting of unicompartmental OA in association with ACL deficiency, UKR combined with ACL reconstruction provided encouraging early results. Studies evaluating the outcomes of combined ACL reconstruction and UKR demonstrate promising results in select patient populations. Improved knee stability, pain relief, functional recovery, and patient satisfaction improved after surgery. Moreover, the combined approach offered advantages such as reduced surgical trauma, faster rehabilitation, and preservation of native knee anatomy compared with traditional treatment strategies. However, still, high-level studies on this topic are lacking; therefore, more comparative studies reporting long-term outcomes are needed to support the potential of this combined procedure to become mainstream. In this paper, we discuss the relevant features and rationale behind the indications and technique of this combined surgical procedure, to help surgeons choose the correct therapeutic approach for a patient with concomitant medial OA and ACL insufficiency. Continued advancements in surgical techniques, patient selection criteria, and rehabilitation strategies will further enhance the success of this combined approach, offering hope to individuals with concomitant ACL injuries and unicompartmental knee OA.

Direct Anterior Approach Total Hip Arthroplasty for Femoral Neck Fractures in the Lateral Position.

To compare the clinical efficacy of artificial total hip arthroplasty(THA) for femoral neck fracture between direct anterior approach(DAA) in lateral position and posterior lateral approach(PLA). Comparison of 200 cases of patients who underwent THA collected between September 2019 and August 2021 was done. Incision length, intraoperative bleeding, operative time, difference in postoperative haemoglobin from preoperative levels, length of hospital stay, postoperative time to get off the floor, visual analogue score (VAS) for pain, preoperative and postoperative Harris scores for the hip, and measurements of the acetabular abduction angle and anterior acetabular tilt angle at 6 months postoperatively were collected, and all the cases were followed up for at least 2 years. Compared with the PLA group, the DAA group had a shorter incision length, less intraoperative blood loss, less postoperative haemoglobin reduction compared with the preoperative period, a shorter hospital stay and an earlier first time to get off the floor after surgery, however, the comparison of operative times was not statistically significant; Patients in the DAA group had a lower VAS in the early postoperative period compared to PLA; Patients in the DAA group had higher hip Harris scores at 6 weeks and 6 months postoperatively; There was no significant difference in acetabular abduction angle and acetabular anterior tilt angle between the two groups at 6 months postoperatively. Compared to PLA, DAA in THA is minimally invasive, has less pain, less bleeding, earlier time out of bed, shorter hospital stay, better early hip function, faster rehabilitation, and better joint stability.

The combination of partial knee arthroplasties in knee osteoarthritis with an intact anterior cruciate ligament- afuture model?

Preserving both cruciate ligaments in knee prosthetics enables approximately physiological joint kinematics. In this way, faster rehabilitation and ahigher return-to-sports rate can be achieved. Accordingly, there are considerations to preserve both cruciate ligaments by combining two partial prostheses in the case of symptomatic bicompartmental (BiCom) knee osteoarthritis. This article summarizes the literature on BiCom arthroplasty and describes our own experiences from 54consecutive cases with robotic-assisted technology. According to current data, BiCom arthroplasty shows good clinical results, without being able to demonstrate aclear advantage over conventional TKA. The revision risk is slightly increased in the short-term interval, which could be positively addressed with robotic-assistance. The disadvantages are the increased implant costs and the risk of subsequent osteoarthritis. Accordingly, patients who may potentially take advantage of this treatment must be critically selected.

Functional outcome of direct anterior versus posterior approach in total hip arthroplasty: a propensity-matched Asian study.

The direct anterior approach (DAA) to total hip arthroplasty (THA) is a surgical approach that minimises soft tissue trauma, resulting in faster rehabilitation when compared to a posterior approach (PA). This study aimed to evaluate the difference between the two groups in an Asian cohort using propensity score matching. A retrospective review of prospectively collected registry data of 794 primary THAs was performed. The effects on patients with DAA THA versus patients with PA THA were investigated. Propensity scores were generated using logistic regression to adjust for confounding variables of age, gender, body mass index and diagnosis. Data analysis was performed, and statistical significance was defined as a P value < 0.05. The average length of stay (LOS) for the PA group and DAA group was 5.4 days and 2.9 days, respectively (P < 0.001). One (1.9%) patient from the PA group suffered a posterior dislocation 6 months after surgery and subsequently underwent revision surgery 2 years later. No dislocations were detected in the DAA group. The DAA group had better functional outcome, satisfaction and expectation scores at 6 months and 2 years. In this study, patients who underwent DAA THA had better functional outcome at 2 years and almost 2 days shorter overall LOS than those who underwent PA THA. Therefore, the DAA to THA is a novel technique that has shown improved functional outcomes, with fewer complications compared to PA THA.

One-stage Intraconal Volume Modification for Exposed and Nonexposed Ball Implants.

To assess long-term outcomes and reinterventions for exposed and nonexposed intraconal orbital implants after single-stage socket revisional surgery. Retrospective case-note review of patients with exposed or nonexposed orbital ball implants, who underwent a single-stage ball exchange (Group I) or ball removal with dermis-fat graft (Group II); Group I was subdivided as having either exposed (A) or nonexposed (B) implants. Outcomes were compared with similar cohorts undergoing multistage surgery. Of 172 patients (54% male), 153 (89%) underwent ball exchange (Group I) and 19 (11%) had dermis-fat graft (Group II). With a mean follow up of 7.8 years, Group I patients without ball exposure (Group IB) had a slightly higher rate of reintervention for persistent volume deficit (21% vs. 9%; p = 0.163) and implant migration (6% vs. 0%; p = 0.091), while Group IA patients-having surgery for exposed implants-had more reexposures (7% vs. 3%; p = 0.270). Single-stage and 2-stage surgery had similar reintervention rates, with the exception of a trend toward fewer volume enhancements for those with nonexposed implants (17% vs. 30%; p = 0.380), and a shorter time to (re)exposure for exposed implants after 2-stage procedures (mean 0.33 vs. 3.5 years; p = 0.571). Group II patients required further volume enhancement in 32% of 1-stage procedures, and one patient needed graft removal. Single-stage volume modification is effective and the results are comparable to staged surgery for either exposed or nonexposed implants. Most patients report a stable prosthesis and satisfactory cosmesis, after a faster rehabilitation.

Percutaneous treatment of radial neck fractures in adult patients.

Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).

The factors affecting rehabilitation to society of emergency department based post-suicidal care program recipients

The aim of this study is to investigate the factors affecting rehabilitation to society of Emergency Department (ED) based post-suicidal care program recipients. This prospective observational study was conducted at the ED of a general hospital in Seoul between March 2018 and October 2020. Patients who agreed to ED based post-suicidal care were followed up after 2 and 4 months and classified into a rehabilitated group and a non-rehabilitated group respectively. We analyzed the patients’ demographic data and suicide-related data. We used the Chi-square test or the Fisher’s exact test, the student’s t-test and multivariate logistic regression analysis. A total of 86 patients were included in this study. Factors that disturb rehabilitation of suicidal attempters were the presence of a housemate, a history of psychiatric admission, an acute disease or disability on 1st follow-up and the presence of a housemate, educational level and 1st non-rehabilitation on 2nd follow-up on univariate analysis. Multivariate logistic regression analysis showed that the absence of a housemate and 1st rehabilitation were associated with rehabilitation. This study shows that fast rehabilitation is important for rehabilitation of suicidal attempters and the presence of housemate can be a risk factor for non-rehabilitation.

Failure Rate and Early Complications of Thumb Carpometacarpal Joint Replacement-A Multicenter Retrospective Study of Two Modern Implant Designs.

Joint replacement arthroplasty for the treatment of thumb osteoarthritis is gaining popularity as recent studies have demonstrated better pinch and grip strength and faster rehabilitation. Our aim was to identify early complications in modern implant designs using a multicenter study. A total of 381 patients who underwent thumb carpometacarpal replacement surgery in six participating hospitals were enrolled. The complications included were fractures, dislocations, infections, tendon and nerve injuries, and complex regional pain syndrome. Major complications were defined as a failure to implant the prosthesis, revision surgery to remove the implant, and any other need for further surgical intervention. The secondary outcomes were any other complications treated non-surgically and the timing of the complications. Eleven procedures failed, and these patients were treated with trapeziectomies. Twelve other patients required repeat surgical interventions. Minor adverse events occurred in 25.4% of the cases, and transient irritation of the superficial radial nerve and De Quervain tendinopathy were the most prevalent complications. Although this cohort depicted the learning curves of multiple surgeons, our study demonstrated low short-term failure rates. An inability to achieve primary stability of the cup in the trapezium was the leading cause of failure. Dislocations and other major complications with modern implants were very few.

Combined Trochlear, Patellar, Medial and Lateral Condyle Fresh Osteochondral Allograft Transplantation: A Case Report

Background: This is a case report of a 41-year-old man with torsional knee trauma in 2019 and chondral lesions. Previous microfracture had failed, and the patient presented with a dull pain and knee effusion. Imaging revealed multiple focal lesions including trochlea, patella, medial condyle, and lateral condyle. Fresh osteochondral allograft (OCA) transplantation is a versatile treatment for large defects as it is based on mature, living hyaline cartilage attached to a bone interface. A patient with multiple chondral lesions is rare, and this report presents a case with multiple symptomatic large focal lesions in the knee that underwent a fresh OCA in all 3 knee compartments. Indications: Osteochondral allograft is indicated for patients who present with activity-related pain and recurrent knee effusion. Contraindications are patient clinical conditions that may lead to complications, such as tobacco use, inflammatory arthritis, or septic arthritis. Technique Description: After the chondral defect is exposed, an appropriate allograft Mega-OATS sizer (15-30 mm) is chosen. Cartilage and the subchondral bone are drilled until the desired depth. The donor allograft is drilled in the desired diameter, and excess bone is removed according to the previous measurements of the recipient site. The graft is advanced with firm pressure into the created socket. Postoperative rehabilitation includes a limited range of motion and proprioceptive weightbearing in the first 2 weeks but expected total weightbearing and a full range of motion by the sixth week. Results: Range of motion was full by 6 weeks of surgery. The effusion lasted for 2 months after the surgery. Fresh OCA is a good surgical option for patients with multiple large chondral defects. Discussion/Conclusion: Patient satisfaction is high since the mature cartilage leads to a fast rehabilitation compared with the other surgical procedures for large chondral defects. This technique appears to be effective also for multiple focal lesions as presented in this article. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Perioperative and Pathological Outcome of Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma (RCC)

Introduction: Laparoscopy has become a well-accepted technique to treat malignant renal conditions. For renal cell carcinoma laparoscopic radical nephrectomy is the treatment of choice in selected patients. Objective: To see the feasibility, perioerative and pathological outcome of laparoscopic radical nephrectomy (LRN) in different size of tumour in renal cell carcinoma (RCC). Materials and methods: A prospective analysis was performed in 29 patients who underwent laparoscopic radical nephrectomy for RCC between October 2017 and September 2019. Patients age, tumor size, co-morbidity index, operating time, duration of hospitalization, complications and pathology were recorded. Results: Nineteen male and ten female patients were treated laparoscopically and conversion to open surgery was not required in any case. The age ranged from 30 to 72 years, tumor size varied from 5 to 15 cm and one patient had left renal vein thrombus. The operative time ranged from 60 to 180 minutes and blood loss was 50 to 150 mL. Nine patients required blood transfusion. Ileus developed in 3 patients, port site infection in 4 patients, fever in 2 patients and respiratory insufficiency in another two patients post operatively which was treated accordingly. There was no major complications and surgery related mortality. Pathological outcome was recorded after getting histopathology reports. Conclusion: The laparoscopic radical nephrectomy for RCC is safe and oncologically sound. It may be done in large tumour also. The process constitutes minimal invasiveness, low death rates, minimal intraoperative blood loss and fast rehabilitation of the patients. Different pathological sub type may predict future outcome. Sir Salimullah Med Coll J 2023; 31: 112-115

Adoption of robotics in arthroplasty- a survey of perceptions, utilization and challenges with technology amongst Indian surgeons

IntroductionTotal joint replacement surgeries are standard procedures for managing end-stage hip or knee arthritis. Despite advances in technology, some patients experience dissatisfaction after total knee arthroplasty (TKA). Robotic technology has evolved significantly and has shown promise in improving component positioning, alignment, and surgical outcomes. However, the widespread adoption of robotics in arthroplasty faces challenges such as high costs, a steep learning curve, and limited evidence on long-term outcomes. MethodsThis cross-sectional observational study used a structured self-administered online survey to assess the perceptions of Indian arthroplasty surgeons regarding robotic technology. The survey included questions about the surgeon's background, experience, perceptions of robotic joint replacement, and limiting factors for robotic usage. A total of 417 responses were collected from practising arthroplasty surgeons. ResultsMost participants(78.1 %) expressed a willingness to adopt robotics in their arthroplasty practice if the cost of installation was reduced. Robotic users were more convinced about the benefits of robotics, including improved alignment, reduced pain, faster rehabilitation, and better outcomes. High-volume robotic surgeons demonstrated a greater belief in the broader potential of robotics beyond implant positioning and alignment. The major barriers to adoption were the high cost of installation and limited insurance coverage for robotic-assisted procedures. Lack of formal robotic training opportunities, resistance from corporate management, patient acceptance issues, and limited published literature supporting robotic advantages were also cited as limiting factors. ConclusionRobotic technology is increasingly being adopted in India for TKA. The main obstacle to widespread adoption is the high cost of installation. As technology costs decrease, we can expect a rise in the number of installations across the country. Advocacy from national orthopaedic organizations may be needed to address insurance reimbursement challenges. Overall, this study provides valuable insights into the perceptions and challenges associated with the adoption of robotic technology in arthroplasty in India.

Surgical Treatment for Isolated Closed Multi-metatarsal Fractures: At Least 2-Year Outcomes in 79 Feet

Multimetatarsal fractures are a particular type possibly associated with worse functional outcomes. Existing studies are scarce, fragmented, and lack control for confounders. This study aimed to explore the functional prognosis of isolated closed extra-articular multimetatarsal fractures and the different outcomes between the plate-screw and K-wire fixation. This retrospective study included 79 patients who underwent surgery for isolated closed extra-articular multimetatarsal fractures from May 2017 to December 2020. We recorded baseline characteristics. The primary outcome measure was Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). Exploratory correlation analysis of the variables with VAS, AOFAS score, and FAOS was performed. The differences between the plate-screw group (n = 58) and K-wire group (n = 21) were compared. Seventy-nine patients (79 feet) were included with a follow-up of (47.3 ± 12.7) months (range, 26-70). Full weight bearing time was (11.7±5.3) weeks. VAS was (1.4±1.8) points, AOFAS score was (86.4±13.3) points, and FAOS was (79.0±11.1) points. Complications were observed in 17 cases (21.5%). According to exploratory correlation analysis, VAS was weakly associated with fixation method and gender, AOFAS was weakly associated with fixation method, FAOS was weakly associated with trauma mechanism. When the plate-screw group (n = 58) was compared with the K-wire group (n = 21), we found the former was superior to the latter in terms of full weight bearing time, VAS, AOFAS score, and malunion rate (all p < .05). FAOS was nonsignificant (p = .056). Operative treatment of isolated closed extra-articular multimetatarsal fractures showed good mid-term results. Plate-screw fixation was associated with faster rehabilitation as well as a lower malunion rate. The mid-term follow-up results showed patients with plate-screw fixation had better VAS and AOFAS scores.

Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study.

Insertional Achilles tendinopathy (IAT) is a common condition causing pain and dysfunction. Patients with diabetes, hyperlipidemia, hypothyroidism, and obesity are at increased risk of developing IAT. These comorbidities also carry an increased risk of wound healing complications following surgery. Therefore, there is a need for alternative management strategies for this high-risk patient population. This study investigated the potential role of isolated GR in patients with chronic IAT. This study is a single-institution retrospective review of adult patients who underwent isolated GR to address chronic IAT with a minimum 1-year follow-up. Demographics, complications, radiographic findings, and preoperative and postoperative patient-reported outcome scores (PROs) were collected. The primary outcome was improvement in PROMIS scores from preoperative to postoperative. Secondary outcomes were complication and reoperation rates. Sixteen patients underwent open GR with a mean follow-up of 2.7 years. Postoperative PROMIS domain scores improved significantly from preoperative scores for physical function, pain interference, pain intensity, and global physical function. Two patients (13%) underwent reoperation (open calcaneal exostectomy and tendon debridement) at a mean time of 7 months from gastrocnemius recession. One patient developed a postoperative hematoma that resolved with conservative management. This single-institution series reports on a small cohort of patients with chronic IAT treated with open GR. We found significant improvement in patient-reported outcomes. Rates of complication and reoperation were low. This study supports the potential use of isolated gastrocnemius recession in IAT patients who, because of age or medical comorbidities, may benefit from a less invasive surgery and faster rehabilitation. Level III, retrospective case control study.

Catheter-based serratus anterior plane block vs. continuous wound infiltration for postoperative pain control following minimally invasive atrioventricular valve surgery : a randomized, prospective trial

Background: Minimally invasive cardiac surgery via mini-thoracotomy reduces surgical trauma compared to full sternotomy. However, thoracotomy can cause severe postoperative pain. Managing postoperative pain is challenging but critical for fast rehabilitation and avoidance of chronic pain. Our objective was to compare the efficacy of analgesia of a bolus in combination with continuous local anaesthetics using a serratus anterior plane block (SAPB) catheter versus a wound infiltration catheter (CWI) in patients after minimally invasive cardiac surgery. Design and setting: We conducted a monocentric, prospective, randomized controlled trial between January 2021 and August 2022. The study was performed at Ghent University Hospital, Belgium. Methods: Patients scheduled for minimally invasive cardiac surgery via thoracoscopy and mini-thoracotomy were randomized to receive either a SABP or a CWI catheter. Postoperatively, continuous ropivacaine 0.2% was started at 10ml/h, and a supplementary bolus of 30ml ropivacaine 0.5% was administered one hour before detubation. The catheter remained in place for at least 24 hours. The primary endpoint was opioid consumption during the first 48 hours postdetubation. Secondary endpoints were anti-emetic consumption, Numerical Analogue Score for 48 hours, length of stay in the Intensive Care Unit and hospital, and incidence of chronic pain. Qualitative data were compared using the Chi – Square test, quantitative data were analyzed with the Student’s t-test. Results: During the study period, a total of 21 patients received a SAPB catheter and 26 patients received a CWI catheter. No statistical significant differences were seen in baseline characteristics. In the first 48 hours postdetubation, morphine equivalent consumption was similar in both groups (p= 0.52), with no differences observed in the early, mid- or late postoperative phases. The total morphine equivalent dose was 21.8 mg in the SAPB and 18.6 mg in the CWI group. There were no significant differences in postoperative vomiting and nausea, length of stay in the Intensive Care Unit and in the hospital and chronic thoracic pain (23% and 33% for the SAPB and CWI group, respectively, p=0.54). Conclusion: This prospective study found no significant difference in postoperative opioid consumption between patients who received a serratus anterior plane block catheter and those who received a wound catheter with bolus and continuous ropivacaine, following minimally invasive cardiac surgery via right thoracoscopy and mini-thoracotomy.

Anterior Talo-Fibular Ligament Reconstruction With InternalBrace™ for Chronic Lateral Ankle Instability in Pediatric Patients.

Ankle injuries and instability in a pediatric age group are common problems and often underreported. The injuries can range from a relatively benign ankle sprain to pain-limiting ankle instability that can inhibit the child from participating in sporting activities. However, conservative management and physiotherapy are the mainstay of treatment; a small group of patients present with persistent instability and benefit from surgical intervention in lateral ligament reconstruction. Our study looked at pediatric patients who had instability following failed conservative management. Retrospective analysis of 14 patients with Chronic lateral Ankle instability (CLAI) who underwent Modified Brostrom-Gould repair( MBG) with or without Internal brace augmentation between January 2015 and October 2020. Patients were evaluated for the visual analogue scale (VAS), Manchester-oxford foot questionnaire (MOxFQ), subjective satisfaction, and return to preinjury activity level. Pain score improved from 8 (average 5-9) to 1 (average 0-3) following surgery. Functional assessment was made by assessing the Manchester Oxford questionnaire pre-and postoperatively. MOxFQ scores improved from 64 (8 SD) to 7 (15 SD). Thirteen of fourteen patients returned to normal sporting activities at the final follow-up. Modified Brostrom-Gould with InternalBrace™ augmentation is an excellent procedure for chronic lateral ligament injuries in the Paediatric population. It can be safely performed if we respect the anatomy and the physeal growth plate. It allows faster rehabilitation and return to preinjury activity level.

A Scarless Method for Correcting Tanzer Group IIB-Constricted Ear Without Cartilage Grafting.

Tanzer group IIB-constricted ear is described as a deformity of the helix, antihelix, or scapha. Deficiency of the auricular skin and cartilage is a key point in the reconstruction of the cartilaginous framework. Traditionally, the treatment of a constricted ear mainly includes 2 aspects: correction of cartilage deformity and restoration of skin volume deficiency. By mimicking the suspension principle of a cable bridge, our technique only requires adjustment of the spatial directions and mechanical forces between the 2 flaps to achieve an aesthetic effect. The authors were able to avoid harvesting the costal cartilage. The desired ear shape was obtained immediately postoperatively. Therefore, Vaseline gauze was not applied and was modeled along the scapha and antihelix. Expansion of the ear was remarkable in both horizontal and vertical lengths. Our technique causes less damage, less scarring, shorter operation time, fewer complications, faster rehabilitation, and no delays.