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Advanced Orthopaedics

  1. Chondral & osteochondral fractures (osteochondritis desiccans) present clinically with IntensiCal symptoms of locking, catching & giving way of the knee.
  2. Arthroscopy is investigation of choice and preferred way of treatment
  3. All loose & overhanging pieces of cartilage must be removed back to a stable base. The base may be drilled, abraded or microfractured to bleeding bone that presumably recruit-pleuripotent stem cells to regenerate cartilage.
  4. Osteochondral autograft transplant should be considered.
Osteochondritis desiccans
  1. It is a poorly understood disorder, which leads to softening & seperation of a portion of joint surface; resulting in development of small segment of necrotic bone in joint.
  2. Knee is the most commonly affected joint.
  3. > 80% of lesions occurs on lateral part of medial femoral condyle (exactly where the patella makes contact in full flexion).
  4. Patient is usually 15-20 years male, presents with intermittent ache & swelling, localized tenderness & Wilson’s sign (i.e. pain is felt in straightening the flexed knee in medial rotation, put not in lateral rotation)
  1. The best X-ray view is intercondylar (tunnel view).
  2. MRI can make early diagnosis.

  1. Treatment options are

    1. Microfracture technique – drilling the defect increasing the vascularity and repair .
    2. Excision of fragment
    3. Fixation of fragment
Patella Alta (High riding patella)
  1. The position of patella is considered high.
  2. Can be idiopathic or secondary to a patellar tendon rupture.
  3. It is associations with idiopathic retro-patellar pain, recurrent dislocation of the patella, chondromalacia patellae, knee joint effusion
Patella baja (Patella infera)
  1. It is an abnormally low lying patella.
  2. Associated with restricted range of motion, crepitations and retropatellar pain
X –ray:
  1. Insall-Salvati ratio - according to the relative height of the patella and length of the patellar tendon. It is assessed on lateral radiographs or sagittal cross-sectional imaging.
  2. Blackburne-Peel ratio - ratio of vertical distance between tibial plateau and patellar articular surface and length of the patellar articular surface.
  3. Caton-Linclau method
  4. Blumensaat's technique
  5. It is important in the setting of previous surgery to ensure that the patella has not been resected, as change in patellar morphology will clearly affect the ratio.
A. Description: C:\Users\RAMKINKAR JHA\Downloads\images (23).jpg
  1. Blumensaat line is a line drawn through the roof of the intercondylar notch, the lower pole of the patella is supposed to touch this line if it is above this line then it is termed as patella alta and thus predisposed to lateral dislocation
  2. Insall Salvati ratio is A / B (as shown in fig) or Length of Patellar Tendon / Length of Patella.
    Normal is 0.8 to 1.2. If it is more than 1.2 is called high riding patella alta. Less than 0.8 is patella baja (Patella infra)
Game Keeper’s/ Skier’s – Thumb/ Stener’s lesion
  1. It is sprain or rupture of ulnar collateral ligament (UCL) of first metacarpophalangeal jointQ.
  2. It is the most common injury of MCP joint.
    This injury occurs when the thumb is forced into radial deviation stressing the ulnar collateral ligament-
  3. When UCL tears from its phalangeal insertion, the adductor pollicis aponeurosis may become interposed between the retracted ligament5 preventing healing of the ligament to the proximal phalynx with closed treatment (stener’s lesion)
The usual management is cast immobilization for 3 to 4 weeks
Indications of surgery are
  1. Complete tear
  2. Bony avulsion with ligament

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