Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA 1. Anatomy of the Rotator Cuff The rotator cuff consists of four muscles: Supraspinatus Infraspinatus Teres minor Subscapularis Each muscle has a specific function in shoulder movement and stability. 2. Rotator Cuff Tears Common source of shoulder pain. May involve: A single tendon Multiple tendons Tears […]
Antalgic Gait
Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA Definition Antalgic gait is a painful gait pattern. The patient avoids spending time on the affected leg due to pain. The goal is to reduce weight-bearing on the painful extremity. Normal Gait Cycle Stance phase: 60% of the gait cycle Swing phase: 40% of the gait […]
Achilles Tendon Pathology
Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA 1. Location and Structure The Achilles tendon is located in the posterior ankle. It is the strongest and thickest tendon in the body. Formed from: Soleus muscle Gastrocnemius muscle Inserts into the calcaneus (heel bone). 2. Associated Bursae Subcutaneous Calcaneal Bursa Located superficial to the Achilles […]
Low Back Pain
Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA Importance of Identifying Red Flags A detailed history and careful physical examination are essential. Red flags are warning signs that may indicate a serious underlying condition. In the absence of red flags, acute low back pain is usually treated conservatively. Management of Uncomplicated Acute Low Back […]
Jones Fracture
Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA Metatarsal Fractures Metatarsal fractures can involve: First metatarsal Fifth metatarsal Second, third, and fourth metatarsals (including stress fractures) 1. First Metatarsal Fractures Key Points Different from fractures of the second, third, and fourth metatarsals. The first metatarsal carries a greater load. Malunion may cause: Transfer lesions […]
Shoulder Arthroplasty: Current Concepts
Courtesy: Prof William Levine, Past President, ASES Historical Evolution of Shoulder Arthroplasty Professor Levine outlined six innovation eras. Era 1: Early Shoulder Arthroplasty (Late 1800s–1950s) Themistocles Gluck (Germany) First shoulder arthroplasty Modular ivory prosthesis Not widely recognized at the time Jules Péan (France) First documented shoulder replacement (1893) Two-stage procedure Ultimately failed due to infection […]
Cartilage Injuries of the Knee
Courtesy: Sachin Allahabadi MD, Houston, TX Why Do Cartilage Defects Matter? 1. Poor Healing Potential Articular cartilage has: Limited blood supply Low chondrocyte density Dense extracellular matrix Limited cell migration capacity Additionally: The knee undergoes repetitive multidirectional load Healing is mechanically and biologically challenging 2. High Prevalence Articular cartilage defects are found in ~60% of […]
Bones that trick you: Fracture Mimics
Courtesy: Prof Shital Parikh MD, Cincinnati Childeren’s Hospital, Philadelphia, PN Part 1: Fracture Mimickers in Children 1. Irregular Ossification – A Common Trap Pediatric ossification centers are irregular and may mimic fractures. The elbow is particularly challenging due to multiple ossification centers. Familiarity with: Order of appearance Timing of fusion Normal variantsis essential to avoid […]
Medial Collateral Ligament Injuries
Courtesy: Prof Wolf Petersen, Martin Luther Krakenhaus, Berlin, Germany Anatomy of the Medial Collateral Ligament Complex The medial side of the knee consists of three principal ligamentous structures: 1. Superficial Medial Collateral Ligament Origin: Medial femoral epicondyle Insertion: Approximately 7–8 centimeters distal to the joint line, below the pes anserinus Function: Primary restraint to valgus […]
Maximising Meniscal Healing
Courtesy: Justin Arner MD, Associate Professor, University of Pittsburgh, Pennsylvania, USA Meniscus Anatomy and Function The medial meniscus is C-shaped; the lateral meniscus is more U-shaped and mobile. Composed primarily of: Type I collagen (predominantly peripheral) Type II collagen (more central) High water content Glycosaminoglycans Functions: Load transmission Shock absorption Stability Lubrication Proprioception Vascular Zones […]
MPFL reconstruction
Courtesy: Dr Strickland, Ashok Shyam TV, Ortho Background and Evolution of Treatment Medial patellofemoral ligament reconstruction was rarely performed two decades ago. The ligament was historically under-recognized in patellar instability. Over the last 12 to 13 years, understanding of its importance has significantly increased. Patellar instability can lead to: Loss of athletic participation for an […]
Lateral meniscus root repair
Courtesy: Dr Ranawat, Ashok Shyam TV, Ortho Evolution in Meniscus Root Management Meniscus root repair represents a major advancement in knee preservation surgery. The medial root has transformed arthritis prevention strategies. The lateral root is increasingly recognized as critical for knee stability, particularly in anterior cruciate ligament–deficient knees. Modern sports medicine now emphasizes identifying and […]
MPFL Repair-Graft Position
Courtesy: Dr B Sabnis, Ashok Shyam TV, Ortho MPFL Anatomy Overview The medial patellofemoral ligament (MPFL) is a fan-shaped structure. Length varies with body habitus: Approximately 46–49 mm in smaller Asian populations. Approximately 50–56 mm in Caucasian populations. Indian population typically in between. Width ranges widely (3–30 mm), consistent with its fan-shaped configuration. Patellar Attachment […]
Patellofemoral cartilage repair
Courtesy: Dr A Gomoll, Ashok Shyam TV, Ortho Clinical Context First-time patellar dislocators traditionally require surgery only when a loose body is present. However, many patients present with: Cartilage defects on magnetic resonance imaging. No loose body. Unclear indication for surgery. Key question:When should patellofemoral cartilage defects be treated surgically? Incidence of Patellofemoral Cartilage Defects […]
Medial meniscus root repair
Courtesy: Dr Strickland, Ashok Shyam TV, Ortho Changing Perspective Repair of medial meniscus root tears has gained momentum only in the last several years. Historically, many of these tears—especially in middle-aged patients—were treated nonoperatively or with meniscectomy. These are sometimes referred to as “underserved tears” because they were frequently missed or undertreated. The key questions: […]