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: […]
Templating in THR
Templating in Total Hip Arthroplasty 1. Why Template? Preoperative templating helps to plan and restore: Hip biomechanics Hip center Femoral offset Leg length Acetabular cup position Femoral stem position Implant size It is particularly useful in patients with unusual anatomy, such as: Developmental dysplasia Protrusio Abnormal femoral neck angles Proximal femoral deformity Templating also helps […]
Hip Imaging Radiograph and MRI
Courtesy: Dr T Vail, Ashok Shyam TV, Ortho Imaging of the Hip 1. Why Hip Imaging Matters Hip imaging is not simply about identifying pathology. It helps us understand: Hip morphology Hip biomechanics Relationship between the femur and pelvis Leg length Femoral offset Acetabular coverage Cartilage and labral pathology Femoroacetabular impingement Wear and osteolysis The […]
Cementless THR
Courtesy: Dr D Padgett, Ashok Shyam TV, Ortho Limitations of Cemented Fixation Cement fatigue fractures may: Lead to implant loosening Contribute to particle-induced osteolysis Certain patient groups historically performed poorly with cemented fixation: Heavy, highly active males Ideal goal: Direct bone–implant fixation Avoidance of an intermediary cement layer Elimination of a second mechanical interface Biologic […]
Current Trends in Hemi Arthroplasty
Courtesy: Dr Suryanaraya, Ashok Shyam TV, Ortho Hemiarthroplasty vs Total Hip Arthroplasty in the Elderly Ongoing debate in displaced femoral neck fractures: Internal fixation vs hemiarthroplasty vs THA. Considerations: Functional outcome Morbidity and mortality Revision risk Historical Failures of Early Hemiarthroplasty Primary Causes of Early Failure Metallurgical failure Fixation failure Cartilage degeneration over time Design-Related […]
Hip-Alternate Bearing Ceramic
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho
Osteolysis in TKR
Courtesy: Dr Ranawat, Ashok Shyam TV, Ortho Background Osteolysis remains a significant long-term complication in total knee arthroplasty (TKA). Strongly associated with: Polyethylene wear debris Modular implant designs Historically uncommon in: Fixed-bearing, monoblock all-polyethylene tibial components. Historical Perspective All-Polyethylene Fixed-Bearing Knees Single-unit tibial component. Long-term data (up to 20+ years): Minimal to no osteolysis reported. […]