dryogeshjain_msorthpaedics

Caught in a moment of genuine satisfaction looking at the final result.
​Yesterday, I performed an Arthroscopic Jewel ACL augment peroneus graft ACL reconstruction with Lateral Extra-Articular Tenodesis (LET) for a hockey player.
​I am pleased with the surgical outcome and the stability achieved. Because the fixation is so secure, we have allowed full weight-bearing mobilization from the very next day with a Range of Motion (ROM) of 0 to 90°.
​Aggressive rehab for a strong return to the turf!

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Sharing a recent case of MPFL (Medial Patellofemoral Ligament) reconstruction performed on a 40-year-old male patient weighing 110kg, who presented with recurrent patellar instability. This time, we opted for an innovative, implant-free approach for graft fixation at the patella, inspired by the pioneering work of Dr. Sven Shafizadeh and Dr. Maurice Balke in their 2014 paper, "Medial Patellofemoral Ligament Reconstruction: A New Technique for Graft Fixation at the Patella Without Implants."

This hardware-free technique, using suture-based fixation, leverages the patella's anatomy for secure, biological graft integration—particularly beneficial for minimizing complications like implant irritation. The procedure went smoothly, with excellent intraoperative stability.

Challenging Knee Dislocation Case: A Multi-Step Approach to Recovery
Encountering a complex trauma case is always a learning experience. Today, I want to share the story of a 30-year-old male who presented with a 5-day-old fracture-dislocation of his knee.

Upon arrival:

Extensive imaging (CT angio, X-ray, MRI, diagnostic arthroscopy) revealed a fractured medial femoral condyle, dislocated tibia, torn ligaments (ACL, PCL, MCL, LCL), and meniscus tears.
Treatment strategy:

Two-stage surgery:
Stage 1: Fixated the fractured condyle, repaired the MCL with a hamstring tendon graft, addressed the medial meniscus root tear and longitudinal tear, and performed a partial lateral menisectomy.
Stage 2 (6 weeks later): Mobilized the joint under anesthesia, achieved greater knee flexion (0-120°), and reconstructed the ACL using a peroneus longus graft (PCL showed partial healing).

Outcome:

Patient achieved active knee flexion of 0-110° and is progressing well with physical therapy.

Key takeaways:

Prompt diagnosis and multi-modal imaging are crucial for complex knee injuries.
Staged surgical intervention can address various aspects of the injury effectively.
Rehabilitation plays a vital role in regaining function after severe trauma.
This case highlights the importance of a comprehensive approach to managing complex knee injuries.

Please feel free to discuss similar cases or ask any questions in the comments below!

55yr old male came with history of 2 month old mal-uniting segmental fracture of Tibia and Fibula successfully managed with Open Osteoclasis, reduction and fixation and Bone grafting from ipsilateral iliac crest autograft with Distal tibial locking plate and 1/3rd tubular plate.

26yr old obese male with weight of 100 kg with complete ACL tear right knee for which we have done Conventional ACL Reconstruction using ipsilateral autologous Peroneus longus tendon as graft - Final graft thickness was 9mm and length 8.5cm.

83yr old male with comminuted intertrochanteric fracture femur managed with Close reduction and internal fixation with Long Proximal femoral nail.
If you want to do a PFN hassle-free then you should have this awl (figure 3) in your armamentarium, this is a cannulated awl with curved shaft which can guide your guide wire.

50yr old male with history of RTA came to us with fracture shaft of humerus left side managed with Close reduction and internal fixation with Humerus interlock Nail.
Many surgeons prefer plate over nail for these kind of fractures. But in my view Nail is far better then plate if done properly- with proper entry point, clean dissection, properly embedded nail, perfect reduction, proper compression at fracture site and fair amount of interlocking screws, multidirectional locking and last and most important properly suturing back rotator cuff with either ethibond or fibre wire can make this surgery do wonders.
Merits are- minimal blood loss, less duration, no struggle with patient postion, no radial nerve dissection, biological fixation with compression and obviously better strength so chances of failure of implant are less.

60yr old Male case of Long split fracture of shaft of tibia right side managed with Closed reduction and internal fixation with Tibia interlock nail.
Magic done by Polar pin.

77yr old obese lady with comminuted subtrochanteric fracture femur left side, managed with close reduction and internal fixation with long proximal femoral nail.