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Fulltext Management of Neglected Multiple Ligament Rupture of the Knee: A Case Report

Maodah FA, Rhatomy S

Malays Orthop J, 2021 Nov;15(3):118-121.
PMID: 34966505 DOI: 10.5704/MOJ.2111.018

Delayed or neglected multiple ligament injury of the knee is challenging or doctors and physiotherapists. We report on a 36-year-old army man who presented to the outpatient orthopaedic department with complaints of pain and deformity of his right knee and an inability to weight-bear on the right leg. The examination of the right knee revealed an unreduced posterior dislocation of the knee with instability in all planes and a limited range of motion (ROM) from 10° to 100°. Quadriceps wasting was noted. Roentgenograms revealed a posterior dislocation of the knee. Magnetic resonance imaging (MRI) showed complete rupture of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and the patellar tendon. A two-stage surgery was planned, involving soft tissue distraction with external fixation to restore the knee joint, followed by multiple ligament reconstruction. Three months after surgery, the patient could walk normally with ROM between 0° to 120°.
The efficacy of pulsed radiofrequency intervention of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain

Marliana A, Yudianta S, Subagya DW, Setyopranoto I, Setyaningsih I, Tursina Srie C, et al.

Med J Malaysia, 2020 03;75(2):124-129.
PMID: 32281592

INTRODUCTION: In recent years, pulsed radiofrequency (PR) has been used as a minimally invasive pain intervention. However, various studies on the efficacy of PR as modalities for the treatment of radicular pain in lumbar disc herniation have had varied results.
OBJECTIVE: This study aims to determine the efficacy of PR in reducing radicular pain among lumbar disc herniation patients compared with conservative treatment.
METHODS: This study was conducted using the before-andafter quasi experimental design. There were 50 subjects that fulfilled the inclusion and exclusion criteria and they were divided into an intervention group (n=25) and control group (n=25). The intervention group was given once PR in the dorsal root ganglion. All subjects were assessed for Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) before treatment, at 1- , 2- and 4-week after treatment.
RESULTS: At1-, 2- and 4-week, the VAS reduction in the intervention group was statistically significant compared to the control group. Four weeks after the intervention, the VAS score decreased in the intervention group (mean VAS -78.5, SD 16.8) more significantly compared to the control group (p<0.001). The ODI score decreased in the intervention group (mean ODI -61.8, SD 20.1) more significantly than in the control group (p<0.001).
CONCLUSION: Finding showed that at1- , 2- and 4-weekPR was more efficacious in reducing radicular pain among lumbar disc herniation patients compared to the conservative therapy.
Fulltext Management of valgus knee with irreducible patellar dislocation and MCL rupture: A case series

Rhatomy S, Purnama H, Singh C, Setyawan R, Utomo DN

Int J Surg Case Rep, 2019;60:175-182.
PMID: 31229772 DOI: 10.1016/j.ijscr.2019.06.018

INTRODUCTION: The high rate of recurrence in patellar dislocation treatment, requires a more comprehensive action, this is due to causes not only single but often multifactorial, including problems with static stability, dynamic stability or both.
PRESENTATION OF CASE: 1st case: A-39-years-old male, complain of irreducible right patella dislocation with valgus knee and already done soft tissue procedure for patella dislocation. Long-leg radiographs of the right leg showed 18° valgus mechanical angle. 2nd case: A-26-years-old obese female, complain of dislocation of left patella and history of surgery for dislocation at 5 years old. Long-leg radiographs of the right leg showed 11° valgus mechanical angle.
DISCUSSION: After knowing the cause of the patellar dislocation from history taking, physical and supporting examination, we performed lateral open wedge distal femoral osteotomy also MPFL and MCL reconstruction, and tibial tuberosity medialization osteotomy. There is improvement mean score in Tegner Lysholm Knee Scoring system and IKDC Scoring at 6 months after surgery.
CONCLUSION: Lateral open wedge distal femur osteotomy combine with MPFL and MCL reconstruction and tibial tuberosity medialization realignment procedure can be successfully done for improve irreducible patellar dislocation in valgus knee, from clinical and radiological evaluation have good outcome after surgery.
Fulltext Cyclops lesion - The entity causing loss of knee extension after ACL reconstruction surgery: A case report

Singh C, Vellasamy SD, Fiolin J, Rhatomy S

Int J Surg Case Rep, 2021 Nov;88:106554.
PMID: 34741861 DOI: 10.1016/j.ijscr.2021.106554

Cyclops is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction surgery that causes loss of knee extension. In this literature, we have discussed about a young gentleman who presented with unresolved swelling and inability to extend knee joint fully 1 year after ACL reconstruction surgery. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). An arthroscopic excision of the cyclops lesion was successfully done on this patient which resulted in a resolution of swelling and progressive improvement of knee extension.