Fully arthroscopic treatment of medial Hoffa fracture associated with anterior cruciate ligament tear: case report and surgical technique

A Hoffa fracture is a rare intra-articular injury consisting of a coronal plane fracture of one or both of the distal femoral condyles. Because of the rarity of medial Hoffa fractures, only a few reports have described this injury and its arthroscopic management. In this article, we present a rare case involving a 32-year-old man with a displaced medial Hoffa fracture associated with a proximal anterior cruciate ligament tear. He was treated by a single-stage fully all-inside arthroscopic technique. Arthroscopic-assisted internal fixation ensured fragment stability and enabled us to visualize the fracture reduction, monitor the screw insertion, and reconstruct the anterior cruciate ligament tear at the same time. This technique is a novel but demanding treatment method for medial Hoffa fractures and is particularly useful for properly selected patients with associated intra-articular knee injuries.

Presentation of the bk21 (Kacprzak) test as a less traumatic alternative to the Lachman test and Drop Leg test in diagnosing anterior cruciate ligament tear

Objective: despite the fact that anterior cruciate ligament injuries are the most common ligament injuries, the problem of making a quick and accurate diagnosis still exists. in our paper, we hypothesized that a modification of the Lachman test — BK21 (Kacprzak test), in comparison to the Lachman test and Drop Leg test will allow for a significant reduction of pain during the test, and thus for less muscular defense, more relaxation, and more reliable test results, whose sensitivity and specificity will be confirmed by magnetic resonance imaging.Materials and methods: using the patient’s subjective pain rating scale, the Numerical Rating Scale (NRS), we were able to easily assess which way of performing the test was less traumatic for the patient. a physical examination in the form of a comparison of those two visits was performed at the private medical office Orto Med Sport in 203 patients with suspected anterior cruciate ligament tear.Results: the BK21 modification (Kacprzak) test was on average 3 points less painful on the NRS scale than the classic Lachman test and 1 point less painful than the Drop Leg test, while the same principle of operation and analogous endpoints in both tests allow for high sensitivity and specificity of the test.Conclusion: the BK21 test was a less traumatic and painful alternative to the Lachman test.

A Case of Posterolateral Corner Injury with Segond Fracture in Association with Anterior Cruciate Ligament Tear on MRI - A Case Report

Knee injuries are common in sports and depending on the mechanism of fall, injury of different ligaments can occur. Knee injury mostly involves the anterior cruciate ligament (ACL), and is the most common injury reported on MRI. It can be associated with posterolateral corner (PLC) injury and other osseous injuries, these injuries are rarely reported as they are very complex in structure. A detail knowledge about this complex helps to evaluate the associated ligaments as well. In association with anterior cruciate ligament injuries presence of a Segond fracture indicates occurrence of a concomitant or isolated injury to the posterolateral corner injury. The evaluation of these associated injuries along with anterior cruciate ligament aids in their repair and hence improving the postoperative outcome. Three main components of posterolateral corner are divided into three layers – superficial, middle, and deep. Clinically few tests have been advised to evaluate injury of different structures of knee joint. For example - McMurray's test and Ege's test are used to evaluate meniscus, Lachman test, Anterior drawer test and Pivot Shift Test are performed to evaluate anterior cruciate ligament tear while posterior drawer test is done to evaluate posterior cruciate ligament tear. Availability of special closely coupled extremity coils, high field systems, open system & extremity units have made MRI supplemental to clinical examination and plain radiographs for virtually all suspected disorders of knee. Here, we are presenting a case of MRI of knee injury involving posterolateral corner injury with anterior cruciate ligament tear and Segond fracture. Along with anterior cruciate ligament, medial meniscus, other ligaments and osseous injury are associated as well. The other structures responsible for stabilizing the knee joints are posterolateral corner and meniscus, which when involved may need to be treated simultaneously with anterior cruciate ligament tear, for full re stabilization of knee joint. If any associated fracture is present, it has to be treated simultaneously as well.

AYURVEDA APPROACH IN THE MANAGEMENT OF ANTERIOR CRUCIATE LIGAMENT TEAR OF KNEE

The knee is one of the largest and most complex joints in the body. The two cruciate ligaments in the knee, anterior and posterior, are often referred to as the ‘crucial’ ligaments, because of their importance in providing knee stability. Anterior cruciate ligament (ACL) injury is one of the most seen injury in sports and has a devastating influence on patients' activity levels and quality of life. Complete ACL rupture can induce other pathological knee conditions including knee instability, damage to menisci and the chondral surface, and osteoarthritis. Here a case report of a 28-year-old male who while playing football had a trauma to the right knee with a pop sound and acute pain at the time of incidence. He presented to the hospital with a knee which was swollen and tender. On MRI he was diagnosed with complete tear of ACL and grade II tear of lateral collateral ligament. A one-month Ayurveda treatment protocol was developed and followed for the patient. The patient was able to return to his daily activities without instability and also got relief from pain with noticeable improvement in the movement of knee joint. Keywords: anterior cruciate ligament tear, knee joint, janu sandhi, bhagna