The Pandemic Hits Us Hard, but We Don’t Lose Hope

At the end of 2019, we faced a new variant of the coronavirus that can cause pneumonia and acute respiratory distress syndrome-like symptoms. It started in Wuhan, Hubei Province, China, and spread quickly to the whole world.This new virus is called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and can manifest as a disease called coronavirus disease 2019 (COVID-19). On March 13th, 2020 World Health Organization (WHO) declared COVID-19 as a global pandemic, and the story of frightening pandemic begin.

LATERAL MENISCUS TEARS IN ACL INJURED KNEE

Anterior cruciate ligament (ACL) tears can be associated with injuries to the lateral meniscus (LM) in about 20-30% cases. The lateral meniscus is more mobile than the medial and besides contributing to load transmission, it also stabilizes the knee in pivot-shift testing. The LM tears more often in the acute setting and its incidence does not rise in cases of chronic ACL instability. Lateral meniscus tears can be minor or major depending how severely the knee function gets impaired. Major tears are the complete radial tears, longitudinal bucket handle tears and posterior root tears. Male gender, high body mass index and contact injury mechanism are all risk factors for an LM tear. Anatomic factors which can contribute to LM tears include a high posterior tibial slope, varus malalignment and greater asymmetry between medial and lateral slopes. The lateral meniscus must be saved and repaired whenever possible to prevent residual knee instability and progressive lateral compartment arthritis, which can set in soon after a meniscectomy. The development of techniques and technology have rendered most tears amenable to repair. Longitudinal tears can be repaired by the all-inside or inside-out technique and the needles and devices must be inserted through a high anteromedial or transpatellar portal to prevent injury to the popliteal neurovascular structures. A lateral safety incision must always be used for inside-out repairs. Radial tears can be repaired by two horizontal sutures, a cross stich, a cross-tag or a hash-tag suture configuration. Lateral meniscus posterior root repairs are repaired by transtibial technique, either by drilling an independent anatomic tunnel or the sutures pulled out via the ACL tibial tunnel. The lateral meniscus has high healing rates and repairs yield improvement in functional outcome, beside delaying radiographic arthritis.

The impact of the COVID-19 pandemic on hip and knee arthroplasty: A systematic review

Background: In order to ameliorate the burden the coronavirus disease 2019 (COVID-19) pandemic had on the medical resources, and to ensure the safety of orthopaedic patients and medical personnel, some hip and knee arthroplasties, as forms of elective surgeries, were suggested to be canceled or postponed. This review aims to analyze the available literature on the impact of COVID-19 pandemic on all areas surrounding hip and knee arthroplasty service. Materials and Methods: A systematic literature search was conducted in five databases from July 5th to 10th, 2020. We included studies that assessed any impacts the COVID-19 pandemic had on the patients who require hip or knee arthroplasty, hip and knee surgeons, and any other areas that are related to hip and knee arthroplasty service. We excluded studies that do not report complete clinical results, reviews, editorials, and letters.Results: After the screening, a total of nine articles were selected. Two studies evaluated the impact of COVID-19 on the hip and knee arthroplasty patients, one study on public interest in hip and knee arthroplasty, three studies on the hip and knee arthroplasty surgeons, two studies on surgical volume, and one study on industry partners. Of 360 surveyed patients, 60% felt anxious about the uncertainty of the rescheduled arthroplasty. Of 1770 surveyed surgeons, 61.9%, 54.7%, and 20.9% of them reported canceled elective inpatient procedures, outpatient procedures, and all types of surgeries, respectively.Conclusions: COVID-19 pandemic had some impacts on the patients, public interest, surgeons, industry partners, and hip and knee arthroplasty volume.

SYMPTOMATIC DISCOID MENISCUS: A CASE SERIES

Background: Discoid meniscus is a rare entity of knee pathology. The discoid meniscus can be encountered incidentally during a treatment of another knee pathology as an asymptomatic entity or can be a symptomatic pathology which warrant treatment Case presentation: There were 8 cases of symptomatic discoid meniscus reported in this retrospective case series. The symptoms presented at age range 16-47 year-old. Majority of the case (6 of 8) are lateral discoid meniscus with female gender predominant. Complete type of discoid meniscus was also found in 6 of 8 cases. There were 5 cases of ruptured discoid meniscus, three of them needed repair. Conclusions: Symptomatic discoid meniscus can be presented on wide range of age of patients. We found female gender, discoid lateral meniscus, and complete type are the predominant pattern of discoid meniscus cases presentation.

Correlation of Anthropometric Features with Peroneus Longus and Hamstring Tendons Graft Size for ACL reconstruction

Background: Reconstruction of the anterior cruciate ligament (ACL) is a commonly performed surgical procedure in recent years. Surgeons have to consider several factors including patient’s anthropometric variables to harvest the best graft. The hamstring tendon has its’ limitation, such as the tendon graft size deemed unfit especially for people of small statures. The peroneus longus tendon is a relatively new choice compared to hamstring. This study was conducted to know the correlation between anthropometric features with graft parameters or graft size in patients who underwent ACL reconstruction using peroneus longus and hamstring tendons.Materials and Methods: This cross-sectional study was performed in patients who underwent ACL reconstruction using peroneus longus or hamstring tendon autografts. We evaluated their anthropometric variables (age, gender, body mass index (BMI), height and weight) and correlated them with the graft diameter obtained during surgery. Post-operative results were assessed with Karlsson and Peterson Scoring System which represent the ankle function.Results: Twenty-three non-athletic patients underwent ACL reconstruction surgery. Patients with hamstring graft have the average height of 170 cm and 163.6 cm for the peroneal graft group. The average body weight of the hamstring graft group was 72.917 kg and the peroneal graft group was 68.82 kg. The measured BMI of the hamstring graft group was 25.2 kg/m2 and 7.833 mm of graft diameter in average, with 25.5 kg/m2 and 7.636 mm respectively for the peroneus graft group. There were strong positive correlations between weight and BMI with hamstring tendon graft diameter, but negative weak correlations with peroneus tendon graft diameter.Conclusion: We found that body weight and BMI correlate with the diameter of both peroneus and hamstring tendon grafts. Both autografts showed equally good functional results.

Range of Motion Outcomes Post Cruciate-Retaining vs Posterior Stabilized Total Knee Arthroplasty: A Retrospective Multi-Centre Cohort Study

Background: The outcome for TKA (total knee arthroplasty) upon whether the posterior cruciate ligament is preserved with cruciate retaining (CR) prostheses or sacrificed with posterior stabilized (PS) prostheses are still debated between studies. Materials and Methods: We included a total of 144 knees operated with cemented fixed bearing primary CR or PS TKAs. Independent t-tests were conducted for the outcomes and possible confounding variables between groups where relevant, with analyses using Chi-squared tests for nominal data. Results: Operation on patients with age of lower than 65 years predicts increased intraoperative bleeding volume (p = 0.037), pre-operative range of motion (ROM) of less than 90 degrees was a predictor for better improved post-operative ROM (p 0.001) and PS prostheses is superior to CR in terms of ROM improvement (p = 0.04), however with both groups achieving similar maximum ROM (p = 0.308). Conclusion: Improvement of ROM is increased by the use of PS prostheses compared to CS prostheses, with pre-operative ROM as a possible confounding factor and the maximum ROM achieved for both prostheses being similar. Lower age of the operation is also related to increased intraoperative bleeding

Choosing between the Conventional Plates, Locking Plates, or Iliosacral Screws for Sacroiliac Joint Dislocation: A Biomechanical Comparison Study

Background: This study examines the comparison of biomechanical strengths of three kinds of the most familiar implants available in Indonesia: conventional and locking sacroiliac plates and screws, also iliosacral screws. Despite the common thought that iliosacral screws are preferred compared to conventional plates and screws due to its biomechanic superiority, this study tested whether the locking plates and screws could offer an alternative.Materials and Methods: This study was an in vitro experimental study with a Randomized Post Test - Only Control Group Design using pelvic bones from male cadavers aged 20-50 y.o. Twelve samples were divided into three treatment groups and one control group. Group P1 was fixed with two conventional plates, P2 was fixed with two locking plates, P3 was fixed with two iliosacral screws, and control group K with sacroiliac joint was intact. Each group was given an increasing load until a vertical shift of the sacroiliac joint ≥ 2.0 mm was obtained.Results: The average force load for 2 mm displacement among the fixation systems being tested shows a statistically significant difference (p0.05). Load failure force for 2 mm displacement in the locking plate and screw group has the highest average (591.33 ± 56.08 N) compared to the iliosacral screw group (583.67 ± 73.56 N) and conventional plate and screw group (574 ± 106.05 N).Conclusions: Biomechanically, the fixation system using two locking anterior sacroiliac plates and screws is more stable than the iliosacral screws and conventional sacroiliac plates and screws.

Comparison of Mortality Rate Between Bipolar Hemiarthroplasty and Proximal Femoral Nail Anti-rotation for Intertrochanteric Fractures in Sanglah Hospital, Bali

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Results: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p = 0.028). Bipolar hemiarthroplasty group also had longer length of stay (50%) than the PFNA group (32.4%), albeit statistically insignificant (p = 0.13). There was no significant difference between the 2-year mortality rate and length of stay (p = 0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2- year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher length of stay than the PFNA group. Future prospective, multi center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.

The Effects Of Prehabilitation Exercise Using Resistance Bands On Functional Performance In Total Knee Replacement

Background:Despite the high succesful rate of Total Knee Replacement (TKR), there are still patients with permanent dysfunction and a longer period of rehabilitation that interfere with functional performance. Strengthening exercise before TKR namely prehabilitation exercise using resistance bands is expected to optimize patient’s condition before surgery that will increase functional performance after TKR and accelerate rehabilitation programs.Methods:16 eligible patients were allocated into the treatment group (n=8) and the control group (n=8). The treatment group received 4 weeks of prehabilitation exercise with a frequency of 2 times and one time as a home program. The control group only received conventional therapy. The TUG and WOMAC scores were measured 3 times; at baseline, after 4 weeks of prehabilitation exercise and at 8 weeks of rehabilitation after TKR.Results:Before intervention, there were no significant differences between groups for the TUG score (p=0.674) and WOMAC (p=0.928). After 4 weeks of intervention, there was significant difference in the TUG score (p=0.003) and WOMAC (p=0.002), whereas at 8 weeks after rehabilitation programs there was a significant difference in the TUG score (p=0.009) while for the WOMAC score there was no significant difference (p=0.125).Conclusion:Prehabilitation exercise using resistance band improved functional performances in patients undergone TKR.