From controversy to contemporary: a narrative review of the anatomy and biomechanics of the posterolateral corner of the knee

Nishank Mehta,Tushar Nayak 대한정형외과 스포츠의학회 2021 Arthroscopy and Orthopedic Sports Medicine Vol.8 No.1

Injuries to the posterolateral corner (PLC) of the knee are more common than what was traditionally believed. Concomitant injuries of the PLC with cruciate ligaments are being increasingly recognized. Failure to address the PLC injury component may result in continuing knee instability and failure of cruciate ligament reconstruction. Moreover, the PLC anatomy remains much-discussed but still poorly understood with the difference in nomenclatures over the years and the discreetly reported anatomical variations being the major bone of contention. A detailed search of the literature reveals that a lot of confusion still exists regarding the nomenclature and precise anatomical details of most structures constituting the PLC. More knowledge has also been shed on the biomechanics of PLC in recent cadaveric studies. This article concludes that a lot of discrepancy in literature was noted regarding the PLC anatomy and a better understanding of the anatomy and biomechanics of the PLC would help in diagnosing and subsequently developing anatomically sound techniques of PLC reconstruction. This article reviews the anatomy and biomechanics of the structures constituting the PLC with a special focus on the different terminology for the same structures and the resultant lack of standardization of the PLC nomenclature.

Epidemiological Insights from 1,652 Patients with Spinal Tuberculosis Managed at a Single Center: A Retrospective Review of 5-Year Data

Garg Bhavuk,Mehta Nishank,Mukherjee Rudra Narayan,Swamy Arun M.,Siamwala Burhan S.,Malik Garima 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2

Study Design: Retrospective cohort. Purpose: To report the demographic characteristics, clinico-radiological presentation, laboratory findings, and outcomes of “middle-path” treatment in patients with spinal tuberculosis from a single public healthcare facility in a developing country. Overview of Literature: Tuberculosis is a global health problem that is endemic in developing countries and undergoing resurgence in developed ones. Spinal tuberculosis can cause disabling back pain, progressive deformity, and neurological involvement. However, there is a lack of large-scale epidemiological studies quantifying the size and severity of the problem of spinal tuberculosis. Methods: Hospital records of spinal tuberculosis patients treated at a single center over a period of 5 years were retrospectively reviewed. A diagnosis of spinal tuberculosis was based on standard clinical, radiological, microbiological, and histopathological evidence. Patients were treated in accordance with the “middle-path” regimen; surgery was reserved for selective indications. Results: A total of 1,652 patients were included. Their median age was 32.4 years, with 53% being male. Axial pain (98%) was the most common presenting symptom; 19% of patients had neurological deficit. Lumbar spine (37%) was the most common site of involvement, with a paradiscal pattern (82%) of involvement predominating. Multi-level involvement was seen in 19% of patients; skip lesions were noted in 2.8%. Transpedicular biopsy was performed in 667 patients; at least one tissue test was diagnostic of tuberculosis in 65% of patients. Forty-four patients had drug resistance to rifampicin. Surgery was required in 10.5% of patients. The “middle-path” regimen was associated with high compliance and significant improvements in pain (Visual Analog Scale score) and function (36-Item Short Form Health Survey). Conclusions: Our findings confirm the widespread prevalence of spinal tuberculosis and describe various epidemiological characteristics of a large sample of spinal tuberculosis patients. Adoption of the “middle-path” regimen is associated with high compliance and favorable outcomes in spinal tuberculosis.

Is 6 Months of Antitubercular Chemotherapy as Effective as More Than 6 Months Regimen in Spinal Tuberculosis? A Systematic Review and Meta-analysis

Aryal Aayush,Garg Bhavuk,Mehta Nishank,Shekhar Shubhankar,Gupta Vivek 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Historically, osteoarticular tuberculosis (TB), including spinal TB, was treated with prolonged course of antitubercular therapy (ATT). Due to various challenges, there has been reluctance to explore the use of short-course ATT in spinal TB. However, with the success of short-course ATT being demonstrated in other forms of extrapulmonary TB, the subject is open for debate again. Therefore, we systematically reviewed various published literature to determine whether short-course treatment regimen (6 months) of ATT provides equivalent results in terms of disease healing as long-course treatment regimen (≥9 months) in the management of spinal TB. Five electronic databases (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and their reference lists were searched to identify relevant randomized controlled trials with at least 1 year of follow-up that compared short-course with standard-course ATT for treatment of spinal TB. The methodological quality of included studies was assessed, and their data were extracted. A meta-analysis was used to calculate pooled effect sizes and 95% confidence interval (CI). The outcome measure was healed status of the disease at the final follow-up. Of 331 publications identified through literature search, eight publications describing six randomized studies were included. Moreover, 375 of 414 patients (90.58%) who received 6 months of ATT had healed status at their final follow-up compared to 404 of 463 patients (87.26%) who received ≥9 months of ATT. Overall, the healed status of spinal TB was equivalent in patients in both groups (pooled relative risk, 0.98; 95% CI, 0.92–1.04; <i>p</i> =0.439). However, there was considerable heterogeneity among the trials (I2=40.8%, <i>p</i> =0.149). The results suggest that the use of short-course (6 months) chemotherapy may be considered for the treatment of spinal TB in view of the similarity in the healing response achieved compared to treatment regimens of longer duration.

Morphological Changes in the Ligamentum Flavum in Degenerative Lumbar Canal Stenosis: A Prospective, Comparative Study

Devanand Hulmani,Bhavuk Garg,Nishank Mehta,Asit Ranjan Mridha,Tapas Chandra Nag,Kamran Farooque 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6

Study Design: Prospective, comparative.Purpose: To compare the histopathological and electron microscopic changes in the ligamentum flavum (LF) between degenerative lumbar canal stenosis (LCS) and lumbar disk herniation (LDH).Overview of Literature: The LF has been implicated as a key structure in the pathogenesis of LCS. With aging, the LF undergoes morphological changes–a decrease in the elastic component and an increase in the collagen component, in addition to other focal changes. By comparing the histopathological and electron microscopic picture of the LF in elderly patients with LCS with that in young patients with LDH, the role of this ligament in the pathogenesis of LCS may be clarified.Methods: Forty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged <35 years. The ligament flava were collected during the patients’ surgery. The features noted on histopathological examination included the fibrosis score, the loss of elastic fibers, calcification, chondroid metaplasia, mucinous degeneration, vascularization, long septa, clefts, granulation tissue, and ganglion-like cysts. The features noted on electron microscopic examination included the elastic fiber thickness, the quality of elastic fibers, the elastic:collagen ratio, calcification, melanin fibers, remnants of necrotic cells, and electron-dense material in the LF. All parameters were compared between group 1 and group 2.Results: On histopathological examination, the two groups exhibited significant differences regarding three parameters: chondroid metaplasia, long septa, and ganglion-like cysts. On electron microscopy examination, significant differences were observed between the two groups regarding two parameters: the quality of elastic fibers and the elastic:collagen ratio.Conclusions: Characteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS.

Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

Garg Bhavuk,Bansal Tungish,Mehta Nishank,Sharan Alok D. 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4

Spine surgery has advanced tremendously over the last decade. The number of spine surgeries performed each year has also been increasing constantly. Unfortunately, the reporting of position-related complications in spine surgery has also been steadily increasing. These complications not only result in significant morbidity for the patient but also raises the risk of litigation for the surgical and anesthetic teams. Fortunately, most position-related complications are avoidable with basic positioning knowledge. Hence, it is critical to be cautious and take all necessary precautions to avoid position-related complications. We discuss the various position-related complications associated with the prone position, which is the most commonly used position in spine surgery, in this narrative review. We also discuss the various methods for avoiding complications. Furthermore, we briefly discuss less commonly used positions in spine surgery, like the lateral and sitting positions.

A new method of arthroscopic assisted management of stiff knee: a technical note

Hemant Bansal,Hira Lal Nag,Nishank Mehta,Arnab Sain 대한정형외과 스포츠의학회 2018 Arthroscopy and Orthopedic Sports Medicine Vol.5 No.2

Arthrofibrosis of the knee is a commonly encountered entity and often results from prolonged immobilization or delay in postoperative mobilization of knee. Arthroscopic arthrolysis has replaced open arthrolysis as the gold standard in the management of the stiff knee. Several authors have described their techniques and modifications for arthroscopic management of the stiff knee. Rare but devastating complications have also been reported, particularly when forceful manipulation of the knee is done during surgery. We describe a safe method of arthroscopic-assisted management of a stiff knee with our own modifications to avoid catastrophic complications like iatrogenic fracture, tendon rupture or avulsion while simultaneously achieving improved range of flexion.