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Does progress in microfracture techniques necessarily translate into clinical effectiveness?

World Journal of Orthopedics 2024年第3期15卷 266-284页

作者： Sathish Muthu vibhu krishnan Viswanathan Manoharan Sakthivel Mohammed Thabrez Department of Orthopaedics Orthopaedic Research GroupCoimbatore 641045Tamil NaduIndia Department of Biotechnology Karpagam Academy of Higher EducationCoimbatore 641021Tamil NaduIndia Manoharan Sakthivel Department of OrthopaedicsGovernment Medical CollegeKarur 639004Tamil NaduIndia Department of Orthopaedics Devadoss Multispecialty HospitalMadurai 625007Tamil NaduIndia Department of Medical Oncology Aster Medcity HospitalKochi 682034India

BACKGROUND Multitudinous advancements have been made to the traditional microfracture(MFx)technique,which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage *** relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely *** To comparatively analyze the functional,radiological,and histological outcomes,and complications of various generations of MFx available for the treatment of cartilage *** A systematic review was performed using PubMed,EMBASE,Web of Science,Cochrane,and *** of any age and sex with cartilage defects undergoing any form of MFx were considered for *** included only randomized controlled trials(RCTs)reporting functional,radiological,histological outcomes or complications of various generations of MFx for the management of cartilage *** meta-analysis(NMA)was conducted in Stata and Cochrane’s Confidence in NMA approach was utilized for appraisal of *** Forty-four RCTs were included in the analysis with patients of mean age of 39.40(±9.46)*** comparing the results of the other generations with MFX-I as a constant comparator,we noted a trend towards better pain control and functional outcome(KOOS,IKDC,and Cincinnati scores)at the end of 1-,2-,and 5-year time points with MFx-III,although the differences were not statistically significant(P>0.05).We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of microfracture(weighted mean difference:17.44,95%confidence interval:0.72,34.16,P=0.025;without significant heterogeneity)at 1 ***,the difference was not maintained at 2 *** was a trend towards better defect filling on MRI with the second and third generation MFx,although the difference was not statistically significant(P>0.05).CONCLUSION The higher generations of traditional MFx

关键词： Cartilage injury Microfracture Mesenchymal stem cells Platelet-rich plasma Bone marrow aspiration concentrates Clinical outcome Radiological outcome Meta-analysis Network meta-analysis

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Ipsilateral fracture dislocations of the hip and knee joints with contralateral open fracture of the leg： a rare case and its management principles

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Chinese Journal of Traumatology 2011年第3期14卷 183-187页

作者： Ramesh Kumar Sen Sujit Kumar Tripathy vibhu krishnan Tarun Goyal Vanyambadi Jagadeesh Department of Orthopedics Postgraduate Institute of Medical Education and Research Chandigarh 160012 India

This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.

关键词： Hip dislocation Knee dislocation Fractures bone

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latrogenic aortic pseudoaneurysm following anterior tho- racic spine surgery masquerading as chronic infection

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Chinese Journal of Traumatology 2013年第6期16卷 368-370页

作者： Vijay Goni A jay Bahl Nirmal Raj Gopinathan vibhu krishnan Rajesh Kumar Department of Orthopaedics Postgraduate Institute ofMedical Research and Education Chandigarh India

Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are *** current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta,mimicking *** patient was treated successfully following concomitant efforts by multidisciplinary experts with *** wish to highlight upon the significance of recognizing the possible sinister consequences of a dangerously prominent spinal implant and the role of a suspicious surgeon in identifying these menacing complications at the right time.

关键词： Fractures, bone Aorta, thoracic Aneurysm, false latrogenic disease

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Management of neglected cervical spine dislocation： a study of six cases

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Chinese Journal of Traumatology 2013年第4期16卷 212-215页

作者： Vijay Goni Nirmal Raj Gopinathan vibhu krishnan Rajesh Kumar Avinash Kumar Department of Orthopaedics Postgraduate Institute ofMedical Education and Research Chandigarh 160012India Department of Orthopedics RML Hospital New DelhiIndia

Objective： To report a case ser/es of six neglected cervical spine dislocations without neurological deficit, which were managed operatively. Methods： The study was conducted fromAugust 2010 to December 2011 and cases were selected from the out- patient department of Postgraduate Institute of Medical Education and Research, India. The patients were in the age group of 30 to 50 years. All patients were operated via both anterior and posterior approaches. Results： During the immediate postoperative period, five （83.33%） patients had normal neurological status. One （16.67%） patient who had C5-C6 subluxation developed neu- rological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level. Conclusion： There is no role of skull traction in ne- glected distractive flexion injuries to cervical spine delayed for more than 3 weeks. Posterior followed by anterior ap- proach saves much time. If both approaches are to be done in the same sitting, there is no need for instrumentation posteriorly. But if staged procedure is planed, posterior sta- bilization is recommended, as there is a risk of deterioration in neurological status.

关键词： Cervical vertebrae Neck Postoperative complications

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A rare case of bicondylar Hoffa fracture associated with ipsilateral tibial spine avulsion and extensor mechanism disruption

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Chinese Journal of Traumatology 2011年第4期14卷 253-256页

作者： Kamal Bali Aditya Krishna Mootha vibhu krishnan Vishal Kumar Saurabh Rawall Department of Orthopaedics Postgraduate Institute ofMedical Education and Research Sector 12 Chandigarh160012 India Department of Orthopaedics Hinduja HospitalMumbai India

Intra-articular coronal fractures （Hoffas fractures） of distal femur are rare. Although bicondylar involvement in these fractures has been reported in the literature in association with high velocity traumata, the occurrence of these fractures involving extensor mechanism rupture and avulsion ofipsilateral tibial spine is extremely rare. To our acquaintance, such a fracture pattern has not yet been reported in the literature so far. In this article, we report one such case and discuss the importance of early diagnosis and prompt internal fixation in the management of such *** believe that these rare combinations of injuries should be treated aggressively by early open reduction and anatomic rigid internal fixation in order to achieve good recovery of function.

关键词： Femoral fracture Tibia Fracture fixation, internal Knee

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Evidence analysis on the utilization of platelet-rich plasma as an adjuvant in the repair of rotator cuff tears

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World Journal of Meta-Analysis 2022年第3期10卷 143-161页

作者： Sathish Muthu Naveen Jeyaraman Keval Patel Girinivasan Chellamuthu vibhu krishnan Viswanathan Madhan Jeyaraman Manish Khanna Department of Orthopaedics Government Medical College and HospitalDindigul 624001Tamil NaduIndia Department of Biotechnology School of Engineering and TechnologySharda UniversityGreater Noida 201306Uttar PradeshIndia Research Associate Indian Stem Cell Study GroupAssociationLucknow 226010Uttar PradeshIndia Research Associate Orthopaedic Research GroupCoimbatore 641001Tamil NaduIndia Fellow in Orthopaedic Rheumatology Dr Ram Manohar Lohiya National Law UniversityLucknow 226010Uttar PradeshIndia Fellow in Joint Replacement Atlas Hospitals(The Tamil Nadu Dr MGR Medical University)Tiruchirappalli 620002Tamil NaduIndia Fellow in Arthroscopy Ortho-One Orthopaedic Speciality Centre(The Tamil Nadu Dr MGR Medical University)Coimbatore 641005Tamil NaduIndia Department of Orthopaedics and Spine Surgery Ganga Medical Centre and HospitalsCoimbatore 641043Tamil NaduIndia Department of Orthopaedics Faculty of MedicineSri Lalithambigai Medical College and HospitalDr MGR Educational and Research InstituteChennai 600095Tamil NaduIndia South Texas Orthopaedic Research Institute LaredoTX 78045United States Department of Orthopaedics Autonomous State Medical CollegeAyodhya 224135Uttar PradeshIndia

BACKGROUND Platelet-rich plasma has been gaining popularity as an agent for biological augmentation either as the sole treatment modality or as an adjunct to surgical *** is substantial discrepancy in the results of the published meta-analyses;and the true efficacy and role of using autologous platelet-rich plasma(PRP)at the time of rotator cuff repair is still *** To performed this systematic overview on the overlapping meta-analyses that analyzed autologous PRP as an adjuvant in the repair of rotator cuff tears and identify the studies which provide the current best evidence on this subject and generate recommendations for the *** We conducted independent and duplicate electronic database searches in PubMed,Web of Science,Scopus,Embase,Cochrane Database of Systematic Reviews,Reference Citation Analysis and the Database of Abstracts of Reviews of Effects on September 8,2021 to identify meta-analyses that analyzed the efficacy of PRP as an adjuvant in the repair of rotator cuff *** quality assessment was made using Oxford Levels of Evidence,AMSTAR scoring and AMSTAR 2 *** then utilized the Jadad decision algorithm to identify the study with the highest quality to represent the current best evidence to generate the *** Twenty meta-analyses fulfilling the eligibility criteria were *** AMSTAR scores of the included studies varied from 6-10(mean:7.9).All the included studies had critically low reliability in their summary of results due to their methodological flaws according to AMSTAR 2 *** heterogeneity was observed in the reporting of VAS,function outcome scores(longterm UCLA score,ASES score,SST score),operative time and long-term re-tear *** metaanalyses are more supportive of the role of intra-operative administration of PRPs at the bonetendon interface in improving the overall healing and re-tear rates,functional outcome and *** initial size of the tear and

关键词： Platelet-rich plasma Rotator cuff tears Meta-analyses Functional outcome Re-tear Recommendation

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Predictors of early outcome in unstable pelvic fractures

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Chinese Journal of Traumatology 2013年第2期16卷 94-98页

作者： Ramesh K. Sen Nirmal Raj Gopinathan Tajir Tamuk Rajesh Kumar vibhu krishnan Radheshyam Sament Department of Orthopaedics and Traumatology Postgraduate Institute of Medical Education and Research Chandigarh India

Objective： To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures. Methods： This study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries. Results： In the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in pa- tients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high. Conclusion： Anterior approach to the pelvis would cause significantly more amount of blood loss than poste- rior approach and extemal fixation. Surgical approaches do not have any influence on the surgical duration or the infec- tion rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influ- enced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient＇s survival and it greatly influ- ences the duration of hospital stay.

关键词： Pelvis Fractures, bone Treatmentoutcome Pubic symphysis

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Is cellular therapy beneficial in management of rotator cuff tears?Meta-analysis of comparative clinical studies

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World Journal of Meta-Analysis 2022年第3期10卷 162-176页

作者： Sathish Muthu Cheruku Mogulesh vibhu krishnan Viswanathan Naveen Jeyaraman Satvik N Pai Madhan Jeyaraman Manish Khanna Department of Orthopaedics Government Medical College and HospitalDindigul 624001Tamil NaduIndia Department of Biotechnology School of Engineering and TechnologySharda UniversityGreater Noida 201306Uttar PradeshIndia Indian Stem Cell Study Group Association Lucknow 226010Uttar PradeshIndia Department of Orthopaedic Rheuamtology Dr Ram Manohar Lohiya National Law UniversityLucknow 226010Uttar PradeshIndia Department of MSK Oncology University of CalgaryAlberta AB T2N 1N4AlbertaCanada Department of Orthopaedics Atlas Hospitals(The Tamil Nadu Dr MGR Medical University)Tiruchirappalli 620002Tamil NaduIndia Department of Orthopaedics Sri Ramachandra Medical College and Research InstituteChennai 600116Tamil NaduIndia Department of Orthopaedics Faculty of MedicineSri Lalithambigai Medical College and HospitalDr MGR Educational and Research InstituteChennai 600095Tamil NaduIndia Department of Orthopaedics South Texas Orthopaedic Research Institute(STORI Inc.)LaredoTX 78045United States Department of Orthopaedics Autonomous State Medical CollegeAyodhya 224135Uttar PradeshIndia

BACKGROUND Mesenchymal stromal cell(MSC)-based cellular therapy promotes type I collagen production,enhance mechanical strength of tissues,and enhance biology at the bone-tendon interface,which primarily explains their potential clinical utility in rotator cuff(RC)*** To analyze the efficacy and safety of cellular therapy utilizing MSCs in the management of RC tears from clinical studies available in the *** We conducted independent and duplicate electronic database searches including PubMed,Embase,Reference Citation Anallysis,Web of Science,and Cochrane Library in August 2021 for studies analyzing the efficacy and safety of cellular therapy(CT)utilizing MSCs in the management of RC *** Analog Score(VAS)score for pain,American Shoulder and Elbow Surgeons(ASES)score,Disability of the Arm,Shoulder,and Hand score,Constant score,radiological assessment of healing,and complications such as retear rate and adverse events were the outcomes *** was performed in R-platform using OpenMeta[Analyst]*** Six studies involving 238 patients were included for *** noted a significant reduction in VAS score for pain at 3 mo(weighed mean difference[WMD]=-2.234,P<0.001)and 6 mo(WMD=-3.078,P<0.001)with the use of CT,which was not maintained at long-term follow-up(WMD=-0.749,P=0.544).Concerning functional outcomes,utilization of CT produced a significant shortterm improvement in the ASES score(WMD=17.090,P<0.001)and significant benefit in functional scores such as Constant score(WMD=0.833,P=0.760)at long-term ***,we also observed significantly improved radiological tendon healing during the longterm follow-up(odds ratio[OR]=3.252,P=0.059).We also noted a significant reduction in the retear rate upon utilization of CT in RC tears both at short-(OR=0.079,P=0.032)and long-term(OR=0.434,P=0.027)*** did not observe any significant increase in the adverse events directly related to cellular therapy,as comp

关键词： Mesenchymal stromal cell Bone-marrow derived mesenchymal stromal cell Adipose-derived mesenchymal stromal cell Rotator cuff tear Cellular therapy Meta-analysis

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Long term surgical treatment outcome of talar body fracture

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Chinese Journal of Traumatology 2011年第5期14卷 282-287页

作者： Ramesh Kumar Sen Sujit Kumar Tripathy Shakthivel RR Manoharan vibhu krishnan Tajir Tamuk Vanyambadi Jagadeesh Department of Orthopaedics Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh 160012 India

Objective： Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome ***： Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level Ⅰ trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot （antero-posterior, lateral and oblique views） and ankle （antero-posterior, lateral and mortise views） were obtained. The patients were followed up both radiologically and functionally （foot function index, FFI） after 3 weeks, 6 weeks, 3 months, 6 months and then ***： There were five crush fractures and three shear fractures （two sagittal shear and one coronal shear）,with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis oftalar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological ***： Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation.

关键词： Fractures, bone Talus Fracture fixation,internal

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Axillary artery thrombosis with anteroinferior shoulder dislocation： a rare case report and review of literature

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Chinese Journal of Traumatology 2012年第4期15卷 244-248页

作者： Sushil S Rangdal Shashidhar B Kantharajanna Daljit Singh Vikas Bachhal Nirmal Raj vibhu krishnan Vijay Goni Mandeep Singh Dhillon Department of Orthopaedics Postgraduate Institute of Medical Education and ResearchChandigarh 160012India

A very rare and serious complication of shoulder dislocation is a lesion to the axillary artery in the elderly population, whose vascular structures have become less flexible. Axillary artery injury secondary to anteroinferior shoulder dislocation is much rarer, especially in the young people. Proper recognition and treatment of this entity of- fers a full recovery to the patient. Present report highlights the possibility of axillary artery injury with anteroinferior shoulder dislocation. A few case reports and small case se- ries of this injury have been reviewed. And recommenda- tions for management have been brought up to date, in line with current thinking.

关键词： Shoulder dislocation Axillary artery Thrombosis

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