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Posterior-stabilized, rotating platform knee prosthesis design was aimed to decrease polyethylene wear for the sake of improving implant survivorship. The purpose of the present prospective study was to evaluate the long-term clinical and radiographic results as well as the survival rate after using a rotating platform, posterior-stabilized knee prosthesis at a minimum of 10 years at a Middle East institution. We compared the results with reports in the literature on western populations. From January 2002 to June 2008, 96 patients (106 knees) underwent total knee arthroplasty (TKA) using a cemented rotating platform posterior-stabilized knee prosthesis. At a mean of 11.5 ± 1.3 years, 85 patients (95 TKAs) were available for clinical, radiographic, and implant survival analysis. At the final follow-up, 78.9% of the patients had excellent Knee Society Scoring system score, the average knee flexion was 110 ± 17 degrees, the average anatomical knee coronal alignment was 186 ± 2 degrees and 187 ± 3 degrees for varus and valgus knees, respectively. Five (5.2%) knees were revised of these: two for bearing dislocation, two for aseptic loosening, and one for infection. The Kaplan-Meier survival rate was 94.7% for all revisions and 97.8% when only revision for aseptic loosening considered as the end point. At a long-term follow-up, reasonable clinical and radiographic outcomes had been achieved after using a rotating platform, posterior-stabilized knee prosthesis in our population with acceptable survival rate reaching up to 95%, which is comparable to reports from the western population.

Purpose Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. Methods Forty-five patients [females/males, 27/18; age, 30–59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. Results After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p p p p p Conclusion Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. Level of evidence Level I prospective randomised control clinical trial.

Background: A tibial plateau fracture refers to a break in the top of the shin bone, at the knee. Aim: To evaluate the effect of implementing the nursing rehabilitation protocol on Patient`s Satisfaction for Tibial Plateau Fracture Surgery. Research design: Quasi-experimental research design. Setting: Trauma unit at Assiut University Hospital. Patient and Methods: Sixty adult patients undergoing tibial plateau fracture surgery. This sample divided into two equal groups (30 patients for each). The study group who received the nursing rehabilitation protocol while the control group received the routine hospital instructions. Tools: I "Patient's health needs assessment sheet ", II "Patient satisfaction with nursing care quality questionnaire ". Results: There was a statistically significant difference (p-value 0,001) between the study and control group regarding patient`s satisfaction (about 80% of the study group was satisfied with nursing care quality, 3.3% of the control group was satisfied with nursing care quality). Conclusion: It was concluded that level of patient`s satisfaction for tibial plateau fracture surgery was improved after application of nursing rehabilitation protocol. Recommendations: Simple nursing rehabilitation protocol booklet should be available for patients with tibial plateau fracture surgery to increase the level of patient`s satisfaction.

Background: Patellofemoral pain syndrome is characterized by anterior knee pain, which may limit the performance of functional daily activities. Aim: to evaluate the effect of physiotherapy integrated exercise rehabilitation protocol on outcomes of patients with patellofemoral pain syndrome Methods: Research design: A quasi - experimental (pre/ post) design was used. Setting: The study was conducted in the Physiotherapy Department at Assiut University Hospital. Sample: A purposive sample of (60) adult patients aged 20- 65 years diagnosed with patellofemoral pain syndrome. Tools: two tools (I): Structured patient interview questionnaire; this tool consisted of two parts; Part 1: Patients demographic characteristics and Part 2: Patient's medical data assessment. Tool (II): Kujala Patellofemoral Questionnaire (KPQ) scale. Results: Exercise rehabilitation protocol resulted in a highly statistically significant difference in the pre / post protocol in the whole items of Kujala patellofemoral score. Conclusion: The exercise rehabilitation protocol was more effective in improving patient's outcomes (reducing pain, improving activities of daily living in patients with patellofemoral pain syndrome. Recommendation: Screening programs to identify the risk factors for prolonged pain and knee functional deficit, and the potential association with degenerative joint disease.

Background: Several arthroscopic techniques for the treatment of avulsion tibial spine fractures have been described in the literature. Purpose: To evaluate the outcomes of the arthroscopically assisted stainless steel wiring technique in the treatment of avulsed tibial spine in adults. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study involved 28 patients (28 knees), 16 to 42 years of age, with tibial spine avulsion fracture that was treated using arthroscopic reduction and cerclage wire fixation by a single surgeon between March 2015 and August 2018. The degrees of avulsion in these patients were type II (n = 12), type III (n = 10), and type IV fractures (n = 6). Clinical assessment included International Knee Documentation Committee (IKDC) objective score (which noted swelling), range of knee movement, Tegner activity scale, Lachman test, and pivot-shift test compared with the normal opposite knee. Results: The mean follow-up period was 24.1 months (range, 18-30 months). The mean IKDC score was 93.7 (range, 88.5-98.9); the IKDC score was normal in 22 patients and nearly normal in 6 patients. The Lachman test was grade 1 in 25 patients and grade 2 in 3 patients, whereas the pivot-shift test was grade 0 in 26 patients and grade 1 in 2 patients. All patients achieved their preinjury Tegner activity levels. Radiological assessment showed healing in all patients within a mean of 12 weeks after surgery. Conclusion: The outcomes of all patients were satisfactory; fixation by cerclage wiring permitted reduction of tibial spine fragment anatomically to its fracture bed, provided stable fixation in displaced tibial spine avulsion, and allowed for early rehabilitation and weightbearing because of stable fixation.

With the vast spread of the RFID applications in most field of life's, most researchers pays more attention to the most cheap but challenging technology in the RFID which is the chipless RFID. The challenges in such a technology stems from the need for a reader antenna that achieve an UWB operation, circular polarization, flat gain and a compact size. This is suitable for tags of either linear or circular orientations. This paper discusses the design, the simulation and the measurement of a quadrifilar spiral antenna with four-arms and six-turns that suits the RFID reader specifications. The antenna is fabricated over FR4 material of thickness 1.6 mm using the photolithographic process. The antenna arms are printed on one side of the substrate while the feeding coaxial connector is mounted on the other side without any ground planes. The radiation pattern and the polarization are controlled by adjusting the phase shift between the four arms. The four arms allow a total length less than the longest wavelength, so the antenna size is miniaturized to large extent. The fabricated antenna has a compact size, a high gain and an ultra-wide band (UWB) radiation as well as circularly polarized (CP) radiation. The antenna has wide bandwidth compared to the antennas in literatures. The antenna operates in the range from 1.2 GHz to 12.4 GHz. By comparing the simulated and the experimental results a very promising coincidence is noticed.

Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. These techniques include the use of various fixation devices such as screws, K-wires, wiring, sutures, and suture anchors. In this study, we evaluate a new wiring technique for the treatment of these injuries. This technique involves fixation by stainless steel tension wires passed over the fractured spine and tied over a bone bridge. The advantages of this technique are that it aids in reduction, allows for compression of the tibial spine fragment anatomically in its fracture bed, provides stable fixation in difficult comminuted fractures, and allows for early mobilization and weight bearing because of the solid fixation.

Knee arthroscopy causes minimal trauma, however, good analgesia is required for early rehabilitation and return to normal life in the patients.We aimed to compare the analgesic effects of intraarticular dexamethasone and dexmedetomidine added to bupivacaine with those of bupivacaine alone.This study uses a double-blind, randomized, controlled design with allocation concealment in a 3-armed parallel group format among patients undergoing arthroscopic meniscal surgery.The study was conducted at Assiut University Hospital in Asyut, Egypt. The study duration was from July 2016 to February 2017.After the ethics committee approval, 60 patients, with the American Society of Anesthesiologists (ASA) physical status of I or II, 20 - 50 years old, and scheduled for arthroscopic meniscal surgery were randomized in a double-blind manner to receive 18 mL intraarticular bupivacaine 0.25% with either dexamethasone 8 mg (group I), dexmedetomidine 1 ug/kg (group II), or 2 mL of normal saline (group III). The total volume of injectate used in each group was 20 mL. All of the patients received spinal anesthesia. Postoperatively, oral paracetamol 1000 mg was given every 8 hours, and oral tramadol 50 mg was administered, as needed, for rescue analgesia. The visual analog scale (VAS) pain scores, time to first analgesic request, and total dose of postoperative analgesics were recorded for 3 days postoperatively.The VAS scores were lower in groups I and II compared with group III. The time to the first analgesic was significantly shorter in group III compared with groups I and II (P = 0.001). The total dose of rescue paracetamol was higher in group III compared with groups I and II (P = 0.001). No need for tramadol rescue analgesia was recorded in any of the groups. No significant differences between groups I and II were noticed.The limitations of this study include the lack of previous research to compare the effect of both intraarticular dexamethasone and dexmedetomidine added to bupivacaine for postoperative analgesia in arthroscopic knee surgery. Additionally, there was a short observation period for the detection of chondrotoxicity, if occurred.The addition of dexamethasone or dexmedetomidine to a solution of bupivacaine 0.25% provided better analgesia than using bupivacaine alone.NCT02818985.Intraarticular, knee arthroscopy, bupivacaine, dexmedetomidine, dexamethasone, postoperative pain.

Triangular fibrocartilage complex (TFCC) injuries are increasingly recognized as a cause of ulnar-sided wrist pain. Palmer grouped these tears into either traumatic or degenerative, with various subclassifications. Magnetic resonance imaging (MRI), arthrogram, and arthroscopy are the methods used to establish the diagnosis. Several arthroscopic methods of TFCC repair including outside-in, inside-out, and all-inside techniques have been described. The outside-in repair, which involves piercing the TFCC via the ulnar side of the wrist, has been described by several authors, but the technique varies among authors with respect to instrumentation and subtle surgical modifications. The purpose of this article was to present the technique of arthroscopic outside-in repair using transverse mattress suture for type 1B TFCC tear by modifying classic vertical mattress sutures into sutures that pass completely through the disc.

There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores.In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria.After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P 0.05).Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex.

Pathologic proximal femoral fracture complicating an aneurysmal bone cyst is a situation sometimes met in clinical practice. It combines the difficulties of tumor eradication, reconstruction of the created bone defect and rigid fixation of the fracture with preservation of the femoral head in young patients. This study included eight patients who presented with pathologic proximal femoral fractures that proved to be aneurysmal bone cysts. There were six women and two men. The ages ranged from 18–28 years. Surgical treatment consisted of curettage and grafting of the lesion and internal fixation of the fracture. Four internal fixation devices were used. A dynamic hip screw was used in three patients, a 130°-angled blade plate in two patients, a condylar blade-plate in two patients and in one patient with severe bone loss, a barrel plate (150°) was used with a fibular graft inserted inside the barrel and impacted into the femoral head. Follow-up ranged from 6–42 months. All fractures united. No recurrence of the tumor was seen until the latest follow-up. Failure of fixation occurred in one patient after fracture collapse and migration of the dynamic hip screw. Overall results were excellent in six patients and good in two patients (using modified Hospital for Special Surgery score). The ideal treatment plan includes effective curettage through a wide exposure in addition to cancellous bone grafting and rigid internal fixation with the optional use of a fibular strut graft in difficult cases. All devices designed for the proximal femur can be used provided that there is anatomical reduction and rigid fixation.

Background There has been controversy regarding the pathogenesis and treatment of TFCC tear. Different surgical techniques for the treatment of TFCC are prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic outside-in repair of the ulnar side TFCC tear with vertical mattress suture. Methods In this study, arthroscopic outside-in repair of the ulnar side TFCC tear was done. 37 patients with TFCC tear with failure of conservative treatment for a minimum of 6 months had surgery. Outcomes were assessed using modified Mayo wrist score (MMWS), the Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS) for pain and satisfaction criteria, and patient-related wrist evaluation score (PRWE), in addition to the range of motion and grip strength. Results After arthroscopic surgery, overall satisfaction was extremely positive, and out of the 37 patients, 91.9% of the patients are satisfied. The mean score for pain improved from 7.6 to 2.9 points. The mean MMWS was improved from 62.1 to 91.2 points. DASH score also improved from 29.9 to 10.2 points and PRWE improved from 60 to 33 points. The ROM was improved from 85.8% to 92% of the normal side. The grip strength of the affected side improved from 82.5% to 89% of the normal side. All improvements are statistically significant ( P Conclusion Arthroscopic outside-in repair of ulnar side TFCC tear with mattress suture is a reproducible method with a marked improvement in function within a short period.

Palmer devised a classification system to guide treatment of triangular fibrocartilage complex tears in 1989. The main division is between traumatic Type I and atraumatic Type II tears. The wrist arthroscopy makes diagnosis and treatment of ulnar impaction syndrome possible in a less invasive way. Arthroscopy is the most valuable tool for diagnosis and treatment of acute scapholunate and lunotriquetral dissociation. Arthroscopic grading of Kienbock's disease better describes articular damage compared with plain radiographs and can help surgical treatment. The wrist arthroscopy generally makes it possible to make the diagnosis of the chondral lesion before they are visible by the usual imaging.

Study design A retrospective review and prospective follow-up were performed of 106 patients who had undergone microscopic decompressive surgery without fusion in the year 2006 at Munich Spine Center, Germany. Objective This study aimed to determine the 4–5-year outcome of microscopic unilateral laminotomy for bilateral decompression in degenerative lumbar spinal stenosis and to detect the possible predictors of the surgical outcome. Summary of background data There is limited information on the impact of surgery for lumbar spinal stenosis on symptoms, functional status, and satisfaction, as well as reoperation. Patients and methods Patients were considered eligible for the study if they had clinical and radiographic evidence of degenerative lumbar spinal stenosis, including patients with degenerative spondylolisthesis type 1 according to Myerding and patients with degenerative scoliosis. All patients underwent microscopic decompressive surgery without fusion in the year 2006 at the Munich Spine Center, Germany. One hundred and six patients were available for follow-up during the year 2010. Results At 4–5 years after the operation, 76 (71.7%) patients were satisfied with the surgical outcome. The overall complication rate was 12.2%. 23 (21%) patients required a second operative procedure, whereas three (2.8%) patients required a third operative procedure after the index operation. Two of the 23 patients who had second operations had presumed instability and underwent fusion. Conclusion Unilateral laminotomy for bilateral decompression is an adequate microsurgical technique for decompression of lumbar spinal stenosis that minimizes operative invasiveness and tissue trauma while maximizing preservation of the spinal integrity and stability. Secondary postoperative instability is avoided and excellent long-term clinical outcome could be expected.

Objectives Several studies have shown that femoral tunnel placement during double bundle anterior cruciate ligament reconstruction through the anteromedial (AM) portal is more accurate compared with the transtibial technique. Our hypothesis is that, for proper transtibial placement of the femoral tunnels, not only the anatomical sites of the tibial tunnels are important but also the slope of the tibial tunnels should match the native slope of the corresponding bundle. The anatomic insertions of the anterior cruciate ligament bundles in the femur and the tibia are well reported in the literature, but to our knowledge no study has reported the degrees of slope of the bundles. Materials and methods We examined eight cadaveric knees of middle-aged adults. The angle between each bundle and the tibial plateau was measured in both planes. The sagittal plane was measured between the bundle and the posterior tibial plateau with the knee flexed at 90°. The coronal plane was measured between the bundle and the lateral tibial plateau with the knee flexed at 90°. Results In the sagittal plane, the mean slope angle was 55.5° for the AM bundles and 90.6° for the posterolateral (PL) bundles. In the coronal plane, the mean slope angle was 80.6° for the AM and 81.3° for the PL bundles. Conclusion Focusing on the slope angles of the PL bundle in the sagittal plane (90.6°), we found that this bundle is oriented almost perpendicular to the tibial plateau. This means that for proper transtibial drilling the starting point should be from the posteromedial surface of the tibia behind the medial collateral ligament. Clinical relevance We confirm that transtibial drilling of the PL bundle is not applicable with the classic starting points on the AM surface of the tibia, and thus transportal techniques are better.

Objective Many surgeons perform anatomic anterior cruciate ligament (ACL) reconstruction through the anteromedial portal due to the difficulty in reaching the anatomic femoral insertion through the transtibial technique. A number of authors have described technical modifications to the transtibial technique to improve and restore the native femoral tunnel obliquity. In this work we present a new technique to reach the native femoral footprint in anatomic single-bundle ACL reconstruction through the transtibial tunnel with the aid of new instruments. Materials and methods From September 2009 to October 2010, 80 consecutive ACL reconstruction surgeries were performed following a prospective study design. The mean patient age was 31 years (range, 18-45 years); there were 72 male patients and eight female patients. The guide pin was inserted in the femoral footprint through the tibial tunnel with a special arthroscopic manipulator and\or pusher. Radiographic evaluation was carried out by measuring the femoral tunnel orientation in anteroposterior view in plain radiographs. Using computed tomography, the angle of femoral tunnel was measured in coronal and sagittal cuts, and the distance of the tunnel from posterior wall was measured. Clinical evaluation was performed with the IKDC scores. Results The mean angle of the femoral tunnel orientation with reference to the bicondylar line was 52.1° (range, 40°-60°). The average clock position was that of 10 O'clock. In the computed tomographic evaluation the femoral entry point at the sagittal view was 1-2 mm. The mean distance of the tunnel from the articular surface in the coronal views was 4 mm. The mean IKDC scores had increased from 55.5±18.0 to 76.8±15.3 postoperatively. Conclusion With the aid of the arthroscopic manipulator and\or the pusher, the anatomic footprint of ACL insertion site could be reached through the transtibial tunnel drilling technique.