Introduction: ACL repair was first performed over a century ago, but reconstruction has overwhelmingly been the surgery of choice for operative ACL ruptures since the 1970s. Modern arthroscopic surgical instrumentation has made repair of ACL tissue easier and advancements in functional tissue engineering and regenerative medicine have resulted in a renewed interest in ACL repair. This is an attractive option to restore normal patient anatomy, retaining proprioceptive fibers, and not causing donor site morbidity that can be associated with reconstructions. Material & Methods:The study included 10 consecutive patients who presented with traumatic ACL avulsions (including bony avulsions) in outpatient or emergency department in last 2 years. Our inclusion criteria were cases with primary ACL injury (avulsion / proximal or distal end) not exceeding 3 months. Patients with severe arthritis of knee, multiligamantous ligament injury, history of previous surgery, bleeding disorders, any comorbidility leading to a non-operable condition were excluded from the study. Results: Out of 10 cases three cases had an avulsion from femoral end while seven had it from the tibial end. The injury surgey interval was in a range of six days to sixtythree days. Post operatively four patients had restriction of knee extension (5 degrees) at 4 weeks follow up. Rest of the cases had attained full range of motion at four weeks. All the cases had pain free gait pattern but needed aggressive physiotherapy to reinforce the normal gait pattern. There was no clinical ACL laxity in any of the cases, whenever seen at routine follow ups Conclusion: The internal brace acts as secondary pillar which supports the strength of the repaired ligament. Patients have a better proprioception, faster recovery to work & are safe guarded against an unpredictable outcome of ACL reconstruction.

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Introduction: Pertrochanteric fractures are defined as "Fractures occurring in the region extending from the extracapsular basilar neck region to the region along the lesser trochanter proximal to the development of medullary canal". Incidence of pertrochanteric fractures increase with increase in the age of population and quite often results in the end of patient's functional independence. Management of pertrochanteric fracture depends on patient's medical condition, quality of bone and the fracture biomechanics. The main goal of this study is to assess and compare the NSA in surgically fixed pertrochanteric fracture of femur at time of surgical fixation and compare it with final NSA attained at time of fracture union. Material & Method: This Observational and prospective study was conducted over a period of 1 year and includes 100 cases of pertrochanteric fractures with mature skeleton. X-ray of pelvis with both hips AP view was taken after fixation of fracture using standard protocol. Measurement of NSAs in the operated hips was done using postoperative digital X -ray films with help of Bersoft image measurement software trial version 8.49. Data was analyzed for NSA in non-fractured limb and the restoration/change in NSA in operated hip after surgical fixation and in follow up period. Result: In our study, the statistical analysis showed that mean NSA after immediate post op was 130.445 ± 11.1976, after 6 weeks was 128.586 ± 11.1954 and 127.305 ± 9.9472 at union. Conclusion: Irrespective of fixation method used (DHS/PFN), NSA significantly changes during first 6 weeks in the post op period and after 6 weeks it remains unaffected and fracture become relatively stable. Therefore it can be concluded that there is no need to delay mobilization past 6 weeks of surgery.

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft– tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student’s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value <0.05 was considered to be significant. Results: The mean age of patients in group A was 30.73±10.02 years whereas in group B it was 29.54±9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23±8.37, at 12 week score was 86.85±5.93 and at 24 week score was 95.58±4.91. For group B, mean Lysholm score at 6 weeks was 74.15±5.82, at 12 weeks score was 87.46±5.95 and at 24 weeks score was 96.92±3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p<0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. Conclusion: ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft.