Staged management of multiple ligament injuries of the knee enabled satisfactory restoration of function, stability, and range of movement in most of our patients. By staging the procedures, the need for subsequent ACL reconstruction can be better evaluated, as ACL reconstruction is not necessary in patients not undertaking strenuous activities.

Background:The lesion in spondylolysis is a nonunion that follows a fatigue fracture of pars interarticularis. Direct repair of the pars defect is a logical alternative to fusion as it helps to preserve the motion segment and prevents abnormal stresses at the adjacent levels. The purpose of the study is to analyze the clinical and radiological results of direct screw osteosynthesis of the pars defect by the Buck’s method in patients with symptomatic spondylolysis with or without grade 1 spondylolisthesis.Materials and Methods:Nine patients (six males, three females, mean age 24 years) with symptomatic spondylolysis with or without grade 1 spondylolisthesis and a normal disc in magnetic resonance imaging (MRI), who failed conservative treatment, underwent surgery between January 2000 and April 2009. Of them five patients had bilateral lysis at one level, one had bilateral lysis at three levels and two levels each and two had unilateral lysis at one level. Direct pars repair by the Buck’s method with internal fixation of the defect using 4.5 mm cortical screws and cancellous bone grafting was done. The mean follow-up period was 45 months. MacNab criteria were used to evaluate the postoperative functional outcome. Healing of the pars defect was assessed by plain radiographs and computed tomography (CT) scan.Results:Spondylolysis was bilateral in seven and unilateral in two patients. Two patients had associated grade 1 spondylolisthesis. The mean operative time was 58 minutes (range 45 – 75 minutes) and blood loss was 98 ml (50 – 140 ml). Although radiological fusion was observed in all patients at a mean follow-up of 45 months (range 9 to 108 months), the functional outcome was excellent in two patients and good in five, with one fair and one poor result. The overall result of the procedure was satisfactory in 78% (7/9) of the patients. The two patients with associated grade 1 spondylolisthesis had fair and poor results. No complications were encountered in the perioperative or postoperative period.Conclusions:In carefully selected patients, direct repair of the pars defect by the Buck’s technique of internal fixation and bone grafting was a safe and effective alternative to fusion in younger patients with symptomatic spondylolysis, without associated spondylolisthesis, who failed conservative management.

The study documents widespread changes in the EP and NP even in discs with minimal wedging. EP damage and alterations in diffusion were observed earlier than MRI changes and could indicate nutritional factors as the primary mechanism of degeneration induced by mechanical stress. Degeneration was more severe in caudal discs and those with truncal decompensation. Its implications on the timing and choice of surgery in scoliosis are discussed.