Aims Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone. Methods This study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain. Results The study group (mean visual analogue scale (VAS) pain score of 5.5 (SD 0.889)) experienced significant reduction in pain 12 hours after surgery compared to the control group (mean VAS 6.62 (SD 1.356); mean difference = 1.12, 95% confidence interval (CI) -1.46 to 0.67; p < 0.001), and pain scores on postoperative day (POD) 1 and POD-2 were lower in the study group compared to the control group (mean difference in VAS pain = 1.04 (-1.39 to -0.68, 95% CI, p < 0.001). Fewer patients in the study group (0 vs 3 in the control group) required additional analgesia for breakthrough pain, but this was not statistically significant. The study group had significantly increased active knee flexion (mean flexion 86.4° (SD 7.22°)), compared to the control group (mean 73.86° (SD 7.88°), mean difference = 12.54, 95% CI 9.97 to 15.1; p < 0.014). Conclusion Combined ACB+ ropivacaine infusion via IAC is a safe, reproducible analgesic modality after primary TKA, with superior analgesia compared to ACB alone. Further large volume trials are warranted to generate evidence on clinical significance on analgesia after TKA. Cite this article: Bone Jt Open 2021;2(12):1082–1088.

Achilles tendinopathy is a common clinical entity for which various modalities have been tried with variable results. This study was undertaken to compare the functional outcomes in patients of Achilles tendinopathy treated with eccentric exercises and shockwave therapy. 76 patients were included in the study and were randomly divided in two groups. Patients in Group 1 were treated with eccentric exercises and in Group 2 were treated with shock wave therapy.6 patients from Group 1 and 2 patients from Group 2 did not complete the duration of follow up and were excluded from the final analysis. Functional outcomes were evaluated using VAS scores and R-FFI scores at the start of intervention and at 6, 12 and 24 weeks. Patients in both groups showed significant improvement (p<0.01) across both the measures of outcome at each follow up visit. This indicated that both these modalities are effective in the treatment of Achilles tendinopathy. The difference in results was also significant (p<0.01) when patients in Group 1 were compared with those in Group 2 indicating that eccentric exercises delivered better functional outcomes than shockwave therapy.

No abstract

Background: Incidence of distal femur fractures is approximately 37/ one lakh person-years. Distal femoral fractures mainly arise from two different injury mechanisms by high energy trauma and low energy trauma. Objective: To find out the causes of Non Union of distal femur and progress of such nonunion. Methodology: Total 35 cases of distal femur fracture nonunion satisfying inclusion and exclusion criteria treated and followed up in post graduate institute of swasthiyog pratishthan, miraj from May 2012 to September 2014 are taken in the study and all patients were followed up according to post-operative follow up protocol. Results: Among the 35 cases 31 were male and 04 were female. The mean age of case presenting to us at the detection of Non Union was 38.5 years. Symmetrical distribution of cases in the age group from 20-49 years which accounted for 29 cases (82.85%). Right limb was involved in more number of cases. Accidents were noted to be the main cause of primary fractures. Most of the cases had a compound injury initially. Aseptic Non Union was seen in 60% and infected Non Union in 40% of cases. The most common cause of non-union was found to be infection Conclusion: Commonest cause of non-union was found to be infection and most common injury associated was found to be Ipsilateral lower limb injuries.

<p><strong>Background: </strong>Lateral epicondylitis is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. Aim of the study was to examine whether a single injection of platelet-rich plasma (PRP) with needling is more effective than needling with placebo in reducing pain in adults with lateral epicondylitis. Study design used was randomized controlled trial.    </p><p><strong>Methods: </strong>A total of 66 patients with chronic lateral epicondylitis were randomized (1:1) to receive either a blinded injection of PRP (group A) or saline (placebo) group B. The primary end point was a change in pain using the VAS and patient-rated tennis elbow evaluation (PRTEE) questionnaire. The secondary outcome being improvement in function (PRTEE scores).<strong></strong></p><p><strong>Results: </strong>The VAS score and PRTEE score improved significantly in both the groups at all 3 follow-up examinations. Group A had significantly better results than the group B.</p><p><strong>Conclusions: </strong>PRP injection are safe and effective management strategy for lateral epicondylitis</p>