Shalby Hospitals

To assess the safety, effectiveness, and postoperative outcomes of medial collateral ligament (MCL) pie-crusting (PC) in arthroscopic meniscus surgery. This systematic review was conducted in accordance with PRISMA guidelines. Three databases (PubMed, EMBASE and MEDLINE) were searched from inception to 21 January 2025, for studies evaluating the use of MCL PC during arthroscopic meniscus or anterior cruciate ligament (ACL) surgery. Data on patient demographics, medial joint space measurements, postoperative instability, patient reported outcome measures (PROMs), and complications were extracted. Fifteen studies comprising 1009 patients were included, with 723 undergoing PC. PC significantly increased medial joint space width by a mean of 5.7 mm intraoperatively (p < 0.05), with no residual laxity reported at mean final follow-up of 16.5 months. The most common complications of PC were transient medial knee pain (12.7%) and ecchymosis (12.9%). There were five reports of saphenous nerve irritation (0.8%), all resolved by final follow-up of 31.6 months. In contrast, iatrogenic chondral injury was reported in 9.0% of patients undergoing meniscal repair without PC. MCL PC is a safe and effective technique to improve visualisation and outcomes in arthroscopic meniscus surgery. It is associated with improved joint access and low complication rates without long-term instability. While current evidence supports its use, further high-quality, long-term comparative studies are needed to validate its safety and efficacy, as this study primarily used retrospective data without long-term follow-up. Level IV.

Intertrochanteric femoral fractures are common in the elderly and typically require internal fixation. This systematic review compared the clinical and radiological outcomes of the proximal femoral nail (PFN) and the dynamic hip screw (DHS) by analyzing 25 studies published between 2000 and 2024 across PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Key parameters included operative time, intraoperative blood loss, complication and reoperation rates, union time, and functional outcomes measured by the Harris hip score (HHS). Pooled evidence showed that PFN offers significant advantages in unstable fractures (AO/OTA 31-A2 and A3), demonstrating shorter operative time, reduced blood loss, lower implant-failure and reoperation rates, faster radiological union, and higher HHS at 3- and 6-month follow-up compared with DHS. DHS produced comparable results in stable fracture patterns (AO/OTA 31-A1) but was associated with higher mechanical complications in complex cases. Although PFN requires greater technical expertise and carries a small risk of iatrogenic femoral shaft fracture, its intramedullary design provides biomechanical superiority that supports early mobilization and improved functional recovery, especially in elderly osteoporotic patients. Surgical decision-making should therefore consider fracture stability, patient comorbidities, and surgeon experience to optimize outcomes.

Introduction:The approach to the management of aneurysmal bone cysts has evolved over time, with the focus shifting from surgery to less invasive therapeutic modalities. Curettage with or without bone grafting was considered the procedure of choice until recently but is associated with high recurrence rates. The management of recurrent aneurysmal bone cysts is challenging, especially in the presence of pathologic fractures. Scant literature is available on total hip arthroplasty for aneurysmal bone cysts of the proximal femur.Case Report:A 27-year-old man underwent extended curettage and bone grafting for an aneurysmal bone cyst of the right proximal femur in 1999. He presented to the emergency department 17 months after the surgery with a recurrence of the aneurysmal bone cyst and a pathologic fracture of the right femoral neck. He underwent cementless total hip arthroplasty with a ceramic-on-ceramic articulation. Intraoperatively, all residual tumor lining was cleared from the proximal femur. Following the fixation of the definitive prostheses, stable hip reduction was attained. Enhanced posterior soft tissue repair was performed. He was permitted partial weight-bearing for six weeks post-operatively, and full weight-bearing thereafter. At 24 years post-operatively, the patient had a Harris Hip Score of 97, with no radiologic evidence of osteolysis or component loosening.Conclusion:Aneurysmal bone cysts primarily affect young individuals. Their initial treatment, therefore, should focus on joint-preserving modalities. However, total hip arthroplasty must be considered for suspected recurrent aneurysmal bone cysts with pathologic fractures of the neck of the femur in patients with extensive bone loss and poor-quality residual bone.

Coronary sinus venous branch stenosis is an uncommon entity. Balloon dilatation of venous tributary may not always be safe. We report a case of venous perforation following balloon dilatation, which was managed by glue occlusion and completion of cardiac resynchronization therapy (CRT) implantation. A 50-year-old man was diagnosed with non-ischaemic cardiomyopathy with New York Heart Association (NYHA) Class III dyspnoea despite optimal medical therapy. The electrocardiogram showed a left bundle branch block with a QRS duration of 168 ms, and 2D echocardiography revealed dilated cardiomyopathy with a left ventricular ejection fraction of 20%. The patient was taken for CRT implantation; however, there was severe stenosis in the posterolateral vein noted during left ventricular (LV) lead implantation, hindering LV lead advancement. Following balloon dilatation, there was perforation of the vein with hypotension. The perforation was sealed with glue injection (n-butyl-2-cyanoacrylate), and LV lead placement was performed. At the 4-year follow-up, the patient is in NYHA Class I and the ejection fraction improved to 60%, with an excellent LV threshold and good synchronization. Glue (n-butyl-2-cyanoacrylate) occlusion can manage coronary sinus perforation with suitable long-term LV lead parameters.

PurposeTo investigate minimal clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS) values for patient‐reported outcome measures (PROMs) after patellar stabilization surgery for patellar instability. Secondary outcomes included to describe methods to calculate clinically significant outcomes (CSOs), and to report on the achievement of these metrics.MethodsOn 31 July 2024, three databases were searched. Information on whether studies calculated MCID, SCB or PASS values or used previously established values was recorded. Data on study characteristics, CSO values, and the method of MCID quantification (e.g., distribution vs. anchor) were extracted.ResultsA total of 17 articles with 1447 patients (1462 knees) were included. A total of 18 unique outcome measures were reported. Six out of 15 (40%), 2 out of 5 (40%), and zero studies used prior established values for MCID, SCB and PASS, respectively. MCID ranged widely (e.g., International Knee Documentation Committee [IKDC]: 5.6–20.5; Kujala Anterior Knee Pain Scale: 5.38–11.9 and Lysholm: 5.6–11.1). Fourteen out of 15 utilized a distribution‐based method to calculate MCID, with only one study using an anchor‐based method. SCB values ranged widely as well (e.g., IKDC: 14.5–23.6; Knee Osteoarthritis and Outcome Score [KOOS] symptoms: 4.2–14.2 and KOOS activities of daily living [ADLs]: 6.5–25.7). Large variability was found among percentages of patients that achieved MCID values (e.g., IKDC: 28%–98.6%, Kujala: 38%–100%, Lysholm: 44%–98.4% and Tegner: 84%–95%).ConclusionThe significant heterogeneity in reported thresholds for MCID, SCB and PASS across studies highlights critical challenges in interpreting results after patellar stabilization surgery, specifically regarding what constitutes a clinically relevant outcome. MCID was the most commonly reported metric and calculated predominantly with distribution‐based methods, with over half of the studies using previously established thresholds. PASS and SCB were widely underreported as well, suggesting a need for studies investigating patellar stabilization to prioritize the calculation of all three metrics, using anchor‐based techniques.Level of EvidenceLevel IV.

Background and Aims: The effectiveness of knee manipulation as a treatment for acute medial knee pain due to early knee osteoarthritis (EOA) has seldom been reported. This study analyzed the effect of the novel Shalby knee manipulation technique on medial pain and disability in patients with EOA. Methods: This prospective pilot study was conducted on patients with acute medial knee pain due to EOA. The manipulation technique was performed in all patients by an orthopedic surgeon at an outpatient clinic of an arthroplasty center. Visual Analog Scale (VAS) score, Knee Society Score (KSS) were recorded pretreatment, immediate posttreatment, and at the end of 1 month, 3 months, and 6 months after the manipulation. Results: In 56 knees which underwent knee manipulation, the mean pretreatment VAS and KSS scores significantly reduced ( P &lt; 0.0001) immediately postmanipulation. At 1-month, 3-month, and 6-month follow-up, the mean VAS and KSS scores were similar to immediate postmanipulation values. Pretreatment, 7% of the knees had a VAS score ≤3 whereas 62.5% of the knees immediate posttreatment, 69% of the knees at 1-month posttreatment, 62% of the knees at 3-month posttreatment, and 67.5% of the knees at 6-month posttreatment had a VAS score ≤3. Conclusion: The novel Shalby knee manipulation technique helped achieve significant improvement in pain and function which was maintained at the end of 6 months posttreatment in 67.5% of the knees in patients with EOA. However, the results of this pilot study should be interpreted in light of its design limitations and needs validation by a randomized controlled trial.

Thalassemia is one of the most common inherited blood disorders worldwide. This defect causes a disproportionate ratio of α- and β-globin chains resulting in ineffective erythropoiesis leading to increased iron absorption. In patients where the imbalance between α and β globin chains is great they are dependent on blood transfusions for survival. This results in transfusional iron overload but also comes with additional risks such as transfusion-transmissible viral infections like hepatitis B and C. This can lead to various complications like liver fibrosis, cirrhosis and hepatocellular carcinoma, which are important causes with morbidity and mortality in patients of thalassemia today. These hepatobiliary manifestations and their management are briefly discussed in this review. Understanding hepatobiliary complications in thalassemia is vital for optimizing patient care.

ACL injury in skeletally immature patients remains a debatable topic in terms of its management, surgical choices and rehabilitation. The treatment preferences vary across the globe. Children are not little adults in terms of their physiology and anatomy. Hence, contemporary treatment inferred from the adult population does not give the same outcomes in pediatric patients. An in-depth study of specific challenges and difficulties is warranted to optimize the treatment strategies to cater to this group of patients. There is a paucity of literature giving long-term follow-up of ACLR in skeletally immature patients and no standardized guidelines are present for managing this group of patients. The authors have tried to summarize the current concepts for managing ACL injuries in skeletally immature patients through this article. Multiple lacunae and controversies exist in the knowledge regarding the optimum treatment of pediatric patients with ACL injuries who are comparatively more prone to ACL tears than their adult counterparts. Identifying the best mode of management of ACL tears in these skeletally immature patients is necessary. Level of evidence: Level IV.