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Papers by Mahmoud Jabal-Ameli

Current Orthopaedic Practice

Background: Internal fixation is the standard choice for treatment of posterior cruciate ligament... more Background: Internal fixation is the standard choice for treatment of posterior cruciate ligament (PCL) avulsion with a large bony fragment. However, it is not without complication. This study investigated PCL avulsions with large bony fragments to determine if conservative management resulted in acceptable outcomes. Methods: In a prospective cohort study, the outcome of conservative management of PCL avulsion with large bony fragment was evaluated in 40 patients. The inclusion criteria were a fracture size of more than 20 mm and a displacement of less than 2 mm. The outcomes were evaluated after 12 mo and included the evaluation knee range of motion and scoring of the modified Lysholm questionnaire and the International Knee Documentation Committee. Knee instability was checked by the drawer test and confirmed by stress radiography. Results: The mean patient age was 36.9±16.1 yr. The mean final knee range of motion (ROM) was 125.6±8.2 degrees. The mean Lysholm score was 92.3±6.1 points. Accordingly, the excellent, good, and fair results were observed in 29 (72.5%), eight (20%), and three (7.5%) patients, respectively. The mean International Knee Documentation Committee score of the patients was 94.2±5.3 points. Postoperative instability was seen in two patients. Nonunion was observed in two other patients. The size of the bony fragment was 30 and 32 mm in patients with nonunion. Conclusions: Conservative management of the PCL avulsion with a large bony fragment could result in acceptable outcome. However, application of this technique needs further characterization, particularly with respect to the size of bony fragment. Level of Evidence: Level II.

Journal of Research in Orthopedic Science, 2021

Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for... more Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis. Objectives: In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA. Patients and Methods: Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3). Results: The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-u...

Journal of Research in Orthopedic Science, 2019

Background: The preoperative identification of patients who might need constrained condylar knee ... more Background: The preoperative identification of patients who might need constrained condylar knee (CCK) prosthesis in total knee arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. Objectives: In this study, we aimed at investigating if the preoperative features of the patients can provide this data. Methods: A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum deformity (varus angle ≥20º) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the deformity, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps. Results: The study population included 4 males and 26 females with a mean±SD age of 64.6±8.7 yea...

Background: High Tibial Osteotomy (HTO) is an approved surgical technique for varus knee deformit... more Background: High Tibial Osteotomy (HTO) is an approved surgical technique for varus knee deformity. For open wedge HTO multiple fixation methods and devices have been used. Advantages and disadvantages of these methods and devices are reported in various studies. Few studies have been conducted on use and final outcome of correction of varus knee deformity by implementation of non locking plates and benefits of this method is not fully evaluated. Objectives: To assess clinical and radiographic features of non-locking 4.5 millimeter L-buttress plate and T-buttress plate, which is used in open wedge High Tibial Osteotomy (HTO), and to find out whether this device is efficient enough or not. Methods: This cross-sectional study was conducted on 39 patients with tibial deformity recruited from a referral orthopedic hospital in Iran. Patients’ information, including their baseline characteristics, Range of Motion (ROM) of the knee, comorbidities, time of weight-bearing, union time in x-ra...

Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alk... more Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alkapton in different tissues, causing darkness and injury, especially in spine and large cartilages, called ochronosis. The urine darkness can be a key to early diagnosis in childhood, but some cases are missed until adulthood and gradual damage to cartilages causes disability and impairs the patients’ quality of life. Here, a 49-year old male patient is presented with a 2 week history of left knee pain and swelling, who underwent arthrotomy, and the macro- and microscopic evaluation revealed ochronosis, superimposed by septic arthritis. Diagnosis of this rare disease should be considered in differential diagnoses of common joint disorders, like septic arthritis and osteoarthritis, so that appropriate management of the disease can prevent further damages.

The archives of bone and joint surgery, 2015

BACKGROUND Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity co... more BACKGROUND Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity could be done in either uniplanar or biplanar fashion.Union time and stability of the osteotomy site has been considered important in this anatomic region. In this study, clinical and radiographic findings of biplane distal femur osteotomy were reported. METHODS Clinical, functional, and radiological findings of eight patients (10 knees) underwent biplane distal femur osteotomy were evaluated. Visual analogue score (VAS) and Lysholm-Tegner knee score were used for the assessment of pain and function before and three months after surgery. RESULTS In this study, eight patients were included. All patients were female. The mean age was 28±6.3. The mean pre-operative mechanical angle was 8.7±2.2° and the post-operative angle was 1.4±0.53° in patients with valgus alignment whileit was 7.0±1.0°preoperatively and 0.66±1.2° postoperatively in patients with varus alignment. The mean lateral distal f...

Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alk... more Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alkapton in different tissues, causing darkness and injury, especially in spine and large cartilages, called ochronosis. The urine darkness can be a key to early diagnosis in childhood, but some cases are missed until adulthood and gradual damage to cartilages causes disability and impairs the patients' quality of life. Here, a 49-year old male patient is presented with a 2 week history of left knee pain and swelling, who underwent arthrotomy, and the macro-and microscopic evaluation revealed ochronosis, superimposed by septic arthritis. Diagnosis of this rare disease should be considered in differential diagnoses of common joint disorders, like septic arthritis and osteoarthritis, so that appropriate management of the disease can prevent further damages.

Background: Management of patellar maltracking during primary TKA is of considerable importance. ... more Background: Management of patellar maltracking during primary TKA is of considerable importance. Lateral release, which is generally performed for this purpose, is associated with several complications. Objectives: In this study, we aimed to evaluate the role of partial lateral facetectomy in tracking the patella in Total Knee Arthroplasty (TKA). Methods: In a retrospective study, the efficiency of partial lateral facetectomy of the patella in achieving proper tracking of the patella was evaluated in 116 patients who underwent unresurfaced patellar-retaining TKA. The radiographic outcome measures included the patellar tilt and patellar shift. The functional outcome was assessed with Kujala anterior knee pain scale. Results: The Mean±SD age of the patients was 66.3±7.6 years. The mean follow-up of patients was ‎‎20.6±8.9 months. The Mean±SD patellar tilt was ‎‎10.5±7.2‎‎‏°‎‏ before the surgery and ‏‎4.4±5‎‎‏° after ‏the operation ‏‎ (‎P‎<‎‏0.001‏‎). ‎The Mean±SD preoperative patel...

Trauma Monthly, 2018

Background: Early detection and treatment of extensor mechanism rupture are essential for a long-... more Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon rupture. Methods: This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18-58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3-132). The mean time of follow-up was 6.2 years (range 3-9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Shafa Orthopedic Journal, 2018

Traumatic bilateral patellar tendon rupture (BPTR) is a rare injury with low levels of clinical s... more Traumatic bilateral patellar tendon rupture (BPTR) is a rare injury with low levels of clinical suspicion, especially in young adults. Since early diagnosis of the BPTR is the cornerstone of a successful management, BPTR reports are valuable as they raise awareness of the careful clinical and radiologic workout in similar cases. Here, we present a case of BPTR in a 34-year-old male following a motorcycle accident. At the emergency department, the necessary examinations including clinical, physical, and radiologic tests were performed and BPTR was diagnosed accordingly. The patient underwent reconstruction surgery the day after the injury. At the last follow-up, the patient was able to perform active straight leg raise with 130°flexion and no extension lag. The superior results of BPTR reconstruction in this report further emphasize the importance of early diagnosis and repair of BPTR. Active straight leg raise test is necessary to perform for all patients with a history of an eccentric load of the knee extensor mechanism, and if positive, extensor mechanism rupture should be strongly suspected.

Shafa Orthopedic Journal, 2018

Introduction: Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Althou... more Introduction: Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Although isolated posterior Hoffa fractures of medial femoral condyle have been rarely reported, no reports are available regarding the anterior fracture of this type. Here, we report a large isolated anterior osteoarticular fracture of the medial femoral condyle. Case Presentation: A 16-year-old girl with a traumatic open joint injury of the right knee caused by a car-to-pedestrian accident was referred to our emergency department for further evaluation. A physical examination of the knee revealed effusion and limited knee range of motion. While no obvious fracture was detectable on plain radiographs of the knee, a large anterior osteoarticular fracture of the medial femoral condyle was observed in computed tomography (CT), which was detached from the medial condyle. The fracture was managed with open reduction and internal fixation. Eight weeks after the surgery, the patient retrieved the full knee motions and the complete union of the fracture was observed. No complication was reported by the patient at a follow-up period of 12 months. Conclusions: In cases with knee tenderness and/or effusion and normal plain radiographs, whenever there is a discrepancy between plain radiographs and clinical symptoms of the patient, a further evaluation of the knee with a CT scan and/or MRI is necessary to avoid missing a Hoffa fracture, which could be successfully treated if timely diagnosed.

Clinical medicine insights. Case reports, 2018

The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arth... more The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported. This report describes 3 cases of chronic anterior knee dislocation treated by total knee arthroplasty. Three female patients with chronic anterior knee dislocation were treated by hinged prosthesis total knee arthroplasty using the Insall rectus snip approach. At a mean of 17 months (range, 12-24 months) of follow-up, all patients showed a painless stable prosthesis and expressed satisfaction with the results. Total knee arthroplasty for chronic anterior knee dislocation is a challenging procedure. The Insall rectus snip approach with quadriceps release and constrained prosthesis is recommended.

Journal of Surgical Case Reports, 2017

Osteochondral fracture (OCF) in the weight-bearing surface of the lateral femoral condyle, associ... more Osteochondral fracture (OCF) in the weight-bearing surface of the lateral femoral condyle, associated with patellar dislocation, is an uncommon lesion. We report three cases of acute lateral patellar dislocation with large OCF in the weight-bearing portion of the lateral femoral condyle. In patients with lateral patella dislocation or lateral femoral condyle OCF, careful physical examination, radiography and MRI are recommended to rule out any associated injury.

Shafa Orthopedic Journal, 2017

Introduction: Osteoarticular allograft, for reconstruction of large bone loss, was introduced for... more Introduction: Osteoarticular allograft, for reconstruction of large bone loss, was introduced for bone loss after tumor resection and subsequently has been used for posttraumatic cases. A main advantage of unicondylar osteoarticular allograft reconstruction is the bone stock preservation, after tumor resection, or traumatic bone loss, providing an opportunity for easier salvage procedures with conventional total knee prosthesis in cases that are complicated by joint pain as well as arthritis. Case Presentation: A 50-year-old female with post-traumatic medial femoral condyle non-union and bone loss after multiple operations was treated by unicondylar fresh osteochondral allograft reconstruction. Three years later, due to severe pain, progressive varus deformity with varus thrust, as well as osteoarthritis, a total knee arthroplasty with conventional PS prosthesis was performed. A long term follow up reveals a stable prosthesis and acceptable functional outcomes. Conclusions: Unicondylar osteoarticular allograft reconstruction can be recommended for post-traumatic massive femoral condylar defect. It has relatively good clinical and radiographic results, low rate of complications, and preserves bone stock for future total knee arthroplasty.

European Journal of Orthopaedic Surgery & Traumatology, 2016

Background There is no consensus regarding the use of filling agent in the re-elevation of depres... more Background There is no consensus regarding the use of filling agent in the re-elevation of depressed tibial plateau fracture (TPF). Although autograft is considered as the gold standard approach of such reconstructions, its limitation has led to a recent attraction toward allograft substitution. In this study, we compare the complications and outcome of autograft and allograft in TPF reconstruction, in order to address the existing controversy. Materials and methods A total of 81 patients with acute TPF were included in this study. Allograft and autograft were applied in 58 and 23 cases, respectively. The mean age of the patients was 40.26 years, and the mean followup period of patients was 19.1 months. Clinical and radiological assessment of the outcome was conducted, employing the modified Rasmussen clinical criteria. Results A total of three infections were observed in our patients, from which two infections occurred in allograft received patients. Articular surface collapse was seen in two cases, including one allograft and one autograft receiving patient. The mean clinical score was 18.65 and 18.55 in autograft and allograft received patients, respectively (p = 0.09). The mean radiological score was 15.65 and 15.68 in autograft and allograft received patients (p = 0.3). Conclusion With respect to the comparable complication rate, clinical and radiological outcome of allogenic versus autologous reconstruction of TPF, freeze-dried allograft could be recommended as an appropriate substitute of autograft in this treatment. Nevertheless, the longer followup period of the patients could further extend our understanding of the clinical outcome of each component.

Shafa Orthopedic Journal, 2016

Background: It is generally accepted that total knee arthroplasty (TKA) after high tibial osteoto... more Background: It is generally accepted that total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is technically more difficult; however, there is still disagreement whether the subsequent arthroplasty is compromised. Objectives: The current case series study aimed to assess patients treated by knee arthroplasty after a previous high tibial osteotomy and to determine the influence of this osteotomy on the clinical and radiologic outcomes of subsequent arthroplasty. Methods: Up to April 2013, twenty-three patients with a history of twenty-five proximal tibial osteotomies prior to TKA were identified and compared with a matched group who underwent primary TKA in Shafa Orthopedic Hospital, Tehran, Iran. Demographic parameters of patients, surgical details, the knee range of motion (ROM), and American functional knee society (AKS) scores before and after TKA were recorded in the HTO and control groups. Weight bearing alignment radiographs were taken preoperatively and at the last follow-up. At the latest visit, patients' satisfaction was recorded. Results: After an average of 49 months follow-up, all patients in the HTO and control groups were satisfied with their current level of function. In the HTO group, the rectus snip had to be used for better exposure in eight cases. There was no statistically significant difference between the two groups in postoperative knee ROM, mechanical leg alignment and mean functional knee society score, but the mean of operation time in the HTO group was significantly longer than that of the TKA time in the control group. Conclusion: Although knee arthroplasty after HTO is technically more challenging than a primary procedure, the results of clinical scores, postoperative ROM and radiological evaluation in the study subjects were comparable with those of the primary TKA in midterm follow-up. Rectus snip is a safe procedure in such difficult cases for better exposure.

Shafa Orthopedic Journal, 2015

Background: There is significant evidence of hip and knee kinematic influence on each other. In s... more Background: There is significant evidence of hip and knee kinematic influence on each other. In some studies, hip restricted range of motion is a risk factor of anterior cruciate ligament (ACL) tear. Objectives: This study was designed to compare hip range of motion in physical examination between non-contact ACL injured patients with normal population. Patients and Methods: One hundred and forty patients with arthroscopically confirmed primary ACL ruptures were evaluated to assess their hip range of motion; these findings were compared with a control group of 100 patients with non ACL injury. Results: All parameters of hip range of motion (internal rotation, abduction and adduction) except external rotation were decreased significantly in ACL injured group compared with control group. Patients with sum of internal and external rotation lower than 80° had an increased odds ratio of having ACL injuries (OR = 2.64; 95% CI, 1.4 to 4.7). Conclusions: There was an association between non-contact ACL rupture and decreased hip range of motions including internal rotation, abduction and adduction as well as sum of internal and external rotation. Therefore, it may be possible to use hip physical exam finding as a predictor of ACL rupture.

Biomedical and Pharmacology Journal, 2014

Total Knee Arthroplasty (TKA) is being used with the main goal of pain reduction and lower extrem... more Total Knee Arthroplasty (TKA) is being used with the main goal of pain reduction and lower extremity alignment correction with a proven positive impact. Surgeons' criterion for the suitability of extremity alignment is to compare them (The angle between femur mechanical axis with tibial mechanical axis) with extremity mechanical axis (a line connecting the midpoint of the femoral head to the midpoint of the talus). Most professionals consider ideal up to 3 degrees difference between extremity alignment with extremity mechanical axis after surgery, thereby increasing the life of the arthroplasty components. In this study, the intention was to show parameters associated with surgery success with the evaluation of patients with ATK successful surgery. In this study, 102 patients with TKA operation in Fajr Hospital of Tehran were selected and required information was extracted from their archived files. Having no arthroplasty after the operation was the main criterion for selecting these patients. Statistical analysis showed that parameters such as BMI, gender, urinary tract infection, and so do not affect the success of ATK surgery. However, it was shown that there is a significant relationship between the success rates of surgery on left knee with the type of surgery. Although there is no significant relationship between some underlying factors such as blood group, gender, or urinary tract infections with the success of TKA surgery, the type of surgery can be an important and determinant factor in the success of the surgery. Statistical analysis on TKA surgery can provide useful information to successfully conduct this type of operation in the future.

Medical journal of the Islamic Republic of Iran, 2014

Pigmented villonodular synovitis (PVNS) is characterized by the presence of inflammation and hemo... more Pigmented villonodular synovitis (PVNS) is characterized by the presence of inflammation and hemosiderin deposition in the synovium. Two forms of PVNS distinguished in the literature are diffused and localized involvements. There are controversies in the literature about the surgical management of PVNS. We report our experience in the management of knee PVNS at a mean follow-up of 4 years. We also introduce our preferred method of treatment for these patients. A number of 26 patients (26 knees) with histologically proven PVNS of the knee in the pathology department at Shafa Yahyaeyan hospital were identified between January 1996 and February 2012. Annual clinical follow-up was conducted in all patients and a follow-up MRI scans was ordered for symptomatic cases. All patients were examined according to the Knee Society Score (KSS) in which the knees were graded from excellent to poor. Mean age of the patients was 28.08±12.5. A number of 15 patients (58%) had diffused involvement of t...

Current Orthopaedic Practice

Background: Internal fixation is the standard choice for treatment of posterior cruciate ligament... more Background: Internal fixation is the standard choice for treatment of posterior cruciate ligament (PCL) avulsion with a large bony fragment. However, it is not without complication. This study investigated PCL avulsions with large bony fragments to determine if conservative management resulted in acceptable outcomes. Methods: In a prospective cohort study, the outcome of conservative management of PCL avulsion with large bony fragment was evaluated in 40 patients. The inclusion criteria were a fracture size of more than 20 mm and a displacement of less than 2 mm. The outcomes were evaluated after 12 mo and included the evaluation knee range of motion and scoring of the modified Lysholm questionnaire and the International Knee Documentation Committee. Knee instability was checked by the drawer test and confirmed by stress radiography. Results: The mean patient age was 36.9±16.1 yr. The mean final knee range of motion (ROM) was 125.6±8.2 degrees. The mean Lysholm score was 92.3±6.1 points. Accordingly, the excellent, good, and fair results were observed in 29 (72.5%), eight (20%), and three (7.5%) patients, respectively. The mean International Knee Documentation Committee score of the patients was 94.2±5.3 points. Postoperative instability was seen in two patients. Nonunion was observed in two other patients. The size of the bony fragment was 30 and 32 mm in patients with nonunion. Conclusions: Conservative management of the PCL avulsion with a large bony fragment could result in acceptable outcome. However, application of this technique needs further characterization, particularly with respect to the size of bony fragment. Level of Evidence: Level II.

Journal of Research in Orthopedic Science, 2021

Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for... more Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis. Objectives: In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA. Patients and Methods: Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3). Results: The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-u...

Journal of Research in Orthopedic Science, 2019

Background: The preoperative identification of patients who might need constrained condylar knee ... more Background: The preoperative identification of patients who might need constrained condylar knee (CCK) prosthesis in total knee arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. Objectives: In this study, we aimed at investigating if the preoperative features of the patients can provide this data. Methods: A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum deformity (varus angle ≥20º) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the deformity, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps. Results: The study population included 4 males and 26 females with a mean±SD age of 64.6±8.7 yea...

Background: High Tibial Osteotomy (HTO) is an approved surgical technique for varus knee deformit... more Background: High Tibial Osteotomy (HTO) is an approved surgical technique for varus knee deformity. For open wedge HTO multiple fixation methods and devices have been used. Advantages and disadvantages of these methods and devices are reported in various studies. Few studies have been conducted on use and final outcome of correction of varus knee deformity by implementation of non locking plates and benefits of this method is not fully evaluated. Objectives: To assess clinical and radiographic features of non-locking 4.5 millimeter L-buttress plate and T-buttress plate, which is used in open wedge High Tibial Osteotomy (HTO), and to find out whether this device is efficient enough or not. Methods: This cross-sectional study was conducted on 39 patients with tibial deformity recruited from a referral orthopedic hospital in Iran. Patients’ information, including their baseline characteristics, Range of Motion (ROM) of the knee, comorbidities, time of weight-bearing, union time in x-ra...

Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alk... more Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alkapton in different tissues, causing darkness and injury, especially in spine and large cartilages, called ochronosis. The urine darkness can be a key to early diagnosis in childhood, but some cases are missed until adulthood and gradual damage to cartilages causes disability and impairs the patients’ quality of life. Here, a 49-year old male patient is presented with a 2 week history of left knee pain and swelling, who underwent arthrotomy, and the macro- and microscopic evaluation revealed ochronosis, superimposed by septic arthritis. Diagnosis of this rare disease should be considered in differential diagnoses of common joint disorders, like septic arthritis and osteoarthritis, so that appropriate management of the disease can prevent further damages.

The archives of bone and joint surgery, 2015

BACKGROUND Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity co... more BACKGROUND Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity could be done in either uniplanar or biplanar fashion.Union time and stability of the osteotomy site has been considered important in this anatomic region. In this study, clinical and radiographic findings of biplane distal femur osteotomy were reported. METHODS Clinical, functional, and radiological findings of eight patients (10 knees) underwent biplane distal femur osteotomy were evaluated. Visual analogue score (VAS) and Lysholm-Tegner knee score were used for the assessment of pain and function before and three months after surgery. RESULTS In this study, eight patients were included. All patients were female. The mean age was 28±6.3. The mean pre-operative mechanical angle was 8.7±2.2° and the post-operative angle was 1.4±0.53° in patients with valgus alignment whileit was 7.0±1.0°preoperatively and 0.66±1.2° postoperatively in patients with varus alignment. The mean lateral distal f...

Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alk... more Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alkapton in different tissues, causing darkness and injury, especially in spine and large cartilages, called ochronosis. The urine darkness can be a key to early diagnosis in childhood, but some cases are missed until adulthood and gradual damage to cartilages causes disability and impairs the patients' quality of life. Here, a 49-year old male patient is presented with a 2 week history of left knee pain and swelling, who underwent arthrotomy, and the macro-and microscopic evaluation revealed ochronosis, superimposed by septic arthritis. Diagnosis of this rare disease should be considered in differential diagnoses of common joint disorders, like septic arthritis and osteoarthritis, so that appropriate management of the disease can prevent further damages.

Background: Management of patellar maltracking during primary TKA is of considerable importance. ... more Background: Management of patellar maltracking during primary TKA is of considerable importance. Lateral release, which is generally performed for this purpose, is associated with several complications. Objectives: In this study, we aimed to evaluate the role of partial lateral facetectomy in tracking the patella in Total Knee Arthroplasty (TKA). Methods: In a retrospective study, the efficiency of partial lateral facetectomy of the patella in achieving proper tracking of the patella was evaluated in 116 patients who underwent unresurfaced patellar-retaining TKA. The radiographic outcome measures included the patellar tilt and patellar shift. The functional outcome was assessed with Kujala anterior knee pain scale. Results: The Mean±SD age of the patients was 66.3±7.6 years. The mean follow-up of patients was ‎‎20.6±8.9 months. The Mean±SD patellar tilt was ‎‎10.5±7.2‎‎‏°‎‏ before the surgery and ‏‎4.4±5‎‎‏° after ‏the operation ‏‎ (‎P‎<‎‏0.001‏‎). ‎The Mean±SD preoperative patel...

Trauma Monthly, 2018

Background: Early detection and treatment of extensor mechanism rupture are essential for a long-... more Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon rupture. Methods: This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18-58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3-132). The mean time of follow-up was 6.2 years (range 3-9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Shafa Orthopedic Journal, 2018

Traumatic bilateral patellar tendon rupture (BPTR) is a rare injury with low levels of clinical s... more Traumatic bilateral patellar tendon rupture (BPTR) is a rare injury with low levels of clinical suspicion, especially in young adults. Since early diagnosis of the BPTR is the cornerstone of a successful management, BPTR reports are valuable as they raise awareness of the careful clinical and radiologic workout in similar cases. Here, we present a case of BPTR in a 34-year-old male following a motorcycle accident. At the emergency department, the necessary examinations including clinical, physical, and radiologic tests were performed and BPTR was diagnosed accordingly. The patient underwent reconstruction surgery the day after the injury. At the last follow-up, the patient was able to perform active straight leg raise with 130°flexion and no extension lag. The superior results of BPTR reconstruction in this report further emphasize the importance of early diagnosis and repair of BPTR. Active straight leg raise test is necessary to perform for all patients with a history of an eccentric load of the knee extensor mechanism, and if positive, extensor mechanism rupture should be strongly suspected.

Shafa Orthopedic Journal, 2018

Introduction: Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Althou... more Introduction: Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Although isolated posterior Hoffa fractures of medial femoral condyle have been rarely reported, no reports are available regarding the anterior fracture of this type. Here, we report a large isolated anterior osteoarticular fracture of the medial femoral condyle. Case Presentation: A 16-year-old girl with a traumatic open joint injury of the right knee caused by a car-to-pedestrian accident was referred to our emergency department for further evaluation. A physical examination of the knee revealed effusion and limited knee range of motion. While no obvious fracture was detectable on plain radiographs of the knee, a large anterior osteoarticular fracture of the medial femoral condyle was observed in computed tomography (CT), which was detached from the medial condyle. The fracture was managed with open reduction and internal fixation. Eight weeks after the surgery, the patient retrieved the full knee motions and the complete union of the fracture was observed. No complication was reported by the patient at a follow-up period of 12 months. Conclusions: In cases with knee tenderness and/or effusion and normal plain radiographs, whenever there is a discrepancy between plain radiographs and clinical symptoms of the patient, a further evaluation of the knee with a CT scan and/or MRI is necessary to avoid missing a Hoffa fracture, which could be successfully treated if timely diagnosed.

Clinical medicine insights. Case reports, 2018

The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arth... more The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported. This report describes 3 cases of chronic anterior knee dislocation treated by total knee arthroplasty. Three female patients with chronic anterior knee dislocation were treated by hinged prosthesis total knee arthroplasty using the Insall rectus snip approach. At a mean of 17 months (range, 12-24 months) of follow-up, all patients showed a painless stable prosthesis and expressed satisfaction with the results. Total knee arthroplasty for chronic anterior knee dislocation is a challenging procedure. The Insall rectus snip approach with quadriceps release and constrained prosthesis is recommended.

Journal of Surgical Case Reports, 2017

Osteochondral fracture (OCF) in the weight-bearing surface of the lateral femoral condyle, associ... more Osteochondral fracture (OCF) in the weight-bearing surface of the lateral femoral condyle, associated with patellar dislocation, is an uncommon lesion. We report three cases of acute lateral patellar dislocation with large OCF in the weight-bearing portion of the lateral femoral condyle. In patients with lateral patella dislocation or lateral femoral condyle OCF, careful physical examination, radiography and MRI are recommended to rule out any associated injury.

Shafa Orthopedic Journal, 2017

Introduction: Osteoarticular allograft, for reconstruction of large bone loss, was introduced for... more Introduction: Osteoarticular allograft, for reconstruction of large bone loss, was introduced for bone loss after tumor resection and subsequently has been used for posttraumatic cases. A main advantage of unicondylar osteoarticular allograft reconstruction is the bone stock preservation, after tumor resection, or traumatic bone loss, providing an opportunity for easier salvage procedures with conventional total knee prosthesis in cases that are complicated by joint pain as well as arthritis. Case Presentation: A 50-year-old female with post-traumatic medial femoral condyle non-union and bone loss after multiple operations was treated by unicondylar fresh osteochondral allograft reconstruction. Three years later, due to severe pain, progressive varus deformity with varus thrust, as well as osteoarthritis, a total knee arthroplasty with conventional PS prosthesis was performed. A long term follow up reveals a stable prosthesis and acceptable functional outcomes. Conclusions: Unicondylar osteoarticular allograft reconstruction can be recommended for post-traumatic massive femoral condylar defect. It has relatively good clinical and radiographic results, low rate of complications, and preserves bone stock for future total knee arthroplasty.

European Journal of Orthopaedic Surgery & Traumatology, 2016

Background There is no consensus regarding the use of filling agent in the re-elevation of depres... more Background There is no consensus regarding the use of filling agent in the re-elevation of depressed tibial plateau fracture (TPF). Although autograft is considered as the gold standard approach of such reconstructions, its limitation has led to a recent attraction toward allograft substitution. In this study, we compare the complications and outcome of autograft and allograft in TPF reconstruction, in order to address the existing controversy. Materials and methods A total of 81 patients with acute TPF were included in this study. Allograft and autograft were applied in 58 and 23 cases, respectively. The mean age of the patients was 40.26 years, and the mean followup period of patients was 19.1 months. Clinical and radiological assessment of the outcome was conducted, employing the modified Rasmussen clinical criteria. Results A total of three infections were observed in our patients, from which two infections occurred in allograft received patients. Articular surface collapse was seen in two cases, including one allograft and one autograft receiving patient. The mean clinical score was 18.65 and 18.55 in autograft and allograft received patients, respectively (p = 0.09). The mean radiological score was 15.65 and 15.68 in autograft and allograft received patients (p = 0.3). Conclusion With respect to the comparable complication rate, clinical and radiological outcome of allogenic versus autologous reconstruction of TPF, freeze-dried allograft could be recommended as an appropriate substitute of autograft in this treatment. Nevertheless, the longer followup period of the patients could further extend our understanding of the clinical outcome of each component.

Shafa Orthopedic Journal, 2016

Background: It is generally accepted that total knee arthroplasty (TKA) after high tibial osteoto... more Background: It is generally accepted that total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is technically more difficult; however, there is still disagreement whether the subsequent arthroplasty is compromised. Objectives: The current case series study aimed to assess patients treated by knee arthroplasty after a previous high tibial osteotomy and to determine the influence of this osteotomy on the clinical and radiologic outcomes of subsequent arthroplasty. Methods: Up to April 2013, twenty-three patients with a history of twenty-five proximal tibial osteotomies prior to TKA were identified and compared with a matched group who underwent primary TKA in Shafa Orthopedic Hospital, Tehran, Iran. Demographic parameters of patients, surgical details, the knee range of motion (ROM), and American functional knee society (AKS) scores before and after TKA were recorded in the HTO and control groups. Weight bearing alignment radiographs were taken preoperatively and at the last follow-up. At the latest visit, patients' satisfaction was recorded. Results: After an average of 49 months follow-up, all patients in the HTO and control groups were satisfied with their current level of function. In the HTO group, the rectus snip had to be used for better exposure in eight cases. There was no statistically significant difference between the two groups in postoperative knee ROM, mechanical leg alignment and mean functional knee society score, but the mean of operation time in the HTO group was significantly longer than that of the TKA time in the control group. Conclusion: Although knee arthroplasty after HTO is technically more challenging than a primary procedure, the results of clinical scores, postoperative ROM and radiological evaluation in the study subjects were comparable with those of the primary TKA in midterm follow-up. Rectus snip is a safe procedure in such difficult cases for better exposure.

Shafa Orthopedic Journal, 2015

Background: There is significant evidence of hip and knee kinematic influence on each other. In s... more Background: There is significant evidence of hip and knee kinematic influence on each other. In some studies, hip restricted range of motion is a risk factor of anterior cruciate ligament (ACL) tear. Objectives: This study was designed to compare hip range of motion in physical examination between non-contact ACL injured patients with normal population. Patients and Methods: One hundred and forty patients with arthroscopically confirmed primary ACL ruptures were evaluated to assess their hip range of motion; these findings were compared with a control group of 100 patients with non ACL injury. Results: All parameters of hip range of motion (internal rotation, abduction and adduction) except external rotation were decreased significantly in ACL injured group compared with control group. Patients with sum of internal and external rotation lower than 80° had an increased odds ratio of having ACL injuries (OR = 2.64; 95% CI, 1.4 to 4.7). Conclusions: There was an association between non-contact ACL rupture and decreased hip range of motions including internal rotation, abduction and adduction as well as sum of internal and external rotation. Therefore, it may be possible to use hip physical exam finding as a predictor of ACL rupture.

Biomedical and Pharmacology Journal, 2014

Total Knee Arthroplasty (TKA) is being used with the main goal of pain reduction and lower extrem... more Total Knee Arthroplasty (TKA) is being used with the main goal of pain reduction and lower extremity alignment correction with a proven positive impact. Surgeons' criterion for the suitability of extremity alignment is to compare them (The angle between femur mechanical axis with tibial mechanical axis) with extremity mechanical axis (a line connecting the midpoint of the femoral head to the midpoint of the talus). Most professionals consider ideal up to 3 degrees difference between extremity alignment with extremity mechanical axis after surgery, thereby increasing the life of the arthroplasty components. In this study, the intention was to show parameters associated with surgery success with the evaluation of patients with ATK successful surgery. In this study, 102 patients with TKA operation in Fajr Hospital of Tehran were selected and required information was extracted from their archived files. Having no arthroplasty after the operation was the main criterion for selecting these patients. Statistical analysis showed that parameters such as BMI, gender, urinary tract infection, and so do not affect the success of ATK surgery. However, it was shown that there is a significant relationship between the success rates of surgery on left knee with the type of surgery. Although there is no significant relationship between some underlying factors such as blood group, gender, or urinary tract infections with the success of TKA surgery, the type of surgery can be an important and determinant factor in the success of the surgery. Statistical analysis on TKA surgery can provide useful information to successfully conduct this type of operation in the future.

Medical journal of the Islamic Republic of Iran, 2014

Pigmented villonodular synovitis (PVNS) is characterized by the presence of inflammation and hemo... more Pigmented villonodular synovitis (PVNS) is characterized by the presence of inflammation and hemosiderin deposition in the synovium. Two forms of PVNS distinguished in the literature are diffused and localized involvements. There are controversies in the literature about the surgical management of PVNS. We report our experience in the management of knee PVNS at a mean follow-up of 4 years. We also introduce our preferred method of treatment for these patients. A number of 26 patients (26 knees) with histologically proven PVNS of the knee in the pathology department at Shafa Yahyaeyan hospital were identified between January 1996 and February 2012. Annual clinical follow-up was conducted in all patients and a follow-up MRI scans was ordered for symptomatic cases. All patients were examined according to the Knee Society Score (KSS) in which the knees were graded from excellent to poor. Mean age of the patients was 28.08±12.5. A number of 15 patients (58%) had diffused involvement of t...