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Papers by Pranjal Kodkani

Journal of Arthroscopic Surgery and Sports Medicine, Jun 3, 2024

Identification of posterior tibial slope (PTS) and slope correction osteotomies have lately gaine... more Identification of posterior tibial slope (PTS) and slope correction osteotomies have lately gained importance in various knee surgeries. The preferred surgical methods have been a flexion (opening)/extension (closing) wedge osteotomy at the proximal tibia. Current methods of PTS measurements use the anterior tibial cortical line (ATL), posterior tibial cortical line (PTL), or the anatomical axis of tibia (AAT) on a short lateral view X-ray of the tibia. This can have a high inter and intra-observer variability. Measuring the PTS using the "mechanical axis" has potentially less inter and intra-observer error. However, simply using the difference between pre-operative and planned post-operative PTS measures as the osteotomy correction angle (OCA), with the reference line as "mechanical axis" gives erroneous correction. A novel "Precision technique" is devised to calculate the OCA with least errors using the "mechanical axis" as the reference line. This technique minimizes errors in pre-operative planning. This can further translate into better clinical results due to a reduction in pre-operative planning errors. The principles of this technique can also be used to plan other osteotomies for angular corrections of long bones where the joint line/slope/alignment is to be corrected with reference to the mechanical axis.

Journal of Arthroscopic Surgery & Sports Medicine, 2024

Basket-Weave Technique for Medial Patellofemoral Ligament Reconstruction, 2015

The anatomy of the medial patellofemoral ligament (MPFL) has been well defined, with parts of its... more The anatomy of the medial patellofemoral ligament (MPFL) has been well defined, with parts of its uppermost fibers having a soft-tissue insertion onto the vastus intermedius. Bone tunnels and implants on the patellar side therefore cannot replicate this anatomic construct precisely. Because of implants and tunnels, complications have been reported with bone tunnel fracture. Similarly, on the femoral side, rigid fixation with implants can result in over-constraint with compromised results. Moreover, bone tunnels cannot be used in skeletally immature cases. To overcome issues related to bone tunneling and implants, as well as to reconstruct the MPFL in a precise anatomic manner, an allesoft-tissue fixation technique was devised. Bony landmarks were used as reference points instead of radiologic markers to achieve a more precise construct and to eliminate intraoperative radiography. Hamstring graft was used to reconstruct the MPFL. Special suturing techniques were used to achieve optimal graft fixation with minimal suture knots. A special tissue elevatoresuture passer device was designed to facilitate graft passage and ease in performing the procedure. This technique permits differential tensioning, and therefore one achieves stability throughout the range of motion.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, Oct 1, 2017

The Journal of Knee Surgery, 2010

An innovative uniplanar-bilateral external fixator was designed, developed, and implemented for b... more An innovative uniplanar-bilateral external fixator was designed, developed, and implemented for barrel-vault osteotomy of the proximal tibia. Eighteen cases of medial compartmental osteoarthritis of the knee with genu varum and one case of tibia vara were treated with dome osteotomy fixed with this new fixator to meet patient expectations regarding pain relief, early recovery with ability to squat, dependency periods, avoiding serious complications, convenience, and economic conditions. All cases achieved the desired degree of bony correction except for one case with 5 degrees undercorrection due to preoperative posterolateral corner laxity. Plaster immobilization was not required during the treatment period, and all osteotomies united within 6-10 weeks with no major complications. Superficial pin tract infection occurred in three cases. All patients returned to their activities of daily living by postoperative week 2. The Knee Society Score was 75-100 with average function/knee scores of 88.89/96.32 by the end of 2 months. Patients maintained these scores up to 2-year follow-up. This new fixator is compact and economical, with excellent patient compliance. It provides a stable fixation for the osteotomy and permits early joint mobilization, full weight bearing, and early return to activities of daily living. The fixator has the ability to alter correction in the early postoperative period to achieve a precise correction of the deformity. It qualifies as a safe device for this procedure, produces reliable and reproducible results, as well as satisfies patient expectations.

Indian Journal of Orthopaedics, 2016

Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (... more Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome. Materials and Methods: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction. Thirty nine were female and 17 male knees. The mean age was 20.6 years (range 9-48 years). Mean followup was 26 months. Five knees had previously failed stabilization procedures. Thirty one cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. Arthroscopy was performed for associated injuries and loose bodies. Seven knees required loose body removal. Five knees underwent lateral retinacular release. Four knees had tibial tuberosity transfer. One knee had an associated anterior cruciate ligament reconstruction. An anatomical MPFL reconstruction was performed using hamstring autograft without the need for intraoperative fluoroscopy. Only soft tissue fixation was necessary with this newly devised technique and suturing. A rapid rehabilitation protocol was implemented with monthly followup until normalcy and 6 monthly thereafter. Results: All achieved full range of motion and normal mediolateral stability. There was no recurrence of dislocation. No major surgery related complications. One patella fracture at 8 months was due to a fall developed terminal restriction of flexion. Those in sports could return to their sporting activities (Tegner 1-9). Cases with osteochondral fractures had occasional pain that subsided in 1 year. Mean Kujala score improved from 64.3 to 99.69 with KOOS score near normal in all. Conclusion: This new method of MPFL reconstruction gives excellent results. It avoids complications related to bone tunneling and implants. It is a safe, effective, reliable and reproducible technique.

Patellofemoral Instability, 2016

Arthroscopy Techniques, 2015

Techniques in Knee Surgery, 2012

The medial patellofemoral ligament (MPFL) of the knee is the primary medial stabilizer for the pa... more The medial patellofemoral ligament (MPFL) of the knee is the primary medial stabilizer for the patella. Statistically it is known to be injured in >94% cases of lateral patellar dislocation. An MPFL reconstruction is therefore necessary in cases of recurrent patellar dislocation to achieve good results. Presently described techniques of MPFL reconstruction have certain pitfalls and disadvantages. To overcome these disadvantages and complications, a new technique of reconstruction was implemented. An anatomic MPFL reconstruction was performed with hamstring autograft from the ipsilateral knee. To avoid bone tunnels and its pitfalls, a soft tissue fixation was used. No implants were used to avoid implant-related complications. The graft was fixed around a ligamentoperiosteal sleeve on the femur. Two limbs of the graft were then sutured to the extensor retinaculum over the patella in a “basket weave” pattern at the anatomic insertion site. After the reconstruction, normal tracking and mobility of the patella was confirmed. This new method of MPFL reconstruction with soft tissue fixation has yielded good results comparable to other series. It avoids complications and pitfalls related to bone tunneling and implants. It is a safe, effective, reliable, and reproducible technique. Therefore, it may be ideally suited for MPFL reconstructions, especially in the skeletally immature.

Techniques in Knee Surgery, 2011

Anatomic ligament reconstructions have shown to give better results than nonanatomic constructs f... more Anatomic ligament reconstructions have shown to give better results than nonanatomic constructs for cruciate ligament injuries. It may therefore be predicted to give good results similarly in case of posterolateral ligament complex injuries as well. Arthro- scopic reconstructions have likewise shown better results than open procedures. An all-arthroscopic, anatomic reconstruction of the pop- liteus was therefore done using a novel technique. The popliteus is an important rotary stabilizer of the posterolateral complex. Depending on the injury pattern, isolated popliteofibular ligament complex injuries have been identified. This popliteus sling procedure was performed in knees presenting with chronic posttraumatic posterolateral rotatory laxity. A special far lateral portal described as the ''popliteus portal'' was used for these reconstructions. The portal provides access to full length of the popliteus tendon through the popliteal hiatus and is used as the instrumentation portal for the procedure. The procedure is sim- plified and least invasive as it uses only 2 portals and causes minimal tissue trauma. A double-stranded autologous gracilis graft was used for reconstruction of the popliteus sling. No complications were encoun- tered so far. The procedure may be combined with a mini open fibular collateral ligament reconstruction to give a minimally invasive anato- mic reconstruction of the posterolateral complex in cases of combined posterolateral injuries involving the fibular collateral ligament.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004