ACL AVULSION - CURRENT CURRENT CONCEPTS I DR.RAJAT JANGIR JAIPUR

Dr. Rajat Jangir has vast experience and specialisation in the field of Arthroscopy and sports surgery. He is working as consultant arthroscopy and sports surgeon at Shoulder & Knee Surgery Clinic, Jaipur.

He is Professor and head of Department of Sports Medicine at Mahatma Gandhi Hospital, Jaipur. He did MBBS from NHL Medical college, Ahmedabad. He did M.S. orthopaedics from BJ Medical College Civil Hospital Ahmedabad. BJ Medical College, Ahmedabad is regarded among the Best Orthopaedics hospital in India.

His basic training in the field of Arthroscopy began with Dr. David Rajan (Pioneer Arthroscopy Surgeon, Coimbatore, India), He completed Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, Seoul, South Korea in 2014. Prof Wang is among world leader in Arthroscopy sugeries.

He did Post Graduate Diploma in Sports Medicine from International Olympic Committee, UK in 2015. He was also invited as Athlete Medical Doctor at Rio Olympic 2016 by International Olympic Committee. He is the only trained Sports Physician at Rajasthan. He has done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete.

He has also operated and treated Athletes of State as well National teams. Till now has done more than 4500 athroscopic Surgeries mostly being Athletes.

He invited as National faculty as Indian Association of Sports Medicine Conference, Bengaluru 2019. He also invited as faculty at Rajasthan Orthopedic Surgeons Conference to speak upon Meniscus repair.

1. Current concepts in TIBIAL SPINE AVULSION Dr.RAJAT JANGIR Professor DEPARTMENT OF ORTHOPAEDICS Mahatma Gandhi Hospital, Jaipur

2. INCIDANCE Paediatric Adult More common Less common 8-13 years High velocity 59 % of displaced avulsion have concomitant Meniscal, Chondral or ligament J pediatr orthop . 2015 mar;35(2):130-5. Incidence of meniscal injury and chondral pathology in anterior tibial spine fractures of children

3. MAYER AND MC KEEVER’S CLASSIFICATION ZARICZYNJ

4. LATERAL XRAY LATERAL XRAY IN FULL EXTENSION

5. CT SCAN

6. MRI Investigation of choice 40 % meniscus 80% bony contusions Soft tissue entrapment

7. GOALS Anatomical reduction of displaced fragment and continuity of ACL fibers . Adequate rigid fixation which allows early range of motion exercises Eliminate the extension block and impingement due to displaced fragments

8. TREATMENT long leg cast immobilization for a period of 4-6 weeks Typically in extension

9. Aspiration Close reduction in extension Cast Closed follow up Loss of reduction on lateral Xray _ FixAtion CONTRAVERSIAL

10. Type III /IV Conservative ORIF Arthroscopic LAXITY LAXITY NON OPERATIVE 70 OPERATIVE 14

11. Type III /IV

12. PULL OUT SUTURE FIXATION

13.  FEW COMPARATIVE STUDIES SCREW FIXATION vs SUTURE FIXATION Bong et al. biomechanical screw versus fibre-wire fibre-wire fixation was significantly stronger Tsukada et al. biomechanical Antegrade Retrograde Pullout suture Initial fixation strength in response to a cyclic tensile load ANTEGRADE SCREW most effective

14. TAKE HOME MESSAGE IDENTIFY AVULSION PATTERN MRI IS CHOICE OF INVESTIGATION ARTHROSCOPIC FIBER-WIRE FIXATION