Chiari pelvic osteotomy (CPO) or medial displacement pelvic osteotomy is a surgical procedure of making a congruent shelf above intact hip joint by using the cancellous bone of ilium along with capsular interpositioning to contain the femoral head and bear weight. CPO is usually considered a salvage procedure indicated in patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. It has been widely performed for several decades but since 1990s number of CPO procedures has decreased because of use of other pelvic osteotomies, total hip arthroplasty (THA), ultrasound screening and narrowing indications for this procedure. However, CPO is not a historical procedure and it has viable indications in modern orthopaedic surgery, especially in patients who prefer joint-conservating procedure or in situations when THA is not feasible. Moreover, keeping the native hip as long as possible should be preferred modern orthopaedic approach. The Chiari osteotomy can produce excellent results in patients who have right indications and when other procedures are not suitable. On the other hand, there are several disadvantages of this procedure such as narrowing of the pelvis, shortening of the limb and risk of sciatic nerve palsy. With in-depth analysis of literature, we discuss indications for CPO, surgical technique of CPO, THA conversion rate after CPO, the interval from the CPO to THA and CPO survival rate.

Increased knowledge of the long-term destructive consequences of meniscectomy has created a shift towards operative repair of isolated meniscus lesions. However, in the literature the results of isolated meniscal repair in athletes currently remain underreported. Our objective was to investigate the clinical and functional outcomes as well as survival and return to sport in patients who underwent meniscal repair after isolated meniscal tear, with a focus on athletes (both professional and recreational) in the study population. This retrospective study included 52 athletes who underwent knee surgery for isolated meniscal tear between 2014 and 2020. Patients with concomitant ligamentous and/or chondral injury were not included in this study. The mean age of the patients was 25.5 years (ranging from 12 to 57 years). The mean follow-up period of all patients was 33.3 months (ranging 10 to 80 months). The mean purpose of the study was to report the return to sport. The International Knee Documentation Committee rating (IKDC), Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS) and Tegner activity level were determined at the follow-up. Failure was defined as re-operation with meniscectomy or revision meniscal repair. In total, 44 out of 52 patients (85%) returned to their previous sports activities. At follow-up, the mean Lysholm score was 90, representing a good to excellent result. Assessment of KOOS (mean value 88.8) and IKDC (mean value 89) scores also showed good to excellent results. A mean level of Tegner scale was 6.2, indicating a relatively high level of sports participation. Failure was encountered in 8 out of 52 knees (15%). Therefore, isolated meniscal repair resulted in good to excellent knee function and most athletes can return to their previous level of sports participation.

Objectives: This study aimed to compare the effectiveness of spinal anesthesia (SA) alone versus combined spinal anesthesia with adductor canal block (ACB) and sciatic nerve block (SNB) (SA + ACB + SNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. We hypothesized that SA + ACB + SNB would provide better analgesia, greater patient satisfaction, and shorter postanesthesia recovery times than SA alone. Methods: A prospective randomized controlled trial was conducted with 60 patients aged 15–49 years scheduled for elective arthroscopic ACL reconstruction. Participants were randomly assigned to receive either SA or SA + ACB + SNB. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4, 12, and 24 h post-operation. General health was evaluated using the 12-item Short Form Survey (SF-12) at 1 month postoperatively. Range of motion and analgesic consumption were also recorded. Results: The median VAS score at 4 h post-operation was significantly lower in the SA + ACB + SNB group compared to the SA group (0 [IQR: 0–1] vs. 2 [IQR: 1–3], p = 0.0137). No significant differences in VAS scores were found at 12 h (p = 0.9282) and 24 h (p = 0.5809). PCS-12 and MCS-12 scores did not differ significantly between groups. The SA group had a lower postoperative range of motion (ROM) compared to the SA + ACB + SNB group, with a mean active ROM of 40.67 degrees (±23.52) versus 72.17 degrees (±24.69), respectively (p < 0.0001). Analgesic consumption was similar, with 53.33% of participants in each group using postoperative analgesics (p = 1.0). The mean surgery duration was 74.6 min. The gender distribution was 83% male and 17% female, with an average age of 27.7 years. Conclusions: Adding ACB and SNB to spinal anesthesia improved immediate postoperative pain relief and preserved range of motion in patients undergoing ACL reconstruction, suggesting potential clinical benefits in pain management and functional recovery.

Background and Objectives: Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has been advocated to improve rotational stability and reduce graft failure in high-risk athletes. We aimed to evaluate the mid-term functional outcomes of a modified combined ACL and ALL reconstruction technique using hamstring tendon autografts developed at our institution. Materials and Methods: We retrospectively reviewed 395 patients who underwent combined ACL and ALL reconstruction between 2018 and 2022. Of these, 291 patients (73.6%) completed the minimum follow-up of 2.5 years and were included in the analysis. Primary outcomes were graft rerupture and return to sport (RTS) at the pre-injury level. Secondary outcomes included graft survival, a change in Tegner score from pre-injury to follow-up and complications. Results: The cohort consisted of 219 males (75.3%) and 72 females (24.7%), with a mean age of 20.6 ± 4.0 years (range 14–35). Eleven patients experienced graft rerupture, yielding a rate of 3.78% (95% CI, 2.1–6.6). At final follow-up, 220 patients (75.6%; 95% CI, 70.4–80.2) returned to their pre-injury level of sport performance. The mean Tegner activity score decreased from 7.9 ± 1.4 preoperatively to 7.2 ± 1.8 postoperatively (paired t-test, p < 0.0001; Wilcoxon signed-rank test, p < 0.0001). Postoperative complications occurred in 18 patients (6.2%), the majority of which related to meniscal re-ruptures. Conclusions: Our modified combined ACL and ALL reconstruction technique demonstrated excellent mid-term results in a high-risk athletic population, with low rerupture rates and high RTS rates, while also being a safe procedure without significant complications. These findings support the use of this technique in young and professional athletes where rotational stability is necessary.

Background and Objectives: Combined anterior cruciate ligament (ACL) and anterol-ateral ligament (ALL) reconstruction has been advocated to improve rotational stability and reduce graft failure in high-risk athletes. We aimed to evaluate the mid-term functional outcomes of a modified combined ACL and ALL reconstruction technique developed at our institution. Materials and Methods: We retrospectively reviewed 395 patients who underwent combined ACL and ALL reconstruction between 2018 and 2022. Of these, 291 (73.6%) completed the minimum follow-up of 2.5 years and were included in the analysis. Primary outcomes were graft rerupture and return to sport (RTS) at the pre-injury level. Secondary outcomes included graft survival, change in Tegner score from pre-injury to follow-up and complications. Results: The cohort consisted of 219 males (75.3%) and 72 females (24.7%), with a mean age of 20.6 ± 4.0 years (range 14–35). Eleven patients experienced graft rerupture, yielding a rate of 3.78% (95% CI, 2.1–6.6). At final follow-up, 220 patients (75.6%; 95% CI, 70.4–80.2) returned to their pre-injury level of sport. Conclusions: Our modified combined ACL and ALL reconstruction technique demonstrated excellent mid-term results in a high-risk athletic population, with low rerupture rates and high RTS rates, while being safe procedure without significant complications. These findings support the use of this technique in young and professional athletes where rotational stability is necessary.