INTRODUCTIONThe management of recurrent traumatic patellar dislocation includes surgical realignment. There is no clear distinction whether proximal soft tissue or distal procedures produce superior results. However, distal realignment procedures are commonly associated with greater morbidity. We advocate a distal procedure only for cases which are more severe, such as the presence of patellar maltracking.

MATERIALS AND METHODSBetween January 2002 and June 2007, all patients who had a history of traumatic patellar dislocation with recurrent symptoms and failed conservative management underwent surgical realignment. Patients who had evidence of lateral patellar subluxation on computed tomography (CT) scan were offered a distal realignment procedure using the Elmslie-Trillat or Roux Goldthwaite procedure. All other patients underwent proximal soft tissue medial patellofemoral ligament (MPFL) reconstruction. Pre and postoperative functional International Knee Documentation Committee (IKDC), Lysholm and Tegner score assessments were performed for a minimum follow-up period of 6 months. The mean scores for each group were analysed using the Wilcoxon Matched-Pairs Signed-Ranks test and the Mann-Whitney U test was used to evaluate the difference between the groups.

RESULTSA total of 23 patients underwent surgery for patellar realignment. Of whom, 14 patients had a distal realignment procedure while 9 patients had a proximal procedure of MPFL reconstruction. There was greater morbidity reported with distal realignment procedures. Pre and postoperative IKDC, Lysholm and Tegner scores showed significant improvement for both treatment arms. However, there was no significant difference between the improvement scores for both groups.

CONCLUSIONPatients with significant patellar maltracking following traumatic patellar dislocation would benefit from distal realignment using the Elmslie-Trillat or Roux Goldthwaite procedure. Otherwise, a proximal soft tissue procedure involving MPFL reconstruction would be adequate. A management algorithm is proposed for clinical use.

Adolescent ; Adult ; Algorithms ; Bone Malalignment ; surgery ; Female ; Humans ; Joint Instability ; surgery ; Male ; Orthopedic Procedures ; Patellar Dislocation ; epidemiology ; physiopathology ; surgery ; Recurrence ; Treatment Outcome

INTRODUCTIONIt is difficult to counsel the anterior cruciate ligament (ACL) deficient patient considering surgical reconstruction on the likelihood of eventual return to sports as information on this is lacking, especially in the Asian context. We wanted to determine how many of our patients who had ACL surgery returned to their previous levels of sports, 5 years after their surgery. For those that had not returned to their previous levels of sports, we wanted to identify their reasons for not doing so.

MATERIALS AND METHODSBased on our inclusion criteria of a minimum 5-year follow-up after primary ACL reconstruction, 146 patients were identified for assessment. Sixty-four patients were successfully recalled. The mean age of our patients was 24.8 years (range, 18 to 40). The patients completed the Lysholm Knee, Tegner activity and the Subjective International Knee Documentation Committee (IKDC) questionnaires. Clinical examination of the operated knee was performed according to the Objective IKDC evaluation form and with a KT-1000 arthrometer.

RESULTSThe mean Lysholm score was 85.2 and the mean subjective IKDC score was 79.5. 81.2% of our patients had normal or nearly normal knees (IKDC A or B) with the remaining 18.8% at IKDC grade C. The mean side-side difference for anterior translation using the KT-1000 arthrometer was 1.2 mm. The median pre-injury Tegner activity level was 7 and the median 5-year post-surgery Tegner activity level was 6. Nineteen patients did not return to their pre-injury sports levels because of social reasons and were excluded. From the remaining 45 patients, 28 patients (62.2%) returned to their previous level of sports and 17 patients (28.8%) did not return to their previous level of sports. Of whom, 9 (20%) said that they did not return due to fear of re-injury and the remaining 8 (17.8%) said they had not returned because of knee instability and pain. At 5 years, the subgroup of patients who had returned to sport had the best scores: Lysholm (88.5), subjective IKDC (84.6) and IKDC Grade A&B (89.3%). When we compared this with the subgroups that did not return to sport because of fear of re-injury and because of an unstable knee, we found that the difference in knee outcome scores between these 3 groups were statistically significant.

CONCLUSIONSixty-two per cent of our patients returned to their previous level of sport at 5 years after ACL reconstruction. Fear of reinjury is an important psychological factor for these patients not returning to sports. Our results would allow the attending surgeon to counsel the ACL deficient patient who is considering surgical reconstruction the likelihood of eventual return to sports.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Athletic Performance ; Female ; Follow-Up Studies ; Humans ; Knee Injuries ; rehabilitation ; surgery ; Male ; Orthopedic Procedures ; rehabilitation ; Physical Examination ; Retrospective Studies ; Sports ; Surveys and Questionnaires

INTRODUCTIONA meniscal deficient knee is at risk of early degenerative osteoarthritis. Allograft meniscal transplantation has been used to treat the meniscus deficiency to alleviate pain symptoms and to delay progression to arthritis. This case series aims to assess the postoperative outcomes of patients who have undergone meniscal allograft transplantation in our hospital.

MATERIALS AND METHODSThis is a prospective clinical review of prospectively collected data of our Meniscal Transplantation Programme from 2004 to 2007. Twelve meniscal allografts were implanted in 12 males with symptomatic knees, using arthroscopically assisted techniques. Preoperative and postoperative assessments were conducted using the Visual Analogue Scale (VAS), Tegner Activity Level Scale, Lysholm Knee Scoring Scale, and 2000 International Knee Documentation Committee (IKDC) scoring systems.

RESULTSThe mean age was 26.7 years with a mean follow-up of 17 months (range, 5 to 37). The VAS score for pain improved from 5.5 (3- 10) to 1.4 (0-2) [P <0.05], Tegner from 3 (2-5) to 5.9 (3-9) [P <0.05], Lysholm from 62.5 (27-88) to 88.6 (70-100) [P <0.05], IKDC Subjective Score from 50 (24-79) to 79.5 (56-95) [P <0.05]. Overall IKDC Knee Examination Grades revealed 10 nearly normal and 2 abnormal scores.

CONCLUSIONSThis is the first series of allograft meniscal transplantation from Southeast Asia. Patient outcome evaluation via VAS, Tegner Activity Level Scale, Lysholm Knee Scoring Scale and 2000 IKDC Knee Evaluation Form showed improvement in symptoms and knee function after implantation.

Adult ; Arthroscopy ; Humans ; Knee Injuries ; surgery ; Male ; Medical Audit ; Menisci, Tibial ; transplantation ; Middle Aged ; Pain Measurement ; Prospective Studies ; Tibial Meniscus Injuries ; Transplantation, Homologous ; Treatment Outcome

BACKGROUND: Dermatologic comorbidities can be the clue for the diagnosis and treatment of systemic conditions and a need for dermatological expert opinion is increased. OBJECTIVE: To analyze the patterns and to quantify the dermatologic consultations referred by the department of obstetrics and gynecology (OBGY). METHODS: We retrospectively studied the data from 479 cases referred by OBGY for a dermatologic consultation during a three-year period in a tertiary hospital. RESULTS: The most common skin disorder was pregnancy-related dermatoses (29.77%) in obstetric inpatients, while cutaneous infection (33.33%) was the most frequent in gynecologic inpatients. The distribution of the skin disorders in consulted OBGY inpatients was consistent with the previous reports. However, there were some differences, such as high proportion of infectious disease. Infectious skin diseases were significantly more frequent (p<0.001) in the chemotherapy group of gynecologic inpatients compared to that of the non-chemotherapy group, viral infection being the most common. In addition, superficial fungal infection accounted for the same proportion as the viral infection (37.50% each) among obstetrical inpatients. Maculopapular or urticarial eruption (51.52%) was the most common type of chemotherapy-related adverse drug reaction. CONCLUSION: This study revealed the distribution of skin disorders in patients referred by OBGY for dermatologic consultation. Furthermore, it could be helpful as an educational material to assist cooperation between dermatology and OBGY.
Communicable Diseases ; Comorbidity ; Dermatology ; Expert Testimony ; Gynecology ; Humans ; Inpatients ; Obstetrics ; Referral and Consultation ; Retrospective Studies ; Skin ; Skin Diseases ; Skin Diseases, Infectious

There have been a small number of recent case reports of patients with erythematous patches around the joints, which histopathologically showed histiocytic aggregations in the dermal vessels. Intralymphatic histiocytosis (ILH) is a rare group of skin diseases that are characterized by the proliferation of histiocytes in a lymphatic vessel lumen, and this is thought to arise as a benign reaction to certain stimuli such as rheumatoid arthritis. The pathogenesis of this intralymphatic proliferation of histiocytes and the reasons they commonly present on the arms are still unknown. We report on a case of ILH with arthritis in a 68-year old female who had no underlying disease, and the ILH presented as irregular erythematous patches on the left antecubital area and these patches demonstrated the distinctive histopathological features of intralymphatic histiocytosis.
Arm ; Arthritis ; Arthritis, Rheumatoid ; Female ; Glycosaminoglycans ; Histiocytes ; Histiocytosis ; Humans ; Joints ; Lymphatic Vessels ; Skin Diseases

BACKGROUND: Because cosmetic laser treatments are getting popular, post-laser wound care becomes more important. Currently, topical moisturizers are reported to be sufficient to accelerate re-epithelialization and reduce downtime in post-laser wound care. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-1001 for post-laser wound care, after ablative fractional laser on the face. METHODS: In this double-blind, split-face study, 41 patients with photo-aged face received ablative fractional laser. They were divided into two groups, APDDR-1001 and vehicle (group 1) or control moisturizer (group 2), which were applied to the opposite sides of the face for 1 week after the laser treatment. The treatment efficacy was evaluated by the transepidermal water loss (TEWL), erythema index, investigator's assessment for recovery in erythema and overall improvement of the wound. Subjects ranked irritating symptoms and overall satisfaction ratings in the overall improvement. RESULTS: APDDR-1001 was well-tolerated and showed improvement in the erythema index and TEWL during the 7 days of treatment. In group 2, improvement in erythema graded by investigators was significantly higher for APDDR-1001 on day 3 (p<0.05). The overall improvement of wound ranked by investigators was significantly higher for APDDR-1001, compared with the controls in both groups. Subjective assessment demonstrated significantly less erythema (p=0.043), edema (p=0.041) and overall satisfaction ratings in the overall improvement (p<0.048) with APDDR-1001; however, no differences were detected in pain and edema between APDDR-1001 and vehicle (group 1). In group 2, subjects ranked 'much or very much improved' in 75 % of APDDR-1001 side and 55% of control moisturizer side. No significant differences in erythema, edema, pain and itching were reported between APDDR-1001 and control moisturizer in group 2. CONCLUSION: The moisturizer APDDR-1001 demonstrated effective improvements in wound healing and subjective symptoms after ablative fractional laser therapy.
Cosmetics ; Edema ; Erythema ; Humans ; Laser Therapy ; Pruritus ; Re-Epithelialization ; Research Personnel ; Treatment Outcome ; Wound Healing

Introduction: Fingermarks left at a crime scene can indicate the presence of an individual and his/her involvement in the crime. Fingermarks, usually invisible, can appear on any surface and may be contaminated by any exogenous substances, including drug substance. Recovery of fingermarks contaminated by drug substance is crucial to link an individual with the drug-related crimes. Hence, this study was aimed to investigate the recovery and visualisation of methamphetamine-contaminated fingermarks from various non-porous surface materials. Methods: In this study, fingermarks were deposited on 11 types of surface materials varied by the presence of methamphetamine contamination, immediacy of deposition, and their concentration levels. Each fingermark was then developed using white and black fingerprint powders, graded, and compared based on the different settings. Results: Application of fingerprint powder was good in developing fingermarks; however, its suitability depends on the nature of the surface materials. Black fingerprint powder produced better visualisation where the fingermarks on all the 11 surface materials tested in this study were successfully recovered compared to white fingerprint powders. Methamphetamine-contaminated fingermarks could still be recovered using the fingerprint powder dusting method, but the fingermark grade was reduced due to the presence of exogenous substance. Conclusion: To conclude, the recovery and visualisation of methamphetamine-contaminated fingermarks on non-porous surfaces were successfully carried out through the application of fingerprint powder. A more severe contamination might lead to lower fingermark grade showing lesser ridge details.