Shaival Dalal

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The flexibility and convenience of using a standard orthopaedic table in peri-articular knee fractures: Allowing ligamentotaxis and improving imaging accessibility

Chinese Journal of Traumatology (2022)

Zaid Al-Ani Shaival Dalal Amit Chandratreya Khalid Sharif Sarvpreet Singh

Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge. Complexity of the fracture often needs multi-planar surgical access. A combined two-staged procedure is frequently suggested both in supine and prone position to address this issue. However, this will significantly increase the operative time and eventually impact the outcome, in addition to the complications associated with prone positioning. In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup, at the same time, giving the flexibility to change the alignment from valgus to varus and vice versa. This facilitates fracture reduction while addressing the anatomical structure of the knee. A further advantage is the unobstructed imaging access throughout the surgical fixation. This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures. We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome. We found that this approach is safe, reproducible and relatively easy to set up in the two centres.

Supine position

10.1016/j.cjtee.2022.01.005

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Comparison of Patella Resurfacing and Patelloplasty in Operated Bilateral Total Knee Replacement

International journal of scientific research (2014)

Kevin Rajesh Choksey HP Bhalodiya Zulfikar M. Patel Hiren K Patel Aditya Banta

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR), because of many factors, an important one being patellofemoral joint. The aim of this study was to study and compare the outcomes of patella resurfacing and modified patelloplasty in controlled matched group of patients. 40 patients had staged bilateral total knee replace- ment surgery and kept blinded to which side patella resurfacing was done. Patella resurfacing was done always on side operated second. In followup, patients were examined for anterior knee pain, range of motion, Standard radiographs, KSS, VAS score, and Feller patellar scores were calculated. There was no significant difference between both groups in terms of scores, function and radiographic alignment. The results of patelloplasty were as good as resurfacing & in case of persistent anterior knee pain it offers option of secondary resurfacing, also avoiding complications associated with resurfacing. Joint replacement is the gold standard surgical treatment for patients with advanced osteoarthritis of the knee.TKR aims at addressing the tibiofemoral joint which the major weight bear- ing joint involved morecommonly in arthritis. However manage- ment of patellofemoral joint remains debatable issue.Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This can be related to multiple factors and the patellofemoral joint remains the important one among this.2

Patellofemoral joint

Total Knee Replacement

Anterior knee pain

Gold standard (test)

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Short term results of platelet rich plasma in early stages of osteoarthritis knee

Santosh University Journal of Health Sciences (2021)

Zulfikar M. Patel Shaival Dalal Harshil R. Patel Bhavya Shah

Introduction: Osteoarthritis of knee is a most common form of arthritis spread rampantly today. Platelet-rich plasma injections enhance cartilage repair and relieve osteoarthritis Symptoms. Thus it delays the need for joint replacement. Objective: To investigate the effect of platelet-rich plasma (PRP) on progression of early stages of osteoarthritis knee. Methodology: A case series study of 50 patients was carried out. Results were analyzed on the basis of following scores: O WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) O KSS (Knee Society Score) O VAS (Visual Analogue Scale) Results: There were no significant adverse event observed. Statistically significant results in the Western Ontario and McMaster Universities Osteoarthritis Index and KSS and VAS scorings were recorded in patients who received PRP injections after a 3 and 6 months follow up. Conclusions: Our study suggests that autologous PRP can be used as an effective and safe method in the treatment of the early stages of osteoarthritis. But further studies are needed to confirm these finding and to investigate the long term effects of autologous PRP. Keywords: Autologous PRP, Osteoarthritis knee

WOMAC

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Utility of SpeedCourt System: A Novel Study of 100 Professional Footballers at FIFA Medical Centre of Excellence Dubai UAE

Open Access Journal of Sports Medicine (2023)

Mourad Ghrairi Shaival Dalal Esther Esteban-García Philippe Chomier Xavier Valle

The SpeedCourt system has been confirmed as an effective and dependable tool for evaluating multi-directional change-of-direction (COD) maneuvers. It has also been employed in the rehabilitation process following Anterior Cruciate Ligament (ACL) injuries and for multi-directional training purposes. This study investigated by means of the SpeedCourt system determines 1) whether there is any difference in COD parameters and countermovement jumps (CMJ) between United Arab Emirates (UAE) and non-UAE professional footballers 2) whether there is any difference between the two lower limbs during change-of-direction manoeuvres.This analysis included 100 professional football players from UAE or Non-UAE football clubs who were tested at FIFA Medical Centre of Excellence. With the help of Speedcourt system, 6-s tapping, countermovement jump (CMJ) and chase 15-s tests were performed. Comparison was done between UAE and non-UAE footballers and also between the dominant and non-dominant sides.Out of the 100 players, 83 players were right foot dominant. Apart from the countermovement jump test, there was no significant difference in results between UAE and non-UAE football players. Average time to turn for dominant and non-dominant sides did not show any significant difference, for either group.There is no difference in 6-s tapping, Chase 15-s tests or limb asymmetry amongst UAE and Non-UAE footballers. However, the non-UAE footballers showed significantly better performance in Countermovement Jump Test. The data provide baseline values for forthcoming sports medicine research, which can be taken into account when creating injury prevention or return-to-sport protocols, particularly with regard to change of direction parameters and countermovement jump.

Countermovement

Excellence

10.2147/oajsm.s434554

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Comparison of Core Decompression with Autologous PRP Infusion v/s Core Decompression Alone in Treatment of AVN Hip

IP International Journal of Orthopaedic Rheumatology (2016)

Zulfikar M. Patel Kalpesh A. Mehta Shaival Dalal Kaushal Patel

Objective: To evaluate the result of core decompression and autologous PRP infusion over other treatment modalities of AVN HIP. Introduction: Osteonecrosis is a disease of impaired blood flow affecting mainly young people in their third, fourth or fifth decades. Proposed risk factors include, chemotherapy, alcoholism, excessive steroid use, post trauma, sickle cell anaemia and Gaucher's Disease. Materials and Methods: Retrospective study of 25 patient of Avascular necrosis of hip.25 patients were included in study. Autologous PRP was prepared a day before surgery. Decompression of the head of femur was done by using Michele trephine of size 8mm. Outcome measures used during study were · Anteroposterior and lateral radiographs · MRI · Harris hip score · VAS for pain Keywords: Core decompression, Autologous prp, Vas score, Harris hip score, Avn hip

Avascular Necrosis

Harris Hip Score

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Clinical and functional outcomes of ACL reconstruction with tibial attachment preserving quadrupled hamstring graft

Orthopaedic Journal of Sports Medicine (2020)

Shaival Dalal Ghislain Aminake Randy Guro Amit Chandratreya Rahul Kotwal

Introduction: Recent literature supports the preservation of tibial attachment of hamstring grafts to enhance ‘‘ligamentization’’ process and prevent the potential problems of free graft such as pull-out or rupture in the early post-operative period. Another factor that has gained attention in recent days is graft diameter, which can be variable and is thought to be a factor contributing to graft failure in biomechanical and clinical studies. Numerous studies have shown conflicting evidence of graft diameter directly influencing the graft failure. Hypotheses: The aim of this study is to present our results of ACL reconstruction with preservation of the tibial attachment of the hamstring grafts along with loop-stitched quadrupled hamstring grafts fixed with Endobutton on the femoral side and an interference screw and staple on the tibial side. Methods: Prospective single-surgeon case-series evaluating patients undergoing surgery by this technique. Patients were followed up clinically and using PROMS from NLR with EQ-5D, KOOS, IKDC and Tegner scores. Paired two-tailed student t-tests were used to assess significance. Results: 45 patients had associated meniscal tear with 73.3 % undergoing repair. 3 cases (4.6 %) returned to theatre including, MUA for arthrofibrosis (n=1) and meniscal repair for recurrent medial meniscus tear (n=2). Incidence of graft re-rupture was seen in 1 patient. At a mean follow-up of 2.3 years, 80% (n=51) had complete peri-operative PROMS scores. Mean peri-operative EQ-5D VAS, EQ-5D Index, KOOS, IKDC and Tegner activity scores showed significant improvement (p<0.001). Multiple regression analysis does not find any correlation between PROMS and graft diameter. Conclusion: ACL reconstruction using tibial attachment preserving hamstring graft is a simple and , reproducible, and cost-effective technique that gives consistent clinical and functional outcomes, irrespective of the graft diameter . The natural tibial side insertion provides secure fixation and adds biology to the anatomic reconstruction, possibly reducing the re-rupture and failure rate.

Arthrofibrosis

Meniscus

10.1177/2325967120s00550

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LONG-TERM OUTCOMES OF PATELLOFEMORAL INSTABILITY WITH AND WITHOUT PATELLAR CARTILAGE DEFECTS: A MATCHED COHORT STUDY

Orthopaedic Proceedings (2020)

Shaival Dalal P Setia Anindya Debnath R Guro R. Kotwal

Background Recurrent patellar dislocation in combination with cartilage injures are difficult injuries to treat with confounding pathways of treatment. The aim of this study is to compare the clini...

Patellofemoral joint

Joint instability

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A Study of Clinical Outcomes, Complications and Their Management, of Total Knee Replacement in Patients With Rheumatoid Arthritis

IJAR - Indian Journal of Applied Research (2014)

Kevin Rajesh Choksey HareshP Bhalodiya Kalpesh Mehta Zulfikar M. Patel Aditya Banta

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Chronic lateral ankle instability: Results of two-staged approach, correlation with magnetic resonance imaging findings, and incidence of associated pathologies – A 4-year follow-up study

Journal of Arthroscopic Surgery and Sports Medicine (2020)

Shaival Dalal G Morgan

Objectives: About 20% of ankle sprains have persistent symptoms even after 6 weeks–3 months of conservative treatment of physiotherapy and bracing. We followed a two-staged operative treatment protocol for the management of patients with persistent chronic lateral ankle instability. This study aims to analyze the outcomes of this two-staged treatment protocol and also to compare the magnetic resonance imaging (MRI) and arthroscopic findings in such patients and note the presence of associated pathologies. Materials and Methods: This is a retrospective study of 87 patients operated for chronic lateral ankle instability in two stages: (1) Diagnostic examination under anesthesia and ankle arthroscopy and (2) modified Brostrom procedure. Results: With a mean follow-up of 4 years, 31% of the patients had a complete resolution of their symptoms 4 months after the first procedure. Mean American Orthopaedic Foot and Ankle Score (AOFAS) and visual analog scale (VAS) scores show a significant improvement in functional outcomes in both the groups ( P < 0.05). Moreover, the MRI findings were equivocal or false negative in 60% of the patients. We also observed associated pathologies such as synovitis, osteochondral defect of talus, and anterolateral impingement in 40% of the patients. Conclusion: The two-staged treatment of ankle arthroscopy and modified Brostrom procedure is highly effective in resolution of the symptoms of patients with chronic lateral ankle instability. As MRI is not very sensitive and because of the associated intra-articular lesions found in this spectrum of patients, a primary ankle arthroscopy followed by a staged Brostrom procedure has shown to improve outcomes significantly with optimal intervention.

10.25259/jassm_34_2020

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Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature

Indian Journal of Orthopaedics (2020)

Shaival Dalal Amit Chandratreya Keshav Singhal Rahul Kotwal

Valgus deformity

Oxford knee score

Lateral release

10.1007/s43465-020-00294-1

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