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Volume 101-B, Issue SUPP_3 April 2019 British Indian Orthopaedic Society (BIOS) Annual Scientific Meeting, Huddersfield, England, June 2018.

V. Batta V. Batra

Background of Study

Identification of the exact make and model of an orthopaedic implant prior to a revision surgery can be challenging depending upon the surgeon's experience and available knowledge base about the available implants. The current identification procedure is manual and time consuming as the surgeon may have to do a comprehensive search within an online database of radiographs of an implant to make a visual match. There is further time lapse in contacting that particular implant manufacturer to confirm the make and model of the implant and then order the whole inventory for the revision surgery. This leads to delay in treatment thus requiring extra hospital bed occupancy.

Materials and Methods

We have analysed image recognition techniques currently in use for image recognition to understand the underlying technologies based on an interface commonly known as Application Programming interface (API). These API's specifies how the software components of the proposed application interact with each other. The objective of this study is to leverage one or a combination of API's to design a fully functional application in the initial phase and that can help recognize the implant accurately from a large database of radiographs and then develop a specialized and advanced API/Technology in the implant identification application.


A. Mannan K. Walmsley V. Mandalia P. Schranz

Background

The meniscal deficient knee often exists in the setting of associated pathology including instability, malalignment and chondral injury. Meniscal allograft transplantation (MAT) is established to be a reliable option in restoring function and treating symptoms. The aim of this study was to establish the role of MAT as part of a staged approach to treatment of the previously menisectomised knee.

Methods

This prospective study included all patients that underwent arthroscopic MAT at our institution between 2010 to 2017. Fresh frozen allograft was utilised using a soft tissue fixation technique. Further data was collected for index surgical procedures before and after MAT. Data for pre and post-operative Knee Injury and osteoarthritis outcome scores (KOOS), Tegner scores, graft survival, reoperation rates, patient satisfaction and MRI extrusion measurements were collected and details of any further surgical intervention and / or complications also documented.


A. Phadke C. M Badole

Introduction

Intramedullary nailing is gaining popularity for treatment of distal tibial fractures due to short operative time and minimum surgical trauma to soft tissues. Distal tibial fractures are commonly associated with concurrent fibular fractures at, above or below the level of tibial fractures. So far there is no consensus for fixation of fibular fractures.

Materials and Methods

Fractures of fibula at or below the level of fracture of tibia were taken into consideration. Fractures of fibula above the tibial level were excluded because they do not add to stability of fracture fixation. Retrospective study was done and distal tibia-fibula fractures were separated into 2 groups based on whether fibula was fixed or not. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up.


N. Gokhale P. Kodumuri C. Brown P. Kothari S. Kulkarni

Background

The decision to resurface the patella during total knee arthroplasty remains controversial. Aim of our study was to evaluate the functional difference between patients undergoing medial rotation knee (MRK) replacement with and without patellar resurfacing at our hospital.

Methods

We did a retrospective analysis of patients undergoing MRK total knee replacement (Matortho) at our hospital between 2008 and 2017 performed by 2 surgeons. Patients were recalled for a clinical review from Oct 2017 for recording of Oxford knee, Baldini and Ferrel scores. Mann-Whitney U test was used for non-parametric data (SPSS v24).


N. Gogi S. Azhar R. Dimri G. Chakrabarty

Fracture neck of femur (NOF) in elderly is a serious debilitating injury and has been presenting in increasing proportions. Some of these patients are unfortunate to come back with a contralateral injury. We attempted at looking into the incidence of these episodes in a cohort attending our trust and compared various parameters

We retrospectively assessed our hospital theatre data for fracture NOF in patients over 60 years in the last 3 years. We reviewed their demographics, mode of injury, time to contralateral injury, incidence of any other insufficiency fracture, operative procedure and any complications.

There were 1435 patients who underwent surgery for fracture NOF over the 3 years. Forty-three of these had bilateral fractures. Females had 3 times more incidence as compared to males; average age at first injury was 84 years and at contralateral side was 85 years. Time between the two injuries ranged from 20 to 855 days (Median 242 days). Almost equal incidence of intra / extracapsular fractures was noted. Contralateral fracture pattern (Intra vs Extracapsular) for the was similar in 34 patients. Twelve patients had an associated insufficiency fracture.

Fracture NOF in elderly is a rising epidemic. Only 3% of these patients suffer a contralateral fracture NOF which usually occurs within a year. The fracture pattern is frequently similar to the first fracture in and hence similar implants have been used. Only 21% patients were on bone protection medications. It is rather difficult to identify this small group and hence prevent a second contralateral incident.


S. Nithin

Computer assisted total knee arthroplasty helps in accurate and reproducible implant positioning, bony alignment, and soft-tissue balancing which are important for the success of the procedure. In TKR, there are two surgical techniques one is measured resection in which bony landmarks are used to guide the bone cuts and the other is gap balancing which equal collateral ligament tension in flexion and extension is done before and as a guide to final bone cuts. Both these procedures have their own advantages and disadvantages.

We retrospectively collected the data of 128 consecutive patients who underwent computer-assisted primary TKA using either a gap-balancing technique or measured resection technique.

All the operations were performed by a single surgeon using computer navigation system available during a period between June 2016 to October 2016. Inclusion criteria were all patients requiring a primary TKA, male or female patients, and who have given informed consent for participation in the study. All patients requiring revision surgery of a previous implanted TKA or affected by active infection or malignancy, who presented hip ankylosis or arthrodesis, neurological deficit or bone loss or necessity of more constrained implants were excluded from the study. Two groups measured resection and gap balancing was randomly selected. At 1-year follow-up, patients were assessed by a single orthopaedic registrar blinded to the type of surgery using the Knee Society score (KSS) and functional Knee Society score (FKSS). Outcomes of the 2 groups were compared using the paired t test.

All the obtained data were analysed. Statistical analysis was performed using SPSS 11.5 statistical software (SPSS Inc. Chicago). Inter-class correlation coefficient (ICC) and paired t-test were used and statistical significance was set at P = 0.05. In the measured resection group, the mean FKSS increased from 48.8769 (SD, 2.3576), to 88.5692 (SD, 2.7178) respectively. In the gap balancing group, the respective scores increased from 48.9333 (SD, 3.6577) to 89.2133(SD, 7.377). Preoperative and Postoperative increases in the respective scores were slightly better with the gap balancing technique; the respective p values were 0.8493 and 0.1045.

The primary goal of TKA is restoration of mechanical axis and soft-tissue balance. Improper restoration leads to poor functional outcome and premature prosthesis loosening. Computer navigation enables precise femoral and tibial cuts and controlled soft-tissue release. Well balanced and well aligned knee is important for good results. Mechanical alignment and soft-tissue balance are interlinked and corrected by soft tissue releases and precise proximal tibial and distal femoral cuts. The 2 common techniques used are measured resection and gap balancing techniques. In our study, knee scores of the 2 groups at 1-year follow-up were compared, as most of the improvement occurs within one year, with very little subsequent improvement. Some surgeons favour gap balancing technique, as it provides more consistent soft-tissue tension in TKA.


H. Sakale A. C. Agrawal

Incidence of Congenital talipes equino varus [CTEV] is 1 to 2 per 1000 birth, Out of all cases 20% cases are Non-idiopathic. The management of non-idiopathic CTEV, however, continues to be challenging due to Rigidity, Poor skin condition, Bony changes, Vascularity and Associated congenital abnormalities. In recent literature, short term results of Ponseti method for correction of non-idiopathic CTEV have been encouraging. As Ponseti method decreases the severity of deformity and hence decreases the need for extensive surgery.

The aim of current study is to evaluate the results of Ponseti method in Non-idiopathic CTEV. Total 7 children below the age of one year with Non idiopathic clubfoot presented to us in the duration of 2013 to 2015 who were treated by us. The cases included are Streeters Dysplasia with congenital constriction rings 3, Arthrogryposis multiplex congenita with Developmental dysplasia of hip 2, Arthrogryposis multiple congenita spina Bifida 1, Pierre Robinson Syndrome with Ichthiosis 1. Initially all the patients treated with Ponseti casting technique and scoring was done using modified pirani scoring. At an average we could correct the foot from Pirani 7 to 2.5 with a relapse in 4 patients. 2 patients were treated again by Ponseti's method with success while treatment was discontinued in 2 feet.

We recommended Ponseti's technique in Syndromic clubfoot as an non-surgical initial modality with good results given. The final outcome may depend more on the underlying condition than the CTEV.


M. Kiran L. Oikonomidis M. AlMutani C. Armstrong G. Kumar V. Peter

Background

Modularity in total hip replacement(THR) enables precise recreation of native hip biomechanics. However, there have been concerns about raised metal ion levels with increased number of interfaces. We present the 3 year results of ML taper with Kinectiv technology(MLKT), a modular neck uncemented stem. This system has modular neck options, but has only one [0] head in various diameters.

Methods

97 hips in 97 patients with a MLKT stem and Continuum socket were included in this prospective study. Harris hip score, Oxford hip scores (HHS and OHS) and yearly blood Cobalt(Co), Chromium(Cr) and Titanium(Ti) were recorded. The primary end point was revision for any reason. Paired t- test was used to assess improvement in functional scores.


G. Matheron G. Hannant P. Harwood G. Wells

Introduction of the National Hip fracture database, best practice tariff and NICE guidelines has brought uniformity of care to hip fracture patients & consequently improved outcomes. Low energy femoral shaft fractures of the elderly are not within these guidelines, but represent a similar though significantly smaller patient cohort.

A retrospective review was performed at Huddersfield Royal Infirmary using theatre, coding & hip fracture databases. Data was filtered to include patients ≥75, excluding non-femoral injuries. Imaging & notes were then reviewed confirming femoral shaft fractures; excluding open, peri-prosthetic & high energy fractures.

Between September 2008 and July 2016 24 patients were identified and split into two equal cohorts, before June 2011 NICE Guidelines and after. The groups were equal in terms of age (Mean: 85.25:84.67, P=0.) & sex (12 females Pre-NICE, 9 Post-Nice, P= 0.22). Our main outcome measures of length of stay were 31.89 days:26 days (p=0.38), time to surgery was 29.8hours: 28.4 hours (p=0.8) and 1-year survival rate conditional odds ratio of 1.48 (p=1.00). A secondary measure demonstrated a significantly higher proportion of post-NICE patients receiving surgery after midday 5/12:11/12 (P= 0.03).

The infrequency of low energy femoral shaft fractures makes them difficult to study and production of an adequately powered study in a single centre impossible. The authors hope this work can inspire discussion and a coordinated multicentre approach to answer this question. These patients could easily be treated with the same level of enthusiasm as hip fractures.


A. Sharma V. Singh V. Singh

Introduction

Aim was to compare the functional outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricotical iliac crest auto graft verses stand-alone PEEK cage.

Material and methods

Prospectively collected data of 60 patients in each group was compared.


K. Syam A. Saraogi P. Siney H. Nagai H. WynnJones B. Purbach P. Kay

Revision total hip arthroplasty (THA) is a challenging scenario following complex primary THA for developmental dysplasia of hip (DDH). Our study envisages the long-term outcomes of revision DDH and the role of lateral structural support in socket fixation in these young patients who may require multiple revisions in their life-time.

Hundred and eighteen consecutive cemented revision THAs with minimum follow up of 5 years following primary diagnosis of DDH operated between January 1974 and December 2012 were analysed for their clinical and radiological outcomes.

The mean follow-up of 118 patients was 11.0 years (5.1–39.6 years). The Kaplan Mier survivorship at 11 years with end point as revision for any reason was 89.8% (CI 81.1–98.4). Of 118 revisions, 88 acetabular revisions were for aseptic loosening. Out of the acetabular revisions, 21 had pre-existing structural bone grafts from primary surgery, of which only 3 needed structural re-grafting during revision. Amongst the remaining 18 hips, the lateral support from the previous graft facilitated revision with no requirement of additional structural graft. Sixty-three hips did not have any form of grafting during primary operation. Amongst them, 35 had bone grafting in revision surgery (18 structural grafting).

This study reports the largest number of revision THAs with primary diagnosis of DDH with the longest follow up. In our experience, the lateral support from the structural graft done in primary operation appears to have provided benefit in subsequent revision socket fixation.


G. S. Satheesh B. G. Sagar C. Vikram Reddy

Many surgical procedures have been put forth for the management of AC disruption none of them proved to be preferred surgical procedure. To provide better surgical stabilization and functional outcome for the management of AC joint disruption. Study period from 2015 to 2017, total of 14 patients presented with AC joint disruption, patients underwent ethibond fixation and reinforcement with K wire.

Out of 14 patients 10 patients participated in the study. The procedure was stabilization of the AC joint by passing the ethibond suture material around the coracoid process and passing through two drill holes made in the clavicle at the attachment of the coracoclavicular ligament. The stabilization was reinforced by passing K wire through the acromion into the lateral end clavicle. After 3 weeks of surgery, K wire was removed and patient was mobilized. Results were assessed by Constant – Murley score. Patients were followed up for 1 year, the mean Constant – Murley score was 86. One patient had infection at the site of k wire entry, another patient had decreased range of movements at the shoulder. No implant back out, no incidence of dislocation were observed.

This method proves to be better alternative fixation as compared to only K wire fixation and also it avoids the blow out of clavicle while drilling to pass semitendon as clavicle in Indian population is relatively thinner. This procedure offers better stabilization, less morbidity and improved functional outcome as compared to the other various surgical procedures.


S. Waliullah V. Kumar D. Rastogi R. N. Srivastava

Spinal tuberculosis is one of the most common presentations of skeletal tuberculosis. It is one of the major health issues of developing countries as it is associated with significant morbidity and mortality. Pott's paraplegia is a dreaded complication which can result in permanent neurological deficit, unless treated by timely intervention. We evaluated the efficacy of transpedicular decompression and functional recovery in patients of spinal tuberculosis with neurological deficit.

A cohort of 23 patients (15 males and 8 female) with diagnosed spinal tuberculosis and having an average age of 37.5±8.4 years, satisfying our inclusion and exclusion criteria's and giving written informed consent were recruited in our study. All patients were managed by transpedicular decompression and fusion with posterior instrumentation. All the patients were followed up clinically, radiologically and hematologically. Patients were followed up at every six weeks for 4 months and thereafter at three monthly intervals to assess the long term outcomes and complications. Neurological evaluation was done by Frankel grading. Functional outcome was assessed by Visual Analog Score (VAS) and Owestry Disability Index score (ODI score).

All the patients were followed for a minimum of 27 months. At the final follow-up, there was a statistically significant improvement in VAS score and ODI score. Out of 23 patients, all except three patients showed neurological recovery.

We observed that transpedicular decompression is safe and effective approach for management of spinal tuberculosis as it allows adequate decompression of spinal cord while pedicular instrumentation provides stable spinal fixation and helps in early rehabilitation.


M. S. Azhar S. Ahmed N. Gogi G. Walsh G. Chakrabarty

Background of study

Total Knee Replacement (TKR) is one of the commonest elective arthroplasty operations. Crepe dressings are used following TKR by most surgeons as it may provide comfort and hemostasis through external pressure however, may reduce early range of motion (ROM). Avoiding crepe dressings after TKR saves operating time, avoids bulky dressings (which may reduce ROM) and allows interventions such as cryotherapy in the early post-operative period. There are no published studies comparing the use of crepe dressing after TKR with an impermeable dressing alone

Materials and Methods

We did a retrospective study, analysing patients who had a TKR with the use of crepe dressings compared with patients who had an impermeable dressing alone. All patients had cruciate retaining PFC Implants through the medial para-patellar approach. We compared ROM (at initial physio contact and on discharge), rate of wound leakage, opioid requirements and duration of inpatient stay.


V. N. Gibbs P. Raval R. Rambani

Background of study

There has been an exponential increase in the use of direct thrombin (DT) and factor Xa inhibitors (FXI) in patients with cardiovascular problems. Premature cessation of DT/FXI in patients with cardiac conditions can increase the risk of coronary events. Our aim was to ascertain whether it is necessary to stop DT and FXI preoperatively to avoid postoperative complications following hip fracture surgery.

Materials and Methods

Prospective data was collected from 189 patients with ongoing DT/FXI therapy and patients not on DT/FXI who underwent hip fracture surgery. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.


K. S. R. K. Prasad S. Punjabi C. Silva S. Sarasin P. Lewis

DAIR procedure is well established for Prosthetic Joint Infection (PJI) in acute setting after total hip and knee replacements. We present our experience of DAIR following hip and knee replacements in a District General Hospital (DGH), where we delivered comparable results to leading tertiary centres in short to mid-term followup.

We undertook a retrospective study involving 14 patients, who underwent DAIR in our DGH between August 2012 and December 2015. Patient cohort included primary, complex primary and revision hip and knee replacements. Microbiological support was provided by a Microbiologist with interest in musculoskeletal infections.

14 patients [9 males, 5 females; age 62 to 78 years (Mean 70.7); BMI 22 to 44.2 (Mean 33.8)] with multiple comorbidities underwent DAIR procedure within 3 weeks of onset of symptoms. 12 out of 14 grew positive cultures with two growing Vancomycin resistant Enterococci. Intravenous antibiotics were started after multiple samples intraoperatively and continued in six patients after discharge, while 8 were discharged with oral antibiotics. One patient died of overwhelming intraoperative septic shock in postoperative period. Another patient died of myocardial infarction subsequently. 12 (85.7%) patients were doing well with regular followup (Mean 20 months).

With good patient selection, DAIR is a far simpler solution and a safe and reproducible surgical option for early PJI following hip and knee replacements compared to one or two stage revisions. But published data in contemporary literature is predominantly from specialised centres. Our small series provides a perspective of comparable early to mid-term results of DAIR from DGH.


N. M. Kurian A. A. Shetty S. J. Kim V. Shetty S. Ahmed S. Trattnig

Gel-based autologous chondrocyte implantation (ACI) over the years have shown encouraging results in repairing the articular cartilage. More recently, the use of cultured mesenchymal stem cells (MSC) has represented a promising treatment option with the potential to differentiate and restore the hyaline cartilage in a more efficient way. This study aims to compare the clinical and radiological outcome obtained in these two groups.

Twenty-eight consecutive symptomatic patients diagnosed with full-thickness cartilage defects were assigned to two treatment groups (16 patients cultured bone marrow-derived MSC and 12 patients with gel-type ACI). The MSC group patients underwent microfracture and bone marrow aspiration in the first stage and injection of cultured MSC into the knee in the second stage. Clinical and radiological results were compared at a minimum follow up of five years

There was excellent clinical outcome noted with no statistically significant difference between the two groups. Both ACI and MSC group showed significant improvement of the KOOS, Lysholm and IKDC scores as compared to their preoperative values and this was maintained at 5 years follow up. The average MOCART score for all lesions was also nearly similar in the two groups. The mean T2* relaxation-times for the repair tissue and native cartilage were 27.8 and 30.6 respectively in the ACI group and 28 and 29.6 respectively in the MSC group.

Use of cultured MSC is less invasive, technically simpler and also avoids the need for a second surgery as compared to an ACI technique. With similar encouraging clinical results seen and the proven ability to restore true hyaline cartilage, cultured MSC represent a favorable treatment option in articular cartilage repair.


P. Lee A. P. Chandratreya

Background of study

Following the Montgomery ruling, consent is now a matter of law. The medical professionals have to show proof that risks and implications and material risks are explained to the patient and that they have accepted to go ahead with surgery.

Materials and Methods

We devised a free web based programme (www.consentplus.com) which introduces a documented checkpoint to the consent process in hip and knee replacement surgery. It enables reproducible high-quality bite-sized information delivery to patients and their families in an optimal environment. It utilises the flip classroom principle to facilitate dialogue between doctors and patients. It generates physical documentation to show patients’ knowledge and understanding of the risks; to produce a truly informed consent.


R. Mohan P. Lee A. Chandratreya

Background of study

Medial patellofemoral ligament (MPFL) reconstructions are often performed using gracilis autografts, this can be associated with donor site morbidity and complications. The use of synthetic material can circumvent a harvest operation and have previously been demonstrated to be effective in other types of reconstructive procedures and may be effective in MPFL reconstruction. We report our experience and clinical results with the use of FiberTape (FT) in MPFL reconstruction and compare it to the same surgical technique using standard autografts.

Materials and Methods

Data were collected prospectively in 50 MPFL reconstructions. The first 27 underwent reconstruction using autograft; the following 23 patients were treated with FT. All patients were clinically and radiologically assessed and underwent pre- and post-operative scoring using the Kujala score, Bartlett score, Modified Tegner activity rating scale, SF 12 score and Lysholm score. Statistical significance was tested between groups using ANOVA with repeated measures.


M. Iqbal V. Batta S. Pulimamidi A. Sharma S. Sundararajan S. Manjure

Background

Bone preservation is desired for future revision in any knee arthroplasty. There is no study comparing the difference in the amount of bone resection when soft tissue balance is performed with or without computer navigation.

To determine the effect on bony cuts when soft tissue balance is performed with or without use of computer software by standard manual technique in total knee arthroplasty.

One hundred patients aged 50 to 88 years underwent navigated TKR for primary osteoarthritis. In group A, 50 patients had both soft tissue release and bone cuts done using computer-assisted navigation. In group B, 50 patients had soft tissue release by standard manual technique first and then bone cuts were guided by computer-assisted navigation.

In group A the mean medial tibial resection was 5 ± 2.3 mm and lateral was 8 ± 1 mm compared to 5 ± 2 mm (P = 0.100) and 8 ± 1 mm respectively in group B (P = 0.860). In group A the mean medial femoral bone cut was 9 ± 2.9 mm and lateral was 8 ± 2 mm as compared to 9.5 ± 2.9 mm (P = 0.316) and 10 ± 2.2 mm respectively in group B (P = 0.001). Average prosthesis size was 6 (range 3 to 8) in group A as compared to size 5 (range 2 to 7) in group B. Average navigation time in group A was 102 minutes (range 45 to 172) and in group B was 83 minutes (range 42 to 165, P = 0.031).

Our results show that performing soft tissue release and bone cuts using computer- assisted navigation is more bone conserving as compared to manual soft tissue release and bone cuts using computer navigation for TKR, thus preserving bone for possible future revision surgery.


A. Sharma V. Singh

Introduction

Aim was to compare the functional outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricotical iliac crest auto graft verses stand-alone PEEK cage.

Material and methods

Prospectively collected data of 60 patients in each group was compared.


R. T. Issac L. E. Thomson K. Khan A. J. Best P. Allen J. Mangwani

Ankle arthrodesis is the gold standard for treatment of end stage ankle arthritis. We analysed the data of 124 Ankle Arthrodesis (Open Ankle Arthrodesis (OAA) −27; Arthroscopic Ankle Arthrodesis (AAA)- 97) performed between January 2005 and December 2015 by fellowship trained foot and ankle surgeons in a single institution. Based on preoperative deformity (AAA- 28 degree valgus to 26 degrees varus; OAA- 41 degree valgus to 28 degree varus), they were subdivided into 2 groups based upon deformity more than 15 degrees. Union rates, time to union, length of hospital stay and patient related factors like smoking, alcoholism, diabetes, BMI were assessed.

Mean age of patients was 60 years (Range 20 to 82 years)(Male:Female-87:32). Overall fusion rate was 93% in AAA and 89% in OAA (p=0.4). On sub group analysis of influence of preoperative deformity, there was no difference in union rates of AAA versus OAA. 7 patients in AAA and 3 in OAA required further procedures. Average time to union was 13.7 in AAA and 12.5 weeks in OAA (p=0.3). Average hospital stay was 2.6 days in AAA and 3.8 days in OAA (p=0.003). Smoking, alcoholism, Diabetes, BMI did not have any correlation with union rates. Although both AAA and OAA showed good union rates, hospital stay was significantly shorter in AAA. A larger deformity did not adversely affect union rates in AAA. Time to union was higher in AAA though it was statistically insignificant. Lifestyle risk factors did not have cumulative effect on union.

We conclude that AAA is a reproducible method of treating end stage tibiotalar arthritis irrespective of preoperative deformity and patient related factors.


S. Muthukumar Balaji S. Tapasvi

BACKGROUND

Injuries of the both menisci and complete ACL tear is quite common. In the literature, functional outcome in these patients is often variable and less than satisfactory. We studied the functional outcome of this group of patients (retrospective study of prospectively followed case series).

MATERIAL AND METHODS

All patients who were diagnosed with ACL injury by arthroscopy at an tertiary hospital in southern India between January2013 and june2017 were enrolled in the study. From the total of 189 consecutive patients who had ACL tears with either one meniscus or both meniscus tear, 41 patients had injuries of both menisci of the same knee with ACL tear. 6 patients were lost to follow up. All patients underwent repair/balancing of one/both meniscus and reconstruction of ACL. There were 29 males and 6 females with age ranging from 18 – 60yrs (mean 25.2) years available for final analysis.