Nagy, M., A. Kholeif, A. R. M. Mansour, S. Abdelhameed, Y. A. Radwan, A. Khedr, A. S. Elhalawany, A. Samir, I. Sarhan, and A. B. Zein, "Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up.", International orthopaedics, vol. 45, issue 10, pp. 2579-2588, 2021. Abstract

PURPOSE: The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults.

METHODS: Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage.

RESULTS: Pre-operative and three years follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eight weeks in Malerba group and nine weeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group.

CONCLUSION: Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.

Din, A. F. S. E., and A. Khedr, "Suprameniscal Portal for Repairing Meniscal Root Tears.", Arthroscopy techniques, vol. 10, issue 6, pp. e1627-e1632, 2021. Abstract

Several techniques and portals have been described for meniscal root repairs. Some authors describe using anterior portals for suture passing and manipulation of meniscal tissue, with some risk of iatrogenic chondral injuries reported. Other authors describe using posterior portals to avoid this risk. In this technique, we used a suprameniscal portal, which allowed a good trajectory for passing sutures in the meniscal tissue with minimal risk of iatrogenic chondral damage without the need to use posterior portals. The meniscal bed is first prepared. The suprameniscal portal is created in 15° of knee flexion and used to pass 2 sutures through the meniscus by a Lasso. The sutures are tied in a cinch configuration, shuttled through the tibial tunnel, and tied over a Dog Bone button.

Sinha, P., A. Khedr, M. P. McClincy, T. S. Kenkre, N. E. Novak, and P. Bosch, "Epiphyseal Translation as a Predictor of Avascular Necrosis in Unstable Slipped Capital Femoral Epiphysis.", Journal of pediatric orthopedics, vol. 41, issue 1, pp. 40-45, 2021. Abstract

BACKGROUND: Physeal instability has been shown to be associated with a higher risk of avascular necrosis (AVN) in patients with slipped capital femoral epiphysis (SCFE). The purpose of this study was to identify additional preoperative factors associated with AVN in patients with unstable SCFE.

METHODS: Basic demographic information, chronicity of symptoms, and estimated duration of nonambulatory status were noted. Preoperative radiographs were used to measure the Southwick slip angle, slip severity by Wilson criteria, and epiphyseal translation. Translation was measured by 3 distinct radiographic parameters in the position demonstrating maximal displacement. Postoperative radiographs at the time of most recent follow-up were assessed for the presence of AVN. Translation measurements were tested for inter-rater reliability. Patients who developed AVN were compared with those that did not by Fisher exact test and Wilcoxon tests. Logistic regression assessed the effect of translation on the odds of developing AVN. Receiver operating characteristic curve was plotted to assess any threshold effect.

RESULTS: Fifty-one patients (55 hips) out of 310 patients (16%) treated for SCFE were considered unstable. Seventeen hips' unstable SCFE (31%) showed radiographic evidence of AVN. Slip severity by Wilson grade (P=0.009) and epiphyseal translation by all measurements (P< 0.05) were statistically significantly greater among patients who developed AVN. Superior translation had the best inter-rater reliability (intraclass correlation coefficient=0.84). Average superior translation in hips that developed AVN was 17.2 mm compared with 12.9 mm in those that did not (P<0.02). Although the receiver operating characteristic curve did not demonstrate a threshold effect for AVN, it did effectively rule out AVN in cases with <1 cm of superior translation. Age, sex, laterality, chronicity of prodromal symptoms or inability to bear weight, Southwick slip angle, and method of treatment did not vary with the occurrence of AVN.

CONCLUSIONS: Epiphyseal translation, either by Wilson Grade or measured directly, is associated with AVN in patients with an unstable SCFE.

LEVEL OF EVIDENCE: Level II-development of diagnostic criteria.

Reda, W., and A. Khedr, "Using a Posterolateral Portal to Pass and Tie the Suture of the Inferior Anchor During Arthroscopic Bankart Repair.", Arthroscopy techniques, vol. 5, issue 6, pp. e1467-e1470, 2016. Abstract

Using a posterolateral portal in passing and tying the inferior knot allows good labral reduction and adequate capsular shift to treat anterior shoulder instability. In this technique, the most inferior anchor is placed through a low anterolateral portal. A penetrating grasper is introduced from a posterolateral portal situated 2 to 3 cm distal and lateral to the viewing portal. This portal is used to pass the 2 limbs of the anchor suture as inferior as possible through the labrum and capsule close to 6 o'clock position to form the 2 limbs of the first mattress suture. Finally, knot tying is performed through this posterolateral portal, thus allowing better superior shift of the capsulolabral tissue. The other 2 anchor sutures are passed and tied through the low anterolateral portal.

Din, A. F. S. E., and A. Khedr, "Suprameniscal Portal for Repairing Meniscal Root Tears.", Arthroscopy techniques, vol. 10, issue 6, pp. e1627-e1632, 2021. Abstract

Several techniques and portals have been described for meniscal root repairs. Some authors describe using anterior portals for suture passing and manipulation of meniscal tissue, with some risk of iatrogenic chondral injuries reported. Other authors describe using posterior portals to avoid this risk. In this technique, we used a suprameniscal portal, which allowed a good trajectory for passing sutures in the meniscal tissue with minimal risk of iatrogenic chondral damage without the need to use posterior portals. The meniscal bed is first prepared. The suprameniscal portal is created in 15° of knee flexion and used to pass 2 sutures through the meniscus by a Lasso. The sutures are tied in a cinch configuration, shuttled through the tibial tunnel, and tied over a Dog Bone button.

Diab, M. M., A. Khedr, L. Zaki, S. Khaled, and A. Balbaa, "Effect of introducing early weight bearing training in rehabilitating patient with tibial plateau fracture fixed with open reduction internal fixation", Bioscience Research, vol. 16, issue 2, pp. 1232-1242, 2019.
Sinha, P., A. Khedr, M. P. McClincy, T. S. Kenkre, N. E. Novak, and P. Bosch, "Epiphyseal Translation as a Predictor of Avascular Necrosis in Unstable Slipped Capital Femoral Epiphysis.", Journal of pediatric orthopedics, vol. 41, issue 1, pp. 40-45, 2021. Abstract

BACKGROUND: Physeal instability has been shown to be associated with a higher risk of avascular necrosis (AVN) in patients with slipped capital femoral epiphysis (SCFE). The purpose of this study was to identify additional preoperative factors associated with AVN in patients with unstable SCFE.

METHODS: Basic demographic information, chronicity of symptoms, and estimated duration of nonambulatory status were noted. Preoperative radiographs were used to measure the Southwick slip angle, slip severity by Wilson criteria, and epiphyseal translation. Translation was measured by 3 distinct radiographic parameters in the position demonstrating maximal displacement. Postoperative radiographs at the time of most recent follow-up were assessed for the presence of AVN. Translation measurements were tested for inter-rater reliability. Patients who developed AVN were compared with those that did not by Fisher exact test and Wilcoxon tests. Logistic regression assessed the effect of translation on the odds of developing AVN. Receiver operating characteristic curve was plotted to assess any threshold effect.

RESULTS: Fifty-one patients (55 hips) out of 310 patients (16%) treated for SCFE were considered unstable. Seventeen hips' unstable SCFE (31%) showed radiographic evidence of AVN. Slip severity by Wilson grade (P=0.009) and epiphyseal translation by all measurements (P< 0.05) were statistically significantly greater among patients who developed AVN. Superior translation had the best inter-rater reliability (intraclass correlation coefficient=0.84). Average superior translation in hips that developed AVN was 17.2 mm compared with 12.9 mm in those that did not (P<0.02). Although the receiver operating characteristic curve did not demonstrate a threshold effect for AVN, it did effectively rule out AVN in cases with <1 cm of superior translation. Age, sex, laterality, chronicity of prodromal symptoms or inability to bear weight, Southwick slip angle, and method of treatment did not vary with the occurrence of AVN.

CONCLUSIONS: Epiphyseal translation, either by Wilson Grade or measured directly, is associated with AVN in patients with an unstable SCFE.

LEVEL OF EVIDENCE: Level II-development of diagnostic criteria.

Nagy, M., A. Kholeif, A. R. M. Mansour, S. Abdelhameed, Y. A. Radwan, A. Khedr, A. S. Elhalawany, A. Samir, I. Sarhan, and A. B. Zein, "Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up.", International orthopaedics, 2021. Abstract

PURPOSE: The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults.

METHODS: Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage.

RESULTS: Pre-operative and three years follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eight weeks in Malerba group and nine weeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group.

CONCLUSION: Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.

A, K., and M. S, "Proximal Metaphyseal and Diaphyseal Humerus Fractures.", Oper Tech Orthop., vol. 29, issue 1, pp. 2-10, 2019.
M, D. M., K. A, A. Z. L, and S. Ahmed Radwan Khaled, "Effect of introducing early weight bearing training in rehabilitating patient with tibial plateau fracture fixed with open reduction internal fixation.", Biosci Res., vol. 16, issue 2, pp. 1232-1242, 2019.