Browsing by Author "Joshi, Amit"
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Publication Is Venous Thromboembolism Prophylaxis Needed in Patients Undergoing Knee Arthroscopy? A Prospective Observational Study(Nepal Health Research Council, 2023) Joshi, Amit; Rijal, Nishchal; Gurung, Subash; Basukala, Bibek; Sharma, Rajiv; Bista, Rohit; Singh, Nagmani; Pradhan, IshorAbstract Background: Although rare, deep vein thrombosis is a potentially life-threatening complication of knee arthroscopy. There are scanty literature analysing deep vein thrombosis after arthroscopy in Nepal. This study aimed to identify the prevalence of deep vein thrombosis in patients undergoing knee arthroscopy without chemoprophylaxis postoperatively at 2 weeks and 6 weeks, respectively. The study also aimed to estimate the risk of deep vein thrombosis in these patients by using Caprini Risk Assessment Model. Methods: This prospective observational study was conducted at AKB center, B&B Hospital, Gwarko, Lalitpur, over a period of 16 months. All patients who underwent arthroscopy knee surgeries fulfilling the inclusion criteria were included in the study. The primary outcome measure was the prevalence of deep vein thrombosis as diagnosed by compression color-coded ultrasonography of the popliteal vein and calf vein at 2 weeks and 6 weeks postoperatively. The secondary outcome measure was the prevalence of deep vein thrombosis in the risk groups according to Caprini Risk Assessment Model. Results: Out of 612 patients who underwent arthroscopic knee surgeries during the study period, 2 patients (0.33%) developed deep vein thrombosis at 6 weeks follow-up as diagnosed with ultrasonography of the popliteal and calf veins. The prevalence rate in high-risk group was 0.33% (1 in 307) and in very high-risk group was 5.88% (1 in 17). Conclusions: There was a low prevalence of deep vein thrombosis without chemoprophylaxis following knee arthroscopy in our study. There was higher prevalence of deep vein thrombosis in very high-risk group patients, so close monitoring of such patients during follow-up is recommended. Keywords: Caprini Risk Assessment Model; deep vein thrombosis; knee arthroscopy; prevalence. Author Biographies Nishchal Rijal, Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal Subash Gurung, Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal Bibek Basukala, Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal Rajiv Sharma, Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal Rohit Bista, Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal Nagmani Singh, Department of Orthopaedics, B and B Hospital Pvt Ltd., Gwarko, Lalitpur, Nepal Ishor Pradhan, Department of Orthopaedics, B&B Hospital Pvt Ltd., Gwarko, Lalitpur, NepalPublication Positive Pivot Shift Test among Patients with Displaced Anterior Tibial Spine Fractures Undergoing Arthroscopic Fixation in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Joshi, Amit; Shrestha, Sabin; Regmi, Subhash; Basukala, Bibek; Sharma, Rajiv; Bista, Rohit; Singh, Nagmani; Pradhan, IshorAbstract Introduction: Understanding of displaced anterior tibial spine fractures has evolved over the years and is now considered to be anterior cruciate ligament avulsion injuries rather than intra-articular fractures. However, there are very few studies available evaluating the presence or absence of a pivot shift test, which is specific in diagnosing anterior cruciate ligament insufficiency, in patients with anterior tibial spine fractures. This study aimed to find out the prevalence of the positive pivot shift test among patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients presented with displaced anterior tibial spine fractures undergoing arthroscopic fixation. The data were collected between 1 January 2020 and 30 May 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC_2019_11_09_1). All patients who presented with displaced anterior tibial spine fractures undergoing arthroscopic fixation were included in the study and those who did not provide consent were excluded. The pivot test was performed under anaesthesia. Point estimate and 90% Confidence Interval were calculated. Results: Among 48 patients, pivot shift was positive in 36 (75%) (64.75-85.25, 90% Confidence Interval). The mean age of the participants was 28.97±11.16 years, 21 (58.33%) were males and 15 (41.66%) were females. Conclusions: The prevalence of positive pivot shift test under anaesthesia in patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation was higher than other studies done in similar settings.Publication Ramp Tear among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction in a Tertiary Care Centre(Nepal Medical Association, 2023) Joshi, Amit; Nepal, Santosh; Regmi, Subhash; Pradhan, Ishor; Singh, Nagmani; Basukala, Bibek; Bista, Rohit; Rajiv SharmaAbstract Introduction: Ramp tear is a specific injury that affects the posterior horn of the medial meniscus and its meniscosynovial or meniscocapsular attachments. The actual prevalence of ramp lesion is unknown due to the high probability of misdiagnosis or underdiagnosis caused by the low sensitivity of imaging modalities and poor visualization during arthroscopy. This study aimed to find out the prevalence of ramp tear among patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing arthroscopic anterior cruciate ligament reconstruction after getting ethical approval from the Institutional Review Committee. Data from 1 March 2019 to 31 December 2022 was collected between 1 May 2023 to 30 May 2023 from medical records. The study included all patients who underwent arthroscopic anterior cruciate ligament reconstruction. Patients with a previous history of medial meniscus injury or repair and undergoing revision anterior cruciate ligament reconstruction were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 412 patients who underwent arthroscopic anterior cruciate ligament reconstruction, 53 (12.86%) (9.63-16.09, 95% Confidence Interval) had ramp tears. The mean age of patients with ramp tears was 28.64±7.57 years. Among 53 patients, 42 (79.24%) were male and 11 (20.75%) were female. Conclusions: The prevalence of ramp tears in patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre was found to be lower than other studies done in other international studies.