Deepu Sethi

@KulveerRanger DC

Guess the capital city……?

This photo of a single spark from the Singapore GP is stunning ✨ (via calloalbanese/IG)

@hjluks Fragment in medial recess / gutter

Ortho residents and sports fellows. This is a classic image. Why does this person have exquisite medial pain.

@sayanamk I would certainly discuss fixation with patient. Young active patient, surgery may reduce (but not stop) future degenerative change. Balance with rehab and risks #informedconsent

10 week old injury in a 40-year old, biker Normal gait, able to straight leg raise, knee flexion 0° - 130° , Clarke’s test positive #Orthotwitter - would you fix it or leave it ?

Attention knee surgery trainees! A last minute change has meant we have a knee fellowship post available starting August 2024. One year post (or 2 x six months) Come join the team of 8 specialist knee consultants to improve your knowledge of sports knee and arthroplasty

Certainly something to note in all ACL tears. In a primary with a high slope it is useful to counsel the patient explain that they may have a higher risk of re-injury. But slope correction in a primary, no. May add a LET to reduce risk of reinjury.

@andrewhallortho @miriam_khalil13 Very true

@miriam_khalil13 It’s just never going to be as elegant as Orthopaedics I’m afraid 😉

If someone can find the colorectal surgery equivalent please send my way 😅🙏🏼

@RoshanaMN That is what everyone wanted to know 🏃‍♀️

And 3rd incase you’re wondering

Yes I DID just do the mums race at my kids sports day despite telling everyone I know not to do it because I see too many people with injuries from them… Couldn’t face the disappointment in his little face 😭🤣

@DrJN_SportsMed Great description of these chronic tears. We are understanding more about them and in some, surgical repair is very helpful

Consent ✅ Caught edge of ski moving slowly on ice 1 year ago - abrupt valgus / external rotation Immediate medial knee pain, but settled quite quickly No effusion Since, nagging medial aching particularly on rotational movement eg side pass football, pivoting in tennis (can be sudden / sharp) - lost confidence in knee Pure lateral movements - side step - ok Exam - some subtle increased travel on anteromedial glide. No overt valgus laxity vs contralateral side Tender on firm palpation proximal MCL POCUS - chronic 'sprain' (arrow) of deep MCL (meniscofemoral ligament) - superficial MCL intact, meniscus normal These deep MCL injuries can niggle on for ages, the key symptom is rotational provocation

@kneedoclond Happy Anniversary James

13 years ago, Mrs MSK Radiologist welcomed me into her family….. What a privilege to have been so included. #HinduWeddings #Verona #orthotwitter

@DrJN_SportsMed I agree with @bellkneesurgeon and @kashakhtar MRI is a static image and aids in diagnosis. Management is decided by basics of history and examination. If persistent instability after adequate rehab, the “healed” ACL is clearly not functional.

Consent ✅ Relevant case with respect to the 'healing' ACL & conservative management of ACL rupture debate Footballer, twist, 'pop' & rapid onset swelling 2 years ago Returned to football but struggled with sensation of imminent giving way / instability esp on change of direction Few buckling episodes Exam - increased travel on Lachman's testing, but firm-ish end point MRI - healed ACL (thickened / scarred / in continuity) So radiological healing definitely occurs, but doesn't necessarily tally with functional recovery

@kashakhtar @expertknee Needs de-rotation - not just coronal correction

@expertknee Surely you must have been seriously considering a double level osteotomy!

Orthopaedics in action, Japanese style! #orthotwitter #straighteninglimbs

We have started randomising participants for METEOR2!! 👏👏👏 to everyone working on this super-important knee RCT Do you see patients with persistent pain >6m after meniscectomy? Send them to one of the trial sites! (sites & more details in thread..)

@NuelleSportsMD Looks great, how about a notchplasty?

ACL Friday! ACL reconstruction is tailored to the individual patient. In this example this is an 8 mm diameter graft in a small patient with a narrow notch. Note the position of the graft in the notch as the knee goes thru motion. A larger graft would potentially overstuff it.

@kashakhtar @baskonline @ArthrexUK My TPD has retired, so where can I sign up?

@baskonline are delighted to announce a soft tissue knee cadaveric training day in conjunction with @ArthrexUK at their amazing facility in Solihull in April. We have 16 places, to be chosen from TPD nominations. (instagram.com/p/C3iWzdGIRSQ/… for awesome music) #bestofthebest

@DrJN_SportsMed @kashakhtar Yes, cysts around proximal tib-fib joint are quite common. Can cause pain, but often incidental finding.

@kashakhtar @DeepuSethi

Consent ✅ The proximal tibiofibular joint is an under-estimated source of lateral knee pain Ganglion cysts arising from the joint can be a giveaway on imaging 🚨 It can be quite challenging to inject US guided as a 'tight' joint esp if degenerative 😤 Injection 'hack' - use the cyst as a portal to the joint - much easier target🚪 Video shows injection of cyst (anechoic black structure) Needle comes from R side of screen - filling up, retrograde flow into joint

@henryknee @KneeUnit @kneedoclond @kashakhtar @expertknee Excellent

@DeepuSethi @KneeUnit @kneedoclond @kashakhtar @expertknee Living donor quad tendon allograft for ACL would be a worthy cause and treatment.

Interesting case. Calcific tendonitis in distal quadriceps. Symptomatic, treatment options? @KneeUnit @kneedoclond @kashakhtar @expertknee

@DrJN_SportsMed @kashakhtar @expertknee @KneeUnit @kneedoclond Yes, not seen one this amount of calcification before - admittedly I don’t use ultrasound, but I do see a lot of knee x-rays

@kashakhtar @expertknee @DeepuSethi @KneeUnit @kneedoclond Agree these are quite big deposits though…

@DrJN_SportsMed @kashakhtar @expertknee @KneeUnit @kneedoclond No history of gout

@DeepuSethi @kashakhtar @expertknee @KneeUnit @kneedoclond I’d assess distal soft tissue & deposits first on US - then consider SWT, deep quad tendon CSI or barbotage depending on what feel i get for it. Then rehab with experienced knee physio. any history gout?

@kashakhtar @expertknee @KneeUnit @kneedoclond @DrJN_SportsMed Thinking this is quite a big lesion and very well calcified. Speaking to shoulder surgeons, they use shockwave and needling, but for much smaller lesions.

@expertknee @DeepuSethi @KneeUnit @kneedoclond Likewise. Have taken some Osgood Schlatter's ossicles out of inflamed distal patella tendons, but rare to see calcific tendonitis. Didn't SEM use to shockwave these @DrJN_SportsMed ??