Osteoarthri􀆟 s (OA) Knee is a common health problem
aff ecô€†Ÿ ng almost 29 % of India’s Populaô€†Ÿ on1. Gold standard
treatment for high grade Arthri􀆟 s is Total Knee Replacement2.
However this procedure carries its risk to benefi t ra􀆟 o and
complica􀆟 ons3 like DVT, persistent pain. High 􀆟 bial osteotomy
and uni-compartmental replacement are other modali􀆟 es for
high grade knee which needs surgical skills and has its risk to
benefi t ra􀆟 o and complica􀆟 ons 4 like fracture, implant failure
and others. Incidental fi ndings Of High Fibular Osteotomy
a Simple Surgical Procedure seems to be boon for those
pa􀆟 ents who have excrucia􀆟 ng pain and wai􀆟 ng for total knee
replacement but cannot go for it due to its prohibi􀆟 ve cost.
Evidence of its effi cacy has been piling up fast and seems to
buy 􀆟 me for pa􀆟 ent with medial compartment arthri􀆟 s for
total knee replacement and gives short to medium term relief.
For Indian subcon􀆟 nent where > 50 % have varus deformity
with medial compartment arthri􀆟 s seems to be best interim
surgery with minimal blood loss, small surgical scar, ability of
full weight bearing walk and squat on the same day and cost
eff ec􀆟 ve with no age limits5. A total follow up of 20 pa􀆟 ent
shows increase in medial joint space of > 2mm and decrease
Tibiofemoral angle around 2° with improved Visual Analogue
Score (VAS) score from 2 To 8. Thus HFO can be considered
as a choice of treatment for medial compartment knee with
varus deformity as a joint preserving procedure for a span of
2-10 years.

Acetabular malposi􀆟 on in total hip arthroplasty can lead
to instability, impingement, and edge loading resul􀆟 ng in
eccentric loading and increased wear that can lead to bearing
failure. Eccentric wear in metal on metal bearings used in
Birmingham Hip Resurfacings (BHR) produces metal debris.
Moun􀆟 ng body of evidence sugges􀆟 ng that one generic
zone such as Lewennik’s “safe zone” is unreliable. Funcô€†Ÿ onal
posi􀆟 oning of acetabular component rela􀆟 ve to pa􀆟 ent
specifi c dynamic pelvic 􀆟 lt throughout a range of ac􀆟 vi􀆟 es is
crucial. The aim use OPS to analyze pre-opera􀆟 ve acetabular
posiô€†Ÿ on, determine paô€†Ÿ ent specifi c funcô€†Ÿ onal “safe-zone”
and employ customized alignment guides to implant BHR
acetabular components resul􀆟 ng in improved func􀆟 onal and
radiographical outcomes. OPS performed pre-opera􀆟 vely in
13 pa􀆟 ents to create customized implant alignment guides.
Data collected pre and post-opera􀆟 vely at 6, 12 and 52 weeks.
Primary outcome measures of func􀆟 onality including Oxford
Hip Scores, disloca􀆟 on and revision rates. OPS post-opera􀆟 vely
to evaluate posi􀆟 oning. Secondary outcome measure of
serum metals ions monitoring for metallosis. Improved Oxford
Hip Scores post-opera􀆟 vely. Currently no revision surgeries
or disloca􀆟 ons have occurred. Preliminary results from postopera
􀆟 ve OPS indicate no edge loading. Use of OPS results in
improved precision and accuracy in achieving pa􀆟 ent specifi c
funcô€†Ÿ onal acetabular “safe-zone” thus improving funcô€†Ÿ onal
outcomes and reducing edge loading in BHR.

Background: Den􀆟 st sits in a chair and leans forward towards
the pa􀆟 ent, lumbar curve fl a􀆩 ens and the bony infrastructure
provides very li􀆩 le support to the spine. Si􀆫 ng in chair forces
the hamstrings to become inac􀆟 ve and places them in a
shortened posi􀆟 on. Repe􀆟 􀆟 ve, prolonged si􀆫 ng eventually
leads to hamstring muscles that adapt to a new shortened
length, and the result is Hamstring 􀆟 ghtness which induces
posterior pelvic 􀆟 lt and decreased lumbar lordosis, which can
result in low back pain
Objec􀆟 ve: We inves􀆟 gated eff ects of hamstring stretch with
pelvic control on pain, disability and work ability in Den􀆟 st
with mechanical low back pain.
Methods: Thirty Den􀆟 st from Dental professional were
randomly assigned to pelvic control hamstring stretching
(Group A) (n = 15) and Supine hamstring stretching (Group
B) (n = 15). All interven􀆟 ons were conducted 3 days per week
for 6 weeks, and included in the hamstring stretching and
lumbopelvic muscle strengthening.
Outcomes: Outcomes were evaluated through Numeric pain
ra􀆟 ng scale (NPRS) for Pain, Oswestry disability index (ODI) for
Disability, and Work ability index (WAI) for Work ability.
Results: The paired t-test was used to compare within group
diff erences and unpaired t-test was used to compare the
between group diff erences. All sta􀆟 s􀆟 cal analyses were
performed using SPSS sta􀆟 s􀆟 cal so􀅌 ware version 21.Signifi cant
diff erences found between Group A and group B in all three
variables.(p<0.05).between pre and pos􀆩 est of subjects.
According to the results of the present research, it could be
concluded that for reducing pain, disability and work ability
in den􀆟 sts pelvic control hamstring stretch and lumbopelvic
strengthening exercises are recommended.
Conclusions: The pelvic control hamstring stretch exercise
would be more helpful in back pain reduc􀆟 on and improvement
of work ability in Den􀆟 st with mechanical low back pain.

Introduc􀆟 on: Hallux valgus is a prevalent condi􀆟 on and aff ects
a reported 30% of adults aged more than 40 years. There are
several methods of conserva􀆟 ve and surgical procedure (150
procedures) for treatment of that. The aim of this review
is evalua􀆟 on of advantages and disadvantages of these
procedures.
Materials and Method: We recognize the studies u􀆟 lizing
data base of PubMed and Google scholar, with the keywords
hallux valgus, osteotomy, minimally invasive, percutaneous,
Conserva􀆟 ve treatment, pain, quality of life and surgery.
Results: Percutaneous as a minimally invasive surgery is one
of the major progresses in the opera􀆟 ng fi eld of orthopedic.
Twenty-four studies compared the eff ec􀆟 veness of various
kinds of surgeries. The results showed there is no diff erence
in rate of pain between chevron-type osteotomy and other
surgical procedures. One study revealed that chevron
osteotomy is more benefi cial than Lindgren osteotomy in
terms of walking speed. A medium quality study evaluated
the effi cient of hallux valgus surgery compared to conserva􀆟 ve
or no treatment. This study revealed that surgery, specifi cally
chevron osteotomy, is a more eff ec􀆟 ve procedure for pain
compared to conserva􀆟 ve treatment and also no treatment
in the fi rst year.
Conclusion: This review showed that diff erences between
various types of surgical procedures are minimal; however
there is evidence that surgery methods, are a more eff ec􀆟 ve
procedure than conserva􀆟 ve or no treatment in decreasing
pain in the fi rst year following surgery. However, this review has
showed that there is a loss of high-quality studies comparing
equivalent types of Hallux valgus treatments that evaluate the
same outcomes.

Background: Forward head posture is one of the most common
abnormali􀆟 es associated with chronic neck pain. In FHP
the altered rib cage mechanics leads to decrease in thoraco
abdominal mobility, impaired diaphragm muscle mobility and
reduced the ven􀆟 lator effi cacy of diaphragm, reduced the
eff ec􀆟 veness of abdominals and intercostals muscles.
Methods: Total of 20 subjects were taken, based on inclusion
& exclusion criteria the experimental group (n=10) &
control group (n=10) were randomized. Experimental group
received Cervical Stabiliza􀆟 on Exercise with the conven􀆟 onal
Physiotherapy and Control group received only Conven􀆟 onal
Physiotherapy for 6 weeks.
Outcome measures: Perceived recovery was assessed with
Numeric Pain ra􀆟 ng Scale (NRPS), Neck Disability Index (NDI),
Forward head posture which was assesses by the digital camera
by measuring the Craniovertebral Angle (CVA), Respiratory
strengths (MIP & MEP) was assessed by Respiratory Pressure
meter.
Results: Signifi cant increase in Craniovertebral angle and
respiratory strength with decrease in NRPS and NDI scores were
found in the group which received the cervical stabiliza􀆟 on
exercises along with the conven􀆟 onal Physiotherapy (p< 0.05).
Conclusion: Cervical stabiliza􀆟 on exercise is an eff ec􀆟 ve
approach to reduce the forward head posture and thus helps
to regain the respiratory muscle strength by improving the
biomechanics of respiratory muscles.

La􀆟 ssimus Dorsi is a large pectoral girdle muscle and powerful
arm adductor (1, 2). Avulsion injuries of its tendinous
inser􀆟 on into the humerus are incredibly rare. Surgical repair
has rarely been reported, literature showing fewer than 15
cases, most with tendon augmenta􀆟 on (1, 3-8). This unique
and complex case of a delayed La􀆟 ssimus Dorsi avulsion injury
in a power-li􀅌 ing athlete cycling anabolic steroids. Using an
intracor􀆟 cal bu􀆩 on technique, we proposed that this robust
repair would enable restora􀆟 on of full func􀆟 on, strength and
cosme􀆟 c defects. 28-year-old compe􀆟 􀆟 ve powerli􀅌 er cycling
anabolic androgenic steroids and testosterone presented
15 weeks post injury. Clinical examina􀆟 on revealed obvious
asymmetry, tenderness and posterior axillary fold defect.
Profound weakness of resisted arm adduc􀆟 on. MRI revealed
absent La􀆟 ssimus Dorsi inser􀆟 on, tendon stump in axilla.
Surgical repair was undertaken via dual axillary approach.
Retracted tendon mobilised and two 􀆟 tanium bu􀆩 ons with
integrated Fibrewire Sutures (Arthrex Inc) created a modifi ed
Krakow suture, a novel technique. A dual fi xa􀆟 on point at its
anatomical inser􀆟 on was created using an intracor􀆟 cal bu􀆩 on.
We described a successful delayed repair of this chronic injury
without the need for tendon augmenta􀆟 on. Dual approach
assists with tendon mobiliza􀆟 on and prepara􀆟 on, along with
restora􀆟 on of anatomy and strong fi xa􀆟 on at bicipital groove.
Clinical and radiological evidence of recovery without pain,
correc􀆟 on of cosme􀆟 c defects and full return to compe􀆟 􀆟 ve
powerli􀅌 ing. This robust intracor􀆟 cal bu􀆩 on technique
produces a successful La􀆟 ssimus Dorsi tendon avulsion repair
with incredible results leading to restora􀆟 on of full func􀆟 on,
even in the most challenging compe􀆟 􀆟 ve athletes.

Background: Patellofemoral pain syndrome is a rela􀆟 vely
common diagnosis in outpa􀆟 ents presen􀆟 ng with anterior
knee pain. Patellofemoral pain syndrome can be defi ned as
retro patellar or peripatellar pain resul􀆟 ng from physical and
biochemical changes in the patellofemoral joint.
Aim: This study was undertaken to inves􀆟 gate the effi cacy of
func􀆟 onal mobiliza􀆟 on approach in terms of pain and func􀆟 on
in young adults with patellofemoral pain syndrome and the
clinical effi cacy of foot orthoses with func􀆟 onal mobiliza􀆟 on
in individuals with patellofemoral pain syndrome.
Methodology: 60 adults with patellofemoral joint pain.
Each par􀆟 cipant was randomly allocated to one of the two
groups (a or b) using block randomiza􀆟 on method. The two
groups were as follows: group a: func􀆟 onal mobiliza􀆟 on
of foot and ankle + exercises and group b: full length medial
wedge insoles + exercises. A 12 week treatment program was
prescribed for each pa􀆟 ent, and each pa􀆟 ent was assessed at
baseline and a􀅌 er 12 weeks (pre- and post- interven􀆟 on) for
primary outcomes using lefs (lower extremity func􀆟 on test),
nprs(numeric pain ra􀆟 ng scale)and fpi(foot posture index).
Results: Pa􀆟 ents from both groups demonstrated clinically
signifi cant improvement in primary outcomes with regard
to self-reported pain and func􀆟 on upon comple􀆟 on of the
study. A signifi cant diff erence was also seen in foot posture.
Post hoc analysis determined that post-interven􀆟 on follow-up
measures signifi cantly improved (p < 0.05 for all) as compared
to baseline values in terms of pain and func􀆟 on .Func􀆟 onal
mobiliza􀆟 on was more eff ec􀆟 ve in reducing pain (mean
diff erence 0.1) and orthoses were more eff ec􀆟 ve in improving
foot posture. Group b showed no immediate change in pain
and func􀆟 on ini􀆟 ally, indica􀆟 ng that improvement occurred at
a slower rate in this group. Pain and func􀆟 on improved faster
in group a. However, the magnitude of change in foot posture
was seen more in group b.
Conclusion: Therefore, incorpora􀆟 ng func􀆟 onal mobiliza􀆟 on
of foot and ankle in addi􀆟 on to conven􀆟 onal therapy in
physical therapy clinical prac􀆟 ce in future may improve short
term benefi cial eff ects with regard to pain and func􀆟 on in
pa􀆟 ents with patellofemoral pain syndrome.

Introduc􀆟 on: The tendini􀆟 s is commonly defi ned as an
infl amma􀆟 on of the tendon, which is what connects bones
to muscle. On the major literature, tendini􀆟 s is usually caused
by repe􀆟 􀆟 on of movements and lack of stretching. However,
the cause was never before associated to a disease in the
liver, such as Autoimmune Hepa􀆟 􀆟 s. According to Tradi􀆟 onal
Chinese Medicine (TCM), tendons are governed by the energy
of the Gallbladder meridian, which is a􀆩 ached to the Liver
energy.
Purpose: The aim of this study is to demonstrate that tendini􀆟 s
may be an early manifesta􀆟 on of Autoimmune Hepa􀆟 􀆟 s.
Methods: Through a clinical case report of a female pa􀆟 ent,
M.C., 42 years old, with chronic pain in shoulder and elbow,
resistant to conven􀆟 onal treatments with an􀆟 -infl ammatories
and physiotherapy. She sought acupuncture treatment,
and even so, the improvement presented was scarce. In her
physical examina􀆟 on, a bulging was detected in the right
ear, on the area that corresponds to the Liver, according to
Auricular Medicine. Laboratory tests were requested to see
if there could be any undiagnosed liver disease un􀆟 l then.
The only exam that was ini􀆟 ally altered was the prothrombin
􀆟 me of 89%. More tests were ordered to see whether an􀆟 -
bodies were present. An􀆟 -nuclear, an􀆟 -smooth muscle, an􀆟 -
microsomal.
Results: To the physician's surprise, the pa􀆟 ent had a 1:160
an􀆟 -nucleus reagent.
Conclusion: The conclusion of this study is that tendini􀆟 s may
be the ini􀆟 al manifesta􀆟 on of an Autoimmune Hepa􀆟 􀆟 s.

Background: In recent past the global agenda for health
burden of disease for women has changed signifi cantly from
maternal morbidity and mortality to non communicable
diseases as the leading cause of death and disability among
women in almost all the countries of the world. A global
agenda for women’s health now, therefore, have a broadened
and redefi ned focus to encompass not only women’s sexual
and reproduc􀆟 ve health, but also the preven􀆟 on of non
communicable disorders which are mostly due to poor lifestyle
habits. Recent reports document a large na􀆟 onal health
burden of chronic disease with signifi cant propor􀆟 ons due
to behavioral dimensions such as physical inac􀆟 vity and low
levels of cardiorespiratory fi tnesss. With a signifi cant number
of women belonging to the status of menopause, it is crucial
to understand the status of psycho-physical fi tness, associated
risk factors so that a comprehensive health programme can be
designed which targets to improve their fi tness level including
life style modifi ca􀆟 ons to help them live an independent and
healthier life in the later stages of their life.
Methodology: Comprehensive health examina􀆟 on was
performed on 100 post menopausal women a􀆩 ending
physiotherapy OPD of SGT Hospital Gurugram. Post
menopausal women in the age group of 45-60 yrs were
included( 48 women from rural Gurugram and 52 women
from Urban Gurugram). Women who suff ered from any
chronic disease like cardiac heart disease, diabetes or with
some orthopedic and musculoskeletal problem that eff ected
the compliance to par􀆟 cipate in exercise tes􀆟 ng were
excluded from study. They were explained about the purpose
and procedure of the study and their consent was taken for
par􀆟 cipa􀆟 on. Cardiopulmonary fi tness was tested using
Harvard Step test and mental health was tested by using
middle sex heath ques􀆟 onnaire.
Result and Conclusion: Results of the study concluded that
40% of the females had below average cardiac fi tness and just
6 % had excellent cardiac fi tness. Physical inac􀆟 vity was 1 of the
contribu􀆟 ng factor for poor fi tness. 64% of post menopausal
women had poor psychological health. They suff ered from
anxie􀆟 es, stress due to declining physical health, growing
health issues, decline in fi tness and various other social and
psychological stressors.