Enhancing glenohumeral joint stability after wide resection of the proximal humerus is important to address rotator cuff insufficiency. The greater levering effect of a longer humeral prosthesis used to increase soft tissue tension may also increase the risk of glenosphere dissociation secondary to trauma. Proper soft-tissue tensioning and surgical technique are critical.
  Alkaptonuria is a rare metabolic disorder of autosomal recessive pattern of inheritance caused due to homogentisic acid oxidase enzyme deficiency. As a result, polymers of homogentisic acid get deposited in excessive amounts in the connective tissues, leading to brownish-black pigmentation termed as ochronosis. As the disease progresses, chronic inflammation results in arthritis of large weight-bearing joints.
 
  A 70-year-old female patient presented with complaints of being non-ambulatory since the past 10 days. She gave a history of difficulty in walking for the past 10-15 years associated with pain in the right hip which did not respond to analgesics and physiotherapy. The radiological assessment revealed severe joint destruction of the right hip. The patient underwent a total hip arthroplasty. A provisional diagnosis of ochronosis was made intraoperatively which was later confirmed on histopathological examination of the tissue.
 
  At present, there is still no known effective medical treatment to halt alkaptonuria entirely.  https://www.selleckchem.com/products/bay80-6946.html  Ochronotic arthropathy is usually managed conservatively. However, for severely involved hip joints, arthroplasty can provide extremely good results.
 At present, there is still no known effective medical treatment to halt alkaptonuria entirely. Ochronotic arthropathy is usually managed conservatively. However, for severely involved hip joints, arthroplasty can provide extremely good results.
  Posterior femur wall blowout and consequent loss of femoral graft fixation are commonly encountered distally at the aperture of the tunnel facing into the joint during anterior cruciate ligament (ACL) reconstruction. However, intratunnel blowout of femoral tunnel at its outer cortical opening during a revision ACL reconstruction is very rare. It compromises the mechanical strength of the cortical bone at the tunnel opening on lateral cortex, making it weaker for providing stability to endobutton. We report this very rare event of intratunnel blowout of femoral tunnel at its proximal opening on the lateral femoral cortex during a revision ACL reconstruction, where the patient was treated with a modification in the suspensory fixation technique using a suture disc.
 
  Two years following a primary ACL reconstruction, our patient presented with a lax knee. Radiography and magnetic resonance imaging images showed malpositioning of femoral endobutton, lax, and degenerated autograft. During revision, we encountered intratunnel blowout at outer opening on lateral femoral cortex. It was rescued with a modification in the suspensory fixation technique by tying the endobutton with a suture-disc, placed directly over the proximal opening of femoral tunnel on lateral cortex.
 
  Our case report highlights, this rare critical surgical event during revision ACL reconstruction managed successfully with a suture disc, which is cost-effective, readily available and using the same prepared graft within a lesser operative time. Functional outcome was excellent and usage of a suture disc.
 Our case report highlights, this rare critical surgical event during revision ACL reconstruction managed successfully with a suture disc, which is cost-effective, readily available and using the same prepared graft within a lesser operative time. Functional outcome was excellent and usage of a suture disc.
  Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease, which causes the ossification of spinal longitudinal ligaments and enthesis leads to stiffness in the affected segment of the spine and neurological deficit due to compression of spinal cord or nerve roots by osteophytes.
 
  We present three cases of DISH, presented with cervical myelopathy, lumbar spondylolisthesis, and dysphagia. All three patients had neurodeficit and radiological examination showed cord compression, canal stenosis, listhesis, and contiguous ossification in the spine with normal sacroiliac joints. The first patient had cervical myelopathy because of compression of cord by ossified posterior longitudinal ligament, which was managed with posterior laminectomy, decompression, and stabilization. The second patient had L4-L5 listhesis with canal stenosis, which was managed with decompression, instrumentation and fusion (TLIF). The third patient had cervical myelopathy due to C6-C7 listhesis and also had dysphagia because of compression of esophagus by anterior osteophytes, which was managed with removal of anterior osteophytes and anterior discectomy and fusion (ACDF). Postoperatively, all three patients recovered completely with no residual neurodeficit.
 
  DISH can present in various ways, which depends on the site of involvement in the spine. Early surgical intervention helps in getting a better outcome in patients with neurodeficit and prevents further complications.
 DISH can present in various ways, which depends on the site of involvement in the spine. Early surgical intervention helps in getting a better outcome in patients with neurodeficit and prevents further complications.
  Synovial chondromatosis (SC) commonly involves large joints such as the knee and hip with smaller joints being less frequently involved. Extra-articular involvement is very rare, and here, we are presenting the first case of giant extra-articular SC originating from the ankle joint.
 
  A 42-year-old male presented to the outpatient department with painless swelling over the lateral malleolus for 2 years. Diagnostic imaging suggested the involvement of the synovial lining with the swelling. The mass was excised and histopathology proved the diagnosis of SC.
 
  Extra-articular involvement in SC has been mainly reported in the synovial sheath or bursae of the hand and foot, but they can involve ankle joint also. In recent times, there have been concerns about potential malignant transformation of these lesion to chondrosarcoma, diagnosing these lesions have become important.
 Extra-articular involvement in SC has been mainly reported in the synovial sheath or bursae of the hand and foot, but they can involve ankle joint also.