scholarly journals Arthroscopic Lunotriquetral Ligamentoplasty, from the Cadaver Lab to the Clinical Practice

2021 ◽  
Vol 49 (02) ◽  
pp. e121-e127
Author(s):  
Marcos Cruz-Sánchez ◽  
Cristóbal Martínez-Andrade
Keyword(s):  
Minimally Invasive ◽  
Range Of Motion ◽  
Clinical Case ◽  
Scar Tissue ◽  
Tendon Graft ◽  
Ligament Injury ◽  
Preoperative Pain ◽  
Anatomical Dissection ◽  
Lunotriquetral Ligament ◽  
Bone Tunnels

Abstract Introduction There has been an increase in the diagnosis of injuries to the intrinsic ligaments of the wrist due to the more widespread use of arthroscopy in the treatment of patients with musculoskeletal wrist pain, and arthroscopy is particularly very helpful to determine the etiology of these lesions at the ulnar level. The treatment of lunotriquetral ligament injuries encompasses different techniques with results that are little reproducible. Ligament reconstruction through tendon grafting has shown favorable results, but it involves extensive open approaches that lead to a slower recovery a lower range of joint motion due to the excess of scar tissue. The objective of the present study is to describe the performance, in a cadaver, of a minimally-invasive lunotriquetral and secondary-stabilizer ligamentoplasty and its application in a representative clinical case. Material and Methods A preliminary study of six specimens in which a lunotriquetral and secondary-stabilizer ligamentoplasty was performed consecutively through a free tendon graft with arthroscopic assistance. We proceeded to recreate the complete ligament injury, and to perform an assessment of lunotriquetral instability according to the Geissler classification and an arthroscopic ballottement test. We describe the surgical technique, ligament stability after the ligamentoplasty, and the subsequent anatomical dissection, assessing the anatomical structures susceptible to iatrogenic injury. We also describe the application of the technique in one case, comparing the clinical parameters before and after the procedure: range of motion of the joint, strength, pain and the shortened version of the Disabilities of the Arm, Hand, and Shoulder (QuickDASH) questionnaire. Results The ligamentoplasties performed showed recovery of the stability of the lunotriquetral interval assessed according to the Geissler classification and the arthroscopic ballottement test. In the dissection of the specimens, no iatrogenic lesions were found in the tendons or the surfaces of the mediocarpal and radiocarpal joints. The average distances between the nearest bone tunnels and nerves were of 7.3 mm for the sensory branch of the ulnar nerve, of 3.6 mm for the posterior interosseous nerve, and of 4.5 mm for the ulnar neurovascular bundle. No fractures were observed in the tunnelled bones. In the clinical case herein presented, six months after the intervention, there was an improvement in strength and preoperative pain, with a slight decrease in the joint range of motion (15% compared to the contralateral joint). Conclusions The lunotriquetral ligamentoplasty herein described could contribute to the biomechanical restoration of the carpus and be an option for recosntruction in selected cases. Its performance through minimally-invasive techniques, and the use of a free tendon graft together with specific rehabilitation should be considered to optimize the outcomes.

Application of a Viscous Liquid as an Aerosol for Post-Operative Adhesion Prevention: First Engineering Steps Towards Nozzle Design

2020 ◽  
Author(s):  
P. Alex Smith ◽  
Timothy J. Keane ◽  
Stefano Serpelloni ◽  
Stephen G. Ramon ◽  
Francesca Taraballi
Keyword(s):  
Thin Film ◽  
Minimally Invasive ◽  
Viscous Liquid ◽  
Scar Tissue ◽  
Adhesion Prevention ◽  
Nozzle Design ◽  
Postoperative Adhesions ◽  
Internal Organs ◽  
Spray Pattern ◽  
3D Printed

Abstract Postoperative adhesions are scar tissue that form between internal organs after surgery, leading to devastating life-long complications. Current adhesion barriers used clinically are solid sheets which can only be applied in open surgeries through large incisions. We have developed a material which can be applied as a liquid in minimally invasive surgeries which transitions into a solid thin film barrier upon contact with warm tissue. However, to be effective, it must be sprayed, and spraying a viscous liquid consistently is challenging. We proposed using a gas dispersant to facilitate aerosolization. In this study, we compared a commercially available nozzle without gas dispersant to a custom 3D printed nozzle with gas dispersant. For comparison, we measured both spray pattern and stiffness of the resulting gel. We found that when sprayed with gas dispersant, the spray pattern covered a larger area, and the resulting gel was stiffer than when sprayed without gas dispersant.

scholarly journals Percutaneous Repair Method and Achilles Tendon Rupture Rehabilitation

2020 ◽  
Author(s):  
Krzysztof Ficek ◽  
Paweł Gwiazdoń ◽  
Jolanta Rajca ◽  
Grzegorz Hajduk
Keyword(s):  
Side Effects ◽  
Soft Tissue ◽  
Minimally Invasive ◽  
Achilles Tendon ◽  
Range Of Motion ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Well Being ◽  
Professional Activity ◽  
Rehabilitation Protocol

Abstract Background: Subcutaneous, spontaneous, complete ruptures of the Achilles tendon are usually caused indirectly by trauma associated with rapid movement. When minimally invasive Achilles tendon repair is performed, an active rehabilitation protocol can be implemented that allows for fast, measurable progress, reduced tissue atrophy, and an improved range of motion, thereby reducing pain and increasing patients’ overall physical well-being. However, overestimating the effectiveness of rehabilitative interventions can lead to arbitrary advancements in rehabilitation that significantly exceed the permitted levels of daily or professional activity. This issue can lead to various side effects and slow rehabilitation. The aim of the study was to evaluate the influence of adverse effects on objective outcomes after minimally invasive Achilles tendon repair.Methods: The study included 36 individuals with complete Achilles tendon rupture who underwent the percutaneous Ma-Griffith technique. The same rehabilitation protocol was used.Results: Five side effects were identified during rehabilitation: deformation of the repair construct (DRC), irritation of the sural nerve (SNI), morning ankle stiffness (MAS), edema of the soft tissue around the tendon (OST) and suture knots. DRC and MAS were associated with a longer time being required to achieve full ankle range of motion. SNI and OST were associated with a longer time being required to meet the criteria for dynamic training. None of the side effects were related to the isokinetic strength of the ankle plantar and dorsiflexors.Conclusions: The incidence of the assessed side effects in the postoperative period is not related to the type of activity, whether it is professional or amateur. Among the identified side effects, deformation of the regenerated shape of the heel tendon and MAS cause a delay in the recovery of full ankle range of motion. Calf nerve irritation and soft tissue swelling increase the time it takes to meet the criteria for starting dynamic training.Trial registration:The study was approved by the ethics committee of the Academy of Physical Education in Katowice (no. 13/2007)

scholarly journals Staged surgical treatment of the patient with chronic pancreatitis

2021 ◽  
Vol 26 (3) ◽  
pp. 149-155
Author(s):  
N. Yu. Kokhanenko ◽  
A. V. Glebova ◽  
O. G. Vavilova ◽  
A. A. Kashintsev ◽  
S. A. Kaliuzhnyi ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Clinical Case ◽  
Minimally Invasive Treatment ◽  
Gastric Fistula ◽  
Invasive Treatment ◽  
Head Of The Pancreas ◽  
Staged Treatment

A clinical case of successful surgical treatment of a patient with chronic pancreatitis, complicated by suppuration of a postnecrotic cyst and the formation of a cysto-gastric fistula. As a result of the conservative and minimally invasive treatment, the pseudocyst was drained, and the cystogastric fistula was closed. The staged treatment was completed by resection of the head of the pancreas with the formation of an anastomosis.

scholarly journals Hybrid minimally invasive multivessel coronary artery bypass grafting to achieve complete myocardial revascularisation: the first clinical case

2020 ◽  
Vol 24 (3S) ◽  
pp. 108
Author(s):  
I. F. Shabaev ◽  
K. A. Kozyrin ◽  
R. S. Tarasov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Conflict Of Interest ◽  
Graft Failure ◽  
Clinical Case ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Myocardial Revascularisation

<p><strong>Aim</strong>. To report the first clinical case of the hybrid procedure combining off-pump minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) and percutaneous coronary intervention (PCI) of the obtuse marginal (OM) artery to achieve complete myocardial revascularisation.</p><p><strong>Clinical case</strong>. Bilateral in situ skeletonised left internal mammary artery (IMA) grafting to the left anterior descending artery was performed, and a Y-shape anastomosis was created from the left IMA-right IMA to the circumflex branch. At 2 hours postoperatively, graft failure caused by subtotal stenosis at the graft was diagnosed. Reconstruction of the anastomosis improved the transit time flow measurement by 3.5 hours postoperatively. Acute myocardial infarction did not develop. On postoperative day 1, graft patency was assessed, and then the OM stent was placed. On postoperative day 8, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. Hybrid revascularisation offers the advantages of both CABG and PCI; however, the technical complexity is a major limitation for its widespread use. This case reports the development of adverse events during the surgeon's training to perform this nonstandard technology. Timely diagnosis of the initial graft failure and surgical revision led to a successful and complication-free outcome and avoided prolonged patient rehabilitation.</p><p><strong>Conclusion</strong>. Hybrid revascularisation combining MICS-CABG and PCI with new-generation drug-eluting stents can be a worthwhile alternative to conventional multivessel CABG with minimal invasiveness and complete revascularisation.</p><p>Received 5 June 2020. Revised 10 September 2020. Accepted 15 September 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals QUADRICEP TENDON TURNDOWNS FOR MPFL RECONSTRUCTION: AN ANATOMICAL DIFFERENCE BETWEEN THE ORIGINS OF THE QUADRICEP TENDON AND MPFL ON THE PATELLA

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0009
Author(s):  
Audrey Rustad ◽  
Nicolas G. Anchustegui ◽  
Stockton Troyer ◽  
Cooper Shea ◽  
Aleksei Dingel ◽  
...  
Keyword(s):  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Mpfl Reconstruction ◽  
Surgical Reconstruction ◽  
Skeletally Immature ◽  
Medial Border ◽  
Text Figure ◽  
Distal Aspect ◽  
Bone Tunnels

Background: Quadriceps tendon (QT) turndowns are an alternative method for medial patellofemoral ligament (MPFL) reconstruction, with several distinct advantages: 1. Avoids the use of patella bone tunnels, which have been associated with patella fracture, 2. Avoids the use of separate incision for hamstring tendon harvest, and 3. Avoids the use of allograft tissue, which adds a significant cost. The disadvantage of the Quad Tendon graft is that the most distal reflection point on the patella may not duplicate the patella origin of the native MPFL. The purpose of this study was to determine whether a QT graft for MPFL reconstruction is anatomically analogous to the native MPFL origin in a skeletally immature population. Methods: Three skeletally immature cadaveric knee specimens (ages 10 and 11, 11) were dissected to reveal the MPFL and QT origins on the patella. The proximal and distal extent of the MPFL was marked on the medial border of the patella. The medial aspect of the quad tendon was reflected as far as possible in both a medial and distal position on the patella, to function as the MPFL graft. The distance was measured between the midpoint of the patellar origin of the MPFL in the coronal plane, and the most distal aspect of the patellar origin of the reflected quad tendon. Results: In the 10, 11, and 11 year-old specimens, the distance between the midpoint of MPFL patellar origin and the QT patellar origin was 3.4 cm, 4.3, and 3.7 mm. In all cases, the QT reflected origin was at least 7 mm anterior to the to native MPFL origin on the medial border of the patella. Conclusion: A disparity exists between the patellar origin of the MPFL and the patellar origin of the quad tendon, with the patellar origin of the MPFL being more medial, more distal, and more posterior than the reflected patellar origin of the QT graft. Surgeons performing MPFL reconstructions may find this anatomically valuable as they attempt to duplicate the normal anatomy of the patella stabilizers during surgical reconstruction. While the QT remains a good graft choice for MPFL reconstruction, attachment of the QT graft at the native origin of the MPFL may better reproduce the anatomy of the MPFL. Figures: [Figure: see text][Figure: see text]

scholarly journals Unusual Iatrogenic Complication of ACL Surgery

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0027
Author(s):  
Serdar Sargın ◽  
Aziz Atik ◽  
Gökhan Meriç ◽  
Ahmet Aslan
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Left Knee ◽  
Ligament Injury ◽  
Complication Rates ◽  
Revision Operation ◽  
Iatrogenic Complication ◽  
Normal Limits ◽  
Arthroscopic Removal

Objectives: Anterior cruciate ligament (ACL) ruptures constitute the most common ligament injury of the knee, and ACL reconstruction is a commonly performed procedure in orthopedic sport medicine. We report a case of on-the-cartilage placement of EndoButton for ACL reconstruction and its treatment with arthroscopic removal. The rehabilitation method was successful, resulting in excellent function and range of motion of the knee. The aim of this study was present an unusual case of iatrogenic complication of ACL reconstruction and to highlight to the surgeons about this complication. Methods: A 22-year-old male patient administered to our outpatient clinic with a history of trauma to his left knee in a soccer game 2 years ago. He underwent arthroscopic transtibial ACL reconstruction using hamstring tendons and EB system in another facility 19 months ago. At the time of initial administration he complained about pain and friction on his left knee, especially when he was running. In his physical examination patellar friction, anterior drawer and lachman tests were pathological which reminded us rerupture of ACL. Knee movements were in normal limits, but he felt pain especially during flexion and extension. Results: We used standard anteromedial and anterolateral portals and an accessory portal for excision of EB. When we explored the knee arthroscopically, we observed the EB misplaced on femoral groove. Firstly the loop of EB was cut then the EB was removed from superolateral portal. Loop remnant was cauterized with RF probe. The knee was irrigated and portals were sutured. The operation was finished without complication. The knee was dressed and the patient was kept in an adjustable knee brace. There was no complaint of crepitation and the range of motion (ROM) of knee was in normal limits. We offered revision operation again but the patient didn’t accept this suggestion. Conclusion: EB is a good and a commonly used option in ACL reconstruction surgery. Even the complication rates seem much more acceptable when compared to other fixation methods; misplacement of fixation device can be seen. In such a situation it is believed that, surgeons must not hesitate for arthroscopic removal and revision surgery.

Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures

2019 ◽  
Vol 40 (5) ◽  
pp. 515-525 ◽  
Author(s):  
Arno Frigg ◽  
Sandrine Zaugg ◽  
Gerardo Maquieira ◽  
Alex Pellegrino
Keyword(s):  
Minimally Invasive ◽  
Range Of Motion ◽  
Open Surgery ◽  
Aofas Score ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Level Ii ◽  
American Orthopaedic ◽  
Tissue Trauma

Background: Stiffness after open hallux valgus surgery affects 7% to 38% of patients. Minimally invasive surgery (MIS) is thought to decrease this rate by reducing soft tissue trauma. MIS, now in its third generation, is advertised as delivering results superior to open surgery. However, no studies have reported stiffness or range of motion (ROM). Methods: Between January 2014 and December 2015, a total of 50 patients received open scarf-Akin surgery and 48 received minimally invasive Chevron Akin (MICA) surgery. The endpoints were American Orthopaedic Foot & Ankle Society (AOFAS) score, range of motion, visual analog scale for pain, scar length, and subjective foot value. The minimal follow-up time was 2 years. Results: Moderate stiffness occurred in 3 cases in both groups. In MICA, extension increased by 10 degrees while it remained unchanged in scarf. Both groups showed similar improvements in AOFAS score, pain, and subjective foot value. Radiographic evidence of correction was comparable, except for an increased shortening of the first metatarsal by 3 mm in MICA. The scars were smaller in MICA (1.2 cm) than in scarf (5 cm). Wound problems included delayed healing in 10% in scarf and wound infections in 4% in MICA. The rate of recurrence and other complications were comparable, except for reoperations, which were higher in MICA (27% mainly for protruding screws) than in scarf (8% mainly for stiffness). In MICA, 14% were intraoperatively converted to open surgery. Conclusion: MICA showed no advantages over scarf other than a shorter scar. The observed gain in extension could be related to the increased shortening of the first metatarsal because of the size of the burr. Level of Evidence: Level II, prospective cohort (nonrandomized, comparative) study.

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