Arthroscopy and Ligament Reconstruction in the Knee

2009 ◽  
Author(s):  
Orr Limpisvasti
Keyword(s):  
Articular Cartilage ◽  
Gold Standard ◽  
Ligament Reconstruction ◽  
Surgical Techniques ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Active Population ◽  
Primary Means ◽  
Articular Ligaments ◽  
Optimal Visualization

Ligament injuries in the knee are a common cause of disability in the active population. The advent of arthroscopy and arthroscopic surgical techniques has changed our ability to diagnose and treat these injuries. Arthroscopy has become the gold standard for diagnosis of intra-articular ligament injuries, as well as meniscal and articular cartilage pathology. It combines optimal visualization and the ability to manipulate tissue under anesthesia to best understand the degree of ligament injury and knee instability. Arthroscopy has also evolved into the primary means for the surgical treatment of injuries to intra-articular ligaments, articular cartilage, and meniscus.

Evaluation and Treatment of Posterior Cruciate Ligament Injuries

1998 ◽  
Vol 26 (3) ◽  
pp. 471-482 ◽  
Author(s):  
Christopher D. Harner ◽  
Jürgen Höher
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Magnetic Resonance Images ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Science Data ◽  
Knee Ligament ◽  
Knee Ligament Injuries

Improved basic science data on the anatomy and bio-mechanics of the human posterior cruciate ligament have provided the orthopaedic surgeon with new information on which to base treatment decisions. Injuries to the posterior cruciate ligament are reported to comprise approximately 3% of all knee ligament injuries in the general population and as high as 37% in an emergency department setting. While the diagnosis of a posterior cruciate ligament injury can often be made with a physical examination, ancillary studies such as radiographs and magnetic resonance images can be very helpful in detecting associated ligament and bony injuries. In general, most partial (grades I and II) posterior cruciate ligament injuries can be treated nonoperatively. However, surgical reconstruction is usually recommended for those posterior cruciate ligament injuries that occur in combination with other structures. In this review, current surgical techniques of posterior cruciate ligament reconstruction based on anatomic and biomechanical studies will be discussed.

How can we Preserve Sexual Function after Ablative Surgery for Benign Prostatic Hyperplasia?

2020 ◽  
Vol 22 (1) ◽  
pp. 4-13
Author(s):  
Ioannis Mykoniatis ◽  
Koenraad Van Renterghem ◽  
Ioannis Sokolakis
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Gold Standard ◽  
Erectile Function ◽  
Bladder Neck ◽  
Surgical Techniques ◽  
Sperm Retrieval ◽  
Treatment Methods ◽  
Ablative Techniques ◽  
Neurovascular Bundles

: Our aim is to provide a narrative review regarding the prevalence, the associated pathophysiologic pathways and the potential management methods of sexual dysfunction related to ablative surgical techniques for Benign Prostatic Enlargement (BPE). Men suffering from BPE are at high risk of sexual dysfunction due to the disease itself, comorbidities, and pharmacological/surgical treatments. Transurethral resection of the prostate, as the gold standard treatment option for BPE has historically been associated with relatively high rates of postoperative sexual dysfunction problems, mainly retrograde ejaculation but also erectile dysfunction. Ablative surgical techniques, including photoselective vaporization of the prostate (PVP), transurethral needle ablation (TUNA), Transurethral Microwave Therapy (TUMT), Convective Water Vapor Energy Ablation (Rezum®) and Aquablation® have been proposed as treatment methods able to reduce treatment-related complications for BPE patients, including adverse effects on erectile and ejaculatory function, without compromising the efficacy rates for BPE. The neurovascular bundles can be damaged during TURP due to posterolateral capsular perforation. Ablative techniques and especially PVP theoretically seems to skip this hazard as the distance created from the necrotic area to the capsule is generally larger compared to the distance induced after TURP . However, indirect thermal injury of erectile nerves, which could be induced also by the majority of available ablative techniques could potentially lead to ED. Two special technical characteristics (physiological saline use for tissue ablation and real time penetration depth control) of Aquablation® could be proved beneficial with regard to the effect of the method on erectile function. In general ablative techniques seems to have minor impact on sexual function. However, low methodological quality characterize the most of the studies included in this review mainly due to the impossibility, in many cases, to perform a blind randomization. Also in many studies did not have erectile and ejaculatory function as primary outcomes limiting that way their statistical power to identify significant variations. Management of sexual dysfunction problems arising from ablative surgeries for BPE treatment could be divided in two levels. Firstly, intraoperatively the avoidance of manipulation of crucial structures regarding ejaculatory (bladder neck or ejaculatory ducts) and erectile function (neurovascular bundles) could possibly decrease the negative effect of these procedures on sexual function. Thus, in this direction, modifications of classic ablative techniques have been proposed resulting in encouraging outcomes regarding postoperative sexual function. Secondly, if EjD and/or ED are established the already known treatment choices should be chosen in order sexual function rehabilitation to be achieved. Thus, regarding ED: PDE5i daily or on demand remain the gold standard first line treatment choice followed by intracaver-nosal alprostadil injections in cases of failure, while penile prosthesis implantation must be kept as final definitive solution when all the other methods have failed. Regarding ejaculation disorders (retrograde ejaculation or anejaculation): medical therapy with a-agonists (pseudoephedrine), sperm retrieval from the urine, bladder neck reconstruction, prostatic massage, electroejaculation, penile vibratory stimulation and surgical sperm retrieval are the available treatment options. Further, high quality studies are required to investigate potential side effects of BPE surgery on sexual function and efficient treatment methods to manage them.

Reconstruction of the Mandibular Condyle

2021 ◽  
Author(s):  
Spencer R. Anderson ◽  
Kaitlynne Y. Pak ◽  
Aurora G. Vincent ◽  
Adrian Ong ◽  
Yadranko Ducic
Keyword(s):  
Gold Standard ◽  
Traumatic Injury ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Mandibular Condyle ◽  
Facial Aesthetics ◽  
Mandibular Growth ◽  
Alloplastic Materials ◽  
Technological Advances ◽  
Integral Structure

AbstractThe mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.

The Incidence of Anterior Cruciate Ligament Injuries among Competitive Alpine Skiers

2007 ◽  
Vol 35 (7) ◽  
pp. 1070-1074 ◽  
Author(s):  
Nicolas Pujol ◽  
Marie Philippe Rousseaux Blanchi ◽  
Pierre Chambat
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Injury Rate ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Injury Rates ◽  
Anterior Cruciate Ligament Injuries ◽  
Alpine Skiers ◽  
Anterior Cruciate

Background Little is known about the evolution of anterior cruciate ligament injury rates among elite alpine skiers. Purpose To evaluate epidemiologic aspects of anterior cruciate ligament injuries among competitive alpine skiers during the last 25 years. Study Design Descriptive epidemiology study. Methods Data were collected from elite French national teams (379 athletes: 188 women and 191 men) from 1980 to 2005. Results Fifty-three of the female skiers (28.2%) and 52 of the male skiers (27.2%) sustained at least 1 anterior cruciate ligament injury. The overall anterior cruciate ligament injury incidence was 8.5 per 100 skier-seasons. The primary anterior cruciate ligament injury rate was 5.7 per 100 skier-seasons. The prevalence of reinjury (same knee) was 19%. The prevalence of a bilateral injury (injury of the other knee) was 30.5%. At least 1 additional anterior cruciate ligament surgery (mean, 2.4 procedures) was required for 39% of the injured athletes. Men and women were similar with regard to primary anterior cruciate ligament injury rate (P = .21), career remaining after the injury (P = .44), and skiing specialty (P = .5). There were more anterior cruciate ligament injuries (primary, bilateral, reinjuries) among athletes ranking in the world Top 30 (P < .001). Anterior cruciate ligament-injured athletes had a career length of 7.5 years, whereas athletes with no anterior cruciate ligament injury had a career of 4.5 years (P < .001). Finally, injury rates remained constant over time. Conclusion Anterior cruciate ligament injury rates (primary injury, bilateral injury, reinjury) among national competitive alpine skiers are high and have not declined in the last 25 years. Finding a way to prevent anterior cruciate ligament injury in this population is a very important goal.

Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft

2007 ◽  
Vol 35 (9) ◽  
pp. 1521-1527 ◽  
Author(s):  
Benjamin R. Coobs ◽  
Robert F. LaPrade ◽  
Chad J. Griffith ◽  
Bradley J. Nelson
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament ◽  
Normal Stability ◽  
Semitendinosus Graft

Background The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated. Purpose To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability. Study Design Controlled laboratory study. Methods Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N·m varus moment and 5 N·m external and internal rotation torques at 0°, 15°, 30°, 60°, and 90° of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system. Results After sectioning, we found significant increases in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, and 30° of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0° and 30° of knee flexion. Conclusion An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury. Clinical Significance An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.

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