Intra-articular fibrous bands at the tibiotalar joint: diagnosis and outcomes of arthroscopic removal in 4 ankles

The authors retrieved the records of 4 patients that exhibited unusual structural anomalies or pathologies, notably the presence of a fibrous band at the anterior aspect of the tibiotalar joint, observed during arthroscopic exploration or treatment between January and December 2019. Only 1 patient had surgical antecedents on the ipsilateral ankle (extra-articular tenodesis 10 years earlier). The remaining 3 patients had no surgical antecedents on the ipsilateral ankle. The fibrous band was removed in all patients during arthroscopic Brostöm procedure or exploration. For the first 3 patients, the intra-articular fibrous band was not observed prior to arthroscopy by either the senior surgeon or radiologist on any of the images (2 MRIs and 1 CTA), but retrospective inspection confirmed that the intra-articular fibrous band was present but had been overlooked.At a follow-up of 22.3 ± 5.0 months (range, 15–26), all patients reported a decrease in pVAS (− 5.0 ± 2.6, range, 2–8), and an improvement in AOFAS (51.0 ± 17.7, range, 26–65), EFAS (14.5 ± 8.7, range, 6–23) and EFAS sport (8.0 ± 5.3, range, 2–10).This case report corroborates the findings of an earlier discovery of an intra-articular fibrous band in 4 ankles, with more detailed information for clinical and radiologic diagnosis, as well as outcomes of arthroscopic removal. Clinicians should beware of such foreign bodies in the ankle, particularly in patients with history of sprains, and consider arthroscopic removal in cases with persistent pain and/or functional impairment.

Deep sclerectomy after DSAEK: A cautionary tale

A 78-year-old pseudophakic women with pseudoexfoliation glaucoma and 6-year history of prior Descemet’s stripping automated endothelial keratoplasty (DSAEK) underwent deep sclerectomy for a poorly controlled glaucoma. Exposure of the trabeculo-Descemet’s window (TDW), showed a very poor drainage. An attempt to dissect the fibrous tissue off the TDW resulted in perforation of the window needing peripheral iridectomy, followed by a white fibrous band which had to be excised to prevent blockade of the filtration channel. Postoperatively, there was complete detachment of the endothelial graft on day 1 with an intraocular pressure of 20 mm Hg. She was commenced on topical steroids and listed for a revisionary DSAEK in 6 weeks but when reviewed in a month postoperatively, a spontaneous reattachment of the endothelial graft was seen.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals: a retrospective analysis of 118 consecutive cases

Background To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up. Methods The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results The average operation time was 18 min (range, 10–30 min) and the average blood loss was 4 ml (range, 2–10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. One hundred eighteen patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. One hundred fifteen patients (97.5%) were able to crouch with knees close to each other after surgery. One hundred fourteen patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5 ± 10.6 before operation to 90.1 ± 5.2 at the last follow-up (p < 0.05). The patient satisfaction rate was 95.8%. Conclusion Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

Thyroid fibrous band and levator glandulae thyroideae muscle: Two different structures associated with the pyramidal lobe of the thyroid gland

We investigated two structures that are in close association with the pyramidal lobe of the thyroid gland. Our investigation was performed using microdissection and histological examination in 106 human postmortem specimens. The first investigated structure was identified as the thyroid fibrous band that was present in 28.3% of cases. This band was always associated with the pyramidal lobe (which was significantly longer and thicker when associated with this band) and it had a constant hyo-pyramidal extension; it was located close to the midsagittal plane and predominantly composed of dense irregular connective tissue. The second investigated structure was the levator glandulae thyroideae muscle, which was associated with the pyramidal lobe in only 13.6% of cases. This muscle had a double extension, hyo-pyramidal and laryngo-pyramidal, located farther from the midsagittal plane, it was longer and thinner than the thyroid fibrous band and predominantly composed of striated muscle fibers. We confirmed our hypothesis that the thyroid fibrous band, which may be considered as the partial fibrous remnant of the thyroglossal duct and levator glandulae thyroideae, and which may be considered as infrahyoid or laryngeal muscle, are two different structures of the thyroid gland.

Pyloric perforation in situs inversus totalis and Ladd’s band with dextrocardia: a collection of rare anomalies and associated operative challenge

Situs inversus totalis with dextrocardia is a rare entity where the liver and gall bladder are on the left side and the spleen on the right. It is an autosomal recessive mode of inheritance and the patients are usually asymptomatic with a normal life span. Ladd’s band on the other hand is a fibrous band of peritoneum lying over the duodenum to the caecum, which usually presents as intestinal malrotation and is most commonly diagnosed and treated with Ladd’s procedure in infancy itself. Asymptomatic adult cases presenting later in life are rarely seen. Here we present a case of a 22-year-old male who presented with symptoms of perforation peritonitis and was diagnosed on clinical and radiological examination to have situs inversus. Intra-operative findings later revealed presence of a Ladd’s band too.

Cyst of the Filum Terminale: Potpourri of 3 Prenatally Diagnosed Cases

The filum terminale (FT) is an extension of pia mater, a fibrous band that connects the conus medullaris and the posterior body of the coccyx. Current advanced technology in ultrasonography has enabled visualisation of the FT and small structures like a FT cyst can be diagnosed prenatally. Reports pf these cysts are rare. We report three cases of a FT cyst diagnosed prenatally. The objective of reporting these is to make clinicians aware of the importance of the relevance of this clinical entity.

Clubfeet and Constriction Band Syndrome - Case Report

Background: Clubfeet and constriction band syndrome is very rare nonidiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in treatment of congenital constriction band syndrome accompanied clubfoot deformity and lymphedema.Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stage completely excising the fibrous band and multiple two stage Z-plasties on the right calf.Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is effective treatment of nonidiopathic clubfoot distal to congenital amniotic constriction band.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals ： a retrospective analysis of 118 consecutive cases

Background: To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up. Methods: The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results: The average operation time was 18 min (range, 10-30 min) and the average blood loss was 4 ml (range, 2-10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. 118 patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. 115 patients (97.5%) were able to crouch with knees close to each other after surgery. 114 patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5±10.6 before operation to 90.1±5.2 at the last follow-up (p<0.05). The patient satisfaction rate was 95.8%. Conclusion: Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

Clubfeet and Constriction Band Syndrome - Case Report

Background: Clubfeet and constriction band syndrome is very rare nonidiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in treatment of congenital constriction band syndrome accompanied clubfoot deformity and lymphedema.Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stage completely excising the fibrous band and multiple two stage Z-plasties on the right calf.Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is effective treatment of nonidiopathic clubfoot distal to congenital amniotic constriction band.